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Systematic Review of Ginger Trials Yields "Promising" Outcome

Throughout centuries of traditional use, treatment of nausea and vomiting has remained one of the primary therapeutic applications of ginger root (Zingiber officinale Roscoe., Zingiberaceae). In order to "evaluate whether or not ginger is truly efficacious for clinical nausea and vomiting," investigators Ernst and Pittler of Exeter University, U.K., reviewed six randomized, controlled clinical trials that met standard methodological quality criteria (Ernst and Pittler, 2000).

Only randomized, double-blind, placebo-controlled trials evaluating the use of ginger as a single agent in the treatment of nausea and vomiting were eligible for inclusion in the review. (Studies assessing the effects of ginger on experimentally induced nausea and/or vomiting were excluded.) The six studies chosen investigated the use of ginger in four different areas: motion sickness (Grøntved et al., 1988), morning sickness (Fischer-Rasmussen et al., 1990), postoperative nausea (Bone et al., 1990; Phillips et al., 1993; Arfeen et al., 1995) and chemotherapy-induced nausea (Pace, 1987).

The majority of the trials reviewed concluded that ginger powder taken at a dose of 1 g daily was significantly more effective than placebo in alleviating nausea and vomiting. The one exception was a postoperative nausea study by Arfeen and colleagues, which demonstrated no significant difference between ginger and placebo or between ginger doses of 0.5 g and 1 g. The authors noted, "The discrepancy between this negative outcome and the positive results from other RCT [randomized controlled trials] is not readily explicable." No adverse events were reported in any of the studies.

Noting that the body of literature on ginger may be influenced by publication bias - i.e., a tendency among researchers not to publish studies with negative outcomes - the authors end on a cautionary note: "In summary, we found that ginger is a promising antiemetic herbal remedy, but the clinical data to date are insufficient to draw firm conclusions."

- Evelyn Leigh, Herb Research Foundation [Arfeen Z, Owen H, Plummer JL, Ilsley AH, Sorby-Adams RAC, Doecke LJ. A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea and vomiting. Anaesth Intensive Care 1995; 23: 449-452. Bone ME, Wilkinson DJ, Young JR, McNeil J, Charlton S. Ginger root-a new antiemetic: The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia 1990; 45: 669-671. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. British Journal of Anaesthesia 2000; 84(3): 367-371. Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1990; 38: 19-24. Grøntved A, Brask T, Kambskard J, Hentzer E. Ginger root against seasickness: a controlled trial on the open sea. Acta Orolaryngol 1988; 105: 45-49. Pace JC. Oral ingestion of encapsulated ginger and reported self-care actions for the relief of chemotherapy-associated nausea and vomiting. Dissertations Abstracts Int 1987; 47: 3297-3298. Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (Ginger) - an antiemetic for day case surgery. Anaesthesia 1993; 48: 715-717.]

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