Health Benefits of Ginger Extract

Ginger (Zingiber officinale Roscoe) is widely used as a spice throughout the world. It has been a component of herbal medicines for colds, constipation, insomnia, and relief from flatulence, etc. in traditional Thai medicine. In other traditions such as Indian and Chinese medicine, ginger has been used for several disorders such as nausea and arthritis ^[1].

Many constituents are abundant in ginger, including as phenolic compounds, lipids, organic acids, polysaccharides, and terpenes. The main functional substances of ginger are phenolic compounds such as gingerols and shogaols ^[2].

 

THE BENEFITS OF GINGER EXTRACT

Effect on Symptoms of Functional Dyspepsia and Gastric Motility

Functional dyspepsia (FD) is manifested by different gastrointestinal symptoms like gastric fullness, early satiety, nausea and vomiting, belching, bloating, heartburn and epigastric pain. It was previously known as non-ulcer dyspepsia or idiopathic dyspepsia. Although the exact etiology of FD is unknown, a number of factors, including stomach hypersensitivity, gastrointestinal motor abnormalities, psychosocial factors, and Helicobacter pylori (H. pylori) infection, are known to be significant ^[3].

According to study results, H. pylori was significantly eradicated by using ginger supplements. The many phenolic chemicals found in ginger rhizome, such as gingerol, shogaol, and zingerone, as well as phenolic acids like gallic and cinnamic acid, appear to have anti-
H. pylori activity. The findings of Siddaraju and Dharmesh showed that, in vitro, the ginger free phenolic fraction was less effective than the hydrolyzed phenolic fraction in inhibiting the growth of H. pylori ^[3].

A clinical trial (Giacosa, Morazzoni, et al., 2015) investigated the effects of ginger extract (100 mg, corresponding to 2 g of rhizome twice a day) on gastrointestinal motility and showed a significant increase in gastrointestinal motility in the intervention group in comparison with the placebo (Micklefield et al., 1999). Wu et al. (2008) demonstrated that in healthy individuals, ginger increases antral contractions and accelerates gastric emptying; similar effects have been observed in patients with functional dyspepsia, with no change in fundus dimension, gastrointestinal symptoms, or serum levels of gut peptides like ghrelin, motilin, and GLP-1 ^[4].

The effects of taking a ginger supplement on the bloating and cramping symptoms of FD have been the subject of numerous studies. According to a 2015 randomized controlled trial (RCT), Ginger supplementation significantly reduced symptoms of FD, including upper abdomen cramps and bloating, when compared to a placebo. Another RCT published in 2016 found that ginger supplementation was associated with a statistically significant reduction in FD symptoms compared to a placebo ^[5].

The ginger extract seems to have the gastro-protective and anti-H. pylori effect through some mechanisms including 1) antimicrobial effect by anti-adhesive effect and also suppression of bacterial enzymes and bacterial growth; 2) inhibiting gastric acid secretion through blocking H⁺, K⁺– ATPase pomp; 3) gastro-protective effect by increased mucin secretion; 4) anti-oxidative and anti-inflammatory effects which prevent H. pylori-induced acute and chronic inflammation ^[3].

Effect on Nausea and Vomiting of Pregnancy

The term “morning sickness” is often used to describe nausea and vomiting of pregnancy (NVP), which affects 80 – 90% of pregnancy to varied degrees and can happen at any time of day or night. Most of these women will experience both nausea and vomiting, and some only nausea without vomiting or retching, but vomiting alone is rare. Typically, symptoms begin between weeks 4 and 9, peak between weeks 7 and 12, and fade by week 16. The symptoms of 15 – 30% of pregnant women will last longer than 20 weeks or maybe until the baby is delivered. The exact cause of NVP remains unclear, and is probably multifactorial. Theories include the rapid increase in hormones such as estrogen and human chorionic gonadotropin (hCG), or H. pylori infection, as well as psychological and genetic predisposition ^[6].

Ginger is a popular herbal that is currently used to treat a variety of conditions, the most prevalent ones being motion sickness, nausea, vomiting, morning sickness related to pregnancy, and indigestion ^[6]. It is known that ginger reduces nausea and vomiting due to the inhibitory effects of gingerols or shogaols against 5-Hydroxytryptamine type 3 (5-HT₃) receptors. Gingerols and shogaols are presumed to have antiemetic effects by binding to the serotonin binding site through acting on the 5-HT₃ receptor ion-channel complex ^[2].

CINAHL, the Cochrane library, MEDLINE, and TRIP were the sources of four RCTs from 2013 regarding the use of ginger for pregnancy-induced nausea and vomiting. Oral ginger administration was found to be considerably more efficacious than placebo in lowering the frequency of vomiting and intensity of nausea in all of the trials. The majority of adverse events were minor and uncommon ^[7].

In 2014, ginger versus placebo was assessed in seven of the included studies. According to the results of each of the seven individual studies, ginger was superior to the placebo at reducing the severity of nausea or NVP in general. This theory is also supported by the possible physiological mechanism by which ginger affects the digestive system. Ginger can increase gastric contractility, speeding up gastric emptying, and therefore increasing the gastro-intestinal transit time of meals, which can decrease the feeling of nausea ^[6].

Despite the existence of considerable literature on the topic, there are currently no precise recommendations for the use of ginger in the treatment of NVP. The most recent data on potential benefits or risks of using ginger in clinical practice to treat NVP can be found through a systematic review of the literature that is currently accessible, with an emphasis on safety issues ^[6]. As a result, the most compelling research to date points to ginger as a safe and effective treatment for NVP. However, there is a lot of unknown about the maximum safe dosage of ginger, the appropriate duration of treatment, the effects of overdosing, and possible interactions between drugs and herbs. These are all crucial topics for additional research ^[7].

Effect on Chemotherapy-Induced Nausea and Vomiting

The majority of chemotherapy patients (88%) reported experiencing one or more side effects; fatigue accounted for 80% of side symptoms, with nausea and vomiting (48%) and pain (48%) following closely behind. In particular, nausea and vomiting require specific attention since they can worsen the patient’s quality of life, negatively affect food intake, and increase the risk of malnutrition during treatment. Meta-analysis studies showed that acute vomiting due to chemotherapy was 60% less likely in patients who took at least 1 g of ginger supplements daily for three days or longer ^[2]. In another study, ginger was tested against acute and delayed forms of chemotherapy-induced nausea and vomiting (CINV) in a population whose primary diagnosis was advanced breast cancer as the main malignancy. In this study, randomized, open-label clinical trial, 100 women with advanced breast cancer who had previously been given standard chemotherapy were randomly assigned to receive either standard antiemetic regimen (granisetron plus dexamethasone) plus ginger (1.5 g/d in 3 divided doses every 8 hours) or standard antiemetic regimen alone (control group). The duration of treatment with ginger was limited to 4 days from the initiation of chemotherapy. In the six to twenty-four hours following treatment, the ginger group experienced a significantly reduced frequency of nausea. In spite of this outcome, ginger (1.5 g/d) did not show any significant additional benefits in terms of the prevalence or severity of nausea, vomiting, or retching throughout any of the evaluated periods ^[7].

Acute CINV is associated with 5-HT in the central and gastrointestinal system, peaking 5 – 6 hours post-chemotherapy. Several mechanisms of the effect of ginger against CINV are proposed with the interactions of neurotransmitters in the central and peripheral, such as 5-hydroxytryptamine (5-HT), substance P (SP), and dopamine (DA), and the modulation of gastrointestinal motility. The intestinal EC cells are responsible for producing the majority of the monoamine neurotransmitter 5-HT. Chemotherapy causes nausea or vomiting by stimulating the release of 5-HT from EC cells, which in turn activates the 5-HT₃ receptor. Gingerols and its ingredients, especially 6-shogaol, significantly mitigate CINV by reducing 5-HT and blocking 5-HT₃ receptor expression ^[2].

Effect on Allergic Rhinitis

From epidemiological studies, the worldwide incidents of allergic rhinitis (AR) continue to increase. There are 400 million AR sufferers worldwide, according to estimates from the World Health Organization. AR results from specific IgE-mediated allergic reactions in the nasal mucosa and is characterized by a nasal congestion, nasal itching, watery nasal discharge or runny nose, and sneezing. Allergic inflammation process is divided into two phases as follows; sensitization phase which is process of IgE production after exposure to the allergen and clinical phase where many symptoms appear during exposure to allergens. The clinical phase is divided into an early phase response that includes degranulation of mast cells such as histamine, leukotriene C₄ (LTC₄), prostaglandin D₂ (PGD₂), the production of cytokines such as interleukin (IL)-3, IL-4, IL-5, and IL-13, as well as tumor necrosis factor-alpha (TNF-a). In late-phase response, which is associated with an increase in inflammatory cells in the nasal mucosa and increased secretion of cytokines results in recurrent symptoms. AR is an allergic-inflammatory disease of the nasal airway that results in discomfort, a decline in quality of life, and chronic symptoms that vary in intensity over time. Therefore, it’s critical to start treating symptoms as soon as possible by reducing inflammation ^[1].

The goal of AR management has typically been to reduce these inflammatory responses. Therefore, ginger has a tendency to target the symptoms of AR, due to its anti-inflammatory and anti-allergic properties. There is evidence to indicate that the ethanolic extract of ginger has been shown to have the highest anti-allergic efficacy by inhibiting the release of β-hexosaminidase in rat basophilic leukemia (RBL-2H₃) cells. Furthermore, two important biomarkers of anti-allergic action are 6-shogaol and 6-gingerol. In an in vivo study, oral administration of 2% ginger diet decreased the severity of nasal rubbing and sneezing by nasal sensitization of ovalbumin (OVA), repressed mast cell infiltration in the nasal mucosa, and reduced serum levels of OVA-specific IgE. Moreover, 6-gingerol (50 μM) may prevent the generation of cytokines for T cell activation and proliferation, which prevented the activation of mast cells and B cells ^[1].

 

ADVERSE EFFECTS AFTER INGESTION OF GINGER

A few moderate gastrointestinal adverse effects, like heartburn, belching, bruising or flushing, rash, and gastrointestinal discomfort, are extremely infrequent when consuming ginger ^[4].

 

DRUG-HERB INTERACTIONS

Ginger can increase the anticoagulant effect of warfarin, possibly leading to warfarin toxicity and bleeding ^[8].

Platelet aggregation may be inhibited by ginger. As a result, patients on antiplatelet medicines should use ginger cautiously to reduce their risk of bleeding ^[8].

Ginger should be used cautiously in patients who are on oral hypoglycemic medicines since it can raise the risk of hypoglycemia ^[8].

 

References

1. Yamprasert R, Chanvimalueng W, Mukkasombut N, Itharat A. Ginger extract versus Loratadine in the treatment of allergic rhinitis: a randomized controlled trial. BMC Complementary Medicine and Therapies. 2020 [Cited 2024 October 4]; 20: 1-11. Available form: https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-020-2875-z
2. Choi J, Lee J, Kim K, Choi H, Lee SA, Lee H. Effects of Ginger Intake on Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Randomized Clinical Trials. Nutrients. 2022 [Cited 2024 October 8]; 14: 1-17. Available form: https://www.mdpi.com/2072-6643/14/23/4982
3. Ebrahimzadeh V, Somi M, Asghari M, Ostadrahimi A, Moaddab S, Lotfi N. The Gastro-protective Effect of Ginger (Zingiber officinale Roscoe) in Helicobacter pylori Positive Functional Dyspepsia. Adv Pharm Bull. 2019 [Cited 2024 October 8]; 9: 321-4. Available form: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664109/
4. Nikkhah M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Science & Nutrition. 2018 [Cited 2024 October 8]; 7: 96-108. Available form: https://onlinelibrary.wiley.com/doi/10.1002/fsn3.807
5. Aregawi L, Shokrolahi M, Gebremeskel T, Zoltan C. The Effect of Ginger Supplementation on the Improvement of Dyspeptic Symptoms in Patients with Functional Dyspepsia. Cureus. 2023 [Cited 2024 October 8]; 15: 1-8. Available form: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10525921/
6. Viljoen E, Visser J, Koen N, Musekiwa A. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutrition Journal. 2014 [Cited 2024 October 8] ;13: 1-14. Available form: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-13-20
7. Giacosa A, Morazzoni P, Bombardelli E, Riva A, Bianchi Porro G, Rondanelli M. Can nausea and vomiting be treated with ginger extract? European Review for Medical and Pharmacological Sciences. 2015 [Cited 2024 October 4]; 19: 1291-6. Available form: https://www.europeanreview.org/article/8750
8. Modi M, Modi K. Ginger Root. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [Cited 2024 October 8]. Available form: https://www.ncbi.nlm.nih.gov/books/NBK565886/

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