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Ginseng   

James Meschino DC, MS, ROHP

General Features
Asian Ginseng is a member of the Araliaceae family, which also includes the closely related American Ginseng and less similar Siberian Ginseng.  The root of the plant is used for medicinal purposes, preferably from plants older than six years of age.  There are three distinct types of Ginseng in the commercial market:

  1. Panax Ginseng (Asian, Chinese, Korean Ginseng)
  2. Siberian Ginseng (Eleuthero Ginseng)
  3. American Ginseng (Panax quinquefolius, Canadian Ginseng)

Panax Ginseng is the most widely used and most extensively studied species of Ginseng.  Primarily the roots of the plant are used for medicinal purposes with standardized extracts available containing up to 5 percent ginsenoside content, in a high quality root extract product.  Ginsenosides, which are triterpenoid saponins, vary between Panax, and American Ginseng.  There are at least 13 different ginsenosides, some occurring more in one type of Ginseng than the other, or not at all as is sometimes the case.  At this time, insufficient research exists to determine which type of Ginseng or ginsenoside complex is best suited to treat or prevent specific health conditions.  However, studies reveal that the most consistent and reliable results occur when using high-quality extracts, standardized for active constituents.  Siberian Ginseng contains seven eleutherosides (A-G), not ginsenosides.

Principle Active Constituents

  1. Triterpenoid Glycosides (saponins), which are known as ginsenosides, and include:
    RO, Rb1, Rb2, Rb3, Rc, Rd, Re, Rf, 20-gluco-Rf, Rg1, and Rg2, R91, Ra2, Rh1, Rh4. These are found in Korean and American Ginseng only. Korean Ginseng contains significant concentrations of Rb1, Rb2, Rc, Re and Rg1.
    American Ginseng contains primarily Rb1 and Re, and does not contain Rb2, Rf or in some instances Rg1.
  2. Eleutherosides (A-G) – found only in Siberian Ginseng
    Eleutherosides are a collection of specific coumarins, lignans, phenylpropanoids, polysaccharides, sterols, triterpenes and miscellaneous compounds.1, 2

Siberian Ginseng is considered to be a milder type of Ginseng compared to Panax Ginseng2

Clinical Application and Mechanism of Action

As there is considerable overlap in the clinical use of the three types of Ginseng they are presented here collectively:

  1. Adaptogen

There is some suggestion that Panax Ginseng has the ability to increase both ascorbic acid and cholesterol stores in the adrenal gland, while decreasing the 17-ketosterol and increasing ACTH excreted in the urine.  An increase in plasma ACTH and corticosteroids following administration of Ginseng is well documented.  These features may explain its use as a substance to help restore homeostasis under periods of stress and its use as an anti-fatigue supplement and general tonic.2, 3, 4, 5, 6, 7, 8
An adaptogen is thought to work in a non-specific manner, helping to re-establish balance and homeostasis at a physiological level.

In Russia, Siberian Ginseng is used by deep sea divers, mine and mountain rescue workers, soldiers, factory workers, cosmonauts, and athletes primarily for its perceived ability to increase endurance and promote the body’s ability to tolerate stressful conditions.9

Studies with Panax Ginseng suggest that anti-fatigue effects may be mediated by stimulation of nerve impulses, direct affect on the hypothalamus-pituitary-adrenal axis, glycogen sparing in exercising muscle, and improved oxygen utilization.  In animal studies, lower lactic acid and pyruvic acid levels in the blood were noted upon exercise, compared to the placebo group – indicating a glycogen – sparing effect through increased fatty acid oxidation during exercise.1, 2

These effects may be beneficial for endurance athletes and weight loss patients employing an exercise program.10, 11, 12  A few studies have noted a performance-enhancing effect with the use of Panax Ginseng.12

  1. Immunostimulating Effects

In general, all three types of Ginseng demonstrate an ability to enhance immune system function.  In particular Panax Ginseng appears to enhance antibody response, increase natural killer cell activity, stimulate macrophage activity, stimulate lymphocytes in vitro, stimulate the reticuloendothelial system, increase proliferation of T cells and B cells, and increase the production of interferon. 1, 2, 13, 14, Both Panax Ginseng and Siberian Ginseng have demonstrated enhanced immune function in placebo-controlled, double blind studies, including significantly higher antibody litres and natural killer activity levels in the Panax Ginseng study.15, 20

However, it should be noted that at high doses there is in vitro evidence that Ginseng may inhibit some immune functions, including lymphocyte proliferation.16, 17, 18, 19

Based upon the available research in this area, some authorities suggest that Ginseng supplementation is appropriate for chronic fatigue syndrome, HIV-infection, to combat infections or to help restore immune function from a compromised state.1, 2, 21

  1. Female Reproductive Tissue Support

Ginsenosides exert an estrogen-like action on the vaginal epithelium, which can prevent atrophic vaginal changes associated with menopause.22  It should be noted that breast tenderness can be a side effect of Ginseng use in women, which disappears when Ginseng is discontinued.23

N.B.: Black cohosh also maintains the vaginal epithelium without risk of this side effect (see Black Cohosh in this document)

  1. Male Reproductive Tissue Support

Panax Ginseng has been shown to increase sperm count and motility in men, as well as increasing plasma total and free testosterone, dihydrotestosterone, follicle stimulating hormone and leutinizing hormone.24   An in vitro study suggests that it may relax the corpus cavernosum by releasing nitric oxide, which facilitates an erection.25, 31

  1. Type II Diabetes

Panax and American Ginseng have demonstrated an ability to reduce fasting and post prandial blood glucose levels in type II diabetic patients.  Its effects may alter the need or the dose of hypoglycemic medications and therefore, should only be used in this instance with knowledge of the attending physician.26, 27

  1. Protection from Radiation Damage

In experimental studies Ginseng has been shown to offer some protection against harmful radiation.2 In particular, Siberian Ginseng is noted for its ability to provide protection in animals subjected to both single exposure and long-term x-ray radiation.  Rats given the Siberian Ginseng have been shown to survive twice or three times as long compared to rats not given Siberian Ginseng, in radiation studies.28, 29

Although no human trials in North America are available, Siberian Ginseng is thought to be useful as an adjunctive treatment for those undergoing radiation treatment for a variety of cancerous conditions.1   Preliminary studies in Russia indicate that the use of Siberian Ginseng in people undergoing chemotherapy and radiation therapy for cancer has been of benefit in reducing side effects and aiding in bone marrow recovery.30

N.B.: Note that Reishi Mushroom Extract and Astragalus are also known to reduce side effects from radiation treatment (see details in related sections of this document)

Dosage and Standardized Grade

  1. Immune Stimulation (Chronic Fatigue Syndrome, weakened immune status):100-500 mg per day in divided doses (std to 4-8 percent ginsenoside content) – Panax Ginseng is considered to be the best choice for this purpose.1, 2
    For Siberian Ginseng – consider 100-200 mg per day in divided doses (20:1 extract)1
  2. Weight Loss or Ergogenic Athletic Aid: 200 mg per day in divided doses (Panax Ginseng std to 4-8 percent ginsenoside content)32
  3. General Anti-Stress Support: 100-200 mg per day (Panax Ginseng std to 4-8 percent ginsenoside content)33
  4. Postmenopausal Support for Women: 100-500 mg per day in divided doses. (std to 4-8 percent ginsenoside content – Panax Ginseng)1
  5. Male Infertility and Erectile Dysfunction: 100-500 mg per day in divided doses (std to 4-8 percent ginsenosides content – Panax Ginseng)1
  6. Type II Diabetes and Syndrome X: 200 mg per day (100 mg, twice daily with meals) (std to 4-8 percent ginsenoside content – Panax Ginseng)1
    B. Must consult the attending physician prior to Ginseng use in these cases
  7. Adjunct to Chemotherapy or Radiation Treatment: Siberian Ginseng 300-400 mg per day in divided doses (20:1 extract)21
    B. Long-term Ginseng supplementation usually involves a cycling effect with a two to three week non-use period, every 30 to 60 days1, 2

Adverse Side Effects and Toxicity

  1. Panax Ginseng: The most common side effects include insomnia,diarrhea, skin eruptions, vaginal bleeding and breast tenderness. “Ginseng Abuse Syndrome” may exist in which over stimulation from Ginseng may cause hypertension, restlessness, nervousness, euphoria, insomnia, diarrhea and skin eruptions – from overuse. This description has been criticized due to the fact that most studied subjects also ingested high levels of caffeine.1
  2. Siberian Ginseng: The most common side effects include insomnia, irritability, melancholy, anxiety Patients with rheumatic heart disease have reported pericardial pain, headaches, palpitations, and elevations in blood pressure.2
  3. American Ginseng: The most common side effects include insomnia and irritability21

Contraindications and Precautionary Measures for all Forms of Ginseng

Ginseng should not be given in the following cases:

  • Hypertension
  • Acute illness and fever
  • Insomnia – (not to be taken at night by these individuals)
  • Asthma
  • Emphysema
  • Cardiac disorders
  • Patients suffering from mania, schizophrenia
  • Insulin dependent diabetes mellitus
  • Fibrocystic Breast Desease1,2,33

Caution must be exercised when administering Ginseng supplements:

  • to type II diabetics
  • as an adjunct to chemotherapy or radiation therapy1, 2, 33

at the same time as caffeine-containing beverages due to potential over stimulation effects.21, 38

Drug-Nutrient Interactions

Ginseng is contraindicated in patients on the following medications:

  1. Drugs affecting brain neurotransmitters, especially monoamine oxidase inhibitors (MAO-inhibitors): Ginseng can potentiate the drug effect leading to headache, euphoria, Central Nervous System stimulation and tremors, mania symptoms.34
  2. Phenobarbital 5
  3. Warfarin – Ginseng has been shown to antagonize the clotting effects of warfarin, altering the prothrombin time or INR.35, 36
  4. Ticlopidine – a platelet-inhibiting drug. Similar effects on clotting due to Ginseng intake may counter effect of this drug, used by patients with intermittent claudication or to prevent stroke.21
  5. Digoxin or Digitalis – Ginseng has been shown to elevate serum levels of digoxin, potentiating the drugs effect on the heart.35, 37 This occurred in one case and no clear relationship exists, but caution should be exercised.37

N.B.: Several studies performed in various countries have repeatedly shown that a high percentage of commercially available Ginseng supplement products do not meet the label claim for the amount of Ginseng, ginsenosides or active constituents they claim to possess.  Furthermore, several cases of athletes consuming adulterated Ginseng products (i.e. ephedrine, pseudoephedrine) have occurred in which athletes have incurred doping charges against them and disqualification.39, 40, 41, 42, 43

As such, it is recommended that Ginseng products used for the intended purposes mentioned here, have available to health practitioners and consumers, “certificate of analysis” on each  new batch of product formulated, to ensure potency and purity of the product.39-43

High quality Ginseng raw materials are expensive and thus may encourage some manufacturers to use inferior grades or to adulterate their products with cheaper ingredients (e.g., ephedra, caffeine) to simulate the anti-fatigue, performance-enhancing effects of Ginseng.

Use with caution with patients on anti-asthmatic and antihypertensive drugs, as Ginseng may potentiate the effects of these drugs.  As such, appropriate patient monitoring under these conditions is recommended.11,19

 

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, Smith M. The Botanical Pharmacy. Quarry Health Books 2000:180-99
  2. Murray M. The healing Power of Herbs. Prima Publishing 1995:265-79, 314-20
  3. Chang H, But P. Pharmacology and Applications of Chinese Materia Medica. World Scientific, Philadelphia PA 1986:p773
  4. Teegarden R. Chinese Tonic Herbs. Japan Publishing Inc NY 1985:p197
  5. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle WA 1986:p556
  6. Fulder SJ. Ginseng and the hypothalmic-pituitary control of stress. American Journal of Chinese Medicine 1981;0:112-8
  7. Hiai S, Yokoyama H Oura H. Features of ginseng saponins-induced corticosterone secretion. Endocrinologia Japonica 1979;26:737-40
  8. Hiai S, Yokoyama H, Oura H, Kawashima Y. Evaluation of corticosterone secretion-inducing effects of ginsenosides and their prosapogenins and sopogenins. Chemical and Pharmaceutical Bulletin 1983;31:168-74
  9. Fulder S. The drug the builds Russians. New Science 1980;21:576-9
  10. Avakian EV et al. Effect of panax ginseng on energy substrates during exercise. Fed Proc 1980;39:287
  11. Avakian EV et al. Effect of panax ginseng extract on erergy metabolism during exercise in rats. Planta Medica 1984;50:p151
  12. McNaughton L et al. A comparison of Chinese and Russian ginseng as ergogenic aids to improve various factets of physical fitness. Int Clin Nutr Rev 1989;9:32-7
  13. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of Echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997;35(3):229-35
  14. Liu J, Wang S, Liu H et al. Stimulatory effect of saponins from Panax ginseng on immune function of lymphocytes in the elderly. Mechanisms of Ageing and Development 1995;83(1):43-53
  15. Bohn B, Nebe CT, Birr C. Flow-cytometric studies with Eleutherococcus senticosus extract as an immunomodulatory agent. Arzneimittelforschung 1987;37(10):1193-6
  16. Jie YH, Cammisuli S, Baggiolini M. Immunomodulatory effects of Panax ginseng C.A. Meyer in the mouse. Agents and Actions 1984;15:386-91
  17. Yun TK, Yun YS, Han IW. Anti-carcinogenic effect of long-term oral administration of newborn mice exposed to various chemical carcinogens. Cancer Detection and Prevention 1983;6:515-25
  18. Yeung HW, Cheung K, Leung KN et al. Immunopharmacology of Chinese medicine. I. Ginseng-induced immuno suppression in virus infected mice. American Journal of Chinese Medicine 1982;10:44-54
  19. Kang M, Yoshimatsu H, Oohara A et al. Ginsenoside Rg1 modulates ingestive behavior and thermal response induced by interleukin-1 beta in rats. Physiology and Behaviour 1995;57(2):393-6
  20. Scaglione F, Cattaneo G, Alessandria M, Cogo R. Efficacy and safety of the standardized Ginseng extract G115 for potentiating vaccination against the influencza syndrome and protection against the common cold. [Published erratum appears in Drugs Exp Clin Res 1996;22(6):p338]. Drugs Under Experimental and Clinical Research 1996;22(2):65-72
  21. Healthnotes Online. Healthnotes Inc. 2000; healthnotes.com: Ginseng
  22. Punnonen R, Lukola A. Oestrogen-like effects of ginseng. British Mecial Journal 1980;281:p1110
  23. Palmer BV, Montgomer ACV, Monteiro JC. Ginseng and mastalgia. [Letter] British Medical Journal 1978;1:p1284
  24. Salvati G, Genovesi G, Marcellini L et al. Effects of Panax Ginseng: C.A. Meyer, Saponins on male fertility. Panminerva Med 1996;38(4):249-54
  25. Chen, X, Lee TJ. Ginsenosides-induced nitric oxide-mediated relaxation of the rabbit corpus cavernosum. British Journal of Pharmacology 1995;115(1):15-8
  26. Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care 1995;18(10):1373-5
  27. Vukson V et al. American ginseng reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Arch Int Med 2000;160:1009-1013
  28. Farnsworth NR, Kinghorn AD, Soejarto D, Waller DP. Siberian ginseng (Eleuthrococcus sentricosus): Current status as an adaptogen. In: Wagner H, hikino H, Farnsworth NR, eds. Economic and Meidicinal Plant Research. Academic Press Orlando FL: 1985:155-215
  29. Ben-Hur et al. Effect of Panax ginseng and Eleutherococcus S. on survival of cultural mammalian cells after ionizing radiation. Am J Chin Med 1981;9:48-56
  30. Kupin VI et al. Stimulation of the immunological reacitivty of cancer patients by eleutherococcus extract. Vopr Onkol 1986;32:21-6 [in Russia]
  31. Salvati G et al. Effects of Panax ginseng C.A. Meryer saponins on male fertility. Panminerva Med 1996;38:249-54
  32. Colgan M. Optimum Sports Nutrition. Advanced Research Press 1993:p310
  33. Brown DJ. Herbal Prescriptions for Better health. Prima Publishing Rocklin CA 1996;129-38
  34. Miller LG. Herbal Medicinals: Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998;158(20):2200-11
  35. McNeil JR. Interactions between hebal and conventional medicines. Can J Cont Med Edu 1999;11(12):97-110
  36. Heck A et al. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57(13):1221-7
  37. McRae S. Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. Can Med Assoc J 1996;155:293-295
  38. Yun TK et al. Preventive effect of ginseng intake against various human cancers: A case-control study on 1987 pairs. Cancer Epidem Biomarkers Prev 1995;4:401-8
  39. Liberti LE, der Marderosian A. Evaluation of commercial ginseng products. Journal of Pharmaceutical Sciences. 1978;67:1487-9
  40. Cui JF, Garle M, Bjorkhem I, Eneroth P. Determination of aglycones of ginsenosides in ginseng preparations sold in Sweden and in urine samples from Sweidsh athletes consuming ginseng. Scandinavian Journal of Clinical and Laboratory Investigation. 1996;56(2):151-60
  41. Cui J, Garle M, Eneroth P, Bjorkhem I. What do commercial ginseng preparations contain? [Letter] Lancet 1994;344(8915):p134
  42. Walker AF. What is in ginseng? [Letter:comment] Lancet 1994;344(8922):p619
  43. Watt J, Bottomley MB, Read MTF. Olympic athletics medical experience, Seoul – personal views. British Journal of Sports Medicine 1989;23(2):76-9
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