Ginger has been used as food and medicine for more than 5,000 years.Recent scientific studies showed that the bioactive compounds have properties that target nausea, pain, lipids, hyperglycemia and cancer. Meta-analysis of these studies are presented.

1. SPICE AS MEDICINE:
GINGER
ZINGIBER OFFICINALE
By
Kevin KF Ng, MD, PhD
Former Associate Professor of Medicine
Division of Clinical Pharmacology
University of Miami, FL, USA
Email: kevinng68@gmail.com
Presented at HealthCare Provider Seminar Aug 2019

2. Outline of lecture
▪ History of ginger
▪ Top ginger producing and consuming countries
▪ Nutrient composition of ginger
▪ Bioactive compounds of ginger
▪ Bioavailability
▪ Medicinal properties of ginger
▪ Clinical studies and meta-analysis
▪ Commercial products
▪ Culinary cuisine
▪ Summary

3. Origin of the name “Ginger”
▪ The name “ginger” is derived from Sanskrit word
“srngaveram” which means “horn body” and describes
its root.
▪ While it grows, it has white and pink buds which bloom
into yellow flowers. When the stalk withers, the
rhizome is harvested and heated to prevent sprouting.
http://www.vegetablefacts.net/vegetable-history/ginger-history/

4. Origin of the name Zingiber officinale
▪ The name Zingiber is derived from the Greek zingiberis,
which comes from the Sanskrit name of the spice,
singabera.
▪ Officinale is a latin term for a substance derived from
plants.

5. Journey of ginger through the ages
1
2
3
4
AsiaMediterraneanEuropeMexico

6. Milestones in the history of ginger

7. Sheng Nong (ca 2695 BC): Father of Chinese Medicine

8. Sheng Nong Ben Cao Jing 200-250 AD
“The classic of Herbal Medicine”

9. Confucius (551-479 BC)
Chinese teacher, politician and philosopher
http://www.flavorandfortune.com/dataaccess/article.php?ID=1389

10. World's top Ginger Producing Countries
https://www.atlasbig.com/en/countries-ginger-production

11. List Of Ginger Exporters On The Basis Of Value: (2012)
http://www.gointernational.org.np/portal/index.php?p1=catalogue&p2=4

12. Top countries consuming the most ginger in 2017
https://www.indexbox.io/blog/which-countries-consume-the-most-ginger/

13. Scientific Classification of Ginger
https://steemit.com/steemit-health/@khansa/benefits-and-history-of-ginger-use-as-an-herbal-medicine

14. Anatomy of a ginger plant
https://www.medicinalplantsarchive.us/ginger-zingiber/morphology-and-anatomy.html

15. Nutrient composition of raw ginger root
Macronutrient
g/100g
Mineral
mg/100g
Vitamin
mg/100g
https://ndb.nal.usda.gov/ndb/search/list/?manu=&fgcd=&ds=&qlookup=Ginger%20root,%20raw

16. Percentage of bioactive phytochemical in raw ginger root
https://ndb.nal.usda.gov/ndb/search/list/?manu=&fgcd=&ds=&qlookup=Ginger%20root,%20raw

17. Nutrient composition of dry ginger root
Volatile oil
Oleoresin
Starch
Proteins
Fats
Others
http://impactfactor.org/PDF/IJPPR/9/IJPPR,Vol9,Issue9,Article8.pdf

18. Bioactive compounds in ginger
https://www.precisionnutrition.com/all-about-ginger
30%

19. Structures of major ginger bioactive compounds
gingerol. Shogaol.
zingerone. zingiberene.
http://impactfactor.org/PDF/IJPPR/9/IJPPR,Vol9,Issue9,Article8.pdf
dehydration
cooking
oil constituent

20. Physical property of major bioactive compounds of ginger
http://impactfactor.org/PDF/IJPPR/9/IJPPR,Vol9,Issue9,Article8.pdf

21. Some properties of ginger bioactive compounds

22. Potential health benefits
▪ Antioxidant activity
▪ Antimicrobial activity
▪ Anti-inflammatory activity
▪ Antitumor activity
▪ Anti-diabetic activity
▪ Neuroprotective effect
▪ Gastro protective effect
▪ Hepatoprotective effect
▪ Antiemetic effect
▪ Migraine
http://impactfactor.org/PDF/IJPPR/9/IJPPR,Vol9,Issue9,Article8.pdf

23. Evolution of inflammation

24. Anti-inflammatory actions of ginger
COX=cyclo-oxygenase
LOX=lipoxygenase

25. Inhibitory Effect of Ginger Extract on Ovarian Cancer Cell Line
(2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527238/

26. Pharmacokinetic studies of ginger bioactive compounds
▪ More than 200 compounds are identified in the ginger.
▪ The bioactive components include:
▪ volatile oil
▪ anthocyanins
▪ tannins
▪ phenolic compounds; gingerols, shogaols and sesquiterpenes
▪ The non-volatile compounds are:
▪ gingerols,
▪ shogaols
▪ paradols
▪ zingerone
▪ Most scientific studies were done with gingerol and shogaol.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384666/

27. Bioavailability of gingerols and shogaol in human subjects
▪ Gingerols and shogaol are not detected in
human plasma after oral administration.
▪ Over 60% of an oral dose of 50 mg/kg
dose of 6-gingerol was excreted as
▪ metabolites in the bile (48%)
▪ metabolites in the urine (16%)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256190/

28. Pharmacokinetic profile of 10-gingerol and 6-shogaol in the plasma of
healthy subjects treated with a single oral dose 50 mg/kg of red ginger suspension.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256190/
Tmax

29. Bioavailability of 10-gingerol and 6-shogaol in man
Extracted from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256190/

30. Mean plasma concentration–time curves of eight analytes
after oral administration of ginger extract at a dose of
400 mg/kg. (n = 10, mean ± SD)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384666/

31. Pharmacokinetic studies with ginger compounds
(400 mg/kg) in rats
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384666/

32. Distribution of ginger bioactive compounds in rat tissue
Adapted from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384666/

33. Use of ginger
Culinary
Gingerbread
Biscuits
Cakes
Puddings
Soups
Pickles
Curry powder
Beverage
Traditional
medicine
Nausea
vomiting
Motion sickness
Pain
Loss of appetite
Digestive disorders
Asthma
cough
Scientific
research
Anti-inflammatory
property
Anti-cancer property

34. Safety, Efficacy and Toxicity of Ginger
▪ Ginger is recognized by the United States Food and Drug
Administration (FDA) “Generally Recognized as Safe”
▪ The dose of ginger is safe when 250 mg – 1gm, 3 times a day used
for nausea treatment and 250 mg, 4 times a day for morning
sickness.
▪ Ginger has shown possible CNS depression, arrhythmias, bleeding
abnormalities with large overdoses
http://impactfactor.org/PDF/IJPPR/9/IJPPR,Vol9,Issue9,Article8.pdf

35. Ginger-drug interaction
▪ Moderate interaction:
▪ Medications that slow blood clotting:
anticoagulant e.g. warfarin
antiplatelet drug e.g. aspirin
▪ Minor interaction:
▪ Medications for diabetes e.g insulin
▪ Medications for high blood pressure e.g.nifedipine
https://www.webmd.com/vitamins/ai/ingredientmono-961/ginger

36. What is meta-analysis: evidence-based medicine
https://rdfeinman.files.wordpress.com/2015/08/meta-anal_whatis.png

37. Meta-analysis: Hierarchy of evidence in clinical studies
use of statistical methods to summarise the results of these studies.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049418/

38. Meta-analysis of clinical studies
▪ Pain
▪ Osteoarthritis
▪ Chronic pain
▪ Nausea
▪ Motion sickness
▪ Pregnancy
▪ Dysmenorrhea
▪ Post-op nausea
▪ vertigo
▪ Inflammatory marker: CRP
▪ Lipid profile
▪ Diabetes
▪ High blood pressure

39. A systematic review and meta-analysis of the effect and safety of
ginger in the treatment of pregnancy-associated nausea and vomiting (2014)
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-13-20

40. Ginger (Zingiber officinale): An alternative for the prevention
of postoperative nausea and vomiting. A meta-analysis (2018)
https://ars.els-cdn.com/content/image/1-s2.0-S0944711318302885-fx1_lrg.jpg

41. Efficacy of Ginger for Alleviating the Symptoms of Primary Dysmenorrhea:
A Systematic Review and Meta‐analysis of Randomized Clinical Trials (2015)
https://onlinelibrary.wiley.com/doi/pdf/10.1111/pme.12853

42. Zingiberaceae extracts for chronic pain (> 24 h):
a systematic review and meta-analysis (2015)
https://link.springer.com/article/10.1186/s12937-015-0038-8

43. Efficacy and safety of ginger in osteoarthritis patients:
a meta-analysis of randomized placebo-controlled trials (2014)
https://www.sciencedirect.com/science/article/pii/S106345841401276X

44. One gram powdered ginger daily helps
lower the concentration of CRP in your blood. (2016)
https://foodandnutritionresearch.net/index.php/fnr/article/view/1063

45. Effect of ginger on lipid profile compared with that of placebo:
A meta analysis on (a) for TG, (b) for TC, (c) for LDL-c, and (d) for HDL-c. (2018)
(a) Triglyceride
(b)Total cholesterol
(c) LDL-cholesterol
(d) HDL-cholesterol
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818945/
favors ginger favors control

46. Effects of ginger on Type 2 diabetes mellitus :
A systematic review and meta-analysis (2015)
Fasting serum glucose with short term study
Fasting serum glucose without short term study
Hemoglobin A1C
Fasting serum insulin
Homeostatic Model Assessment
of Insulin Resistance (HOMA-IR)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818945/
favors ginger favors ginger

47. Does ginger supplementation lower blood pressure?
A systematic review and meta-analysis of clinical trials (2019)
https://www.ncbi.nlm.nih.gov/pubmed/30972845

48. Effect of Ginger (Zingiber officinale) on Platelet Aggregation:
A Systematic Literature Review (2015)
Due to the potential effects of ginger on platelet aggregation, ginger is a commonly-cited
example of an herbal supplement that should be avoided in patients with
thrombocytopenia, platelet function defects or coagulopathy, such as populations using
ginger for its antiemetic effect in cancer chemotherapy. While in vitro data, as well as
some clinical studies and epidemiological evidence suggest that ginger inhibits platelet
aggregation, the evidence is equivocal with multiple limitations, particularly within the
clinical data, which prevents firm recommendations being made. Limitations include the
lack of standardisation of ginger preparations used, significant variations in dosage and
time frame studied, and the high level of bias in the study designs used. Therefore,
further research is needed to clearly define the safety, or otherwise, of ginger in patient
population at increased risk of bleeding.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619316/

49. Commercial ginger products

50. Some delicious ginger cuisines

51. Summary
▪ Ginger is the root of a plant called zingiber offficinale
▪ Its use as food and medicine is known more than 5000 years.
▪ Its medicinal properties lie mainly in gingerols and shogaols.
▪ Scientific investigations show that the bioactive compounds
are beneficial for health.
▪ Ginger is widely used in beverages, food, cosmetics and
pharmaceuticals.
▪ Ginger is relatively safe and untoward side effects are rare.

52. ANY QUESTION?
Contact
Kevin KF Ng, MD, PhD
Email: kevinng68@gmail.com
52