Is ginger a good treatment for nausea?

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Elsevier ClinicalKey Drug Monograph

Content last updated: May 3, 2024.

Description Ginger is a dietary supplement derived from the underground stem (rhizome) of the perennial plant Zingiber officinale Roscoe. Usually grown in warmer climates, ginger is often referred to by its country of origin. Jamaican ginger, African ginger, and Cochin ginger (China) contain different concentrations of the active ingredient(s). Ginger is chemically classified as an essential oil with pungent principles. The dried rhizome contains approximately 1 to 3% volatile oil which is the source of ginger's characteristic aroma; an oleoresin contains the pungent properties. Ginger has been in use as a digestive aid, spice, and flavoring agent for over 20 centuries. Primarily used as a spice or a dietary supplement, ginger has been used for the prevention of motion sickness. The American College of Obstetricians and Gynecologists (ACOG) guidelines state that ginger may be considered as a first-line nonpharmacologic option for nausea/vomiting during pregnancy; use of ginger may reduce nausea in pregnant women but is not shown to be effective at reducing vomiting episodes. The German Commission E lists anorexia as an indication for a fixed combination of Ginger root, Gentian root, and Wormwood. Reports of neurotoxicity associated with Jamaican ginger in the 1930s were due to an adulterant used in the extract. Ginger is listed in the USP and is Generally Recognized As Safe (GRAS) by the FDA. NOTE: In the U.S., herbal products and dietary supplements are marketed under the Dietary Supplement and Health Education Act of 1994 (DSHEA). Consequently, scientific data supporting claimed benefit(s) are not always available for dietary supplements as they are for traditional pharmaceuticals since supplements are not regulated as drugs. Consumers should also note that rigid quality control standards are not required for these products and substantial variability can occur in both the potency and the purity of these products.

Indications And Dosage Oral dosage Adult pregnant females: 250 mg PO 4 times per day. Suggested Max: 1 gram/day. The American College of Obstetricians and Gynecologists (ACOG) states that ginger may be considered as a first-line nonpharmacologic option. Per ACOG, meta-analyses and systematic reviews of controlled trials (randomized and nonrandomized) have found that ginger was associated with improvements in nausea, but studies have not shown reductions in vomiting.

Pregnancy The American College of Obstetricians and Gynecologists (ACOG) states that ginger can be considered as a first-line nonpharmacologic option for nausea/vomiting during pregnancy. While the German Commission E does not recommend the use of ginger during pregnancy, it lists no specific contraindications related to pregnancy. Controlled trials to date during human pregnancy have not indicated that ginger causes harm to the mother or fetus or other severe toxicity; the dose of ginger ingested during these trials (i.e., no more than 1 gram of fresh root) has generally been below the amounts of ginger used as a spice in various foods. Females should be advised not to exceed normal dietary intakes of ginger.

Mechanism Of Action Ginger posesses antiemetic, anti-inflammatory, analgesic, and cardiotonic properties. Ginger is a cholagogic agent that promotes the flow of bile into the intestine, especially through contraction of the gallbladder. Pharmacologically active components of the oleoresin include gingerols, a class of structurally similar cardioactive compounds, and shogaols. In vitro, gingerols produce concentration-dependent inotropic effects through activation of sarcoplasmic reticulum calcium adenosine triphosphatase (SR Ca2+ATPase). • ** Antiemetic Actions:** Ginger's mechanism of action for the prevention of motion sickness and nausea is not clear. In animal studies, ginger produced antispasmodic effects and exhibited anticholinergic and antihistaminic action. Ginger increases salivation and stimulates intestinal motility through increased tone and peristalsis of the intestines in humans. However, the results of a double-blind randomized crossover trial of healthy volunteers demonstrated no measurable effect on gastric emptying. Galanolactone, a diterpenoid constituent of ginger, demonstrated activity as a 5HT3 antagonist in vitro. Receptors for 5HT3 are located on intestinal vagal nerve terminals and in the chemoreceptor trigger zone. • ** Anti-inflammatory Actions:** Ginger inhibits thromboxane synthetase and is a prostacyclin agonist. Prostaglandins induce vasodilation and increase tissue permeability, which, in turn, promote the influx of fluids and leukocytes. Ultimately, the classic symptoms of inflammation result: swelling, redness, warmth, and pain. It is believed that at least one of the mechanisms by which ginger produces its antiinflammatory effects is through the inhibition of prostaglandin and leukotriene biosynthesis. Through this dual inhibition of eicosanoid biosynthesis, ginger decreases capillary permeability, thus reducing swelling and the influx of inflammatory mediators.

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Crichton M, Marshall S, Isenring E, et al. Journal of the Academy of Nutrition and Dietetics. 2024;124(3):313-330.e6. doi:10.1016/j.jand.2023.09.003.

Publish date: March 5, 2024.

RESULTS: One hundred three participants (ginger: n = 52; placebo: n = 51) were enrolled and analyzed. There was clinically relevant evidence against the null hypothesis, favoring ginger, in change scores for nausea-related QoL (F[df] = 9.34[1,101]; P = 0.003; partial η2 = 0.09), overall CINV-related QoL (F[df] = 12.26[1,101]; P < 0.001; partial η2 = 0.11), delayed nausea severity (F[df] = 9.46[1,101]; P = 0.003; partial η2 = 0.09), and fatigue (F[df] = 10.11[1,101]; P = 0.002; partial η2 = 0.09). There was a clinically meaningful lower incidence of delayed nausea and vomiting in the ginger group at Cycle 2 (53% vs 75%; P = 0.020 and 4% vs 27%; P = 0.001, respectively) and Cycle 3 (49% vs 79%; P = 0.002 and 2% vs 23%; P = 0.001, respectively).

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Elsevier ClinicalKey Clinical Overview

Treatment Dietary modifications for mild-to-moderate nausea and vomiting and recommendations to improve oral tolerance after hyperemesis gravidarum: Most recommendations are empirical, as there are few published studies evaluating the effect of dietary changes Avoid foods that trigger nausea Eat frequent small meals every 1 to 2 hours; avoid an empty or completely full stomach Avoid spicy or fatty foods Choose foods low in fat and high in carbohydrates and/or protein Eat a bland carbohydrate snack before getting out of bed in the morning Discontinue iron-containing vitamins while maintaining folic acid supplements Lifestyle modifications: Increase rest as necessary Avoid sudden movements, as when getting out of bed Avoid sensory stimuli that may trigger nausea (eg, strong odors, heat, humidity, noise, flickering lights) Nondrug treatments: Use ginger in food preparation or as an extract to mitigate symptoms Use of ginger has been shown to reduce nausea, but not vomiting Ginger Root Extract Oral capsule; Adult Pregnant Females: 250 mg PO 4 times per day with a max of 1 g/day has been used in a controlled trial.