About Herbs, Botanicals & Other Products

Scientific Name
Zingiber officinale
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Common Name

Zingiberis rhizoma, ginger root, shen jiang

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Clinical Summary

Derived from the rhizome of the plant, ginger is native to Asia. It has been used as food and as medicine primarily for gastrointestinal symptoms. In vitro studies suggest that ginger has antiemetic (18), anticancer (8) (9) (10), anti-inflammatory (23), and hypoglycemic effects (23) and may protect against Alzheimer’s disease (11). The antiemetic action of ginger is attributed to its constituents, shogaol and gingerol, and their interactions with 5HT-3 receptors (18).
Clinical trials indicate that ginger can effectively reduce nausea and vomiting associated with pregnancy (3) (4), motion sickness (6) and following surgery (2). But evidence of ginger’s potential against chemotherapy-induced nausea and vomiting is mixed (20) (21) (24). More studies are warranted.
Conclusions from a systematic review suggest moderate efficacy of ginger for treating osteoarthritic and chronic low back pain (22). Ginger also influences gastric emptying in healthy individuals (7).

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Purported Uses
  • Appetite
  • Colic
  • Diarrhea
  • Drug withdrawal symptoms
  • Indigestion
  • Motion sickness
  • Nausea and vomiting
  • Promote urination
  • Rheumatoid arthritis
  • Spasms
  • Stomach and intestinal gas
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Constituents
  • Carbohydrates: Starch (up to 50%)
  • Lipids: Free fatty acids (6-8%); palmitic acid, oleic acid, and linoleic acid
  • Oleo-resin: Gingerol homologue (up to 33%)
  • Volatile oils: Hydrocarbons (1-3%), B-bisabolene, curcumene, farnesene, sesquiphellandrene, zingiberol, and zingiberene
  • Monoterpenes: Linalool, borneol, neral, and geraniol
  • Amino acids
  • Proteins
    (12) (16)
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Mechanism of Action

The antiemetic action of ginger is attributed to the shogaol and gingerol constituents found in the rhizome. They are believed to stimulate the flow of saliva, bile, and gastric secretions. Additional activities include the suppression of gastric contractions and improvement of the intestinal muscle tone and peristalsis (17). Constituents in ginger are thought to interact with 5HT-3 receptors and may be partially responsible for the antiemetic activity (18). Ginger has been shown to inhibit thromboxane formation and inhibit platelet aggregation (15); however, this effect appears dependent on dose and formulation (e.g., dried, fresh, or extract) (19). An in vitro study suggests that ginger may have therapeutic effects against Alzheimer’s disease by protecting neuronal cells from beta-amyloid insult (11). Apoptosis of gastric cancer cells by gingerol is mediated through TRAIL-dependent caspase 3/7 activation while shogaol alone reduces in vivo tumor growth (8). Gingerol inhibits cell cycle progression by reducing cyclin D1 expression and induces apopotsis in colorectal cancer cells (9), and inhibits secretion of angiogenic cytokines such as VEGF and IL-8 in ovarian cancer cells (10).

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Adverse Reactions
  • Common: Heartburn and dermatitis (12).
  • Case Report: A 76-year-old woman on long-term phenprocoumon therapy developed an elevated INR and epistaxis following use of ginger products. Her INR returned to the normal range after discontinuing ginger along with administration of vitamin K (25).
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Herb-Drug Interactions

Anticoagulants / Antiplatelets: Because ginger can inhibit thromboxane formation and platelet aggregation, concomitant use with anticoagulants may increase the risk of bleeding (14).
Hypoglycemics / Insulin: Ginger may cause additive reductions in blood glucose (23).

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Literature Summary and Critique

Wu KL, et al. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol 2008;20(5):436-440.
The influence of ginger on gastric emptying and motility was assessed in this randomized, double-blind, controlled study of 24 healthy participants. Following an 8 hour fast, participants received placebo or 1200 mg of ginger. After 1 hour, participants consumed a low-nutrient soup (500 ml) after which dimensions of the antrum and fundus and antral contractions were analyzed. In participants that received ginger, antral area was reduced and contractions were more frequent. The authors suggest using more sensitive three-dimensional ultrasound or MRI to further define the exact stomach areas affected by ginger. Because this study analyzed healthy individuals, the effect of ginger on gastric emptying and motility should also be assessed in individuals with gastrointestinal symptoms such as dyspepsia.

Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-82.
Administration of ginger to women less than 17 weeks pregnant and experiencing related nausea and vomiting were included in this study. Seventy women (32 ginger, 38 placebo) were enrolled and administered the study medication four times a day for 4 days. All patients had episodes of vomiting 24 hours prior to enrollment. Nausea and vomiting scores were significantly reduced on the fourth day of treatment with ginger as compared to placebo. On day 4, 12 of 32 patients receiving ginger compared to 23 of 35 on placebo had at least one episode of vomiting. No difference in outcome of pregnancy was noted between the groups. This study suggests that ginger is effective for short term management of nausea and vomiting associated with pregnancy.

Smith C, Crowther C, Willson K, Hotham N, McMillian V. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol. 2004 Apr;103(4):639-45.
291 women less than 16 weeks pregnant participated in this study of ginger and the nausea and vomiting due to pregnancy. The women were randomly assigned to receive either 1.05 grams of ginger or 75 mg of Vitamin B6 daily for three weeks. Nausea and vomiting scores were measured weekly. Women receiving ginger had similar reductions in nausea, vomiting and retching as those receiving vitamin B6. In addition, women in both groups had similar outcomes of pregnancy suggesting that ginger is a safe and effective treatment for nausea and vomiting due to pregnancy.

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References
  1. Bone ME, et al. Ginger root—a new antemetic. The effect of ginger on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia 1990;45:669-71.
  2. Phillips S, et al. Zingiber officinale (ginger)— an antiemetic for day case surgery. Anaesthesia 1993;48:715-7.
  3. Smith C, Crowther C, Willson K, Hotham N, McMillian V. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol. 2004 Apr;103(4):639-45.
  4. Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-82.
  5. Hickok JT, Roscoe JA, Morrow GR, Ryal JL. A Phase II/III Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Ginger (Zingiber officinale) for Nausea Caused by Chemotherapy for Cancer: A Currently Accruing URCC CCOP Cancer Control Study. Support Cancer Ther. 2007 Sep 1;4(4):247-50.
  6. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systemic review of randomized clinical trials. Br J Anaesth 2000;84:367-71.
  7. Wu KL, Rayner CK, Chuah SK, et al. Effects of ginger on gastric emptying and motility in healthy humans.Eur J Gastroenterol Hepatol. 2008 May;20(5):436-40.
  8. Ishiguro K, Ando T, Maeda O, et al. Ginger ingredients reduce viability of gastric cancer cells via distinct mechanisms. Biochem Biophys Res Commun. 2007 Oct 12;362(1):218-23. Epub 2007 Aug 10.
  9. 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. 2008 Mar;47(3):197-208.
  10. 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 Dec 20;7:44.
  11. 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 2002;68:375-6.
  12. Newall, CA et al. Herbal Medicines: A Guide for Health-Care Professional. London: Pharmaceutical Press; 1996.
  13. Brinker F. Herb Contraindications and Drug Interactions, 2nd ed. Sandy (OR) Eclectic Med. Publications; 1998.
  14. 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 2007;27(9):1237-47.
  15. Srivastava KC. Isolation and effects of some ginger components on platelet aggregation and eicosanoid biosynthesis. Prostaglandins Leukot Med 1986;25:187-98.
  16. Fetrow CW, et al. Professional’s Handbook of Complementary and Alternative Medicines. Philadelphia: Springhouse; 1999.
  17. Bisset NG. Herbal Drugs and Phytopharmaceuticals; a Handbook for Practice on Scientific Basis. Boca Raton: Medpharm Publishers; 1994.
  18. Lumb AB. Mechanism of antiemetic effect of ginger. Anaesthesia 1993;48:1118.
  19. Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost 1994;71:110-1.
  20. 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. 2009 May;17(5):563-72.
  21. Levine ME, Gillis MG, Koch SY, et al. Protein and ginger for the treatment of chemotherapy-induced delayed nausea. J Altern Complement Med. 2008 Jun;14(5):545-51.
  22. 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. 2007 Jul;21(7):675-83.
  23. Ojewole JA. Analgesic, antiinflammatory and hypoglycaemic effects of ethanol extract of Zingiber officinale (Roscoe) rhizomes (Zingiberaceae) in mice and rats. Phytother Res. 2006 Sep;20(9):764-72.
  24. Pillai AK, Sharma KK, Gupta YK, Bakhshi S. 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. 2011 Feb;56(2):234-8.
  25. Krüth P, Brosi E, Fux R, Mörike K, Gleiter CH. Ginger-associated overanticoagulation by phenprocoumon. Ann Pharmacother. 2004 Feb;38(2):257-60.
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How It Works

Bottom Line: Ginger is effective against nausea and vomiting but whether it helps nausea and vomiting after cancer treatment is not clear.

Ginger root contains compounds that may help relieve or prevent nausea and vomiting. These substances can increase the flow of saliva and digestive juices. They may also help to calm the stomach and intestine. Scientists are still unsure exactly how ginger exerts these effects. In humans, studies have shown that eating fresh ginger (but not dried ginger) in high doses can “thin” the blood by preventing the platelets from sticking together. In addition, one laboratory study suggested that ginger can protect brain cells from the plaques that cause Alzheimer’s disease, but this effect has not been studied in humans.

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Purported Uses
  • To stimulate appetite
    Ginger is known to stimulate the flow of saliva and digestive secretions, but no clinical trials have been performed.
  • To treat colic and reduce gas in the stomach and intestine
    Compounds found in ginger are known to calm the stomach and intestine, but human data is lacking.
  • To treat diarrhea
    Compounds found in ginger are known to calm the stomach and intestine. Scientific evidence is lacking.
  • To relieve indigestion
    Ginger is known to stimulate the flow of saliva and digestive secretions, but no clinical trials have been performed to evaluate this use.
  • To treat nausea and vomiting
    Several clinical trials support use of ginger for short-term treatment of nausea and vomiting associated with pregnancy, motion sickness, and surgical anesthesia.
  • To treat rheumatoid arthritis and osteoarthritis
    A few studies have been conducted with positive results but more research is needed.
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Research Evidence

Nausea and vomiting during pregnancy:
To test the ability of ginger to treat pregnancy-related nausea and vomiting, researchers randomly gave 70 women early in their pregnancy (less than 17 weeks along) either one gram of ginger or a placebo. All of the patients had episodes of vomiting 24 hours prior to starting the study. After four days of therapy with ginger or a placebo, women taking ginger reported significantly fewer episodes of nausea and vomiting than women taking the placebo. In addition, women taking ginger had no more problems with their pregnancies than women taking the placebo, suggesting that ginger is safe of pregnant women to take.

Another trial of ginger involved 291 women less than 16 weeks pregnant. The women were randomly assigned to receive either ginger or vitamin B6 (a vitamin that is known to reduce nausea and vomitind during pregancy) daily for three weeks. Women receiving ginger had similar reduction in nausea, retching and vomiting.

Post-surgery nausea and vomiting:
Many patients experience nausea and vomiting after general anesthesia for surgery. A randomized, controlled trial compared ginger root to a placebo pill and to metoclopramide, a prescription anti-vomiting drug, to prevent post-operative nausea and vomiting. One hundred and twenty women who were undergoing laparoscopic outpatient surgery enrolled in the study. After surgery, ginger performed as well as metoclopramide in preventing nausea and vomiting, and both did better than the placebo pill.

In a similar study, 60 women who were undergoing major gynecological surgery took ginger root, metoclopramide, or a placebo pill to test their effects on post-surgical nausea and vomiting. As in the last study, ginger performed as well as metoclopramide, and both fared better than the placebo pill at preventing nausea and vomiting.

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Patient Warnings
  • Due to its blood thinning effects, you may want to stop taking ginger supplements a week or two before undergoing surgery. Consult with your surgeon about any supplements you are taking.
  • This product is regulated by the FDA as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. The product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
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Do Not Take If
  • You are taking warfarin or any other blood thinners (Ginger supplements may increase the risk of bleeding).
  • You are taking insulin or medication to lower blood glucose (Ginger supplements may cause additive reductions in glucose level).
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Side Effects
  • Heartburn
  • Dermatitis (swelling, irritation, and redness of the skin)
  • Case Report: A 76-year-old woman on long-term phenprocoumon therapy developed an elevated INR and epistaxis (nosebleed) following use of ginger products. Her INR returned to the normal range after discontinuing ginger along with administration of vitamin K.
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Dosage (Inside MSKCC Only)
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Aliases
Zingiber Officinale
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E-mail your questions and comments to aboutherbs@mskcc.org.
Last updated: March 17, 2011