Ginger

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Ginger

Common Names

  • Ginger root
  • Shen jiang

For Patients & Caregivers

How It Works

Ginger may help relieve or prevent 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 intestines. Some studies have found ginger may help nausea caused by chemotherapy, but larger studies are needed to confirm these effects.

Eating fresh ginger in high doses can have blood-thinning effects by preventing platelets from sticking together. 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 saliva flow and digestive secretions, but clinical trials are lacking.
  • To relieve indigestion
    Compounds in ginger are known to stimulate saliva flow and digestive juices, reduce gas, and calm the digestive system, but human data are lacking.
  • To treat diarrhea
    Compounds in ginger are known to calm the digestive system, but clinical data are lacking.
  • To treat nausea and vomiting
    Some studies support the short-term use of ginger for chemotherapy-associated nausea and vomiting 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 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 reduce inflammation and protect against certain viruses, but human studies are lacking.
  • To treat drug withdrawal symptoms
    A small animal study suggests that ginger may help ease withdrawal symptoms from drugs like morphine. However, clinical data are lacking.
Patient Warnings
  • Due to its blood-thinning effects, ginger supplements should be stopped 2 weeks before surgery, and should not be used immediately after surgery to control nausea or vomiting.
  • 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 risk of bleeding when used with these drugs.
  • You are taking insulin or medication to lower blood glucose: Ginger supplements may cause larger reductions in glucose levels. Clinical relevance is not known.
  • You are taking tacrolimus: Ginger supplements increase the blood levels of this drug and may increase side effects. Clinical relevance is not known.
  • 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 risk of bleeding.
  • You are pregnant or lactating: The effect of ginger supplements on human gestational development are unknown.
Side Effects
  • Heartburn
  • Skin irritation, swelling, and redness

Case Report

  • Nosebleed, slow blood clotting: In a 76-year-old woman on long-term blood-thinning therapy who took ginger products. Clotting returned to normal after discontinuing ginger and with vitamin K administration.
  • Fatal bleeding: In an 80-year-old man on dabigatran (a blood thinner) with a known history of non-valvular atrial fibrillation. He presented with 1-day history of vomiting blood and black stool that began 3 days after taking a boiled mixture of ginger and cinnamon.
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For Healthcare Professionals

Scientific Name
Zingiber officinale, Zingiberis rhizoma
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. Preclinical studies indicate 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 suggest its effectiveness for treating dysmenorrhea (55), with a study showing it to be comparable to standard treatment (62); and moderate efficacy against osteoarthritic and chronic low back pain (15) (16). As an adjunct to standard care, ginger may also be beneficial for treating migraine (63). Although clinical trials indicate that ginger can 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 antiplatelet (31) effects.

In oncology settings, ginger has been reported useful for preventing chemotherapy-induced nausea and vomiting (CINV) (33) (34) (35) (36), but a systemic review cited the need for further research (37). Another study suggested that adjuvant ginger supplementation may improve CIN-related quality of life and cancer-related fatigue (58). 6-gingerol, a bioactive compound in ginger, was also shown to improve overall CINV, appetite, and quality of life (59). However other studies did not show benefit with ginger as an adjunct to CINV prophylaxis (60); or in patients receiving high-dose cisplatin except in female and head and neck cancer subgroups (61).

Additional studies reported aromatherapy with ginger to be useful in reducing nausea and vomiting in postoperative patients (64), but data on CINV are mixed (56) (65) (66). Supplementation may also have chemopreventive effects for those at increased risk for colon cancer with normal-appearing colonic mucosa (38). Larger studies are needed to confirm potential benefits of ginger supplementation for symptom control or for chemoprevention.

Purported Uses
  • Appetite Stimulant
  • Gas and indigestion
  • Diarrhea
  • Nausea and vomiting
  • Rheumatoid arthritis
  • Respiratory ailments
  • Drug withdrawal symptoms
Mechanism of Action

The antiemetic action of ginger is attributed to shogaol and gingerol, compounds present in the rhizome, which stimulate the flow of saliva, bile, and gastric secretions, and galanolactone that 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 (eg., 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 reduced lipopolysaccharide-induced secretion of IL-8 in human bronchial epithelial cells (8), along with inhibiting human telomerase reverse transcriptase (hTERT) and c-Myc expression in human lung cancer cells (44).

In other studies, gingerol induced apoptosis of gastric cancer cells through TRAIL-dependent caspase 3/7 activation (3) and inhibited cell-cycle progression by reducing cyclin D1 expression (4). It also inhibited secretion of angiogenic cytokines such as VEGF and IL-8 in ovarian cancer cells (5). In animal models, shogaol reduced in vivo tumor growth by damaging microtubules and by 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).

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 herbs that have antiplatelet and anticoagulation properties due to perioperative bleeding concerns, although a systematic review found inconclusive evidence. Further study is warranted (57).
  • 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 Reports

  • 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).
  • Fatal bleeding: In an 80-year-old man on dabigatran with a known history of non-valvular atrial fibrillation. He presented with 1-day history of haematemesis and black stool that began 3 days after taking a boiled mixture of ginger and cinnamon (67).

 

Herb-Drug Interactions
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Ginger may increase risk of bleeding with concomitant use of drugs such as diclofenac or ibuprofen (26).
  • Anticoagulants / Antiplatelets: Because ginger can inhibit thromboxane formation and platelet aggregation, simultaneous use with anticoagulants may increase the risk of bleeding (51), although a systematic review determined that current evidence is inconclusive. Further study is warranted (57).
  • Hypoglycemics / Insulin: Ginger may cause additive reductions in blood glucose (7). Clinical relevance is not known.
  • Tacrolimus: Pretreatment with ginger increased the plasma levels of tacrolimus (52). Clinical relevance is not known.
  • Cyclosporine: Concomitant use with ginger resulted in decreased blood concentrations of cyclosporine in vivo (54). Clinical relevance is not known.
Dosage (OneMSK Only)
References
  1. Lumb AB. Mechanism of antiemetic effect of ginger. Anaesthesia. Dec 1993;48(12):1118.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (ginger)—an antiemetic for day case surgery. Anaesthesia. Aug 1993;48(8):715-717.

  12. Kleinschmidt S, Rump G, Kotter J. [Herbal medications. Possible importance for anaesthesia and intensive care medicine]. Anaesthesist. Dec 2007;56(12):1257-1266.

  13. Cheng B, Hung CT, Chiu W. Herbal medicine and anaesthesia. Hong Kong Med J. Apr 2002;8(2):123-130.

  14. 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.

  15. Larkin M. Surgery patients at risk for herb-anaesthesia interactions. Lancet. Oct 16 1999;354(9187):1362.

  16. Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia. Sep 2002;57(9):889-899.

  17. Marcus DM, Snodgrass WR. Do no harm: avoidance of herbal medicines during pregnancy. Obstet Gynecol. May 2005;105(5 Pt 1):1119-1122.

  18. 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.

  19. 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.

  20. Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost. Jan 1994;71(1):110-111.

  21. 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.

  22. 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.

  23. 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.

  24. 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.

  25. 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.

  26. 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.

  27. Shukla Y, Singh M. Cancer preventive properties of ginger: a brief review. Food Chem Toxicol. May 2007;45(5):683-690.

  28. 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.

  29. 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.

  30. 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.

  31. Wilkinson JM. Effect of ginger tea on the fetal development of Sprague-Dawley rats. Reprod Toxicol. Nov-Dec 2000;14(6):507-512.

  32. Yamahara J, Miki K, Chisaka T, et al. Cholagogic effect of ginger and its active constituents. J Ethnopharmacol. May 1985;13(2):217-225.

  33. Kruth P, Brosi E, Fux R, et al. Ginger-associated overanticoagulation by phenprocoumon. Ann Pharmacother. Feb 2004;38(2):257-260.

  34. 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.

  35. 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.

  36. Colombo D, Lunardon L, Bellia G. Cyclosporine and herbal supplement interactions. J Toxicol. 2014;2014:145325.

  37. Marx W, McKavanagh D, McCarthy AL, et al. The Effect of Ginger (Zingiber officinale) on Platelet Aggregation: A Systematic Literature Review. PLoS One. 2015 Oct 21;10(10):e0141119.

  38. Adib Rad H, Basirat Z, Bakouei F, et al. Effect of Ginger and Novafen on menstrual pain: A cross-over trial.Taiwan J Obstet Gynecol. 2018 Dec;57(6):806-809.

  39. Karaman S, Karaman T, Tapar H, Dogru S, Suren M. A randomized placebo-controlled study of aromatherapy for the treatment of postoperative nausea and vomiting.Complement Ther Med. 2019 Feb;42:417-421.

  40. Evans A, Malvar J, Garretson C, Pedroja Kolovos E, Baron Nelson M. The Use of Aromatherapy to Reduce Chemotherapy-Induced Nausea in Children With Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial. J Pediatr Oncol Nurs. 2018 Nov/Dec;35(6):392-398.

  41. Maadarani O, Bitar Z, Mohsen M. Adding Herbal Products to Direct-Acting Oral Anticoagulants Can Be Fatal. Eur J Case Rep Intern Med. 2019 Jul 19;6(8):001190.

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