Articles

Panax Ginseng

Plant Part Used

Root

Active Constituents

Saponin glycosides (ginsenosides), Glycans (panaxans A-E), sterols (beta-sitosterol), adenosine, minerals including zinc and magnesium, vitamins B1, B2.(1),(24) Ginsenoside compound K is the main metabolite of protopanaxadiol type ginseng saponins in intestine after oral administration and also is the major form of protopanaxadiol saponins absorbed to the body.(25)

[span class=alert]This section is a list of chemical entities identified in this dietary supplement to possess pharmacological activity. This list does not imply that other, yet unidentified, constituents do not influence the pharmacological activity of this dietary supplement nor does it imply that any one constituent possesses greater influence on the overall pharmacological effect of this dietary supplement.[/span]

Introduction

The ginsengs are some of the most frequently purchased herbal supplements in the world. There are several types of ginsengs available on the market. This monograph is on Panax or Asian ginseng, which is also referred to as Chinese ginseng or Korean ginseng. Historically, Panax ginseng has been used for a variety of health benefits, especially for its adaptogenic and tonic effects for people fatigued or under stress.(2) Panax is an adaptogen, having a non-specific action on various functions of the body that increases its ability to cope with various stressors, including physiologic, emotional, and endogenic (external) stress.(26) Thus, Panax can reduce susceptibility to illness.

Purified individual ginsenoside are becoming popular in integrative medicine to treat various health conditions. Individual ginsenosides may have different effects in pharmacology and mechanisms due to their different chemical structures.

Interactions and Depletions

Interactions

Dosage Info

Dosage Range

100-600mg (standardized extract) daily; a regimen of 4 weeks on, 2 weeks off is recommended for maximum benefits.

Most Common Dosage

100-250mg (standardized extract), 2 times a day; a regimen of 4 weeks on, 2 weeks off is recommended for maximum benefits

Standardization

[span class=doc]Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.[/span]

The most current available medical and scientific literature indicates that this dietary supplement should be standardized to greater than 5% ginsenosides per dose, containing Rg1 at >0.75% and an optimal ratio of Rg1:Rb1 of >0.5.

Uses

Frequently Reported Uses

  • Adaptogen, Tonic
  • Anti-Fatigue (Physical And Mental), Concentration
  • Anti-Stress
  • Convalescence And Weakness
  • Adrenal Support
  • Anti-Aging
  • Increases Stamina, Endurance
  • Increase Concentration, Mental Function, Memory
  • Nervous Exhaustion

Other Reported Uses

  • Blood sugar regulation imbalances
  • Adjunctive Support In Chemotherapy And Radiation
  • Immune Enhancement
  • Cholesterol Lowering
  • Hepatoprotective
  • Cancer
  • Alzheimer’s disease

Toxicities & Precautions

General

Ginseng is safe if used in recommended dosages.

Health Conditions

Ginseng should not be recommended in acute inflammatory diseases, in the acute phase of infection, especially with high fever or for bronchitis. Do not use ginseng for chronic disease of the GI tract, such as diverticulitis, esophageal reflux or if similar conditions exist. Based on pharmacology, ginseng should not be recommended to people with kidney disorders.

Side Effects

Adverse effects can include diarrhea, insomnia, restlessness, nausea, vomiting , anxiety and extreme nervousness.(2),(3)

If excitability occurs, it may be necessary to reduce the dose.

Ginseng may cause breast tenderness or menopausal bleeding in some women.(4),(5)

Ginseng Abuse Syndrome (GAS) may occur in prolonged and high doses (includes diarrhea, hypertension, nervousness, skin eruptions, and sleeplessness).(6)

Pregnancy/ Breast Feeding

Use is contraindicated in pregnancy and lactation.(7),(31)

Age Limitations

Do not use in children under 2 years of age, unless recommended by a physician.

Pharmacology

Adaptogen

The main biologically active ingredients of ginseng root (American and Korean/Asian) are the more than 20 saponin triterpenoid glycosides called "ginsenosides". There are two major sub-types of ginsenosides, protopanaxadiol and protopanaxatriol. Rb1, Rb2, Rc, and Rd are examples of protopanaxadiol ginsenosides. Re, Rf, Rg1, and Rg2 are examples of protopanaxatriols.i The Rb1 groups, predominant in the diol series, are reported to have an ability to improve stamina and learning capacity, as well as sedative and hypoglycemic properties. American ginseng (Panax quinquifolius) contains more of the Rb1 diols than Asian/Korean, and may be more suitable for individuals who are coffee drinkers, overweight, or with insomnia. The Rg1 groups, predominant in the triol series, reportedly raise blood pressure slightly in some instances and are mild central nervous system stimulants. Asian or Korean ginseng (Panax ginseng) contain more Rg1 triols and may be more suitable for individuals who are non-hypertensive, athletes, fatigued or with high stress jobs.(9)

It is thought that ginsenosides act at hormone receptor sites, especially the hypothalamic-pituitary adrenal axis (HPA), stimulating secretion of adrenocorticotropic hormone (ACTH).(8) ACTH stimulates the production of adrenal hormones and other factors, leading to balance and regulation of the hypothalamic/adrenal axis that may have been influenced by stress.

Hepatic Effects

Ginsenosides reportedly stimulate RNA, protein synthesis and cholesterol production in the liver.(10) Ginsenosides may increase hepatic rough endoplasmic reticulum and have carbohydrate-sparing and stamina-increasing activity in muscle tissues. Ginsenosides have also been reported in laboratory studies to increase enzyme activity, fatty acid production and decrease oxidative stress in the liver.(32)

Blood Sugar Regulation

Panax ginseng has been reported in laboratory and human studies to have blood sugar regulatory activity.(33),(34),(35) Human studies support the use of Panax in individuals with diabetes and blood sugar regulatory problems.(36),(37) Components of Panax ginseng, including glycans and adenosine, reportedly exhibit the ability to lower blood sugar in diabetic mice and yet have no effect on normally functioning lab animals.(11) An animal study evaluated obese diabetic mice who received intraperitoneal Panax ginseng berry extract and its major constituent, ginsenoside Re, for twelve days. On the twelfth day the mice were normoglycemic (137 ± 6.7 mg/dl) and had significantly improved glucose tolerance. Other effects observed were reduced serum cholesterol as well as weight loss due to less food consumption, increased body temperature and increased energy expenditure.(12) Rg3 extract from Panax has been reported to affect insulin secretion and AMPK activation in laboratory studies.(38) Studies report that Panax ginseng lowers cortisol levels in diabetics, having a positive benefit with regard to insulin regulation. In non-diabetic subjects, Panax ginseng elevates cortisol levels - showing the "adaptogenic" effect of Panax.

Cardiovascular Effects

Ginsenosides and Panax ginseng extracts have been reported in laboratory studies to exert protective effects on vascular dysfunctions, such as hypertension, atherosclerotic disorders and ischemic injury.(39) Panax ginseng reportedly has hypertensive and hypotensive effects that are dose dependent.(13) Lower doses have produced a hypertensive effect, and higher doses have a hypotensive effect.(14) Panax ginseng may decrease total cholesterol, triglycerides and platelet adhesiveness and may increase HDL cholesterol, making it valuable in cardiovascular health.(15) A 2006 meta anaysis found that Panax ginseng had no appreciable effects on cardiovascular risk factors.(40)

A systematic review of human studies found Panax ginseng extracts to be beneficial in improving erectile dysfunction in men though improved nitric oxide production.(41)

Immune/Anticancer

Panax ginseng may reduce the risk of viral infection.(16) Additionally, Panax ginseng is reported to have anticancer and anti-aging effects on cells and immunostimulating activity, especially to the reticuloendothelial system.(17)

Panax ginseng is reported to have anticancer activity in laboratory studies by increasing apoptosis, decreasing inflammation and improving immunity.(42),(43),(44),(45) Panax ginseng may have protective effects for individuals undergoing chemotherapy and radiotherapy.(18) Studies have reported a decrease in weight loss and greater white blood cell counts in lab animals administered ginseng simultaneously with chemotherapeutics.(19) Rg3 extract from Panax ginseng has been reported useful as an adjuvant anti-cancer agent, improving susceptibility of cancer cells to chemotherapy drugs.(29),(30) Panax ginseng may also speed recovery from surgery. Panax ginseng has been reported to help the body adapt to physiologic stress caused by chemotherapy and radiation.(20),(21)

Results of The Shanghai Women’s Health Study Cohort found no association between ginseng intake and gastric cancer risk in 74,942 Chinese women aged 40-70.(51)

Memory/Cognition

A randomized, double-blind, placebo controlled trial involving 30 individuals indicated that Panax ginseng seemed to improve mental health and social functioning after 4 weeks of therapy in the areas measured. Though the study continued therapy for 4 additional weeks, the benefits noted at the 4 week point were no longer observed at the 8 week point.(22)

Panax ginseng has been reported in laboratory and human studies to improve memory and reduce cognitive decline, showing potential usefulness in dementia and Alzheimer’s disease.(47),(48),(49) Components of Panax ginseng, including Rg3, are reported to decrease neuroinflammation and have neuroprotective activity.(50),(51),(52) Rg3 was reported to promote beta-amyloid peptide degradation in a laboratory study.(53) 

Panax ginseng may offer some positive benefits as a general tonic for improved stamina and overall health, especially for stressful conditions, fatigue, concentration, and recovery from illness. A 2009 human study following ginseng use in 6282 Korea individuals 55 years or older from March 1985 to December 2003 was analyzed.(54) Adjusting for age, education, occupation, drinking, smoking, self-reported chronic disease, body mass index, and blood pressure, all-cause mortality for male ginseng users was significantly lower than that for male nonusers, but not in women.

References

  1. Hiai S, et al. A Colorimetric Estimation of Ginseng Saponins. Planta Medica. 1975;28(4):363-69.
  2. Bradley PR, ed. British Herbal Compendium. vol. 1. Bournemouth: British Herbal Medicine Association; 1992:115-17.
  3. Newall CA, et al. Herbal Medicines: A Guide for Health Care Professionals. London: The Pharmaceutical Press; 1996:145-49.
  4. Dukes MN. Ginseng and Mastalgia. Br Med J. Jun1978;1(6127):1621.
  5. View Abstract: Hopkins MP, et al. Ginseng Face Cream and Unexplained Vaginal Bleeding. Am J Obstet Gynecol. Nov1988;59(5):1121-22.
  6. Chen KJ. The Effect and Abuse Syndrome of Ginseng. J Tradit Chin Med. Sep1981;1(1):69-72.
  7. View Abstract: Chan LY, et al. An in-vitro study of ginsenoside Rb1-induced teratogenicity using a whole rat embryo culture model. Hum Reprod. Oct 2003;18(10):2166-8.
  8. View Abstract: Hiai S, et al. Stimulation of Pituitary-Adrenocortical System by Ginseng Saponin. Endocrinol Jpn. 1979;26(6):661-65.
  9. View Abstract: Wang X, Sakuma T, Asafu-Adiave E, et al. Determination of Ginsenosides in Plant Extracts from Panax ginseng and Panax quinquefolius L. by LC/MS/MS. Anal Chem. Apr1999;71(8):1579-84.
  10. Gommori K, et al. Effect of Ginseng Saponins on Cholesterol Metabolism. II. Effect of Ginsenosides on Cholesterol Synthesis by Liver Slice. Chem Pharm Bull. (Tokyo). 1976;24(12):2985-87.
  11. View Abstract: Ng TB, et al. Hypoglycemic Constituents of Panax Ginseng. Gen Pharmacol. 1985;16(6):549-52.
  12. View Abstract: Attele AS, Zhou YP, Xie JT, Wu JA, Zhang L, Dey L, et al. Antidiabetic Effects of Panax ginseng Berry Extract and the Identification of an Effective Component. Diabetes. Jun 2002;51(6):1851-1858.
  13. View Abstract: Lei XL, et al. Cardiovascular Pharmacology of Panax Notoginseng (Burk) F.H. Chen and Salvia Miltiorrhiza. Am J Chinese Med. 1986;14:145-52.
  14. Siegel RK. Ginseng and High Blood Pressure. JAMA. Jan1980;243(1):32.
  15. View Abstract: Chen X. Cardiovascular Protection by Ginsenosides and Their Nitric Oxide Releasing Action. Clin Exp Pharmacol Physiol. 1996;23(8):728-32.
  16. View Abstract: Lucerno MA, et al. Alternatives to Estrogen for the Treatment of Hot Flashes. Ann Pharmacother. 1997;31(7-8):915-17.
  17. Krylov AV, et al. Effect of Juices from Araliaceae Plants on the Infectivity of Phytopathogenic Viruses. Acta Virol. 1972;16(1):75-76.
  18. Nakagawa S, et al. Cytoprotective Activity of Components of Garlic, Ginseng and Ciuwjia on Hepatocyte Injury Induced by Carbon Tetrachloride in Vitro. Hiroshima J Med Sci. 1985;34:303-09.
  19. Lee TK, Allison RR, O'Brien KF, et al. Ginseng reduces the micronuclei yield in lymphocytes after irradiation. Mutat Res. Jan2004;557(1):75-84.
  20. View Abstract: Hasegawa H, et al. Reversal of Daunomycin and Vinblastine Resistance in Multidrug-Resistant P388 Leukemia in Vitro through Enhanced Cytotoxicity by Triterpenoids. Planta Med. 1995;61(5):409-13.
  21. View Abstract: Chong SK, et al. Ginseng--Is There a Use in Clinical Medicine? Postgrad Med J. Nov1988;64(757): 841-46.
  22. View Abstract: Kim JY, et al. Panax ginseng as a Potential Immunomodulator: Studies in Mice. Immunopharmacol Immunotoxicol. 1990;12(2):257-76.
  23. View Abstract: Ellis JM, Reddy P. Effects of Panax ginseng on Quality of Life. Ann Pharmacother. Mar2002;36(3):375–379.
  24. [No authors listed]. Panax ginseng. Monograph. Altern Med Rev. 2009;14(2):172-176.
  25. Zhou W, Zhou P. [Advances in the study of ginsenoside compound K] Yao Xue Xue Bao. Sep 2007;42(9):917-923. Review. Chinese.
  26. Choi KT. Botanical characteristics, pharmacological effects and medicinal components of Korean Panax ginseng C A Meyer. Acta Pharmacol Sin. Sep 2008;29(9):1109-1118.
  27. Wang Y, Ye X, Ma Z, et al. Induction of cytochrome P450 1A1 expression by ginsenoside Rg1 and Rb1 in HepG2 cells. Eur J Pharmacol. 28 Dec 2008;601(1-3):73-78. Epub  2008 Nov 11.
  28. Lee SH, Ahn YM, Ahn SY, Doo HK, Lee BC. Interaction between warfarin and Panax ginseng in ischemic stroke patients. J Altern Complement Med. Jul 2008;14(6):715-721.
  29. Kim SM, Lee SY, Yuk DY, et al. Inhibition of NF-kappaB by ginsenoside Rg3 enhances the susceptibility of colon cancer cells to docetaxel. Arch Pharm Res. May 2009;32(5):755-765. Epub 2009 May 27.
  30. Fishbein AB, Wang CZ, Li XL, Mehendale SR, Sun S, Aung HH, Yuan CS. Asian ginseng enhances the anti-proliferative effect of 5-fluorouracil on human colorectal cancer: comparison between white and red ginseng. Arch Pharm Res. Apr 2009;32(4):505-513. Epub 2009 Apr 29.
  31. Seely D, Dugoua JJ, Perri D, Mills E, Koren G. Safety and efficacy of panax ginseng during pregnancy and lactation. Can J Clin Pharmacol. Winter 2008;15(1):e87-94. Epub 2008 Jan 18. Review.
  32. Lee M, Sorn S, Baek S, Jang S, Kim S. Antioxidant and apoptotic effects of korean white ginseng extracted with the same ratio of protopanaxadiol and protopanaxatriol saponins in human hepatoma HepG2 cells. Ann N Y Acad Sci. Aug 2009;1171:217-227.
  33. Vuksan V, Sung MK, Sievenpiper JL, et al. Korean red ginseng (Panax ginseng) improves glucose and insulin regulation in well-controlled, type 2 diabetes: results of a randomized, double-blind, placebo-controlled study of efficacy and safety. Nutr Metab Cardiovasc Dis. Jan 2008;18(1):46-56. Epub 2006 Jul 24.
  34. Reay JL, Kennedy DO, Scholey AB. Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained 'mentally demanding' tasks. J Psychopharmacol. Nov 2006;20(6):771-781. Epub 2006 Jan 9.
  35. Reay JL, Kennedy DO, Scholey AB. The glycaemic effects of single doses of Panax ginseng in young healthy volunteers. Br J Nutr. Oct 2006;96(4):639-642.
  36. Reay JL, Scholey AB, Milne A, Fenwick J, Kennedy DO. Panax ginseng has no effect on indices of glucose regulation following acute or chronic ingestion in healthy volunteers. Br J Nutr. Jun 2009;101(11):1673-1678. Epub 2008 Nov 19.
  37. Ma SW, Benzie IF, Chu TT, et al. Effect of Panax ginseng supplementation on biomarkers of glucose tolerance, antioxidant status and oxidative stress in type 2 diabetic subjects: results of a placebo-controlled human intervention trial. Diabetes Obes Metab. Nov 2008;10(11):1125-1127. Epub 2008 Mar 18. No abstract available.
  38. Park MW, Ha J, Chung SH. 20(S)-ginsenoside Rg3 enhances glucose-stimulated insulin secretion and activates AMPK. Biol Pharm Bull. Apr 2008;31(4):748-751.
  39. Yue PY, Mak NK, Cheng YK, et al. Pharmacogenomics and the Yin/Yang actions of ginseng: anti-tumor, angiomodulating and steroid-like activities of ginsenosides. Chin Med. 2007;15(2):6.
  40. Buettner C, Yeh GY, Phillips RS, Mittleman MA, Kaptchuk TJ. Systematic review of the effects of ginseng on cardiovascular risk factors. Ann Pharmacother. Jan 2006;40(1):83-95. Epub 2005 Dec 6. Review.
  41. Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. Oct 2008;66(4):444-450. Epub 2008 Jun 9. Review
  42. Jia L, Zhao Y, Liang XJ. Current evaluation of the millennium phytomedicine- ginseng (II): Collected chemical entities, modern pharmacology, and clinical applications emanated from traditional Chinese medicine. Curr Med Chem. 2009;16(22):2924-2942. Review.
  43. Kim YJ, Kwon HC, Ko H, et al. Anti-tumor activity of the ginsenoside Rk1 in human hepatocellular carcinoma cells through inhibition of telomerase activity and induction of optosis. Biol Pharm Bull. May 2008;31(5):826-830.
  44. Park TY, Park MH, Shin WC, et al. Anti-metastatic potential of ginsenoside Rp1, a novel ginsenoside derivative. Biol Pharm Bull. Sep 2008;31(9):1802-1805.
  45. Hofseth LJ, Wargovich MJ. Inflammation, cancer, and targets of ginseng.J Nutr. Jan 2007;137(1 Suppl):183S-185S. Review.
  46. Amangar F, Gao YT, Shu XO, et al. Ginseng intake and gastric cancer risk in the Shanghai Women's Health Study cohort. Cancer Epidemiol Biomarkers Prev. Mar 2007;16(3):629-630. No abstract available.
  47. Kennedy DO, Scholey AB, Wesnes KA. Dose dependent changes in cognitive performance and mood following acute administration of Ginseng to healthy young volunteers. Nutr Neurosci. 2001;4(4):295-310.
  48. Lee ST, Chu K, Sim JY, Heo JH, Kim M. Panax ginseng enhances cognitive performance in Alzheimer disease. Alzheimer Dis Assoc Disord. Jul-Sep 2008;22(3):222-226.
  49. Heo JH, Lee ST, Chu K, et al, An open-label trial of Korean red ginseng as an adjuvant treatment for cognitive impairment in patients with Alzheimer's disease.Eur J Neurol. Aug 2008;15(8):865-868.
  50. Tian J, Zhang S, Li G, Liu Z, Xu B. 20(S)-ginsenoside Rg3, a neuroprotective agent, inhibits mitochondrial permeability transition pores in rat brain. Phytother Res. Apr 2009;23(4):486-491.
  51. Choi K, Kim M, Ryu J, Choi C. Ginsenosides compound K and Rh(2) inhibit tumor necrosis factor-alpha-induced activation of the NF-kappaB and JNK pathways in human astroglial cells. Neurosci Lett. 21Jun 2007;421(1):37-41. Epub 2007 May 22.
  52. Rausch WD, Liu S, Gille G, Radad K. Neuroprotective effects of ginsenosides. Acta Neurobiol Exp (Wars). 2006;66(4):369-375. Review.
  53. Yang L, Hao J, Zhang J, et al. Ginsenoside Rg3 promotes beta-amyloid peptide degradation by enhancing gene expression of neprilysin. J Pharm Pharmacol. Mar 2009;61(3):375-380.
  54. Yi SW, Sull JW, Hong JS, Linton JA, Ohrr H. Association between ginseng intake and mortality: Kangwha cohort study. J Altern Complement Med. Aug 2009;15(8):921-928