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Ginger

Scientific Name(s): Zingiber capitatum Smith., Zingiber officinale Roscoe.
Common Name(s): Black ginger, Ginger, Ginger root, Zingiberis rhizoma

Medically reviewed by Drugs.com. Last updated on Jan 12, 2023.

Clinical Overview

Use

There are many traditional uses for ginger, but recent interest centers on the prevention and management of nausea. However, information to support ginger’s use for nausea, especially in pregnancy, is limited or lacking. Ginger may possess anti-inflammatory and analgesic effects, and has been effective in dysmenorrhea in limited studies.

Dosing

Ginger has been used in clinical trials in dosages of 170 mg to 1 g 3 to 4 times daily. Essential oils of ginger have been administered as aromatherapy for postoperative and chemotherapy-induced nausea and vomiting.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use. Despite trials conducted to determine its effectiveness in pregnancy-related nausea, data on fetal outcomes are lacking.

Interactions

Anticoagulants (eg, warfarin), agents with antiplatelet properties, nonsteroidal anti-inflammatory agents, salicylates or thrombolytic agents, antihypertensives, hypoglycemic agents, and crizotinib interact with ginger.

Adverse Reactions

The US Food and Drug Administration (FDA) lists ginger as generally recognized as safe (GRAS), but large doses carry the potential for adverse reactions. Mild GI effects (eg, heartburn, diarrhea, mouth irritation) have been reported, and case reports of arrhythmia and immunoglobulin E (IgE) allergic reaction are documented.

Toxicology

Toxicological information regarding the use of ginger in humans is limited, and mutagenicity is contested.

Scientific Family

Botany

Native to tropical Asia, ginger is a perennial plant cultivated in the tropical climates of Australia, Brazil, China, India, Jamaica, West Africa, and parts of the United States. The rhizome, which is used medicinally and as a culinary spice, is harvested at 6 to 20 months; taste and pungency increase with maturity. The plant carries a green-purple flower in terminal spikes, and the showy flowers are pollinated by insects.1, 2

History

Medicinal use of ginger dates back to ancient China and India; references to its use are found in Chinese pharmacopeias, the Sushruta scriptures of Ayurvedic medicine, and Sanskrit writings. When its culinary properties were discovered in the 13th century, use of this herb became widespread throughout Europe. In the Middle Ages, apothecaries recommended ginger for travel sickness, nausea, hangovers, and flatulence.

Ginger is found in the official pharmacopeias of Austria, China, Egypt, Great Britain, India, Japan, the Netherlands, and Switzerland. It is approved as a nonprescription drug in Germany and as a dietary supplement in the United States.2, 3, 4

Chemistry

Only unbleached ginger (scraped or unscraped) is accepted as a medicinal-grade drug, containing 1.5% or more volatile oil. Quality standards for ginger can be found in the United States Pharmacopeia.

More than 400 different compounds have been identified in ginger. The major constituents in ginger rhizomes are carbohydrates (50% to 70%), which are present as starch. The concentration of lipids is 3% to 8% and includes free fatty acids (eg, palmitic, oleic, linoleic, linolenic, capric, lauric, myristic), triglycerides, and lecithins. Oleoresin provides 4% to 7.5% of pungent substances as gingerol homologues, shogaol homologues, zingerone, and volatile oils. Volatile oils are present in 1% to 3% concentrations and consist mainly of the sesquiterpenes beta-bisabolene and zingiberene; other sesquiterpenes include zingiberol and zingiberenol. Numerous monoterpenes are also present. Amino acids, raw fiber, ash, protein, phytosterols, vitamins (eg, nicotinic acid, vitamin A), and minerals are among the other constituents.

Analyses of the oleoresins have resulted in the identification of a class of structurally related compounds called gingerols, which form shogaols and degrade further to zingerone when dehydrated. The main components are [6]-gingerol and [6]-shogaol; however, the pharmacologically active compounds [6]- and [10]-dehydrogingerdione and [6]- and [10]-gingerdione have also been identified.1, 5, 6, 7, 8, 9

Uses and Pharmacology

The ginger rhizome is a widely used culinary spice. The relative safety of ginger and the availability of randomized clinical trials in humans render data from animal trials largely irrelevant for some indications.

Analgesic/Anti-inflammatory effects

Animal data

Anti-inflammatory effects of ginger include effects on the inflammatory precursor arachidonic acid(6, 10) and inhibition of prostaglandin and leukotriene synthesis.(5, 11)

Clinical data

Results from published studies are equivocal, and several trials are compromised by methodological flaws.(6, 12, 13, 14) Ginger 2 g/day over 11 days was effective in reducing exercise-induced muscle pain; however, markers of prostaglandin synthesis were unaffected, and a single dose was ineffective.(15, 16) A randomized, double-blind, placebo-controlled trial in 20 non–weight-trained adults found that ginger supplementation (4 g/day × 5 days) significantly improved muscle recovery in the early stages after exercising (24 to 48 hours) (P=0.002) but not 72 or 96 hours after exercising, in contrast to placebo. Additionally, ginger appeared to increase indicators of muscle damage, as pairwise comparisons revealed significant increases in overall creatine kinase (P=0.01) and impaired flexibility (P<0.005).(86) A systematic review and meta-analysis of 8 randomized clinical trials (N=734) published before December 2014 found an overall moderate to large effect of Zingiberaceae extracts (including turmeric, ginger, and galangal) on chronic pain compared with placebo; however, substantial heterogeneity was found. Significantly lower subjective pain was reported with the intervention (P=0.004). A strong dose-response relationship was also demonstrated. Patient groups included 3 studies in patients with osteoarthritis of the knee or hip, and 1 study each in patients with gonarthritis, irritable bowel syndrome, muscle soreness following exercise, postoperative pain, and primary dysmenorrhea. The 4 trials that used ginger monotherapy (n=315) used doses of ginger rhizome extract or powder ranging from 510 mg/day to almost 2 g/day over a period of 3 days to 3 months.(89) In 100 patients with knee osteoarthritis, 3 months of supplementation with ginger (500 mg twice daily) resulted in a significant reduction in the proinflammatory cytokines TNF-alpha and IL-1beta (P<0.001 each) compared to baseline and placebo. The study was a double-blind, randomized, placebo-controlled design conducted in patients 50 to 70 years of age.(95)

A systematic review of randomized controlled trial data identified 6 studies overall that met inclusion criteria that investigated oral spice supplementation for rheumatoid arthritis. The one study that assessed ginger was double-blinded and administered ginger powder 750 mg twice daily or placebo for 12 weeks in 63 adults with a 2-year disease duration currently treated with methotrexate, hydroxychloroquine, and prednisone. Compared to placebo, ginger significantly improved 2 of 2 outcome measures, including disease activity erythrocyte sedimentation rate score (P<0.001) C-reactive protein (P=0.044).(52)

The updated American Academy of Orthopedic Surgeons clinical practice guideline on the treatment of osteoarthritis of the knee (2021) recommends that ginger extract may be helpful in reducing pain and improving function for patients with mild to moderate osteoarthritis of the knee (limited).(75)

Limited studies suggest ginger is effective in reducing dysmenorrhea when administered at 500 mg 3 times daily either at the onset of menses or 2 days earlier. A few studies have demonstrated ginger to be as effective as mefenamic acid or ibuprofen in women with primary dysmenorrhea.(17, 18, 19, 84) In another randomized, placebo-controlled, double-blind trial conducted in Iranian high school females (N=150) with primary dysmenorrhea and a pain score higher than 4 on the visual analog scale, reduction in pain was significant in the ginger (250 mg 3 times daily) and zinc sulfate (220 mg 3 times daily) groups compared with placebo (P<0.001). Interventions were taken for 4 days: the day before menstruation and for the next 3 days. Adverse effects were not significantly different among groups.(83) These data have been supported by results of a meta-analysis evaluating the effectiveness of ginger (750 to 2,000 mg for the first 3 to 4 days of menstruation) for treating primary dysmenorrhea in females 13 to 30 years of age. Of the 7 trials included in the analysis, 4 randomized clinical trials (N=366) provided efficacy data for ginger versus placebo and demonstrated a significant reduction with ginger (P=0.0003).(85) A Cochrane systematic review and meta-analysis of dietary supplements for dysmenorrhea identified only low or very low quality studies with very small sample sizes. Very limited evidence of effectiveness was found for the treatment of primary dysmenorrhea with ginger powder 500 to 750 mg/day compared to placebo or no treatment (4 randomized clinical trials; N=335); however, no difference was identified between ginger 250 mg 3 times daily and zinc sulfate 220 mg 3 times daily (1 randomized clinical trial; n=101). No adverse events from ginger supplementation were observed.(90)

Anti-tuberculosis drug–induced hepatotoxicity

Clinical data

In a double-blind, randomized, controlled trial (n=69), newly diagnosed and treatment-naive tuberculosis patients received 500 mg/day of ginger (1.62 mg/day of 6-gingerol and 0.64 mg/day of 6-shogaol) or placebo for 4 weeks. Interventions were administered 30 minutes prior to morning anti-tuberculosis medications; medications usually used for controlling tuberculosis drug-induced GI adverse effects, including nausea and vomiting, were omitted during the study period. Administration of ginger significantly reduced the anti-tuberculosis drug-induced frequency of nausea compared to placebo (P=0.001); however, no difference was found between groups for frequency of vomiting, abdominal pain, or hepatotoxicity. Factors that were significantly associated with anti-tuberculosis drug-induced hepatotoxicity included serum albumin less than 3.5 mg/dL, injection drug use, diabetes mellitus, and co-infections with HIV and hepatitis C virus. Mild heartburn occurred in 10% (n=3) of the ginger-treated patients, which was tolerable within 1 week of continuing treatment.(94)

Cancer

Animal data

Antitumor activity of ginger and its constituents has been demonstrated in several in vitro and animal experiments. Apoptotic cell death and antiproliferative effects caused by gingerol, paradol, shogaol, essential oil of ginger, and dried homogenized ginger have been demonstrated in mice and in human cell lines.(6, 20, 21, 22)

Clinical data

No human trials using ginger in cancer treatment have been published.(20, 22) A pilot trial reported findings after evaluating the efficacy of ginger root extract in decreasing eicosanoids as a marker of colorectal cancer risk.(23) Results from another pilot randomized controlled trial that evaluated effects of ginger supplementation on cell-cycle biomarkers suggested that 2 g of ginger daily for 28 days may reduce proliferation in normal-appearing colonic mucosa of patients at increased risk of colorectal cancer as well as increase apoptosis and differentiation relative to proliferation.(71)

Diabetes mellitus

Clinical data

A systematic review and meta-analysis identified 10 randomized controlled studies that reported on the effects of ginger on the metabolic profiles of 597 patients with type 2 diabetes. The majority of the studies were of high quality, while 2 were of moderate quality. Pooled data from 8 studies found a significant improvement in fasting blood glucose for ginger compared to controls with a weighted mean difference (WMD) of −18.81 (95% CI, −28.7 to −8.92, high heterogeneity) with significant reductions also observed in all subgroups (cut-offs, 50 years of age; ginger dose, 2,000 mg/day; study duration, 11 weeks; and sample size, 60). Similar results were produced with ginger regarding HbA1c based on pooled data from 7 studies with a WMD of −0.57 (95% CI, −0.93 to −0.2; high heterogeneity) with significance retained across all subgroups except for patients older than 50 years. Triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were not affected overall by ginger supplementation (5 studies); however, subgroup analysis found significant improvement in triglycerides and LDL among studies with a sample size of less than 60 participants and also for LDL and total cholesterol in studies with a duration of less than 11 weeks in duration. Systolic as well as diastolic blood pressure measurements were significantly reduced with ginger (5 studies), except in studies that used a dose of 1,600 mg/day or less for longer than 11 weeks in less than 70 participants.(118)

A randomized, double-blind, placebo-controlled trial conducted in patients who had type 2 diabetes mellitus for at least 10 years (n = 88) found a significant improvement in mean fasting blood glucose (FBS; 10.5%) in the ginger group compared with a significant increase in FBS in the placebo group (21%) (P = 0.01). Additional insulin resistance indices that were statistically significantly improved with ginger included fasting insulin level, insulin sensitivity, and homeostasis model assessment (HOMA) (P<0.005).(78) Similarly, 63 adult patients with type 2 diabetes mellitus who completed a 12-week intervention of ginger (1,600 mg/day) in a double-blind, randomized, controlled trial, experienced significantly improved changes in fasting plasma glucose (P=0.02), glycated hemoglobin (HbA1c) (P=0.001), insulin (P=0.01), HOMA (P=0.000), triglycerides (P=0.001), total cholesterol (P=0.02), high-density lipoprotein/total cholesterol ratio (P=0.02), serum C-reactive protein (P=0.01), and PGE2 (P=0.000). No significant changes were noted between groups with regards to body mass index or body weight.(79) Similar effects on glycemic markers were found in a double-blind, randomized, placebo-controlled trial in 50 Iranian adults with a body mass index up to 30 who had type 2 diabetes for mean duration of approximately 5 years. Ginger 3 g/day was provided for 3 months. Compared with placebo and baseline, significant improvements were observed in serum glucose, HbA1c, insulin, insulin resistance, malondialdehyde, high-sensitive C-reactive protein, total antioxidant capacity, and paraoxonase-1. Oral medications given during the trial included metformin, glibenclamide, or both to control blood sugar.(88)

Gastrointestinal, irritable bowel syndrome

Clinical data

Disease severity and symptom relief of irritable bowel syndrome was not found to be significantly different between placebo and 1 or 2 g/day of ginger in a 28-day randomized, controlled, parallel group study (n=45). However, pre- and posttreatment severity scores were significantly improved in both the placebo (P=0.001) and ginger 1 g/day groups (P=0.007); significant symptom improvement was experience by 34.8% and 26.4%, respectively. Mild side effects were reported and were more common in the placebo group (35.7%) than the ginger group (16.7%).(77)

Gout, acute attack

The American College of Rheumatology guidelines on the management of gout (2012) voted that the use of various oral complementary agents, including ginger, was inappropriate for the treatment of an acute attack of gout. The new guideline (2020) based on additional evidence regarding the management of gout no longer included a statement regarding the use of ginger. (68, 111)

Heavy menstrual bleeding

Clinical data

Administration of freshly prepared ginger capsules (250 mg 3 times daily) significantly reduced blood loss in Iranian teenage high school girls who experienced heavy menstrual bleeding. In a placebo-controlled, double-blind, randomized trial, mean hemorrhage within the ginger-treated group decreased by 46.6% (mean, 113.73 mL to 60.67 mL) during the 3 intervention months compared with the 3 pre-intervention assessment months (P<0.001). Additionally, the percent reduction in mean bleeding was significantly different between the ginger (46.6%) and placebo (2.1%) groups (P<0.001).(82)

Insomnia

Clinical data

In an open-label, randomized, controlled study (N=29) that enrolled adults with self-reported moderate insomnia, the addition of ginger powder to a daily warm water foot bath used 1 to 3 hours before bedtime for 2 weeks did not significantly affect the global sleep quality or insomnia severity scores compared to warm water alone.(117)

Migraine

Clinical data

A randomized, double-blind, placebo-controlled trial (n = 100) comparing efficacy of ginger and sumatriptan in treating migraine without aura found the 2 agents equally effective. Within 2 hours of taking ginger (250 mg ginger rhizome powder) or sumatriptan (50 mg), patients experienced at least a 90% reduction in headache severity.(74)

Nausea and vomiting

Animal data

Animal studies have described enhanced GI transport, anti-5-hydroxytryptamine, and possible CNS antiemetic effects. It has been theorized that the mode of administration, due to gingerol and shogaol effects on GI motility, depends on route.(1)

Clinical data

Human experiments to determine the mechanism of action show varying effects on gastric motility, antral contractions, and corpus motor response.(24, 25, 26, 27, 28) No impact on GI symptoms and gut peptides, and no change in measurements of fundus dimensions have been shown.(29, 30, 31) The influence of gender and supplemental information has been examined by some researchers evaluating the effect of ginger on motion sickness.(32) A case report describes a reduction in disequilibrium and nausea associated with abrupt discontinuation or intermittent noncompliance with selective serotonin reuptake inhibitors (ginger 1 g given 3 times daily).(33)

Antiretroviral-induced nausea and vomiting

Ginger (500 mg twice daily) administered 30 minutes prior to antiretroviral therapy for 2 weeks, significantly reduced antiretroviral-induced nausea and vomiting. The total number of patients experiencing any nausea was 56.9% vs 90.2% for ginger and placebo, respectively (P = 0.001). Frequency of nausea was also significantly lower with ginger (mild [P = 0.02]; moderate [P = 0.04]; severe [P = 0.001]). Additionally, 9.8% in the ginger group vs 47.1% in the placebo group experienced at least 1 episode of vomiting (P = 0.01). The most common antiretroviral regimen was efavirenz and lamivudine plus zidovudine (97%).(81)

Chemotherapy-related nausea and vomiting

Results from published studies are equivocal.(34, 35, 36, 37, 38) A meta-analysis published in 2013 including 5 clinical trials, with a total of 872 participants, reported that evidence does not support the use of ginger for reducing short-term nausea (P = 0.12) or short-term vomiting (P = 0.37), nor severity of short-term nausea (P = 0.12).(36) Two large, multicenter trials not included in the meta-analysis subsequently reported equivocal results.(39, 69) The first (N=576) found a decrease in nausea, but not vomiting, when ginger 0.5 to 1 g daily was added to standard management (5-HT3 receptor antagonists and dexamethasone).(39) The second trial (N=251) reported no significant differences in the incidence of nausea, significant nausea, or delayed nausea, or its intensity for patients on high-dose cisplatin and antiemetic therapy who received 160 mg/day ginger or placebo.(69) A second meta-analysis reported an overall beneficial effect with powdered and fresh ginger for acute as well as delayed chemotherapy-induced nausea and vomiting (CINV); however, heterogeneity was significant among the 3 trials.(115) A single-blind, randomized, controlled crossover trial examined the effect of inhaled ginger aromatherapy on chemotherapy-induced nausea and vomiting in 60 adult female breast cancer patients in Malaysia. For 5 days, ginger essential oil vapors or placebo were inhaled at least 3 times daily for a 2-minute minimum duration at each inhalation regardless of if symptoms were present. A significant reduction in nausea and vomiting incidence (P < 0.001 each) was seen only in the acute phase (day 2) and was not sustained over the 5 days of therapy. However, significant improvements were observed in 6 health-related quality of life subscores for some patients, including: global health status, role functioning, fatigue, nausea and vomiting, pain, appetite loss, and constipation. No major adverse events were observed.(87) Similarly, powdered ginger 500 mg twice daily taken orally 30 minutes prior to chemotherapy for 3 days by women with stage II or III breast cancer was found to produce a statistically significant reduction in nausea severity and number of vomiting/retching episodes on days 2 to 5 compared to controls in a randomized controlled trial (n=60). Five-day mean scores for both of these outcomes were also statistically significantly lower in the ginger group than controls (P<0.05). However, the number of vomiting/retching episodes did not differ significantly from baseline.(91) In contrast, ginger (500 mg twice daily) given during adriamycin-cyclophosphamide or cisplatin-based chemotherapy did not provide any benefit compared to placebo in chemotherapy-induced nausea or vomiting in 34 women with breast cancer or 140 patients with lung cancer enrolled in double-blind, randomized, placebo-controlled trials. Additionally, no significant difference was observed in the rate of rescue medication use. No treatment-related adverse effects were observed.(96, 99)

The American Society of Clinical Oncology (ASCO) updated guideline for antiemetics (2020) states that evidence remains insufficient to recommend for or against the use of ginger for the prevention of nausea and vomiting in patients with cancer.(114) Similarly, the Pediatric Oncology Group of Ontario updated guideline on the prevention and treatment of anticipatory CINV in pediatric cancer patients and hematopoietic stem cell recipients (2021) suggests that ginger not be used routinely for secondary prevention of anticipatory CINV (conditional, low).(116) However, in 2018, ASCO endorsed the Society for Integrative Oncology (SIO) evidence-based guideline for the use of integrative therapies after breast cancer treatment, stating that ginger could be considered as an addition to antiemetic drugs to control nausea and vomiting during chemotherapy.(101, 102, 113)

Motion sickness

Results from the limited published studies are equivocal.(6, 12, 29, 32)

Postoperative nausea and vomiting

Results from published guidelines, trials, and meta-analyses are equivocal. The Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines for the management of postoperative nausea and vomiting (2008) note that although ginger root is a commonly used nonmedical therapy, it is not effective for postoperative nausea and vomiting (PONV) prophylaxis.(70) American Society of Enhanced Recovery and Society for Ambulatory Anesthesia 2020 updated guideline for the management of PONV now recommend multimodal prophylaxis in adults with at least 1 risk factor. As a nonpharmacologic option, they reported results from 1 meta-analysis that demonstrated a small reduction in nausea scores with ginger prophylaxis, particularly with 1,000 mg (level A1). Additionally, in patients with PONV who experienced either no or failed prophylaxis, results from another meta-analysis indicated that ginger treatment may provide a small reduction in nausea.(112)

Limitations of meta-analyses include lack of comparators, heterogenous study populations, various scales and outcome measures, ginger product processing and composition, and varying surgical procedures.(40, 41, 105) In a 2006 meta-analysis of 5 randomized clinical trials investigating the efficacy of ginger in postoperative nausea, ginger 1 g was more effective than placebo (relative risk, 0.69; confidence interval, 0.54 to 0.89).(41) Other reviews and meta-analyses, some including trials excluded by others, did not find ginger useful in the postoperative setting; the numbers needed for effect range from 11 to 25.(6)

Data from a 2013 double-blind, placebo-controlled, randomized clinical trial in 239 full-term parturients undergoing elective C-section are congruent with the SOGC guidelines. Although the number of episodes of intraoperative nausea were significantly reduced, no effect was found overall on intraoperative or postoperative nausea and vomiting in women administered dry powder ginger capsules versus placebo.(73)

A 2012 randomized, placebo-controlled trial in 1,151 patients who reported nausea in postanesthesia care found a statistically significant reduction in nausea level and the number of antiemetic medications requested after essential oil of ginger as well as a blend of ginger, spearmint, peppermint, and cardamom essential oils were administered as aromatherapy. Postoperative nausea improved almost 2 to 1 with ginger versus saline, and almost 3 to 1 with the blend versus saline.(72)

Pregnancy-related nausea

Results from limited published high-quality studies are equivocal. Ginger appears to be more efficacious than placebo in reducing nausea, but equal or less than metoclopramide and vitamin B6. No effect on vomiting was demonstrated in these trials.(41, 42, 43, 44, 45, 46) However, a meta-analysis of 6 randomized clinical trials showed 1 g/day of ginger for at least 4 days to be better than placebo at reducing pregnancy-related nausea and vomiting (pooled odds ratio, 4.89; P < 0.0001).(76) A subsequent systematic review and meta-analysis built upon the previous review by including 6 additional randomized controlled trials and also by parsing out data for each unique comparator (placebo, dimenhydrinate, metoclopraminde, and vitamin B6). The data indicated that ginger significantly decreased pregnancy-related nausea compared with placebo (P = 0.0002) but not compared with vitamin B6; subgroup analysis favored efficacy for doses less than 1,500 mg daily. No significant difference was seen in the number of vomiting episodes between ginger and placebo or vitamin B6. No significant difference was observed between ginger and metoclopramide for severity of nausea or vomiting; no efficacy results could be calculated for the ginger–dimenhydrinate study. Ginger was well tolerated; it caused less drowsiness than dimenhydrinate and more belching than vitamin B6.(80) Ginger was identified as the most common herb used for pregnancy-related nausea/vomiting by certified or licensed midwives in state-wide surveys conducted in California, Texas, and North Carolina.(104)

Little information on fetal outcomes has been published in relation to clinical trials investigating the use of ginger in pregnancy, and studies have generally been too small to detect abnormalities.(43, 45)

The American College of Obstetrics and Gynecologists (ACOG) practice guideline for nausea and vomiting of pregnancy (2018) recommend the consideration of ginger as a nonpharmacologic treatment option for the reduction of nausea (Level B).(97)

Inhibition of platelet aggregation

Animal data

Studies from animal models are inconclusive, but experiments with different ginger extracts have suggested antiaggregation effects.(6)

Clinical data

Results in human experiments are inconclusive. Ginger demonstrated an inhibitory effect in 1 study and, in another, no effect on platelet aggregation at recommended daily doses (less than 5 g).(1, 47, 48)

Other uses

Clinical studies have found equivocal effects on the lipid profile.(49, 50) A small double-blind, randomized, placebo-controlled trial conducted in 38 patients on continuous ambulatory peritoneal dialysis found a significant decrease only in serum triglycerides compared to baseline and placebo in patients who consumed ginger 1,000 mg/day for 10 weeks. No significant changes were documented in serum total cholesterol, low-density lipoprotein cholesterol, or lipoprotein(a). However, high-density lipoprotein cholesterol was noted to be significantly decreased compared to baseline in the placebo group but not in the ginger group.(92) Similarly, a 2018 systematic review and meta-analysis of 12 placebo-controlled clinical trials (N=586) found the administration of ginger to have significant overall effects on triacylglycerol (−17.59 mg/dL, P=0.003) and LDL (−4.9 mg/dL, P=0.02) but not total cholesterol or HDL, however significant heterogeneity was observed for each of these meta-analyses. Subgroup analysis among trials without significant heterogeneity identified significant improvements only in total cholesterol for ginger given for less than 50 days duration (−9.78 mg/dL, P=0.007), in triacylglycerol for ginger doses greater than 2 g/day (−10.41 mg/dL, P=0.014), and for LDL in low-quality studies (−6.99 mg/dL, P=0.019).(100)

A one-time dose of 1% ginger orally disintegrating tablets (2 mg ginger powder/tablet) was shown to significantly increase the amount of salivary substance P in elderly individuals (P<0.05); low secretion of salivary substance P has been noted as the cause of dysphagia.(93)

Although animal studies tend to suggest a beneficial effect of ginger on excess weight, the limited clinical studies that are available provide little to no support for weight loss in overweight subjects.(103)

Dosing

Nausea

Dosages ranged from 250 mg to 2 g/day given in 3 to 4 divided doses, with no greater effectiveness found for the 2 g dose over the 1 g dose.6, 7, 12, 41

Ginger as an adjunctive agent has been studied in individuals 8 to 21 years of age for chemotherapy-related nausea at dosages of 1 and 2 g/day.38

Dysmenorrhea

500 mg 3 times daily either at the onset of menses or 2 days earlier.17, 18, 19

Pregnancy / Lactation

Avoid use.22, 58, 59 Despite the availability of clinical trials investigating the use of ginger in pregnancy-related nausea, data on fetal outcomes are lacking.22, 43 One animal study showed early embryo loss, while no effect was found in another.22 Chemical constituents of ginger possess apoptotic effects in human lymphoma cells.6, 20, 21, 22 Ginger affects protein binding of testosterone, which has led to concerns related to the embryo development.22 In the Complete German Commission E Monographs, ginger is contraindicated for use in morning sickness.4

Interactions

Agents with antiplatelet properties: Herbs (anticoagulant/antiplatelet properties) may enhance the adverse/toxic effect of agents with antiplatelet properties. Bleeding may occur. Consider therapy modification.(60, 61, 62, 63)

Anticoagulants: Herbs (anticoagulant/antiplatelet properties) may enhance the adverse/toxic effect of anticoagulants. Bleeding may occur. Consider therapy modification.(60, 61, 62, 63)

Antihypertensives: Herbs (hypertensive properties) may diminish the antihypertensive effect of antihypertensives. Monitor therapy.(64, 65, 98)

Crizotinib: Ginger may increase the serum concentration of crizotinib. Monitor therapy.(106, 107)

Herbs (anticoagulant/antiplatelet properties): May enhance the adverse/toxic effect of other herbs (anticoagulant/antiplatelet properties). Bleeding may occur. Consider therapy modification.(60, 61, 62, 63)

Hypoglycemic agents: Herbs (hypoglycemic properties) may enhance the hypoglycemic effect of hypoglycemic agents. Monitor therapy.(66)

Nonsteroidal anti-inflammatory agents: Herbs (anticoagulant/antiplatelet properties) may enhance the adverse/toxic effect of nonsteroidal anti-inflammatory agents. Bleeding may occur. Consider therapy modification.(60, 61, 62, 63)

Nonsteroidal anti-inflammatory agents (topical): Herbs (anticoagulant/antiplatelet properties) may enhance the antiplatelet effect of nonsteroidal anti-Inflammatory agents (topical). Monitor therapy.(60, 61, 62, 63, 108, 109, 110)

Salicylates: Herbs (anticoagulant/antiplatelet properties) may enhance the adverse/toxic effect of salicylates. Bleeding may occur. Consider therapy modification.(60, 61, 62, 63)

Thrombolytic agents: Herbs (anticoagulant/antiplatelet properties) may enhance the adverse/toxic effect of thrombolytic agents. Bleeding may occur. Consider therapy modification.(60, 61, 62, 63)

Ginger drug interactions (more detail)

Adverse Reactions

The FDA lists ginger as GRAS.67 In culinary quantities, the root is generally devoid of activity, although larger doses carry the potential for adverse reactions. Adverse reactions reported in trials are uncommon and include mild GI effects (eg, heartburn, diarrhea, mouth irritation).6, 12 Case reports of arrhythmia, jaundice, and IgE allergic reaction have been documented.6, 12, 104

Ginger side effects (more detail)

Toxicology

Toxicological information regarding the use of ginger in humans is limited, and mutagenicity is contested.1, 6, 22 The median lethal dose of ginger oil has been estimated to be more than 5 g/kg of body weight in rats.6 Teratogenicity studies reported that rat fetuses exposed to high-dose ginger tea were heavier and had more advanced skeletal development than controls. Embryonic loss was greater in the treatment group. In another similar study with different types of rats, no teratogenicity was observed.6, 22

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

Frequently asked questions

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4. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.
5. Grzanna R, Lindmark L, Frondoza CG. Ginger—an herbal medicinal product with broad anti-inflammatory actions. J Med Food. 2005;8(2):125-132.16117603
6. Chrubasik S, Pittler MH, Roufogalis BD. Zingiberis rhizoma: a comprehensive review on the ginger effect and efficacy profiles. Phytomedicine. 2005;12(9):684-701.16194058
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