Ginger

• How It Works

  Studies on ginger for nausea and vomiting are generally positive, but there are instances in which it may not be effective or should be avoided.

  Ginger root contains compounds that may help relieve or prevent nausea and vomiting. These substances can increase the flow of saliva and digestive juices and may also help calm the stomach and intestines. Some studies have found ginger may help nausea caused by chemotherapy, but larger studies are needed to confirm these effects.

  Eating fresh ginger in high doses can have blood-thinning effects by preventing platelets from sticking together. Laboratory studies suggest that ginger can protect brain cells from the plaques that cause Alzheimer’s disease, but this effect has not been studied in humans.

• Purported Uses
  • To stimulate appetite
    Ginger is known to stimulate saliva flow and digestive secretions, but clinical trials are lacking.
  • To relieve indigestion
    Compounds in ginger are known to stimulate saliva flow and digestive juices, reduce gas, and calm the digestive system, but human data are lacking.
  • To treat diarrhea
    Compounds in ginger are known to calm the digestive system, but scientific evidence is lacking.
  • To treat nausea and vomiting
    Several clinical trials support the short-term use of ginger for chemotherapy-associated nausea and vomiting and motion sickness. However, because of blood-thinning effects, ginger supplements should not be used around the time of surgery. It is also not suggested for use during pregnancy because of possible unknown risks to the developing embryo.
  • To treat rheumatoid arthritis and osteoarthritis
    A few studies have been conducted with positive results, but more research is needed.
  • To treat respiratory ailments
    Certain compounds in ginger may improve inflammation and protect against certain viruses, but human studies are lacking.
  • To treat drug withdrawal symptoms
    A small animal study suggests that ginger may help ease withdrawal symptoms from drugs like morphine. However, studies in humans are lacking.
• Patient Warnings
  • Due to its blood-thinning effects, ginger supplements should be stopped 2 weeks before surgery, and should not be used immediately after surgery to control nausea or vomiting. Other types of medications given by your healthcare provider can be used to control these symptoms.
  • Ginger supplements should be avoided in patients with bleeding disorders.
  • Ginger supplements should be avoided during pregnancy or lactation.
  • Ginger supplements should be avoided by individuals with gallstones.
• Do Not Take If
  • You are taking warfarin or other blood thinners: Ginger supplements may increase the risk of bleeding.
  • You are taking NSAIDs, nonsteroidal anti-inflammatory drugs: Ginger supplements may increase bleeding tendency when used with these drugs.
  • You are taking insulin or medication to lower blood glucose: Ginger supplements may cause larger reductions in glucose levels.
  • You are taking tacrolimus: Ginger supplements increase the blood levels of this drug and may increase side effects.
  • You have a bleeding disorder: Ginger supplements may increase bleeding time.
  • You have gallstones: Ginger supplements may increase the flow of bile.
  • You are having surgery: Ginger supplements may increase bleeding risk.
  • You are pregnant or lactating: The effect of ginger supplements on the human gestational development are unknown.
• Side Effects
  • Heartburn
  • Skin irritation, swelling, and redness

  Case Report

  • Nosebleed, slow blood clotting: In a 76-year-old woman on long-term blood-thinning therapy who took ginger products. Clotting returned to normal after discontinuing ginger and with vitamin K administration.
• Scientific Name

  Zingiber officinale, Zingiberis rhizoma

• Clinical Summary

  Derived from the rhizome of the plant, ginger is native to Asia and is used both as food and as medicine. In traditional Chinese medicine, ginger is used to expel “cold”, “wind” and “dampness”, and is believed to stop the reverse flow of Qi (energy) ⁽¹⁾. Western use has been primarily for gastrointestinal symptoms and respiratory ailments.

  In vitro and animal studies suggest that ginger has antiemetic ⁽²⁾, anticancer ^{(3) (4) (5) (6)}, anti-inflammatory ^{(6) (7) (8)}, anti-drug-dependence ⁽⁹⁾, and hypoglycemic effects ⁽⁷⁾. It may also protect against Alzheimer’s disease ^{(10) (11) (12)}. Ginger influences gastric emptying in healthy individuals ⁽¹³⁾ and may promote feelings of satiety ⁽¹⁴⁾. Systematic reviews suggest its effectiveness for treating dysmenorrhea ⁽⁵⁵⁾ and moderate efficacy against osteoarthritic and chronic low back pain ^(15) (16).

  Although clinical trials indicate that ginger can reduce nausea and vomiting, ^{(17) (18) (19) (20)} it should be avoided perioperatively due to its anticoagulant/antiplatelet effects ^{(21) (22) (23) (24) (25) (26)}, and during pregnancy since animal studies highlight concerns regarding embryo development ^(26) (27). Dietary ginger seems to be without these effects ^{(28) (29) (30)}, although some studies suggest that high concentrations of fresh ginger have both antiplatelet ⁽³¹⁾ and antiviral ⁽³²⁾ potential.

  The evidence for ginger in prevention of chemotherapy-induced nausea and vomiting (CINV) is generally positive ^{(33) (34) (35) (36)}, although a systemic review of randomized controlled (RCTs) or crossover trials was unable to draw any conclusions ⁽³⁷⁾. Another study suggests adjuvant ginger supplementation may improve CIN-related quality of life and cancer-related fatigue ⁽⁵⁸⁾. 6-gingerol, a ginger compound, also improved overall CINV, appetite, and quality of life ⁽⁵⁹⁾. However other studies did not show benefit with ginger adjunctive to CINV prophylaxis ⁽⁶⁰⁾ or in patients receiving high-dose cisplatin, except for female and head and neck cancer subgroups ⁽⁶¹⁾.

  Ginger aromatherapy was ineffective in relieving CINV, but improved quality of life ⁽⁵⁶⁾. Another pilot study suggests that ginger supplementation may have chemopreventive effects for those at increased risk for colon cancer with normal-appearing colonic mucosa ⁽³⁸⁾. More and larger studies are needed to confirm any true benefit with ginger supplementation for symptom control or chemoprevention.

• Purported Uses
  • Diarrhea
  • Drug withdrawal symptoms
  • Gas and indigestion
  • Motion sickness
  • Nausea and vomiting
  • Respiratory ailments
  • Rheumatoid arthritis
• Mechanism of Action

  The antiemetic action of ginger is attributed to the rhizome constituents shogaol and gingerol, which stimulate the flow of saliva, bile, and gastric secretions, and galanolactone, which can act as a competitive antagonist at serotonin 5-HT3 receptors ^(2) (22). Additional activities include the stimulation of antral contractions, reduction of postprandial antral area, and acceleration of gastric emptying ⁽¹³⁾. Ginger inhibits thromboxane formation and platelet aggregation ⁽⁴³⁾. However, these effects appear to be dose- and formulation-dependent (eg, dried, fresh, or extract) ⁽³¹⁾.

  In vitro studies suggest that fresh ginger stimulates mucosal cells to secrete IFN-β to combat viral infection ⁽³²⁾, while certain ginger preparations reduced lipopolysaccharide-induced secretion of IL-8 in human bronchial epithelial cells ⁽⁸⁾ and inhibited human telomerase reverse transcriptase (hTERT) and c-Myc expression in human lung cancer cells ⁽⁴⁴⁾.

  Gingerol induces apoptosis of gastric cancer cells through TRAIL-dependent caspase 3/7 activation ⁽³⁾ and inhibits cell-cycle progression by reducing cyclin D1 expression ⁽⁴⁾. It also inhibits secretion of angiogenic cytokines such as VEGF and IL-8 in ovarian cancer cells ⁽⁵⁾. In animal models, shogaol reduces in vivo tumor growth by damaging microtubules and inducing mitotic arrest ⁽³⁾. Increased levels of circulating antioxidant and phase II enzymes, and reduced lipid peroxidation levels are also mechanisms by which ginger protects against DMH-induced colon cancers ⁽⁴⁵⁾.

• Contraindications
  • Ginger supplements should not be used in the perioperative setting due to the potential risk for increased bleeding ^(21) (24). This is in line with a general caution to avoid herbs that have antiplatelet and anticoagulation properties due to perioperative bleeding concerns, although a systematic review found inconclusive evidence. Further study is warranted ⁽⁵⁷⁾.
  • Likewise, ginger supplements should be avoided in patients with bleeding disorders ⁽⁴⁶⁾.
  • Ginger supplements should be avoided during pregnancy or lactation due to lack of data on human fetal outcomes and concerns regarding embryo development in animal studies ^(27) (47). The German Commission E also contraindicates ginger for morning sickness during pregnancy ⁽⁴⁸⁾.
  • Individuals with gallstones should avoid ginger supplements due to potential cholagogic effects ⁽⁴⁹⁾.
• Adverse Reactions

  Common: Heartburn and dermatitis ⁽³⁶⁾ .

  Case Report
  Overanticoagulation: A 76-year-old woman on long-term phenprocoumon therapy developed an elevated international normalized ratio (INR) and epistaxis following use of ginger products. INR returned to normal range after discontinuing ginger along with administration of vitamin K ⁽⁵⁰⁾.

• Herb-Drug Interactions
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Ginger may increase bleeding tendency with concomitant use of drugs such as diclofenac or ibuprofen ⁽²⁶⁾.
  • Anticoagulants / Antiplatelets: Because ginger can inhibit thromboxane formation and platelet aggregation, concomitant use with anticoagulants may increase the risk of bleeding ⁽⁵¹⁾, although a systematic review determined that current evidence is inconclusive. Further study is warranted ⁽⁵⁷⁾.
  • Hypoglycemics / Insulin: Ginger may cause additive reductions in blood glucose ⁽⁷⁾.
  • Tacrolimus: Pretreatment with ginger increases the plasma levels of tacrolimus ⁽⁵²⁾.
  • Cyclosporine: Concomitant use with ginger resulted in decreased blood concentrations of cyclosporine in vivo ⁽⁵⁴⁾.
• References

  1. Wang W, Li CY, Wen XD, et al. Simultaneous determination of 6-gingerol, 8-gingerol, 10-gingerol and 6-shogaol in rat plasma by liquid chromatography-mass spectrometry: Application to pharmacokinetics. J Chromatogr B Analyt Technol Biomed Life Sci. Mar 15 2009;877(8-9):671-679.

  2. Lumb AB. Mechanism of antiemetic effect of ginger. Anaesthesia. Dec 1993;48(12):1118.

  3. Ishiguro K, Ando T, Maeda O, et al. Ginger ingredients reduce viability of gastric cancer cells via distinct mechanisms. Biochem Biophys Res Commun. Oct 12 2007;362(1):218-223.

  4. Lee SH, Cekanova M, Baek SJ. Multiple mechanisms are involved in 6-gingerol-induced cell growth arrest and apoptosis in human colorectal cancer cells. Mol Carcinog. Mar 2008;47(3):197-208.

  5. Rhode J, Fogoros S, Zick S, et al. Ginger inhibits cell growth and modulates angiogenic factors in ovarian cancer cells. BMC Complement Altern Med. 2007;7:44.

  6. Plengsuriyakarn T, Viyanant V, Eursitthichai V, et al. Anticancer activities against cholangiocarcinoma, toxicity and pharmacological activities of Thai medicinal plants in animal models. BMC Complement Altern Med. 2012;12:23.

  7. Ojewole JA. Analgesic, antiinflammatory and hypoglycaemic effects of ethanol extract of Zingiber officinale (Roscoe) rhizomes (Zingiberaceae) in mice and rats. Phytother Res. Sep 2006;20(9):764-772.

  8. Podlogar JA, Verspohl EJ. Antiinflammatory effects of ginger and some of its components in human bronchial epithelial (BEAS-2B) cells. Phytother Res. Mar 2012;26(3):333-336.

  9. Darvishzadeh-Mahani F, Esmaeili-Mahani S, Komeili G, et al. Ginger (Zingiber officinale Roscoe) prevents the development of morphine analgesic tolerance and physical dependence in rats. J Ethnopharmacol. Jun 14 2012;141(3):901-907.

  10. Zeng GF, Zhang ZY, Lu L, et al. Protective effects of ginger root extract on Alzheimer disease-induced behavioral dysfunction in rats. Rejuvenation Res. Apr 2013;16(2):124-133.

  11. Oboh G, Ademiluyi AO, Akinyemi AJ. Inhibition of acetylcholinesterase activities and some pro-oxidant induced lipid peroxidation in rat brain by two varieties of ginger (Zingiber officinale). Exp Toxicol Pathol. May 2012;64(4):315-319.

  12. 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. Apr 2002;68(4):375-376.

  13. Wu KL, Rayner CK, Chuah SK, et al. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol. May 2008;20(5):436-440.

  14. Mansour MS, Ni YM, Roberts AL, et al. Ginger consumption enhances the thermic effect of food and promotes feelings of satiety without affecting metabolic and hormonal parameters in overweight men: a pilot study. Metabolism. Oct 2012;61(10):1347-1352.

  15. Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. Jul 2007;21(7):675-683.

  16. Terry R, Posadzki P, Watson LK, et al. The use of ginger (Zingiber officinale) for the treatment of pain: a systematic review of clinical trials. Pain Med. Dec 2011;12(12):1808-1818.

  17. Smith C, Crowther C, Willson K, et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol. Apr 2004;103(4):639-645.

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

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

  20. Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (ginger)—an antiemetic for day case surgery. Anaesthesia. Aug 1993;48(8):715-717.

  21. Kleinschmidt S, Rump G, Kotter J. [Herbal medications. Possible importance for anaesthesia and intensive care medicine]. Anaesthesist. Dec 2007;56(12):1257-1266.

  22. Cheng B, Hung CT, Chiu W. Herbal medicine and anaesthesia. Hong Kong Med J. Apr 2002;8(2):123-130.

  23. Ciocon JO, Ciocon DG, Galindo DJ. Dietary supplements in primary care. Botanicals can affect surgical outcomes and follow-up. Geriatrics. Sep 2004;59(9):20-24.

  24. Backon J. Ginger as an antiemetic: possible side effects due to its thromboxane synthetase activity. Anaesthesia. Aug 1991;46(8):705-706.

  25. Larkin M. Surgery patients at risk for herb-anaesthesia interactions. Lancet. Oct 16 1999;354(9187):1362.

  26. Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia. Sep 2002;57(9):889-899.

  27. Marcus DM, Snodgrass WR. Do no harm: avoidance of herbal medicines during pregnancy. Obstet Gynecol. May 2005;105(5 Pt 1):1119-1122.

  28. Janssen PL, Meyboom S, van Staveren WA, et al. Consumption of ginger (Zingiber officinale roscoe) does not affect ex vivo platelet thromboxane production in humans. Eur J Clin Nutr. Nov 1996;50(11):772-774.

  29. Lee A, Chui PT, Aun CS, et al. Incidence and risk of adverse perioperative events among surgical patients taking traditional Chinese herbal medicines. Anesthesiology. Sep 2006;105(3):454-461.

  30. Phang M, Lazarus S, Wood LG, et al. Diet and thrombosis risk: nutrients for prevention of thrombotic disease. Semin Thromb Hemost. Apr 2011;37(3):199-208.

  31. Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost. Jan 1994;71(1):110-111.

  32. Chang JS, Wang KC, Yeh CF, et al. Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines. J Ethnopharmacol. Jan 9 2013;145(1):146-151.

  33. Zick SM, Ruffin MT, Lee J, et al. Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting. Support Care Cancer. May 2009;17(5):563-572.

  34. Levine ME, Gillis MG, Koch SY, et al. Protein and ginger for the treatment of chemotherapy-induced delayed nausea. J Altern Complement Med. Jun 2008;14(5):545-551.

  35. Pillai AK, Sharma KK, Gupta YK, et al. Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer. Feb 2011;56(2):234-238.

  36. Ryan JL, Heckler CE, Roscoe JA, et al. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer. Jul 2012;20(7):1479-1489.

  37. Marx WM, Teleni L, McCarthy AL, et al. Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review. Nutr Rev. Apr 2013;71(4):245-254.

  38. Citronberg J, Bostick R, Ahearn T, et al. Effects of ginger supplementation on cell-cycle biomarkers in the normal-appearing colonic mucosa of patients at increased risk for colorectal cancer: results from a pilot, randomized, and controlled trial. Cancer Prev Res (Phila). Apr 2013;6(4):271-281.

  39. Yu Y, Zick S, Li X, et al. Examination of the pharmacokinetics of active ingredients of ginger in humans. AAPS J. Sep 2011;13(3):417-426.

  40. Gupta S, Pandotra P, Ram G, et al. Composition of a monoterpenoid-rich essential oil from the rhizome of Zingiber officinale from north western Himalayas. Nat Prod Commun. Jan 2011;6(1):93-96.

  41. Chrubasik S, Pittler MH, Roufogalis BD. Zingiberis rhizoma: a comprehensive review on the ginger effect and efficacy profiles. Phytomedicine. Sep 2005;12(9):684-701.

  42. Shukla Y, Singh M. Cancer preventive properties of ginger: a brief review. Food Chem Toxicol. May 2007;45(5):683-690.

  43. Srivastava KC. Isolation and effects of some ginger components of platelet aggregation and eicosanoid biosynthesis. Prostaglandins Leukot Med. Dec 1986;25(2-3):187-198.

  44. Tuntiwechapikul W, Taka T, Songsomboon C, et al. Ginger extract inhibits human telomerase reverse transcriptase and c-Myc expression in A549 lung cancer cells. J Med Food. Dec 2010;13(6):1347-1354.

  45. Manju V, Nalini N. Chemopreventive efficacy of ginger, a naturally occurring anticarcinogen during the initiation, post-initiation stages of 1,2 dimethylhydrazine-induced colon cancer. Clin Chim Acta. Aug 2005;358(1-2):60-67.

  46. Silva BM, Hosman AE, Devlin HL, et al. Lifestyle and dietary influences on nosebleed severity in hereditary hemorrhagic telangiectasia. Laryngoscope. May 2013;123(5):1092-1099.

  47. Wilkinson JM. Effect of ginger tea on the fetal development of Sprague-Dawley rats. Reprod Toxicol. Nov-Dec 2000;14(6):507-512.

  48. Blumenthal M, Busse W (eds.) German Commission E Monographs: Therapeutic Monographs on Medicinal Plants for Human Use. Austin, TX: American Botanical Council. 1997.

  49. Yamahara J, Miki K, Chisaka T, et al. Cholagogic effect of ginger and its active constituents. J Ethnopharmacol. May 1985;13(2):217-225.

  50. Kruth P, Brosi E, Fux R, et al. Ginger-associated overanticoagulation by phenprocoumon. Ann Pharmacother. Feb 2004;38(2):257-260.

  51. Shalansky S, Lynd L, Richardson K, et al. Risk of warfarin-related bleeding events and supratherapeutic international normalized ratios associated with complementary and alternative medicine: a longitudinal analysis. Pharmacotherapy. Sep 2007;27(9):1237-1247.

  52. Egashira K, Sasaki H, Higuchi S, et al. Food-drug interaction of tacrolimus with pomelo, ginger, and turmeric juice in rats. Drug Metab Pharmacokinet. 2012;27(2):242-247.

  53. 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. Mar 2003;284(3):G481-489.

  54. Colombo D, Lunardon L, Bellia G. Cyclosporine and herbal supplement interactions. J Toxicol. 2014;2014:145325.

  55. Daily JW, Zhang X, Kim da S, Park S. Efficacy of Ginger for Alleviating the Symptoms of Primary Dysmenorrhea: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Pain Med. 2015 Dec;16(12):2243-55.

  56. Lua PL, Salihah N, Mazlan N. Effects of inhaled ginger aromatherapy on chemotherapy-induced nausea and vomiting and health-related quality of life in women with breast cancer. Complement Ther Med. 2015 Jun;23(3):396-404.

  57. Marx W, McKavanagh D, McCarthy AL, et al. The Effect of Ginger (Zingiber officinale) on Platelet Aggregation: A Systematic Literature Review. PLoS One. 2015 Oct 21;10(10):e0141119.

  58. Marx W, McCarthy AL, Ried K, et al. The Effect of a Standardized Ginger Extract on Chemotherapy-Induced Nausea-Related Quality of Life in Patients Undergoing Moderately or Highly Emetogenic Chemotherapy: A Double Blind, Randomized, Placebo Controlled Trial. Nutrients. Aug 12 2017;9(8).

  59. Konmun J, Danwilai K, Ngamphaiboon N, et al. A phase II randomized double-blind placebo-controlled study of 6-gingerol as an anti-emetic in solid tumor patients receiving moderately to highly emetogenic chemotherapy. Med Oncol. Apr 2017;34(4):69.

  60. Thamlikitkul L, Srimuninnimit V, Akewanlop C, et al. Efficacy of ginger for prophylaxis of chemotherapy-induced nausea and vomiting in breast cancer patients receiving adriamycin-cyclophosphamide regimen: a randomized, double-blind, placebo-controlled, crossover study. Support Care Cancer. Feb 2017;25(2):459-464.

  61. Bossi P, Cortinovis D, Fatigoni S, et al. A randomized, double-blind, placebo-controlled, multicenter study of a ginger extract in the management of chemotherapy-induced nausea and vomiting (CINV) in patients receiving high-dose cisplatin. Ann Oncol. Oct 1 2017;28(10):2547-2551.