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Ginseng

Definition

Ginseng refers to two closely related herbs of the genus Panax. Asian ginseng (P. ginseng) and American ginseng (P. quinquefolius) have traditionally been used for healing. Asian ginseng is also known as Korean red ginseng, Chinese ginseng, Japanese ginseng, ginseng radix, ninjin, sang, and ren shen. American ginseng is also known as Canadian ginseng, North American ginseng, Ontario ginseng, Wisconsin ginseng, red berry, sang, and ren shen. Siberian ginseng (Eleutherococcus senticosus) is a plant with different properties that belongs to a completely different genus. Ginseng in this entry refers only to Asian and American ginseng of the genus Panax.

Purpose

Ginseng has been used for about 2,000 years in Traditional Chinese Medicine (TCM) to boost energy, hasten recovery from illness or injury, reduce stress, improve mental and physical performance (including sexual performance) and to treat a several dozen different infections, gastrointestinal disorders, circulatory problems, and conditions as diverse as burns, cancers, diabetes, migraine headaches, and weight loss. The genus name Panax means “heal all,” and ginseng is considered by herbalists to be an almost universal remedy. Most of these traditional uses of ginseng have not yet been substantiated by conventional medicine, however encouraging results from some well-designed, controlled human studies strongly suggest that ginseng may improve mental performance and have other health benefits.

Description

Northern China and today is grown as a cash crop in China, Korea, Japan, and Russia. American ginseng once grew wild from the Appalachian Mountains to Minnesota. Today it is cultivated mainly in Wisconsin and in the Canadian provinces of Ontario and British Columbia. Most cultivated ginseng from North America is exported to Asia. In both Asia and North America, wild ginseng is threatened with extinction from over harvesting. In the United States, a government permit is usually required to export wild ginseng. High-quality wild ginseng is very expensive. Illegal harvesting of wild ginseng from public lands is an ongoing law enforcement problem for the United States Fish and Wildlife Service.

Ginseng is a slow-growing plant that reaches a height of 12–30 inches and produces red berries. Only the root used for medicinal purposes. Ginseng is difficult to cultivate. Plants must grow 4–6 years before the roots can be harvested. Ginseng roots are forked and twisted, looking somewhat like a miniature human body. They are occasionally used fresh but more often are dried and ground or powdered. The root can be soaked to make an extract or tincture. Ground ginseng can be added to tea and powered ginseng put into capsules. Ginseng extract can be added to products as diverse as chewing gum and soft drinks. Ginseng is sold under dozens of different brand names. It is often found in multi-herb remedies sold under a huge variety of names. The active ingredients of ginseng are thought to be more than twenty compounds called ginsenosides. Some manufacturers standardize the amount of ginsengosides in their product while others do not. Standardized products usually contain 4-% ginsenosides.

Regulation of ginseng sales

In the United States, ginseng is regulated by the Food and Drug Administration (FDA) as a dietary supplement under the 1994 Dietary Supplement Health and Education Act (DSHEA). At the time the act was passed, legislators felt because many dietary supplements such as ginseng come from natural sources and have been used for hundreds of years by practitioners of complementary and alternative medicine (CAM), these supplements did not need to be regulated as rigorously as prescription and over-the-counter drugs used in conventional medicine.

The DSHEA regulates ginseng in the same way that food is regulated. Like food manufacturers, manufacturers of herbal products containing ginseng do not have to prove that they are either safe or effective before they can be sold to the public. This differs from conventional pharmaceutical drugs, which must undergo extensive human testing to prove their safety and effectiveness before they can be marketed. Also unlike conventional drugs, the label for a dietary supplement such as ginseng does not have to contain any statements about possible side effects. All herbal supplements sold in the United States must show the scientific name of the herb on the label. Consumers should look for ginseng of the Panaxvariety. Sometimes less expensive herbs such as Siberian “ginseng” are substituted for true ginseng.

Health claims

Dozens of health claims are made for ginseng, many based on traditional or folk use of the herb. These claims are difficult to substantiate in ways that satisfy conventional medicine for several reasons including:

  • The amount and strength of ginseng in dietary supplements is not standardized and a wide range of doses are used in different studies
  • Ginseng is often one of several herbs contained in herbal remedies, making it difficult to tell if the effects are due to ginseng or another herb
  • Many studies done on ginseng are poorly designed so that it is impossible to show a direct link between cause and effect, or they poorly reported, making analysis of the results difficult
  • Many rigorous and well-designed human studies have a small sample size

KEY TERMS

Alternative medicine—A system of healing that rejects conventional, pharmaceutical-based medicine and replaces it with the use of dietary supplements and therapies such as herbs, vitamins, minerals, massage, and cleansing diets. Alternative medicine includes well-established treatment systems such as homeopathy, Traditional Chinese Medicine, and Ayurvedic medicine, as well as more-recent, fad-driven treatments.

Alzheimer’s disease—An incurable disease of older individuals that results in the destruction of nerve cells in the brain and causes gradual loss of mental and physical functions.

Conventional medicine—Mainstream or Western pharmaceutical-based medicine practiced by medical doctors, doctors of osteopathy, and other licensed health care professionals.

Dietary supplement—A product, such as a vitamin, mineral, herb, amino acid, or enzyme, that is intended to be consumed in addition to an individual’s diet with the expectation that it will improve health.

Traditional Chinese Medicine (TCM)—An ancient system of medicine based on maintaining a balance in vital energy or qi that controls emotions, spiritual, and physical well being. Diseases and disorders result from imbalances in qi, and treatments such as massage, exercise, acupuncture, nutritional and herbal therapy is designed to restore balance and harmony to the body.

  • Many studies are sponsored by ginseng growers, manufacturers, or importers who have a financial interest in obtaining positive results.

Despite these drawbacks, there is enough evidence that ginseng provides health benefits that the National Center for Complementary and Alternative Medicine (NCCAM), a government organization within the National Institutes of Health, is sponsoring clinical trials to determine safety and effectiveness ginseng as a treatment for several diseases and disorders. Individuals interested in participating in a clinical trial at no charge can find a list of open trials at <http://www.clinicaltrials.gov>.

Some health claims for ginseng appear more promising than others. There is good evidence that ginseng can cause short-term improvement in mental performance in both healthy young adults and elderly ill adults. Not enough information is available to determine if long-term gains also occur, but the results have been promising enough that ginseng is being studied in patients with Alzheimer’s disease and other dementias. Along with improved mental performance, some studies have shown that ginseng improves the sense of well being and quality of life. Results of these studies are mixed, with some finding improvements and others finding no change. The situation is complicated by the fact that different studies define and measure “well being” and “quality of life” in different ways. In general, people with the worst quality of life report the most improvement.

Many claims are made that ginseng boosts the immune system, thus helping to prevent disease and promote a more rapid recovery from illness and injury. Some studies also claim that ginseng boosts the effect of antibiotics and improves the body’s response to influenza vaccines. Some studies of patients with diseases that cause a low white cell count (white cells are a part of the immune system) show that white cell count increases with high doses of ginsenosides. Better studies are needed before the effect of ginseng on the immune system can be determined.

There is good evidence that ginseng lowers blood sugar in people with type 2 (non-insulin dependent) diabetes. The effect of ginseng on blood sugar in people with type 1 (insulin dependent) diabetes has not been studied enough to produce any definite findings.

Ginseng has been promoted as a preventative and/ or cure for cancer. According the American Cancer Society in 2007, “There is no reliable scientific evidence that ginseng is effective in preventing or treating cancer in humans.” However, controversial evidence from some studies done in Asia suggests the possibility that ginseng powder or extract may prevent some cancers. More and better studies are needed to clarify these results.

Some studies have reported that ginseng improves stamina and athletic performance and decreases fatigue, while other studies find no effect. There are so many other lifestyle variables in most of these studies that it is difficult to separate the effect of ginseng from other factors.

Studies of the effect of ginseng on the circulatory system are mixed. Some studies find that ginseng lowers blood pressure and in combination with other herbs prevents coronary artery disease and possibly congestive heart failure. Other studies find no effect, or that the effect is apparent only at very high, and possibly unsafe, doses. The effect of ginseng on the circulatory system continues to be investigated.

Many other health claims are made for herbal mixtures that contain ginseng. These claims are extremely difficult to evaluate because of the number of variables, including the strength of the mixture, the effects of the different herbs, and potential interactions among other herbs. Until much more is known about the chemical properties and active ingredients of common medicinal herbs, it is almost impossible to evaluate these mixtures in a way that satisfies the demands of conventional medicine.

Precautions

Ginseng is generally safe and causes few side effects when taken at recommended doses. The generally recommended dose is 100–200 mg of standardized ginseng extract containing 4% ginsenosides once or twice daily. The safety of ginseng in children and pregnant and breastfeeding women has not been studied. Pregnant and breastfeeding women should be aware that some tinctures of ginseng contain high levels of alcohol. Some herbalists recommend that individuals take ginseng for 2–3 weeks and then take a break of 1–2 weeks before beginning the herb again.

Independent laboratory analyses have repeatedly found that many products labeled as ginseng contain little or none of the herb. True ginseng is expensive, and unscrupulous manufacturers often substitute low-cost herbs for ginseng. Another problem is that some ginseng products have been found to be contaminated with pesticides and other chemicals that can cause serious side effects.

Interactions

Ginseng appears to interact with blood-thinning and anti-coagulant medicines such as warfarin (Cou-madin), clopidogrel (Plavix), aspirin, and nonsteroidal anti-inflammatory drugs (e.g. Advil, Motrin). Individuals taking these drugs should not begin taking ginseng without consulting their health care provider.

Because ginseng lowers blood sugar levels, individuals who are taking insulin or other medications that also lower blood sugar, and those with type 2 diabetes, should be monitored for low blood sugar if they begin taking ginseng. Adjustments are needed in their other medications.

Ginseng may also interact with monoamine-oxi-dase (MAO) inhibitors used to treat certain kinds of depression and mental illness. Examples of MAOs include isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). Individuals taking MAOs with ginseng may develop headache, tremors, increased anxiety, restlessness, sleeplessness, and mania.

Preliminary evidence suggests that ginseng may interact with certain blood pressure and heart medications. The herb may also interfere with the way the liver processes other drugs and herbs. Before beginning to take a supplement containing ginseng, individuals should review their current medications with their health care provider to determine any possible interactions.

Complications

Serious side effects of ginseng are rare. The most common side effects are increased restlessness, insomnia, nausea, diarrhea, and rash. Allergic reactions are possible, but uncommon. Some of the more serious side effects reported are thought to be the result of contamiNation with pesticides, heavy metals, or other chemicals rather than a side effect caused by ginseng.

Parental concerns

Parents should be aware that the safe dose of many herbal supplements has not been establsihed for children. Accidental overdose may occur if children are give adult herbal supplements.

BOOKS

Court, William E. Ginseng: The Genus Panax. Australia: Harwood Academic, 2000.

Johanssen, Kristin. Ginseng Dreams: The Secret World of America’s Most Valuable Plant. Lexington, KY: University Press of Kentucky, 2006.

PDR for Herbal Medicines, 3rd ed. Montvale, NJ: Thompson Healthcare, 2004.

Pierce, Andrea. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: William Morrow, 1999.

Taylor, David. Ginseng, the Divine Root: The Curious History of the Plant That Captivated the World. Chapel Hill, NC: Algonquin Books of Chapel Hill, 2006.

Wildman, Robert E. C., ed. Handbook of Nutraceuticals and Functional Foods, 2nd ed. Boca Raton, FL: CRC/Taylor &Francis, 2007.

PERIODICALS

Kaneko, Hitoshi and Kozo Nakanish. “Proof of the Mysterious Efficacy of Ginseng: Basic and Clinical Trials: Clinical Effects of Medical Ginseng, Korean Red Ginseng: Specifically, Its Anti-stress Action for Prevention of Disease.” Journal of Pharmacological Sciences 95 (2004):158–62.

Kiefer, David and Traci Pantuso. “Panax Ginseng.” American Family Physician 68 (October 15, 2003):1539–42. Also available at <http://www.aafp.org/afp/20031015/1539.html>

ORGANIZATIONS

Alternative Medicine Foundation. P.O. Box 60016, Potomac, MD 20859. Telephone: (301) 340-1960. Fax: (301) 340-1936. Website: <http://www.amfoundation.org>

National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gathersburg, MD 20898. Telephone: (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. Website: <http://nccam.nih.gov>

Ginseng Board of Wisconsin. 555 N. 72nd Avenue, Suite 2, Wausau, WI 54401. Telephone: (714) 845-7300. Fax: (715) 845-7300. Website: <http://www.ginsengboard.com>

National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gathersburg, MD 20898. Telephone: (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. Website: <http://nccam.nih.gov>

Natural Standard. 245 First Street, 18th Floor, Cambridge, MA 02142. Telephone: (617) 444-8629. Fax: (617) 444-8642. Website: <http://www.naturalstandards.com>

Office of Dietary Supplements, National Institutes of Health. 6100 Executive Blvd., Room 3B01, MSC 7517, Bethesda, MD 20892-7517 Telephone: (301) 435-2920. Fax: (301)480-1845. Website: <http://dietary-supplements.info.nih.gov>.

OTHER

American Cancer Society. “Ginseng.” American Cancer Society, October 3, 2005. <http://www.cancer.org/docroot/eto/content/eto_5_3x_ginseng.asp?sitearea=eto>

Harrison, H. C. et al. “Ginseng.” Alternative Field Crops Manual, University of Wisconsin-Extension, undated; accessed February 7, 2007. <http://www.purdue.edu/newcrop/afcm/ginseng.html/Coo>

Mayo Clinic Staff. “Ginseng (American Ginseng, Asian Ginseng, Chinese Ginseng, Korean Red Ginseng, Panax Ginseng: Panax ssp. Including P. Ginseng C.C. Meyer and P. quincefolium L., excluding Eleutherococcus senticosus.” MayoClinic.com, May 1, 2006. <http://www.mayoclinic.com/health/ginseng/NS_patient-ginseng>

Medline Plus. “Ginseng.” U. S. National Library of Medicine, November 1, 2006. <http://www.nlm.nih/gov/medlineplus/druginfo/natural/patient-ginseng.html>

National Center for Complementary and Alternative Medicine. “Asian Ginseng.” National Center for Comple mentary and Alternative Medicine, December 2006. <http://nccam.nih.gov/health/asianginseng>

Personal Health Zone. “Ginseng Side Effects, Interactions and Warnings.” Personal Health Zone October 2006. <http://www.personalhealthzone,com/ginseng.html>

Tish Davidson, A.M.



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