Group Magnificient

Ginseng: The Cure-All?

1. History

Ginseng has been used in East Asia and Chinese medicine for thousands of years. It comes from the root of a plant from the genus Panax, which is derived from the word panacea, which means "cure-all" in Greek.1 Asian or Korean ginseng, American ginseng, and Siberian ginseng are the most common types of ginseng used in the United States, although Siberian ginseng does not belong to the Panax genus and is not considered to be a true ginseng.1,2 Ginseng has been grown in Korea since “ancient times” and has been grown in the United States since around 1870.3

2. Medicinal and non-medicinal use

In Chinese medicine, ginseng was thought to bring “long life, strength, and wisdom to those who took it.”2 In Chinese medicine, it is also used to help treat asthma, indigestion, hypertension, diabetes, insomnia, heart problems, and is also used as an appetite stimulant and aphrodisiac.1

In the United States, Asian ginseng has been used to help treat anemia, diabetes, insomnia, impotence, as well as boosting immune response, alleviating mental and physical stress, and for cancer prevention.4 It is also marketed as a product that will boost energy, improve memory, and promote longevity.1

3. Major components hypothesized to be the active ingredients. Include chemical entities if applicable

The active ingredients in ginseng are triterpenoid saponins, which includes ginsenosides.4 There are at least 30 known ginsenosides that have been found. Ginseng also contains glycans (panaxans), polysaccharide fraction DPG-3-2, peptides, maltol, B vitamins, flavonoids, and volatile oil.2

4. Theorized mechanism of action

It is unclear how ginseng works, but it is referred to as an “adaptogen” that acts on multiple parts of the body to restore immune function and lower the risk of stress-related illness.1 It also seems to act as an antioxidant.2

5. Clinical issues; DDIs, suggested dose, adverse effects, pharmacokinetics, overdose, use in special population (pregnant women, elderly, etc.)

There are different forms and dosages of available, depending on the type of ginseng. Asian ginseng extract is standardized to be 4% ginsenosides and is given as 200 mg/day, while crude powdered root has been given at 2-3 g/day.4 According to the University of Maryland, for those that wish to improve physical/mental performance or for those that want to prevent illness, Asian ginseng should be taken every day for 2-3 weeks, stopped for 3 weeks, then continued again.2

Adverse effects of ginseng can include insomnia, headache, changes in blood pressure, anorexia, rash, menstrual abnormalities, gastric upset, and CNS stimulation.4 Ginseng can interfere with the effects of ACE inhibitors, calcium channel blockers, anticoagulants, antiplatelet medications, caffeine, diabetes medication, immunosuppressants, stimulants, MAOIs, morphine, furosemide, and medications that are metabolized by the liver.2 Ginseng should not be given to children, to those with a history of breast cancer, pregnant women, or breastfeeding women as the side effects are unknown and there is concern about estrogenic effects.2,4

6. Efficacy vs. safety

There have been inconsistent and conflicting results on the efficacy of ginseng. Several small studies have found that ginseng is effective in helping to control glucose levels in diabetes patients, can help arousal in men with ED, can help improve mental and physical performance, and may slow tumor growth.2,4 However, there have also been studies that show no superiority over placebo.4 As it stands, it is unclear on the effectiveness of ginseng, but it seems that for most patients (besides the ones mentioned above), there are no severe risks to trying ginseng.

7. Info. about the standard of the various preparations available

Standardized ginsenoside concentrations are available in preparations. Ginseng extract may contain 4-7% of ginsenoside. The content of panaxosides can vary from 1.9-9%. One product that was FDA-approved in 2006, Cold-fX, claims it helps antiviral immunity. The product is standardized to be consistent in having the same amount of active ingredients. A study that compared products sold throughout Europe and the U.S. showed 6 of the 50 products sold did not contain any ginsenosides. For American ginseng roots, preparation of a product by using fresh roots that had been stored for 180 days in sand without washing had a better quality compared to roots that had been stored in a plastic bag with a preservative after being washed.5 Ginseng is available as a standardized extract, fresh or dried root, tincture, and fluid extract, tablets, capsules, teas, and oils.7, 8

8. Costs

Nature's Bounty Ginseng complex jelly capsules, 75 count: $11.99 (Rite-Aid)

Nature's Way Korean Ginseng, 65 count: $17.99 (CVS)
The Vitamin Shoppe Ginseng Complex- Herbs, 100 count: $16.99(Vitamin Shoppe)

Compared to:
Use as a dietary supplement/weight loss: Orlistat 60 mg, 60 count: $38.88 (Walmart); OTC
Use as a diabetes medication: Metformin 500 mg: FREE (Meijer, Family-Fare); Prescription

9. Prevalence of use

Ginseng is included in many energy drinks, but the amount is below standard dosing is generally safe. Ginseng is used as a folk remedy in Native American populations for such therapeutic use as for digestion aide, earache, female infertility, fever, and earache, headache, and mild stimulant. Traditionally has been used for treatment of cancer, low back pain, asthma, coughs, shortness of breath, etc. Study in 2006 of prevalence of use in Saudi Arabia, was 47% of the most used product as an herbal product. 5 Dr. Shimp mentioned that in 2007 in the United States, 14.1% of adults that utilized herbal products had used ginseng.

10. Evidence-based studies

One study looked at a Traditional Chinese medicine called shengmai which is a ginseng combination, used to treat diseases that are associated with the individual having a weak pulse, i.e. cardiac or pulmonary conditions. Its outcome was positive evidence and this medicine is increasing in popularity.5

A prospective study was conducted with administering 400 mg of ginseng every day for 8 weeks. Significant increases in abstract thinking and faster responses for simple reaction, but there was no change in concentration nor memory. 9

In 2014, Korean red ginseng was used as a supplement in glucose control in newly diagnose type 2 diabetes patients, people with impaired fasting glucose, and impaired glucose tolerance. Measurements taken 30 and 60 minutes after intake of ginseng had significant decreases in blood glucose levels. 10

11. Comparable prescription or nonprescription medications

Ginseng is in a class of herbs referred to as tonics or adaptogens, with the purpose of boosting physical and mental ability, along with increasing resistance to stress and sickness.9 Nonprescription medications that may have comparable effects, include Siberian ginseng, rose root, five flavor berry, and twisting-vine orchid.

12. Any regulatory issues

In 2002, the FDA had data showing pesticides in both domestic and imported bulk ginseng.6

Pharmacist’s Views

One pharmacist heard it was good for memory and energy, but he never saw studies that said it helps. He says it can't hurt and that no one asks about it at the pharmacy.

-Pharmacist at Village Apothecary on South University

Health Store Views

Used to boost energy and also useful for weight loss. It’s safe to use and recommend for people that are interested in using it.

-Employee at the Vitamin Shoppe on Washtenaw

Sources:

1- http://www.encyclopedia.com/topic/ginseng.aspx

2- http://umm.edu/health/medical/altmed/herb/asian-ginseng

3- http://www.britannica.com/EBchecked/topic/233978/ginseng

4- http://www.pharmacylibrary.com.proxy.lib.umich.edu/content/617888

5 - http://www.naturalstandard.com.proxy.lib.umich.edu/databases/herbssupplements/ginseng.asp?

6 - http://www.fda.gov/Food/FoodborneIllnessContaminants/Pesticides/ucm116752.htm

7 - http://umm.edu/health/medical/altmed/herb/american-ginseng