Ginger

Overview

Ginger has a long history of traditional use in many cultures, as well as cultivation in India since before written history. Ginger is considered a spice, a flavor and a medicine in many countries. Traditional medicine indications for ginger include indigestion, flatulence, diarrhea, malaria, as an aphrodisiac and fever. In traditional Chinese medicine, it is used for diarrhea, abdominal pain, vomiting abnormal uterine bleeding, cough and dyspnea, and topically for inflamed joints. In traditional Indian medicine it is used for strengthening the memory, as an aphrodisiac, a digestive, and a carminative (McKenna et al., 2002).

The pungent principals in ginger, the gingerols, give it its aroma, and there are a number of other compounds present, including terpenoids and phenolic compounds, such as the shogaols. Western science has confirmed many of the traditional indications for ginger, and found that it possesses many activities: antiemetic, promotes gastric secretion and saliva, anti-inflammatory, spamyolytic, peripheral circulatory stimulant, and increases gastric motility (McKenna et al., 2002). The mechanisms of action of ginger for nausea are not fully understood, but may be due to the prevention of gastric dysrhythmias by inhibiting the production but not the function of prostaglandins (Gonlachanvit et al., 2003). In 1992, Qian and Liu performed preclinical studies that indicated ginger’s antimotion sickness action may be by central and peripheral anticholinergic and antihistaminic effects. Regardless, ginger is quickly gaining more clinical confirmation as a safe and effective treatment for nausea and gastric distress.

Comments

Ginger is a good example of a food that is also an effective medicine. Ginger has been proven, both through a long traditional use and in clinical studies, to be effective in relieving nausea from different origin, and may be found effective in the future for other indications, such as pain relief and inflammation.

Scientific Support

Gastric Disorders

In an attempt to understand the mechanism by which ginger is able to prevent motion sickness, a crossover-design, double-blind, randomized placebo-controlled clinical study was conducted subjecting 13 people (with a history of motion sickness) to circular vection. The authors had previously theorized that the mechanism might be by preventing the development of gastric dysrhythmias and the elevation of plasma vasopressin. The outcome measures were nausea (score 0-3), electogastrographic recordings, and plasma vasopressin levels. Ginger (1,000 and 2,000 mg) was able to reduce nausea, tachygastria and plasma vasopressin. It also prolonged the time before the onset of nausea, and shortened recovery time (Lien et al., 2003).

In an exploration of the mechanism by which ginger is able to prevent nausea, it was hypothesized that ginger prevents disruption of slow wave rhythm by acute hyperglycemia via inhibition of prostaglandin production. In 22 volunteers, ginger (1 g) or placebo was administered then subjected to fasting electrogastrography during hyperglycemic clamping to 250-290 mg/dl. It was confirmed that ginger was able to prevent slow wave dysrhythmias evoked by acute hyperglycemia, but was not able to have any affect on dysrhythmias elicited by prostaglandin E(1) analog. This confirmed that ginger was able to inhibit the production but not action of the prostaglandins (Gonlachanvit et al., 2003).

In a study on the gastric emptying rate of ginger, ginger root (1 g) or placebo was given to 16 volunteers. Ginger did not affect the effect of gastric emptying, so the authors concluded that this did not have to do with the antiemetic action of ginger (Phillips et al., 1993).

A placebo-controlled study was conducted to characterize the effects of ginger on gastric function and to evaluate the antimotion sickness activity of ginger. Ginger was given as either dry powdered ginger (500 or 1,000 mg) or fresh ginger root (1,000 mg). Subjects were tested by making timed head movements in a rotating chair until the reached an endpoint of motion sickness that was short of vomiting. Ginger was found not to possess antimotion sickness activity or the ability to alter gastric function during motion sickness (Stewart et al., 1991).

Several clinical studies have also investigated ginger for its use in alleviating pregnancy-related nausea (Smith et al., 2004; Willetts et al., 2003; Sripramote and Lekhyananda, 2003; and Portnoi et al., 2004). For instance, Vutyavanich et al. (2001) studied in a randomized, placebo-controlled, double-blind parallel design the efficacy of ginger powder against nausea and vomiting in 67 pregnant women characterized as having pregnancy-related nausea and vomiting. After 4 days of treatment the ginger group had 37.5% incidence in vomiting vs. 65.7% in the placebo group. The subjective outcomes, had the highest difference between groups, with 87.5% of the ginger group reporting improved symptoms, vs. 28.6% of the placebo group.

Inflammatory Response

In a clinical study on the effect of ginger consumption on thromboxane2 (TBX2) production, 7 volunteers ingested 5 g of fresh ginger for 7 days. A significant decrease in TXB2 production was found in 6 out of 7 of the volunteers (Srivastava, 1989)

Later, Lumb (1994) performed a randomized, double-blind, placebo-controlled study on ginger powder (2 g in capsules) in 8 volunteers, and measured whole blood platelet aggregation, platelet count, and bleeding time before and at 3 h and 24 h postadministration. No significant differences were found in measurements.

Janessen et al. (1996) studied the effects on ginger (both cooked and raw) on TBX2 production in a randomized, placebo-controlled, multiple crossover study, and found no significant difference in TBX2 production.

Pain Relief

Srivastava and Mustafa (1992) conducted a questionnaire-based open study on ginger in a group of 46 patients with osteoarthritis or rheumatoid arthritis who had taken ginger for 3 months to 2.5 years. Significant pain relief was reported by 55% of the osteoarthritis patients and 74% of the rheumatoid arthritis patients.

Bliddal et al. (2000) performed a randomized, double-blind, placebo-controlled study on the effect of a ginger extract (Eurovita, Extract 33, standardized to contain hyroxy-methoxy-phenyl compounds) on pain relief. There were no observed significant differences in pain relief were found for ginger. However, the authors of the study questioned whether there were carry-over effects from the washout period that produced confounding results, and whether the amount of time for treatment was sufficient.

Safety / Dosage

The dosage of ginger is typically 1-2 g of fresh or powdered root daily. Ginger extracts are on the market, but fresh ginger root is thought to be superior (McKenna et al., 2002).

Side effects from ginger are unknown. In a couple studies, side effects, such as headache were reported, but this could have been a result of motion sickness rather than ginger. Ginger should only be used in the case of gallstones after consulting a physician. Small-scale studies on the use of ginger during pregnancy or lactation have found no adverse effects (McKenna et al., 2002).

References

1.Bliddal H, Rosetzsky A, Schlichting P, Weidner MS, Andersen LA, Ibfelt HH, Christensen K, Jensen ON, Barslev J. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage. 2000 Jan;8(1):9-12.

2.Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 1991 Jan 4;38(1):19-24.

3.Gonlachanvit S, Chen YH, Hasler WL, Sun WM, Owyang C. Ginger reduces hyperglycemia-evoked gastric dysrhythmias in healthy humans: possible role of endogenous prostaglandins. J Pharmacol Exp Ther. 2003 Dec;307(3):1098-103. Epub 2003 Oct 08.

4.Janssen PL, Meyboom S, van Staveren WA, de Vegt F, Katan MB Consumption of ginger (Zingiber officinale roscoe) does not affect ex vivo platelet thromboxane production in humans. Eur J Clin Nutr. 1996 Nov;50(11):772-4.

5.Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang C. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol. 2003 Mar;284(3):G481-9.

6.Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost. 1994 Jan;71(1):110-1.

7.McKenna, D.; K. Jones and K. Hughes. Botanical Medicines: The Desk Reference for Major Herbal Supplements. 2nd Ed. 2002 Haworth Press: Binghamton, NY. 1138 pp.

8.Phillips S, Hutchinson S, Ruggier R. Zingiber officinale does not affect gastric emptying rate. A randomised, placebo-controlled, crossover trial. Anaesthesia. 1993 May;48(5):393-5.

9.Portnoi G, Chng LA, Karimi-Tabesh L, Koren G, Tan MP, Einarson A. Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy. Am J Obstet Gynecol. 2003 Nov;189(5):1374-7.

10.Qian DS, Liu ZS. Pharmacologic studies of antimotion sickness actions of ginger. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1992 Feb;12(2):95-8, 70.

11.Smith C, Crowther C, Willson K, Hotham N, McMillian V. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol. 2004 Apr;103(4):639-45.

12.Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Med Assoc Thai. 2003 Sep;86(9):846-53.

13.Srivastava KC, Mustafa T. Ginger (Zingiber officinale) and rheumatic disorders. Med Hypotheses. 1989 May;29(1):25-8.

14.Srivastava KC, Mustafa T.Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses. 1992 Dec;39(4):342-8.

15.Stewart JJ, Wood MJ, Wood CD, Mims ME. Effects of ginger on motion sickness susceptibility and gastric function. Pharmacology. 1991;42(2):111-20.

16.Vutyavanich T, Kraisarin T, Ruangsri R.Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. 2001 Apr;97(4):577-82.

17.Willetts KE, Ekangaki A, Eden JA. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2003 Apr;43(2):139-44.

EDITOR'S NOTE: This monograph can be found in The Health Professional's Guide to Dietary Supplements (Lippincott, Williams & Wilkins) by Shawn M. Talbott, PhD and Kerry Hughes, MS.