Health Care Professional Information

Scientific Name
Zingiber officinale
Common Name

Zingiberis rhizoma, ginger root, shen jiang

Clinical Summary

Derived from the rhizome of the plant, ginger is native to Asia and is used both as food and as medicine. In traditional Chinese medicine, ginger is used to expel “cold”, “wind” and “dampness”, and is believed to stop the reverse flow of Qi (energy) (1). Western use has been primarily for gastrointestinal symptoms and respiratory ailments.
In vitro and animal studies suggest that ginger has antiemetic (2), anticancer (3) (4) (5) (6), anti-inflammatory (6) (7) (8), anti-drug-dependence (9), and hypoglycemic effects (7). It may also protect against Alzheimer's disease (10) (11) (12). Ginger influences gastric emptying in healthy individuals (13) and may promote feelings of satiety (14). Systematic reviews of ginger suggest moderate efficacy for treating osteoarthritic and chronic low back pain (15) (16).
Although clinical trials indicate that ginger can effectively reduce nausea and vomiting (17) (18) (19) (20) it should be avoided perioperatively due to its anticoagulant/antiplatelet effects(21) (22) (23) (24) (25) (26), and during pregnancy since animal studies highlight concerns regarding embryo development (26) (27). Dietary ginger seems to be without these effects (28) (29) (30), although some studies suggest that high concentrations of fresh ginger have both antiplatelet (31) and antiviral (32) potential.

The evidence for ginger to prevent chemotherapy-induced nausea and vomiting is generally positive (33) (34) (35) (36), although a systemic review comprising randomized controlled (RCTs) or crossover trials was unable to draw any conclusions (37). A small pilot study suggests that ginger supplementation may have chemopreventive effects for those at increased risk for colon cancer with normal-appearing colonic mucosa (38). More and larger studies are needed to confirm any true benefit with ginger supplementation for symptom control or chemoprevention.

Purported Uses
  • Diarrhea
  • Drug withdrawal symptoms
  • Indigestion
  • Motion sickness
  • Nausea and vomiting
  • Respiratory ailments
  • Rheumatoid arthritis
  • Spasms
  • Stomach and intestinal gas
Constituents
  • Oleoresins: Gingerol, shogaol, paradol
  • Volatile oils (sesquiterpene compounds): curcumene, farnesene, zingiberene, and zerumbone
  • Monoterpenoids: 1,8-cineole, linalool, borneol, neral, and geraniol
  • Diterpenoid: galanolactone
  • Fats, waxes, carbohydrates, vitamins and minerals
    (1) (39) (40) (41) (42)
Mechanism of Action

The antiemetic action of ginger is attributed to the rhizome constituents shogaol and gingerol, which stimulate the flow of saliva, bile, and gastric secretions, and galanolactone, which can act as a competitive antagonist at serotonin 5-HT3 receptors (2) (22). Additional activities include the stimulation of antral contractions, reduction of postprandial antral area, and acceleration of gastric emptying (13). Ginger inhibits thromboxane formation and platelet aggregation (43). However, these effects appear to be dose- and formulation-dependent (e.g., dried, fresh, or extract) (31). In vitro studies suggest that fresh ginger stimulates mucosal cells to secrete IFN-β to combat viral infection (32), while certain ginger preparations have been shown to reduce lipopolysaccharide-induced secretion of IL-8 in human bronchial epithelial cells (8) and inhibit human telomerase reverse transcriptase (hTERT) and c-Myc expression in human lung cancer cells (44).

Gingerol induces apoptosis of gastric cancer cells through TRAIL-dependent caspase 3/7 activation (3) and inhibits cell-cycle progression by reducing cyclin D1 expression (4). It also inhibits secretion of angiogenic cytokines such as VEGF and IL-8 in ovarian cancer cells (5). In animal models, shogaol reduces in vivo tumor growth by damaging microtubules and inducing mitotic arrest (3). Increased levels of circulating antioxidant and phase II enzymes, and reduced lipid peroxidation levels are also mechanisms by which ginger protects against DMH-induced colon cancers (45).

Pharmacokinetics

After administering 2.0 g/day ginger extract to healthy human subjects for 24 days, blood samples were drawn within 24 hours of the last dose. Levels of 10-gingerol sulfate, 8-gingerol glucuronide, 8-gingerol sulfate, 6-shogaol gluruconide, and 6-shogaol sulfate were below the detection limit in all participants due to short half-lives (between 1 and 3 h) and rapid clearance (39).

Contraindications
  • Ginger supplements should not be used in the perioperative setting due to the potential risk for increased bleeding (21) (24). This is in line with a general caution to avoid such herbs that have antiplatelet and anticoagulation properties due to concerns for perioperative bleeding.
  • Likewise, ginger supplements should be avoided in patients with bleeding disorders (46).
  • Ginger supplements should be avoided during pregnancy or lactation due to lack of data on human fetal outcomes and concerns regarding embryo development in animal studies (27) (47). The German Commission E also contraindicates ginger for morning sickness during pregnancy (48).
  • Individuals with gallstones should avoid ginger supplements due to potential cholagogic effects (49).
Adverse Reactions

Common: Heartburn and dermatitis (36) .

Case Report
Overanticoagulation: A 76-year-old woman on long-term phenprocoumon therapy developed an elevated international normalized ratio (INR) and epistaxis following use of ginger products. INR returned to normal range after discontinuing ginger along with administration of vitamin K (50).

Herb-Drug Interactions
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Ginger may increase bleeding tendency with concomitant use of drugs such as diclofenac or ibuprofen (26).
  • Anticoagulants / Antiplatelets: Because ginger can inhibit thromboxane formation and platelet aggregation, concomitant use with anticoagulants may increase the risk of bleeding (51).
  • Hypoglycemics / Insulin: Ginger may cause additive reductions in blood glucose (7).
  • Tacrolimus: Pretreatment with ginger increases the plasma levels of tacrolimus (52).
  • Cyclosporine: Concomitant use with ginger resulted in decreased blood concentration of cyclosporine, in vivo (54).
Literature Summary and Critique

Ryan JL, et al. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer. 2012 Jul;20(7):1479-89.
This double-blind multicenter trial was conducted by the University of Rochester Cancer Center Community Clinical Oncology Program to evaluate whether ginger could help reduce severity of chemotherapy (CT)-induced nausea on CT-Day 1. Investigators randomized 744 cancer patients who reported nausea from a previous chemotherapy cycle to one of four arms: ginger 0.5 g, 1.0 g, or 1.5 g daily, or placebo, starting 3 days before CT-Day 1 of cycles 2 and 3. All patients also received a 5-HT(3) receptor antagonist antiemetic on CT-Day 1 of all cycles. Patients reported nausea severity four times daily (morning, afternoon, evening, and night) for Days 1-4 during each cycle (baseline, cycle 2, and cycle 3). In the final analysis of evaluable data (n=576; mostly women), all doses of ginger significantly reduced acute nausea severity compared with placebo on CT-Day 1 (p=.003), with the largest reduction occurring in the 0.5 g (p=.017) and 1.0 g (p=.036) groups. However, there was a lack of effect on delayed nausea and quality of life. There were 9 study-related adverse reactions including Grade 2 heartburn, bruising/flushing, and rash, for which those patients withdrew from the study. Investigators concluded that ginger 0.5 g–1.0 g daily significantly reduced acute CT-induced nausea severity in adult cancer patients, but the higher dose of 1.5 g did not increase effectiveness, which supports the idea of 5-HT3 receptor saturation also suggested by other studies (53). The authors cite lack of controls for high vs low emetogenic regimens and nausea severity levels before enrollment as potential contributors to the small effect size for nausea severity.

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 ginger 1200 mg. 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 who received ginger, the 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 in individuals with gastrointestinal symptoms such as dyspepsia remains unknown.

Smith C, et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol. 2004 Apr;103(4):639-45.
A total of 291 women who were less than 16 weeks pregnant were randomly assigned to receive either 1.05 grams of ginger or 75 mg of vitamin B6 daily for 3 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. However, due to other papers and guidelines cited, it is recommended that ginger supplements be avoided during pregnancy (27) (47) (48).

Dosage (Inside MSKCC Only)
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References
  1. Wang W, Li CY, Wen XD, et al. Simultaneous determination of 6-gingerol, 8-gingerol, 10-gingerol and 6-shogaol in rat plasma by liquid chromatography-mass spectrometry: Application to pharmacokinetics. J Chromatogr B Analyt Technol Biomed Life Sci. Mar 15 2009;877(8-9):671-679.
  2. Lumb AB. Mechanism of antiemetic effect of ginger. Anaesthesia. Dec 1993;48(12):1118.
  3. Ishiguro K, Ando T, Maeda O, et al. Ginger ingredients reduce viability of gastric cancer cells via distinct mechanisms. Biochem Biophys Res Commun. Oct 12 2007;362(1):218-223.
  4. 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. Mar 2008;47(3):197-208.
  5. 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;7:44.
  6. Plengsuriyakarn T, Viyanant V, Eursitthichai V, et al. Anticancer activities against cholangiocarcinoma, toxicity and pharmacological activities of Thai medicinal plants in animal models. BMC Complement Altern Med. 2012;12:23.
  7. Ojewole JA. Analgesic, antiinflammatory and hypoglycaemic effects of ethanol extract of Zingiber officinale (Roscoe) rhizomes (Zingiberaceae) in mice and rats. Phytother Res. Sep 2006;20(9):764-772.
  8. Podlogar JA, Verspohl EJ. Antiinflammatory effects of ginger and some of its components in human bronchial epithelial (BEAS-2B) cells. Phytother Res. Mar 2012;26(3):333-336.
  9. Darvishzadeh-Mahani F, Esmaeili-Mahani S, Komeili G, et al. Ginger (Zingiber officinale Roscoe) prevents the development of morphine analgesic tolerance and physical dependence in rats. J Ethnopharmacol. Jun 14 2012;141(3):901-907.
  10. Zeng GF, Zhang ZY, Lu L, et al. Protective effects of ginger root extract on Alzheimer disease-induced behavioral dysfunction in rats. Rejuvenation Res. Apr 2013;16(2):124-133.
  11. Oboh G, Ademiluyi AO, Akinyemi AJ. Inhibition of acetylcholinesterase activities and some pro-oxidant induced lipid peroxidation in rat brain by two varieties of ginger (Zingiber officinale). Exp Toxicol Pathol. May 2012;64(4):315-319.
  12. 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. Apr 2002;68(4):375-376.
  13. Wu KL, Rayner CK, Chuah SK, et al. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol. May 2008;20(5):436-440.
  14. Mansour MS, Ni YM, Roberts AL, et al. Ginger consumption enhances the thermic effect of food and promotes feelings of satiety without affecting metabolic and hormonal parameters in overweight men: a pilot study. Metabolism. Oct 2012;61(10):1347-1352.
  15. 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. Jul 2007;21(7):675-683.
  16. Terry R, Posadzki P, Watson LK, et al. The use of ginger (Zingiber officinale) for the treatment of pain: a systematic review of clinical trials. Pain Med. Dec 2011;12(12):1808-1818.
  17. Smith C, Crowther C, Willson K, et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol. Apr 2004;103(4):639-645.
  18. Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. Apr 2001;97(4):577-582.
  19. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth. Mar 2000;84(3):367-371.
  20. Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (ginger)—an antiemetic for day case surgery. Anaesthesia. Aug 1993;48(8):715-717.
  21. Kleinschmidt S, Rump G, Kotter J. [Herbal medications. Possible importance for anaesthesia and intensive care medicine]. Anaesthesist. Dec 2007;56(12):1257-1266.
  22. Cheng B, Hung CT, Chiu W. Herbal medicine and anaesthesia. Hong Kong Med J. Apr 2002;8(2):123-130.
  23. Ciocon JO, Ciocon DG, Galindo DJ. Dietary supplements in primary care. Botanicals can affect surgical outcomes and follow-up. Geriatrics. Sep 2004;59(9):20-24.
  24. Backon J. Ginger as an antiemetic: possible side effects due to its thromboxane synthetase activity. Anaesthesia. Aug 1991;46(8):705-706.
  25. Larkin M. Surgery patients at risk for herb-anaesthesia interactions. Lancet. Oct 16 1999;354(9187):1362.
  26. Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia. Sep 2002;57(9):889-899.
  27. Marcus DM, Snodgrass WR. Do no harm: avoidance of herbal medicines during pregnancy. Obstet Gynecol. May 2005;105(5 Pt 1):1119-1122.
  28. Janssen PL, Meyboom S, van Staveren WA, et al. Consumption of ginger (Zingiber officinale roscoe) does not affect ex vivo platelet thromboxane production in humans. Eur J Clin Nutr. Nov 1996;50(11):772-774.
  29. Lee A, Chui PT, Aun CS, et al. Incidence and risk of adverse perioperative events among surgical patients taking traditional Chinese herbal medicines. Anesthesiology. Sep 2006;105(3):454-461.
  30. Phang M, Lazarus S, Wood LG, et al. Diet and thrombosis risk: nutrients for prevention of thrombotic disease. Semin Thromb Hemost. Apr 2011;37(3):199-208.
  31. Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost. Jan 1994;71(1):110-111.
  32. Chang JS, Wang KC, Yeh CF, et al. Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines. J Ethnopharmacol. Jan 9 2013;145(1):146-151.
  33. 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. May 2009;17(5):563-572.
  34. Levine ME, Gillis MG, Koch SY, et al. Protein and ginger for the treatment of chemotherapy-induced delayed nausea. J Altern Complement Med. Jun 2008;14(5):545-551.
  35. Pillai AK, Sharma KK, Gupta YK, et al. 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. Feb 2011;56(2):234-238.
  36. Ryan JL, Heckler CE, Roscoe JA, et al. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer. Jul 2012;20(7):1479-1489.
  37. Marx WM, Teleni L, McCarthy AL, et al. Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review. Nutr Rev. Apr 2013;71(4):245-254.
  38. Citronberg J, Bostick R, Ahearn T, et al. Effects of ginger supplementation on cell-cycle biomarkers in the normal-appearing colonic mucosa of patients at increased risk for colorectal cancer: results from a pilot, randomized, and controlled trial. Cancer Prev Res (Phila). Apr 2013;6(4):271-281.
  39. Yu Y, Zick S, Li X, et al. Examination of the pharmacokinetics of active ingredients of ginger in humans. AAPS J. Sep 2011;13(3):417-426.
  40. Gupta S, Pandotra P, Ram G, et al. Composition of a monoterpenoid-rich essential oil from the rhizome of Zingiber officinale from north western Himalayas. Nat Prod Commun. Jan 2011;6(1):93-96.
  41. Chrubasik S, Pittler MH, Roufogalis BD. Zingiberis rhizoma: a comprehensive review on the ginger effect and efficacy profiles. Phytomedicine. Sep 2005;12(9):684-701.
  42. Shukla Y, Singh M. Cancer preventive properties of ginger: a brief review. Food Chem Toxicol. May 2007;45(5):683-690.
  43. Srivastava KC. Isolation and effects of some ginger components of platelet aggregation and eicosanoid biosynthesis. Prostaglandins Leukot Med. Dec 1986;25(2-3):187-198.
  44. Tuntiwechapikul W, Taka T, Songsomboon C, et al. Ginger extract inhibits human telomerase reverse transcriptase and c-Myc expression in A549 lung cancer cells. J Med Food. Dec 2010;13(6):1347-1354.
  45. Manju V, Nalini N. Chemopreventive efficacy of ginger, a naturally occurring anticarcinogen during the initiation, post-initiation stages of 1,2 dimethylhydrazine-induced colon cancer. Clin Chim Acta. Aug 2005;358(1-2):60-67.
  46. Silva BM, Hosman AE, Devlin HL, et al. Lifestyle and dietary influences on nosebleed severity in hereditary hemorrhagic telangiectasia. Laryngoscope. May 2013;123(5):1092-1099.
  47. Wilkinson JM. Effect of ginger tea on the fetal development of Sprague-Dawley rats. Reprod Toxicol. Nov-Dec 2000;14(6):507-512.
  48. Blumenthal M, Busse W (eds.) German Commission E Monographs: Therapeutic Monographs on Medicinal Plants for Human Use. Austin, TX: American Botanical Council. 1997.
  49. Yamahara J, Miki K, Chisaka T, et al. Cholagogic effect of ginger and its active constituents. J Ethnopharmacol. May 1985;13(2):217-225.
  50. Kruth P, Brosi E, Fux R, et al. Ginger-associated overanticoagulation by phenprocoumon. Ann Pharmacother. Feb 2004;38(2):257-260.
  51. 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. Sep 2007;27(9):1237-1247.
  52. Egashira K, Sasaki H, Higuchi S, et al. Food-drug interaction of tacrolimus with pomelo, ginger, and turmeric juice in rats. Drug Metab Pharmacokinet. 2012;27(2):242-247.
  53. Lien HC, Sun WM, Chen YH, et al. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol. Mar 2003;284(3):G481-489.
  54. Colombo D, Lunardon L, Bellia G. Cyclosporine and herbal supplement interactions. J Toxicol. 2014;2014:145325.

Consumer Information

How It Works

Bottom Line: Ginger may help relieve nausea and vomiting.
Ginger root contains compounds that may help relieve or prevent nausea and vomiting. These substances can increase the flow of saliva and digestive juices and may also help 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, laboratory studies suggest that ginger can protect brain cells from the plaques that cause Alzheimer's disease, but this effect has not been studied in humans.

Purported Uses
  • To stimulate appetite
    Ginger is known to stimulate the flow of saliva and digestive secretions, but clinical trials have not been performed.
  • To relieve indigestion
    Compounds found in ginger are known to stimulate the flow of saliva and digestive juices, reduce gas, and calm the stomach and intestine, but human data are lacking.
  • To treat diarrhea
    Compounds found in ginger are known to calm the stomach and intestine, but scientific evidence is lacking.
  • To treat nausea and vomiting
    Several clinical trials support use of ginger for short-term treatment of nausea and vomiting associated with chemotherapy and motion sickness. However, because of blood-thinning effects, ginger supplements should not be used around the time of surgery. It is also not suggested for use during pregnancy because of possible unknown risks to the developing embryo.
  • To treat rheumatoid arthritis and osteoarthritis
    A few studies have been conducted with positive results but more research is needed.
  • To treat respiratory ailments
    Certain compounds in ginger may improve inflammation and protect against certain viruses, but no human studies have been conducted to confirm this.
  • To treat drug withdrawal symptoms
    A small animal study suggests that ginger may help ease withdrawal symptoms from drugs like morphine. However, no other studies have been published and human studies would be needed to see if this was true.
Research Evidence

Nausea and vomiting

During pregnancy Although several small studies on ginger for pregnancy-related nausea and vomiting have shown it reduces symptoms, animal studies raise concerns about possible negative effects on the developing embryo. The German Commission E, a former science advisory board which made recommendations on herbal medicine safety and effectiveness also advised against the use of ginger for this purpose.

After surgery Although several small studies on ginger for surgery-related nausea and vomiting have shown it reduces symptoms, use of ginger supplements may increase the bleeding risk. Therefore, it should be avoided around the time of a schedule surgery.

During chemotherapy The evidence for ginger to prevent nausea and vomiting caused by chemotherapy appears to be positive with short-term use. However, some papers comparing many trials together were unable to draw any conclusions.

Patient Warnings
  • Due to its blood-thinning effects, ginger supplements should be stopped 2 weeks before undergoing surgery, and should not be used immediately after surgery to control nausea or vomiting. Other types of medications given by your healthcare provider can be used to control these symptoms.
  • Ginger supplements should be avoided in patients with bleeding disorders.
  • Ginger supplements should be avoided during pregnancy or lactation.
  • Ginger supplements should be avoided by individuals with gallstones.
Do Not Take If
  • You are taking warfarin or other blood thinners (Ginger supplements may increase the risk of bleeding).
  • You are taking NSAIDs, nonsteroidal anti-inflammatory drugs (Ginger supplements may increase bleeding tendency when used with these drugs).
  • You are taking insulin or medication to lower blood glucose (Ginger supplements may cause larger reductions in glucose levels).
  • You are taking tacrolimus (Ginger supplements increase the blood levels of this drug and may increase side effects).
  • You have a bleeding disorder (Ginger supplements may increase bleeding time).
  • You have gallstones (Ginger supplements may increase the flow of bile).
  • You are having surgery (Ginger supplements may increase bleeding risk).
  • You are pregnant or lactating (The effect of ginger supplements on the human gestational development are unknown).
Side Effects
  • Heartburn
  • Skin irritation, swelling, and redness
  • Case Report: A 76-year-old woman on long-term blood-thinning therapy who took ginger products developed a nosebleed, and it was found that her blood was clotting too slowly following use of ginger products. Clotting returned to normal after discontinuing ginger and with the administration of vitamin K.
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