Natural Standard Featured CE/CME: Ginger

Natural Standard's featured CE/CME for the month of December is Ginger: Safety & Effectiveness.

The rhizomes and stems of ginger have assumed significant roles in Chinese, Japanese and Indian medicine since the 1500s. The oleoresin of ginger is often contained in digestive, antitussive, antiflatulent, laxative and antacid compounds. There is supportive evidence from several clinical trials that ginger reduces the severity and duration of nausea/vomiting due to chemotherapy. Effects appear to be additive to prochlorperazine (Compazine®). The optimal dose remains unclear. Ginger's effects on other types of nausea/vomiting, such as postoperative nausea or motion sickness, remain indeterminate.

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Comments

[SB]

The hospital I work in has a large withdrawal unit, and ginger lozenges are used as the first line of defense against nausea for these patients. About half of the patients never have the need for any other medications for nausea.

[NL]

Ginger seems to have several benefits especially for patients not achieving adequate nausea relief from Compazine alone. However, it is important to look to see if a patient may be at an increased risk of bleeding.

[kl]

One thing I learned this week about ginger was the "G's" mnemonic. This is a trick to help healthcare providers remember that ginger, garlic, ginseng, and saw palmetto all increase the risk of bleeding when taken at supplemental doses. The amount of these compounds contained within foods is not enough to affect bleeding risk. However, it is important to ask patients if they use any of the "G's" prior to surgeries or dental procedures as the bleeding risk is very serious for people taking any one of these at supplemental doses.

[af]

In May, my dad was diagnosed with stage 4 bladder cancer. He also has prostate cancer. Understandably, he has been treated with very strong chemotherapy, one of his drugs being a platinum analog and therefore infamous for causing nausea and vomiting. I told him about ginger, and he said he’d be interested in trying it. I read up on ginger a little bit on the Natural Standard site about how it’s taken in the “dosing” section, and ginger tablets, capsules, and teas seem to be the likely forms of ginger that he would be willing to try. I wonder if gingerbread and gingerbread cookies have protective effects against nausea, too? This would be interesting to look into.

[kl]

Check out Natural Standard's Recipe Tool to find some great recipes incorporating ginger. There are currently 20 ginger recipes of which I will highlight one.

Honey ginger chicken breasts:

It's super easy! Takes about an hour and nutritionally it is low fat, low carb, gluten-free, heart healthy, and high in protein!

Ingredients:
4 large boneless skinless chicken breasts
2 tablespoons honey
1-2 tablespoon Dijon mustard
4 tablespoons water
2-3 teaspoons ground ginger or 1 tablespoon freshly grated ginger root
2-4 garlic cloves, peeled and crushed
Salt, to taste
Freshly ground black pepper, to taste
1/2-1 teaspoon cayenne pepper (optional)

Directions:

Preheat the oven to 350 degrees F. Place the chicken breasts into a sturdy, non-stick baking dish. In a measuring jug, mix the honey, mustard, water, ginger, and crushed garlic (also add the cayenne pepper if using). Pour the mixture over the chicken breasts, making sure to pull them up that so the mixture runs underneath. Season with salt and freshly ground black pepper, to taste. Bake for 45-60 minutes. For each serving, place one chicken breast on a plate and drizzle some of the cooking sauce on top.

Refer to the Natural Standard recipe for nutritional information on honey ginger chicken breasts and other similar recipes. Happy cooking!

[BC]

Ginger is a natural food product that is heavily used in cooking and consumed as a supplemental aid for patients undergoing cancer. It is essential for consumers to understand the safety and effectiveness of ginger prior to consuming as with other medications. It is assuring that there are supportive evidence from clinical trials that support the role of ginger in alleviating nausea and vomiting in chemo patients. However, like other supplements out there, it is important to look at the whole picture as ginger may cause an increased risk of bleeding. Therefore, if a patient is taking anticoagulation medication, it may not be ideal to take ginger regularly. CE’s are a great tool to get the latest information on supplements because it is to the point.

[Mina Nguyen]

Ginger has been a part of many cultures in cooking and medicine for centuries. It’s very interesting to realize that it also has many desirable effects like helping with nausea/vomiting due to chemotherapy. This would be very helpful for those who are undergoing chemotherapy as it has additive effect to antiemetic as well. In some of the Asian countries, ginger is often used to make into candies for dessert. It can be found at health food stores or easily made at home. This may help with the intense flavor of ginger.

[aw]

In regards to JH's comment, I did not realize that ginger has such a powerful effect on prostate cancer cells. I wonder what component of ginger has this effect and if any links to more information can be provided? This compound sounds like it has a lot of potential, as it would be interesting to see the effects of this compound on patients with various stages of prostate cancer. Certainly an area that would benefit from further research.

[JS]

It was a good point to bring up the safety issues associated with ginger. Besides the suggestion that ginger should be cautiously used in patients who are at risk of bleeding, it’s important to note that ginger should also be used cautiously during pregnancy or breastfeeding especially amounts higher than what is commonly found in food. The reason why high doses are not generally recommended during pregnancy is because of ginger’s suggested emmenagogic, abortifacient, mutagenic, and antiplatelet effects. However, some studies have suggested that ginger is safe and effective in the treatment of nausea in pregnant women. Overall, I think it’s important for clinicians to make their patients who may be pregnant aware of the risks associated with ginger supplementation since some potential risk may exist.

[JH]

Not only ginger is effective in peventing nausea and vomiting, but also it has been shown to kill 5-LO enzymes that is essential for prostate cancer cells to survive and without it prostate cancer cells die within hours. A component of ginger has also demonstrated the ability to slow or stop several types of cancer progression.

[tx]

I appreciate the comment by af reminding us that ginger can inhibit platelet aggregation. When I read the database entry for Ginger, I just glanced through it quickly and did not make a mental note of this action. This is an important note to make, as I have many patients on blood thinning agents and counsel patients often on interactions with those medications. It is always important to verify the over the counter supplements a patient is taking when looking for drug interactions, especially for patients on blood thinning or antiplatelet medications. Thanks af for bringing up this important point.

[af]

As the Natural Standard database points out, something important to note about ginger is its ability to possibly inhibit platelet aggregation or decrease platelet thromboxane production. This means that ginger may increase a patient’s risk of bleeding and is one example of why medication profiles must include any herbs or supplements that a patient may be taking. It is important to ask any patient on anticoagulants or antiplatelet drugs, such warfarin, aspirin, or clopidogrel, if he/she has also taken ginger, and vice versa, and to educate the patient about the interaction that may occur between ginger and these drugs.

[dp]

This is a great CE to sum up the uses and effects of ginger. I have often used ginger for nausea, usually in the form of ginger ale or ginger candies. I did not realize its effects were additive to Compazine. This is great news for the treatment of such an uncomfortable condition, especially for patients undergoing chemotherapy and using multiple medications to control nausea.

[MS]

The exact mechanism of action for ginger in preventing nausea/vomiting is not clear. In animal studies it has been shown that ginger produces antispasmodic effects and has anti-cholinergic and anti-histaminic action. A study showed that ginger increased salivation and intestinal motility in humans. While I was doing an oncology rotation, I saw several cases in which ginger was used as a supplement among the cancer patients.