Ginger
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Zingiber officinale Roscoe
[Fam. Zingiberaceae]
Overview
Ginger has been used for millennia as a common spice, food,
and medicine; and was described in ancient Indian, Chinese, and Greco-Roman
medical texts (Langner et al., 1998).
Ginger dietary supplements have become increasingly popular in the past decade
to help allay nausea associated with motion sickness. In 2000, ginger sales
ranked 17th of all herbal supplements sold in U.S. mainstream retail stores
(Blumenthal, 2001). Ginger is frequently used as an alternative to
antihistamines and anticholinergics, and as a prophylactic for motion sickness
when side effects from pharmaceuticals warrant them unsuitable or intolerable
for use (Robbers and Tyler, 2000). Ginger has also been investigated as an
antiemetic for postoperative nausea and nausea induced by chemotherapy (Arfeen et al., 1995; Meyer et al., 1995). China and India have cultivated ginger since
antiquity and remain the world’s leading producers of ginger (Blumenthal et al., 2000; USP, 1998).
Description
Ginger preparations consist of the peeled, finger-long,
fresh or dried rhizome of Zingiber
officinale Roscoe [Fam. Zingiberaceae]
(Blumenthal et al., 2000).
Preparations include decoctions and infusions (teas), powdered ginger capsules,
liquid extracts, tinctures, and candies made from ginger syrup or crystallized
ginger (Blumenthal et al., 2000).
Some ginger products are standardized to 0.8% essential oils (McCaleb et al., 2000).
Primary Uses
Gastrointestinal
Motion sickness (Careddu et al., 1999; Riebenfeld and Borzone, 1999; Schmid et al., 1994; Grøntved et al., 1988; Grøntved and Hentzer,
1986; Mowrey and Clayson, 1982)
Other Potential Uses
Hyperemesis gravidarum (Fischer-Rasmussen et al., 1990)
Chemotherapy-induced nausea (Meyer et al., 1995)
Morning sickness (Vutyavanich et al., 2001)
Nausea, postoperative (Bone et al., 1990; Phillips et al., 1993)
Osteoarthritis (Altman and Marcussen, 2001;
Bliddal et al., 2000)
Dosage
Internal
Crude Preparations
Fresh or dried rhizome: 2–4
g daily (Blumenthal et al., 1998).
Powdered dry extract: 500
mg, 30 minutes before travel, and then 500 mg every 4 hours until end of travel
(Riebenfeld and Borzone, 1999; Tenne, 1999).
Infusion or decoction:
0.25–1.0 g in 150 ml boiled water, up to 3 times daily.
Fluid extract: 1:1
(g/ml), 0.25–1.0 ml 3 times daily
(Blumenthal et al., 1998).
Tincture: 1:5 (g/ml), 1.25–5.0 ml 3 times daily.
Duration of Administration
Internal
For motion sickness, at least 30 minutes before travel and
every 4 hours as needed (Tenne, 1999).
Chemistry
Ginger rhizome contains 4.0–10.0% oleoresin composed of
nonvolatile, pungent principles (phenols such as gingerols and their related
dehydration products, shogaols); nonpungent fats and waxes; 1.0–3.3% volatile
oils, of which 30–70% are sesquiterpenes, mainly b-bisaolene, (-)zingiberene, b-sesquiphellandrene, and (+)arcurcumene; monoterpenes,
mainly geranial and neral; 40–60% carbohydrates, mainly starch; 9–10% proteins
and free amino acids; 6–10% lipids composed of triglycerides, phosphatidic
acid, lecithins, and free fatty acids; vitamin A; niacin; and minerals (BHP,
1996).
Pharmacological Actions
Crude Preparations
Human
Antiemetic (Grøntved and Hentzer, 1986; Grøntved et al., 1988; Mowrey and Clayson, 1982;
Fischer-Rasmussen et al., 1990; Bone et al., 1990; Phillips et al., 1993; Meyer et al., 1995); antiplatelet aggregation (Bordia et al., 1997; Verma et al., 1993; Srivastava, 1989).
Animal
Antiemetic (Chang and But, 1987); reduces
chemotherapy-induced vomiting in dogs (Sharma et al., 1997); enhances bile secretion; works as an antiulcer
agent; enhances gastrointestinal motility; suppresses gastric contraction
(Yamahara et al., 1990); strengthens
cardiac muscle (Shoji et al., 1982);
inhibits cholesterol synthesis (Tanabe et
al., 1993).
In vitro
Antiplatelet aggregation (Bordia et al., 1997; Surh et al.,
1998); stimulates calcium uptake in skeletal and cardiac muscles (Kobayashi et al., 1987); antibacterial (Mascolo et al., 1989); antifungal (Endo et al., 1990); antirhinoviral (Denyer et al., 1994); anti-schistosomal
(Adewunmi et al., 1990); antioxidant
(Cao et al., 1993; Zhou and Xu, 1992); anti-atherosclerotic
(Fuhrman et al., 2000);
anti-inflammatory (Surh et al.,
1998); chemopreventative (Surh et al.,
1998).
Standardized Preparations
Human
Antiemetic (Careddu et
al., 1999; Riebenfeld et al.,
1999; Schmid et al., 1994);
anti-inflammatory (Srivastava, 1989; Bliddel et al., 2000).
Mechanism of Action
Acts directly at the gastric level and not
on the central nervous system for anti-nausea effect (Holtman et al., 1989).
Increases gastrointestinal motility, but
does not seem to influence gastric emptying rate (Philips et al., 1993; Meyer et al.,
1995).
Reduces stimuli in gastrointestinal tract
by absorbent
property, blocking nausea feedback loop between brain stem and tract (Mowrey
and Clayson, 1982).
Inhibits cyclo-oxygenase and lipo-oxygenase
pathways, inhibiting both prostaglandin and leukotriene synthesis (Verma et al., 1993; Srivastava and Mustafa,
1992; Srivastava, 1989).
Inhibits thromboxane synthetase; inhibits
conversion of arachidonic acid (AA) to thromboxane (TXA2); decreases platelet
aggregation (Bordia et al., 1997;
Verma et al., 1993; Backon, 1991).
Ginger’s effect on thromboxane synthetase activity is dose dependent, or occurs
with fresh ginger only. Up to 2 g of dried ginger is unlikely to cause platelet
dysfunction when used therapeutically (Lumb, 1994).
Inhibits prostaglandin PGE2 and leukotriene
LTB4 synthesis, producing an anti-inflammatory effect (Kiuchi et al., 1992; Srivastava and Mustafa,
1992; Srivastava, 1989).
Contraindications
According to the German Commission E, patients with
gallstones should consult a healthcare provider before use (Blumenthal et al., 1998).
Pregnancy and Lactation: A recent clinical trial reported no
adverse effects of ginger use in pregnancy (Vutyavanich et al., 2001). However, the Commission E previously contraindicated
ginger during pregnancy based on in vitro
research on single compounds from ginger (Blumenthal et al., 1998); and the American Herbal Products Association advised
against its therapeutic use during pregnancy (McGuffin et al., 1997), based in part on the Commission E contraindication,
but there is little clinical evidence to support these precautions when used in
normal doses.
Adverse Effects
None known (Blumenthal
et al., 1998).
Drug Interactions
None known (Blumenthal
et al., 1998). Reports of
interaction with warfarin are anecdotal and speculative and not substantiated
by documented case reports (Heck et al.,
2000). Nevertheless, the narrow therapeutic index of warfarin warrants the
cautious use of ginger in conjunction with warfarin. Ginger does not appear to
affect absorption of concomittant medications (Philips et al., 1993; Meyer et al.,
1995).
American Herbal Products Association (AHPA) Safety Rating
Fresh root
Class 1: Can
be safely consumed when used appropriately.
Dried root
Class 2b: Not to be used during
pregnancy based on in vitro research
and cautions from Chinese texts related to excessive use of dried ginger. See
Contraindications/Pregnancy and Lactation Section.
Class 2d:
Persons with gallstones should consult a practitioner prior to use.
Note: The
classifications and concerns for this herb are based upon therapeutic use and
may not be relevant to its consumption as a spice (McGuffin et al., 1997).
Regulatory Status
Austria:
Dried rhizome official in the Austrian
Pharmacopoeia, ÖAB (Meyer-Buchtela, 1999; Wichtl, 1997).
Australia:
Ginger is permitted as an active ingredient in listable Therapeutic Goods. High
single dose of crude ginger (2 g and above) and/or highly concentrated extracts
(25:1 or higher) are subject to required label warnings (TGA, 2000).
Belgium: Traditional Herbal Medicine (THM)
accepted for specific indication as digestive aid (Bradley, 1992).
Canada: Food, Drug, or New Drug
depending on label claim statements (HPB, 1993). When labeled as a Traditional
Herbal Medicine (THM) or as a homeopathic drug, ginger is regulated as a
non-prescription drug requiring pre-market registration and assignment of a
Drug Identification Number (DIN) (Health Canada, 1995, 2001).
China: Dried ginger, fresh
ginger, ginger tincture, and ginger fluid extract are all official preparations
of the Pharmacopoeia of the People’s
Republic of China (PPRC, 1997).
European Union: Dried rhizome official
in the European Pharmacopoeia, Third
edition, Supplement 2001 (Ph.Eur., 2001).
France: Food. No monograph in
the French Pharmacopoeia.
Germany:
Dried rhizome, for preparation as tea or other equivalent galenical dosage
forms, is an approved nonprescription drug of the German Commission E
monographs (Blumenthal et al., 1998).
Dried rhizome is official in the German
Drug Codex (DAC, 1993) and in the German
Pharmacopoeia (DAB, 1999). The dried rhizome, for preparation of alcoholic
mother tincture and liquid dilutions, is official in the German Homoeopathic Pharmacopoeia (GHP, 1993).
India: Dried rhizome official
in the Government of India Ayurvedic
Pharmacopoeia of India, First edition, volume I (API I, 1989) and fresh
rhizome official in API, First edition, volume II (API II, 1999). Dried rhizome
also occurs in the Indian Herbal
Pharmacopoeia (IHP II, 1999).
Japan: Dried rhizome and
powdered dried rhizome official in Pharmacopoeia
of Japan (JSHM, 1993).
Sweden: Classified as
foodstuff. As of January 2001, no ginger products are listed in the Medical
Products Agency (MPA) “Authorised Natural Remedies” (MPA, 2001).
Switzerland:
Dried rhizome official in the Swiss
Pharmacopoeia, Ph.Helv. (Meyer-Buchtela, 1999; Wichtl, 1997). Dried
powdered rhizome in capsule has positive classification (List D) by the Interkantonale Konstrollstelle für
Heilmittel (IKS) and corresponding sales category D with sale limited to
pharmacies and drugstores, without prescription (Morant and Ruppanner, 2001).
U.K.:
Herbal medicine on General Sale List,
Schedule 1, Table A (Bradley, 1992). Dried rhizome official in the British Pharmacopoeia, BP 1993 (ESCOP,
1996; Newall et al., 1996). Strong
Ginger Tincture and Weak Ginger Tincture official preparations of the British Pharmacopoeia (BP, 1980).
U.S.:
Generally recognized as safe (GRAS) (US FDA, 1998). Dietary supplement (USC,
1994). Dried rhizome and powdered dried rhizome official in the United States National Formulary, 19th
edition (USP, 2002).
Clinical Review
Twenty-one studies (2,669 total participants) are outlined
in the following table, “Clinical Studies on Ginger.” All but four (Bliddal et al., 2000; Janssen et al., 1996; Arfeen et al., 1995; Vislyaputra et al., 1998) demonstrated positive
effects for indications including motion sickness, postoperative nausea,
cardiovascular conditions, and osteoarthritis. Nine of the studies were
randomized, double-blind, and placebo-controlled (R, DB,PC); two of these
(Grøntved et al., 1986 and 1988)
concluded that ginger significantly reduced the incidence of motion sickness.
One study (Lumb, 1994) found that 2 g of ginger did not significantly change
bleeding time, platelet count, or platelet aggregation. Two studies
demonstrated that ginger was as effective as metoclopramide in reducing postoperative
nausea (Bone et al., 1990; Phillips et al., 1993). Two trials resulted in no
significant reduction in postoperative nausea (Vislyaputra et al., 1998; Arfeen et al.,
1995). Two studies demonstrated some effect from ginger in the treatment of
osteoarthritis (Altman and Mercussen, 2001; Bliddel et al., 2000). Three R, DB, comparison (Cm) trials (1,577
participants), found that Zintona® (standardized ginger preparation)
was equally or more effective than dimenhydrinate (Dramamine®), with
better tolerability and fewer side effects as a prophylaxis for motion sickness
(Careddu et al., 1999; Riebenfeld and
Borzone, 1999; Schmid et al., 1994).
One R, DB, crossover trial (Fischer-Rasmussen et al., 1990) found ginger diminished or eliminated symptoms of
hyperemesis gravidarum, a severe form of morning sickness during pregnancy; and
a recent R, DB, PC trial showed that ginger reduced nausea in pregnant women
during the first trimester with no adverse effects on birth rates or newborns
(Vutyavanich et al., 2001). An early
R, PC, single-blind, Cm study (Mowrey and Clayson, 1982) showed ginger to be
superior to both placebo and dimenhydrinate in preventing motion sickness in
patients with nausea induced in a tilted, rotating chair. A recent
meta-analysis of six R, DB, PC studies concluded that ginger is a “promising
antiemetic herbal remedy, but the clinical data to date are insufficient to
draw firm conclusions” (Ernst and Pittler, 2000).
Branded Products*
Blackmores custom powdered ginger capsules: Blackmores Ltd.
/ 23 Roseberry Street / Balgowlah / NSW 2093 / Australia / Tel: +61-29-95-1011-1
/ Fax: +61-29-94-9195-4 / www.blackmores.com. Capsules contain 500 mg of ginger
powder BP 1988 custom made according to standards of the British Pharmacopoeia of 1988.
EV. EXT 33: Ferrosan A/S / Sydmarken 5 / 2860 Soeborg /
Denmark / Tel: +45-3969-2111 / Fax: +45-3969-6518 / www.ferrosan.com. Chinese
ginger standardized to hydroxy-methoxy phenyl compounds (HMP) formulated in
soft gelatin capsules.
EV. EXT 77: Ferrosan A/S. Each capsule contains 255 mg
extract from 2,500–4,000 mg dried ginger rhizomes and 500–1,500 mg dried
galanga [Alpinia galanga] rhizomes.
Martindale powdered ginger capsules: Martindale
Pharmaceuticals Pty. Ltd. / Hubert Road / Brentwood / Essex / CM14 4LZ / U.K. /
Tel: +44-01-27-72-6660-0 / Fax: +44-01-27-78-4897-6 / Email: mail@martindalepharma.co.uk /
www.martindalepharma.co.uk. Capsules contain 500 mg powdered ginger rhizome.
Zintona®: Dalidar Pharma c/o BioDar Ltd. / Yavne
Technology Park / P.O. Box 344 / Yavne 81103 / Israel / Tel: +972-08-942-0930 /
Fax: +972-08-942-0928 / Email: dalidar@dalidar.com / www.dalidar.com. Ginger
powder standardized to min. 1.4% volatile oils and min. 2.0 mg gingerols and
shogaols in a capsule containing 250 ginger material. (As per 7th Supplement,
USP-NF 18).
*American equivalents, if any, are found in the Product
Table beginning on page 398.
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