Food as Medicine Ginger (Zingiber officinale, Zingiberaceae)

HerbalEGram: Volume 12, Issue 3, March 2015 Editor’s Note: Each month, HerbalEGram will highlight a conventional food and briefly explores its history, traditional uses, nutritional profile, and modern medicinal research. We also feature a nutritious recipe for an easy-to-prepare dish with each article to encourage readers to experience the extensive benefits of these whole foods. With this series, we hope our readers will gain a new appreciation for the foods they see at the supermarket and frequently include in their diets. The basic materials for this series were compiled by dietetic interns from Texas State University in San Marcos and the University of Texas at Austin through the American Botanical Council’s (ABC’s) Dietetic Internship Program, led by ABC Education Coordinator Jenny Perez. We would like to acknowledge Perez, ABC Special Projects Director Gayle Engels, and ABC Chief Science Officer Stefan Gafner, PhD, for their contributions to this project. By Hannah Baumana and Kelly Hillb a HerbalGram Assistant Editor b ABC Dietetics Intern (TSU, 2014) History and Traditional Use Range and Habitat Ginger (Zingiber officinale, Zingiberaceae) is a tropical perennial herb native to Southeast Asia and widely cultivated in China, India, Nigeria, Australia, Jamaica, and Haiti.1 Its subterranean stem, known as a rhizome, is the edible and medicinal portion of the plant.2 Ginger root is characterized by its knotted, beige exterior and its yellow interior. The herb features thick, protruding, reed-like3 stems and lanceolate leaves arranged in two vertical columns on opposite sides of the stem.4 Seasonally unfurling from ginger’s leaves are dense, ovoid-shaped flower structures that produce yellow-green flowers with a deep purple, yellow-marked lip.3 Ginger plants can have an indefinite spread in tropical climates, though it is susceptible to pests and disease.5 The flavor of ginger is described as sweet and peppery with a prominent spicy aroma due to the presence of gingerols and ketones.6 Phytochemicals and Constituents Thus far, researchers have identified 115 chemical components in a variety of dried and fresh ginger types.6 The most important phenolic elements of the ginger root are gingerols and their ginger-related composites — paradols, zingerone, and shogaols.6,7 Gingerols are the most abundant constituents of fresh ginger6; the three other phenolic compounds are not as plentiful. When gingerols are cooked or dried, they transform into various bioactive compounds,6 many of which have beneficial antioxidant, anti-inflammatory, and anticarcinogenic properties.7 Research suggests that the optimal dosage of ginger ranges from 250 mg to 4.8 g per day of fresh or dried rhizomes.6,8 Other dosages for ginger intake vary depending on the form in which they are consumed and the purpose for which they are intended.8 Historical and Commercial Uses In India, ginger has been used as a flavoring agent in food and beverage preparations as well as in traditional Ayurveda medicinal practices.4 Historically, it was regarded as the mahaoushadha (“the great medicine”) among ancient Indians.9 Fresh and dried ginger is used commonly in Ayurvedic medicine for the treatment of ailments such as indigestion, fever, and digestive disorders.8 Fresh ginger is thought to be beneficial in reducing nausea and vomiting due to the presence of shogaol, and dried ginger has been shown to alleviate chronic respiratory conditions.10 In addition, gingerol, the most predominate pungent bioactive compound of ginger, has been reported to stimulate digestive enzymes to help improve gastrointestinal (GI) issues. In Traditional Chinese Medicine, fresh ginger root (sheng jiang) is considered warm and pungent and recognized for dispersing cold within the stomach, which contributes to the treatment of nausea and vomiting.11 It also is acknowledged as an expeller of exterior cold, quelling inflammation of the stomach and infections related to the cold and flu. Dry ginger (gan jiang) is considered to be more hot and pungent than fresh ginger, and it is responsible for dispersing cold in the spleen region, thereby alleviating ailments such as diarrhea and poor appetite. Quick-fried ginger (pao jiang) is warm and bitter and used to treat symptoms associated with conditions such as dysmenorrhea and diarrhea. Asian cuisine features ginger in a number of dishes for flavoring, including soups, curries, rice dishes, stir-fries, and sauces.12 It is believed that both the Chinese and Indians have used ginger root for medicinal purposes for more than 5,000 years; however, the exact origin is unknown.6 Highly prized for its medicinal properties, ginger was a popular trading commodity exported to the Roman Empire more than 2,000 years ago from India. (Anecdotally, Queen Elizabeth I of England is credited with the creation of the gingerbread man, which evolved into a popular treat consumed during the Christmas holidays.) Ginger is used commercially in a variety of forms, including, but not limited to, fresh, dried, and candied.6 The age of the ginger plant determines its culinary and medicinal use. Young ginger root harvested at five months has not matured and typically has a mild flavor, suitable to be used fresh. At nine months, ginger characteristically has a thick skin and pungent root, from which the volatile oils can be extracted. This material also is used in dried or ground form as a spice and in commercial baking products. Further, ginger is added as a flavoring to a number of different beverages such as ginger ale, ginger beer, and ginger wine.12 Modern Research A considerable amount of research demonstrates and supports the significant health benefits of ginger. The majority of clinical evidence for ginger’s medicinal properties is related to nausea caused by pregnancy or chemotherapy.13 Three clinical studies have explored the effects of ginger in reducing chemotherapy-induced nausea in young adults and children.14-16 The results from these studies indicated that ginger is effective in decreasing chemotherapy-induced nausea and vomiting. More specifically, one trial indicated that supplementing with ginger (0.5 g to 1.0 g liquid ginger root extract) reduces nausea.16 In a separate study, researchers observed reductions in the prevalence of nausea in patients with breast cancer when 1.5 g powdered dried ginger root was added to an antiemetic therapy following chemotherapy.14 Another clinical study observed the effects of powdered ginger in patients with intra- and postoperative nausea accompanying Cesarean sections.17 The results indicated that episodes of intraoperative nausea were reduced when ginger was administered orally. However, ginger did not have an effect on the overall incidence of intraoperative nausea and vomiting. Ginger has been explored as a possible treatment for other GI issues such as dyspepsia, gastric emptying, and irritable bowel syndrome (IBS).18-20 The authors of one clinical study tested the effects of ginger on functional dyspepsia and gastric motility.18 The results indicated that ginger increased gastric emptying more rapidly than the placebo; however, ginger did not influence any GI symptoms. Researchers of a related clinical trial examined ginger’s effects on IBS over a period of 28 days.20 The results indicated that the group taking 1 g of ginger had a 26.4% reduction in symptoms. Studies have shown that ginger may be beneficial for non-GI-related conditions as well. In two separate clinical studies, researchers explored ginger’s mitigating impact on dysmenorrhea. The first study was conducted for a period of three days based on reports of pain experienced during the first two days of menstruation each month.21 The results suggested that ginger had more of an impact on dysmenorrhea symptoms compared to muscle-relaxation exercises. A similar clinical study found that at the end of the study period, 82.85% of the participants in the experimental group reported symptom improvement compared to 47.05% of the participants in the placebo group.22 Three clinical studies have examined the effects of ginger in the treatment of colorectal cancer.7,23,24 As noted, the bioactive compounds of ginger contain antioxidant, anti-inflammatory, and anticarcinogenic properties, which can interfere with pathways responsible for cancer development.7 The results of all three studies demonstrated that an intake of 2 g of ginger root was able to reduce proliferation in the colorectal epithelium. Further, one trial illustrated that ginger simultaneously increased apoptosis (normal, programmed cell death) and differentiation.7 Ginger also exhibited an anti-inflammatory effect in individuals of normal risk and lowered COX-1 in individuals at higher risk.23,24 Other clinical studies have explored the effects of ginger in relation to muscle pain, respiratory distress syndrome, chronic lower-back pain, satiety, migraines, osteoarthritis, and type 2 diabetes.25-32 Nutrient Profile33 Macronutrient Profile: (Per 1 tablespoon [6 g] raw ginger) 5 calories 0.11 g protein 1.07 g carbohydrate 0.04 g fat Secondary Metabolites: (Per 1 tablespoon [6 g] raw ginger) Good source of: Magnesium: 3 mg (0.75% DV) Potassium: 25 mg (0.7% DV) Vitamin B6: 0.01 mg (0.5% DV) Vitamin C: 0.3 mg (0.5% DV) Dietary Fiber: 0.1 g (0.4% DV) Folate: 1 mcg (0.25% DV) Niacin: 0.05 mg (0.25% DV) Phosphorus: 2 mg (0.2% DV) Calcium: 1 mg (0.1% DV) DV = Daily Value as established by the US Food and Drug Administration, based on a 2,000 calorie diet. Recipe: Candied Ginger Ingredients: 1 cup fresh ginger root 3 cups water 3 cups granulated sugar, plus additional for coating Directions: 1. Spray a cooling rack with nonstick spray and set it in a sheet pan lined with wax paper. 2. Peel and thinly slice the ginger root. 3. Bring sugar and water to a boil in a saucepan. When the sugar is dissolved, add the ginger and simmer for 30 to 45 minutes, until ginger is tender. 4. Drain the ginger and reserve the liquid for another use. (The reserved liquid can be further reduced to make ginger syrup or added to drinks.) Spread the ginger on the cooling rack in a single layer and dry for 30 minutes. 5. Once dry, toss ginger slices with additional sugar to coat. Store in an airtight container. References Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Austin, TX: American Botanical Council and Newton, MA: Integrative Medicine Communications; 2000. Webb GP. Dietary Supplements and Functional Foods. West Sussex, UK: Blackwell Publishing; 2011. Bown D. The Herb Society of America New Encyclopedia of Herbs and Their Uses. London, UK: Dorling Kindersley Ltd.; 2001. Ginger. University of Maryland Medical Center website. Available here. Accessed February 23, 2015. Ginger Root Production in Hawaii. Hawaii Cooperative Extension Service website. Available here. Accessed February 23, 2015. Bode AM, Dong Z. Herbal Medicine: Biomolecular and Clinical Aspects. Boca Raton, FL: CRC Press; 2011. Citronberg J, Bostick R, Ahearn T, et al. Effects of ginger supplementation on cell-cycle biomarkers in the normal-appearing colonic mucosa of patients at increased risk for colorectal cancer: results from a pilot, randomized, and controlled trial. Cancer Prev Res. 2013;6(4):271-281. Blumenthal M, Hall T, Goldberg A, Kunz T, Dinda K, Brinckmann J, et al, eds. The ABC Clinical Guide to Herbs. Austin, TX: American Botanical Council; 2003. Ravindran PN, Babu KN. Ginger: the Genus Zingiber. Boca Raton, FL: CRC Press; 2005. Ginger – Ayurveda “Root” to Good Health. Kerala – Home of Ayurveda website. Available here. Accessed March 4, 2015.. Yang Y. Chinese Herbal Medicine Comparisons and Characteristics. London, UK: Churchill Livingston; 2002. Van Wyk BE. Food Plants of the World. Portland, OR: Timber Press; 2006. Weimer K, Schulte J, Maichle A, et al. Effects of ginger and expectations on symptoms of nausea in a balanced placebo design. PLoS One. 2012;7(11):e49031. Panahi Y, Saadat A, Sahebkar A, Hashemian F, Taghikhani M, Abolhasani E. Effect of ginger on acute and delayed chemotherapy-induced nausea and vomiting: a pilot, randomized, open-label clinical trial. Integr Cancer Ther. 2012;11(3):204-211. Pillai AK, Sharma KK, Gupta YK, Bakhshi S. Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer. 2011;56(2):234-238. Ryan JL, Heckler CE, Roscoe J, et al. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer. 2012;20(7):1479-1489. Kalava A, Darji SJ, Kalstein A, Yarmush JM, SchianodiCola J, Weinberg J. Efficacy of ginger on intraoperative and postoperative nausea and vomiting in elective cesarean section patients. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):184-188. Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, et al. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011;17(11):105-110. Shariatpanahi ZV, Taleban FA, Mokhtari M, Shahbazi S. Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in adult respiratory distress syndrome patients hospitalized in an intensive care unit. J Crit Care. 2010;25(4):647-50. Van Tilburg MA, Palsson OS, Ringel Y, Whitehead WE. Is ginger effective for the treatment of irritable bowel syndrome? A double blind randomized controlled pilot trial. Complement Ther Med. 2014;22(1):17-20. Halder A. Effect of progressive muscle relaxation versus intake of ginger powder on dysmenorrhoea amongst the nursing students in Pune. Nurs J India. 2012:103(4)152-157. Jenabi E. The effect of ginger for relieving of primary dysmenorrhoea. J Pak Med Assoc. 2013;63(1):8-10. Jiang Y, Turgeon DK, Wright BD, Sidahmed E, Ruffin MT, Brenner DE, Sen A, Zick S. Effect of ginger root on cyclooxygenase-1 and 15-hydroxyprostaglandin dehydrongenase expression in colonic mucosa of human at normal and increased risk of colorectal cancer. Eur J Cancer Prev. 2013;22(5):455-460. Zick SM, Turgeon DK, Vareed SK, et al. Phase II study of the effects of ginger root extract on eicosanoids in colon mucosa in people at normal risk for colorectal cancer. Cancer Prev Res. 2011;4(11):1929-1937. Black CD, Herring MP, Hurley DJ, O’Connor PJ. Ginger (Zingiber officinale) reduces muscle pain caused by eccentric exercise. J Pain. 2010;11(9):894-903. Cady RK, Goldstein J, Nett R, Mitchell R, Beach ME, Browning R. A double-blind placebo-controlled pilot study of sublingual feverfew and ginger in the treatment of migraine. Headache. 2011;51(7):1078-1086. Drozdov VN, Kim V a, Tkachenko E V, Varvanina GG. Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip. J Altern Complement Med. 2012;18(6):583-588. Mozaffari-Khosravi H, Talaei B, Jalali B-A, Najarzadeh A, Mozayan MR. The effect of ginger powder supplementation on insulin resistance and glycemic indices in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial. Complement Ther Med. 2014;22(1):9-16. Mansour MS, Ni Y-M, Roberts AL, Kelleman M, Roychoudhury A, St-Onge M-P. Ginger consumption enhances the thermic effect of food and promotes feelings of satiety without affecting metabolic and hormonal parameters in overweight men: a pilot study. Metabolism. 2012;61(10):1347-1352. Vahdat Shariatpanahi Z, Mokhtari M, Taleban FA, et al. Effect of enteral feeding with ginger extract in acute respiratory distress syndrome. J Crit Care. 2013;28(2):217.e1-217.e6. Sritoomma N, Moyle W, Cooke M, O’Dwyer S. The effectiveness of Swedish massage with aromatic ginger oil in treating chronic low back pain in older adults: a randomized controlled trial. Complement Ther Med. 2014;22(1):26-33. Maghbooli M, Golipour F, Esfandabadi AM, Youse M. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytother Res. 2014;28(3):412-415. Basic Report: 11216, Ginger root, raw. Agricultural Research Service, United States Department of Agriculture website. Available here. Accessed February 23, 2015.