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REF:  http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.html    

Ginseng

• Unproven Uses
• Potential Dangers
• Interactions
• Dosing
• Summary
• Resources
  

Evidence    

Asian ginseng (Panax ginseng), also known as Korean ginseng, and American ginseng (Panax quinquefolium) should not be confused with Siberian ginseng (Eleutherococcus senticosus). Scientists have studied Asian and American ginseng for the following health problems:

Cognitive and psychomotor performance

Multiple studies report that ginseng may improve reaction times, psychomotor performance during exercise, math skills and logical thinking in healthy individuals. However, most research in this area has been poorly designed. It is not clear what dose may be safe or effective. Further studies are needed to determine who may benefit most from ginseng and whether long-term therapy continues to add benefits to performance.

Memory, dementia

Ginseng has been studied alone or in combination with other herbs, such as ginkgo, for memory and dementia in the elderly. Further research is needed before a conclusion can be drawn.

Fatigue, stress

Several studies suggest that ginseng may improve fatigue and reduce stress. These symptoms are difficult to measure, and most research in this area has been poorly designed. More research that focuses on specific areas of well-being is needed to determine which groups of people may benefit most.

Exercise performance

Although early studies suggest that ginseng may enhance exercise performance, results from more recent studies disagree. Therefore, it is unclear whether there is any benefit from using ginseng to improve exercise performance.

Immune system stimulation

A small number of studies report that ginseng may stimulate activity of immune cells in the body, improve the effectiveness of antibiotics in people with acute bronchitis, enhance the body's response to influenza vaccines and protect against damaging side effects of radiation. Much of the research in this area has been published by the same lead author. Additional studies, which examine the effects of ginseng on specific types of infections, are necessary before a clear conclusion can be reached.

Diabetes

Several studies suggest that ginseng may help lower blood sugar levels in people with type 2 (non-insulin-dependent) diabetes. Early studies suggest that ginseng may lower both fasting blood sugar levels and glucose levels after meals, without causing blood sugar levels to fall too low. However, these studies have been small, and further studies, conducted for longer periods of time, are needed to compare ginseng with other drugs commonly used to treat diabetes.

High blood pressure

Early evidence from a small number of poorly designed studies suggests that ginseng may lower high blood pressure and improve the vascular endothelial dysfunction in patients with high blood pressure. However, it is not clear what doses may be safe or effective. Further research is needed before a recommendation can be made.

Aplastic anemia, neutropenia

Early study using ginseng in combination with other herbs found an improvement in people with aplastic anemia. However, there have also been reports of blood cell counts dropping with ginseng use. Further research is needed, as study results conflict.

Bronchodilation

There is one study in adults that suggests that ginseng has positive effects on breathing function. Further studies are needed in this area.

Cancer prevention

A small number of studies report that ginseng taken by mouth may lower the risk of being affected by various cancers, especially if ginger powder or extract is used. However, most of these studies have been published by the same research group and have used a type of research design (case control) that can only be considered preliminary. Results may have been affected by other lifestyle choices in people who use ginseng, such as exercise or dietary habits. Additional trials are necessary before a clear conclusion can be reached.

Postmenopausal symptoms

Ginseng has been suggested to improve postmenopausal symptoms in women. A small number of studies report modest improvements in depression and sense of well-being, without changes in hormone levels. However, these studies have had flaws in their designs. Therefore, it is not clear what effects ginseng has on postmenopausal symptoms, and it is not clear what dose may be safe or effective.

Congestive heart failure

One study suggests that ginseng may provide benefits for treating congestive heart failure. Another study suggests that red ginseng and digoxin had synergism for treatment of congestive heart failure. However, these studies were small, with flaws in their design. Therefore it is unclear whether there is any benefit from ginseng for this condition.

Coronary artery disease

Although several studies have evaluated the role of ginseng in the relief of chest pain (angina) and electrocardiogram changes, it is not clear what effect ginseng has on coronary artery disease.

Diabetic kidney damage

Ginseng has been proposed as a possible therapy for kidney damage in people with diabetes, but the only study that is specifically evaluating this has several flaws in its design.

Erectile dysfunction

Several studies suggest that ginseng may help improve erectile dysfunction, sex drive and satisfaction with sexual activities, but these studies are small, with flaws in their design. Therefore, it is unclear whether ginseng is of any benefit for erectile dysfunction.

Liver protection

Ginseng has been proposed to have beneficial effects in some cases of liver damage. There is only limited research specifically evaluating this use in humans, and it is not clear what dose may be safe or effective.

Male infertility

Early evidence suggests that ginseng may improve male fertility by increasing sperm numbers and movement of sperm. Further studies are needed to determine what dose may be safe and effective.

Premature ejaculation

One study that used ginseng in combination with other herbs found that combination therapy greatly improved sexual satisfaction in men with premature ejaculation. However, there were flaws with this study, and it is not clear whether benefits were the result of ginseng or other herbs in the formulation.

Mental health

Ginseng may safely improve some aspects of mental health and social functioning after four weeks of therapy. Further research is needed to confirm these results.

Respiratory illness

Ginseng (CVT-E002) may be safe, well tolerated, and potentially effective for preventing acute respiratory illness caused by influenza or respiratory syncytial virus. More study is needed.

Fistula

Preliminary evidence in infants with peri-anal abscess or fistula-in-ano shows that a treatment of GTTC (ginseng and tang-kuei ten combination) may accelerate recovery. Further research is needed to confirm these results.

Intracranial pressure

Preliminiary study of Xuesaitong injection (a preparation of Panax notoginseng) shows that it may help to decrease intracranial pressure and benefit coma patients. Further study is needed to confirm these results.

Viral myocarditis

Poorly described research of patients treated with Shenmai and Shengmai injection (a ginseng preparation) shows that there may be some related cardiac improvement. More in-depth and reliable studies are needed before a conclusion can be drawn.

Well-being

Preliminary study of Siberian ginseng (E. senticosus) administration to elderly patients reports that it may safely improve some aspects of mental health and social functioning after four weeks of therapy. Alertness, relaxation, and appetite improvements have been reported. Further well-designed clinical trials are needed to determine possible effects of ginseng on overall quality of life.

Unproven Uses    

Ginseng has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care provider before taking ginseng for any unproven use.

Adrenal disorders Aerobic capacity Aggression Aging Allergy Alzheimer's disease Antidepressant Antioxidant Anxiety Aphrodisiac Appetite stimulant Athletic stamina Attention-deficit hyperactivity disorder Bleeding disorders Burns Cerebrovascular deficits Chemotherapy support Chronic renal failure Cold limbs Convulsions Craniocerebral injury Dementia Diaphragmatic muscle fatigue Diarrhea Disease development Diuretic Dizziness Fatigue Female sexual dysfunction Fever Fibromyalgia Fistula-in-ano recovery Geriatric rehabilitation Hangover Headaches Herpes High cholesterol HIV Hot flashes Inflammation Inflammation of the colon

Influenza Insomnia Ischemic brain injury Learning Liver cancer Liver detoxification Long-term debility Malignant tumors Menopausal symptoms Mood enhancement Morphine tolerance Mucus membrane irritation Myocardiac ischemic and reperfusion injuries Nerve pain Neurasthenia Neurosis Oxidative damage Oxygen uptake Pain relief Palpitations Physical work capacity improvement Pseudomonas infection in cystic fibrosis Psycho-asthenia Psychological symptoms of menopause Physiological symptoms of postmenopause Recovery after radiation therapy Recovery after surgery Rehabilitation Retinal vein occlusion Sedation Senility Shortness of breath Stomach problems Stress Sweating Upper respiratory infection Vomiting Weight loss

Potential Dangers    

Allergies

• People should avoid ginseng if they have a known allergy to plants in the Araliaceae family. Signs of allergy may include rash, itching or shortness of breath. Inhalation of ginseng root dust has been associated with immediate and late-onset asthma.

Side Effects

• Ginseng has been well tolerated by most people in research studies when used at recommended doses. Some people may experience skin disturbances, such as itching or rose spots. There is a report of a serious life-threatening skin reaction, possibly caused by contaminants in the ginseng formulation.
• Ginseng may cause stomach discomfort, including diarrhea, nausea, vomiting, throat irritation or loss of appetite, especially after long-term use. Other side effects may include difficulty sleeping, nervousness, headache, fever, dizziness, blurred vision and drowsiness. Rarely, ginseng may alter blood pressure and hearth rhythm or may cause water retention and swelling, chest pain, or rapid and pounding heartbeats. Ginseng may affect the menstrual cycle, causing vaginal bleeding in postmenopausal women or the cessation of menstruation in younger women.
• Breast tenderness has been reported in women, and men have reported increased breast growth. Other effects experienced by some men taking ginseng include erectile dysfunction or increased sex drive. Additionally, ginseng cream applied topically to the penis may cause erectile dysfunction, delayed ejaculation, mild pain, irritation and burning.
• Ginseng may alter blood clotting. If you use anticoagulants (blood thinners) or antiplatelet drugs and are considering using ginseng, speak with your health care provider or pharmacist. Nosebleeds have occurred. It is possible that ginseng may alter blood cell counts. This has led to life-threatening infections and one death. This effect may have been caused by a contaminant. Be aware that many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery.
• Patients should always advise their doctor before surgery if they use herbal medications, food supplements, or cosmetics, as well as prescription drugs. This is of great importance for both diagnosis and avoidance of drug interactions and side effects during anesthesia.

Pregnancy And Breast-Feeding

• Although ginseng is not believed to cause birth defects, it is not clear whether ginseng is safe during pregnancy and breast-feeding because there is not enough scientific information. However, neonatal death and male characteristics in a developing baby girl were reported after exposure to ginseng. Be aware that many tinctures contain high levels of alcohol and should be avoided during pregnancy.

Interactions    

Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with your health care provider or pharmacist before using herbs or dietary supplements.

Interactions With Drugs

• Ginseng may alter the ability of the blood to clot. There is one report that the effects of warfarin (Coumadin), a blood thinner, were reduced in a patient using ginseng. This would increase the risk of a blood clot. Another study found no effect with coadministration. Other reports from laboratory experiments and in humans suggest that ginseng may increase the risk of bleeding. If you use anticoagulants (blood thinners), such as warfarin (Coumadin) or heparin, or antiplatelet drugs, such as aspirin or clopidogrel (Plavix), and are considering taking ginseng, speak with your health care provider or pharmacist. Increased monitoring of blood tests may be required.
• There is some evidence that ginseng may interfere with the way the liver breaks down certain drugs (using the P450 system), although study results conflict. As a result, ginseng may alter the levels of drugs in the body, causing them to be either too high or too low, which could lead to serious side effects or lack of beneficial effects. HIV drugs called protease inhibitors are among the drugs that may be affected. If you are taking prescription drugs, ask your health care provider and pharmacist for advice before you take ginseng.
• Ginseng may lower blood sugar levels. Caution is advised if you are also taking prescription drugs that may lower blood sugar levels. Patients taking oral drugs for diabetes or using insulin should be monitored closely by their health care provider while using ginseng. Dosing adjustments may be necessary.
• It is possible that ginseng may increase the effects of digoxin (Lanoxin) on the heart, and the combination may lead to increased side effects. In theory, ginseng may lead to increased effects and increased side effects when taken with heart drugs such as nifedipine (Procardia), blood pressure drugs, over-the-counter drugs for treating cold symptoms (such as pseudoephedrine), diuretics and central nervous system stimulants such as methylphenidate (Ritalin). Other interactions may occur if ginseng is used with corticosteroids, hormonal drugs or antipsychotic drugs. It is possible that ginseng may inhibit the development of tolerance to opioids such as morphine. Use of ginseng with phenelzine (Nardil) has caused headache, tremor, difficulty sleeping, or mania. Be aware that many tinctures contain high levels of alcohol and may cause nausea or vomiting when taken with metronidazole (Flagyl) or disulfiram (Antabuse). Some hormone levels and therefore hormonal drugs may be affected. Panax ginseng may enhance the clearance of alcohol.

Interactions With Herbs And Dietary Supplements

In theory, ginseng may alter the blood's ability to clot. This could increase the risk of bleeding if ginseng is taken with other products that are believed to alter the ability of the blood to clot. Examples include Ginkgo biloba and garlic (Allium sativum). It is also possible that ginseng may alter the blood levels of herbs processed by the liver, such as chasteberry (Vitex agnus-castus). If you are taking other herbs or supplements, check with your health care provider before starting ginseng.

Ginseng may lower blood sugar levels. People using other herbs or supplements that may alter blood sugar levels, such as bitter melon (Momordica charantia), should be monitored closely by their health care provider while using ginseng. Dosing adjustments may be necessary.

In theory, ginseng may increase the effects and adverse effects of herbs that contain glycoside components, such as oleander (Nerium oleander, Thevetia peruviana); herbs that lower blood pressure, such as hawthorn (Crataegus oxyacantha); and herbs with stimulant effects, such as guarana and maté. Theoretically, ginseng can potentiate the stimulant effects of caffeine, coffee, or tea. Alternatively, it is possible that ginseng may decrease the effects of herbs with diuretic properties, such as horsetail (Equisetum arvense).

Soy and ginseng have been shown to interact in the laboratory, but this has not been proven in humans. Other herbs and supplements broken down by the liver may be affected by ginseng. Some hormone levels and therefore hormonal herbs and supplements may be affected.

Dosing    

The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with a health care provider before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas.

Ginseng extracts are often standardized to 4 percent G115® or 7 percent total ginsenosides. Tests of ginseng products have found that many brands do not contain the claimed ingredients, and some include detectable pesticides. It is often recommended that people should abstain for one or two weeks after using ginseng continuously for two to three weeks. There are no standard or well-studied doses of ginseng, and many different doses are used traditionally.

• Ginseng is sold in the forms of tea, capsules, tablets, chewing gum, candy, cigarettes, elixirs, and extracts.
• Ginseng tablets/capsules: A dose of 100 milligrams of ginseng extract (4 percent ginsenosides) taken by mouth once or twice daily has been used. Higher doses are sometimes used under the supervision of a qualified health care provider. For short-term administration, the daily dose is 0.5 to two grams of dry ginseng root, which is equivalent to 200 to 600 milligrams of extract. E. senticosus dry extract in a dose of 300 milligrams per day has been studied for eight weeks to improve quality of life in elderly patients. Proprietary ginseng root extract (Cold-FX, CV Technologies Inc., Edmonton, AB) has been studied in athletes for 28 days at a dose of 400 milligrams per day. For long-term administration, one gram of dry root should not be exceeded daily.
• Ginseng liquid/fluid: Doses that have been used include a decoction of one to two grams in 150 milliliters of water; a 1:1 (gram per milliliter) fluid extract taken as one to two milliliters daily; or one to two teaspoons of a 1:5 tincture (gram per milliliter).
• Topical ginseng: SS-cream containing ginseng has been used is the treatment of premature ejaculation at a dose of 0.20 grams.

Children (Younger Than 18): Preliminary evidence in infants with peri-anal abscess or fistula-in-ano, a treatment of GTTC (ginseng and tang-kuei ten combination) in a dose of 0.1 to 0.2 grams per kilogram of body weight twice a day may accelerate recovery. Further research is needed to confirm these results, and this condition should only be treated by a qualified health care provider.  Overall, there are not enough scientific data to recommend ginseng for use in children, and ginseng is not recommended because of potential side effects.

Summary    

Ginseng may alter blood clotting and may lower blood sugar levels. It should also be avoided in pregnant or breast-feeding women and in children. Discuss any products you are taking with your health care provider or pharmacist to screen for possible interactions. Consult your health care provider immediately if you have any side effects.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources      

Selected Scientific Studies: Ginseng

• Natural Standard reviewed more than 565 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

Last updated June 30, 2005