Ginseng

Ginseng is an herb also known as Anchi Ginseng, Baie Rouge, Canadian Ginseng, Ginseng à Cinq Folioles, Ginseng Américain, Ginseng Americano, Ginseng Root, North American Ginseng, Occidental Ginseng, Ontario Ginseng, Panax Quinquefolia, Racine de Ginseng, Red Berry, Ren Shen, Sang, Shang, Shi Yang Seng, Xi Yang Shen and other names.

Ginseng has been used in alternative medicine as a possibly effective aid in lowering blood sugar after a meal in patients with diabetes type 2, and for respiratory infections.

Ginseng has also been used to improve athletic performance. However, research has shown that ginseng may not be effective in treating this condition.

Other uses not proven with research have included attention deficit-hyperactivity disorder (ADHD), breast cancer, cancer related fatigue, menopausal symptoms, memory loss, anemia, insomnia, bleeding disorders, digestive disorders and other conditions.

It is not certain whether ginseng is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Ginseng should not be used in place of medication prescribed for you by your doctor.

Ginseng is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Ginseng may also be used for purposes not listed in this product guide.

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use ginseng, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Do not use different formulations of ginseng (such as tablets, liquids, and others) at the same time, unless specifically directed to do so by a health care professional. Using different formulations together increases the risk of an overdose.

Call your doctor if the condition you are treating with ginseng does not improve, or if it gets worse while using this product.

If you need surgery or dental work, stop taking ginseng at least 2 weeks ahead of time.

Store at room temperature away from moisture and heat.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Follow your healthcare provider's instructions about any restrictions on food, beverages, or activity.

Avoid using ginseng together with other herbal/health supplements that can lower blood sugar, such as alpha-lipoic acid, chromium, devil's claw, fenugreek, garlic, guar gum, horse chestnut, psyllium, and others.

According to the Complete German Commission E Monographs , crude preparations of dried root powder 1 to 2 g can be taken daily for up to 3 months. In numerous clinical trials, the dosage of crude root has ranged from 0.5 to 3 g/day and the dose of extracts has generally ranged from 100 to 400 mg.

Reviews of the effects of ginseng have been published. Most studies have used whole-root preparations, with considerable variations due to uncertain species identification, age of the roots, and curing process used. Variations in saponins between the species also may contribute to the lack of consensus among researchers on ginseng's pharmacology. 2 , 6 , 11

Both ginsenosides and polyacetylenes have demonstrated anticarcinogenic effects in vitro, including direct cytotoxic and growth inhibitory effects, induction of differentiation, and inhibition of metastasis. High concentrations of M1, an active metabolite of Rb1, Rb2, and Rc, induced cell death of mouse melanoma cells by regulating proteins involved in apoptosis. Ginsenosides Rh2 and Rh3 induced differentiation of promyelocytic leukemia cells into granulocytes; Rg3 inhibited adhesion and invasion of melanoma cells and decreased pulmonary metastasis. 6 , 12 , 13

Epidemiological data support a protective effect of ginseng on nonspecific organ cancers. 6 , 14 A long-term study of ginseng 1 g taken weekly for 3 years among adults with long-term atrophic gastritis showed no effect on the overall relative risk of cancer. In the male subgroup analysis, there was a reduction in the risk of non–organ-specific cancers. 14

Trials evaluating the effect of ginseng (both P. quinquefolius and P. ginseng ) on cancer-related fatigue at doses of 1 to 2 g/day over 8 to 12 weeks have shown effects for some, but not all, aspects of mental and physical functioning. 15 , 16 Ginseng may improve some of the adverse effects of chemotherapy-related transcatheter arterial chemoembolization. 17

Ginseng saponins have been reported to act as selective calcium antagonists and enhance the release of nitric oxide from endothelial and neuronal cells. In vitro studies have shown that total ginseng saponins extracted from Panax notoginseng and P. quinquefolius inhibited calcium entry through receptor-operated calcium channels without affecting calcium entry through voltage channels or intracellular calcium release. 6 , 18

In studies involving rabbits and dogs, ginsenosides Ro and Rb from P. ginseng offered a protective effect in myocardial ischemia and reperfusion injuries. This effect may be partly mediated by increased release of prostacyclin and by activation of nitric oxide synthase and subsequent release of nitric oxide. An inhibitory effect on platelet aggregation and on the conversion of fibrinogen to fibrin has been demonstrated, and the prevention of atheroma in rabbits fed a high-cholesterol diet has been observed. 6 , 19

Clinical trials evaluating the effect of ginseng on the cardiovascular system are limited. Hypotensive and hypertensive effects have been postulated. In a short-term study in healthy adults, ginseng 3 g had no effect on blood pressure but lowered the arterial augmentation index, 20 while a 12-week study among hypertensive adults found no effect of ginseng on 24-hour blood pressure or on renal function. 21 Shenfu injection, a mixture of ginseng and monkshood, has been used to prevent reperfusion injury following mitral valve replacement. 22 Sanchi ( P. notoginseng ) is widely used in traditional Chinese medicine in acute ischemic stroke. The saponins in sanchi are similar to those found in P. ginseng and are classified as dammarane saponins (Rb1 and Rg1 primarily). A review of clinical trials found limited evidence of effect of sanchi on short-term effects of ischemic stroke, but noted that the trials were of limited methodological quality. 23

Rb1 and Rg1 appear to play a major role in CNS stimulatory and inhibitory effects and may modulate neurotransmitters. Cholinergic activity, implicated in mediating learning and memory processes, is affected by certain ginsenosides. Antioxidant, anti-inflammatory, antiapoptotic, and immune stimulatory effects are suggested to contribute to a protective effect in neurodegenerative disorders. 24

Animal studies show that Rb1, Rg1, and Re prevent scopolamine-induced memory deficits, and that Rb1 and Rg1 appear to increase central choline uptake and facilitate the release of acetylcholine from hippocampal tissues. Results from a study in aged rats suggest that daily oral administration of P. ginseng extract 8 g/kg/day for 12 days improved learning performance. In animal tissues, ginseng extract inhibited gamma-aminobutyric acid (GABA), glutamine, dopamine, noradrenalin, and serotonin uptake in a concentration-dependent manner. 6 , 24 , 25 , 26

Limited high-quality clinical trials have been conducted, and systematic reviews include data from very few studies. 11 , 27 An anxiolytic effect via GABA modulation was suggested to be responsible for an observed improvement in sleep disorders for fermented ginseng. 28 Among healthy adults, short-term effects of P. ginseng and P. quinquefolius include increased mental performance, increased calmness, and decreased mental fatigue. 29 , 30 , 31 A review of the effect of ginseng on cognitive function in Alzheimer disease found an effect in favor of ginseng for the mini-mental status examination and Alzheimer Disease Assessment Scale for the 2 included studies. 27 , 32

Widespread usage of ginseng and the availability of limited clinical trial data make animal studies largely redundant.

Evidence appears to support the modulation of insulin sensitization and secretion based on cholinergic, dopaminergic, adrenergic, and nitric oxide actions found with ginsenosides. These have been noted to affect glucose metabolism in animal studies. 24 , 33 , 34

Limited quality clinical trials have been conducted among adults with diabetes, with the majority of studies evaluating ginseng in healthy volunteers. Improvements in blood glucose measures and glycemic control have been reported in some, 33 , 34 , 35 , 36 , 37 but not all, 31 , 38 , 39 studies.

Widespread usage of ginseng and the availability of limited clinical trial data make animal studies largely redundant.

Evidence supporting the efficacy of ginseng in improving physical performance is conflicting. Physical performance in young, active volunteers did not improve in 4 studies; however, other studies reported a decrease in heart rate and an increase in maximal oxygen uptake. 11 , 40 One comprehensive literature search evaluated P. ginseng preparations in data from human studies. Properly controlled studies using higher doses (standardized to 2 g/day of dried root) administered for at least 8 weeks and in larger subject numbers more often exhibited improvement in physical or psychomotor performance. Benefit was seen in untrained subjects or in those older than 40 years. 41

Animal studies have shown that ginseng extracts can prolong swimming time, prevent stress-induced ulcers, stimulate the proliferation of hepatic ribosomes, increase natural killer-cell activity, and possibly enhance the production of interferons. 42 Increased spleen B lymphocyte proliferation and serum immunoglobulin production have been documented in animal models. Increased peritoneal exudate macrophage production of the cytokines IL-1, tumor necrosis factor–alpha, and IL-6, and the production of nitric oxide has also been reported. 43 , 44

Studies in healthy volunteers measuring T-lymphocyte immunomodulation yield equivocal results. 11 , 26 Studies in healthy sedentary men and healthy physically active men have found no effect of ginseng on immune markers. 40 , 45 Modulation of CD8+ T cells and interleukin production was reported in sedentary men beginning to exercise. 45 A possible effect of ginseng on the CD4+ T cell count in HIV-positive men was reported. 46

Clinical trials supported by the manufacturers of a patented P. quinquefolius preparation suggest a lowered incidence of influenza with the use of ginseng as a prophylactic, especially among elderly patients. 47 , 48 , 49 , 50 , 51 Dosage studies have taken place to evaluate the effect of ginseng in children with upper respiratory tract infections. 52

Studies in postmenopausal women suggest ginseng 1 g daily (as Korean red ginseng) may increase sexual arousal possibly via a relaxing effect on the clitoral cavernosal muscle and vaginal smooth muscle. 53

In men, an improvement in erectile function has been shown in a meta-analysis of clinical studies. 54 , 55

Summary of Use during Lactation

The roots of American ginseng (Panax quinquefolius), Asian ginseng (Panax ginseng), and several other species contain steroidal saponins called ginsenosides that are purported to be adaptogens (i.e., to increase endurance and improve memory). Ginseng has no specific uses during breastfeeding. Ginseng is generally well tolerated in adults and is "generally recognized as safe" (GRAS) by the U.S. Food and Drug Administration. The most common side effects include headache, hypertension, diarrhea, sleeplessness, skin rash, and vaginal bleeding. Ginseng decreases the blood levels of some drugs, such as warfarin, and enhances the effect of sedating drugs. With long-term use, nervousness, diarrhea, confusion, depression or depersonalization may occur. Gynecomastia and breast pain have been reported.[1][2] No data exist on the safety and efficacy of ginseng in nursing mothers or infants. Because of its possible estrogenic activity and lack of information during breastfeeding, many sources recommend that ginseng not be used during lactation.

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1. Seely D, Dugoua JJ, Perri D et al. Safety and efficacy of Panax ginseng during pregnancy and lactation. Can J Clin Pharmacol. 2008;15:e87-94. PMID: 18204104

2. Coon JT, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions. Drug Saf. 2002;25:323-44. PMID: 12020172

Substance Name

Ginseng

Scientific Name

Panax ginseng; Panax quinquefolius

CAS Registry Number

50647-08-0; 92347-06-3

Drug Class

Complementary Therapies

Phytotherapy

Plants, Medicinal