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Ginger (Zingiber officinale Roscoe)

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Also listed as: Zingiber officinaleRoscoe
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • 6-gingerol, 6-shogaol, 8- gingerol, 8-shogaol, 10-gingerol, 10-shogaol, African ginger, alpha-curcumene, alpha-zingiberene, Amomum zingiber L., black ginger, bordia, chayenne ginger, cochin ginger, curcumene, curcumin, gan jiang, gegibre, gingembre, gingerall, ginger BP, ginger oil, ginger oleoresin, ginger power BP, ginger root, ginger trips, gingerall, gingerglycolipid A, gingerglycolipid B, gingerglycolipid C, gingerly, gingerols, ingwer, Jamaica ginger, kankyo, Myanmar ginseng, oleoresins, P. zingiberensis, race ginger, rhizoma zingeberis, sheng jiang, shogasulfonic acid, Shokyo, vanillyl ketones, verma, zerzero, Zingiber capitatum, Zingiber officinale Roscoe, Zingiber zerumbet Smith, Zingiber blancoi Massk, Zingibermajus Rumph, zingerone, zingibain, zingiberene, Zingiberis rhizoma, Zinopin® (Pycnogenol® and standardized ginger root extract), Zintona EC.
  • Combination product examples: NT (dietary herbal supplement made from ginger, rhubarb, astragalus, red sage, and turmeric, combined with gallic acid), GelStat Migraine® (combination of ginger and feverfew), Zinopin® (combination of Pycnogenol® and standardized ginger root extract), Hochu-ekki-to (combination of astragalus root, licorice (liquorice), jujube, ginseng, white Atractylodes rhizome, fresh ginger, and Chinese angelica root), Zhengchaihu Yin (combination of six traditional Chinese medicines including Chinese thorowax, orange peel, root of fangfeng, Chinese herbaceous peony, licorice root, and ginger), Keishi-ka-kei-to, a traditional Chinese herbal medicine composed of a mixture of crude extracts from five medicinal plants (Cinnamomi cortex, Paeoniae radix, Zizyphi fructus, Zingiberis rhizome, and Glycyrrhizae radix), Goshuyuto (Evodiae fructus, Zingiberis rhizoma, Zizyphi fructus, and Ginseng radix).
  • Note: Zingiber officinale Roscoe (ginger) is the official drug mentioned in various pharmacopoeias. Other Zingiber species such as Zingiber zerumbet, Zingiber cassumunar, Zingiber capitatum, Zingiber blancoi, and Zingiber majus also share some common medicinal properties and uses with Zingiber officinale but are very different species from the official ginger with different chemical constituents.

Background
  • The rhizomes 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 several clinical trials that ginger reduces the severity and duration of nausea/vomiting due to chemotherapy. Effects appear to be additive to prochlorperazine (Compazine®). The optimal dose remains unclear. Ginger's effects on other types of nausea/vomiting, 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.

Evidence Table

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. GRADE *


Early 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. Some publications discourage large doses of ginger during pregnancy due to concerns about mutations or abortions. 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


One study suggested that ginger may have a synergistic effect on anti-platelet aggregation in patients with high blood pressure when used in combination with nifedipine. More study is warranted in this area.

C


Preliminary evidence suggests that ginger-partitioned moxibustion may have benefits on decreased white blood cells due to chemotherapy. While the results are promising, the role of ginger is unclear and additional studies are needed to make a firm conclusion.

C


Based on limited study, ginger did not affect muscle pain, rating of perceived exertion (RPE), or recovery of oxygen consumption during and after moderate-intensity cycling exercise {Black, 2008, 19164834}. More well-designed trials are needed before a firm conclusion can be made.

C


Based on one open trial, the combination of Codonopsis pilosulae, Atractylodes macrocephala, Poria cocos, Glycyrrhiza uralensis, Zingiber officinale, Os sepiae, Halloysitum rubrum, and Astragalus membranaceus may benefit patients with upper digestive tract hemorrhage; however, the effects of ginger alone are not clear and additional studies are needed.

C


Ginger may lower cholesterol levels. More studies are needed before a strong conclusion can be drawn.

C


One human trial suggests that ginger may exert antiarrhythmic affects by decreasing the production of prostaglandins. Additional research is needed in this area before a firm conclusion can be made.

C


An aromatic essential oil (1% Zingiber officinale and 0.5% Citrus sinensis) combined with massage was effective in reducing knee pain. There is not enough available scientific evidence in this area for ginger alone.

C


An herbal combination prevented migraines when used during the early signs of a headache. There is not enough available scientific evidence in this area for ginger alone.

C


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


Initial human research reports that ginger may reduce the severity and length of time that cancer patients feel nauseous after chemotherapy. Other studies show no effects. 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.

C


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


Ginger has been studied as a possible treatment for osteoarthritis. However, results of these studies are mixed. More research is needed in this area.

C


Based on preliminary evidence, ginger may be as effective as mefenamic acid and ibuprofen in alleviating symptoms associated with painful menstruation; however, more well-designed trials are needed before a conclusion can be made.

C


There is limited scientific evidence in this area, and it is not clear if ginger is beneficial.

C


There is not enough available scientific evidence in this area.

C


It is unclear if ginger can help treat urinary disorders in patients recovering from strokes.

C


Ginger has been suggested as a possible weight loss aid, but more study is needed to a make a firm conclusion.

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 for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. 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. There may be other proposed uses that are not listed below.

  • Acute bacterial dysentery, alcohol withdrawal, allergies, Alzheimer's disease, analgesic, anesthesia, antacid, anthelmintic, antibacterial, anti-inflammatory, antioxidant, antiseptic, anti-spasm, antiviral, aphrodisiac, asthma, atherosclerosis (hardening of the arteries), athlete's foot, baldness, bile secretion problems, bleeding, blood circulation, blood thinner, bronchitis, burns (applied to the skin), cancer, cholera, colds, colic, constipation, coronary artery disease, cough suppressant, cramps, Crohn's disease, dementia, depression, diabetes, diarrhea, digestive aid, diminished appetite, diuresis, dysentery, dyspepsia, energy metabolism, fungal infections, flatulence (gas), flu, food flavoring, gallbladder disease, gastrointestinal motility, headache, heart disease, infection, hepatitis, high blood pressure, high blood sugar, immune system disorders (Kawasaki disease), immune stimulation, impotence, increased drug absorption, insecticide, intestinal parasites, irritable bowel syndrome, kidney disease, kidney toxicity, laxative, leukemia, liver disease, liver toxicity, low blood pressure, low blood sugar, malabsorption, malaria, menopause hot flashes, muscle aches, neuroblastoma, neurological disorders, orchitis (painful or swollen testes), pain relief, poisonous snake bites, promotion of menstruation, psoriasis (applied to the skin), radioprotection, respiratory infections, selective serotonin reuptake inhibitor discontinuation or tapering, serotonin-induced hypothermia, sexual arousal, sore throat, stimulant, stomach ulcers, stomachache, sweating, thrombosis (traveler's thrombosis), tonic, toothache, ulcerative colitis, ulcers, urinary disorders, vomiting (general), wrinkles.

Dosing

Adults (over 18 years old)

  • 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 grams. It is believed that the mild stomach upset sometimes caused by ginger may be reduced by taking ginger capsules rather than powder.
  • Many experts and publications suggest that ginger powder, tablets, or capsules or freshly cut ginger can be used in doses of 1 to 4 grams daily, by mouth, divided into smaller doses. For dysmenorrhea (painful menstruation), 250 milligrams four times daily for three days from the start of the menstrual period. For exercise recovery, 2 grams of ginger 30 minutes prior to moderate intensity cycling. For nausea and vomiting during pregnancy, 50-1,950 milligrams for up to three weeks. For motion sickness or seasickness, 1-2 grams of ginger daily. For nausea and vomiting after surgery, 0.5-1 grams of ginger one hour before surgery. For rheumatoid arthritis, 1-2 grams daily of powdered ginger..

Children (under 18 years old)

  • 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, its components, 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. There is a lack of available studies that confirm the long-term, safe 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 have been 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 ginger supplements cautiously and should avoid large amounts of freshly 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.
  • Ginger may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Use cautiously with drugs that affect the serotonin system, drugs that affect the function of the immune system, estrogen, central nervous system depressants, antiseizure medications, antibiotics, metronidazole, nifedipine, and cyclosporine.
  • In addition, ginger may theoretically prevent blood clotting by preventing the clumping of platelets. In one study, gingerol compounds and their derivatives were shown to be more potent anti-platelet agents than aspirin. 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. In one study, two of eight participants reported an intense urge to urinate 30 minutes after ingesting ginger. Ginger has also been associated with pinkeye (conjunctivitis), but this was considered a rare occurrence.
  • Large doses of ginger may result in depression of the central nervous system. Sleepiness and minor sedation has been reported in humans.

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 a lack of 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. There is controversy in this area. The use of ginger in pregnancy is cautioned against in traditional Chinese medicine (TCM). However, higher doses of ginger are generally used in Chinese medicine.

Interactions

Interactions with Drugs

  • There is evidence that ginger may increase stomach acid production. As a result, it theoretically may work against the effects of antacids, sucralfate (Carafate®), or anti-reflux medications such as H-2 blockers like ranitidine (Zantac®) or proton pump inhibitors like lansoprazole (Prevacid®). In contrast, other laboratory and animal studies report that ginger may act to protect the stomach.
  • In theory, ginger may increase the risk of bleeding when taken with blood-thinners (although clear human evidence is lacking). Some examples include aspirin, anticoagulants such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • In theory, large doses of ginger may increase the effects of medications that slow thinking or cause drowsiness, such as benzodiazepines or CNS depressants.
  • Ginger may also interfere with medications that change the contraction of the heart, including beta-blockers, digoxin, and other heart medications.
  • Because ginger can theoretically lower blood sugar levels, it may interfere with the effects of insulin or diabetes medications that are taken by mouth.
  • Ginger may interact with drugs broken down by the liver.
  • Ginger may also interact with drugs taken for nausea/vomiting, arthritis, blood disorders, cough, high cholesterol, high/low blood pressure, allergies (antihistamines), cancer, inflammation, or weight loss. Use cautiously with antibiotics, antidepressants, antifungals, antiparasitic drugs, antivirals, cyclosporine, erectile dysfunction drugs, stimulants, and estrogens. Caution is advised when taking ginger with drugs that weaken the immune system, due to a possible interaction.

Interactions with Herbs and Dietary Supplements

  • Ginger may increase stomach acid production. As a result, it theoretically may work against the effects of antacids.
  • In theory, ginger may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding (although clear human evidence is lacking). Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • In theory, ginger with large amounts of calcium may increase the risk of abnormal heart rhythms. Study results suggest that dietary phytochemicals, such as capsaicin, curcumin, and resveratrol, have inhibitory effects on P-glycoprotein and potencies to cause drug-food interactions.
  • Ginger may also theoretically lower blood sugar levels. Caution is advised when using herbs or supplements that may also affect blood sugar.
  • Ginger may interact with herbs broken down by the liver.
  • Ginger may also interact with herbs or supplements taken for nausea/vomiting, pain, arthritis, blood disorders, high cholesterol, high/low blood pressure, allergies (antihistamines), cancer, inflammation, vasodilators, or weight loss. Use cautiously with antibiotics, antidepressants, antifungals, antiparasitics, antivirals, phytoestrogens, sedatives, and stimulants. Caution is advised when taking ginger with herbs or supplements that affect the immune system, due to possible interactions. Ginger may have antioxidant properties and use with other antioxidants may result in additive effects.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Alizadeh-Navaei R, Roozbeh F, Saravi M, et al. Investigation of the effect of ginger on the lipid levels. A double blind controlled clinical trial. Saudi Med J 2008 Sep;29(9):1280-4.
  2. Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001;44(11):2531-2538.
  3. Apariman, S., Ratchanon, S., and Wiriyasirivej, B. Effectiveness of ginger for prevention of nausea and vomiting after gynecological laparoscopy. J Med Assoc.Thai. 2006;89(12):2003-2009.
  4. Bean P. The use of alternative medicine in the treatment of hepatitis C. Am Clin Lab 2002;21(4):19-21.
  5. 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.
  6. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, et al. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol 2006 Jan;194(1):95-9.
  7. Dupuis LL, Nathan PC. Options for the prevention and management of acute chemotherapy-induced nausea and vomiting in children. Paediatr Drugs 2003;5(9):597-613.
  8. Eberhart LH, Mayer R, Betz O, et al. Ginger does not prevent postoperative nausea and vomiting after laparoscopic surgery. Anesth Analg 2003;96(4):995-8, table.
  9. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2002;(1):CD000145.
  10. Mahesh R, Perumal RV, Pandi PV. Cancer chemotherapy-induced nausea and vomiting: role of mediators, development of drugs and treatment methods. Pharmazie 2005;60(2):83-96.
  11. Ozgoli, G., Goli, M., and Moattar, F. Comparison of Effects of Ginger, Mefenamic Acid, and Ibuprofen on Pain in Women with Primary Dysmenorrhea. J Altern.Complement Med 2-13-2009;
  12. Ozgoli, G., Goli, M., and Simbar, M. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern.Complement Med 2009;15(3):243-246.
  13. 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.
  14. Wigler I, Grotto I, Caspi D, et al. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 2003;11(11):783-789.
  15. Zick, S. M., Ruffin, M. T., Lee, J., Normolle, D. P., Siden, R., Alrawi, S., and Brenner, D. E. Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting. Support.Care Cancer 2009;17(5):563-572.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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