Clinician Fact Sheet: Medicinal Foods
Ginger
(Zingiber officinale; Family: Zingiberaceae)Ginger is an ancient spice that has documented antiemetic effects in post-anesthesia, hyperemesis gravidarum, chemotherapy, and motion sickness. Nausea and vomiting are the most common symptoms experienced in early pregnancy; approximately 70-85% of pregnant women experience nausea and 50% experience vomiting. Ginger is most effective when taken prophylactically.
Historical Medical Use
• Orally, ginger is used for motion sickness, colic, dyspepsia, flatulence, rheumatoid arthritis, loss of appetite, post-surgical nausea and vomiting, and discontinuing serotonin reuptake inhibitor drug therapy.
• Topically, the fresh juice of ginger is used for treating burns.
• In Chinese medicine, ginger is used as a diaphoretic, diuretic, and stimulant, as well as to treat stomachache, diarrhea, nausea, cholera, bleeding, acute bacterial dysentery, baldness, malaria, orchitis, poisonous snake bites, rheumatism, and toothaches.
• Pharmaceutically, the oleoresin of ginger is used as an ingredient in digestive, laxative, antitussive, antiflatulent, and antacid preparations.
Formulation and Dosage
• 0.25-1 g dried root or one cup of tea tid, not to exceed 4 g/d.
• A weak ginger tincture is dosed at 1.5-3 ml; a strong ginger tincture is dosed at 0.25-0.5 ml.
• For morning sickness, 250 mg ginger qd.
• As an antiemetic, 2 g freshly powdered root is mixed with water.
• For nausea and disequilibrium resulting from serotonin reuptake inhibitor discontinuation or tapering, 550-1,100 mg ginger tid.
• For postoperative nausea and vomiting (in the absence of narcotic anesthesia or analgesia), 1 g powdered ginger root one hour before induction of anaesthesia.
Adverse Reactions
• Ginger can cause heartburn or dermatitis in sensitive individuals.
• Large overdoses can cause central nervous system depression and cardiac arrhythmias.
Contraindications
• Ginger is safe in pregnancy and lactation when ingested in typical food quantities; safety at therapeutic doses has not been demonstrated.
• Ginger should be avoided in patients with gallstones until a health care provider has determined that ginger will not aggravate symptoms.
Interactions
• Theoretically, excessive amounts of ginger may increase the effects of anticoagulant and antiplatelet drugs and the risk of bleeding.
• Although never reported or observed, theoretically there also exists an increased risk of bleeding in some people using ginger concomitantly with herbs that have anticoagulant/antiplatelet potential. These herbs include: capsicum, danshen, feverfew, garlic, ginkgo, ginseng (Panax sp.).
• Because of theoretical claims that ginger rhizome increases stomach acid, ginger may interfere with acid-inhibiting drugs.
• Theoretically, ginger may increase the effects of barbiturates.
• Theoretically, ginger may potentiate the effects of antihypertensive drugs.
• Theoretically, cyclophosphamide-induced vomiting might be prevented by prior administration of the ginger constituent 6-gingerol or an acetone ginger extract.
• Theoretically, the inotropic effects of ginger may interfere with cardiac drug therapy (animal data).
• Theoretically, concomitant use of ginger might increase effects and adverse effects of hypoglycemic drugs; therefore, adjustments to insulin dosages may be necessary.
• Case reports suggest that ginger might be effective for treating nausea and dizziness associated with the discontinuation or tapering of sertraline and other serotonin reuptake inhibitors.
Clinical Research
A recent review of nausea and vomiting interventions in early pregnancy appeared in the Cochrane Database Systematic Reviews.1 Twenty-six trials were included and reviewed independently by two reviewers; trial quality was variable. Treatments included anti-histamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox® (Bendectin®), and P6 acupressure. Two trials were identified using treatments with ginger root and ACTH (adrenocorticotropic hormone) injections. The reviewers concluded that antiemetic medications reduced the frequency of nausea in early pregnancy (odds ratio 0.17, 95% confidence interval 0.13 to 0.21). There was some evidence of adverse effects, but little information on effects on fetal outcomes. The analysis of pyridoxine trials suggested it is more effective in reducing the severity of nausea. The results of the trial using adrenocorticotropic hormone to treat hyperemesis gravidarum showed no evidence of benefit. Although the studies of ginger implied possible benefit, the evidence was too weak to be conclusive.
Other studies of ginger have moved beyond testing its ability to reduce nausea and vomiting. A randomized controlled trial of 12 healthy volunteers examined ginger’s effect (100 mg bid) on postprandial gastroduodenal motility.2 Study results showed improved gastroduodenal motility in the fasting state and after a standard meal test.
A randomized, placebo-controlled, crossover study compared ginger extract and ibuprofen in the treatment of osteoarthritis of the hip or knee.3 A one-week wash-out period was followed by three treatment regimens (ginger, ibuprofen, and placebo), each of three week’s duration and in a randomized sequence. No serious adverse events were reported. In the first treatment phase, ginger extract and ibuprofen both proved superior to placebo; however, ginger extract was not significantly different from placebo in the crossover segment or in the study as a whole.
References
1. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2000;2:CD000145.
2. Micklefield GH, et al. Effects of ginger on gastroduodenal motility. Int J Clin Pharmacol Ther 1999;
37:341-346.
3. Bliddal H, et al. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage 2000;8:9-12.
Additional Resources
Alternative Medicine Alert. Atlanta, GA: American Health Consultants; 1998;1:1-144; 1999;2:1-144.
McGuffin M, et al. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press; 1997.
McDermott JH. Herbal Chart for Health Care Professionals. American Pharmaceutical Association; 1999.
Natural Medicines Comprehensive Database. Stockton, CA: Therapeutic Research Center, Inc.
PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co.; 1998.
Schulz V, et al. Rational Phytotherapy. 3rd ed. Berlin: Springer-Verlag; 1998.
The Review of Natural Products. St. Louis, MO: Facts and Comparisons.
Foster S, Tyler VE. Tyler’s Honest Herbal. 4th ed. Binghamton, NY: The Haworth Herbal Press; 1999.
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