sign in sign up
<<
Home , American ginseng, Eleutherococcus, Ginseng, Panax, Panax ginseng

FEATURE : Fact Versus Myth

WILLIAM HAMILTON, Pharm.D. Assistant Professor, Creighton University School of Pharmacy and Allied Health Professions, Omaha, NE WILLIAM KIRCHAIN, Pharm.D. Associate Professor, Philadelphia College of Pharmacy, Philadelphia, PA

erbalists claim that preparations of ginseng improve overall physical and mental performance, regulate brain function and raise resistance to stress.1 Known as atale-kule to the Cherokee, it Hwas used for headaches, premenstrual syndrome and other menstrual-associated complaints.2 Traditional Chinese textbooks describe near-mythical qualities such as restoring balance to one’s life force, increasing longevity, improving memory, stopping convulsions, and increasing happiness.3

Ginseng is one of the Few herbs carry the history and senticosus on vari- most frequently used ous physiologic measurements therapeutic promise of ginseng. failed to support either supple- herbs reported in a study ment as a reliable aid to athletic of customers visiting Is the promise fulfilled? performance.15-18 health food stores.4 Improved Erectile Function: blood pressure, anti-stress activity, and COMMON NAMES has shown positive better athletic performance. Ginseng is effects on male copulatory behavior in ginseng C. A. Meyer [Fam. also believed to protect the liver, male rats.19 Reproductive performance ] is also referred to as reduce radiation effects, improve blood was studied in two generations of rats 3,5 Korean ginseng or Chinese ginseng. sugar in diabetics, and help to prevent using ginseng extract G115. Results Used extensively in Asia, it is the cancer. revealed no significant differences in subject of numerous historical anec- Improved Concentration and Anti- physiologic or reproductive parame- dotes and subjective publications.6 stress Activity: Studies have shown ters in two generations.20 In a separate Another major species is Panax quin- mixed results with respect to memory study, Korean red ginseng (Panax quefolius L., commonly referred to as and anti-stress responses in rats. ginseng) was compared to placebo and American ginseng. A third variety— Ginseng standardized extract (G115) trazodone. Choi HK, et al.,21 noted Siberian ginseng—is not a species of and American ginseng produce modest increased “penile rigidity and girth, Panax. The preferred name is eleuthero positive improvements in standardized libido and patient satisfaction (p < (Eleutherococcus senticosus Maxim.)6 10,11 0.05)” in a group of 90 men. Ginseng American and Korean ginseng contain tests of memory in animal models. has been shown to enhance the conver- a complex mixture of triterpenoid In a double-blind study evaluating 22 classified into panaxosides, quality-of-life parameters, a multivita- sion of L- to . and chikusetsusaponins.7 min product was compared to a Cardiovascular Protection: RB-1 must be hydrolyzed with ginseng extract American ginseng has an inhibitory by intestinal bacteria to be absorbed.8 G115. The 12-week study involved 501 effect on low density lipoprotein oxida- outpatients. Results, assessed by a tion in hyperlipidemic-prone rats.23 In REPORTED USES standardized questionnaire, indicated an animal model, Herbalists classify ginseng as an that ginseng was effective in improv- enhanced release of from “adaptogen,” a term with no allopathic ing quality of life.12 endothelial cells, which appeared equivalent. These are substances that Improved Athletic Performance: partially responsible for its cardiopro- “enhance endurance for physical and Most claims of improved athletic tective effects.24 An extract of ginseng mental work and increase nonspecific performance are not supported by has been shown to inhibit high- resistance to stress…in physiologically scientific evidence.13 Ginseng is threshold, voltage-dependent 9 adverse habitats.” promoted for “accelerating the restora- channels.25 When added to a cardio- Claims for ginseng include tive processes after intensive activity plegic solution, ginsenosides were improved concentration, increased and increasing the body’s resistance to claimed to have protective effects in a stamina, improved erectile function, unfavorable external influences.”14 human trial of 30 mitral valvular surgi- cardiovascular protection, decreased Investigations of Panax ginseng and cal patients.26 A study of 45 patients

10 COMMUNICATION JULY/AUGUST 2000 with class IV congestive to benefit in this study included female with a multivitamin was found effec- compared red ginseng alone and in breast, uterine cervix, urinary bladder tive for developing resistance to combination with digoxin to digoxin and thyroid gland. In , stomach physical stress.9 A small, double-blind, alone. A synergistic benefit was cancer is the most frequently reported controlled study of geriatric inpatients suggested for the treatment of conges- neoplasm. There appears to be a correla- found no identifiable effect of ginseng tive heart failure with ginseng in tion with people who have the highest in length of hospital stay or in the combination with digoxin.27 Another consumption of broiled meats and fish, functional outcomes measured.41 study of red ginseng on blood pressure especially salted and fermented prod- Another double-blind study investi- in 26 subjects showed decreased ucts. Ginseng, mung bean pancake, tofu gated the effect of ginseng extract G115 systolic blood pressure (p = 0.03) and a spinach, cabbage and sesame oil appear added to a multivitamin in 501 outpa- trend to lowering diastolic blood pres- to decrease this risk.36 tients under environmental stress. sure (p = 0.17).28 Reduced Effect from Radiation: They found a significant increase in the quality-of-life index.12 Liver Protection: One animal study Eleuthero has shown protection 37 suggests a possible liver-protective against the effects of radiation in rats. Immunity: A study of 20 young effect with ginseng. Ginseng signifi- Improved Blood Sugar in Thai males on the effects of prolonged cantly decreased AST and ALT levels Diabetics: Sotaniemi, Haapakoski, and administration of standardized ginseng in dexamethasone-treated rats.29 A Rautio38 generated interest in the extract on peripheral blood leukocytes preparation containing a standardized impact of ginseng on type 2 and lymphocyte subsets. Two equal ginseng extract, trace elements and mellitus. In an 8-week, double-blind, groups, one supplemented with was compared to placebo in placebo-controlled study of 36 newly ginseng and one taking placebo, were 24 elderly outpatients with toxin- diagnosed patients, ginseng (100 or 200 used. The treatment group received induced ( and drugs) chronic mg) reduced fasting blood glucose and two capsules daily of standardized liver disease. No significant difference body weight, and improved ginseng extract 150 mg per capsule for in these parameters was observed.30 psychophysical performance. 8 weeks. No significant differences were seen in total and differential Cancer Preventative: An leukocyte counts or lymphocyte animal model evaluating the subpopulations between the two ability of red ginseng to protect subject groups.42 In Milan, Italy, a against a papilloma induced by two-arm, randomized, placebo- 7,12-dimethylbenz[alpha]anthracene controlled, double-blind showed a significant benefit.31 investigation looked at whether Ginseng showed inhibition of some ginseng supplementation increased lung metastasis. It was not effective the protective effect of influenza in preventing the invasion of vaccination. Volunteers (227) 32 melanoma and fibrosarcoma cells. received daily oral capsule doses of Ginsenoside Rh2 inhibits the growth either placebo or 100 mg of a stan- of B16 melanoma cells. Oral but not dardized ginseng extract for a period intraperitoneal treatment with Rh2 of 12 weeks, within which they resulted in induction of apoptotic received an anti-influenza polyvalent cells in the tumor, in addition to vaccination at week 4. There were 42 augmenting natural killer activity in cases of influenza or common cold in spleen cells from tumor-bearing the placebo group, versus 15 cases in nude mice.33 American ginseng root the ginseng group. The difference extract has been evaluated in breast Adaptogen-Anti-aging: Traditional was highly significant (p = 0.001). cancer cell lines. Results indicate an anti-aging products are being studied Antibody titers and natural killer cell exhibition of estrogen-like effects on extensively in . Chen and Li39 activities were twice as high in the certain estrogen receptor-positive reviewed 386 traditional effective anti- ginseng group versus placebo (p = breast cancer cells. This induction of aging medications. Ginseng heads that 0.0001). was reported to be a pS2 expression appears to promote a list, but the authors of the review clas- common adverse event.43 34 protective role against breast cancer. sify the results of most studies as Polymorphonuclear leukocyte chemi- A Korean study compared the preliminary and suggest further inves- luminescence increased in a rat cancer risk to the reported intake of tigations. One animal study in mice model.44 A comparison of wild and ginseng. A decreased risk of some investigated four different ginseng cultured Panax ginseng measured pan T types of cancer was associated with infusions for up to 96 days. The cells, helper T cells, and cytotoxic T groups ingesting fresh ginseng extract, comparison of eleuthero, Chinese and cells. Results indicate a positive effect white ginseng extract, white ginseng American ginseng showed no differ- in mice from wild Panax ginseng. powder and red ginseng. Benefit ences in stamina or longevity between Cultures did not show the same increase correlated with the frequency them. The researchers concluded that change in mitogenic activity.45 and duration of ginseng use. There ingesting adaptogenic did Eleutherococcus senticosus extract was no attempt to sort out other not significantly affect the survival of (Eleukokk) showed a pronounced health-promoting behaviors and other mice under major environmental increase in T lymphocytes in a double- risk factors beyond smoking, stress.40 In another animal model, blind human study of 36 healthy however.35 Cancers that did not appear Panax ginseng alone and combined volunteers.46

COMMUNICATION JULY/AUGUST 2000 11 SPECIAL CONSIDERATIONS Commission E monographs, which provides some cautions for ginseng or Several weeks are recommended for indicate no known side effects. Many eleuthero therapy. of these reactions are extensions of the full benefits to be realized. Although DOSAGE lifetime use may be common in Asia, possible effects of ginseng. there are no long-term clinical studies Pharmacist’s Letter makes a good case The dry root is usually dosed at to evaluate risk or benefit. References for the possible disparity in adverse 0.5–3 g daily. Commercial ginseng suggest limiting therapy at various effects as secondary to the adulteration extract products range from 100–600 mg durations (TABLE 1). and mislabeling common with ginseng standardized to a percent of genseno- products.50 sides daily, in one or two equal doses. ADVERSE REACTIONS Unusual Side Effects: A regular COMBINATION PRODUCTS Hypertension was noted as part of a ginseng user experienced the symp- “ginseng abuse syndrome” described toms of Stevens-Johnson syndrome A combined preparation (60 mg by Siegel.47,48 The report relied on (painful erosions in mouth and urogen- biloba + 100 mg ginseng), stan- patient accounts of unverified but ital mucosa, corneal ulceration and dardized of 24% ginkgo flavone reportedly high-dose ginseng use and purpuric macules) after taking two glycosides and 4% ginsenosides, was concurrent use in a group of pills a day for three days to help studied for its effect on blood pressure psychiatric patients. Of the 133 patients recover from a cold. It is possible that a in 10 healthy medical students. Systolic studied, elevated blood pressure devel- contaminant such as a nonsteroidal blood pressure was decreased both for oped in 14 patients using Panax anti-inflammatory could have been the large-dose (120 mg + ginseng and 8 patients using present. Consideration should be given 200 mg ginseng) and low-dose admin- Eleutherococcus senticosus. Ginseng to any change in blood pressure, and istration (60 mg Ginkgo biloba + 100 mg has not been confirmed in other stud- hypertensive patients should not use ginseng). Diastolic blood pressure and ies to cause an abuse syndrome.49 The ginseng without medical supervision heart rate decreased only in the high 57 German Commission E monographs and frequent monitoring. Extremely dosage group. A combination of and the PDR for Medicines list high doses should be avoided. Any Ginkgo biloba and ginseng produced a high blood pressure as a contraindica- unusual symptoms associated with modest improvement in cognitive tion to using Eleuthero, but not Panax recent additions to therapy should be function in a short-term, double-blind, ginseng. evaluated. placebo-controlled study of 64 other- wise healthy volunteers (aged 40–65 Interactions and Cautions: The This contrasts with the PDR and years) with neurasthenia.58 Commission E monographs and Table 1 the PDR for Herbal Medicines References available upon request to MSP. Selected Guidelines for Duration of Therapy list no known interactions with Suggested Duration of Therapy Three Cases Eleutherococcus ginseng. The Professional’s REFERENCE Panax ginseng senticosus Handbook suggests caution in Case 1. TC is a 23-year-old male in good physical condition. He is considering using ginseng to improv e his Professional’s Continual 3 weeks patients using antidiabetic workouts and physical conditioning. Handbook of Case 2. FX is a 34-year-old female seeking advice for Complementary & agents and insulin because of supplements to help prevent cancer. Her older sister was Alternative Medicines hypoglycemic effects. The just diagnosed with breast cancer and she is concerned The Complete 3 months, a repeated 3 months, a repeated combination of monamine about her own risk. She has Type 2 diabetes mellitus. German Commission course is feasible course is feasible Case 3. GB is a 59-year-old man complaining of fatigue. E Monographs oxidase inhibitors (parnate, He goes home at night after work with just enough energy PDR for Herbal 3–4 weeks None listed selegiline, etc.) and ginseng is to eat and sit on the couch for the rest of the evening. He Medicines is 28 pounds over his ideal body weight and is being Herbal Medicinals: A A 2-week break every 2 A 2-week break every 2 reported to cause headache, treated for mild hypertension with a low dose of an Clinician’s Guide months months tremors and mania. Eleuthero angiotension II receptor antagonist. His average blood Therapeutic Short-term for young and Up to 3 months, or a pressure with treatment is 132 systolic over 84 diastolic. Monographs of healthy. Long-term for course 1 month with 2 may increase the excretion of He wants to have more energy so he can try an exercise (American Botanical older and unhealthy. months off, then repeat some and program. Council) C.60 McRae reported elevated Nutritional Herbology Only in response to Only as needed in APPLICATION TO CASES specific stress response to stress digoxin levels following the Case 1. It is recommended not to incorporate ginseng into The Pharmacology of None listed None listed addition of eleuthero to a TC’s supplement plan. Proper diet and consistency in Chinese Herbs patient with constant levels for training are the two most significant factors in any physical conditioning program. Ginseng has not been shown to Table 2 many years.52 add to these two factors in any substantial way. Suggested Cautions with Ginseng Use Case 2. Studies in both areas are extremely limited. Medications Action One animal study on the non- Korean ginseng is not helpful for breast cancer fraction from the of Panax ginseng prevention. However, one study demonstrated a benefit, , heparin, Avoid concomitant use or in vitro, from American ginseng. It will be much more aspirin and NSAIDs monitor carefully demonstrated inhibition of platelet important for FX to have a complete work-up for the HER2 MAOIs Avoid concomitant use aggregation.53 Anticoagulation was also genotype and other inherited risks for breast cancer. Oral hypoglycemics, Monitor blood sugar Based on results of this work-up, she may be a candidate insulin described after 30 days of eleuthero for tamoxifen or early mammography. Regarding her type Vitamins B1, B2, C Increase vitamin dose administration in rats.54 A probable 2 diabetes mellitus, one human study using Panax Estrogens or Avoid concomitant use ginseng demonstrated improvement in blood glucose. corticosteroids (possible additive effects) interaction between warfarin and One approach could be to try Panax ginseng with the ginseng was reported.55 A patient had a consent of her physician for 8 weeks while she monitors Digoxin Avoid concomitant use or blood sugars daily. monitor closely reduction in the international normal- Case 3. GB could benefit from improved immunity, improved mental function, and the adaptogenic effects Table 3 ized ratio (INR) following the addition possible with ginseng. Although physical performance Potential Adverse Reactions of ginseng. The INR returned to previ- appears not to be improved with ginseng, increased Chest pain ous levels following discontinuation of energy is a historical use. The World Health Organization Nervousness (WHO) Guidelines for the Assessment of Herbal Epistaxis Palpitations the ginseng. Mastalgia has been reported Medicines considers “historical use of a substance [as] a Headache Pruritus in a woman after using ginseng powder valid form of information on safety and efficacy, in the Hypertension Skin eruptions absence of scientific documentation to the contrary.”59 If Impotence (with ginseng abuse) for 3 weeks.49 A case of postmenopausal GB believes that ginseng could help him, and his Insomnia Vaginal bleeding bleeding attributed to the use of topical physician consents, treatment can begin. His dose shoul d Mastalgia Vomiting start at the low range, with biweekly monitoring for 56 Source: Based on reference 60 ginseng has been reported. TABLE 2 changes in blood pressure during the first two months of treatment.

12 COMMUNICATION JULY/AUGUST 2000