Natural Products

Ginseng

Panax ginseng, Chinese or Korean ginseng

Efficacy

• Indications with proven efficacy:
  To restore work and concentration capacity
  To strengthen the body in the presence of fatigue or during convalescence
• Indications with possible, but poorly documented efficacy - the use of this product cannot be recommended:
  Diabetes (improves fasting blood glucose and glycosylated hemoglobin)
  To increase resistance to stress
• Also used for these other indications, but with no proof of efficacy:
  Atherosclerosis
  Cancer (prevention)
  Congestive heart failure
  Depression
  Erectile disorder
  Loss of appetite and vomiting
  Rheumatism
  Sexual disorder
  To protect against ulcers, radiations, infections and some toxins
  To slow the aging process

Security

• Risk of Drug Interactions: High
• Adverse Effects: Not Frequents

What is it?

Ginseng (Panax ginseng) is a small perennial plant that used to grow wild in China and Korea. Its root has been used for medicinal purposes for several thousand years. However, because of over-harvesting, wild ginseng is now very rare. It is widely cultivated in China, Korea, Russia and Japan. Other related species, with similar properties, are also used: Panax quinquefolium (American ginseng), Panax japonicum (Japanese ginseng) and Panax pseudoginseng (Himalayan ginseng). However, Siberian ginseng (Eleutherococcus senticosus) should be avoided since it is not real ginseng.

The source, age and part of the root used in the various commercial preparations all determine the quality of ginseng or ginseng extract available. Well-formed old roots from wild plants are very precious while small roots from cultivated plants are less sought after. For economical reasons, most ginseng preparations available in North America contain only low quality ginseng often mixed with products of no interest.

Ginseng root contains saponins, called ginsenosides, thought to be responsible for the plant's medicinal activity

Ginseng is available in capsules or drinkable ampules.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

Ginseng appears to have an adaptogen effect (tonic) on people who suffer from fatigue or are in convalescence. It also seems to effectively improve work and concentration capacity.

• To restore work and concentration capacity
  To strengthen the body in the presence of fatigue or during convalescence:
  The usual dose is 500 to 2000 mg of dried root daily, in divided doses.

  To restore work and concentration capacity in young patients or those in otherwise good health, the treatment should last 2 to 3 weeks, with a 2-week product-free period between cycles.

  To strengthen the body in the presence of fatigue or during convalescence in sick or elderly patients, the treatment duration can be indefinite (3 consecutive months followed with a 2-week product-free period).

There is insufficient reliable information to conclude that ginseng is effective in any other indication.

Is it safe?

• Ginseng is not associated with any specific toxicity. Most users will suffer no adverse reactions, however insomnia, euphoria, decreased appetite, tachycardia, headaches, nausea and diarrhea may occur in some individuals. Women may experience breast tenderness, vaginal bleeding or amenorrhea.
• Ginseng is contraindicated for children, and in cases of coagulation dysfunction. Hypertensive patients should not use this product since there are reports of ginseng-induced hypertension. People with diabetes and cardiac disease should also use Ginseng with caution.
• Since there is no safety data available concerning its use during pregnancy, pregnant women should not take ginseng. Ginseng is contraindicated in newborns following reports of intoxication leading to death. It should not be used by lactating women.
• Allergic reactions are possible but rare.
• Ginseng appears to enhance caffeine's effect. During concomitant administration with insulin, insulin dosage adjustment may be necessary. The effect of anticoagulants (such as Coumadin) may be reduced while the effect of CNS stimulants may be enhanced. Ginseng may interact with several drugs, before taking ginseng, check with your pharmacist to make sure that there are no interactions with your regular medication.

Clinical notes

• Ginseng is probably the most widely used medicinal plant around the world. Unfortunately, several studies have shown that ginseng preparations are often adulterated. More often than not, commercial products do not contain the amounts of ginseng listed on the label, but are made of totally unrelated substances and some products may be contaminated with lead or fungicide. Ephedrine and caffeine are often added to commercial ginseng preparations to produce the desired stimulant effect.

References

1. Blumethal M et al. The Complete German Commission E monographs, 1998
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Lininger S. et Al. The Natural Pharmacy, Prima Health, 1998
4. Barnes J. et Al. Herbal Medicines, 2nd edition, Pharmaceutical Press, 2002
5. Pierce Andrea, Practical Guide to Natural Medicines, 1999
6. Passeportsanté.net. Ginseng. http://www.passeportsante.net
7. Taylor J. CE: Phytomedicinals: Uses, precautions, and drug interactions. Drug Topics 2003;1:79
8. Herbal Companion to AHFS DI, American Society of Health-System Pharmacists, 2001
9. Kiefer D. and Pantuso T. Panax ginseng, American Family Physician, 2003;68:1539-42

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