Ginger (Zingiber officinale Roscoe)
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| Ginger |
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- 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 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.
- African ginger, Amomum zingiber L., black ginger, bordia, chayenne ginger, cochin ginger, curcumin gan jiang, gegibre, gingembre, gingerall, ginger BP, ginger oil, ginger power BP, ginger root, ginger trips, ingwer, Jamaica ginger, kankyo, oleoresins, race ginger, rhizoma zingeberis, sheng jiang, vanillyl ketones, verma, zerzero, Zingiber capitatum , Zingiber officinale Roscoe, Zingiber zerumbet Smith, Zingiber blancoi Massk, Zingiber majus Rumph, zingerone , zingibain, Zingiberis rhizoma, Zinopin® (Pycnogenol® and standardized ginger root extract), Zintona EC.
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 evidence | Grade* |
| Nausea and vomiting of pregnancy (hyperemesis gravidarum)
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 |
| Anti-platelet agent
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 |
| Migraine
There is not enough available scientific evidence in this area.
| 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 |
| Nausea (due to chemotherapy)
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 |
| 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 |
| Osteoarthritis
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 |
| Rheumatoid arthritis
There is limited scientific evidence in this area, and it is not clear if ginger is beneficial.
| C |
| Urinary disorders (post-stroke)
It is unclear if ginger can help treat urinary disorders in patients recovering from strokes.
| C |
| Shortening labor
There is not enough available scientific evidence in this area.
| C |
| Weight loss
Ginger has been suggested as a possible weight loss aid, but more study is needed to a make a firm recommendation.
| 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;
F: Strong scientific evidence against this use.
Grading rationale
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, antibacterial, anti-inflammatory, antioxidant, antiseptic, anti-spasm, antiviral, aphrodisiac, asthma, atherosclerosis, athlete's foot, baldness, bile secretion problems, bleeding, blood circulation, blood thinner, bronchitis, burns (applied to the skin), cancer, cholera, colds, colic, coronary artery disease, cough suppressant, depression, diarrhea, digestive aid, diminished appetite, diuresis, dysmenorrhea (painful menstruation), dysentery, dyspepsia, elevated cholesterol, energy metabolism, fungal infections, flatulence (gas), flu, gallbladder disease, gonarthritis, headache, heart disease, Helicobacter pylori infection, hepatitis, high blood pressure, immune system disorders (Kawasaki disease), immune stimulation, impotence, increased drug absorption, insecticide, intestinal parasites, kidney disease, kidney toxicity, laxative, leukemia, liver disease, liver toxicity, low blood pressure, low blood sugar, malaria, neuroblastoma, orchitis (painful or swollen testes), pain relief, poisonous snake bites, promotion of menstruation, psoriasis (applied to the skin), respiratory infections, selective serotonin reuptake inhibitor discontinuation or tapering, serotonin-induced hypothermia, stimulant, stomach ache, sweating, thrombosis (traveler's thrombosis), tonic, toothache, ulcers.
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.
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 5 grams daily, by mouth, divided into smaller doses.
Children (under 18 years old)
- There is insufficient scientific evidence to recommend the use of ginger in children.
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.
- 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. Ginger is traditionally said to reduce blood sugar levels at high doses, but there is a lack of scientific evidence available. 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.
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.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. 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.
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.
- 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 or with xanthine oxidase drugs.
- Ginger may also interact with drugs taken for nausea/vomiting, arthritis, blood disorders, high cholesterol, high/low blood pressure, allergies (antihistamines), cancer, inflammation, vasodilators, or weight loss. 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 or with xanthine oxidase herbs.
- 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. 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.
- This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); E-P Barrette, MD (Case Western Reserve); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Samuel Basch, MD (Mt. Sinai Medical Center); Steve Bent, MD (University of California, San Francisco); Heather Boon, BScPhm, PhD (University of Toronto); J. Kathryn Bryan, BA (Natural Standard Research Collaboration); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Sean Dalton, MD, PhD, MPH (University of Cambridge, UK); Michael Smith, MRPharmS, ND (Canadian College of Naturopathic Medicine); Philippe Szapary, MD (University of Pennsylvania School of Medicine); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Natasha Tiffany, MD (Ohio State University); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Minney Varghese, BS (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration).
Methodology details
- Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001;44(11):2531-2538.
- Bean P. The use of alternative medicine in the treatment of hepatitis C. Am Clin Lab 2002;21(4):19-21.
- 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.
- Borrelli F, Capasso R, Aviello G, et al. Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting. Obstet Gynecol 2005 Apr;105(4):849-56.
- Bryer E. A literature review of the effectiveness of ginger in alleviating mild-to-moderate nausea and vomiting of pregnancy. J Midwifery Womens Health 2005;50(1):e1-e3.
- 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.
- Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thai 2007 Jan;90(1):15-20.
- 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.
- 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.
- Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2002;(1):CD000145.
- 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.
- Roberts AT, Martin CK, Liu Z, et al. The safety and efficacy of a dietary herbal supplement and gallic acid for weight loss. J Med Food 2007 Mar;10(1):184-8.
- 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.
- 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.
- 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.
March 01, 2008.
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This evidence-based monograph was prepared by the Natural Standard Research Collaboration. The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Talk to your health care provider before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Copyright© 2008 Natural Standard (www.naturalstandard.com). All Rights Reserved.
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