General Features
Ginger is native to southern Asia and has been used as food and medicine in many areas of the world for
millennia. 16 The knotted and branched rhizome, commonly called the “root” is the portion of Ginger used for
culinary and medicinal purposes. 1,13,16 Ginger’s modern day use dates back to the early 1980’s when a scientist
named D. Mowrey noticed that the Ginger-filled capsules reduced his nausea during an episode of flu. 16
Principle Active Constituents
The rhizome of the plant contains approximately 1 – 4% volatile oils, which are the aromatic constituents (zingiberene
and bisabolene) that are responsible for Ginger’s characteristic odor and taste. Its more pungent constituents are
known as gingerols and shogaols, which are the agents credited with Ginger’s anti-nausea and anti-vomiting effects.
The gingerols are a collective group of aromatic ketones. The pungent principles are thought to be the most
pharmacologically active components of Ginger.1,17
Clinical Application and Mechanism of Action
1. Motion Sickness, Nausea, and Vomiting
Ginger is thought to act directly on the intestinal system to reduce nausea. 18 This is in contrast to anti-nausea
medications that act on the brain and inner ear.19 Its action has been shown to partially inhibit the excessive gastric
motility characteristics of motion sickness. 13
Several studies have demonstrated that Ginger supplementation can be effective to control motion sickness, nausea,
and vomiting. In one study involving women with morning sickness, 250 mg of Ginger powder was taken four times
per day and was shown to be very effective in a trial of 27 patients, during the early stages of pregnancy. However,
several animal studies have demonstrated that Ginger can cause mutagenic changes in vitro and thus, Ginger is
contraindicated during pregnancy within the traditional Chinese medical model and as reported in the German
Commission E Monographs. Its safety during pregnancy is still in question. Current thinking suggests that a pregnant
woman should not exceed a daily dose of 1,000 mg of Ginger, used for a short time interval, and she must seek
clearance from her attending physician prior to starting this supplementation regime.1,2,3,4,5
Other studies have also provided convincing evidence of Ginger’s anti-nausea (anti-emetic) effects. A double-blind
placebo-controlled trial of 79 Swedish naval cadets showed that 1 gm of Ginger could decrease nausea and vertigo at
sea. 20,4 Another double-blind trial aboard a ship showed that Ginger was equally as effective as various medications
(cinnarizine, cinnarizine with domeperdone, cyclizine, dimehydrinate with caffeine, meclozine with caffeine, and
scopolamine) in controlling seasickness, in a large study of 1,489 individuals. 21 In another study of 60 passengers
aboard a ship, 500 mg of Ginger taken every 4 hours was shown to be as effective as the drug dimenhydrinate at 100
mg, every 4 hours, as a means to control nausea and vomiting (seasickness). 22 A study comparing Ginger to the drug
dimenhydrinate, and a placebo, also showed that Ginger was an effective means to reduce nausea and vomiting. 2,23
In general, most, but not all, studies have shown Ginger to be effective as an anti-nausea and anti-vomiting
intervention.13,14,15,16 It has even been used successfully in some cases to reduce nausea and vomiting in patients
recovering from surgery and patients receiving chemotherapy treatment. 24,25
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2. Anti-inflammatory Effects in Arthritis
Ginger has been shown to posses anti-inflammatory properties and has been effective in several small studies to
control pain and inflammation in patients with a variety of arthritic and musculoskeletal inflammatory conditions. 10,26
Experimental investigations suggest that Ginger inhibits the synthesis of pro-inflammatory prostaglandins, by inhibiting
both the cyclo-oxygenase and 5-lipoxygenase enzymes. 7,8,9,10 It also has antioxidant properties and contains
protease enzymes, which may add to its anti-inflammatory properties. 13 In a study of 56 patients (28 with rheumatoid
arthritis, 18 with osteoarthritis and10 with muscular discomfort), Ginger supplementation was effective in reducing pain
and inflammation in three-quarters of the arthritis patients and all of the patients with muscular discomfort. No adverse
side effects were reported in these patients who were followed for up to 2.5 years. 10 Experimental evidence is strong
to illustrate the anti-inflammatory activities of Ginger. 1,2,3,4,5
An interesting side note is that in contrast to anti-inflammatory drugs (aspirin, ibuprofen, COX-2 inhibitors and other
non steroidal anti-inflammatory medications) that are known to cause erosion and ulceration (sometimes internal
bleeding) of the intestinal tract, Ginger has been shown to protect the stomach from the damaging effects of alcohol,
non steroidal anti-inflammatory drugs and, may help prevent peptic ulcers. 27
3. Migraines
Ginger may also help to prevent the recurrence of migraines due to its anti-inflammatory and anti-platelet aggregation
properties.1 However, greater substantial evidence exists for the herb feverfew as a daily preventive supplement for
migraine prevention (see Feverfew in this document).
Dosage and Standardized Grade
1. Motion sickness, Nausea and Vomiting: 1-2 gms per day of dry powdered Ginger or Ginger capsules (e.g., 500
mg, 2–4 times per day) for nausea, vomiting, motion sickness has been used successfully. This is equivalent to
approximately 10 grams or one-third of an ounce of fresh Ginger root (1/4 inch slice). The most current research
suggests that Ginger should be standardized to contain at least 5% gingerols per dose and/or 4% volatile oils.
13,14,15,16
2. Arthritis and Musculoskeletal Inflammatory Conditions: Studies show that if used as a sole anti-inflammatory
intervention that the daily dosage can range from 1,000 mg to 4,000 mg per day, based upon the dose required to
reduce symptoms. 13,26
Adverse Side Effects, Toxicity and Contraindications
Side effects from Ginger supplementation are rare when taken at recommended doses, and include heartburn and
intolerance to the taste of Ginger. At 6 gms per day, Ginger may cause GI irritation to an empty stomach due to
increased exfoliation of gastric epithelial cells. This could lead to ulcer formation if taken at a high dose for an
extended period.13,14,15,16
It is not advisable at this time for pregnant women to use Ginger without their physician’s consent, to reduce symptoms
of morning sickness as recent experimental studies have indicated that Ginger may produce mutagenic changes in
DNA. 14 In otherwise healthy individuals, Ginger has been shown to be very non-toxic13 Ginger has been shown to
inhibit blood coagulation in experimental studies, but no evidence of this effect has been found in humans, as indicated
by a number of European studies. 9,28,29
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Drug-Nutrient Interactions
Anticoagulant Medications (e.g., Aspirin, warfarin, coumadin, heparin, Plavix, Ticlid, Trental): As test tube experiments
show that Ginger may reduce platelet clotting it may potentiate the activity of anticoagulant drugs, although no
evidence of an anti-clotting effect for Ginger has been found in humans. Nevertheless, the patient’s prothrombin time
(INR) should be monitored if Ginger is to be taken concurrently with any anti-coagulant drug, to guard against a
potential bleeding disorder. 30,31,32
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insufficient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Boon H and Smith M, Health Care Professional Training Program in Complementary Medicine, Institute of Applied Complementary
Medicine Inc., 1997.
2. Mowrey D and Clayson D, Motion Sickness, Ginger, and Psychophysics, Lancet I, 1982, 655-657.
3. Stewart JJ, et.al., Effects of ginger on Motion Sickness Susceptibility and Gastric Function, Pharmacology 42, 1991, 111-120.
4. Grontved A, et.al., Ginger Root Against Seasickness – A Controlled Trial on the Open Sea, Acta Otalaryngol 105, 1988, 45-49.
5. Fischer-Rasmussen W, et.al., Ginger Treatment of Hyperemesis Gravidarum, Eur J Obstet Gynecol Reprod Biol 38, 1990, 19-24.
6. Bone ME, et.al., Ginger Root-a New Antiemetic: The Effect of Ginger Root on Postoperative nausea and Vomiting After Major
Gynecological Surgery, Anaesthesia 45, 1990, 669-671.
7. Kiuchi F, et.al., Inhibition of Prostaglandin and Leukotriene Biosynthesis by Gingerols and Diaryheptanoids, Chem Pharm Bull 40,
1992, 387-391.
8. Kuichi F, Shibuyu M, and Sankawa U, Inhibitors of Prostaglandin Biosyntheses from Ginger, Chem Pharm Bull 30, 1982, 754-757.
9. Srivastava KC, Isolation and Effects of Some Ginger Components on Platelet Aggregation and Eicosanoid Biosyntheses,
Prostaglandin Leurotrienes Med 25, 1986, 187-198.
10. Srivastava KC and Mustafa T, Ginger (Zingiber Officinale) and Rheumatice Disorders, Med Hypotheses 39, 1992, 342-348.
11. Srivastava KC and Mustafa T, Ginger (Zingiber Officinale) in Rheumatism and Muscoloskeltel Disorders, Med Hypotheses 39, 1992,
342-348.
12. Mustafa T and Srivastava KC, Ginger (Zingiber Officinale) in Migraine Headaches, J Ethnopharmacol 29, 1990, 267-273.
13. Murray MT, The Healing Power of Herbs (2nd edition), Prima Publishing, 1995.
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14. Healthnotes, Inc.2001 www.healthnotes.com: Ginger
15. Dietary Supplement Information Bureau. www.content.intramedicine.com: Ginger
16. Natural Products Encyclopedia. www.consumerslab.com: Ginger
17. Tyler VE. Herbs of Choice: the Therapeutic Use of Phytomedicinals. Binghampton, NY: Pharaceutical Products Press 1994: 39-42
18. Holtmann S, Clarke AH, Scherer H, Hohn M. The anti-motion sickness mechanism of ginger. A comparative study with placebo and
dimenhydrinate. Acta Otolaryngol (Stockh) 1989;108:168-74
19. Holtmann S, Clarke AH, Scherer H et al. The anti-motion sickness mechanism of ginger. Acta Otolaryngol 1989;108:168-74
20. Bradley PR (ed.). British Herbal Compendium, vol 1. Bournemouth, Dorset, UK: British Herbal Medicine Association, 1992:112-4
21. Schmid R, Schick T, Steffen R et al. Comparison of seven commonly used agents for prophylaxis of seasickness. J Travel Med
1994;1:203-6
22. Riebenfeld D, Borzone L. Ranomized double-blind study comparing ginger (ZintonaW) and dimenhydrinate in motion sickness.
Healthnotes Rev 1999;6:98-101
23. Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York, NY: Pharmaceutical Products Press; 1994:p42
24. Phillips S, Hutchinson S, Ruggier R. Zingiber officinale (ginger) – An antiemetic for day case surgery. Anaesthesia 1993;48:715-7
25. Meyer K, Schwartz J, Craer D, Keyes B. Zingiber officinale (ginger) used to prevent 8-Mop associated nausea. Dermatol Nursing
1995;7:242-4
26. Srivastava KC, Mustafa T. Ginger (Zingiver officinale) in rheymatism and musculoskeletal disorders. Med hypotheses December
1992;39(4):342-8
27. al-Yahya MA, Rafatullah S, Mossa JS et al. Gastroprotective activity of finger in albino rats. Am J Chinese Med 1989;17:51-6
28. Srivastava KC. Effects of aqueous extracts of onion, garlic and ginger on platelet aggreagation and metabolism of arachidonic acid
in the blood vascular system: in vitro study. Prostaglandins Leukoit Med 1984;13:227-35
29. Srivastava KC. Effect of onion and ginger consumption on platelet thromboxane production in humans. Prostaglandins Leukot
Essent Fatty Acids 1989;35:183-5
30. Suekawa M et al. Pharmacological studies on Ginger. I. Pharmacological actions of pungent constitutents, (6)-gingerol and (6)-
shogaol. J Pharmacobiodyn 1984;7(11):836-48
31. Guh JH et al. Antiplatelet effect of gingerol isolated from zingiber officinalte. J Pharm Pharmacol 1995;47(4):329-32
32. Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc.) and fenugreek (Trigonella foenumgraecum L.) on
blood lipids, blood sugar and platelet aggregation in patient swith coronary artery disease. Prostaglandins Leukot Essent Fatty
Acids. May 1997;56(5):379-84
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Ginkgo Biloba
General Features
Ginkgo Biloba is a deciduous tree that lives as long as 1,000 years and may grow to a height of 100-122 feet.
Extracts from the leaves are used medicinally.1 It is the world’s oldest living tree species, traceable back 300
million years.1,38 Presently, ginkgo is the most wisely prescribed herb in Germany, reaching a total prescription
count of over 6 million in 1995. German physicians consider it to be as effective as any other drug treatment for
Alzheimer’s disease and other severe forms of memory and mental function decline. 38
Principle Active Constituents
Ginkgo flavones
Ginkgolides and bilobalide – terpene molecules unique to ginkgo.
Ginkgo Biloba extract is standardized to contain 24 percent flavonoid glycosides, as these molecules represent a
convenient analytical reference group.
The three major back bone flavonoids include:
Quercetin
Kaempferol
Isorhamnetine
It also contains other flavonoid components such as proanthocyanidins. The ginkgolides and bilobalides account for
6% of Ginkgo Biloba Extract.1,2
Clinical Application and Mechanism of Action
1. Age-related Mental Decline and Memory Impairment
A large number of well-controlled clinical trials have established that Ginkgo Biloba extract is an effective intervention
in the management of Age-related Cognitive Decline (ARCD) and other conditions involving memory loss. A review of
this evidence was reported in Lancet in 1992, which noted that of 40 double-blind controlled trials evaluating the
efficacy of Ginkgo Biloba Extract, eight of these trials were rated of good quality, involving a total patient population of
1,000 subjects. Seven of the eight studies showed very good results and the authors of the article indicated that the
evidence was strong enough to conclude that Ginkgo Biloba Extract is an effective treatment for ARCD. Most studies
reported since 1992 have supported this conclusion, both in people with Alzheimer’s disease and other patients with
age-related memory impairment. 38 A placebo-controlled study published in the Journal of the American Medical
Association in 1997, involving over 300 patients with Alzheimer’s disease, revealed that Ginkgo Biloba Extract
significantly improved patient outcomes compared to the placebo group. This was the first North American study using
Ginkgo Biloba, which has helped to establish Ginkgo as a credible intervention for Alzheimer’s patients and other
cognitive-impaired subjects, in the mind of some members of the medical community. In this study, Ginkgo Biloba
Extract taken at 40 mg, three times daily, was shown to stabilize a large number of Alzheimer’s patients, improving the
cognitive performance and the social functioning of demented patients during a 6-month to one -year period. 30 A
1998 quantitative analytical review of ginkgo studies, published in the Archives of Neurology, reported that Ginkgo
Biloba Extract exhibits a small, but significant effect within a 3 – 6 month treatment course, using 120 – 240 mg per
day, on objective measurements of cognitive function in Alzheimer’s disease. According to this review, Ginkgo Biloba
Extract has not shown any significant adverse side effects in formal trials, but there are two case reports of bleeding
complications (e.g.,sub-dural hematoma) with the use of ginkgo. 31
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2. Prevention of Memory Loss and Enhanced Memory in Healthy Subjects
Several recent studies have evaluated the ability of ginkgo to prevent age-related memory loss, and to enhance the
memory of otherwise healthy young subjects. A 30 day double-blind placebo-controlled study, following 50 healthy
men and women (18 – 40 years of age ), demonstrated that 120 mg per day of Ginkgo Biloba Extract resulted in
significant improvement in some measures of memory function. A double-blind study of 26 subjects found that a single
dose of 120 mg of Ginkgo Biloba Extract improved short-term memory, especially in people over 50 years of age. In a
double-blind placebo-controlled crossover trial involving 20 individuals aged 19 – 24 years, a one time dose of Ginkgo
Biloba Extract at 120, 240, or 360 mg resulted in improvement of mental-performance, most dramatically in one test
that measured ability to rapidly perform attention-related tasks. A smaller trial involving eight subjects (25 – 40 years
of age) found some improvement in short-term memory with a single dosing of Ginkgo Biloba Extract at 60 mg, but not
at lower levels of intake. However, not all studies with younger patients have shown an improvement in memory
function and larger, more long-term trials are required before Ginkgo can be recommended with confidence for this
application. 38
Mechanism of Action
Experimental evidence has suggested that the active constituents in Ginkgo Biloba are able to improve memory and
other aspects of cognitive function via the following actions:
Decreased Platelet Aggregation – Due to its antioxidant effects, increased synthesis of prostacyclin and
antagonism of platelet-activating factor (PAF), Ginkgo Biloba Extract has been shown to improve blood flow to
deeper centers of the brain, allowing a greater concentration of nutrients to reach these brain cells. This appears
to have important considerations in cases of cognitive impairment due to cerebral vascular insufficiency.
Decreased Lipid Peroxidation of Cellular Membranes of Red Blood Cells (which carry oxygen) and Nerve Cells
(enhancing depolarization capacity and transmission of impulses) - Brain cells contain the highest percentage of
unsaturated fatty acids in their membranes than any other cells in the body. This makes them extremely
susceptible to free radical damage as unsaturated fatty acids contain double bonds, which are easily broken by
free radicals in search of an electron. Ginkgo Biloba Extract, through its antioxidant capabilities, has been shown
to prevent free radical damage to these structures, blocking lipid peroxidation and preserving the integrity of nerve
cell membranes. This may help preserve or improve the transmission of nerve impulses from one nerve cell to
the next, enabling better communication to occur among brain cells.
Improves Synthesis and Turnover of Brain Neurotransmitters, and Normalizes Acetylcholine Receptors in the
Hippocampus (the area of the brain most affected by Alzheimer’s disease) – Evidence exists to show that Ginkgo
Biloba Extract can enhance the synthesis of the memory chemical acetylcholine, and improve its ability to relay
important chemical signals to other nerve cells in key areas of the brain that are af ected in Alzheimer’s disease,
and ARCD.
Vasodilation Action – Ginkgo Biloba Extract has been shown to cause the release of endothelium-derived relaxing
factor (EDRF) and prostacyclin (a beneficial prostaglandin). The release of these bioactive agents within the body
results in increased blood circulation and nutrient delivery to brain cells. 3 - 21
Direct Stimulation of Nerve Cell Activity – Recent evidence suggests that like other drugs used for the treatment
of dementia, Ginkgo Biloba Extract appears to directly stimulate nerve cell activity and in various ways protects
nerve cells from further injury. 38
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1. Senile Macular Degeneration and Diabetic Retinopathy
Preliminary studies indicate that Ginkgo Biloba Extract may be beneficial in the management of macular degeneration
and diabetic retinopathy. 22, 38 Ginkgo’s antioxidant properties and its ability to improve blood flow through the tiny
blood vessels in the macular region of the eye, may be of value in preserving vision in these patients. 22 Other
synergistic nutrients for this condition include the antioxidants, Vitamin E, Vitamin C, Beta-carotene and zinc, the
herbal agent bilberry, and the accessory nutrient grape seed extract (see details in related sections of this document).
2. Peripheral Artery Insufficiency (i.e., intermittent claudication due to atherosclerosis)
Due to its ability to improve microcirculation, Ginkgo Biloba Extract has been shown to improve blood flow, and reduce
pain (pain-free walking distance), in at least 10 studies involving patients with peripheral vascular insufficiency.23 A
review the American Journal of Medicine (2000) indicates that eight double-blind placebo-controlled trials, provide
evidence that Ginkgo can significantly increase pain-free walking distance in these patients. 38
3. Altitude Sickness
Exposure to high altitudes and cold conditions can cause vertigo, insomnia, shortness of breath, headache, as well as
pain and numbness in the extremities. A single double-blind study of 44 mountain climbers demonstrated that 160 mg
per day of Ginkgo Biloba Extract helped prevent many of these symptoms upon expedition in the Himalayan mountain
range. 38
4. Vertigo (dizziness)
70 patients suffering from vertigo were given 160 mg of Ginkgo Biloba Extract daily or a placebo for three consecutive
months. Results showed that the group given Ginkgo had a 47% recovery rate as compared to 18% in the