Continuing Education Activity

Ginger root is a plant-based, whole food spice used in the personal or professional treatment of various conditions, ranging from gastrointestinal upsets to cancer. It originates from the root of the Zingiber officinale plant. This activity reviews the history, nutritional properties, health benefits, mechanism of action, potential side effects, and the role of ginger root as a valuable agent in lifestyle medicine.

Objectives:

• Describe the recommended dosing for consuming ginger.
• Summarize the reported health benefits of ginger root.
• Review the mechanism of action of ginger root.
• Explain some potential contraindications to using ginger root.

Indications

Ginger root has gained worldwide popularity in recent years. We will review the health and medical benefits of ginger in this article. 

Ginger root has been used for centuries around the world in preparing cuisine. Ginger root has been mentioned in traditional Ayurvedic and Chinese medical literature. Southeast Asian countries are the largest producers of the root. Ginger’s name originates from the ancient Sanskrit word, srngaveram, translating to “horn root.” The root itself originates from the root of the Zingiber officinale plant, a tropical plant with green-purple flowers and a fragrant stem known as a rhizome.[1] The Indians and Chinese are thought to have used it as a tonic for thousands of years to treat illness.[2]

Ginger root is a member of the family of roots consisting of turmeric and cardamom. There are over 1300 different species of ginger root plants. Its strong aroma and taste are due to ketones called gingerols, a primary component of the root. It is high in vitamin C, vitamin B6, micronutrients like magnesium, potassium, copper, manganese, fiber, and water. It is also high in phytochemicals and polyphenols. Gingerols, shogaols, and paradols are the three major active components from terpenes found in ginger, and the suggested serving size ranges from 170mg to 1g of powder a day. A primary metabolite of gingerol is known as (S)-[6]-gingerol-4’-0-β-glucuronide. Ginger and its metabolites appear to accumulate in the gastrointestinal tract and exert their effects by relieving pain through anti-inflammatory effects, soothing the digestive system through carminative effects, and alleviating nausea. Recently, research has focused on the mechanism of action of ginger and its various components.

Studies have shown ginger’s promising preventative properties against chronic diseases, such as hypertension and CHD, as well as its contribution to the overall improvement of immune system action. One study showed increasing ginger intake by 1g per day based on a proper diet could provide such preventative benefits.[3] There is evidence for its health benefits as an antibacterial/viral agent, antioxidant, anti-inflammatory agent, antinausea compound, and anticancer agent. These benefits will be discussed next.

Mechanism of Action

The exact mechanism is not understood entirely, but several active compounds of ginger have been shown to have biological activity.

• Gingerol and gingerol-related compounds: Antioxidant activity, anti-tumor activity via induction of apoptosis and modulation of genetic activity, anti-inflammatory and anti-analgesic activity, antimicrobial activity, and hepatoprotective activity
• Paradol: Antioxidant, anti-cancerous, and antimicrobial properties
• Shogaol: Antioxidant, anti-inflammatory, anti-cancerous activity via inhibition of cell invasion, reduction of matrix metalloproteinase-9 expression, and anti-proliferation activity
• Zingerone: Antioxidant activity, anti-inflammatory, and anti-bacterial properties
• 1-Dehydro-10-gingerdione: Regulation of inflammatory genes
• Terpenoids: Induction of apoptosis via activation of p53
• Ginger flavonoids: Antioxidant activity

Microbes are an essential part of the human body and gut, most often keeping us healthy. However, foreign microbes can invade the body and make us ill, causing diseases such as the flu. There is evidence that harmful microbes can contribute to the formation of chronic conditions, such as cancer and coronary heart disease. As pathogens become more resistant to developed drugs, the use of antibiotics and vaccines can be non-effective. Ginger has been shown to play a vital role as an antimicrobial agent. Several active components have been shown to be active against E coli, Salmonella typhi, Bacillus subtilis, Candida albicans, M. avium, and M. tuberculosis.[4]

Antioxidants help free the body of free radicals and reduce oxidative stress. The imbalance between reactive oxygen species (ROS) production and antioxidative defense mechanisms can induce oxidative stress. Long-term exposure can lead to many chronic diseases, such as rheumatoid arthritis, post-ischemic perfusion injury, myocardial infarction, chronic inflammation, and cancer. Ginger is a source of numerous antioxidants and plays a role in reducing lipid oxidation and ROS formation. Studies have shown ginger root's active compounds' ability to scavenge superoxide anion and hydroxyl radicals and inhibit lipid peroxidation in vivo.[5]

Inflammation is an important immune response mechanism to damage and can be mediated via interleukin-1 (IL-1), tumor necrosis factor (TNF), and anti-inflammatory cytokines. Just as NSAIDs are commonly used to treat inflammation, medicinal plants are of interest as well. In vivo studies have shown ginger's ability to suppress pro-inflammatory cytokines and down-regulate induction of inflammatory genes.[6]

The exact mechanism of ginger on nausea and vomiting is not clear, but studies have shown that active compounds such as gingerols, shogaols, and diterpenoids possess antiserotoninergic and 5-HT3 receptor antagonistic effects, known to play a role in providing nausea sensation relief.[7]

Unregulated cell growth and tumor development are complex processes involving many genetic and metabolic alterations. Medicinal plants have long been studied for such chronic disease management. Ginger's active compounds have been shown to control tumor development via regulation of tumor suppressor genes, induction of apoptosis, and inactivation of VEGF signaling. Numerous studies have shown 6-gingerols ability to suppress hyperproliferation and inflammatory processes leading to carcinogenesis, angiogenesis, and metastasis.[8]

Ginger has specifically been found to be effective against various GI cancers such as gastric cancer, pancreatic cancer, liver cancer, colorectal cancer, and cholangiocarcinoma.[9]

Administration

Ginger root is a whole plant-based food. It can be consumed in healthy breakfast items such as oatmeal and chia seed puddings, as a spice in Indian or Asian curries and cuisine, in soups, in salad dressings, in herbal tea as crushed or minced root, in powder form as a supplement, in juice or a smoothie to flavor the beverages, in baking, or the hard candy form for the common cold and sore throat. The recommended serving is a tablespoon of ground ginger or 2/3 cup of freshly ground ginger.

The most common edible form of ginger root is in its yellow/beige form. Methods of consuming ginger for a healthy lifestyle include whole, crushed, or minced in herbal tea, powdered form as a supplement, juice form as a flavor, or crystallized candy form for the common cold and sore throat. Ginger pills can be prepared by adding fresh ginger juice to ginger powder and blending it in mortar and pestle until it becomes a thick paste; it can be rolled into pills once dried. The proportion of juice to powder is roughly 4 to 1. Two tablets can be taken three times a day.[2]

Adverse Effects

Ginger root is generally considered safe by the U.S. Food and Drug Administration (FDA), and daily approved intake of up to 4 grams is deemed safe. With higher doses, there is potential for the development of gastrointestinal discomfort, allergic reactions, prolonged pre-existing bleeding, central nervous system depression, and arrhythmia. 

Studies have shown that in cases of above 6 grams ingestion, ginger root can exacerbate gastrointestinal disturbances such as gastrointestinal reflux, heartburn, and diarrhea. It can cause warfarin toxicity and potentiate warfarin’s anticoagulant properties, potentially leading to bleeding. It can lower blood pressure and has been shown to cause arrhythmia in a small number of cases. By increasing the bile acid secretion, it can aggravate gallstone formation.[10]

Contraindications

There are no known allergic reactions to any form of ginger exposure if taken at recommended doses.

Monitoring

It is recommended to minimize ginger intake to below 4 grams of ginger per day if noted adverse side effects are experienced.

Toxicity

In high doses, ginger root can exacerbate gastrointestinal disturbances such as gastrointestinal reflux, heartburn, and diarrhea. As mentioned above, it can potentially cause warfarin toxicity, potentiating the drug's anticoagulant properties and leading to bleeding. It can lower blood pressure and has been shown to cause arrhythmia in a small number of cases. By increasing the bile acid secretion, it can aggravate the gallstone formation.[11]

Enhancing Healthcare Team Outcomes

Managing health outcomes following delivery of a herbal remedy such as ginger root requires an interprofessional team of healthcare personnel such as pharmacists, primary care physicians, nurses, and other mid-level providers. To enhance and reap the benefits of such a beneficial natural herb, the dosage should be optimized. Age, sex, pre-existing conditions, and diet can influence the remedial characteristics of ginger root that have been studied and should be optimized for different cohorts of our population [Level 1 and 2] if a patient is taking ginger root as a daily antioxidant or alleviating joint inflammation pain, their healthcare team to monitor health improvements or side effects. The provider can actively review signs of side effects such as GI reflux, heartburn, or diarrhea and consult with a pharmacist to optimize dosing as needed. This holistic approach will provide an evidence-based method of utilizing ginger root as a supplement in lifestyle medicine.

Review Questions

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References

1.

Kumar KM, Asish GR, Sabu M, Balachandran I. Significance of gingers (Zingiberaceae) in Indian System of Medicine - Ayurveda: An overview. Anc Sci Life. 2013 Apr;32(4):253-61. [PMC free article: PMC4078479] [PubMed: 24991077]

2.

Bode AM, Dong Z. The Amazing and Mighty Ginger. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd ed. CRC Press/Taylor & Francis; Boca Raton (FL): 2011. [PubMed: 22593941]

3.

Wang Y, Yu H, Zhang X, Feng Q, Guo X, Li S, Li R, Chu D, Ma Y. Evaluation of daily ginger consumption for the prevention of chronic diseases in adults: A cross-sectional study. Nutrition. 2017 Apr;36:79-84. [PubMed: 28336112]

4.

Chang JS, Wang KC, Yeh CF, Shieh DE, Chiang LC. Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines. J Ethnopharmacol. 2013 Jan 09;145(1):146-51. [PubMed: 23123794]

5.

Mashhadi NS, Ghiasvand R, Askari G, Hariri M, Darvishi L, Mofid MR. Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: review of current evidence. Int J Prev Med. 2013 Apr;4(Suppl 1):S36-42. [PMC free article: PMC3665023] [PubMed: 23717767]

6.

Young HY, Luo YL, Cheng HY, Hsieh WC, Liao JC, Peng WH. Analgesic and anti-inflammatory activities of [6]-gingerol. J Ethnopharmacol. 2005 Jan 04;96(1-2):207-10. [PubMed: 15588672]

7.

Lete I, Allué J. The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Integr Med Insights. 2016;11:11-7. [PMC free article: PMC4818021] [PubMed: 27053918]

8.

Rahmani AH, Shabrmi FM, Aly SM. Active ingredients of ginger as potential candidates in the prevention and treatment of diseases via modulation of biological activities. Int J Physiol Pathophysiol Pharmacol. 2014;6(2):125-36. [PMC free article: PMC4106649] [PubMed: 25057339]

9.

Prasad S, Tyagi AK. Ginger and its constituents: role in prevention and treatment of gastrointestinal cancer. Gastroenterol Res Pract. 2015;2015:142979. [PMC free article: PMC4369959] [PubMed: 25838819]

10.

Ryan JL, Morrow GR. Ginger. Oncol Nurse Ed. 2010 Feb;24(2):46-49. [PMC free article: PMC5008850] [PubMed: 27595143]

11.

Chuah SK, Wu KL, Tai WC, Changchien CS. The effects of ginger on gallbladder motility in healthy male humans. J Neurogastroenterol Motil. 2011 Oct;17(4):411-5. [PMC free article: PMC3228982] [PubMed: 22148111]

Disclosure: Morni Modi declares no relevant financial relationships with ineligible companies.

Disclosure: Kalgi Modi declares no relevant financial relationships with ineligible companies.