Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting : a systematic literature review

Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of cytotoxic treatment. It continues to affect a significant proportion of patients despite the widespread use of anti-emetic medication. In folk-medicine, ginger (Zingiber officinale) has been used to prevent and treat nausea in many cultures for thousands of years. However, its use has not been validated in the chemotherapy context. To determine the potential use of ginger as a prophylactic or treatment of CINV, a systematic literature review was conducted. Reviewed studies comprised randomised controlled trials or cross-over trials that investigated the anti-CINV effect of ginger as the sole intervention independent variable in chemotherapy patients. Seven studies met the inclusion criteria. All studies were assessed on methodological quality and their limitations were identified. Studies were mixed in their support of ginger as an anti-CINV treatment in patients receiving chemotherapy, with three demonstrating a positive effect, two in favour but with caveats and two showing no effect on measures of CINV. Future studies are required to address the limitations identified before clinical use can be recommended.

Ginger - mechanism of action in chemotherapy-induced nausea and vomiting: A review

Despite advances in anti-emetic therapy, chemotherapy-induced nausea and vomiting (CINV) still poses a significant burden to patients undergoing chemotherapy. Nausea, in particular, is still highly prevalent in this population. Ginger has been traditionally used as a folk remedy for gastrointestinal complaints and has been suggested as a viable adjuvant treatment for nausea and vomiting in the cancer context. Substantial research has revealed ginger to possess properties that could exert multiple beneficial effects on chemotherapy patients who experience nausea and vomiting. Bioactive compounds within the rhizome of ginger, particularly the gingerol and shogaol class of compounds, interact with several pathways that are directly implicated in CINV in addition to pathways that could play secondary roles by exacerbating symptoms. These properties include 5-HT3, substance P and acetylcholine receptor antagonism; anti-inflammatory properties; and modulation of cellular redox signalling, vasopressin release, gastrointestinal motility, and gastric emptying rate. This review outlines these proposed mechanisms by discussing the results of clinical, in vitro and animal studies both within the chemotherapy context and in other relevant fields. The evidence presented in this review indicates that ginger possesses multiple properties that could be beneficial in reducing chemotherapy-induced nausea and vomiting.

Can ginger ameliorate chemotherapy-induced nausea? Protocol of a randomized double blind, placebo-controlled trial

Background Preliminary research shows ginger may be an effective adjuvant treatment for chemotherapy-induced nausea and vomiting but significant limitations need to be addressed before recommendations for clinical practice can be made. Methods/Design In a double–blinded randomised-controlled trial, chemotherapy-naïve patients will be randomly allocated to receive either 1.2 g of a standardised ginger extract or placebo per day. The study medication will be administrated as an adjuvant treatment to standard anti-emetic therapy and will be divided into four capsules per day, to be consumed approximately every 4 hours (300 mg per capsule administered q.i.d) for five days during the first three cycles of chemotherapy. Acute, delayed, and anticipatory symptoms of nausea and vomiting will be assessed over this time frame using a valid and reliable questionnaire, with nausea symptoms being the primary outcome. Quality of life, nutritional status, adverse effects, patient adherence, cancer-related fatigue, and CINV-specific prognostic factors will also be assessed. Discussion Previous trials in this area have noted limitations. These include the inconsistent use of standardized ginger formulations and valid questionnaires, lack of control for anticipatory nausea and prognostic factors that may influence individual CINV response, and the use of suboptimal dosing regimens. This trial is the first to address these issues by incorporating multiple unique additions to the study design including controlling for CINV-specific prognostic factors by recruiting only chemotherapy-naïve patients, implementing a dosing schedule consistent with the pharmacokinetics of oral ginger supplements, and independently analysing ginger supplements before and after recruitment to ensure potency. Our trial will also be the first to assess the effect of ginger supplementation on cancer-related fatigue and nutritional status. Chemotherapy-induced nausea and vomiting are distressing symptoms experienced by oncology patients; this trial will address the significant limitations within the current literature and in doing so, will investigate the effect of ginger supplementation as an adjuvant treatment in modulating nausea and vomiting symptoms. Trial registration

The effect of ginger (Zingiber officinale) on platelet aggregation: A systematic literature review

Background The potential effect of ginger on platelet aggregation is a widely-cited concern both within the published literature and to clinicians; however, there has been no systematic appraisal of the evidence to date. Methods Using the PRISMA guidelines, we systematically reviewed the results of clinical and observational trials regarding the effect of ginger on platelet aggregation in adults compared to either placebo or baseline data. Studies included in this review stipulated the independent variable was a ginger preparation or isolated ginger compound, and used measures of platelet aggregation as the primary outcome. Results Ten studies were included, comprising eight clinical trials and two observational studies. Of the eight clinical trials, four reported that ginger reduced platelet aggregation, while the remaining four reported no effect. The two observational studies also reported mixed findings. Discussion Many of the studies appraised for this review had moderate risks of bias. Methodology varied considerably between studies, notably the timeframe studied, dose of ginger used, and the characteristics of subjects recruited (e.g. healthy vs. patients with chronic diseases). Conclusion The evidence that ginger affects platelet aggregation and coagulation is equivocal and further study is needed to definitively address this question.

Ginger (Zingiber officinale) autotetraploids with improved processing quality produced by an in vitro colchicine treatment

Ginger autotetraploids were produced by immersing shoot tips in a 0.5% w/v colchicine, 2% v/v dimethyl sulfoxide solution for 2 h. Stomatal measurements were used as an early indicator of ploidy differences in culture with mean stomata length of tetraploids (49.2 μm) being significantly larger than the diploid (38.8 µm). Of the 500 shoot tips treated, 2% were characterised as stable autotetraploid lines following field evaluation over several seasons. Results were confirmed with flow cytometry and, of the 7 lines evaluated for distinctness and uniformity, 6 were solid tetraploid mutants and 1 was a periclinal chimera. Significant differences were noted between individual tetraploid lines in terms of shoot length, leaf length, leaf width, size of rhizome sections (knob weight) and fibre content. The solid autotetraploid lines had significantly wider, greener leaves than the diploids, they had significantly fewer but thicker shoots and, although ‘Queensland’ (the diploid parent from which the tetraploids were derived) had a greater total rhizome mass at harvest, its knob size was significantly smaller. From the autotetraploid lines, one line was selected for commercial release as ‘Buderim Gold’. It compared the most favourably with ‘Queensland’ in terms of the aroma/flavour profile and fibre content at early harvest, and had consistently good rhizome yield. More importantly it produced large rhizome sections, resulting in a higher recovery of premium grade confectionery ginger and a more attractive fresh market product.

Field evaluation of micropropagated and conventionally propagated ginger in subtropical Queensland

The growth and performance of micropropagated ginger (Zingiber officinale Roscoe) was compared with 'seed'-derived plants in field trials conducted in south-eastern Queensland. In the first generation ex vitro, micropropagated plants had significantly (P<0.01) reduced rhizome yield with smaller knobs and more roots. Micropropagated plants had a greater (P<0.01) shoot: root (rhizome) ratio compared with seed-derived plants. Shoots from micropropagated plants were also significantly (P<0.01) smaller with a greater number of shoots per plant. The unusual shoot morphology of the micropropagated plants did not appear to be related to the presence of benzylaminopurine, a plant growth hormone added to the multiplication medium, as plants subcultured for 3 cycles on a hormone-free medium also exhibited similar characteristics. Seed collected from the micropropagated plants and seed-derived plants was harvested and, despite the micropropagated seed being significantly (P<0.01) smaller, by the second generation ex vitro there were no significant differences between the treatments. Factors that can improve rhizome size, while reducing production costs, need to be identified before micropropagated plants can be recommended for routine use in the ginger industry as a source of disease and pest-free planting material.

Essential Oil Composition of Diploid and Tetraploid Clones of Ginger (Zingiber officinale Roscoe) Grown in Australia

Ginger oil, obtained by steam distillation of the rhizome of Zingiber officinale Roscoe, is used in the beverage and fragrance industries. Ginger oil displays considerable compositional diversity, but is typically characterized by a high content of sesquiterpene hydrocarbons, including zingiberene, arcurcumene, â-bisabolene, and â-sesquiphellandrene. Australian ginger oil has a reputation for possessing a particular “lemony” aroma, due to its high content of the isomers neral and geranial, often collectively referred to as citral. Fresh rhizomes of 17 clones of Australian ginger, including commercial cultivars and experimental tetraploid clones, were steam distilled 7 weeks post-harvest, and the resulting oils were analyzed by GC-MS. The essential oils of 16 of the 17 clones, including the tetraploid clones and their parent cultivar, were found to be of substantially similar composition. These oils were characterized by very high citral levels (51-71%) and relatively low levels of the sesquiterpene hydrocarbons typical of ginger oil. The citral levels of most of these oils exceeded those previously reported for ginger oils. The neral-to-geranial ratio was shown to be remarkably constant (0.61 ( 0.01) across all 17 clones. One clone, the cultivar “Jamaican”, yielded oil with a substantially different composition, lower citral content and higher levels of sesquiterpene hydrocarbons. Because this cultivar also contains significantly higher concentrations of pungent gingerols, it possesses unique aroma and flavor characteristics, which should be of commercial interest.

Improved Farming Systems for Managing Soilborne pathogens of ginger in Fiji and Australia

Development of improved farming systems for ginger to decrease damage caused by soil-borne pathogens in Fiji and Australia.

Controlling Pythium and associated pests in ginger

This project is to identify treatments that ginger growers can use to control two serious soil-borne pathogens that have emerged and threaten the viability of the ginger industry. Pythium myriotylum, responsible for a severe rhizome rot, is the more serious of the two. It was first identified by ginger growers in the 2007/08 growing season, with some producers reporting total crop losses in some blocks. Symphylids are wingless soil-inhabiting arthropods that feed on the ginger plant's root tips and impair the plants´ ability to absorb nutrients, seriously restricting plant growth and development. Damage caused by symphylids to ginger roots is also expected to facilitate entry of Pythium into the plant.

Organic inputs, tillage and rotation practices influence soil health and suppressiveness to soilborne pests and pathogens of ginger.

A field experiment was established in which an amendment of poultry manure and sawdust (200 t/ha) was incorporated into some plots but not others and then a permanent pasture or a sequence of biomass-producing crops was grown with and without tillage, with all biomass being returned to the soil. After 4 years, soil C levels were highest in amended plots, particularly those that had been cropped using minimum tillage, and lowest in non-amended and fallowed plots, regardless of how they had been tilled. When ginger was planted, symphylans caused severe damage to all treatments, indicating that cropping, tillage and organic matter management practices commonly used to improve soil health are not necessarily effective for all crops or soils. During the rotational phase of the experiment, the development of suppressiveness to three key pathogens of ginger was monitored using bioassays. Results for root-knot nematode (Meloidogyne javanica) indicated that for the first 2 years, amended soil was more suppressive than non-amended soil from the same cropping and tillage treatment, whereas under pasture, the amendment only enhanced suppressiveness in the first year. Suppressiveness was generally associated with higher C levels and enhanced biological activity (as measured by the rate of fluorescein diacetate (FDA) hydrolysis and numbers of free-living nematodes). Reduced tillage also enhanced suppressiveness, as gall ratings and egg counts in the second and third years were usually significantly lower in cropped soils under minimum rather than conventional tillage. Additionally, soil that was not disturbed during the process of setting up bioassays was more suppressive than soil which had been gently mixed by hand. Results of bioassays with Fusarium oxysporum f. sp. zingiberi were too inconsistent to draw firm conclusions, but the severity of fusarium yellows was generally higher in fumigated fallow soil than in other treatments, with soil management practices having little impact on disease severity. With regard to Pythium myriotylum, biological factors capable of reducing rhizome rot were present, but were not effective enough to suppress the disease under environmental conditions that were ideal for disease development.

Bacterial wilt of ginger in Queensland: Reappraisal of a disease outbreak

In 1955 a severe wilt disease occurring on ginger in the Near North Coast district of Queensland was incorrectly attributed to infection by a Fusarium sp., and later shown to be caused by a strain of Ralstonia solanacearum, now reclassified as R. sequeirae. The disease was brought from China into Australia on latently infected rhizomes, and possibly also with associated soil. Several DNA-based diagnostic methods have shown that the pathogen causing bacterial wilt of ginger in parts of China is indistinguishable from the pathogen uniquely associated with the disease in Queensland. © 2012 Australasian Plant Pathology Society Inc.

Microbial indicators related to yield and disease and changes in soil microbial community structure with ginger farm management practices

TRFLP (terminal restriction fragment length polymorphism) was used to assess whether management practices that improved disease suppression and/or yield in a 4-year ginger field trial were related to changes in soil microbial community structure. Bacterial and fungal community profiles were defined by presence and abundance of terminal restriction fragments (TRFs), where each TRF represents one or more species. Results indicated inclusion of an organic amendment and minimum tillage increased the relative diversity of dominant fungal populations in a system dependant way. Inclusion of an organic amendment increased bacterial species richness in the pasture treatment. Redundancy analysis showed shifts in microbial community structure associated with different management practices and treatments grouped according to TRF abundance in relation to yield and disease incidence. ANOVA also indicated the abundance of certain TRFs was significantly affected by farming system management practices, and a number of these TRFs were also correlated with yield or disease suppression. Further analyses are required to determine whether identified TRFs can be used as general or soil-type specific bio-indicators of productivity (increased and decreased) and Pythium myriotylum suppressiveness.

Controlling Pythium in Ginger: Phase 2

The fungal disease Pythium Soft Rot is regarded by the ginger industry as their most serious disease threat. This project was developed to further investigate the factors contributing to the persistence and spread of Pythium Soft Rot on ginger farms and to identify measures for their control. The study demonstrated that the pathogen capable of causing Pythium Soft Rot in ginger was spread in contaminated ‘seed’, soil and water and that it can be managed through a combination of strategies that rely on early detection, reducing pathogen levels in soils, preventing water logging and restricting movement of contaminated ‘seed’, soil and water. However, in order to have an effective level of control, all strategies need to be integrated in an effective manner.