Ginger (Zingiber officinale Roscoe)

Ginger (Zingiber officinale Roscoe)

Background

The rhizomes (underground stem) and stems of ginger have assumed significant roles in Chinese, Japanese and Indian medicine since the 1500s. The oleoresin of ginger is often contained in digestive, antitussive, antiflatulent, laxative, and antacid compounds.

There is supportive evidence from one randomized controlled trial and an open-label study that ginger reduces the severity and duration of chemotherapy-induced nausea/emesis. Effects appear to be additive to prochlorperazine (Compazine®). The optimal dose remains unclear. Ginger's effects on other types of nausea/emesis, such as postoperative nausea or motion sickness remain indeterminate.

Ginger is used orally, topically, and intramuscularly for a wide array of other conditions, without scientific evidence of benefit.

Ginger may inhibit platelet aggregation/decrease platelet thromboxane production, thus theoretically increasing bleeding risk.

Synonyms

African ginger, Amomum zingiber L., black ginger, chayenne ginger, cochin ginger, gan jiang, gegibre, gingembre, gingerall, ginger BP, ginger power BP, ginger root, ginger trips, ingwer, jamaica ginger, kankyo, race ginger, rhizoma zingeberis , sheng jiang, zerzero, Z. capitatum, Z. officinale Roscoe , Z. zerumbet Smith, Z. blancoi Massk, Z. majus Rumph, Zingiberis rhizoma.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidenceGrade*Nausea and vomiting of pregnancy (hyperemesis gravidarum)
Preliminary studies suggest that ginger may be safe and effective for nausea and vomiting of pregnancy when used at recommended doses for short periods of time (less than five days). Some publications discourage large doses of ginger during pregnancy due to concerns about mutations or abortion. Additional research is needed to determine the safety and effectiveness of ginger during pregnancy before it can be recommended for longer periods of time.

B

Nausea (due to chemotherapy)
Initial human research reports that ginger may reduce the severity and length of time that a patient feels nausea after chemotherapy. Additional studies are needed to confirm these results and to determine safety and dosing. Numerous prescription drugs are highly effective at controlling nausea in cancer patients undergoing chemotherapy, and the available options should be discussed with the patient's medical oncologist.

B

Nausea and vomiting (after surgery)
Some human studies report improvement in nausea or vomiting after surgery if patients take ginger before surgery. However, other research shows no difference. Additional studies are needed before the use of ginger before surgery to help with nausea and vomiting can be recommended.

C

Motion sickness, seasickness
There is mixed evidence in this area, with some studies reporting that ginger has no effect on motion sickness, and other research noting that ginger may reduce vomiting (but not nausea). Before a recommendation can be made, more studies are needed comparing ginger to other drugs used for this purpose.

C

Rheumatoid arthritis, osteoarthritis, joint and muscle pain
There is limited scientific evidence in this area, and it is not clear if ginger is beneficial.

C

* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Alcohol withdrawal, antacid, antioxidant, antiseptic, anti-spasm, antiviral, aphrodisiac, asthma, atherosclerosis, athlete's foot, bacterial dysentery, baldness, bile secretion problems, blood thinner, body warming, bronchitis, bleeding, burns (applied to the skin), cancer, cholera, colds, colic, cough suppressant, depression, diarrhea, digestive aid, diminished appetite, dysmenorrhea, dyspepsia, elevated cholesterol, fungal infections, flatulence (gas), flu, headache, heart disease, infection, high blood pressure, immune stimulation, impotence, increased drug absorption, increased metabolism, insecticide, intestinal parasites, Kawasaki's disease, kidney disease, laxative, liver disease, low blood pressure, migraine headache, malaria, pain relief, perspiration, poisonous snake bites, promotion of menstruation, psoriasis (applied to the skin), dose reduction or stopping of selective serotonin reuptake inhibitor (SSRI) drugs, serotonin-induced hypothermia, stimulant, stomach ache, stomach ulcers, testicular inflammation, tonic, toothache, upper respiratory tract infections.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. While there is no universal standard, ginger products are often standardized to gingerol content.

Adults (18 years and older)

Note : Common forms of ginger include fresh root, dried root, tablets, capsules, liquid extract, tincture, and tea. Many publications note that the maximum recommended daily dose of ginger is 4.0 grams. It is believed that the mild stomach upset sometimes caused by ginger may be reduced by taking ginger capsules rather than powder.

General use : Many experts and publications suggest that ginger powder, tablets, or capsules or fresh cut ginger can be used in doses of 1 to 4 grams daily, by mouth, divided into smaller doses.

Nausea and vomiting : To prevent nausea after surgery, ginger has been given as 1 gram by mouth 1 hour before surgery. For nausea and vomiting of pregnancy, 1 to 2 grams daily, by mouth, in divided doses has been used for 1 to 5 days. Some sources warn against higher doses in pregnancy due to concerns about mutations or abortion. Supervision by a qualified healthcare provider is recommended for pregnant women considering the use of ginger.

Motion sickness, seasickness : 1 to 2 grams daily, by mouth, in divided doses has been used.

Arthritis : 1 to 2 grams of powdered ginger daily, by mouth, in divided doses has been used. In one study, patients who mistakenly took 2 to 4 grams daily reported faster and better relief, although superiority of this dose has not been proven.

Children (younger than 18 years)

There is insufficient scientific evidence to recommend the use of ginger in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Ginger supplements should be avoided by individuals with a known allergy to ginger or other members of the Zingiberaceae family, including alpinia formosana, alpinia purpurata (red ginger), alpinia zerumbet (shell ginger), costus barbatus, costus malortieanus, costus pictus, costus productus, dimerocostus strobilaceus, or elettaria cardamomum (green cardamom). Allergic contact rashes have been reported, and these rashes may be more likely in people who work with ginger, who apply ginger to the skin, or who have a positive allergy test for balsam of Peru. An allergic eye reaction has also been reported.

Side Effects and Warnings

Few side effects have been associated with ginger at low doses. No studies confirm the safety of long-term use of ginger supplements. The most commonly reported side effects of ginger involve the stomach and intestines. Irritation or bad taste in the mouth, heartburn, belching, bloating, gas, and nausea are reported, especially with powdered forms of ginger. There are several reports that fresh ginger that is swallowed without enough chewing can result in blockage of the intestines. Individuals who have had ulcers, inflammatory bowel disease, or blocked intestines should use caution when taking ginger supplements, and should avoid large quantities of fresh cut ginger. People with gallstones should use ginger with caution.

In theory, ginger can cause abnormal heart rhythms, although reports in humans are lacking. Some publications suggest that ginger may raise or lower blood pressure, although limited scientific information is available. In addition, ginger may theoretically prevent blood clotting by preventing the clumping of platelets. This raises a concern that individuals who are treated with medications that slow blood clotting or who undergo surgery may have a high risk of excessive bleeding if they take ginger supplements. Ginger is traditionally said to reduce blood sugar levels at high doses, but no scientific evidence is available. In one study, two of eight participants report an intense urge to urinate 30 minutes after ingesting ginger.

Pregnancy and Breastfeeding

Some authors suggest that pregnant women should not take ginger in amounts greater than found in food (or more than 1 gram dry weight per day). There are reports that ginger can increase discharge from the uterus in menstruating women, and possibly lead to abortion, mutations of the fetus, or increased risk of bleeding. However, other reports state that there is no scientific evidence that ginger endangers pregnancy. Little scientific study is available in this area to support either perspective, although ginger has been studied in a small number of pregnant women (to assess effects on nausea), without reports of adverse pregnancy outcomes. Notably, this matter is sometimes confused because the use of ginger in pregnancy is discouraged in traditional Chinese medicine (TCM), in which much higher doses of ginger may be used.

References

1. Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther 2002;27(6):391-401.

2. Akoachere JF, Ndip RN, Chenwi EB, et al. Antibacterial effect of Zingiber officinale and Garcinia kola on respiratory tract pathogens. East Afr Med J 2002;79 (11) :588-592.

3. Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001;44(11):2531-2538.

4. Arfeen Z, Owen H, Plummer JL, et al. A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea and vomiting. Anaesth Intensive Care 1995;23(4):449-452.

5. Bean P. The use of alternative medicine in the treatment of hepatitis C. Am Clin Lab. 2002 May;21(4):19-21.

6. Bliddal H, Rosetzsky A, Schlichting P, et al. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage 2000;8(1):9-12.

7. Blumenthal M. Ginger as an antiemetic during pregnancy. Altern Ther Health Med. 2003 Jan-Feb;9(1):19-21; author reply 19-21. Comment on: Altern Ther Health Med 2002;8(5):89-91.

8. Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc.) and fenugreek (Trigonella foenumgraecum L.) on blood lipids, blood sugar and platelet aggregation in patients with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids 1997;56(5):379-384.

9. Chandra K, Einarson A, Koren G. Taking ginger for nausea and vomiting during pregnancy. Can Fam Physician 2002;48:1441-2.

10. Eberhart LH, Mayer R, Betz O, et al. Ginger does not prevent postoperative nausea and vomiting after laparoscopic surgery. Anesth Analg 2003;96(4):995-998.

11. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth 2000;84(3):367-371.

12. Handler J. Drug-induced hypertension. J Clin Hypertens (Greenwich) 2003;5(1):83-85.

13. Hashimoto K, Satoh K, Murata P, et al. Component of Zingiber officinale that improves the enhancement of small intestinal transport. Planta Med 2002;68(10):936-9.

14. Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia 2002;57(9):889-99 [Comments in: Anaesthesia 2002;57(10):947-948, Anaesthesia 2003;58(2):184-185, Anaesthesia 2003;58(6):597-598].

15. Jewell D. Nausea and vomiting in early pregnancy. Clin Evid 2002;(7):1277-1283.

16. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2002;(1):CD000145. Comment in: ACP J Club. 2002 Sep-Oct;137(2):67. Update of: Cochrane Database Syst Rev. 2000;(2):CD000145.

17. Kalveniene Z, Savickas A, Svambaris L, et al. Development and analysis of revitalizing tincture [Article in Lithuanian]. Medicina (Kaunas) 2002;38(10):1009-1013.

18. Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Med. 2002 Sep-Oct;8(5):89-91. Comment in: Altern Ther Health Med 2003;9(1):19-21.

19. Kim DS, Kim DS, Oppel MN. Shogaols from Zingiber officinale protect IMR32 human neuroblastoma and normal human umbilical vein endothelial cells from beta-amyloid(25-35) insult. Planta Med 2002;68(4):375-376.

20. Lien HC, Sun WM, Chen YH, et al. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol 2003;284(3):G481-9.

21. Marcus DM, Suarez-Almazor ME. Is there a role for ginger in the treatment of osteoarthritis? Arthritis Rheum 2001;44(11):2461-2462.

22. Meyer K, Schwartz J, Crater D, et al. Zingiber officinale (ginger) used to prevent 8-Mop associated nausea. Dermatol Nurs 1995;7(4):242-244.

23. Moneret-Vautrin DA, Morisset M, Lemerdy P, et al. Food allergy and IgE sensitization caused by spices: CICBAA data (based on 589 cases of food allergy). Allerg Immunol (Paris) 2002;34(4):135-140.

24. Morelli V, Naquin C, Weaver V. Alternative therapies for traditional disease states: osteoarthritis. Am Fam Physician 2003;67(2):339-344.

25. Murakami A, Takahashi D, Kinoshita T, et al. Zerumbone, a Southeast Asian ginger sesquiterpene, markedly suppresses free radical generation, proinflammatory protein production, and cancer cell proliferation accompanied by apoptosis: the alpha,beta-unsaturated carbonyl group is a prerequisite. Carcinogenesis. 2002;23(5):795-802 [Comment in: Carcinogenesis 2002;23(11):1961; author reply 1963].

26. Visalyaputra S, Petchpaisit N, Somcharoen K, et al. The efficacy of ginger root in the prevention of postoperative nausea and vomiting after outpatient gynaecological laparoscopy. Anaesthesia 1998;53(5):506-510.

27. Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97(4):577-582.

January 01, 2004