Ashwagandha (Withania somnifera) is a plant traditionally used in Ayurvedic medicine, with over 3,000 years of historical use. You might not find it listed in many of the Western herbal compendiums, but it is gaining much popularity in Western herbal medicine as well, for many reasons. In this article, I’ll share with you some of the benefits of ashwagandha for those with breast cancer and for survivors, including the latest research.

I’m often asked whether or not ashwagandha is safe for those with hormone receptor positive breast cancer. Apparently there is some misinformation out there that ashwagandha increases estrogen levels. While it does have an effect on adrenal hormones there is research (see below) to indicate that it actually helps hormone driven breast cancers.

So what exactly is ashwagandha?

Ashwagandha is an evergreen shrub commonly found in dry regions of South and Central Asia and Africa. Just as a matter of interest, the Sanskrit definition of ashwagandha is “that which has the smell of a horse, as it gives the vitality and sexual energy of a horse”. Well, that says a lot!

In Ayurvedic medicine, ashwagandha is used to nourish and strengthen the tissues of the body – it is known for its rejuvenating properties, for increasing vigor, fending off illness, for its anti-aging properties and as a sleep aid.

Ashwagandha is considered by modern herbalists to be a fine nervine (that means it calms the nerves) and an adaptogen (which helps the body adapt to stress, whether short-term, long-term, mental or physical). In addition, it is an anti-inflammatory, antispasmodic, liver protective, cholesterol-lowering, thyroid stimulating, immunomodulant! That last one is especially important – the word means that a substance has the ability to boost an under-reacting immune system, or dampen down an over-reacting immune system.

Withaferin A is the main biologically-active phytochemical in ashwagandha, and it has a variety of anti-cancer properties.

The Science Behind Ashwagandha

Over 1,300 research studies exist on ashwagandha. As is usually the case, there are few clinical trials with actual breast cancer patients but there do exist many cell studies and animal studies. Here’s what we know about ashwagandha from these preliminary studies:

Ashwagandha:
• showed inhibitory activity against estrogen receptor-positive (ER+) tumors [1] [3] [4] [8] [10] [11] [14] [15]
• activated the P53 tumor suppressor gene [1]
• acted as an anti-estrogen and suppressed estrogen receptor alpha, which is associated with the proliferation (rapid growth) of breast cells [2]
• had cancer preventive activity [5] [12]
• in estrogen receptor-negative breast cancer (ER-), targeted specific cancer processes related to cell death, cell cycle and proliferation [6] [8] [10] [15]
• in ER- breast cancer, decreased invasion, cell adhesion and inflammation, plus increased expression of the breast cancer metastasis suppressor gene (BRMS1) [6]
• had anti-cancer activity in normal, non-malignant breast cells; in malignant cells it suppressed a protein known as vimentin, which has been studied for its potential as a target for cancer therapies [7]
• dysregulated mitochondrial function in both ER+ and ER- breast cancer cells [9]
• enhanced tumor cell sensitivity to the chemotherapy drug cisplatin [10]
• reduced invasiveness of tumor cells and their ability to spread to other regions [11]
• reduced inflammation [11] [13]
• had immunomodulatory activity [12] [16] [17] [20]
• in a cell study with renal cancer cells, was shown to increase the effects of radiotherapy [12] [13]
• was shown to be beneficial for stress and anxiety [12] [23]

Clinical Studies

One clinical trial done in 2012 [18] [19] investigated the use of ashwagandha for helping to relieve fatigue in 100 breast cancer patients receiving chemotherapy.

In the study group (those receiving the herb) 54 percent had ER+ breast cancer, 48 percent of the study group had progesterone receptor-positive (PR+) cancer, and 26 percent also had cancer overexpressing human epidermal growth factor receptor 2 (HER2+).

In the control group (those not receiving the herb) 56 percent had ER+ breast cancer, 50 percent had PR+ breast cancer, and 52 percent also had HER2+ breast cancer.

This was an open-label prospective non-randomized comparative trial including breast cancer patients in all stages undergoing either a combination of chemotherapy with oral ashwagandha (the study group) or those receiving chemotherapy alone (the control group). Researchers found that those in the study group had less cancer-related fatigue. The dosage was 500 mg per day during 6 cycles of chemotherapy.

In addition, a smaller study reported in 2021 [20] investigated ashwagandha for immune function. The study included 24 healthy adult males and females aged between 45–72 years. Those in the study group received just 60 mg of ashwagandha, the control group receive none. After only 30 days of taking the herb, those in the study group had significant increases in their immune parameters.

One last thing I feel compelled to share. I found a 2021 study [21] that had interesting findings, and I quote: “Here, we have investigated the therapeutic prospective of Ashwagandha for the COVID-19 pandemic. Nine withanolides were tested in silico for their potential to target and inhibit (i) cell surface receptor protein (TMPRSS2) that is required for entry of virus to host cells and (ii) viral protein (the main protease Mpro) that is essential for virus replication. We report that the withanolides possess capacity to inhibit the activity of TMPRSS2 and Mpro. Furthermore, withanolide-treated cells showed downregulation of TMPRSS2 expression and inhibition of SARS-CoV-2 replication in vitro, suggesting that Ashwagandha may provide a useful resource for COVID-19 treatment.”

Sounds like we should all be taking ashwagandha.

Safety of Ashwagandha

Ashwagandha is generally regarded to be a safe herb, with few reported serious side effects. A 2021 randomized, double-blind, placebo-controlled trial including 80 healthy participants (40 males, 40 females) randomized in a 1:1 ratio received either 300 mg of ashwagandha or a placebo of the same dosage, twice daily, orally for 8 weeks. No adverse events were reported by any of the participants in this study. [22]

However, there are cautions. Avoid taking ashwagandha:
* if you are on immuno-suppressing drugs
* if you are taking sedatives (due to its calming effect)
* if you are taking thyroid hormone medications as there *may* be an interaction

Dosages:

Ashwagandha has often been used by adults in doses up to 1000 mg daily, for up to 12 weeks. You will note that in the study at [20], just 60 mg per day was sufficient to the improve immune systems of the study participants. Be sure to take certified organic ashwagandha.

Caution: Please do not consider ashwagandha as a stand-alone therapy against breast cancer. As with any natural therapy, be sure to consult with a naturopath or herbalist for advice for your particular health challenge.

References:

[1] Selective Killing of Cancer Cells by Leaf Extract of Ashwagandha: Identification of a Tumor-Inhibitory Factor and the First Molecular Insights to Its Effect –
https://clincancerres.aacrjournals.org/content/13/7/2298
[2] Withaferin a suppresses estrogen receptor-a expression in human breast cancer cells – https://onlinelibrary.wiley.com/doi/10.1002/mc.20760
[3] Withaferin A-Induced Apoptosis in Human Breast Cancer Cells Is Mediated by Reactive Oxygen Species – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154436/
[4] Role of Mitogen-Activated Protein Kinases and Mcl-1 in Apoptosis Induction by Withaferin A in Human Breast Cancer Cells – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859703/
[5] Effect of Withania somnifera Root Extract on Spontaneous Estrogen Receptor-negative Mammary Cancer in MMTV/Neu Mice – https://ar.iiarjournals.org/content/34/11/6327
[6] Pharmacological Levels of Withaferin A (Withania somnifera) Trigger Clinically Relevant Anticancer Effects Specific to Triple Negative Breast Cancer Cells – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912072/
[7] Withaferin A Inhibits Experimental Epithelial-Mesenchymal Transition in MCF-10A Cells and Suppresses Vimentin Protein Level in Vivo in Breast Tumors – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039625/
[8] Withaferin A induced impaired autophagy and unfolded protein response in human breast cancer cell-lines MCF-7 and MDA-MB-231 – https://pubmed.ncbi.nlm.nih.gov/28782635/
[9] Withaferin A-mediated apoptosis in breast cancer cells is associated with alterations in mitochondrial dynamics – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599725/
[10] Withaferin A inhibits expression of ataxia telangiectasia and Rad3-related kinase and enhances sensitivity of human breast cancer cells to cisplatin – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800812/
[11] Keeping abreast about ashwagandha in breast cancer –
https://www.sciencedirect.com/science/article/abs/pii/S0378874120336473?via%3Dihub
[12] Article: The Asco Post – https://ascopost.com/issues/august-25-2020/ashwagandha/
[13] Withaferin A enhances radiation-induced apoptosis in Caki cells through induction of reactive oxygen species, Bcl-2 downregulation and Akt inhibition – https://pubmed.ncbi.nlm.nih.gov/21256832/
[14] Growth inhibition of human tumor cell lines by withanolides from Withania somnifera leaves – https://pubmed.ncbi.nlm.nih.gov/14575818/
[15] Withaferin A Causes FOXO3a- and Bim-Dependent Apoptosis and Inhibits Growth of Human Breast Cancer Cells In Vivo – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562581/
[16] Network ethnopharmacological evaluation of the immunomodulatory activity of Withania somnifera – https://pubmed.ncbi.nlm.nih.gov/27487266/
[17] Immunomodulatory Effect of Withania somnifera (Ashwagandha) Extract—A Randomized, Double-Blind, Placebo Controlled Trial with an Open Label Extension on Healthy Participants – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397213/
[18] Effect of Withania somnifera (Ashwagandha) on the Development of Chemotherapy-Induced Fatigue and Quality of Life in Breast Cancer Patients – https://journals.sagepub.com/doi/10.1177/1534735412464551
[19 ]Adjunct Treatment with Ashwagandha Root Extract for Fatigue from Chemotherapy for Breast Cancer – https://www.herbalgram.org/resources/herbclip/issues/bin_474/021366-474/
[20] Immunomodulatory Effect of Withania somnifera (Ashwagandha) Extract—A Randomized, Double-Blind, Placebo Controlled Trial with an Open Label Extension on Healthy Participants – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397213/
[21] Molecular mechanism of anti-SARS-CoV2 activity of Ashwagandha-derived withanolides – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188803/
[22] Safety of Ashwagandha Root Extract: A Randomized, Placebo-Controlled, study in Healthy Volunteers – https://pubmed.ncbi.nlm.nih.gov/33338583/

[23] A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/