Cynthia R. Biron, RDH
Since so many Americans are taking herbs as health supplements, health professionals frequently are quite interested in getting the facts on these products. In 1999, the Medical Alert column will discuss some of these alternative medicines.
Ginseng is one of the top 12 herbs to be consumed by Americans. In fact, some six million Americans are taking ginseng regularly or sporadically. Not only is ginseng one of the most popular herbs in the world, it is also one of the most expensive. Commercial preparations of ginseng cost as much as $20 an ounce. Asians still are the greatest consumers of ginseng. They feel it is a panacea and the name given to the ginseng so widely used today is Panax for that reason. More specifically, the actual plant from China, Japan, and Korea is called P ginseng C.A. Meyer. Panax quinquefolius L is the American version. Ginseng is a perennial herb that has a large root with a shape that is similar to the human body. The root`s unique shape apparently inspired the Chinese to believe it would be good for all ailments of the human body.
Each year it sprouts a stem with palmately leaves and terminates with small flowers and red, pea-sized fruits that bear the seeds that propagate the species. The ginseng root extracts are called ginsenosides saponins or just ginsenosides. Because ginseng is a plant, many Americans are convinced that it is a natural, harmless substance, just as they view all other herbal products. What we must realize is that 25 percent of the medicines in the world come from botanical origins, and not all of them are harmless. Ginseng does have a very good track record with regard to safety. Fatalities associated with ginseng use have been due to other contaminants in the packaging and one incident of a ginseng-ephedra concomitant use.
The claims made for ginseng are for:
* Stimulants - Ginseng users often claim that they have increased energy and more stamina for exercise routines or physically demanding work. The studies conducted for this claim have been contradictory. Studies performed on animals demonstrated enhancement in aerobic performance, but those conducted on 31 human male subjects did not support claims that P ginseng C.A. Meyer is an ergogenic aid to improve performance in aerobic exercise. To date, no significant data support this claim. Small, controlled trials reported increased endurance, but others showed no increase in endurance.
* Tonics - The Chinese use ginseng as a tonic for overall improvement of the quality of life and the prevention of disease. The data on ginseng`s health benefits are difficult to interpret accurately. The double-blind studies relied on the subjective feedback of simply asking those who took ginseng or the placebo if they experienced a higher degree of vitality or an improvement in their quality of life. Some 625 people, who had unknowingly taken ginseng instead of the placebo for a period of three months, did answer a questionnaire in a manner that indicated that they were experiencing an improvement in their quality of life.
* Mental benefits - Some studies have indicated that ginseng improves mental acumen. One study demonstrated that college-aged volunteers who had taken 100 mg. of ginseng twice daily for 12 weeks had increased the speed in which they could perform mathematical calculations. Enhanced cognitive abilities were shown in studies of rats that had been given ginseng. Another study involved a senescence-accelerated mouse that had been given ginseng for nine months. Afterwards, a test for passive avoidance showed an improvement in a memory retention disorder and an increase in a conditioned avoidance rate in a lever-press test.
* Anti-stress - Studies on laboratory animals have shown anti-stress effects on animals given ginseng, as opposed to the same animals exposed to the same stress situations with no blood levels of ginseng. While some tests on humans have revealed similar outcomes, there is not enough evidence to prove that ginseng has anti-stress effects on human beings. More research is necessary.
* Regulating blood pressure - Long-term use of ginseng in elderly patients has shown minor reductions in blood pressure. However, one adverse effect is tachycardia (rapid heart rate), which causes a reflex hypertension reaction. Patients who are hypertensive should consult their physicians before taking ginseng.
* Anti-diabetic - Ginseng`s effects on blood-sugar levels indicate that less insulin is necessary. It is not wise for diabetic patients to take ginseng, since such a reduction in blood-sugar levels could increase the possibility of an insulin reaction. There is evidence of a three-fold higher incidence of gestational diabetes among ginseng consumers. Because ginseng`s effects on blood-sugar levels are not completely known, diabetic patients and pregnant women should not take ginseng until more studies have been conducted with these groups.
* Sexual function - Some ginseng users claim they experience aphrodisiac effects from ginseng. Ginseng, though, is not an aphrodisiac. Some leaders in alternative medicine believe that the overall improvement in vitality that people seem to feel when taking ginseng is what increases libido. When you "feel good," all of your drives are increased.
However, numerous studies indicate hormonal effects from the use of ginseng. A study monitored sperm count/motility disorders on 66 males who were separated into ginseng-treated and placebo-control groups. The group taking the ginseng extract had an increase in spermatozoa number/ml and progressive oscillating motility, an increase in the plasma total and free testosterone, and some stimulating hormones.
In addition, several studies have shown that ginseng enhances nitric oxide synthesis in endothelium of the corpus cavernosum. This is similar to the mechanism of action for Viagra. The difference between Viagra and ginseng, though, is two-fold. Viagra studies have provided overwhelming evidence proving the drug`s effectiveness in the treatment of impotency, and Viagra is to be taken one to two hours before having sex. It does not need to be taken daily for effectiveness. Ginseng has been effective in some cases, although not overwhelmingly so, and must be taken daily for an average of four weeks for such efficacy.
In isolated cases, individuals felt that taking ginseng within a few hours of sex has been beneficial. In double blind studies, however, the placebo has been almost equally effective. One study involving Korean red ginseng showed multiple-action mechanisms that had a relaxing effect on vascular smooth muscle of the corpus cavernosum of rabbits. The actions included release of nitric oxide from the corporal sinusoids, an increase in intracellular calcium sequestration, and a hyperpolarization action, all of which contribute to penile erection.
Other cases indicate adverse hormonal effects from ginseng. One isolated case involved postmenopausal vaginal bleeding that was attributed to ginseng face cream.
Another case reported associated neonatal androgenization. A 30-year-old nurse took 650 mg. of Siberian ginseng twice daily for the entire nine months of her pregnancy. When her baby boy was born, he had thick black hair over the entire forehead, pubic hair, and red, swollen nipples. The mother stopped nursing the baby after he was two weeks old, and, immediately, the pubic hair and forehead hair began to fall out and was quite scant at 71/2 weeks. At 71/2 weeks, he was in the 97th percentile in weight and growth. The examination results were unremarkable except that his testicles were enlarged. The reversal of hair growth after the discontinued exposure to ginseng strongly indicates that ginseng increased hormone levels.
Some positive hormonal effects of ginseng include results from small studies showing that ginseng relieved menopausal symptoms, especially hot flashes, which are actually vasospasms that occur from estrogen depletion.
* Anti-cancer effects - Several studies have shown that ginseng has some potential for boosting the immune system, preventing cancer, and the metastasis of existing cancers. A study conducted at the Korea Cancer Center Hospital revealed that ginseng users had a decreased risk for cancer compared with nonginseng users (odds ratio = 0.50, 95% confidence interval = 0.44-0.58 for cancer compared with nonusers).
The study showed a dose-response relationship. Ginseng extract and powder were more effective than fresh sliced ginseng, juice, or tea. But, on the basis of other research efforts, more studies need to be conducted to prove that ginseng really has anti-cancer effects.
* Drug interactions - Since it is a stimulant, ginseng should be avoided in combinations with other stimulants such as caffeine, ephedra, amphetamines, epinephrine, norepinephrine, and other sympathomimetic drugs. Other isolated cases of drug interactions include a report on increased digoxin levels in association with ginseng, warfarin/ginseng interactions, and increased alcohol clearance with blood levels of ginseng.
* Vitamin combinations - One study indicated that the combination of ginseng with multiple vitamin/mineral supplements was more effective than multivitamin/mineral supplements alone. Pharmaton Capsules with standardized ginseng extract G11 was used in the study. It is not known whether or not Pharmaton funded the study, which was conducted in Mexico at the Universidad Nacional Aut/Eonoma.
Ginseng users make numerous statements about improvements they have noticed in their overall health, as well as some specific benefits that are not addressed in this article. The Food and Drug Administration and the National Institutes of Health have indicated that benefits of ginseng have not been completely proven. In addition, adverse effects have been associated with contaminants in packaging and/or large dosages of ginseng.
Pharmacological studies reveal a variety of effects from ginseng use, and some cases of ginseng poisoning have been reported. The effects of ginseng poisoning include mydriasis and disturbance in accommodation of both eyes, dizziness, and semiconsciousness. Consumers would be wise to buy ginseng that contains standardized extracts, such as those available from prominent companies in the United States. They should not exceed recommended dosages listed on the packages or their inserts.
Although American medical experts feel ginseng claims are not proven, it certainly has promise. Some studies provide strong evidence on its effectiveness; it is relatively safe when taken as directed. It is, of course, very expensive.
Should you recommend it to patients? No, leave that to their physicians. Never recommend high doses of vitamins or any types of herbs to patients with the belief that they are all harmless; they are medicines and should be prescribed by physicians. Should you take ginseng yourself for various ailments? Ask your physician.
References available upon request.
Cynthia R. Biron, RDH, is chair of the dental hygiene program at the Tallahassee Community College. She is also a certified emergency medical technician.
What to tell patients about herbal remedies
In a letter to the editor of the Journal of American Medical Association (November 11, 1998), Drs. M. Cirigliano and A. Sun provided the following guide for health professionals in their treatment of patients who take herbal remedies:
1. All patients should be asked about use of herbal therapies and dietary supplements. Use of these agents should be documented in the medical record.
2. "Natural" does not necessarily mean safe.
3. Herbal-pharmaceutical interactions do occur; therefore, avoid combined use.
4. Lack of standardization of herbal agents may result in variability in herbal content and efficacy among manufacturers.
5. Lack of quality control and regulation may result in contamination during manufacture and potential misidentification of plant species.
6. Herbal treatments should not be used if the patient is contemplating pregnancy, or during pregnancy or lactation, because of a lack of long-term clinical trials proving safety.
7. Herbal treatments should not be used in larger dosages than what`s recommended.
8. Herbal treatments should not be used for more than several weeks, because of a lack of studies proving long-term safety.
9. Herbal treatments with known adverse effects and toxic effects should be avoided.
10. Infants, children, and the elderly should not use herbal treatments without professional advice.
11. An accurate diagnosis and discussion of proven treatment options are essential prior to the patients considering use of herbal treatments.
12. Adverse effects should be documented in the patient`s chart and therapy discontinued.