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To study the efficacy of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. Double blind randomized controlled trial. Department of Obstetrics and Gynecology, Thammasat Hospital, Faculty of Medicine, Thammasat University. Between January 2005 and December 2005, 170 pregnant women who attended at antenatal clinic Thammasat University Hospital with the symptoms of nausea and vomiting in pregnancy were randomly allocated into group A (n = 85) and group B (n = 85). The patients in group A received one capsule of ginger twice daily (one capsule contained 0.5 gm of ginger powder) while the patients in group B received the identical capsule of 50 mg dimenhydrinate twice daily. The visual analogue nausea scores (VANS) and vomiting times were evaluated at day 0-7 of the treatment. There was no significant difference in the visual analogue nausea scores (VANS) between group A and group B in day 1-7 of the treatment. The vomiting episodes of group A were greater than group B during the first and second day of the treatment with statistically significant difference. No difference in vomiting episodes during the day 3-7 of treatment was found in both groups. There was a statistically significant difference in the side effect of drowsiness after treatment in group B greater (77.64%) than group A (5.88%) (p < 0.01). From the presented data, ginger is as effective as dimenhydrinate in the treatment of nausea and vomiting during pregnancy and has fewer side effects.
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J Med Assoc Thai Vol. 90 No. 9 2007 1703
Correspondence to : Pongrojpaw D, Department of Obstetrics
and Gynecology, Faculty of Medicine, Thammasat University,
Pathumthani 12120, Thailand. Phone: 081-987-8817, E-mail:
pongrojpaw@hotmail.com
A Randomized Comparison of Ginger and Dimenhydrinate
in the Treatment of Nausea and Vomiting in Pregnancy
Densak Pongrojpaw MD*,
Charinthip Somprasit MD*, Athita Chanthasenanont MD*
* Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani
Objective: To study the efficacy of ginger and dimenhydrinate in the treatment of nausea and vomiting in
pregnancy.
Study design: Double blind randomized controlled trial.
Setting: Department of Obstetrics and Gynecology, Thammasat Hospital, Faculty of Medicine, Thammasat
University.
Material and Method: Between January 2005 and December 2005, 170 pregnant women who attended at
antenatal clinic Thammasat University Hospital with the symptoms of nausea and vomiting in pregnancy were
randomly allocated into group A (n = 85) and group B (n = 85). The patients in group A received one capsule
of ginger twice daily (one capsule contained 0.5 gm of ginger powder) while the patients in group B received
the identical capsule of 50 mg dimenhydrinate twice daily. The visual analogue nausea scores (VANS) and
vomiting times were evaluated at day 0-7 of the treatment.
Results: There was no significant difference in the visual analogue nausea scores (VANS) between group A
and group B in day 1-7 of the treatment.The vomiting episodes of group A were greater than group B during
the first and second day of the treatment with statistically significant difference. No difference in vomiting
episodes during the day 3-7 of treatment was found in both groups. There was a statistically significant
difference in the side effect of drowsiness after treatment in group B greater (77.64%) than group A (5.88%)
(p < 0.01).
Conclusion: From the presented data, ginger is as effective as dimenhydrinate in the treatment of nausea and
vomiting during pregnancy and has fewer side effects.
Keywords: Ginger, Dimenhydrinate, Nausea, Vomiting
Nausea and vomiting are common symptoms
experienced by women in early pregnancy and affect
50-90% of pregnant women
(1,2)
. Although there are a
number of medications available for the treatment of
nausea and vomiting in pregnancy, many women
hesitate to take them due to fear of harming the fetus.
No anti-emetics for nausea and vomiting in pregnancy
have been approved by the United States Food and
Drug Administration (FDA). Evidences on the efficacy
of ginger have been evaluated in many randomized
controlled trials
(3-5)
.These three randomized controlled
trials found ginger to be better than placebo. The
studies of Smith C
(6 )
and Sripramote M
(7)
revealed that
ginger was as effective as vitamin B6 in the treatment
of nausea and vomiting in pregnancy.
Ginger (Zingiber officinale) is used as a broad-
spectrum anti-emetic. The pharmacological activity is
thought to lie in the pungent principles (gigerols and
shagaols) and volatile oils (sequiterpenes and mono-
terpenes)
(8)
.
Ginger acts within the gastrointestinal
tract by increasing tone and peristalsis due to anti-
cholinergic and anti-serotonin action. Ginger avoids
the central nervous system side effects caused by most
onions and garlic, extracts of ginger can inhibit blood
coagulation in vitro
(9-11)
. Ginger has few recorded side
effects. In large doses, ginger may increase gastric
J Med Assoc Thai 2007; 90 (9): 1703-9
Full text. e-Journal: http://www.medassocthai.org/journal
1704 J Med Assoc Thai Vol. 90 No. 9 2007
exfoliation and anti-prostaglandin activity in vitro
(9,10)
.
However, the clinical significance of these observa-
tions is yet to be determined. There are no known
reports of toxicity in humans from ginger ingestion
in normal amount. Many studies about ginger and
pregnancy revealed no adverse effects to the fetus
and pregnancy outcome
(3-7)
.
In Thailand, most pregnant women who had
nausea and vomiting in first trimester were given di-
menhydrinate for the treatment. The undesirable side
effect of dimenhydrinate is drowsiness. There were
studies that compared ginger and dimenhydrinate
only in motion sickness
(12,13)
. The authors would like to
evaluate the efficacy of ginger and dimenhydrinate in
the treatment of nausea and vomiting in pregnancy.
Material and Method
The present study was approved by the ethi-
cal committee of the Faculty of Medicine, Thammasat
University, Pathumthani, Thailand. The trial took place
at the antenatal clinic Thammasat University Hospital
between January - December 2005. Pregnant women with
nausea and vomiting were eligible for the trial if they
were less than 16 weeks of gestation. Women were
excluded if they 1) had any signs of clinical dehydra-
tion, 2) had other gastrointestinal diseases, 3) unable
to take oral capsule, 4) unable to return for one week
follow up, 5) had known allergy to ginger or dimenhy-
drinate, 6) had taken other medication in the past week
that might aggravate or alleviate nausea and vomiting,
7) refused to participate in the trial.
The pregnant women underwent a physical
examination and routine obstetrics evaluation. Ultra-
sonography was performed for evaluating gestational
age and fetal heart motion. Then, the pregnant women
were randomly allocated to receive either a 0.5 gm cap-
sule of ginger (group A) or 50 mg capsule of dimenhy-
drinate (group B) orally twice daily for one week. Both
capsules were identical in size, color, and odor. They
were asked to return in one week and gave back the
capsule envelope and the record forms. The women
who were lost to follow up were excluded from the trial.
The primary outcome in the present study was
the improvement in nausea and vomiting symptoms.
The degree of nausea was measured using the visual
analogue scale (VAS).The patients were asked on their
first visit to grade the severity of their nausea over the
past 24 hours (baseline score) by marking on “X” cor-
responding to their perceived station a 10 cm. vertical
line ranging from 0 = no nausea to 10 = nausea as bad
as it could be. On the following 7 days of the treatment,
recordings of the severity of nausea were made twice
daily in the morning and evening. The average daily
nausea scores were calculated. The frequency of
vomiting was recorded daily. The change in nausea
score and frequency of vomiting in both group were
compared. The secondary outcome was the occurrence
of the side effect for example drowsiness, heartburn,
palpitation, and mouth dryness.
The data was analyzed by using statistics
program SPSS version 14.0. Data were analyzed using
Chi-square test or Fishers exact test and general linear
model in the form of repeated measurement adjust
for the co-variate by controlling the variation of the
difference nausea score and vomiting times before the
treatment in both groups (day 0). Student t-test was
used to test the coefficient of independent variable
(B). A p-value of less than 0.05 was considered signifi-
cance different.
Results
There were 85 women randomized to ginger
(group A) and 85 women to dimenhydrinate (group B).
There were 8 women in group A and 11 women in group
B who were lost to follow up. The baseline characteris-
tics were similar in both groups (Table 1). After adjust-
ing the variation of the difference nausea score and
vomiting times before the treatment in both groups
(day 0), the mean of nausea score in day 1-7 of the
treatment were decreased in both groups (Fig. 1). The
daily mean nausea scores between both groups were
not statistically different (p > 0.05 ) (Table 2). The fre-
quency of vomiting times in day 1-7 of the treatment
was decreased in both groups (Fig. 2). The daily mean
vomiting times in the dimenhydrinate group in day 1-2
of the treatment were less than the ginger group with
statistical significance (p < 0.05). After day 3-7 post
treatment, the daily mean vomiting times in both
groups were not statistically different (p > 0.05). The
occurrence of drowsiness in the ginger group and
dimenhydrinate group were 5/85 (5.88%) versus 66/85
(77.64%) (p < 0.01). The occurrence of heart burn was
13/85 (15.2%) versus 9/85 (10.58%) (p = 0.403), respec-
tively. No other adverse effect was observed in both
groups during the one-week follow up.
Discussion
Ginger (Zingiber officinale) has traditionally
been used for gastrointestinal symptoms such as nau-
sea and vomiting
(14).
Recent evidences suggest that
its anti-emetic activities may be derived from its anti-
serotonin-3 effects on both the central nervous and
J Med Assoc Thai Vol. 90 No. 9 2007 1705
Table 1. Dermographic data of the patients in both groups. (Group A = Ginger, Group B = Dimenhydrinate)
Group A (n = 85) B (n = 85)
Age (year) 27.85 (
+5.3) 26.38 (+5.8)
Weight (kg) 53.22 (
+6.9) 52.18 (+6.2)
BMI 21.38 (+3.4) 20.87 (+2.9)
GA (week) 10.25 (
+2.8) 9.3 (+3.1)
Nullipara (n) 49 57.65% 56 65.88%
Occupation
Employee 39 45.88% 43 50.59%
Government Officer 6 7.06% 6 7.06%
Trader 18 21.16% 6 7.06%
Housewife 22 25.88% 30 35.29%
Education
Elementary 30 35.29% 24 28.24%
Junior high school 29 34.12% 32 37.65%
High school 15 17.65% 16 18.22%
Bachelor 11 12.94% 13 15.29%
BMI: Body Mass Index
GA: Gestational age
(Group A = Ginger, Group B = Dimenhydrinate)
Table 2. Mean of nausea score post treatment
Dependent Parameter B Std. t Sig. 95% confidence interval
variable error
Lower bound Upper bound
N day 1 Intercept 0.2898 0.3004 0.9648 0.3361 -0.3032 0.8828
N_DAY_0 0.8215 0.0443 18.5295 0.0000 0.7340 0.9090
[GROUP B] -0.1991 0.1333 -1.4941 0.1370 -0.4623 0.0640
[GROUP A] 0.0000 . . . . .
N day 2 Intercept -0.1124 0.5112 -0.2200 0.8262 -1.1216 0.8967
N_DAY_0 0.6847 0.0755 9.0753 0.0000 0.5358 0.8337
[GROUP B] -0.0463 0.2268 -0.2041 0.8385 -0.4941 0.4015
[GROUP A] 0.0000 . . . . .
N day 3 Intercept -0.3182 0.5406 -0.5885 0.5570 -1.3855 0.7492
N_DAY_0 0.6198 0.0798 7.7675 0.0000 0.4623 0.7774
[GROUP B] -0.0513 0.2399 -0.2140 0.8308 -0.5249 0.4223
[GROUP A] 0.0000 . . . . .
N day 4 Intercept 0.0870 0.4770 0.1824 0.8555 -0.8548 1.0288
N_DAY_0 0.4984 0.0704 7.0778 0.0000 0.3594 0.6374
[GROUP B] -0.2240 0.2117 -1.0580 0.2916 -0.6419 0.1940
[GROUP A] 0.0000 . . . . .
N day 5 Intercept 0.3762 0.4722 0.7968 0.4267 -0.5560 1.3084
N_DAY_0 0.3821 0.0697 5.4827 0.0000 0.2445 0.5197
[GROUP B] -0.2423 0.2095 -1.1563 0.2492 -0.6559 0.1714
[GROUP A] 0.0000 . . . . .
N day 6 Intercept 0.1688 0.4716 0.3578 0.7209 -0.7624 1.0999
N_DAY_0 0.3485 0.0696 5.0066 0.0000 0.2111 0.4860
[GROUP B] -0.0627 0.2093 -0.2997 0.7648 -0.4759 0.3505
[GROUP A] 0.0000 . . . . .
N day 7 Intercept 0.5712 0.4803 1.1893 0.2360 -0.3770 1.5193
N_DAY_0 0.2293 0.0709 3.2352 0.0015 0.0894 0.3693
[GROUP B] -0.1995 0.2131 -0.9360 0.3506 -0.6202 0.2213
[GROUP A] 0.0000 . . . . .
(Group A = Ginger, Group B = Dimenhydrinate)
1706 J Med Assoc Thai Vol. 90 No. 9 2007
Fig. 1 Comparative means of nausea score between both groups (Group A = Ginger, Group B = Dimenhydrinate)
B
A
Fig. 2 Comparative means of vomiting times between both groups (Group A = Ginger, Group B = Dimenhydrinate)
A
B
J Med Assoc Thai Vol. 90 No. 9 2007 1707
Table 3. Mean of vomiting times post treatment
Dependent variable Parameter B Std. t Sig. 95% confidence interval
error
Lower Upper
bound bound
Frequency of vomiting Intercept -0.0831 0.0733 -1.1329 0.2589 -0.2279 0.0617
at day 1 B_DAY_0 0.8730 0.0274 31.8715 0.0000 0.8189 0.9271
[GROUP B] -0.1991 0.0762 -2.6126 0.0098 -0.3495 -0.0486
[GROUP A] 0.0000 . . . . .
Frequency of vomiting Intercept -0.1595 0.1003 -1.5899 0.1138 -0.3575 0.0386
at day 2 B_DAY_0 0.7551 0.0375 20.1597 0.0000 0.6812 0.8291
[GROUP B] -0.2259 0.1042 -2.1685 0.0315 -0.4316 -0.0202
[GROUP A] 0.0000 . . . . .
Frequency of vomiting Intercept -0.1810 0.1078 -1.6785 0.0951 -0.3938 0.0319
at day 3 B_DAY_0 0.5566 0.0403 13.8230 0.0000 0.4771 0.6361
[GROUP B] -0.0266 0.1120 -0.2377 0.8124 -0.2477 0.1945
[GROUP A] 0.0000 . . . . .
Frequency of vomiting Intercept -0.2225 0.1176 -1.8912 0.0603 -0.4547 0.0098
at day 4 B_DAY_0 0.4962 0.0439 11.2956 0.0000 0.4095 0.5830
[GROUP B] -0.0571 0.1222 -0.4669 0.6412 -0.2983 0.1842
[GROUP A] 0.0000 . . . . .
Frequency of vomiting Intercept -0.2425 0.1135 -2.1356 0.0342 -0.4667 -0.0183
at day 5 B_DAY_0 0.4370 0.0424 10.3055 0.0000 0.3533 0.5207
[GROUP B] -0.0762 0.1180 -0.6464 0.5189 -0.3091 0.1566
[GROUP A] 0.0000 . . . . .
Frequency of vomiting Intercept -0.2318 0.1078 -2.1498 0.0330 -0.4447 -0.0189
at day 6 B_DAY_0 0.3930 0.0403 9.7601 0.0000 0.3135 0.4725
[GROUP B] -0.0908 0.1120 -0.8109 0.4186 -0.3120 0.1303
[GROUP A] 0.0000 . . . . .
Frequency of vomiting Intercept -0.2692 0.1017 -2.6473 0.0089 -0.4700 -0.0685
at day 7 B_DAY_0 0.3560 0.0380 9.3716 0.0000 0.2810 0.4309
[GROUP B] -0.0616 0.1057 -0.5833 0.5605 -0.2702 0.1470
[GROUP A] 0.0000 . . . . .
(Group A = Ginger, Group B = Dimenhydrinate)
Table 4. Side effects
(Group A = Ginger, Group B = Dimenhydrinate)
Group A % B % p-value
Drowsiness 5 5.88 66 77.64 <0.001
Heart burn 13 15.29 9 10.58 0.493
gastrointestinal system
(11-14)
. Four confirmatory studies,
two vs. placebo
( 4,5)
and two vs. vitamin B6
(6,7)
, demon-
strated that the 0.5 gm or 1 gm of ginger powder or
extract was effective in treating nausea and/or vomit-
ing during pregnancy. These exploratory studies back
this result.
In the present study, the duration of ginger
treatment was very short and the dosage used was
very low. The authors used 0.5 gm of ginger powder
twice daily for one week. In the study of Smith C et al
(6)
,
the dosage of ginger was 1.05 gm daily compared with
75 mg of vitamin B6 for three weeks. Sripramote M
(7)
1708 J Med Assoc Thai Vol. 90 No. 9 2007
used 0.5 gm of ginger compared with vitamin B6 10 mg
three times daily for one week (total 1.5 gm ginger per
day). The authors usually use dimenhydrinate 50 mg
one to three times per day for treating nausea and
vomiting in pregnancy. Because the undesirable effect
is drowsiness, in this study the authors used 500 mg of
ginger compared with 50 mg of dimenhydrinate twice
daily to minimize this adverse effect that might result
in the higher rate of patient non-compliance and loss
to follow up.
Because the variation in nausea score and
vomiting times before the treatment (day 0) were signi-
ficant, in the present study the authors used general
linear model in the form of repeated measurement
adjust for the co-variate by controlling these variation.
The authors found that ginger was as effective as di-
menhydrinate in the treatment of nausea and vomiting.
Although the vomiting times of the ginger group in
day 1-2 of the treatment were greater than the dimen-
hydrinate group, the effectiveness were similar after
day 3-7 post treatment.
According to the safety of ginger in preg-
nancy, the study of Vutyavanich T et al
(4)
found that
ginger had a similar adverse pregnancy outcome as
the control group (abortion, preterm delivery, cesarean
section, congenital anomaly). The study of Portnoi G
et al
(15)
confirmed the safety of ginger but they found
the rate of low birth weight in the control group greater
than the ginger group (6.4% vs. 1.6%).This study
explained that they had eight sets of twins in the
control group. However, the other adverse pregnancy
outcomes were similar.
Nausea and vomiting in early pregnancy
remain a significant public health that have physiologi-
cal, emotional, social, and economic consequences to
women, their family, and society. Many medications,
for example vitamin B6, metoclopamide etc, are used in
the treatment of nausea and vomiting in pregnancy. In
spite of its undesirable effect, dimenhydrinate is still
commonly used in general practice. Ginger has long
been recommended as folklore treatment for nausea
and vomiting in pregnancy without significant side
effects. The present study support that ginger can be
used as an alternative choice for the treatment of
nausea and vomiting in pregnancy.
References
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nal complications. In: Burrow GN, Diffy TP, editors.
Medical complication during pregnancy. 6
th
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frequency, intensity, and patterns of change. Am J
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3. Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping
U. Ginger treatment of hyperemesis gravidarum.
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6. Smith C, Crowther C, Willson K, Hotham N,
McMillian V. A randomized controlled trial of
ginger to treat nausea and vomiting in pregnancy.
Obstet Gynecol 2004; 103: 639-45.
7. Sripramote M, Lekhyananda N. A randomized
comparision of ginger and vitamin B6 in the treat-
ment of nausea and vomiting in pregnancy. J Med
Assoc Thai 2004; 86: 846-52.
8. Bryer E. A literature review of the effectiveness of
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9. Srivastava KC. Isolation and effects of some
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10. Srivas KC. Effects of aqueous extracts of onion,
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cular system: in vitro study. Prostaglandins Leukot
Med 1984; 13: 227-35.
11. Lumb AB. Mechanism of antiemetic effect of
ginger. Anaesthesia 1993; 48: 1118.
12. Mowrey DB, Clayson DE. Motion sickness,
ginger, and psychophysics. Lancet 1982; 1: 655-7.
13. Holtmann S, Clarke AH, Scherer H, Hohn M. The
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J Med Assoc Thai Vol. 90 No. 9 2007 1709
การศกษาเปรยบเทยบขงกบยา dimenhydrinate ในการรกษาภาวะคลื่นไสอาเจยนในสตรีตั้งครรภ
เดนศกดิ์ พงศโรจนเผ่า, จรนทร์ทิพย สมประสทธิ์, อธตา จันทเสนานนท
วัตถประสงค: เพื่อศกษาเปรยบเทยบประสทธภาพของขงกบยา dimenhydrinate ในการรกษาอาการคลื่นไสอาเจยน
ในสตรีตังครรภ
รูปแบบการวิจัย: Double blind randomized controlled trial
สถานที่: ภาควชาสูตศาสตร-นรเวชวทยา คณะแพทยศาสตร มหาวทยาลยธรรมศาสตร
วัสดและวิธีการ: ศึกษาตั้งแต มกราคม .. 2548 - ธันวาคม .. 2548 สตรีตั้งครรภ์ที่มารบการตรวจครรภ
โรงพยาบาลธรรมศาสตรเฉลมพระเกยรต ที่มีอาการคลื่นไสอาเจยนระหวางตั้งครรภ จำนวน 170 ราย ไดทำการแบ่ง
กลุ่มแบบสุ่ม เป็น 2 กลุ่ม ละ 85 ราย กลุ่ม A จะได้รับ ยาขิง 1 แคปซูล วันละ 2 ครั้ง (1 แคปซลประกอบดวยขิง 0.5
กรัม) และกลุ่ม B จะได้รับยา dimenhydrinate (50 mg) ประเมิน Visual analogue nausea score (VANS) จำนวนครั้ง
ที่อาเจยน และผลขางเคยง วันที่ 0-7 ของการรกษา
ผลการศกษา: ไมพบความแตกตางอยางมนัยสำคญทางสถิตของคะแนนอาการคลนไส (VANS) ในการรกษาท้ง
สองกลุ่ม ในวนที่ 1 และ 2 ของการรกษา กลุ่มที่ได้รบยาขงพบวามจำนวนครั้งของการอาเจยนมากกวากลมที่ได้รับ
ยา dimenhydrinate อยางมีนยสำคญทางสถติ แตในวนที่ 3-7 ของการรกษา พบวาจำนวนครงของการอาเจยน
ไมแตกตางกนทั้งสองกลุ่ม กลุ่มทได้รับยาขงพบวามอาการงวงนอนนอยกวากลุ่มที่ได้รับยา dimenhydrinate อยาง
มีนัยสำคญทางสถติ
สรุป: จากการศกษา พบวาขงมประสทธภาพในการรกษาอาการคลื่นไสอาเจยนในสตรีตั้งครรภไมแตกตางจากยา
dimenhydrinate แต่มีอาการขางเคยงนอยกว่า
... The interventions included in this review can be grouped into four interventions and the most commonly found intervention is ginger. Seven studies discuss ginger intervention (Ensiyeh & Sakineh, 2009;Ozgoli et al., 2009;Pongrojpaw et al., 2007;Saberi et al., 2014;Sharifzadeh et al., 2017;Smith et al., 2004), two studies on aromatherapy interventions (Joulaeerad et al., 2018;Kia et al., 2014), two studies on acupuncture (Habek et al., 2004;Neri et al., 2005), and five studies on acupressure (Adlan et al., 2017;Heazell et al., 2006;Jamigorn & Phupong, 2007;Puangsricharern & Mahasukhon, 2008;Shin et al., 2007). The various studies in this review reveal mixed results as described below. ...
... The study did not aim to see the difference between metoclopramide and ginger, so it cannot be said that ginger is less effective than metoclopramide. However, ginger can be used as an alternative to metoclopramide.This study is in line with Pongrojpaw et al. (2007) research that ginger has the same effectiveness as dimenhydrinate in treating nausea and vomiting and has fewer side effects (Pongrojpaw et al., 2007). ...
... The study did not aim to see the difference between metoclopramide and ginger, so it cannot be said that ginger is less effective than metoclopramide. However, ginger can be used as an alternative to metoclopramide.This study is in line with Pongrojpaw et al. (2007) research that ginger has the same effectiveness as dimenhydrinate in treating nausea and vomiting and has fewer side effects (Pongrojpaw et al., 2007). ...
... Jarisch et al. (2014) found that vitamin C was effective in suppressing symptoms of seasickness on a life raft. Ginger root is another remedy against motion sickness with fewer undesirable side-effects, as compared to conventional drug agents (Pongrojpaw et al. 2007). Some evidence exists for its effectiveness in reducing general motion sickness (Grøntved et al. 1988;Mowrey and Clayson 1982), nausea (Pongrojpaw et al. 2007), and VIMS (Lien et al. 2003). ...
... Ginger root is another remedy against motion sickness with fewer undesirable side-effects, as compared to conventional drug agents (Pongrojpaw et al. 2007). Some evidence exists for its effectiveness in reducing general motion sickness (Grøntved et al. 1988;Mowrey and Clayson 1982), nausea (Pongrojpaw et al. 2007), and VIMS (Lien et al. 2003). The mechanism of action appears to be that ginger suppresses the increase in plasma vasopressin levels, thereby alleviating gastric dysrhythmias and nausea (Kim et al. 1997;Lien et al. 2003). ...
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Visually induced motion sickness (VIMS) is a common side-effect of exposure to virtual reality (VR). Its unpleasant symptoms may limit the acceptance of VR technologies for training or clinical purposes. Mechanical stimulation of the mastoid and diverting attention to pleasant stimuli-like odors or music have been found to ameliorate VIMS. Chewing gum combines both in an easy-to-administer fashion and should thus be an effective countermeasure against VIMS. Our study investigated whether gustatory-motor stimulation by chewing gum leads to a reduction of VIMS symptoms. 77 subjects were assigned to three experimental groups (control, peppermint gum, and ginger gum) and completed a 15-min virtual helicopter flight, using a VR head-mounted display. Before and after VR exposure, we assessed VIMS with the Simulator Sickness Questionnaire (SSQ), and during the virtual flight once every minute with the Fast Motion Sickness Scale (FMS). Chewing gum (peppermint gum: M = 2.44, SD = 2.67; ginger gum: M = 2.57, SD = 3.30) reduced the peak FMS scores by 2.05 (SE = 0.76) points as compared with the control group ( M = 4.56, SD = 3.52), p < 0.01, d = 0.65. Additionally, taste ratings correlated slightly negatively with both the SSQ and the peak FMS scores, suggesting that pleasant taste of the chewing gum is associated with less VIMS. Thus, chewing gum may be useful as an affordable, accepted, and easy-to-access way to mitigate VIMS in numerous applications like education or training. Possible mechanisms behind the effect are discussed.
... The recommended daily doses were: 3 × 650 mg, 4 × 250 mg, 2 × 500 mg, 4 × 125 mg, 3 × 350 mg, 3 × 250 mg, and five biscuits. The majority of the studies were conducted over four days, but three studies chose seven days [75][76][77], one study was conducted for two weeks [78], and one study was conducted for three weeks [79]. Clinical studies were realized in Asia (Thailand), Europe (Denmark), Oceania (Australia), and the Middle East (Iran). ...
... To determine the effectiveness of ginger on NVP, its effect was compared to control [77] or placebo [77,78,80,[84][85][86] groups, but also vitamin B6 [70,79,81,83], drugs like dimenhydrinate [75], metoclopramide [84], or acupuncture [76]. ...
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Ginger, Zingiber officinale Roscoe, is increasingly consumed as a food or in food supplements. It is also recognized as a popular nonpharmacological treatment for nausea and vomiting of pregnancy (NVP). However, its consumption is not recommended by all countries for pregnant women. Study results are heterogeneous and conclusions are not persuasive enough to permit heath care professionals to recommend ginger safely. Some drugs are also contraindicated, leaving pregnant women with NVP with few solutions. We conducted a review to assess effectiveness and safety of ginger consumption during early pregnancy. Systematic literature searches were conducted on Medline (via Pubmed) until the end of December 2017. For the evaluation of efficacy, only double-blind, randomized, controlled trials were included. For the evaluation of the safety, controlled, uncontrolled, and pre-clinical studies were included in the review. Concerning toxicity, none can be extrapolated to humans from in vitro results. In vivo studies do not identify any major toxicities. Concerning efficacy and safety, a total of 15 studies and 3 prospective clinical studies have been studied. For 1 g of fresh ginger root per day for four days, results show a significant decrease in nausea and vomiting and no risk for the mother or her future baby. The available evidence suggests that ginger is a safe and effective treatment for NVP. However, beyond the ginger quantity needed to be effective, ginger quality is important from the perspective of safety.
... It has been used in diet-induced metabolic disorders (19,21,22) and also safely in cooking and folk medicine (23). Besides, ginger is used in the treatment of arthritis (24), nonalcoholic fatty liver disease (25), primary dysmenorrhea (26), and nausea caused by pregnancy (27) and chemotherapy (28) in traditional Chinese medicine and the Indian ayurvedic system of medicine. ...
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Metabolic syndrome is a multifactorial disorder characterized by hyperglycemia, hyperlipidemia, obesity, and hypertension risk factors. Moreover, metabolic syndrome is the most ordinary risk factor for cardiovascular disease (CVD). Numerous chemical drugs are being synthesized to heal metabolic risk factors. Still, due to their abundant side effects, herbal medicines have a vital role in the treatment of these abnormalities. Ginger (Zingiber officinale Roscoe, Zingiberaceae) plant has been traditionally used in medicine to treat disorders, including CVD. The unique ginger properties are attributed to the presence of [6]-gingerol, [8]-gingerol, [10]-gingerol, and [6]-shogaol, which through different mechanisms can be beneficial in metabolic syndrome. Ginger has a beneficial role in metabolic syndrome treatment due to its hypotensive, anti-obesity, hypoglycemic, and hypolipidemic effects. It can significantly reduce atherosclerotic lesion areas, VLDL and LDL cholesterol levels, and elevate adenosine deaminase activity in platelet and lymphocytes. Also, it promotes ATP/ADP hydrolysis. In the current article review, the critical properties of ginger and its constituents' effects on the metabolic syndrome with a special focus on different molecular and cellular mechanisms have been discussed. This article also suggests that ginger may be introduced as a therapeutic or preventive agent against metabolic syndrome after randomized clinical trials.
... Interestingly, retching was also reduced to a level with ginger extracts with no obvious risk of fetal abnormalities [146]. Similar double blind randomized controlled trials at Thammasat Hospital, although with increased population of 170 pregnant woman and twice daily dosage of ginger (0.5 g) and dimenhydrinate (50 mg) for 7 days showed improved efficacy comparable to the control in reducing pregnancy induced nausea and vomiting only after three days of treatment with significant difference in the side effect of dimenhydrinate (77.64%) relative to ginger (5.85%) [147]. ...
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Ginger is one of the most valuable culinary medicinal spice with inestimable economic uses. Because it is, a well acknowledged plant both in folkloric and advanced medicine, there are no paucity of information on the many important uses of ginger in the literature. In this review, we conveyed important details on the chemistry, pharmacology, toxicity and clinical uses of ginger. Our review of over 171 articles showed that ginger use has a worldwide coverage. Randomized clinical trial studies on ginger are most prominent on the alleviation of pregnancy-induced nausea and vomiting with fascinating outcome. In addition, the prospective use as anti-inflammatory, thrombolytic, and anti-diabetic agent were well noticed. Although the dependent on plant as source of drug in the search for disease remedy is premised on their acclaimed effectiveness and safety, available data have showed plants may possess some toxic potential, overall, our review showed that ginger might be safe with no adverse effects when investigated in normal rodent and human. Review Article Adewale et al.; JOCAMR, 15(4): 44-67, 2021; Article no.JOCAMR.72871 45
... Ginger enhanced the secretion of digestive enzymes including pancreatic lipase, sucrase, maltase and stimulate trypsin and chymotrypsin. In clinical studies, ginger has been shown to be as effective as dimenhydrinate [38] and even more effective than vitamin B6 [39] in treating nausea and vomiting in pregnancy. It has also been recommended for the treatment of nausea associated with chemotherapy [40] , gynecological laparoscopy [41] and postoperative prophylactic antiemetics [42] . ...
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The most prevalent forms of ailments affecting a huge number of individuals throughout the world are digestive system problems. According to the World Health Organization (WHO), over 100 million people died globally as a result of digestive system diseases in 2012. Despite this, most scientific bodies disregard the relevance of a healthy digestive system and associated problems in health debates. Food and lifestyle have a direct influence on digestive health, and a healthy diet or a change in lifestyle can address a variety of issues. Plants provide a variety of phytochemicals and nutraceuticals that may aid in the treatment and prevention of a number of digestive problems. Plant-based remedies, including spices, are widely used by ordinary people across the world and can help digestion without causing adverse effects. Numerous ethnomedicinal studies show that the use of medicinal plants by traditional populations to treat digestive problems is widespread across the world. The biological activities of traditional herbal medicine used to treat digestive problems have been studied and generally indicate minimal side effects. However, as the demand for herbal medicines derived from plants grows across the world, more comprehensive clinical research on the advantages and toxicity of herbal medicines should be conducted. The goal of this study is to provide examples of research that have established and verified the use of plant-based medicines to treat digestive problems. In particular, traditional medicinal plant extracts or phytochemicals that have been shown to reduce symptoms of digestive system disorders along with mode of action and safety will be discussed.
... Ginger is often used as an effective and harmless treatment for nausea and vomiting in pregnancy [27]. Pongrojpaw et al. [28] conducted comparative studies on the use of ginger and dimenhydrinate (which is a substance used as an anti-emetic). 170 pregnant women who experienced nausea and vomiting caused by pregnancy participated in the study. ...
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Introduction. Ginger (Zingiber officinale) is a plant widely used all over the world. Due to its rich aroma and characteristic, spicy taste, it has been used in the kitchen as a spice additive. However, the multitude of phytonutrients it contains makes ginger a plant with a positive effect on the human body. Objective. The aim of the study is to present the possibilities of using ginger and its bioactive ingredients in the treatment of selected diseases. Brief description of the state of knowledge. Ginger is a source of many valuable nutrients that determine its organoleptic characteristics, which also has pro-health properties. Essential oils and oleoresin are the main compounds responsible for the specific smell and sharp taste of ginger [8]. Additionally, ginger contains many phytonutrients, such as sesquiterpenes and monoterpenes, which include α – zingiberene, α – faranezene, β – bisabolene, β – felandren, zingiberol, geraniol, linalool, and cineole, as well as zingerone and shogaole. Ginger has been used for a long time to treat gastrointestinal and cardiovascular disorders, rheumatic pains, diabetes, cancer and depression. It is still used in Chinese and Arab folk medicine as a warming agent, or as a remedy for the digestive system and liver diseases. Moreover, it is used in constipation, cold, rhinitis and bronchitis. Research also indicates high antioxidant, antimicrobial and anti-inflammatory properties. These health benefits are attributed to its phenolic compounds, mainly gingerols and shoagols. Conclusions. Ginger is a rich source of multiple bioactive compounds which have medicinal value, and has a supporting effect in several diseases, such as diabetes, cardiovascular diseases, nausea, emesis and inflammatory processes.
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Culinary spices and herbs have been used in food and beverages to enhance aroma, flavor, and color. They are rich in phytochemicals that provide significant antioxidant and anti-inflammatory effects. There is growing interest in identifying compounds from spices and herbs responsible for modulating oxidative and inflammatory stress to prevent diet-related diseases. This contribution will provide an overview of culinary spices and herbs, their classification , their sources or origins and more importantly, their chemical composition, antioxidant activity and their impacts on human health based on important and recent studies.
Article
Background & objectives: Physical activity is one of the several factors which stimulate the secretion of growth and nerve growth factors in patients with Multiple Sclerosis (MS). Therefore, the aim of this study was to evaluate the effect of 12 weeks of Pilates training and ginger consumption on serum level of BDNF and TNF-α in women with MS. Methods: Forty women with MS were randomly selected from 85 women referred to the Welfare Office of Urmia city, in Iran, with the age range of 30-35 in the form of a pre-test and post-test quasi-experimental study design. Participants were divided into four groups including: exercise+ supplement, exercise+ placebo, ginger supplement and control group with 10 individuals in each group. The intervention groups performed Pilates exercises for 12 weeks, 3 sessions of 60 minutes every week, and the supplement groups took three ginger capsules of one gram daily. In order to analyze the data, analysis of covariance was done using SPSS-22 software. Results: The results showed that ginger consumption combined with physical exercises increases BDNF in the intervention groups compared to the control groups, but this increase is more significant in the exercise+supplement group (p
Article
Mild-to-moderate nausea and vomiting of pregnancy affects up to 80% of all pregnancies. Concern about antiemetic use and the time-limited nature of symptoms has restrained the development of effective treatment approaches, yet supportive, dietary, and lifestyle changes may be ineffective. This article reviews 4 recent well-controlled, double-blind, randomized clinical studies that provide convincing evidence for the effectiveness of ginger in treating nausea and vomiting of pregnancy. It also provides a dosage update for the various forms of ginger.
Article
Thirty women participated in a double-blind randomized cross-over trial of the efficacy of a natural product, the powdered root of ginger (Zingiber officinale), and placebo in hyperemesis gravidarum. Three patients had to be withdrawn. Each woman swallowed capsules containing either 250 mg ginger or lactose q.i.d. during the first 4 days of the treatment period. Interrupted by a 2 days wash-out period the alternative medication was given in the second 4-day period. The severity and relief of symptoms before and after each period were evaluated by two scoring systems. The scores were used for statistical analyses of possible differences. Subjectively assessed, 19 women (70.4%) stated preference to the period in which ginger, as was later disclosed, had been given (P = 0.003). More objectively assessed by relief scores a significantly greater relief of the symptoms was found after ginger treatment compared to placebo (P = 0.035). No side effects were observed. The possible mutagenic and antimutagenic characters of ginger reported in a study of E. coli have not been evaluated with respect to any significance in humans. Powdered root of ginger in daily doses of 1 g during 4 days was better than placebo in diminishing or eliminating the symptoms of hyperemesis gravidarum.
Article
A controlled, double-blind study was carried out to determine whether nystagmus response to optokinetic or vestibular stimuli might be altered by some agent contained in powdered ginger root (Zingiber officinale). For comparative purposes, the test subjects were examined after medication with ginger root, placebo and with dimenhydrinate. Eye movements were recorded using standard ENG equipment and evaluation was performed by automatic nystagmus analysis. It could be demonstrated that the effect of ginger root did not differ from that found at baseline, or with placebo, i.e. it had no influence on the experimentally induced nystagmus. Dimenhydrinate, on the other hand, was found to cause a reduction in the nystagmus response to caloric, rotatory and optokinetic stimuli. From the present study it can be concluded that neither the vestibular nor the oculomotor system, both of which are of decisive importance in the occurrence of motion sickness, are influenced by ginger. A CNS mechanism, which is characteristic of the conventional anti-motion sickness drugs, can thus be excluded as regards ginger root. It is more likely that any reduction of motion-sickness symptoms derives from the influence of the ginger root agents on the gastric system.
Article
Aqueous ginger extract was extracted in three organic solvents viz., n-hexane, chloroform and ethyl acetate with increasing polarity. The extracted materials from these solvents reduced platelet thromboxane formation from exogenous arachidonate (AA) and also inhibited platelet aggregation induced by AA, epinephrine, ADP and collagen; in this respect they were most effective against AA-induced aggregation. The extracted material in n-hexane was further resolved by thin-layer chromatography into various fractions some of which were effective in inhibiting platelet thromboxane formation and platelet aggregation. Aqueous ginger extract reduced the formation of TxB2 from AA-labelled platelets without showing effects on platelet phospholipase activity. Thromboxane formation in labelled platelets on activation with calcium ionophore A23187 was reduced by ginger components, isolated from two TLC bands, in a dose-dependent manner (10-100 ug/500 ml). At the higher dose lipoxygenase products were also reduced. Interestingly the incorporation of AA into platelet phospholipids increased in platelets treated with aqueous ginger extract.
Article
The effects of the powdered rhizome of Zingiber officinale on the symptoms of motion sickness were compared with those of dimenhydrinate and placebo in 36 undergraduate men and women who reported very high susceptibility to motion sickness. Motion sickness was induced by placing the blindfolded subject in a tilted rotating chair. Measurements of perceived degree of gastrointestinal distress were reported every 15 s for up to 6 minutes by means of psychophysical methods. Z. officinalewas superior to dimenhydrinate in reducing motion sickness.
Article
Aqueous extracts of onion, garlic and ginger were found to inhibit aggregation induced by ADP, epinephrine, collagen and arachidonate in a dose-dependent manner in vitro. In the case of onion and garlic extracts relatively much higher volumes were need to bring about even a modest inhibition (by ca. 13-18%) of thromboxane synthesis in washed platelets from labelled AA. On the other hand a good correlation was found between the amounts of ginger extract needed to inhibit platelet aggregation and those to inhibit platelet thromboxane synthesis. Ginger extract reduced also platelet prostaglandin-endoperoxides. A dose-related inhibition of platelet thromboxane- and prostaglandin (PGF2 alpha, PGE2 and PGD2) synthesis was affected by ginger extract. Extracts of onion, garlic and ginger inhibited biosynthesis of prostacyclin in rat aorta from labelled AA. Ginger extract mildly inhibited the synthesis of prostacyclin from endogenous pool of AA in rat aorta; the other two extracts were without effect.
Article
Ginger is well known in the form of ginger sticks or ginger ale. If these are consumed during travel, the traveler imbibes, albeit subconsciously, a healing plant for motion sickness. The efficacy of ginger rhizome for the prevention of nausea, dizziness, and vomiting as symptoms of motion sickness (kinetosis), as well as for postoperative vomiting and vomiting of pregnancy, has been well documented and proved beyond doubt in numerous high-quality clinical studies. The use of this ancient medicine for gastrointestinal problems (stimulation of digestion) has been given scientific approval. Today, medicinal ginger is used mainly for prevention of the symptoms of travel sickness.
Article
Our purpose was to provide a detailed description of patterns of nausea and vomiting of pregnancy. A prospective study was performed with 160 women who provided daily recordings of frequency, duration, and severity of nausea and vomiting. Seventy-four percent of women reported nausea lasting a mean of 34.6 days. "Morning sickness" occurred in only 1.8% of women, whereas 80% reported nausea lasting all day. Only 50% of women were relieved by 14 weeks' gestation; 90% had relief by week 22. Data based on the McGill Nausea Questionnaire indicate that the nausea experienced by pregnant women is similar in character and intensity to the nausea experienced by patients undergoing cancer chemotherapy. Traditional teachings about nausea and vomiting of pregnancy are contradicted by our findings. Standardized tools for measuring the distribution, duration, and intensity of nausea are applicable to the study of nausea and vomiting of pregnancy and could be used in clinical trials to assess palliative measures.