Ginger

Scientific Name(s): Zingiber officinale Roscoe; occasionally Zingiber capitatum Smith. Family: Zingiberaceae

Common Name(s): Ginger , ginger root , black ginger , zingiberis rhizoma

Uses

There are many traditional uses for ginger, but more recent interest in the use of ginger centers on the prevention and management of nausea. Ginger may play a role in osteoarthritic pain and cancer. However, there is limited clinical information to support these uses.

Dosing

Ginger has been used in clinical trials in doses of 250 mg to 1 g, 3 to 4 times daily.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Despite trials conducted to determine its effectiveness in pregnancy-related nausea, reasons for caution exist. Avoid use until safety is established.

Interactions

None well documented.

Adverse Reactions

The United States Food and Drug Administration (FDA) considers ginger to be a safe food supplement (“generally recognized as safe”). Large doses carry the potential for adverse reactions. Mild GI effects (eg, heartburn, diarrhea, mouth irritation) have been reported. Case reports of arrhythmia and immunoglobulin E (IgE) allergic reaction are documented.

Toxicology

Toxicologic information regarding use in humans is lacking.

Botany

Native to tropical Asia, ginger is a perennial 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; the flowers are similar in appearance to orchids. 1 , 2

History

Medicinal use of ginger dates back to ancient China and India; references to its use are found in Chinese pharmacopeias, the Sesruta scriptures of Ayurvedic medicine as well as Sanskrit writings. 1 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. 1

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. 1 , 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 National Formulary . 1

Over 400 different compounds have been identified in ginger. 5 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 and vitamin A), and minerals are among the other constituents. 1 , 5 , 6 , 7 , 8 , 9

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 , 7 , 10

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.

Cancer

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 human cell lines. 7 , 8 , 11 , 12 No human trials with the use of ginger in cancer have been published. 8 , 12

Nausea

Human clinical trials have examined ginger's antiemetic effects related to motion sickness, postoperative and pregnancy–related nausea, and other causes. The mechanism of action by which ginger might exert effects is still unclear. Animal studies have described enhanced GI transport, anti-5-hydroxytryptamine, and possible CNS antiemetic effects. 13 Human experiments to determine the mechanism of action show varying results regarding gastric motility and corpus motor response. 14 , 15 , 16 , 17 , 18

Chemotherapy-related nausea

A trend toward effectiveness has been demonstrated in a limited number of trials in chemotherapy-related nausea, 7 whereas others have found no effect with the addition of ginger to standard antiemetic regimens. 19 , 20 , 21 A case report describes a reduction in disequilibrium and nausea associated with abrupt discontinuation or intermittent noncompliance with selective serotonin reuptake inhibitors (1 g of ginger given 3 times daily). 22

Motion sickness

Results from the limited published studies are equivocal, with 3 of 7 trials reporting ginger root effective as a preventative or in treatment. The remaining 4 trials found no benefit over the comparator/placebo. Doses ranged from 250 mg to 2 g in 1 trial, 18 with no greater effectiveness for 2 g over the 1 g dose. 7 , 20

Postoperative nausea

Results from published trials and meta-analyses are equivocal. Limitations of meta-analyses include the lack of comparators, the heterogenous study populations, and surgical procedures. 21 , 23 In a meta-analysis of 5 randomized clinical trials investigating the efficacy of ginger in postoperative nausea, 1 g of ginger was more effective than placebo (relative risk, 0.69; confidence interval, 0.54 to 0.89). 23 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. 7

Pregnancy-related nausea

In a Cochrane meta-analysis, only 1 trial using ginger met inclusion criteria. 24 , 25 The majority of women in this crossover trial (n = 70) preferred using ginger to placebo. 25 A 2005 review of 6 quality trials found ginger to be superior to placebo in 4 trials and comparable with vitamin B6 in 2 trials. 7 , 20 , 26 Little information on fetal outcomes has been published in relation to clinical trials investigating the use of ginger in pregnancy. 24

Inhibition of platelet aggregation

Studies from animal models are inconclusive, but experiments with different ginger extracts have suggested an antiaggregation effect. 7 Results in human experiments are equally inconclusive. Ginger has demonstrated an inhibitory effect as well as no effect on platelet aggregation at recommended daily doses (less than 5 g). 9 , 27 , 28 , 29 , 30 , 31 , 32

Osteoarthritis

Trials exploring the anti-inflammatory and pain-relieving effects of ginger have provided mixed results, with the majority of trials showing a trend toward pain relief greater than placebo but less than traditional anti-inflammatory drugs. 7 , 20 , 33 , 34 , 35 , 36 Several trials have methodological flaws, including sponsorship by ginger-manufacturing companies. 7 , 35 Mechanisms of action have been proposed and include inhibition of prostaglandin and leukotriene synthesis. 5 , 34 , 35

Other uses

Other actions of ginger and its constituents include cardiotonic/toxic effects, 1 , 7 , 20 , 37 effects on the CNS, 7 , 10 enhanced testosterone production, 7 , 12 and inhibition of prostaglandin synthesis. 7 , 28 However, human studies are lacking.

Dosage

Ginger has been used in clinical trials in doses of 250 mg to 1 g, repeated 3 to 4 times daily. 20

Pregnancy/Lactation

Avoid use. 12 , 38 , 39 Despite the availability of clinical trials investigating the use of ginger in pregnancy-related nausea, there is a lack of data on fetal outcomes in these trials. 12 , 24 One animal study showed early loss of embryos, while no effect was found in another. 12 Chemical constituents of ginger possess apoptotic effects in human lymphoma cells. 7 , 8 , 11 , 12 Ginger affects protein binding of testosterone, which has led to concerns related to the developing embryo. 12 In the German Commission E Monographs ginger is contraindicated for use in morning sickness. 3

Interactions

Reports of interactions with warfarin are limited, despite suggested potential for interaction. Pharmacokinetic studies showed warfarin kinetics to be unchanged with coadministration of ginger, with no changes in protein binding or international normalized ratio levels. 27 Extra monitoring may be advised only with high ginger consumption. 20

Adverse Reactions

The FDA considers ginger to be a safe food supplement. 40 , 41 In culinary quantities, the root is generally devoid of activity. Larger doses carry the potential for adverse reactions. Adverse reactions reported in trials are uncommon and include mild GI effects such as heartburn, diarrhea, and mouth irritation. 7 , 20 Case reports of arrhythmia and IgE allergic reaction have been documented. 7 , 20

Toxicology

Toxicologic information regarding use in humans is lacking. The acute oral lethal dose 50 of ginger oil has been estimated to be more than 5 g/kg of body weight in rats. 7 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. 7 , 12 Some ginger compounds have shown mutagenicity. 7 , 12

Bibliography

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40. Food and Drug Administration, Department of Health and Human Services. Code of Federal Regulations, 21CFR182.10. http://www.access.gpo.gov/nara/cfr/cfr-table-search.html . Accessed February 7, 2008.
41. Ginger. Herb Safety and Drug Interactions. Herb Information Packet Series . Boulder, CO: Herb Research Foundation; 1998.

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