Ginseng

1. Ginseng Tomomi Kimura

2. What is Ginseng? • “Low-growing, shade-loving perennial herb of the Aralianceae family” (http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/Ginseng.htm) • Latin name= Panax • The scientific names • Panax Ginseng • Derived from the Greek word for cure-all, related to the word Panacea.

3. Types of Ginseng True Ginseng: • American Ginseng • (Panax Quinquefolium) • Korean, Chinese or Japanese Ginseng • (Panax Ginseng)

4. Types of Ginseng Ginseng Companions and Relatives: • Siberian Ginseng • (Eleutherococcus senticosus) • Dwarf Ginseng • (Panax trifolious) • Fool's sang or wild sarsaparilla • (Aralia nudicaulis) http://www.supertrition.com http://www.allstarhealth.com

5. History • Ginseng root has been used for over 2000 years • Has traditionally used for treatment of a number of disorders in China and Korea • Crossed to Western by the eighteenth century • US expoted $20.9 million worth of ginseng last year (NYtimes, 2005)

6. Active Components Ginsenosides or Panaxosides Major ginsenosides: Rg1, Re, Rf, Rb1, Rc, Rg2, Rb2, Rb Panaxans Ginsenans

7. Forms of Ginseng • Root itself ($25~ per root) • Dried root • Teas, capsules, tablets, tinctures, powders.

8. Dosage • usually provide 100mg to 400mg of dried extract • (equivalent to 0.5g to 2g of ginseng root.)

9. Marketing Claims • “Heart tonic” • “Energy and mood booster” • “Healthy glucose metabolism formula” • “Helps normalize imbalances in the body’s energy in different disease status” • “Sex drive” • “Immune support” • “Stress management” • “Menopausal control”

10. Traditional and modern uses • Improving the health of people recovering form illness • Increasing a sense of well-being and stamina, and improving both mental and physical performance.

11. Traditional and modern uses(cont’d) • Treating erectile dysfunction, hepatitis C, and symptoms related to menopause. • Lowering blood glucose and controlling blood pressure.

12. Current Research Area • Ginseng vs. Exercise performance • Mood and cognitive function • Cardiovascular disease • Sexual function • Diabetes • Obesity • Cancer

13. Prevalence of Diabetes • Diabetes is a major health problem • 5% of the total population in the US • 3% of the population worldwide. • Canadian Diabetes Association • Allocated $6 million to support 123 diabetes research teams across the country last year.

14. Diabetes vs. Ginseng • Historically used to treat type-2 diabetes. • No. 6th commonly suggested herbal medicine to improve glycemic control by Italian herbalists • Many studies support its antihyperglycemic activity.

15. Theoretical Basis • Well tolerated by oral intake • Molecular mechanisms of antihyperglycemic reaction are unclear.

16. Theoretical Basis • Ginsenosides alter blood glucose levels by • stimulating the biosynthesis of insulin by the pancreas • inducing the production of a glucose transporter in the liver • The polysaccharides in ginseng lower blood glucose by • either decreasing the production of glucose by the liver • increasing the use of glucose by tissues

17. Scientific Evidences By Vuskan, V. et al & Xie, J. et al.

18. Study #1 Antidiabetic effects of Panax ginseng berry extract and the identification of an effective component Diabetics (2002) 51 By Xie, J. et al. Specific Aim • Evaluate antihyperglycemic and anti-obese effects of Panax ginseng berry extract in obese diabetic mice. Study Design • In vitro, double blind, placebo controlled.

19. Antidiabetic effects of Panax ginseng berry extract and the identification of an effective component Diabetics (2002) 51 By Xie, J. et al. Subjects • 14mice 10-18 weeks of age Methods • Injection of 150 mg/kg berry extract (n=8) • Monitored by measuring blood glucose and serum insulin levels, and glucose tolerance test for 12 days. • Compared the results with 6 vehicles.

20. Antidiabetic effects of Panax ginseng berry extract and the identification of an effective component Diabetics (2002) 51 By Xie, J. et al. Results • Significantly improved glucose tolerance • Became normoglycemic • - 46% BG glucose tolerance test • Significant reduction in serum insulin levels • Lost significant amount of weight • (-12%BW than day 0) Ginseng berry extract is effective treatment for obese diabetic mice, and may work for weight loss.

21. Study #2 Antihyperglycemic effect of the polysaccharides fraction form American ginseng berry extract in ob/ob mice Phytomedicine (2004) 11 By Xie, J. et al. Specific Aim • Evaluate antihyperglycemic effects of the polysaccharides fraction from Panax ginseng berry extract in obese diabetic mice. Study Design • In vitro, double blind, placebo controlled.

22. Antihyperglycemic effect of the polysaccharides fraction form American ginseng berry extract in ob/ob mice Phytomedicine (2004) 11 By Xie, J. et al. Subjects • 15 mice 10-15 weeks of age Methods • Injection of 150 mg/kg polysaccharides fraction from AG to 5 mice • Injection of 50 mg/kg polysaccharides fraction from AG to 5 mice • Monitored by measuring blood glucose and serum insulin levels, and glucose tolerance test for 10 days. • Compared the results with 5 vehicles.

23. Antihyperglycemic effect of the polysaccharides fraction form American ginseng berry extract in ob/ob mice Phytomedicine (2004) 11 Results • Significant improvement in glucose tolerance in comparison to the beginning of the study. • Significant change in fasting blood glucose levels on day 5 (-19%) and even more on day 10 (-19% in 50 mg/kg dosage group, -45% in 150 mg/kg group). Additional observation: • The fasting blood glucose levels stayed lower and returned on day 30. • No significant changes in body weight.

24. Study #3 Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes. Diabetes Care (2000) 23 Vuscan, V. et al Specific Aim • Investigated whether American ginseng (AG) reduce postprandial glycemia in type 2 diabetic individuals and time of American ginseng administration. Study Design • In vivo, randomized, blind, placebo controlled

25. Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes. Diabetes Care (2000) 23 Vuscan, V. et al Subjects • 10 type 2 diabetic patients (6M, 4F) with age 61-65. Methods • Used 3, 6, 9g of grounded AG root in capsules • Administrated 120, 80, 40min before a 25g oral glucose test. • Measured capillary blood glucose before AG ingestion, 0,15,30,45,60,90, and 120 min from the start of the glucose test.

26. Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes. Diabetes Care (2000) 23 Vuscan, V. et al Results • 3, 6, 9g of AG significantly lowered blood glucose at 30, 45, 120 min. • No differences between dosage and the timing of administration.

27. Study #4 American Ginseng Improves Glycemia in Individuals with Normal Glucose Tolerance: Effect of Dose and Time Escalation American College of Nutrition (2000) 19 Vuscan, V. et al Specific Aim • Investigated whether American ginseng (AG) achieve further improvements in glucose tolerance in non-diabetic individuals and effectiveness of timing of AG ingestion Study Design • In vivo, blind, randomized, placebo controlled

28. American Ginseng Improves Glycemia in Individuals with Normal Glucose Tolerance: Effect of Dose and Time Escalation American College of Nutrition (2000) 19 Vuscan, V. et al Subjects • 10 nondiabetic individuals (6M 4F) with age 28-54. Methods • Used 3, 6, 9g of grounded AG root in capsules • Administrated 120, 80, 40min before a 25g oral glucose test. • Measured capillary blood glucose before AG ingestion, 0,15,30,45,60,90, and 120 min from the start of the glucose test.

29. American Ginseng Improves Glycemia in Individuals with Normal Glucose Tolerance: Effect of Dose and Time Escalation American College of Nutrition (2000) 19 Vuscan, V. et al Results • All AG doses (3, 6, 9g) of AG significantly lowered blood glucose at 30, 45, 60 min. • No relationship between dosage and the timing of administration.

30. Side Effects • Bleeding disorders • Diarrhea • Edema • Headache • Hypoglycemia • Hyperpyrexia • Menstrual abnormalities • Nausea and vomiting • Nervous excitation • Palpitations • Itchiness • Dizziness • Rose spots

31. Side Effects (cont’d) Large doses over an extended period of time • Diarrhea • Estrogenic effect • HTN • Hypertonicity • Decreased libido • Insomnia • Menstruation in menopausal women • Nervousness

32. Herb-Drug interactions • Hypoglycemic drugs • hypoglycemic effect • Furosemide • Decreased diuretic effect • Digoxin • May increase serum digoxin concentrations

33. Herb-Drug Interactions (cont’d) • Monoamine oxidaseinhibitors (MAOIs) • Headache, visual hallucination, tremor, manic episodes • Anticoagulants, antiplatelet agents • Decreased effectiveness of warfarin • Estrogens, corticosteroids • Additive drug effects

34. Herb-Drug Interactions (cont’d) • Drugs that cause gynecomastia • e.g. • Calcium channel blockers • Cardiac glycosides • Methyldopa • Phenothiazines • Spironolactone • Herb contains estrone, estradiol, estriol; • Has additive estrogenic effects

35. Herb-Nutrition Interactions • Alcohol • May decrease alcohol absorption • Caffeine • Maybe additive stimulant effects

36. Summary and Recommendations • Many of studies reported ginseng’s benefits in diabetes animals, but there is little comparable research in humans. • More clinical research would be needed to prove ginseng’s benefits in humans

37. Summary and Recommendations (cont’d) • Seek physicians and use cautiously when taking any other psychiatric, estrogenic or hypoglycemic medication. • Should not be used in combination with warfarin.

38. Thank you!