Ginger


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The use of dietary supplements by cancer patients has risen significantly over the past 2 decades despite insufficient evidence of safety and effectiveness. Finding reliable sources of information about dietary supplements can be daunting. Patients typically rely on family, friends, and the Internet, often receiving misleading information.

The ASCO Post’s Integrative Oncology series is intended to facilitate the availability of evidence-based information on integrative and complementary therapies commonly used by patients with cancer. We chose ginger for this issue because of its increasing use by cancer patients.

Compiled by Barrie R. Cassileth, PhD, and Jyothi Gubili, MS, Memorial Sloan-Kettering Cancer Center. The About Herbs website is managed by K. Simon Yeung, PharmD, MBA, Lac, Memorial Sloan-Kettering Cancer Center.

Scientific name: Zingiber officinale
Common names: Ginger root, shen jian

Overview

The rhizome or the underground stem of the plant Zingiber officinale, ginger has been used as a culinary spice and medicine in Asian and Arabic traditions for thousands of years. Native to Asia, ginger is used to treat a range of ailments including the common cold, headache, fevers, and gastrointestinal and inflammatory disorders.

Fresh ginger is used in cooking and for preparing tea. Both fresh and dried forms of ginger are marketed in the form of extracts, tinctures, oils, and capsules.

Current evidence supports the effectiveness of ginger in controlling nausea and vomiting following surgery and associated with pregnancy and motion sickness. However, its therapeutic value against chemotherapy-induced nausea and vomiting await more definitive data.

The Science

Ginger has demonstrated antiemetic,1 anticancer,2-4 anti-inflammatory,5 and hypoglycemic5 effects in vitro, and may protect against Alzheimer’s disease.6 Shogaol and gingerol, two bioactive constituents of ginger, are thought responsible for its antiemetic properties.1

Clinical trials indicate that ginger can effectively reduce nausea and vomiting due to pregnancy,7,8 motion sickness,9 and following surgery.10 But data on its efficacy in preventing chemotherapy-induced nausea are conflicting.11,12

A systematic review found moderate efficacy for the use of ginger in treating osteoarthritic and chronic low back pain.13 Ginger can also influence gastric emptying in healthy individuals.14

Adverse Effects

Elevated international normalized ratio (INR) and epistaxis were reported in a patient on long-term phenprocoumon therapy, following use of ginger products.15

Herb-Drug Interactions

Anticoagulants/antiplatelets: Ginger inhibits thromboxane formation and platelet aggregation. Therefore, concomitant use with anticoagulants may increase the risk of bleeding.16

Hypoglycemics/insulin: Studies in mice indicate that ginger has hypoglycemic effects. Therefore, concurrent use with hypoglycemics may result in greater reduction in blood glucose levels.5

Tacrolimus (an immunosuppressive agent): Pretreatment with ginger increased plasma levels of tacrolimus in a study of rats.17 ■

References

1. Haniadka R, Rajeev AG, Palatty PL, et al: Zingiber officinale (ginger) as an anti-emetic in cancer chemotherapy: a review. J Altern Complement Med 18:440-444, 2012.

2. Hessien M, El-Gendy S, Donia T, et al: Growth inhibition of human non-small lung cancer cells h460 by green tea and ginger polyphenols. Anticancer Agents Med Chem 12:383-390, 2012.

3. Ishiguro K, Ando T, Maeda O, et al: Ginger ingredients reduce viability of gastric cancer cells via distinct mechanisms. Biochem Biophys Res Commun 362:218-223, 2007.

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 47:197-208, 2008.

5. Ojewole JA: Analgesic, antiinflammatory and hypoglycaemic effects of ethanol extract of Zingiber officinale (Roscoe) rhizomes (Zingiberaceae) in mice and rats. Phytother Res 20:764-772, 2006.

6. Lee C, Park GH, Kim CY, et al: [6]-Gingerol attenuates β-amyloid-induced oxidative cell death via fortifying cellular antioxidant defense system. Food Chem Toxicol 49:1261-1269, 2011.

7. Smith C, Crowther C, Willson K, et al: A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol 103:639-645, 2004.

8. Ding M, Leach M, Bradley H: The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: A systematic review. Women Birth 26:e26-e30, 2013.

9. Lien HC, Sun WM, Chen YH, et al: Effects of ginger on motion sickness and gastric slowwave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol 284:G481-G489, 2003.

10. Nanthakomon T, Pongrojpaw D: The efficacy of ginger in prevention of postoperative nausea and vomiting after major gynecologic surgery. J Med Assoc Thai 89(suppl 4):S130-S136, 2006.

11. 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 20:1479-1489, 2012.

12. 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 17:563-572, 2009.

13. 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 21:675-683, 2007.

14. Wu KL, Rayner CK, Chuah SK, et al: Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol 20:436-440, 2008.

15. Krüth P, Brosi E, Fux R, et al: Ginger-associated overanticoagulation by phenprocoumon. Ann Pharmacother 38:257-260, 2004.

16. 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 27:1237-1247, 2007.

17. Egashira K, Sasaki H, Higuchi S, et al: Food-drug interaction of tacrolimus with pomelo, ginger, and turmeric juice in rats. Drug Metab Pharmacokinet 27:242-247, 2012.


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