---
title: "Ashwagandha Liver Injury DILI Audit: Aerial Leaf Contamination vs Root Extract Safety (Dutch-Icelandic DILI Audit Audit) | Nutrition Research Labs"
source_url: "https://nutritionresearchlabs.com/studies/ashwagandha-drug-induced-liver-injury-dili-case-series-audit"
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description: "Clinical audit of Dutch-Icelandic DILI Audit (PMID: 31991029, 5 clinical case reports (Iceland and Netherlands)): 5 patients presented with severe cholestatic j"
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> **Canonical Source:** [https://nutritionresearchlabs.com/studies/ashwagandha-drug-induced-liver-injury-dili-case-series-audit](https://nutritionresearchlabs.com/studies/ashwagandha-drug-induced-liver-injury-dili-case-series-audit)
>
> *Clinical audit of Dutch-Icelandic DILI Audit (PMID: 31991029, 5 clinical case reports (Iceland and Netherlands)): 5 patients presented with severe cholestatic j*

## Media Hype vs. Absolute Clinical Reality (Information Gain Audit)

- **Viral Headline Claim:**
- **True Placebo-Adjusted Absolute Outcome:** 5 patients presented with severe cholestatic jaundice, hyperbilirubinemia, and elevated transaminases after taking non-standardized commercial ashwagandha formulas, resolving fully within 1-5 months post-cessation.
- **Relative vs. Absolute Statistical Breakdown:** Chemical investigations demonstrated that implicated formulations utilized aerial plant parts (leaves, stems) rather than traditional roots. Aerial parts contain concentrated cytotoxic withaferin A (a known hepatotoxin), whereas USP-monographed standardized root extracts (e.g. KSM-66) contain withanolide glycosides with proven hepatic safety.
- **Funding & Sponsor Audit:** Dutch National Institute for Public Health & University Hospital Reykjavik (Independent Academic / NIH)
- **Human Equivalent Dosing Protocol:** Standard therapeutic threshold: 300mg to 600mg daily of standardized water/ethanol root extract (withaferin A <0.1%). Avoid leaf/stem extracts.

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