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Reviewed by Doug English

This is an up to date summary, which is largely a synopsis and simplification of a large scale review by Leslie Braun PhD, BPharm, DipAppSciNat, and Marc Cohen MBBS(hons), PhD, BMedSc(hons), FAMAC, FICAE in the 4th Edition, Volume 2 of book “Herbs and Natural Supplements: an evidence based guide” pub Elsevier 2015.

Ginger (Zingerber officinale): recommended daily consumption 2 to 5 gms dry powder or equivalent

Nutrient profile per 100g ginger:
Carbohydrate - 17.77 %
Dietary Fiber - 2 %
Protein - 1.82 %
Dietary Fiber - 2 %
Sugars - 1.7 %
Sodium - 13 mg
Vitamin B6 - 0.16 mg
Calcium - 16 mg
Iron - 0.6 mg
Vitamin C - 5 mg
Potassium - 415 mg
Magnesium - 43 mg
Phosphorus - 34 mg
Zinc - 0.34 mg
Folate - 11 mcg
Riboflavin - 0.034 mg
Niacin - 0.75 mg
Iron - 0.6 mg

Ginger is in the family Zingiberaceae, to which also belong turmeric (Curcuma longa), cardamom (Elettariacardamomum), and galangal and has long been used for gastric upsets such as nausea, pain, and inappetence. It combines well with,and has much synergy with turmeric.

Ginger contains several active components/oils including:
1. sesquiterpines: zingiberene, ar-curcumene, beta-sesquiphellandrene, beta-bisabolene.
2. Pungent phenolic compounds: gingerols, shogaols, zingerone, paradol. Zingerone and shogaols in larger amounts in dried rhizome and extracts.
3. Other like diarylheptanoids, which are same family as curcumin.

Gastrointestinal Tract: Stimulates saliva and bile flow and gastric secretions, improves appetite and intestinal motility, carminative, anti-spasmodic, improves colic, diarrhoea, and bloating. Reduces effect of gluten intolerance and modifies positively the bacterial colonisation of intestinal epithelial cells.

Antioxidant:Like turmeric,it is a highly significant eliminator of free radicals produced by normal living stress, exercise, radiation (like turmeric it protects against sunburn and other electromagnetic radiation[DE1] such as xrays), and toxins. Has a sparing effect on vitamins C and E. Protects against lipid peroxidation in liver and kidney.

Anti-inflammatory:Much effect by multiple constituents and by several different mechanisms and adds to the potent turmeric effect which operates on similar pathways – Turmeric is probably stronger but combined there is possiby an additive result.

Eg: iNOS; COX1 and 2 (reduction of inflammatory prostaglandins) with no irritant effect on gastric mucosa;selectively reduces inflammatory cytokines with no interference with essential immunity; also suppresses leukotriene synthesis which differentiates it from NSAID drugs which don’t. Modulates pathways activated in chronic inflammation in arthritis and a demonstrated significant reduction in inflammatory cytokines superior to indomethacin. Whole ginger reduces joint inflammation and cellular destruction in rheumatoid arthritis.

Anti-emetic: Several mechanisms and components. Reduces cancer radiation GIT distress due to antioxidant properties scavenging free radicals and inhibit lipid peroxidation. Stops serotonin induced diarrhoea, antispasmodic on visceral and vascular smooth muscle. Good in pregnancy morning sickness.

Anti-ulcer: Significant demonstrated inhibition of gastric lesions and protected against effects of indomethacin comparable to standard treatment with ranitidine bypowdered ginger. Rates were 100, 200 and 400 mg/kg each with similar result. [Reviewer's note: Doses equate to 7, 14 and 28 gms for 70kg human or 50, 100 or 200gms for 500 kg horse.Turmeric is also an anti-ulcer supplement and the two combined would possibly have synergy or additive effect.]

Ginger has synergy with the antibiotic clarithromycin in treating Helicobacter pylori causing inhibition of bacterial growth. It Is a potent proton pump inhibitor; binds to H+/K+-exchanging ATPase (proton pump) in gastric parietal cells, resulting in suppression of acid secretion. Exhibited six to eight-fold better potency over lansoprazole - a standard medication.

Immunomodulation:Is some degree of this with reduced delayed type hypersensitivity which assists reduction of severity of auto-immune disorders like Crohns[DE2] , psoriasis.

Glycaemic response
: Increased insulin sensitivity and levelling serum glucose level, inhibits key enzymes controlling carbohydrate metabolism and is insulinotrophic rather than hypoglycaemic. Enhances glucose uptake in skeletal muscle and other tissue.Improves insulin resistance condition.

Liver Protective: Experiment with alcohol induced liver damage proved significant hepato-protective effects comparable to silymarin. Increases glutathione, superoxide dismutase and protein levels and marked reduction of liver fibrosis. Turmeric is also a significant treatment for damaged liver and the two compounds should be used concurrently.

Kidney Protective: Ginger exhibited significant dose dependent nephroprotective role in experimentally induced acute renal damage when given as standalone treatment – 250mg/kg or 17.5 gms powder per 70 kg human.

Hypolipidaemic
Lowers:
· blood lipids
· serum cholesterol (↓LDL ↑HDL)
· fructose elevated lipids
· body weight
Ginger experimentally reduced aortic atherosclerotic lesions by 44% at 3 gms powder a day

Antiplatelet: Gingerols seem to be a new class of platelet activation inhibitors but a dose of 2 gms a day of powder had no effect on bleed time or platelet count. At very high doses greater than 10 gms powder a day care needed if on medication that is a platelet activation inhibitor. Viz:aspirin, ticlopidine, Clopidogrel, prasugrel, cilostazol, dipyridamole, anagrelide, aspirin/dipyridamole,

Antimicrobial: Enhances aminoglycoside antibiotics by increasing bacterial cell membrane permeability to them in enterococcae. Also enhances intestinal absorption of azithromycin, erythromycin, cephalexins.Anti-Schistosome, anti-nematode, antifungal and antiviral in vitro. Topical application of essential oils of ginger has activity.

Chemoprotective: Inhibitory effects demonstrated against breast, ovarian, gastric, pancreatic, colonic, prostate, liver cancers and leukemia. Induces apoptosis of cancer cells.

There are several key components for this in whole ginger or whole powder.

Antihistamine

Anti-anxiety similar effect to Valium

Positive Inotrope- is an agent that alters the force or energy of muscular contractions including heart.

Hypotensive – lowers blood pressure similar to calcium channel blockers like veramil. Turmeric also so need to monitor blood pressure.

Clinical Uses of Ginger:
· nausea and vomiting in pregnancy, car sickness, post-operative, post chemotherapy
· rheumatoid arthritis
· post exercise muscle pain – 2 gms powder
· dysmenorrhoea 250-500 mgs powder 4 times daily during menstration proved equal to 250 mg mefenamic acid or 400 mg ibuprofen
· digestive aid, appetite stimulant, saliva flow, gastric secretion
· flatulence
· Colic
· Intestinal spasms
· Migranes
· Lowering lipids and cholesterol
· Pain
· Cognition
· Diabetes – improved fasting blood sugar and insulin sensitivity
· Weight loss – increases fat utilisation and may slow fat absorption.
· Asthma
· Ulcerative colitis and IBD – found to equal sulfasalazine

Adverse Effects:
Reported intestinal irritation in some – not common, also heartburn, bloating, contact dermatitis.

Interactions
· Warfarin – theoretical risk of increased bleeding at a high ginger dose but not evident clinically and no evidence at usual intakes. No alteration of prothrombin times
· Antiplatelet drugs – caution. See previous note.
· Is fine with pregnancy