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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