Asparagus racemosus

Shatavari

Common names

Shatavari (Sanskrit), ataawar, satmuli, satavari (Hindi), wild asparagus, asparagus bush

Part Used

Root

Family

Asparagaceae

Description

Shatavari grows throughout the tropical and subtropical parts of India and Bangladesh up to an altitude of 1500 m. It is a spinous under-shrub, with tuberous, short rootstock bearing numerous succulent tuberous roots (30-100 cm long and 1-2 cm thick) that are silvery white or ash coloured externally and white internally. The stem is woody, climbing, whitish grey or brown coloured with small spines. The plant flowers during February-March leaving a mild fragrance in its surrounding and by the end of April, fruits can be seen with attractive red berries. Shatavari is also found in other countries in Asia, Australia and Africa.

Constituents

The word asparagus originates from the Greek word for stalk or shoot. The genus Aspargaus has recently been moved from the subfaimily Aspragae in the Liliaceous family to a newly created family Asparagaceae. The Asparagaceae genus, containing some 300 species, is considered to be of medical importance because of the presence of sapogenins and saponins. Shatavari contains 8-9% steroidal saponins, known as shatavarin I, immunoside, asparagin A, shatavarins IV-X.1 The major saponins in the roots are shatavarin I and especially shatavarin IV(44%).

Shatavari also contains isoflavones including 8-methoxy-5,6,4'- trihydroxyisoflavone 7-O-beta-D-glucopyranoside2, phytosterols (0.8%), polyphenols (1.7%) and flavonoids.3

Pharmacological activities

Hormone-regulating activity

The high level of steroidal saponins may be responsible for the oestrogenic effect of shatavari and explain its traditional use as a reproductive tonic. Phyto-oestrogens are defined as any plant compound structurally and/or functionally similar to ovarian and placental oestrogens and their active metabolites.4 Phyto-oestrogens affect the regulation of ovarian cycles and oestrous in female mammals and the promotion of growth, differentiation and physiological functions of the female genital tract, pituitary, breast and several other organs and tissues in both sexes. It has been demonstrated that a chloroform and methanol root extract of shatavari inhibited chemically-induced mammary carcinogenesis in rats. The extract was added in different percentages to the animal feed. Rats fed on a 2% extract diet showed a significant (p < 0.05) decline in both tumour incidence and mean number of tumours per tumour bearing animal. The authors concluded that shatavari root extract exerted a mammotropic and/or lactogenic influence on normal as well as on oestrogen-primed animals thereby rendering the mammary epithelium refractory to the carcinogen.5

Earlier studies found that that the saponin-rich fraction inhibited oxytocin-induced uterine contractions in vivo6 and that an ethanol extract increased both the weight of mammary lobulo-aveolar tissue and the milk yield. These effects were attributed to the action of released corticosteroids or an increase in prolactin.7 The anti-oxytocin effect has been found to be due to shatavarin I, as it was demonstrated that the compound competitively blocked oxytocin-induced contraction of rat, guinea pig and rabbit's uteri, in vitro as well as in vivo.8 Shatavari was also found to stimulate milk production in buffaloes.9 An increase in milk production was observed after administration of a shatavari (40 mg concentrated root extract per tablet) to women suffering from deficient milk secretion in one study; however no galactogenic effect could be demonstrated in a later clinical trial. Women who had delivered at term without complications received 100 g dose of a medicine containing 15 g shatavari root extract. However, they found that a 4-week treatment did not improve lactation10.

Pilot studies in India furthermore suggest that shatavari may be beneficial in the treatment of dysfunctional uterine bleeding (DUB) and PMS. Seventy women aged 20-45 years with DUB were included in the first study. It was found that by the end of the treatment, 63 women had achieved a regular menstrual cycle. The authors contributed this result to the local healing of the endometrium stimulated by endometrial microvascular thrombosis caused by the high doses of phyto-oestrogens in the preparation ('U-3107' or EveCare®, containing 32 mg Asparagus racemosus extract per 5ml syrup). In another study, a group of 40 patients suffering from dysmenorrhoea and pre-menstrual syndrome (PMS) were found to be symptom free after treatment with shatavari (EveCare capsules). Another product containing about 85% shatavari has been shown to be effective in the treatment of PMS.11

A more recent study suggests that shatavari may have oestrogenic effects on breast tissue and genital organs in female rats. An alcoholic extract of the shatavari rhizome was administered orally to adult pregnant female albino rats at a dose of 30 mg/100 g body weight, daily for 15 days (days 1-15 of gestation). The macroscopic findings revealed a prominence of the mammary glands, a dilated vaginal opening and a transversely situated uterine horn in the treated group of animals. The weight of the uterine horns of the treated group was found to be significantly higher (p < 0.001) but the length was shorter (p > 0.01). Microscopic examination of the treated group showed proliferation in the lumen of the duct of mammary gland. It was obliterated due to hypertrophy of ductal and glandular cells. Hyperplasia of the glandular and muscular tissue and hypertrophy of the glandular cells were observed in the genital organs. The parenchyma of the genital organs showed abundant glycogen granules with dilated blood vessels and thickening of the epithelial lining. The oviduct in the treated group showed hypertrophied muscular wall, whereas the ovary revealed no effect of the drug. The results suggest an oestrogenic effect of shatavari on the female mammary gland and genital organs.12

Another formulation containing 110 mg Asparagus racemosus extract per tablet (Menosan®) was found to cause an increase in uterine weight and uterine glycogen without altering serum oestrogen and progesterone levels in immature rats as against ovariectomised rats used as control.13 This study indicates that the phyto-oestrogen performs its function by binding directly to the oestrogen receptor without enhancing the endogenous oestrogen levels. Menosan has also been found beneficial in reducing menopausal symptoms. In a trial comprising 27 women aged 35-56 years, significant relief from post-menopausal symptoms such as depression (90% relief), insomnia (83.33% relief), irritability (50% relief), weight gain (50% relief), bone and joint pains (40%), sweating (37.88%) and hot flashes (37.03%) was observed after the use of Menosan.11

Adaptogenic activity

Shatavari is considered to be a rasayana herb. Rasayana means rejuvenation. Rasayana consist of the Sanskrit word ayana meaning path and rasa which means taste, essence, flavour, juice, or emotion. In therapeutic process rasa is concerned with the conservation, transformation, and revitalisation of energy. Rasa nourishes the body, boosts immunity and promote physical and mental health. They are given to small children as tonics, and are also taken by the middle-aged and elderly to increase longevity.

Six of the major rasayana plants from Ayurveda have been studied for adaptogenic activities. The whole, aqueous, standardised extracts of selected plants (Tinospora cordifolia, Asparagus racemosus, Emblica officinalis, Withania somnifera, Piper longum and Terminalia chebula) were administered orally to experimental animals, in a dose extrapolated from the human dose, after which they were exposed to a variety of biological, physical and chemical stressors. The plant extracts were found to protect against the stressors, as measured by markers of stress responses and objective parameters for stress manifestations. Using a model of cisplatin induced alterations in gastrointestinal motility, the ability of the plants to exert a normalizing effect, irrespective of direction of pathological change was tested.

All the plants reversed the effects of cisplatin on gastric emptying, while Asparagus racemosus also normalised cisplatin-induced intestinal hypermotility. All the plant drugs were found to be safe in both acute and subacute toxicity studies. Studies on the mechanisms of action of the plants revealed that they all produced immunostimulation.14

Another traditional adaptogenic/rasayana formulation (Siotone) containing Withania somnifera, Ocimum sanctum, Asparagus racemosus, Tribulus terristris and shilajit (a mineral-rich, composted plant exudate scraped off rocks) was found in animal studies to improve glucose tolerance, libido, depression, cognitive dysfunction and immunosupression caused by chronic stress.15

Immunological and antibacterial activities

Shatavari is an immunomodulator. Animal studies found that shatavari is capable of producing leucocytosis with neutrophilia and, furthermore, was able to prevent myelosuppression by reducing cyclophosphamide-induced leucopenia.16 Shatavari has also been shown to inhibit drug induced mammary carcinogenesis.5

The hypothesis that macrophages play a pivotal role in the development of intraperitoneal adhesions and that modulation of macrophage activity may therefore prevent adhesions, was tested in an Indian study.17 The effect of shatavari was evaluated in an animal model of intraperitoneal adhesions. Shatavari reduced the severity of the adhesions and this correlated with a significant increase in the activity of the macrophages.

Macrophages are involved at all stages of the immune response. They can produce a rapid response before T cell-mediated amplification has taken place. Activated macrophages play a key role in host defence against intracellular parasitic bacteria, pathogenic protozoa, fungi and helminths as well as against tumours, particularly in metastasising tumours. In addition, macrophages are important killer cells. They also take part in the initiation of T cell activation by processing and presenting antigen. Finally they are central effector and regulatory cells of the inflammatory response. An vitro study found that shatavari increased phagocytic activity of macrophages.18

Ochratoxin (OTA) is a mycotoxin, which has been found as a frequent contaminant in various grains and to a lesser extent coffee, milk and foods from animal origin. It is a well-known tumour promoter that contributes to cancer of the kidney. Asparagus racemosus, Tinospora cordifolia, Withania somnifera and Picrorhiza kurrooa have been shown in an in vivo study to inhibit OTA-induced immune-suppression of chemotactic activity and production of interleukin-1 and TNF-alpha by macropahges. The immune enhancing effects were significant for all four herbs with withania producing the strongest chemotactic activity of peritoneal macrophages. In terms of Interleukin-1 and TNF-alpha production by macrophages, all four herbs had significant effects with shatavari and withania again showing the strongest effects.8

Oral administration of an aqueous root extract (100 mg/kg per day for 15 days) to animals immunised with diphtheria, tetanus, pertussis (DTP) vaccine resulted in significant increase (p = 0.0052) in antibody titers to Bordtella pertussis as compared to untreated (control) animals. Immunised animals (treated and untreated) were challenged with B. pertussis and the animals were observed for 14 days. The treated animals showed a significant increase in antibody titers as compared to untreated animals after challenge (p = 0.002). Immunoprotection against intra-cerebral challenge of live B. pertussis cells was evaluated based on degree of sickness, paralysis and subsequent death. Reduced mortality accompanied with overall improved health status was observed in treated animals after intra-cerebral challenge of B. pertussis indicating that shatavari promoted a protective immune response. There was significant reduction in morbidity score in animals receiving treatment as compared to untreated animals (P = 0.03). Lower morbidity score indicates fewer incidences and lesser severity of paralysis that results in reduced mortality in treatment groups. The mortality incidence also confirmed the same as reduced mortality was seen in treatment group (25%) as compared to control (50%). Adjuvants are used to enhance the immune response to a particular antigen of interest. This enhancement results in improving titers, sustained response duration and avidity. Pertussis antibody titers declined with duration (from day 14 to day 28) in untreated groups (P = 0.04). No such decline in antibody titers was observed in treated groups till the end of study. No significant effect on haemoglobin, polymorphs, lymphocyte and WBC counts was observed at end of study period. The study suggests that shatavari extract exhibited three important characteristics - immunostimulation, immunoprotection and adjuvant activity. Shatavari's immunomodulatory activities may be beneficial in reducing morbidity associated with vaccinations.19

Shatavari roots are traditionally used in the treatment of dysentery, diarrhoea, tuberculosis, leprosy, gonorrhoea and in various skin diseases and research has shown it to have antimicrobial activities. Different concentrations (50, 100, 150 mcg/mL) of the methanol extract of the roots of Asparagus racemosus showed considerable in vitro antibacterial efficacy against Escherichia coli, Shigella dysenteriae, Shigella sonnei, Shigella flexneri, Vibrio cholerae, Salmonella typhi, Salmonella typhimurium, Pseudomonas putida, Bacillus subtilis and Staphylococcus aureus. The effects produced by the methanol extract were compared with chloramphenicol.20 The antimicrobial activity may be due to 9,10-dihydrophenanthrene.21

Antioxidant, cytoprotective and neuroprotective effects

Membrane damage induced by free radicals generated during gamma-radiation was examined in rat liver mitochondria. An extract of shatavari was shown in vitro to have potent antioxidant properties in mitochondrial membranes of the rat liver. Both the crude extract as well as a polysaccharide-rich fraction significantly inhibited lipid peroxidation and protein oxidation. Both fractions also partly protected against radiation-induced loss of protein thiols and inactivation of superoxide dismutase.22

Oral pre-treatment with Asparagus racemosus (200 mg/kg/day) was found to protect against chemical induced gastric damage in rats. Pre-treatment with shatavari has also been shown to reduce drug induced lung fibrosis. Bleomycin increases the hydroxyproline content of lung tissue causing intra-alveolar fibrosis and deranged alveolar architecture. Shatavari significantly (p<0.001) the bleomycin induced lung fibrosis. These protective effects were associated with a significant increase in alveolar macrophage activity.23

In Ayurveda gastric disorders are classified as sula, parinamasula and amlapitta, which are very similar to modern classification of peptic ulcer and functional dyspepsia. Shatavari has been shown to reduce alcohol-induced damage to the gastric mucosa. Pretreatment for seven days caused a 70% reduction in the ulcer index.24 A traditional powder formulation containing herbs and minerals (Satavari mandur) with shatavari as the main ingredient has been shown to significantly (p<0.05) protect against pyloric ligation induced gastric ulcers during the treatment of ulcers with the allopathic drug Ranitidine.25 Shatavari methanol extract has been shown to have a dose-dependent ulcer protective effect against cold restraint stress- and pyloric ligation induced gastric ulcers and against cysteamine-induced duodenal ulcers in rats. However, the extract was ineffective against ethanol- and aspirin-induced gastric ulcers. The anomaly in ulcer protective effect may be due to variability of factors affecting ulcerogenesis in different models. In this study it was concluded that the healing of gastric ulcers could be attributed to the effect of the protective factors as the effect seems to be more due to enhancement of protective factors such as increased mucous secretions rather than a reduction in acid and pepsin secretions.26

A later study compared the anti-ulcer and antisecretory activity of shatavari and withania root extracts with a standard drug, ranitidine, in various models of gastric ulcer in rats. Ulcers were induced by the indomethacin (NSAID) and swim (restraint) stress treatment. Results demonstrated that shatavari as well as withania methanolic extract (100 mg/kg per day) given orally for 15 days significantly reduced the ulcer index, volume of gastric secretion, free acidity and total acidity. A significant increase in the total carbohydrate and total carbohydrate/protein ratio was also observed. The study also suggest that the herbs increase the antioxidant defence, as indicated by increases in the antioxidant enzymes superoxide dismutase, catalase and ascorbic acid, with a concomitant and significant decrease in lipid peroxidation. Shatavari was more effective in reducing gastric ulcer in indomethacin-treated gastric ulcerative rats, whereas withania was effective in stress-induced gastric ulcer. Results obtained for both herbal drugs were comparable to those of the standard drug ranitidine.27

Excitotoxicity and oxidative stress are the major mechanisms of neuronal cell death in neurodegenerative disorders that occurs in both Alzheimer's and Parkinson's diseases. Reactive oxygen species (ROS) that are generated extracellularly and intracellularly by various mechanisms are among the major risk factors that initiate and promote neurodegeneration. Shatavari has been shown in experimental designs to be protective against kainic acid-induced hippocampal and striatal neuronal damage. The impairment of hippocampus and striatal regions of brain was marked by an increase in lipid peroxidation and protein carbonyl content and decline in glutathione peroxidase activity and reduced glutathione content. Shatavari supplementation improved the glutathione peroxidase activity and glutathione content and reduced the membrane lipid peroxidation and protein carbonyl.28

Protection during chemotherapy (biological response modifiers)

Herbal immunomodulators are often employed as supportive or adjuvant therapy to overcome the undesired effects of cytotoxic chemotherapeutic agents. Total extract, polar and non-polar extracts, and their formulations, prepared from Withania somnifera, Tinospora cordifolia, and Asparagus racemosus have been shown to have various immunopharmacological activities in cyclophosphamide -treated mouse ascitic sarcoma. Shatavari significantly increased the white cell counts (p<0.02) and antibody titers (p<0.04) in tumor-bearing animals treated with cyclophosphamide. However it was accompanied with inflammatory changes as seen from increased polymorph counts. Significant myeloprotective and immunoprotective, i.e. significantly increased white cell counts (p=0.004) and antibody titers (p<0.001) was seen in animals treated with withania (alkaloid free, polar fraction). Similar activity was also seen with a combination of whole extracts of withania and tinospora (ratio 80:20), which also had significant anti-inflammatory activity. Treatment of ascitic sarcoma-bearing mice with a formulation of total extracts of Withania somnifera and Tinospora cordifolia (80:20) and alkaloid-free polar fraction of Withania somnifera resulted in protection towards cyclophosphamide -induced myelo- and immunoprotection as evident by significant increase in white cell counts and hemagglutinating and haemolytic antibody titers. Antitumor activity of cyclophosphamide was not altered by any to the herbal extracts as was evident from no significant change in tumor mass compared to the group of tumour-bearing mice treated with cyclophosphamide alone. None of the herbal extracts showed any significant effect on haemoglobin and red cell count. In this study the combination of whole extracts of withania and tinospora produced the strongest effect.29

Diuretic and antilithic activities

Shatavari has been shown to inhibit antidiuretic hormone (ADH)6 and to reduce urinary stone formation in rats. An ethanol extract of shatavari was evaluated for its inhibitory potential on lithiasis (stone formation), induced by oral administration of 0.75% ethylene glycolated water to adult male albino Wistar rats for 28 days. The ionic chemistry of urine was altered by ethylene glycol, which elevated the urinary concentration of calcium, oxalate and phosphate ions, thereby leading to renal stone formation. The ethanol extract, however, significantly (p < 0.05) reduced the elevated level of these ions in urine. Furthermore, shatavari elevated the urinary concentration of magnesium, which is considered to be one of the inhibitors of crystallization. The high serum creatinine level observed in the ethylene glycol-treated rats was also reduced, following treatment with the shatavari extract. The histopathological findings also showed signs of improvement after treatment with the extract.30

Antitussive activity

Rural tribal people of the Khatra region of West Bengal in India use the root juice against cough. The methanol extract of Asparagus racemosus root (200 and 400 mg/kg, p.o.) has been shown to have significant antitussive activity on sulfur dioxide-induced cough in mice, the cough inhibition (40.0 and 58.5%, respectively) being comparable to that of 10-20 mg/kg of codeine phosphate (36.0 and 55.4%, respectively).31

Digestive and anti-diarrhoeal activity

Shatavari is used in Ayurveda for dyspepsia (amlapitta) and it has been shown to improve digestion by increasing the levels of amylase and lipase.32 Other studies have found shatavari to be extremely effective the treatment of diarrhoea, dysentery and gastritis. Both the ethanol and the aqueous extract have been shown to have significantly anti-diarrhoeal activity against castor oil induced diarrhoea in rats demonstrating an activity similar to loperamide. 33Shatavari extract, 200 mg/kg significantly (p< 0.05) inhibited castor oil induced diarrhoea and PGE2 induced enteropooling (excessive secretion of water and electrolytes). The release of ricinoleic acid from castor oil results in inflammation and irritation of the intestinal mucosa causing the release of prostaglandins, which in turn stimulate motility and hypersecretion. Both extracts also showed significant (p < 0.001) reduction in gastrointestinal motility in a charcoal meal test in rats. 11

An Indian study with eight healthy male volunteers compared shatavari with the drug metoclopramide, which is used in dyspepsia to reduce gastric emptying time. Metoclopramide and shatavari did not differ significantly in their effects. It was found that shatavari reduced gastric emptying time by 37% (p<0.001).34

Hyperlipidemia/hypercholesteremia

Hyperlipidemia/hypercholesteremia are major risk factors for atherosclerosis and cardiovascular diseases. Shatavari root powder has been shown to decrease lipid peroxidation and cause a dose-dependent reduction in lipid profiles. The total lipids, total cholesterol and triglycerides in plasma and liver as well as plasma LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein)-cholesterol decreased by more than 30%.3 It is thought that the effect is due to a decrease in exogenous cholesterol absorption coupled with an increased conversion of endogenous cholesterol to bile acid.11

Actions

Adaptogen, antitussive, antioxidant, antibacterial, immunomodulator, digestive, cytoprotective, galactogogue, anti-oxytocic, antispasmodic, antidiarrhoeal, antiulcerogenic, oestrogen modulator.

Traditional usage

In Western herbal medicine, shatavari is often seen as a female reproductive tonic and shatavari does indeed mean to 'possess a hundred husbands'. However, it is equally considered a great general tonic. Withania is sometimes also seen as a 'female' female tonic by Western herbalists, perhaps due to the fact that it is less stimulating than Korean ginseng (Panax ginseng), however, in Ayurvedic medicine, shatavari is the main rejuvenative tonic for the female, as is Withania for the male. Shatavari is however, used for sexual debility and infertility in both sexes. It is also used for menopausal symptoms and to increase lactation.35, 36

In Ayurvedic medicine, Shatavari is significant urinary herb where its soothing and antispasmodic properties are employed in the treatment of cystitis and urinary stones, and by extension also for rheumatic pain where the diuretic action improves the excretion of inflammatory products. Shatavari is also used for dysentery, tumours, inflammatory disorders, neuropathy, nervous conditions, bronchitis, hyperacidity, infectious diseases, conjunctivitis and chronic fever.

Energetically, shatavari is sweet and bitter and it is particularly balancing to the Pitta Dosha.

Indications

  • Stress, fatigue, general weakness
  • Chronic disease, prevention of adhesions, cancer
  • Cough
  • Fluid retention
  • Inflammatory conditions of the gastrointestinal and urinary tracts including cystitis, gastritis, diarrhoea and gastrointestinal ulceration.
  • Prevention of urinary stones
  • Sexual debility and infertility; insufficient lactation, menopausal symptoms.
  • Threatened miscarriage.
  • As an alternative to False Unicorn Root.
  • General antioxidant, neuroprotection

 

Toxicity

The LD50 is >1g/kg. No toxic effects or mortality were observed with doses ranging from 50mg/kg to 1g/kg for four weeks. Acute and subacute (15-30 days administration) toxicity studies did not detect any changes in vital organ function tests.37

Teratogenicity

Methanolic extract of shatavari roots (1000 mg/kg/day for 60 days) showed teratological effects such as increased resorption of foetuses and gross malformations, e.g. swelling in legs and intrauterine growth retardation with a small placental size in Charles Foster rats. Pups born to a mother exposed to shatavari roots for the full duration of gestation showed evidence of higher rate of resorption and therefore smaller litter size. The live pup showed significant decrease in body weight and length and delay of various developmental parameters when compared to respective control groups.38 The dosage used would be equivalent to around 70 g or 140 ml of an 1:2 liquid extract per day for a human adult. This is more than 16 times the recommended dosage.

Another study examining the teratogenicity of a formulation containing shatavari did not find any signs of teratogenicity with the dosage used. Rats received 3 gm/kg of the product once a day orally from day 0 of gestation till day 21 of lactation or just during gestation. No adverse effects was observed on pregnancy and growth of the foetus.39 The daily dose of the formulation was 3mg/kg, which would be equivalent to 210 g for a 70 kg human. It is difficult to calculate the amount of shatavari in the formulation but it could be as high as 2-3% which would equate to about 5 g which is not to dissimilar to the recommended dosage of shatavari 1:2 extract.

However, shatavari should nevertheless, be used with caution in pregnancy.

Use in pregnancy

Use with caution in pregnancy.

Contraindications and cautions

None documented.

Drug interactions

Asparagus may have diuretic effects and may positively affect diuretic drugs such as chlorothiazide (Chlotride). Caution is advised.

Administration and Dosage

1:2 root extract in 25% alcohol: 30-60 ml per week

Reference list

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