Adaptogens and what the trials found

SUPPLEMENTS IN MIDLIFE

7 min read

You added the ashwagandha in July. The magnesium started a month before that. One label says adaptogen. The other says sleep support. Between the two, something was supposed to shift. Neither is regulated as a medication. Neither was tested in the menopausal population in the trials the marketing relies on. What follows is what the trials actually found.

You are not wrong for trying them. When the body changes and no one explains what changed, a bottle with a clear promise is the most available answer. The question is whether the evidence behind that promise holds up.

The most recent systematic review of magnesium supplementation for sleep, published in 2026, included 12 randomized controlled trials. It concluded that current evidence does not support oral magnesium as a routine treatment for insomnia. Certainty of evidence was graded low to very low. The review noted that magnesium may provide modest benefits for selected subjective outcomes in some adults, but the findings across trials were inconsistent.

Ashwagandha has a larger trial base. Meta-analyses of randomized controlled trials have found statistically significant reductions in anxiety and stress scores and a small effect on sleep. But heterogeneity across studies is very high, above 90 percent for anxiety, meaning results vary widely from trial to trial. A 2025 analysis found ashwagandha reduced cortisol levels but had no significant effect on perceived stress, splitting the biological and experiential results.

Then there is the safety question. The National Institutes of Health LiverTox database classifies ashwagandha as a likely cause of clinically apparent liver injury. A 2026 scoping review of peer-reviewed clinical literature identified 25 cases of liver injury across 13 publications. The UK Committee on Toxicity reviewed the evidence in 2025 and was unable to establish a safe level of consumption for food or supplements.

The word adaptogen itself is not a clinical category. It is not recognized by the FDA, the European Medicines Agency, or any major clinical guideline body as a therapeutic class. Products carrying the label are regulated as dietary supplements, which means they do not require proof of efficacy before sale.

Other substances sold under the label face similar evidence gaps. A systematic review of rhodiola rosea for fatigue found the evidence contradictory, with high or unclear risk of bias in every included trial and no two studies measuring the same outcome. Maca, marketed for menopausal symptoms specifically, has been assessed in a systematic review of four small randomized trials, which concluded that the evidence was limited.

WHAT IT DOES NOT ESTABLISH

That magnesium or ashwagandha are ineffective for any individual. The evidence says the average effect across trials is either not significant or inconsistent. But that also means the person taking them cannot know whether what she feels is the supplement, the placebo response, or the passage of time.

THE ADAPTOGEN LABEL

The term was introduced in 1947 to describe substances that increase resistance to stress. It is not recognized by any major regulatory agency or clinical guideline body. Products marketed as adaptogens are regulated as dietary supplements, meaning they require no proof of efficacy before reaching the shelf. The category groups substances with very different evidence bases under a single reassuring word.

THE NUMBERS

Randomized controlled trials in the most recent systematic review of magnesium for sleep (2026). Certainty of evidence: low to very low. The review does not support routine use for insomnia.

Cases of ashwagandha-associated liver injury identified in a 2026 scoping review of the peer-reviewed literature. The NIH classifies it as a likely cause of clinically apparent liver injury.

These are not the numbers that appear on the label. The label carries the numbers from the trials that showed an effect. The systematic reviews carry all the trials, including the ones that did not. The difference between the two is the distance between marketing and medicine.

WHAT THE EVIDENCE SUPPORTS

Matching the symptom to the guideline

PROFESSIONAL BODY GUIDELINES

No professional body recommends adaptogens as a category for menopausal symptom management. The evidence-based treatments are symptom-specific. For persistent sleep disruption: cognitive behavioral therapy for insomnia, which the American Academy of Sleep Medicine gives a strong recommendation. For anxiety: clinical evaluation and, if warranted, structured therapy. For fatigue: blood work to rule out iron deficiency and thyroid dysfunction before supplementing anything.

“We recommend clinicians use multicomponent CBT-I for the treatment of chronic insomnia disorder in adults.”

AMERICAN ACADEMY OF SLEEP MEDICINE, EDINGER ET AL., 2021

WHAT THIS IS NOT

A claim that supplements never help anyone. Some people taking magnesium feel they sleep better, and the placebo response is itself a real neurological event. The issue is that the current evidence cannot distinguish supplement effect from placebo effect with confidence, and one of these supplements carries a documented risk of liver injury.

WHEN TO CALL

You are taking ashwagandha and notice new itching, dark urine, nausea, or yellowing of the skin or eyes. Stop taking it and see your doctor. These can be signs of liver injury, and the NIH LiverTox database classifies ashwagandha as a likely cause.

You are taking any supplement alongside a prescription medication. Drug-supplement interactions are real and underreported. Your doctor or pharmacist needs the full list.

Fatigue persists regardless of what you take. Persistent fatigue can indicate iron deficiency, thyroid dysfunction, or other conditions that need blood work, not supplementation.

THIS WEEK

Gather every supplement bottle you are currently taking. Put them in a bag and bring them to your next doctor visit. Your doctor needs the full list, especially alongside any prescription medication.

Name the symptom you bought the supplement for. If it is sleep, ask about CBT-I. If it is anxiety, ask for evaluation. If it is fatigue, ask for iron and thyroid blood work. Start with the symptom. Sleep. Anxiety. Fatigue. That word opens a better door than any ingredient name.

If you are currently taking ashwagandha, read the liver injury information at the NIH LiverTox page for ashwagandha. It is publicly available at no cost. Make an informed decision with that information in hand.

The supplement aisle is where people go when the medical system has not given them an answer. That impulse is reasonable. The something you found there has simply not been held to the same standard as the treatment your doctor would prescribe. Putting the bottles in a bag and taking them to your next appointment is the beginning of a better conversation.

ONE TAP, NO FORM

What were you hoping the supplement would do?

Tapping opens a pre-written reply. Nothing is public, nothing goes to a list. What most readers tap decides what gets explained next.

Help me sleep

Take the edge off the anxiety

Give me back some energy

I am not sure anymore

Or write in your own words. Every reply is read.

Read recent issues

EVERY SOURCE READ FOR THIS ISSUE

Nine sources: one systematic review on magnesium and sleep, one meta-analysis on ashwagandha and sleep, one meta-analysis on ashwagandha and cortisol, one scoping review on ashwagandha liver injury, one regulatory safety review, one NIH toxicology entry, one systematic review on rhodiola rosea, one systematic review on maca, and one clinical practice guideline.

1	Magnesium supplementation for sleep in adults: a systematic review of randomized controlled trials Systematic review, 2026

2	Effect of ashwagandha extract on sleep: a systematic review and meta-analysis Meta-analysis, PLOS One, 2021

3	Dual impact of ashwagandha: significant cortisol reduction but no effects on perceived stress Systematic review and meta-analysis, Albalawi, 2025

4	Ashwagandha-associated liver injury: a scoping review of clinical characteristics and safety considerations Scoping review, 2026

5	Review of the safety of ashwagandha in food, drinks and food supplements UK Committee on Toxicity, 2025

6	Ashwagandha LiverTox entry, National Institutes of Health

7	Rhodiola rosea for physical and mental fatigue: a systematic review Systematic review, BMC Complementary Medicine, 2012

8	Maca for treatment of menopausal symptoms: a systematic review Systematic review, Maturitas, 2011

9	Behavioral and psychological treatments for chronic insomnia disorder in adults AASM clinical practice guideline, Edinger et al., 2021

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