Talk:Withania somnifera

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Cureus

I'm not expert enough to edit the article directly, but would like to point out that Cureus (which seems to have an impact factor of 1.9) published a study reporting a decrease in reported levels of stress and in serum cortisol levels when subjects took 250mg or 600mg of ashwagandha daily vs. placebo: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979308/ — Preceding unsigned comment added by Jonas42 (talk • contribs) 02:59, 3 November 2020 (UTC)

"Ayurvedic Journals"

I would like to know exactly which sources are considered to be "quackery" associated with "Ayurvedic journals". This herb has been extensively researched, and it is a disservice to the community not to publish some of this research. While it is appropriate to include the limitations of this research, it is not appropriate to refuse to allow legitimate secondary sources and the conclusions of their authors.

It has been previously agreed on this thread that MSK is a reliable source, and yet there appears to be a continued issue with publishing the content of their analysis.

What evidence is there that the Indian Journal of Psychological Medicine is not a reliable source? Wikipedia should be strictly about evidence, not who has the most degrees. Digeridoodle (talk) 23:08, 30 January 2019 (UTC)

References

The IJPM - as with all Ayruveda journals - does not publish the quality of research, especially high-quality reviews of completed clinical trials to meet the standard of WP:MEDRS. We are writing for an encyclopedia, not for an herbalism research article or folk medicine publication. The impact factor for IJPM falls far below the minimum standard typically accepted for medical content on Wikipedia (2.0 or higher). Accordingly, none of these sources is reliable or acceptable. --Zefr (talk) 23:24, 30 January 2019 (UTC)

Using this metric, some of the existing sources which you have cited would not pass muster. "Indian Journal of Microbiology" scores only a 0.988 and yet it stands. I replaced that IJPM citation with a review published in the Journal of Alternative and Complementary Medicine with an impact factor of 1.398 making it more reliable by these metrics than existing cited source materials. Yet you once again rolled it back and accused me of edit warring. This hardly constitutes a reasonable dialogue with equitable standards. Digeridoodle (talk) 23:56, 30 January 2019 (UTC)

JACM is not a reliable source for encyclopedic medical content; it publishes quackery and low-quality herbalism research. When you take some time to read WP:MEDRS and WP:MEDHOW, it will be clearer for you. Another explanation about source quality is here. --Zefr (talk) 00:01, 31 January 2019 (UTC)

The problem with that argument is that none of the existing citations meet your criteria, hence the clear bias. The JACM score is over 2-3x the score of other journals already cited in this article. In addition to the one I have already mentioned, the cited World Applied Sciences Journal has an equally abysmal score. This is a clear bias against a substantial body of research. Digeridoodle (talk) 00:23, 31 January 2019 (UTC)

The only sources used to support content in the traditional medicine section are Drugs.com and MedlinePlus, both of which are acceptable as reliable medical references. The problem with expanding medical content is that reviews on high-quality clinical research have not been published, so there is nothing to add. --Zefr (talk) 00:35, 31 January 2019 (UTC)

At minimum, the MSK analysis should be allowed along with the conclusions of its authors. Also this review exceeds the MEDRS standards and should be similarly allowed. Digeridoodle (talk) 00:39, 31 January 2019 (UTC)

Not sure what more could be said from the MSK source because it is already used to refer to the potential for drug interactions and absence of high-quality clinical trials; nothing more meets the MEDRS standard. As for the 2016 review, it could be used - but adds little - for history, methods of extraction, and phytochemicals. Nothing can be said about in vivo or clinical effects because the research reviewed was all primary, and mostly of low quality. --Zefr (talk) 02:19, 31 January 2019 (UTC)

Me! Me!! ME!!! I am the one with the most degrees!!!! (PhD Nutritional Biochemistry from MIT, post-doctoral fellowship at - MSK!!!!!) But that is beside the point. The proper approach is to look through MSK to its references, and none of those stand up to Wikipedia criteria. Likewise, here, your Talk and Teahouse, the 2016 review is not sufficient for summarizing human trials. Not even close to MEDRS. Says itself - no human evidence. David notMD (talk) 20:46, 31 January 2019 (UTC)

References

New clinical research

This study seems to support the efficacy of ashwagandha for anxiety, though sample size is a tiny N=61 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/ Can someone knowledgeable on the subject review and add if relevant? Tgalos90 (talk) 20:39, 13 March 2019 (UTC)

Preliminary research (not new, 2012) in an obscure journal with a low impact factor. Not usable. --Zefr (talk) 23:13, 13 March 2019 (UTC)

Would this article be of interest here? https://www.tandfonline.com/doi/full/10.1080/07391102.2020.1775704? Briancady413 (talk) 20:36, 26 May 2021 (UTC)

Numerous credible laboratory studies done have proved the significant stress reduction that ashwagandha root provides

Here is a document from NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270108/

So "Dietary supplements containing ashwagandha are marketed in the U.S., but there is no evidence they have any effect" is completely invalid.

Content in the Journal of Alternative and Complementary Medicine cannot be trusted. It has weak editorial practices and a low impact factor of 1.9. --Zefr (talk) 15:02, 10 September 2019 (UTC)

And what about the Indian Journal of Psychological Medicine, which says it's safe and effective? https://journals.sagepub.com/doi/10.4103/0253-7176.106022

That journal is not Medline-indexed (does not have enough history to be notable, so is not used on Wikipedia) and has an impact factor of 1 or less, here. It is not useable as a source. Zefr (talk) 15:16, 27 October 2021 (UTC)

It now has an impact factor of 1.52 https://www.resurchify.com/impact/details/20000195020 Taseck1 (talk) 11:00, 19 November 2022 (UTC)

Cancer Treatment?

Effect of Withania somnifera on DMBA induced carcinogenesis

LeemolDavisGirijaKuttan Amalanagar Cancer Research Centre, Amalanagar, Thrissur, 680 553 Kerala, India Received 5 September 2000, Revised 4 December 2000, Accepted 12 December 2000, Available online 4 April 2001. — Preceding unsigned comment added by 2001:569:7ED1:2E00:2C47:8658:AC3:E300 (talk) 20:28, 1 December 2019 (UTC)

A primary report about a small scale animal study published in a lower tier journal falls well short of the type of sourcing needed to make claims regarding cancer treatment. Please see WP:MEDRS for details. -- Ed (Edgar181) 20:36, 1 December 2019 (UTC)

Acceptable?

Can we add these?

PMID	Journal	Impact Factor	Extract
PMID 31742775	Phytotherapy Research	3.092	"W. somnifera extract improved performance on cognitive tasks, executive function, attention, and reaction time."
PMID 31731424	International Journal of Molecular Sciences	4.183	"WS was not only effective, but most importantly at these dosages WS was safe and well tolerated"

Sthubbar (talk) 03:28, 17 January 2020 (UTC)

Nice table. A high-quality review of clinical research would not be published in Phytotherapy Research, and indeed, the studies mentioned for assessment were fraught with inconsistencies and design weaknesses, including mixed subject groups of different disorders. No good journal would have published this mess of research. The article in IJMS discusses extracts of W. somnifera, so is really a review of speculations from lab research which is too inconclusive for an encyclopedia. Further, IJMS is listed as unreliable as an MDPI journal in WP:CITEWATCH, so is unusable. --Zefr (talk) 03:45, 17 January 2020 (UTC)

Ok. Thank you for the response.Sthubbar (talk) 05:30, 17 January 2020 (UTC)

Zefr, can we address the contention that IJMS is listed as unreliable as an MDPI journal in WP:CITEWATCH? WP:CITEWATCH describes MDPI as:

• hit-and-miss
• removed in 2015
• some are fine

This reads to me as though some journals from MDPI are perfectly acceptable.

Furthermore, the Beall's List website says "I decided not to include MDPI on the list itself." I understand you have two objections to the second resource. If the journal is not allowed than there is no need to address the first objection. Can we first agree that the journal is acceptable, or show further justification why this particular journal is unnacceptable beyond a simple association with MDPI, and then address the first concern?Sthubbar (talk) 09:02, 19 January 2020 (UTC)

All of the research in PMID 31731424 is on extracts and is low quality, primary research based on conjecture from in vitro lab studies, a source condition discouraged by WP:PRIMARY and WP:MEDANIMAL. About primary research on medical content, WP:MEDREV says "A reason to avoid primary sources in the biomedical field – especially papers reporting results of in vitro experiments – is that they are often not replicable and are therefore unsuitable for use in generating encyclopedic, reliable biomedical content." That's enough guidance to exclude it and justify its negative position in Citewatch. --Zefr (talk) 16:38, 19 January 2020 (UTC)

Zefr, OK, so since you jumped right to supporting the first objection of the quality of the research, I'm assuming that the quality of the journal is no longer an issue. Let's consider a different quote from the conclusion: "As reviewed herein, the recent clinical trials using randomized double-blind placebo control designs using WS extracts have shown that at specified dosage ranging from 200 mg/kg to 1000 mg/kg WS was not only effective, but most importantly at these dosages WS was safe and well tolerated."

As to your objection about primary sources, you have me totally confused. As I understand it the process is:

1. Primary research is done
2. Secondary research in the form of a review or meta-analysis of the primary research is done.
3. Tertiary research in the form of Wikipedia summarizes the secondary research.

PMID 31731424 is secondary research summarizing the primary research.

What am I misunderstanding?Sthubbar (talk) 01:36, 20 January 2020 (UTC)

First, IJMS is generally a low-quality journal often containing poorly written or poorly edited content based on thin or disputable evidence, so it has a deserving place on Citewatch. The questionable value of clinical studies cited in PMID 31731424 is revealed in Table 1 where are displayed the so-called "randomized double-blind placebo controlled trials", all of which were on small subject groups and dubious designs published in weak journals rarely (or never) cited for Wikipedia medical content. WP:MEDHOW requires editors to judge the quality of research for use as sources, and this criterion fails for the Dutta review. Most of the research discussed in that paper is on in vitro models, which are too preliminary and non-reproducible to use as an encyclopedic reference. None of the content in question can be attributed to high-quality reliable medical sources. I've provided enough feedback on this topic, and will not be responding further unless other editors join with new dispute issues of interest. --Zefr (talk) 17:26, 20 January 2020 (UTC)

Thank you for the feedback.Sthubbar (talk) 05:10, 23 January 2020 (UTC)

It seems like Zefr is starting with the premise that research about this plant is shoddy and proceeding accordingly. I appreciate that skepticism is a virtue in science, but at this point one Wikipedia user seems to be preventing readers from even seeing the evidence, in context? And from viewing the talk page has seemingly been doing that for years. Would love to discuss w/ you Zefr, but it kinda seems like many people have tried to have this conversation over the years to no availAshwinr (talk) 22:39, 2 October 2023 (UTC)

There are over 200 Wikipedia editors watching this article, and anyone can jump into the conversation or edit the article. According to WP:BURDEN, it is the obligation of an editor wishing to change from the prevailing content and sources to provide a reliable source. Phytotherapy Research is not a reliable source for medical content, as it meets no WP:MEDRS standards - see WP:MEDASSESS pyramids.

Your edit here today is a vague statement that does not make the article clearer, and is not an improvement beyond what existed before. Herbalism is quackery and dietary supplements do not treat any clinical conditions. The mainstream scientific consensus is that "there is insufficient scientific evidence that this herb is safe or effective for treating any health condition or disease" (the existing status in the article). Use of W. somnifera for treating clinical disorders is a WP:FRINGE practice.

If you want views from experienced medical editors, post a topic at WT:MED or request an RFC. I think you'll get the same feedback as I'm giving you. Zefr (talk) 04:18, 3 October 2023 (UTC)

Phytotherapy does meet WP:MEDRS standards based on the available evidence. Please provide specific warrants for your claim that it does not, otherwise you are deleting evidence without a basis in Wikipedia standards. Ashwinr (talk) 22:47, 5 October 2023 (UTC)

I would also note that your claim that "herbalism is quackery" is an ascientific claim that is not germane to the issue at hand: namely, is there robust evidence that Ashwagandha extract has an impact on stress, insomnia, and other conditions? My claim is that the linked sources suggest an affirmative answer to this. In my view, you are insisting that the scientific consensus suggests a negative answer, abjectly contradicting the actual evidence provided. When I and others make efforts to hold you accountable to evidentiary standards for your claim, you insist that the journal is not rigorous, again without any evidence. Ashwinr (talk) 22:52, 5 October 2023 (UTC)

• I have procedurally closed your RfC. A statement requesting an RfC must be neutral, and yours is far from it. If you would like to start an RfC, please do so in a new section, describing in an entirely neutral fashion what you would like comments regarding. (Note that you may still of course express your views, but do so as a comment of your own on the RfC, not within the RfC statement itself.) Seraphimblade ^{Talk to me} 23:49, 5 October 2023 (UTC)

Requesting separate objective input on the following question: does Phytotherapy Research meet Wikipedia standards for reliability? It is a peer-reviewed journal with an impact factor of 6.338. By user Ashwinr, 8 October 2023.

That information does not address the issue discussed above: Phytotherapy Research is not a reliable source for medical content, as it meets no WP:MEDRS standards - see WP:MEDASSESS pyramids for the quality of evidence needed to support medical content. High-quality reviews of Phase III clinical trials do not appear in Phytotherapy Research because there are no such trials on W. somnifera to review - the existing trials are all rudimentary and low-quality with design and compliance problems, as commonly mentioned by the authors. Phytotherapy Research publications do not guide national clinical organizations for their recommendations about using W. somnifera for treating any supposed medical disorder (because no such recommendations exist), and do not influence national regulatory agencies about approving W. somnifera as a drug (W. somnifera is not approved for treating anything). An acceptable source would be "medical guidelines or position statements by internationally or nationally recognized expert bodies also often contain recommendations, along with assessments of underlying evidence" (from MEDASSESS) or a Cochrane review.

The concluson is that Phytotherapy Research publications on W. somnifera are preliminary at best, and too low-quality to imply an effect on any physiological mechanism or clinical disorder. Zefr (talk) 04:25, 8 October 2023 (UTC)

I have closed your RfC; that is a question to be asked at WP:RSN, preferably as a specific question in relation to its use on this page. BilledMammal (talk) 05:33, 8 October 2023 (UTC)

"no conclusive clinical evidence that it is effective for treating any ailment." - Conclusive evidence? .

"Conclusive evidence" is evidence which cannot be contradicted by other evidence. Given that scientific progress in empirical fields relies on falsifiability (read Karl Popper), there will NEVER be conclusive evidence on this topic... We must instead make an assessment on whether there is a preponderance of evidence in favour of a specific conclusion. I agree that many of the journals talked about on this page are 3rd rate, but we also have a randomized, double-blind, placebo-controlled study posted on Medicine (IF = 2.1) which observed reductions in anxiety and cortisol. A meta-analysis found in CNS Drugs (IF = 4.2) also finds support for efficacy in regards to anxiety. Perhaps you do not think this is sufficient, but please do not wait for conclusive evidence because there will not be any.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750292/ https://link.springer.com/article/10.1007%252Fs40263-013-0059-9 — Preceding unsigned comment added by 2.99.252.166 (talk) 02:25, 19 July 2020 (UTC)

The linked page for Withaferin A lists significant evidence, which would suggest that the Withania_somnifera page in its current state should be tagged as incoherent. 119.18.33.114 (talk) 21:34, 17 September 2022 (UTC)

This is correct, and I've attempted to address this with a recent edit. The wikipedia page asserted previously that there was insufficient evidence, and (incoherently) cited two pages that listed...clinical trials and systematic reviews indicating that it is in fact effective.

The above comment is right - science does not provide conclusive evidence. Of the studies available to us now, the evidence suggests that it is effective. Ashwinr (talk) 22:36, 2 October 2023 (UTC)

There is no reputable source that says W. somnifera is effective for treating anything. A reputable source would be 1) a high-quality systematic review or meta-analysis in a respected clinical journal or book, 2) a national clinical organization proclaiming its efficacy and safety in a guideline for a specific disorder - see WP:MEDORG, or 3) a national regulatory agency publishing a guide for its dose-related safety and efficacy, in which case it would become a prescription drug. No such evidence exists.

W. somnifera is prescribed by herbalist quacks or purchased as a supplement by uninformed consumers. Its use to supposedly treat clinical disorders is WP:FRINGE content far outside the mainstream of clinical science. Results from lab research and low-quality clinical trials are too preliminary and unencyclopedic to include, WP:NOTJOURNAL #6-8. Zefr (talk) 14:48, 3 October 2023 (UTC)

No high-quality evidence for efficacy as a drug or dietary supplement

This edit states the general conclusion both of Drugs.com and MedlinePlus that there is no high-quality clinical evidence that using ashwagandha provides any benefit. There's no need to massage the language that it "possibly may affect" or there is "limited" possible evidence for benefit. The bottom line for an encyclopedia is to clearly state the fact: there is no approved use of it as a drug, and there is no clinical proof it has value as a supplement. Zefr (talk) 17:23, 26 December 2020 (UTC)

Zefr is correct, only research with massive selection bias published by groups with financial ties to pharmaceutical companies (as is invariably the case with antidepressants) can be considered high quality evidence. 82.26.113.110 (talk) 21:23, 9 January 2021 (UTC)

Zefr is correct. Netanyahuserious (talk) 10:03, 19 July 2022 (UTC)

Toxicity

Toxicity is being discussed at Wikipedia talk:WikiProject Medicine#Toxic effects of the herb Ashwagandha (Withania somnifera) Venkat TL (talk) 08:25, 18 December 2021 (UTC)

Ashwagandha is Grown and Supplied in USA also

I actually wanted to add that Ashwagandha is also Grown and Supplied in the USA by submitting a link as a piece of evidence which you reverted, https://the-unwinder.com/news/best-source-of-ashwagandha/. Ricalston (talk) 10:35, 3 January 2022 (UTC)

I don't doubt it's grown in a bunch of places (which raises questions about notability), but surely there's a better source for that info than a promo text written by a personal trainer on a website focusing on selling supplements. Robincantin (talk) 13:59, 3 January 2022 (UTC)

Evergreen annual?

Is it correct to describe a plant as evergreen shrub and also an annual? 92.40.172.239 (talk) 19:02, 13 February 2022 (UTC)

side effect: "increased testosterone levels"

For men, this is most definitely a benefit, and an indication that it could be used to treat low testosterone levels. It's interesting how when an effect is named as a side effect, it gets into Wikipedia very easily these days, as long as it's for an article on alternative medicine. MarshallKe (talk) 17:18, 29 March 2022 (UTC)

For clarification for User:Zefr, the article *does* say "increased testosterone levels" is a side effect. My suggestion is perhaps to remove that part. MarshallKe (talk) 20:30, 29 March 2022 (UTC)

Maybe it is possible to squeeze it into the text as a biological effect, not stating whether it is good or bad (as it would be with original definition of side effect, but the term got to be commonly used to refer to adverse effects only nowadays). Whether the effect is adverse or not would obviously depend on the context and size of the effect, both for man and woman. TK synantropijny (talk) 16:58, 4 June 2022 (UTC)

"History" section?

There is a lengthy history of this plant used therapeutically and even as food. The use is widespread such that the whole fresh root is sold in the markets where the plant locally occurs. Drsruli (talk) 19:41, 30 October 2022 (UTC)

Adaptogen

The plant is universally considered an adaptogen in the disciplines that recognize this term. It seems to me that this designation should occur somewhere on the page. Drsruli (talk) 19:43, 30 October 2022 (UTC)

That would be giving credibility to such "disciplines", which are outside of mainstream science. The adaptogen concept is quackery nonsense, with no notability in science, WP:FRINGE. It has no place being discussed in this article as part of an encyclopedia presenting facts. Zefr (talk) 21:16, 30 October 2022 (UTC)

We have an entry on adaptogen. Herbalism exists. The concept of what is an adaptogen has existed, well-defined, for decades. The word is associated with ashwagandha inextricably. Additionally, science is not the only world in which a plant exists. There may be references from literature, music, completely fictitious. Not identifying ashwagandha with adaptogen is denial. It's a fact that ashwagandha is identified as an adaptogen. (Even if you are compelled to mention it as a fallacy, not documenting it is absurd.) (If Ashwagandha was historically identified with The Philosopher's Stone or The Holy Grail, then that would also warrant mention.) (Despite concerns of possibly granting plausibility to Alchemy.) Drsruli (talk) 08:52, 1 November 2022 (UTC)

WP:UNDUE also applies to this topic to rule out discussing adaptogen. And there are people - over history and currently - who believe the Earth is flat, WP:FLAT. We don't give mainspace attention to lunatic ideas: "Simply stick to the principles: if mainstream science holds that the Earth is round, and there are reliable sources establishing this as a fact, that is sufficient." See Jimmy Wales' statement: "What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse”. It isn’t." Zefr (talk) 16:34, 1 November 2022 (UTC)

We DO "give mainspace attention to lunatic ideas". https://en.wikipedia.org/wiki/Modern_flat_Earth_beliefs Western Herbalism, and specifically the concept of adaptogens as a class, is no less deserving of space than Flat Earth. (Or Alchemy.) (Or religion.) It exists. It has a history. And Ashwagandha, among other specific items, is a part of it. You can do that, and still maintain your standards. The Vitamin C page has a whole section about Linus Pauling and Orthomolecular medicine. "In the scientifically discredited discipline of Western Herbalism, Ashwagandha root is classified as an adaptogen."

Additionally, this category of herbs has (some) legal significance. In the US, distributors may not generally make claims on the bottles of natural remedies. However, Ginseng, Eleuthero, Ashwagandha etc, CAN be labeled as Adaptogens (but not usually delineate the specific claims that this designation would imply). In the stores that sell these items, such as GNC, Vitamin Shoppe, there are sections for Adaptogens, labeled as such. In Europe, this is also established. https://cohenhealthcarelaw.com/2022/03/adaptogens-and-fda-ftc-compliance/

https://www.healthline.com/health/adaptogenic-herbs#takeaway

https://www.foodnavigator-usa.com/Article/2017/12/15/Adaptogens-are-here-to-stay-but-marketing-them-effectively-will-require-creativity-and-innovation-say-experts

Additionally, in the case of certain Ashwagandha products, the claim can legally be made on the label: "clinically proven to reduce cortisol and perceived stress". The basis is this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979308/ - Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study Drsruli (talk) 08:39, 5 November 2022 (UTC)

There are no WP:MEDRS sources supporting the concept or clinical use of ashwagandha or any herbal product supposed to have adaptogen properties. You are in error to state that ashwagandha products have approved label claims for reducing cortisol levels and stress, and you are in error to state that the above study PMC 6979308 would be sufficient for any regulatory authority to assess a clinical effect - that is a primary research project published in a weak journal not even having a Medline index. Further, the FDA has issued numerous warning letters in recent years to US supplement companies illegally marketing ashwagandha products, such as this one in 2022. Attempting to market such unapproved products is "in violation of sections 505(a) and 301(d) of the Federal Food, Drug, and Cosmetic Act." As you seem to have no MEDRS sources, regulatory evidence or editor consensus here to support your views, I will have no further comments. Zefr (talk) 03:14, 6 November 2022 (UTC)

Nevertheless, this is the claim and the reference that it is based on, that is on the Nature Made national brand that is on the shelves at this time. It appears to have met the legal requirements. I was unaware of the more recent warning (although this does not address the Sensoril and Nature Made claims). Nevertheless, the term "adaptogen" has entered common vocabulary, and my initial (and primary) points regarding documenting the use of the term remain. "In the scientifically discredited discipline of Western Herbalism, Ashwagandha root is classified as an adaptogen." There is precedent for weaker things. Drsruli (talk) 03:21, 6 November 2022 (UTC)

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