The Metabolic Effects of Consuming Ginger - Report Example

The Metabolic Effects of Consuming Ginger Contents Abstract, page 1 Introduction page 1 Aims of This Research page 4 Method page 5 Literature Search page 5 Discussion page 12 Conclusion page 14 References page 15 Extra Reading page 20 Abstract This is an investigation using a literature search into the medicinal properties of ginger. It considers this over ideas covering many centuries, from ancient times to modern laboratory based and patient based clinical scientific reports. Some possible adverse reactions and negative interactions are also mentioned. Despite some promising results, the conclusion is that much more research is required, especially in the form of proper double blind and bigger investigations based upon human physiology and disease patterns. In the meantime though, its proponents continue to benefit in a variety of circumstances often without any trained medical intervention or consultation. Introduction Eating ginger has long been thought of as having positive effects on human physiology. The University of Maryland (2015) states that it has been in use for at least 4,400 years. This continues, with Ernst reporting in 1993 that up to half of the British population use ginger and other alternative remedies ( Cited by Kelly, 2002). Russo reported a figure of a third of American adults as using herbal supplements . ( 2000) Kelly believes this usage is because these people have some doubts about mainstream medicine, and that they prepare more traditional items such as ginger as being ‘more natural’. She also cites the fact that choosing an alternative medicine gives the patient more choice and involvement. It could also be because it is so easy and inexpensive to obtain , whether as the root, dried and ground, in forms such as ginger tea, or derivatives of various types, a statement backed up by Russo who stated in 2000 that:- People all over the world are increasingly concerned about the harm inflicted by modern, technological medicine, especially pharmaceuticals, and the high cost of these treatments. Baraldin et al (2007) mention such things as ginger being anti-inflammatory, and how it affects the blood pressure, clotting abilities, and effects lipid and glucose concentrations in the blood. Eat This (2011), citing a research report from the University of the Aga Khan in Pakistan, states that ginger can be used to block calcium channels:- When ginger is consumed, it has been found that the compounds can block calcium channels, which in turn can reduce blood pressure. As well as acting on the blood pressure Ali et al ( 2008) mention that it is believed to act in a large number of unrelated conditions , mentioning :- Arthritis, rheumatism, sprains, muscular aches, pains, sore throats, cramps, constipation, indigestion, vomiting, hypertension, dementia, fever, infectious diseases and helminthiasis. In particular Al-Nahain et al ( 2014) describe how ginger has long been used in many countries to treat rheumatoid arthritis in older people. Inflammation is one part of the complex biological reaction of body tissues to a number of harmful stimuli such as bacteria and viruses, to damaged cells and to irritants, which may have come from external sources as when certain foods are injected. Inflammation involves the immune cells, the blood vessels, and molecular mediators such as leukotrienes, histamine and cytokines that work to limit the amount of exudate produced after injury, which, if uncontrolled, cause the muscles to swell. Baldarin et al ( 20017) go on to describe how Ginger (Zingiber officinale Roscoe,of the family Zingiberacae) has long been widely consumed as a spice, but also how, for hundreds of years, it played a part in a number of traditional medicine systems such as those of China, Hindu Ayurvedic medicine and Tibb-Unani ( Greek) . The latter are herbal medicines developed in the early Islamic period (Brought to life, undated) for the treatment of conditions such as catarrh, nervous diseases rheumatism and gingivitis. In Ayurvedic texts ginger is hailed as a “universal great medicine” ( Andrews, 2015) or a ‘natural medicine chest’ (Food Matters, 2011) and even as an aphrodisiac . Andrews goes on to describe how in Chinese medicine it is thought of as being useful as it “restores devastated yang” and “expels cold”. This idea about the need to restore balance in the body is a very old one, and is included in ancient Greek ideas , central to the teaching of such great teachers as Galen and Hippocrates, as well as being a prominent principle in Ayurveda and Unani Tibb medicine, the medieval doctrine of humours, as well as in traditional Chinese medicine even in modern times ( Brought to Life, undated). In these ancient systems dosages of from one to three grams are used to ease nausea and larger doses to increase testosterone ( Examine.com .2015) According to Cholesterol and Fat Disease ( 2015) ginger roots are very complex and contain ‘6-Gingerol, 8-gingerol, 6-shogaol and 10-gingerol. ‘The gingerols, together with other compounds , the flavonoids ,which give it its yellow colour , are known to be active as antioxidants . The group claim that there are round about 50 types of antioxidants which have been identified in ginger roots, and it is also high in dietary fibre. Andrews ( 2015) although he admits that data is mixed, states that there is a theory is that ginger may inhibit cyclooxygenase COX) and lipoxygenase(LOX), which means it is anti-inflammatory. This inhibition leads to lower amounts of several types of chemical messengers and when this happens, both systemically and at the site of particular inflammation, this brings about some degree of pain relief, although as can be seen from some reports included in the literature search, this may not be as much relief as can be obtained by using other substances. Ginger originated in South East Asia and is the rhizome, of a bamboo like plant, that is an underground plant stem from which both roots and leaves can develop,. It can be eaten fresh or used in cookery, but may also be dried, powdered or candied. Once an eastern spice, it is now freely available right round the globe in a variety of forms from the whole root down to individual components. Many modern pharmacological substances are based on ancient remedies. Aspirin and digitalis are just two of many possible examples. These are however more recent in use as relatively modern drugs, despite both being part of ancient medicine systems. Aspirin was first produced by Bayer in the late 19th century (Bayer Aspirin, Aspirin history , 2009) and Digitalis Purpurea, undated ) . Aims of this research There has been considerable research into the benefits or otherwise of ginger in the diet. This essay will consider this research and analyse it in order to get a better picture of the true benefits of this ancient remedy, as well as considering any possible negative effects. It will try to answer questions such as what are the traditional functions and use of ginger? Why are these associated with a number of metabolic disorders such as inflammations? It will also consider literature which considers whether ginger protects various parts of the body such as the liver, kidneys and adipose tissue and its role in a wide variety of conditions. Finally it questions why ginger is considered to be an alternative therapy, rather than mainstream. Method This study will consider a variety of research papers, using search terms such as Chinese medicine, ginger, herbal medicines, alternative remedies , Ayuredic medicine and Tibb-Unani treatments. These texts will be those available in English and preference is given, where possible, to the most recent papers and especially those which use scientific methods, although other texts are also mentioned and considered. Much of the available data about ginger is anecdotal and unproven scientifically, but even these reports are based in empirical evidence, often repeated over many centuries, but would not be considered as valid according to the criteria usually applied in western medical research. On searching it was found that there were many articles which fitted the criteria needed. For this reason only a few have been considered in detail, but a number of others are listed under ‘Other Reading’. This does not necessarily mean that they are of lesser value. The aim was to show how many different ways ginger could be used beneficially. Literature Research Much of the scientific research which has been carried out into ginger has been based on laboratory investigations, often using rats or mice as test animals, rather than carrying out double blind human trials. Some of the research uses pure ginger, whereas some researchers have looked at only certain components. This means that in many cases like on like comparisons are not possible. One of the most common things said about ginger is that it has an anti-inflammatory effect. Ming et al (2014) for instance looked at rats and the way in which ginger can be helpful in preventing inflammation of their kidneys. This kind of inflammation , if untreated, leads on to metabolic syndrome , a cluster of several conditions which include raised cholesterol levels, raised blood pressure , high blood sugars, and excessive fat being laid down at waist level ( Mayo Clinic , 2015). The aim of their study was to investigate the impact of ginger on fructose consumption-induced adverse renal effects. They concluded that :- The present results suggest that ginger supplement diminishes fructose-induced kidney injury through suppression of renal overexpression of macrophage-associated proinflammatory cytokines in rats. Our findings provide evidence supporting the protective effect of ginger on the metabolic syndrome-associated kidney injury. This was of course a study in rats rather than in humans, but they are commonly used in research because , according to Canadians for Health Research ( undated) rats can be used to study disease processes. Because they are relatively short lived changes occur quickly, and because these are lab animals they are in controlled conditions. Although this is not direct human research it can lead on to other things. According to Huanging et al (2012) ginger has been show to improve derangements of lipids. They did however remain unsure as to exactly how this was taking place, such doubts being a feature of a number of such studies. This was again a study based upon animal rather than human physiology. Wang et al ( 2012) looked at insulin resistance, an increasing medical problem as the frequency of Type 2 Diabetes is on the increase in western societies, as described for instance by McMahon et al ( 2004) . Once more this was a laboratory based study using rodents. These researchers proved, that at least in rats, the use of ginger had a positive effect in that insulin resistance was reduced, and felt that that gave a new insight into the possible use of ginger pharmaceutically. Eat This ( 2011) cite a number of studies into the effects of ginger on diabetes. They cite a study described in the Journal of Pharmacology and Experimental Therapeutics which showed how taking ginger could result in better control of elevated blood sugar. Another cited report was into how ginger reduced the disruptive actions of gastric contractions . This is beneficial as when the gastric muscles are acting normally blood sugars levels at normal amounts can be maintained. The same article from Eat This ( 2011) also cites an article from The International Journal of Food Science and Nutrition which reveals that the consumption of ginger prevents the production of enzymes which occur when a person develops Type 2 diabetes. Another study in mice which is cited on this page showed how the development of cataracts can be slowed. In the Journal of Medical Food ( 2005) Grzanna et al describe how there has been much research into ginger since the 1970s and that these have probed ginger’s anti-inflammatory effects, and that it shares pharmacological properties with several ‘non-steroidal anti-inflammatory drugs’ such as Aspirin or Ibruprofen. Later there was the discovery of the genetic makeup which led to ginger’s anti-inflammatory action. This study describes how ginger modulates the biochemical pathways which are active in cases of chronic inflammation, something backed up by researcher Susanne Zick ( 2011, cited by Goodman , 2011) . This idea that ginger relieves inflammation is followed by MNT(2015) who cite a number of studies including that from the University of Georgia who found that it could reduce exercise induced pain by a quarter. Balderin et al ( 2007) also refer to a quantity of earlier research and state that :- The main pharmacological actions of ginger and compounds isolated therefrom include immuno-modulatory, anti-tumorigenic, anti-inflammatory, anti-apoptotic, anti-hyperglycemic, anti-lipidemic and anti-emetic actions. Ginger is a strong anti-oxidant substance and may either mitigate or prevent generation of free radicals. It is considered a safe herbal medicine with only few and insignificant adverse/ side effects. WebMB (2015) list side effects and possible safety issues. In some cases these are unknown, as in the case of breast feeding mothers , when they suggest it is avoided. They do state that in conditions which produce bleeding ginger may exacerbate the bleeding as it increase bleeding times . If used in order to reduce blood sugar levels in diabetes there is a warning that medications may need to be readjusted, and it can also have negative effects on heart conditions. Aneja ( 2011) is cited by Rattue ( 2011) as having found that whole ginger extract has been shown to stop the growth of cancer cells and actually kills off a range of prostate cancer cells. She believes this to be because of a synergistic interplay between many the components of ginger. Shukla and Singh ( 2007, in a study looking at the cancer preventative properties of ginger , concluded that : - A number of mechanisms that may be involved in the chemo-preventive effects of ginger and its components have been reported from the laboratory studies in a wide range of experimental models. This is rather vague language. There are no statistics given, or exact descriptions. Unfortunately this type of vaguely scientific report is common when it comes to ginger. Everyone seems to agree that it works in positive ways, but how this works or which of many components contained in ginger is acting and how, and whether it only works in conjunction with other components or alone is still not known in most instances. The University of Maryland ( 2015) lists some 33 research projects which studied the action of ginger , such as that by Gonlachanvit et al ( 2003) which looked at how ‘ginger reduces hyperglycemia-evoked gastric dysrhythmias’. They also include a list of possible negative interactions with both over the counter and prescribed medications. It can for instance increase the blood thinning properties of drugs such as Aspirin and Warfarin ( Heck et al, 2000). In diabetes it can cause a lowering of blood sugar levels and so, if taken in excessive amounts can cause hypoglycaemia. In those taking anti –hypertension medications their actions can be enhanced, leading to low blood pressure and even arrhythmias. Russo ( 2000) gives an example of a surgery patient being asked if she was on any medication. Her answer was negative, but when asked if she took herbal medicines it was found that she was taking twelve herbal medicines on a daily basis. These were found to be having such an effect on her bleeding times that the surgery had to be postponed until the time she had rid her body of its effects. In 2001 Altman and Marcussen used at the use of both Alpina galanga and ginger in cases of osteoarthritis, specifically that of the knees. This was a short term ( six weeks) double blind trial involving 261 patients with pain from osteoarthritis of the knee. This was a placebo controlled, multicentre trial. They used a highly purified form of the two substances and these were found to have a definite but moderate effect on pain levels. Although they admit that some people had mild gastro intestinal side effects, with these being found more commonly in those taking ginger extract rather than in those who had been given placebo medication. It was also found that there was a decrease in taking rescue medications in those given ginger as compared to the control group, that is medications intended to relieve immediate pain rather than medication designed to prevent the pain developing. This is modern scientific research , but alongside it there are long held beliefs ( Brought to Life , undated) based on the ancient Greek idea of bodily humours in which the combinations of various humours contribute towards an individual’s temperament and health. The aim of the ancients was to maintain an internal harmony , and ginger, with its anti-inflammatory properties, was one of the tools used to do this, alongside changes in lifestyle, such as in diet and exercise. Modern practitioners of herbal medicine still recommend such things as ginger tea (Mihalovic, 2013). Kelly ( 2002) looked at how and why certain medications and treatments are classed as either orthodox or alternative or perhaps complementary , that is something which is used alongside orthodox western medicines and treatment interventions. She points out this is not a cut and dried matter with the British Medical Association in 1993 classifying herbal medications such as ginger as alternative medicines , whereas others such as Dunning et al ( 2001) counts them as being complementary medications. Ginger can definitely have an effect on human metabolism. In their study into the effects of ginger in cases of hyperemesis graviderum (having excessive nausea and vomiting during pregnancy ) where the majority of affected mothers found it beneficial, Fischer- Rasmussen et al ( 1991) mention that :- The possible mutagenic and antimutagenic characters of ginger reported in a study of E. coli have not been evaluated with respect to any significance in humans. This suggests that although many women use ginger to alleviate nausea in pregnancy , this should not be done in excessive doses. In 2014 Vijoen et al looked at both the effects and the safety of taking ginger in pregnancy, pointing out that some orthodox medications used to combat nausea are not suitable in pregnancy as they might affect the foetus. The intention of this particular research was both to assess the effectiveness of ginger in combating nausea in pregnancy , and also its safety during the period of pregnancy. This was a bibliographic study looking at controlled and randomised trials carried out at any stage in pregnancy. Ginger had a significantly positive effect when compared with placebos. It was also found that the side effects which occurred did not present any significant risks. This fits in with the way women have long used ginger, often in the form of ginger biscuits eaten first thing in the morning, in order to combat nausea in pregnancy. In contrast to these findings, both scientific research results and more anecdotal data, back in 1995 Arfeen et al found that, in gynaecological patients undergoing laparoscopic examination, that , in the dosages used, ginger was ineffective. Despite these negative findings Lien et al in 2006 found ginger to be very effective in treating motion sickness. This was only a small study involving 15 sufferers, but it was a double blind, placebo controlled and randomised study. They found the ginger put off the time before nausea occurred, and also helped to shorten any recovery time, as well as diminishing vasopressin production, so preventing hypertension. Leckridge ( 2004) describes how the current definitions of what is orthodox medicine and what is classed as complementary and alternative medicine (CAM) are determined culturally and politically. Leckridge describes several models of biomedical care including CAM. The author however believes that the three models, the market model, the assimilated model and the regulated model, should best be succeeded by a patient centred model, once which shifts the power away from medical therapists and towards the patients and would ‘support the development truly integrated medicine.’ however the medicines used are defined. On the same theme Barrett et al ( 2003) describe how herbal medicines such as ginger are always described as alternatives , so there is an implication of being second choice. They describe CAM as being more accessible and intuitive rather than deductive, but that this is not necessarily a negative quality. The authors state that it better reflects the ideas of ordinary people. They also state that :- More and better evidence is needed if CAM therapies are to be accepted by mainstream medicine. State-of-the-art research methods developed by conventional science will be needed to test CAM therapies. Conventional medicine, however, has much to learn from CAM. By incorporating a more holistic, empowering and accessible therapeutic approach, conventional medicine could build on its present legitimacy, and thereby enhance its power to "HEAL." Discussion Ginger is considered an alternative or herbal remedy in western medical circles. Nowadays though, its use has spread far beyond its historic homes and ginger is freely available in many forms right round the globe. This perhaps is why it has not been taken up by a major pharmacological company - they simply would not make money selling ginger which people can get elsewhere. With proper scientific research it can however be investigated and shown to have true value, and it would be arrogance on the part of western medicine to give it only a secondary place if it really is of real clinical value. The literature review above shows how valuable ginger might be pharmacologically. Despite this , as described by Balderin et al ( 2007) more studies are needed ‘on the kinetics of ginger and its constituents and on the effects of their consumption.’ over a long period of time. That is part of the problem in evaluating research into ginger - each research project seems to be looking at its effectiveness in different conditions, often dosages are varied, and in some instances only particular components are being tested so cannot be evaluated one along another. There is also the warnings about its use, as described by the Mayo clinic, although they do not cite actual research. Their report gives a long list of conditions in which ginger has a possible beneficial effect, but in many of these their verdict is ‘Insufficient evidence.’ So people are often relying on word of mouth , rumour almost, rather than actual scientific evidence , in at least some conditions in which it is often believed that ginger has a positive effect. Writers such as Mihalovic ( 2013) combine older ideas with more scientific and modern evidence, so he takes the idea of the 100 year old man who attributes his good health to ginger and put this alongside evidence from scientific research, such as the positive evidence about its success in cases of prostate cancer, which he does not give full references for. He seems to give his anecdotal evidence equal value with the scientific research cited. This comes alongside such researchers as Gregory et al, 2008, who mention ginger among other supplements as being unproven in its effects upon osteoarthritis and that by Arthritis Research UK ( 2013) who describe research into ginger and osteoarthritis. There were three groups involved, one given ginger, one Ibupofen and the third group were given a placebo. It was found that ginger did have a positive effect as an analgesic , but on the other hand Ibupofen was considered even more effective and it did not have the slight gastro-intestinal side-effects associated with taking ginger. So the results are rather muddy and unclear. There may or may not be a positive effect, or when there is it may not be the most effective substance. It is clear that not enough research has been done in humans for ginger to be given a high place pharmacologically as some of its supporters would like. Stevenson ( 2012) lists many studies in which components of ginger have been isolated and used, but seems to be convinced that , in many cases, using whole ginger, rather than isolated components, is not as effective. This however is a supposition rather than a carefully calculated clinical judgment. Gizanna et al ( 2005) identified ginger as being a herbal medicinal product, despite the fact that it shares a number of properties which produce pharmacological actions which are identical to those of non-steroidal anti-inflammatory drugs such as Ibuprofen and Aspirin. That is it can be used to relieve pain from a variety of causes such as period pain and headache. It can also be used to reduce inflammation (redness and swelling) which occurs as a response to injury or infection, and to lower a high temperature (fever) ( NHS Choices, undated). If it is to continue to be classed it as an alternative therapy, rather than as a pharmacological drug is this a cultural or political response, or is it because often the exact way in which the ginger is acting is not clear, as it would be in a modern laboratory designed medication from which a pharmacological company can make a large amount of money? Conclusion Much of the data mentioned above is laboratory based, often using test animals, rather than because of testing in humans in double blind trials, preferably large and long term. Other statements are anecdotal, and based on very ancient beliefs such as the doctrine of humours, which are no longer accepted by modern scientific research. The more scientific studies tend on the whole to be quite short in duration or involve only small numbers of participants, sometimes both. Taken together these facts mean that research is still in its early stages, and yet there are positive signs, such as its effects on cancer cells in laboratory situations. This means that further research is required. The result of further investigations, especially properly conducted blind trials among humans with a variety of conditions, could mean that ginger eventually moves from a purely alternative remedy into a modern day pharmacological remedy backed by long term, careful studies and scientific data. Meanwhile people will continue to believe in its efficacy and use ginger regularly. References Ali B., Blunden G, Tanira M., Nemmar A., (2008), Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscoe): a review of recent research. Food and Chemical Toxicology. 2008; 46(2):409-20. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17950516 Altman R. and Marcussen K.( 2001). 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Y., (2012), Improvement of Liquid Fructose-Induced Adipose Tissue Insulin Resistance by Ginger Treatment in Rats Is Associated with Suppression of Adipose Macrophage-Related Pro- inflammatory Cytokines. Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2013, University of Maryland Medical Center, (2015), Ginger, Retrieved from http://umm.edu/health/medical/altmed/herb/ginger Viljoen E., Visser,J., Koen,N. and Musekiwa, A., (2014), A systematic review and meta- analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting, Nutritional Journal, vo. 13, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995184/ WebMB, (2015), Ginger Side Effects and Safety , Retrieved from http://www.webmd.com/vitamins-supplements/ingredientmono-961- GINGER.aspx?activeIngredientId=961&activeIngredientName=GINGER Extra Reading Apariman S, Ratchanon S, Wiriyasirivej B. (2006), Effectiveness of ginger for prevention of nausea and vomiting after gynecological laparoscopy. Journal of the Medical Association of Thailand, ;89(12):2003-9.Cite Seer x Retrieved from http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.561.5190 Bone M., Wilkinson D., Young J., McNeil J, Charlton S.( 1990). Ginger root -- a new antiemetic. The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia.;45(8):669-71. Chaiyakunapruk N. ( 2006). The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. American Journal of Obstetric Gynaecology 194(1):95-9. Fuhrman B, Rosenblat M, Hayek T, Coleman R, Aviram M., (2000) Ginger extract consumption reduces plasma cholesterol, inhibits LDL oxidation, and attenuates development of atherosclerosis in atherosclerotic, apolipoprotein E-deficient mice. Journal of Nutrition , 130(5):1124-1131. Griffenhagen G. (1992) Materia medica of Christopher Columbus. Pharmacy in History (USA) 1992;34:131-145. Gujral S, Bhumra H, and Swaroop M. (1978) Effect of ginger (Zingebar officinate roscoe) oleoresin on serum and hepatic cholesterol levels in cholesterol fed rats. Nut Report International 17:183-189. Janngam, J.( 2003), The efficacy of ginger in prevention of postoperative nausea and vomiting after intrathecal morphine for lower extremity surgery [master's thesis]. Krutzfeldt K.(2003) Ginger - heavenly fire. AZ Deutsche Apotheker-Zeitung (Germany) 143:83-91. Larkin M. (1999), Surgery patients at risk for herb-anaesthesia interactions. Lancet.;354(9187):1362. Leach M. and Kumar S.(2008), The clinical effectiveness of ginger (zingiber officinale) in adults with osteoarthritis. International Journal of Evidence-Based Healthcare;6:311-320. Phillips S, Ruggier R, Hutchinson S., (1993), Zingiber officinale (ginger) -- an antiemetic for day case surgery. Anaesthesia. ;48(8):715-717. Read More