Ginger (Zingiber officinale): Benefits, Uses, Safety and Dosing

Ginger is a common culinary herb belonging to the family Zingiberaceae. It is commonly known as adrak, sringasera, jiang, tangawizi, shaga, and zanjabil. It is native to the islands of Southeast Asia and is currently cultivated in India, Jamaica, China, Australia, and Peru.

Ginger is used as follows:

• Manage nausea and motion sickness
• In managing period pain and osteoarthritis/muscle aches
• Improve fasting blood glucose
• Lower triglycerides and increase high-density lipoproteins
• Alleviating dyspepsia

Medical Uses and ethnopharmacological profile of Ginger

Traditional Uses

The fresh root was used in common colds and coughs and as an ingredient in remedies for detoxifying other herbs. It was also used to encourage menstruation and alleviate nausea. The dry herb was used as a stomachic, digestive aid, lung tonic, and joint inflammation (amavata) treatment. It is part of the trikatu formula alongside black and long pepper to enhance the bioavailability of other nutrients.

Clinical Uses and Research

Pregnancy nausea: Rhizome powdered capsules at a dose of 1-1.5 grams for 4 to 21 days exhibited action comparable to vitamin B6 in inhibiting nausea and reducing nausea scores. This was linked to the activity of 6-gingerol and shogaol, which act by antagonizing serotonin and cholinergic gut receptors, altering gut motility.

Osteoarthritis: Root ethanolic extract at a dose of 255 mg twice daily for 6 weeks elicited a reduction of knee pain after periods of standing or walking. This was due to the activity of gingerols and shogaols, which acted via inhibition of cyclooxygenase and lipoxygenase pathways, thus suppressing pro-inflammatory cytokines, which are usually enhanced in conditions like osteoarthritis.

Type 2 diabetes mellitus: Supplementation of 2 grams of powder daily over 12 weeks reduced HbA1c levels by 10% and fasting sugar levels by 12%. This was due to the actions of 6-gingerol via increasing insulin sensitivity and inhibition of hepatic gluconeogenesis.

Primary dysmenorrhea: Powder extract rich in gingerols provided pain relief comparable to mefenamic acid and ibuprofen in period pain. This was achieved with a dosing of 250 mg four times daily for three days. The mechanism of action was extrapolated to be the inhibition of prostaglandin synthesis, thereby naturally inhibiting pain.

Dyslipidemia: Standardized 4-gram powdered capsules taken for 45 days decreased levels of triglycerides and low-density lipoproteins while increasing the levels of high-density lipoproteins. Phenolics in the powdered extract acted by activating hepatic cholesterol and enhancing the conversion of cholesterol to bile acids. ( Talaei 2016)

In Vivo Uses and Research

Anti-inflammatory: In a rat paw edema model, a single dose of 100 or 400 mg/kg rhizome methanolic extract was able to reduce acute inflammatory swelling by up to 60%. This was through the action of 6-shigaol, which reduces the expression of iNOS and cyclooxygenase 2, both inflammation inducers, thus reducing inflammatory responses.

Weight management: In a mouse model, mice with high fat content were given a 1% ginger powder dietary supplement for 16 weeks. It resulted in decreased body weight gained and visceral fat accumulation. This was linked to the activity of zingerone and gingerols that increased fatty acid oxidation in adipose tissues via thermogenic activation. ( Misawa 2015)

Neuropathic pain: In mice with neuropathic pain, an intraperitoneal dose of 50 mg/kg for 7 days of rhizome ethanolic extract was able to reduce oxidative stress in the spinal cord. 6- Gingerol was believed to act by modulating NMDA receptor signaling.

In Vitro Uses and Research

Anti-cancer: Ethanolic/acetone extract when applied to human colorectal/ovarian cancer cell lines exhibited reduction of angiogenesis factors and inhibited tumor cell proliferation. This was thought to be through the action of 6-gingerol and 10-gingerol that induce apoptosis via P53 upregulation.

Joint preservation: 6-gingerols in ginger extract elicited preservation of collagen matrix structure and reduction of nitric production in joints when applied to human chondrocytes. This was noted to be through inhibition of metalloproteinases that are supposed to degrade joint cartilage. ( Reinhard 2005)

Antibacterial: In disc diffusion, methanolic and essential oil extracts worked against Streptococcus aureus and Escherichia coli through disruption of cell membranes and inhibition of biofilm formation. Compounds linked to this activity included citral, bisabolene, and 6-gingerol. ( Mostafa 2018)

Safety and Dosing profile of Ginger

Forms and Dosing

Fresh rhizomes 1-2 grams daily chewed or for culinary uses

Crystallized/candied– used for energy and mild nausea

Pickled- 20-30 grams a day

Juice rhizome extract– 10-20ml a day

Essential oils– dillute drops as needed in carrier oil

Infusions/ teas- 1-2 grams dissolved in water. Taken up to 3 times a day.

Powdered capsules/tablets- 250mg-1000 mg in divided doses a day depending on the condition being treated.

• Nausea and vomitting- 500mg upto 4 times daily
• Joint pain and osteoarthritis- 500-1000 mg twice a day
• digestive aid(dyspepsia)- 500 mg up to twice a day
• Menstrual pain- 250 mg up to 4 times a day
• Metabolic effects- 1-2 grams in divided doses a day

NB: Do not exceed 4 grams a day, and take standardized extracts in a cyclic manner. In culinary settings it can be used daily.

Interactions

• Blood thinners like clopidogrel and aspirin increase the risk of bleeding, as ginger has anti-thromboxane activity.
• Antidiabetic medication like insulin- risk of hypoglycemia
• Anti-hypertensives like amlodipine and nifedipine- ginger has mild calcium channel blocking activity and may potentiate drugs, leading to hypotension.

Side effects

• Heartburn
• Mild diarrhea
• Mouth/throat irritation
• Stomach discomfort
• Increased flatulence

Contraindications

• Gallstones- Ginger increases bile secretion, which increases the pain of stones obstructing the bile duct.
• Bleeding disorders