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Efficacy and safety of ginseng

  • DD Kitts (a1) and C Hu (a1)


Ginseng (Panax ginseng, C.A. Meyer) has been a popular herbal remedy used in eastern Asian cultures for thousands of years. In North America, the ginseng species indigenous to both Canada and the United States (Panax quinquefolium) represents an important industry for both domestic and export markets. There are numerous theories and claims describing the efficacy of ginseng, which can combat stress, enhance both the central and immune systems and contribute towards maintaining optimal oxidative status against certain chronic disease states and aging. Risk issues concerning the safety of ginseng at recommended dosages are less prominent and scientifically based. While some epidemiological or clinical studies have reported indications of efficacy for specific health benefits or potential toxicity, there are an equal number of studies that provide contradictory evidence. This situation has led to questionable conclusions concerning specific health benefits or risks associated with ginseng. Recent advances in the development of standardized extracts for both Panax ginseng (G-115) and Panax quinquefolius (CNT-2000) have and will continue to assist in the assessment of efficacy and safety standards for ginseng products. This paper reviews the scientific literature and evidence for ginseng efficacy and safety derived mostly from in vitro and animal studies and places emphasis on the need for more randomized, double-blinded, placebo clinical studies that can provide unequivocal conclusions. An example of the efficacy and safety of ginseng is provided with the description of biological activity of a North American ginseng extract (NAGE), which includes illustrating mechanisms for antioxidant activity without prooxidant properties.

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1Liu, CX, Xiao, PG. Recent advances on ginseng research in China. J. Ethnopharmacol. 1992; 36: 2738.
2Gillis, CN. Panax ginseng pharmacology: A nitric acid link? Biochem. Pharmacol. 1997; 54: 18.
3Attele, AS, Wu, JA, Yuan, CS. Ginseng pharmacology. Biochem. Pharmacol. 1999; 58: 1685–93.
4Vogler, BK, Hittler, MH, Ernst, E.The efficacy of ginseng. A systematic review of randomised clinical trials. Eur. J. Clin. Pharmacol. 1999; 55: 567–75.
5Lee, YS, Chung, IS, Lee, IR, Kim, KH, Hong, WS, Yun, YS. Activation of multiple effector pathways of immune system by the antineoplastic immunostimulator acid polysaccharide ginsan, isolated from Panax ginseng. Anticancer Res. 1997; 17: 323–31.
6Kim, K, Lee, YS, Jung, IS, et al. Acidic polysaccharide from Panax ginseng, ginsan, induces TH-1 cell and macrophage cytokines and generates LAK cells in synergy with IL-2. Planta Med. 1998; 64: 110–15.
7Ma, YC, Zhu, J, Luo, L, et al. . A comparative evaluation of ginsenosides in commercial ginseng products and tissue culture samples using HPLC. J. Herb Spices Med. Plants 1995; 3, 4150.
8Li, TSC, Mazza, G, Cottrell, AC, Gao, L.Ginsenosides in roots and leaves of American ginseng. J. Agric. Food Chem. 1996; 44: 717–20.
9Yuan, C-S, Wu, JA, Lowell, T, Gu, M.Gut and brain effects of American ginseng root on brainstem neuronal activities in rats. Am. J. Chin. Med. 1998; 26: 4755.
10Mizuno, M, Yamada, J, Terai, H, Kozukue, N, Lee, YS, Tsuchida, H.Differences in immunomodulating effects between wild and cultured Panax ginseng. Biochem. Biophys. Res. Commun. 1994; 200: 1672–8.
11Marasco, C, Vargas Ruiz, R, Salas Villagomez, A, Begona Infante, C.Double blind study of a multivitamin complex supplemented with ginseng extract. Drugs Exp. Clin. Res. 1998; 22: 323–9.
12Zuin, M, Attezzati, ZM, Camisasca, M, Riebenfield, D, Podda, M.Effects of a preparation containing a standardized ginseng extract combined with trace elements and multi-vitamins against hepatotoxin-induced chronic liver disease in the elderly. J. Int. Med. Res. 1987; 15: 276–81.
13Takino, Y, Odani, T, Hisayuki, T, Hayashi, T.Studies on the absorption, distribution, excretion and metabolism of ginseng saponins. I. Quantitative analysis of ginsenoside Rg1 in rats. Chem. Pharm. Bull. 1982; 30: 2196–210.
14Kajiwara, H, Hewmming, AM, Hirano, H.Evidence of metal binding activities of pentadecapeptid from Panax ginseng. J. Chromatogr. 1996; 687: 443–8.
15Hasegawa, H, Sung, J-H, Benno, Y.Role of human intestinal prevotella oris in hydrolyzing ginseng saponins. Planta Med. 1997; 63: 436–40.
16Lee, BH, Lee, SJ, Hui, JH, Lee, S, Huh, JD, Moon, CK. In vitro antigenotoxic activity of novel ginseng saponin metabolites formed by intestinal bacteria. Planta Med. 1998; 64: 500–3.
17Brekham, II, Dardymov, IV. New substances of plant origin, which increase non-specific resistance. Annu. Rev. Pharmacol. 1969; 9: 419–30.
18Pieralisi, G, Ripari, P, Vecchiet, L.Effects of standardized ginseng extract combined with dimethylaminoethanol bitartrate, vitamins, minerals and trace elements on physical performance during exercise. Clin. Ther. 1991; 13: 373–82.
19Brahrke, MS, Morgan, WP. Evaluation of the ergogenic properties of ginseng. Sports Med. 1984; 18: 229–48.
20Hassan-Samira, MM, Attia Attia, M, Allam, M, Elwan, O.Effect of the standardized ginseng extract G115 on the metabolism and electrical activity of the rabbit's brain. J. Int. Med. Res. 1985; 13: 342–8.
21Kirchdorfer, AM. Clinical trials with the standardized ginseno-side concentrate G115. In: Chang, HN, Yeung, HW, Tso, WW, Koo, A, eds. Advances in Chinese Medicinal Materials Research. Singapore: World Scientific Publishers, 1985: 529–42.
22Wang, L, Lee, T.Effect of ginseng saponins on exercise performance in non-trained rats. Planta Med. 1998; 64: 130–3.
23Cherdrungsi, P, Rungroeng, D.The effects of standardized extract and exercise training on aerobic and anaerobic exercise capacities in humans. Korean J. Ginseng Sci. 1995; 19: 93100.
24Engels, HJ, Said, JM, Wirth, JC. Failure of chronic ginseng supplementation to affect work performance and energy metabolism in healthy adult females. Nutr. Res. 1996; 16: 12951305.
25Morris, AC, Jacobs, I, McLellan, TM, Klugerman, A, Wanga, LCH, Zamecnik, J.No ergogenic effect of ingestion. Int. J. Sport Nutr. 1996; 6: 263–71.
26Herman, J, Engels, HJ, Wirth, J.No ergogenic effects of ginseng (Panax ginseng C.A. Meyer) during graded maximal exercise aerobic exercise. J. Am. Diet. Assoc. 1997; 97: 1110–15.
27Fulder, SJ. Ginseng and the hypothalamic-pituitary control of stress. Am. J. Chin. Med. 1981; 9: 112–18.
28Hiai, S, Yokoyama, H, Oura, H, Kawashima, Y.Evaluation of corticosterone-secretion-inducing activities of ginsenosides and their prosapogenins and sapogenins. Chem. Pharm. Bull. 1983; 31: 168–74.
29Lee, YJE, Chung, K, Lee, YH, Lee, B, Huh, B, Lee, SK. Ginsenoside-Rg1, one of the major active molecules from Panax ginseng, is a functional ligand of glucocorticoid receptor. Mol. Cell. Endocrinol. 1997; 113: 135–40.
30Hiai, S, Yokoyama, H, Oura, H.Features of ginseng saponin induced corticosterone release. Endocrinol. Jpn. 1979; 26: 737–40.
31Waki, I, Kyo, H, Yasuda, M, Kimura, M.Effects of hypoglycemic component of ginseng radix on insulin biosynthesis in normal and diabetic animals. J. Pharmacobio-dynamics. 1982; 5: 547–9.
32Sotaniemi, EA, Haapakoski, E, Rautio, A.Ginseng therapy in non-insulin dependent diabetic patients. Diabetes Care 1995; 18, 1373–5.
33Yuan, YV, Kitts, DD. Endogenous antioxidants. Role of antioxidant enzymes in biological systems. In: Shahidi, F, ed. Natural Antioxidants: Chemistry, Health Effects and Applications. Champaign, IL: AOCS Press, 1996: 258–70.
34Deng, HL, Zhang, JT. Anti-lipid peroxidative effect of ginsenoside Rb1 and Rg1. Chin. Med. J. 1991; 104: 395–8.
35Rimar, S, Lee-Mengel, M, Gillis, CN. Pulmonary protective vasodilating effects of a standardized Panax ginseng preparation following artificial gastric digestion. Pulm. Pharmacol. 1996; 9: 205–9.
36Voces, J, Alvarez, AI, Vila, L, Ferrando, A, Cabral de Oliveria, C, Prieto, JG. Effects of administration of the standardized Panax ginseng extract G-115 on hepatic antioxidant function after exhaustive exercise. Comp. Biochem. Physiol. 1999; 123: 175–84.
37Jeong, TC, Kim, HJ, Park, JI, et al. . Protective effects of red ginseng saponins against carbon tetrachloride-induced hepatotoxicity in Sprague-Dawley rats. Planta Med. 1997; 63: 136–40.
38Li, Y, Zhao, XJ. Effects of panaxadiol saponins on the contents of serum enzymes, lipid peroxides and SOD in hemorrhagic shock dogs. Chin. J. Pathophysiol. 1989; 5: 539–44.
39Hui-Ling, D, Jun-Tian, Z.Anti-lipid peroxidative effect of ginsenoside Rb1 and Rg2. Chin. Med. J. 1991; 104: 395–8.
40Kim, YH, Park, KH, Rho, HM. Transcriptional activation of the Cu/Zn superoxide dismutase gene through the AP2 site by ginsenoside Rb2 extracted from a medicinal plant, Panax ginseng. J. Biol. Chem. 1996; 271: 24539–43.
41Zhang, YG, Liu, TP. Protective effects of total saponins of Panax ginseng on ischemia-reperfusion injury in rat brains. Chin. J. Pharmacol. Toxicol. 1994; 8: 712.
42Chen, X, Gillis, CN. Effect of free radicals on pulmonary vascular response to acetylcholine. J. Appl. Physiol. 1991; 71: 821–5.
43Kim, HY, Chen, X, Gillis, CN. Ginsenosides protect pulmonary vascular endothelium against free radical-induced injury. Biochem. Biophys. Res. Commun. 1992; 189: 670–6.
44Yuan, C-S, Attele, AS, Wu, JA, Lowell, TK, Gu, Z, Lin, Y.Panax quinquefolium L. inhibits thrombin-induced endothelin release in vitro. Am. J. Chin. Med. 1999; 27: 331–8.
45Wink, DA, Hanbauer, I, Krishna, MC, DeGraft, W, Ganson, J, Mitchell, JB. Nitric oxide protects against cellular damage and cytotoxicity from reactive oxygen species. Proc. Natl. Acad. Sci. 1993; 90: 9813–17.
46Kang, SY, Schini-Kerth, VB, Kim, ND. Ginsenosides of the protopanaxatriol group causes endothelium-dependent relaxation in the rat aorta. Life Sci. 1995; 56: 1577–86.
47Peng, CF, Li, YJ, Li, YJ, Deng, HW. Effects of ginsenosides on vasodilator nerve actions in the rat perfused mesentery are mediated by nitric oxide. J. Pharm. Pharmacol. 1995; 47: 614–17.
48Maffei-Facino, R, Carini, R, Aldini, G, Berti, F, Rossoni, G.Panax ginseng administration in the rat prevents myocardial ischemia-reperfusion damage induced by hyperbaric oxygen: evidence for an antioxidant intervention. Planta Med. 1999; 65: 614–19.
49Abuja, PM, Murkovic, M, Pfannhauser, W.Antioxidant and prooxidant activities of elderberry (Sambucus nigra) extract in low-density lipoprotein oxidation. J. Agric. Food Chem. 1998; 46: 4091–6.
50Wang, H, Cao, G, Prior, RL. Oxygen radical absorbing capacity of anthocyanins. J. Agric. Food Chem. 1997; 45: 304–9.
51Kitts, DD, Yuan, YV, Wijewickreme, AN, Thompson, LU. Antioxidant activity of the flaxseed lignan secoisolaiciresinol diglycoside and its mammalian lignan metabolites enterodiol and enterolactone. Mol. Cell. Biochem. 1999; 202: 91100.
52Hu, C, Kitts, DD. Studies on the antioxidant activity of echinacea root extract. J. Agric. Food Chem. 2000; 48: 466–72.
53Zhang, D, Yasuda, Y, Yu, P.Ginseng extract scavenges hydroxyl radical and protects unsaturated fatty acids from decomposition caused by iron-mediated lipid peroxidation Free Radical. Biol. Med. 1996; 20: 145–50.
54Kitts, DD, Wijewickreme, AN, Hu, C.Antioxidant properties of a North American ginseng extract. Mol. Cell. Biochem. 2000; 203: 110.
55Huong, NTT, Matsumoto, K, Kasai, R, Yamosaka, K, Watanabe, H.In vitro antioxidant activity of vietnamese ginseng saponin and its components. Biol. Pharm. Bull. 1998; 21: 978–81.
56Zhong, GG, Qi, H, Zhao, CY, Jiang, Y.Comparative observation on the influence of 11 ginsenoside monomers on the free radical contents of myocardiocytes with the electron spin resonance method Acta. Biochem. Biophys. Sin. 1993; 25: 667–71.
57Mei, B, Wang, YF, Wu, JX, Chen, WZ. Protective effects of ginsenosides on oxygen free radical induced damages of cultured vascular endothelial cells in vitro Acta. Pharm. Sin. 1994; 29: 801–8.
58Suh, DY, Han, YN, Han, BH. Malitol, an antioxidant component of Korean red ginseng shows little prooxidant activity. Arch. Pharm. Res. 1996; 19: 112–15.
59Juurlink, BNJ. Management of oxidative stress in the CNS: The many roles of glutathione. Neurotoxicity Res. 1999; 1: 119–40.
60Coteller, N, Bernier, JL, Henichart, JP, Catteau, JP, Gaydou, E, Wallet, JC. Scavenger and antioxidant properties of ten synthetic flavones Free Radical. Biol. Med. 1992; 13: 211–19.
61Ko, FN, Cheng, ZJ, Lin, CN, Teng, CM. Scavenger and antioxidant properties of prenylflavones isolated from Artocarpus heterophyllus Free Radical. Biol. Med. 1998; 25: 166–8.
62Hess, FG, Parent, RA, Stevens, KR, Cox, GE, Becci, PJ. Effect of subchronic feeding of ginseng extract G-115 in beagle dogs Food. Chem. Toxicol. 1983; 21: 95–7.
63Siegel, RK. Ginseng abuse syndrome: Problems with the panacea. JAMA 1979; 241, 1614–15.
64The German Commission E Monographs. Translated into English: Blumenthal, M, Hall, T, Rister, R, eds. Klein, S, Rister, R, transl. Austin, TX: American Botanical Council, 1996.
65Klepser, TB, Klepser, ME. Unsafe herbal therapies. Am. J. Health System. Pharm. 1999; 56, 125.
66Awang, DVC. Maternal use of ginseng and neonatal androgenization. [Letter, comment]. JAMA 1991; 265, 1828.
67Palmer, BV, Montgomery, ACV, Monteiro, JCMP. Ginseng and mastalgia. BMJ 1978; 6122, 1284.
68Jones, BD, Runkis, AM. Interaction of ginseng with phenelzine. J. Clin. Psychopharmacol. 1987; 7: 201–2.
69Janetzky, K, Morreale, AP. Probable interactions between warfarin and ginseng. Am. J. Health Syst. Pharm. 1997; 54: 692–3.
70Awang, DVC. The anti-stress potential of North American ginseng (Panax quinquefolius L.). J. Herbs, Spices Med. Plants 1998; 62, 8791.
71Mahoney, JR, Graft, E.Role of alpha-tocopherol, ascorbic acid, citric acid and EDTA as oxidants in model systems. J. Food Sci. 1986; 51: 1293–6.
72Aruoma, OI, Evans, PJ, Kaur, H, Sutcliffe, L, Halliwell, B.An evaluation of the antioxidant and potential prooxidant properties of food additives and trolox C, vitamin E and probucol. Free Radical Res. Commun. 1990; 10: 143–57.
73Biaglow, JE, Manevich, Y, Uckin, F, Held, KD. Quantitation of hydroxyl radicals produced by radiation and copper-linked oxidation of ascorbate by 2-deoxy-D-ribose method. Free Radical Biol. Med. 1997; 22: 1129–38.
74Laughton, ML, Halliwell, PL, Evans, PL, Hoult, JRS. Antioxidant and prooxidant actions of the plant phenolics, quercetin, gossypol and myricetin. Biochem. Pharmacol. 1989; 38: 2859–65.
75Roedig-Penman, A, Gordon, MH. Antioxidant properties of catechins and green tea extracts in model food emulsions. J. Agric. Food Chem. 1997; 45: 4267–70.
76Halliwell, B, Grootveld, M, Gutteridge, B.Methods for the measurement of hydroxyl radicals in biochemical systems. Deoxyribose degradation and aromatic hydroxylation. Methods Biochem. Anal. 1987; 33: 5987.
77Ueda, J, Saito, N, Shimazu, Y, Ozawa, T.A comparison of scavenging abilities of antioxidants against hydroxyl radicals. Arch. Biochem. Biophys. 1996; 333: 377–84.
78Cui, J, Garle, M, Bjorkhem, I, Eneroth, P.What do commercial ginseng preparations contain? Lancet 1994; 344, 134.
79Choi, SW, Cho, EH, Chi, SY. 1995; Ginsenosides activate DNA polymerase from bovine placenta. Life Sci. 1994; 57: 1359–65.
80Tachikawa, E, Kudo, K, Kashimoto, T.Ginseng saponins reduce acetylcholine-evoked Na+ influx and catecholamine secretion in bovine adrenal chromaffin cells. J. Pharmacol. Exp. Ther. 1995; 273: 629–36.
81See, DM, Broumand, N, Sahl, L, Tills, JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficient syndrome patients. Immunopharmacology 1997; 35, 229–35.
82Kenarova, B, Neychev, H, Hadijiivariova, C, Petkov, VD. Immunomodulatory activity of ginsenoside Rg1 from Panax ginseng. Jpn. J. Pharmacol. 1990; 54: 447–54.
83Ro, JY, Ahn, YS, Kim, KH. Inhibitory effect of ginsenoside on the mediator release of the guinea pig mast cells activated by specific antigen-antibody reactions. Int. J. Immunopharmacol. 1998; 20: 625–41.
84Lui, J, Zhang, JT. Immunoregulatory effects of ginsenoside Rg1 in aged rats. Yao Hsueh Hsueh Pao-Acta Pharm. Sin. 1995; 30: 818–23.
85Lui, J, Wang, S, Liu, H, Yang, L, Nan, G.Stimulatory effect of saponin from Panax ginseng on immune function of lymphocytes in the elderly. Mech. Ageing Dev. 1995; 83: 4353.
86Matsunaga, H, Katano, M, Yamamoto, H, Mori, M, Takata, K.Studies on the panaxatriol of Panax ginseng C.A. Meyer. Isolation, determination and antitumour activity. Chem. Pharm. Bull. 1989; 37: 1281–91.
87Duda, RB, Zhong, Y, Navas, V, Li, MZC, Toy, BR, Alavarez, JG. American ginseng and breast cancer therapeutic agents synergistically inhibit MCF-7 breast cancer cell growth. J. Surg. Oncol. 1999; 72: 230–9.
88Tode, T, Kikuchi, Y, Kita, T, Hirata, J, Imaizumi, I, Nagata, I.Inhibitory effects by oral administration of ginsenoside Rh2 on the growth of human ovarian cancer cells in nude mice. J. Cancer Res. Clin. Oncol. 1993; 120: 24–6.
89Zhu, JH, Takeshita, T, Kitagawa, I, Morimorto, K.Suppression of the formation of sister chromatid exchanges by low concentrations of ginsenoside Rh2 in human blood lymphocytes. Cancer. Res. 1995; 55: 1221–3.
90Wakabaayashi, C, Murakami, K, Hasegawa, H, Murata, J, Saiki, I.An intestinal bacterial metabolite of ginseng protopanaxadiol saponins has the ability to induce apoptosis in tumour cells. Biochem. Biophys. Res. Commun. 1998; 246: 725–30.
91Oh, M, Choi, YH, Choi, SH. Antiproliferating effects of ginsenoside Rh2 on MCF-& human breast cancer cells. Int. J. Oncol. 1999; 14: 869–75.
92Kim, T-H, Lee, Y-S, Cho, C-K, Park, S, Choi, S-Y, Yoo, S-Y. Protective effect of ginseng on radiation-induced DNA double strand breaks and repair in murine lymphocytes. Cancer Biother. Radiopharm. 1996; 11: 267–72.
93Mochizuki, M, Yoo, YC, Maatsuzawa, K.Inhibitory effect of tumor metastasis in mice by saponins, ginsenoside-Rb2, 20(R)- and 20 (S)-ginsenoside-Rg3, of red ginseng. Biol. Pharm. Bull. 1995; 18: 11971202.
94Yun, TK. Experimental and epidemiological evidence of the cancer-preventative effects of Panax ginseng. C.A. Meyer Nutr. Rev. 1996; 54, S71–81.
95Yun, T-K, Choi, SY. Non-organ specific cancer prevention of ginseng: a prospective study in Korea. Int. J. Epidemiol. 1998; 27: 359–64.
96Zhang, Y, Xu, XU, Jiang, YP. Effects of ginsenosides on myocardial ischemia/re-perfusion damage in open heart surgery patients. Med. J. China 1994; 74, 626–8.
97Lee, J-H, Park, H-J. Effects of lipophilic fraction from Korean red ginseng on platelet aggregation and blood coagulation in rats fed with corn oil and beef tallow diet. Korean J. Ginseng Sci. 1995; 19: 206–11.
98Chen, X.Cardiovascular protection by ginsenosides and their nitric oxide releasing action. Clin. Exp. Pharmacol. Physiol. 1996; 23: 728–32.
99Huang, YS. Effect of ginsenosides Rb1 and Rg1 on lipid peroxidation of rat in vitro. Chung Kuo I Shueh Ko Hsueh Yuan Hsueh Pao 1989; 11, 460–2.
100Kim, J-S, Kim, K-W, Choi, K-J. Screening of active components of red ginseng saponin Korean. J. Ginseng Sci. 1996; 20: 173–8.
101Chang, MS, Choi, KJ, Rho, HM. Effect of the contents of ratio of panaxadiol ginsenosides extracted from compartments of ginseng on the transcription of Cu/Zn superoxide dismutase gene. J. Ginseng Res. 1999; 23: 44–9.


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Efficacy and safety of ginseng

  • DD Kitts (a1) and C Hu (a1)


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