Health Propaganda, Exposed
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“Ashwagandha-HILI presents with cholestatic hepatitis and can lead to the syndrome of acute-on-chronic liver failure with high mortality in those with pre-existing liver disease.”
Retrospective case series (8 patients with single-ingredient products, from 23 identified cases). Case series cannot prove causation.
No funding statement appears in the article text we reviewed; authors state "The authors have no conflicts to report." Authors are hospital-based hepatologists (Rajagiri Hospital and others).
A multicenter review of medical records for herb-induced liver injury attributed to ashwagandha, with liver biopsies and chemical analysis of retrieved products.
"Out of 23 patients with liver injury from ashwagandha (January 2019 to December 2022), we report 8 patients with single-ingredient formulation-related HILI." "Five patients had underlying chronic liver disease; 3 presented with acute-on-chronic liver failure, and all 3 died on follow-up." "Chemical analysis revealed only natural phytochemicals without adulteration or contamination."
It does not establish how often liver injury occurs among ashwagandha users (there is no denominator), and it is a retrospective record review.
Controlled trials such as the 2019 Arjuna-funded study reported no adverse events over 60 days; liver injury appears to be uncommon and may be concentrated in people with existing liver disease, per this series.