The Herbal Mini-Series: Case 1, Ginseng!

This is the start of a small series on common supplements that are often asked about or used in our patients.  The inspiration, and most of the information, comes from our wonderful nutrition intern Allison Vogel!  Since the winter often comes with fatigue, difficulty concentrating, and times of physical or emotional stress, I thought I'd start with Ginseng.

Disclosure:  We do not approve or disapprove the use of Ginseng in anyone without speaking to his/her health care practitioner.  We are merely providing information to the public.

Ginseng (Panax ginseng and Panax quinquefolius) is the dried root of one of several species of the Araliaceae family of herbs. Ginseng is widely used in the United States with the belief that it will improve overall energy and vitality, particularly during times of fatigue or stress. It is used for improving thinking, concentration, memory and work efficiency, physical stamina, and athletic endurance.

The most commonly used type is Asian ginseng. Closely related to Asian ginseng is American ginseng, which interestingly, is more widely used in China than in America and is sometimes preferred for its milder effects. 

When ginseng root is left mostly unprocessed it is called "white ginseng." "Red ginseng" refers to Asian ginseng root when it has been steamed and dried. Ginseng-containing foods and dietary supplements are typically made from a powder or extract of "white" or "red" ginseng root.

Dosage and Standardization (from UpToDate, an accepted physician’s reference)

Oral: 100-600 mg/day in divided doses, standardized to contain a minimum of 5% ginsenosides per dose. A regimen of 4 weeks on, followed by 2 weeks off, is recommended for maximum benefit. Up to 900 mg three times daily has been used.

Approved Ginseng Products

• Good Neighbor Pharmacy Ginseng (100mg root extract/softgel)
• Imperial Elixir Korean White Ginseng (500mg root powder/softgel)
• Nature Made Ginseng (250mg root extract/capsule)
• Paradise Herbs Panax Red Ginseng (200mg root extract/vegetable capsule)
• Solgar Korean Ginseng (250mg root extract/vegetable capsule)
• Bluebonnet Herbals American Ginseng (500mg root extract/vegetarian capsule)
• Nature’s Plus Herbal Actives American Ginseng (250mg root extract/vegetarian capsule)
• NSI American Ginseng 80% (250mg root extract/capsule)
• GNC Herbal Plus Standardized Triple Ginsa (400mg Asian Ginseng root extract, 200mg American Ginseng root extract/capsule)
• TruNature Triple Energy Ginsengs with Eleuthero (100 mg Asian Ginseng root extract, 100mg American Ginseng root extract/softgel)
• Vitamin Shoppe Ginseng Complex (400mg Asian Ginseng root, 20mg American Ginseng root/capsule)
• Whole Foods Triple Ginseng (100mg root extract Asian Ginseng, 50mg root extract American Ginseng/vegetarian capsule)

Potential Interactions and Contraindications:

Due to the lack of research, there are a lot of possible interactions with ginseng but few are confirmed. Some of them include:

·         Renal failure

·         Pregnancy or breastfeeding

·         Acute infection

·          Phenelzine, a MAO inhibitor (case reports and theoretical)

·         Warfarin (case reports and theoretical)

·         stimulant medications, including decongestants, caffeine, and caffeine-containing beverages (theoretical)

·         blood pressure medication or in anyone who has danger of low blood pressure (theoretical)

·         diabetics or people on glucose medication (theoretical)

·         anyone with active bleeding, bleeding disorders, or is on any anti-coagulant or medication that affects bleeding (warfarin, heparin, aspirin, clopidogrel, etc.) (theoretical)

References:

Izzo AA, Ernst E.  Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs. 2009;69(13):1777-98. doi: 10.2165/11317010-000000000-00000.

Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997; 54:  692-3

Jones BD, Runikis AM. Interaction of ginseng with phenelzine. J Clin Psychopharmacol 1987; 7: 201-2

Kiefer D, Pantuso T. Panax ginseng. Am Fam Physician  2003; 68: 1539-42

Panax ginseng: Natural drug information.  http://www.uptodate.com/contents/panax-ginseng-natural-drug information?source=search_result&search=ginseng&selectedTitle=1~150 Copyright 1978-2012 Lexicomp, Inc. © 2012 UpToDate, Inc

Shader RI, Greenblatt DJ. Bees, ginseng and MAOIs revisited [letter]. J Clin Psychopharmacol 1988; 8: 235

Shader RI, Greenblatt DJ. Phenelzine and the dream machine:  ramblings and reflections [letter]. J Clin Psychopharmacol  1985; 5: 65

Yuan CS, Wei G, Dey L, et al. Brief communication:  American ginseng reduces warfarin’s effect in healthypatients – a randomized, controlled trial. Ann Intern Med 2004; 141: 23-7