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    Introduction

    There are actually three different herbs commonly called ginseng: Asian or Korean ginseng (Panax ginseng), American ginseng (Panax quinquefolius), and Siberian "ginseng" (Eleutherococcus senticosus). The latter herb is actually not ginseng at all, but the Russian scientists responsible for promoting it believe that it functions identically.

    Asian ginseng is a perennial herb with a taproot resembling the human body. It grows in northern China, Korea, and Russia; its close relative, Panax quinquefolius, is cultivated in the United States. Because ginseng must be grown for 5 years before it is harvested, it commands a high price, with top-quality roots easily selling for more than $10,000. Dried, unprocessed ginseng root is called "white ginseng," and steamed, heat-dried root is "red ginseng." Chinese herbalists believe that each form has its own particular benefits.

    Ginseng is widely regarded by the public as a stimulant, but according to everyone who uses it seriously that isn't the right description. In traditional Chinese herbology, Panax ginseng was used to strengthen the digestion and the lungs, calm the spirit, and increase overall energy. When the Russian scientist Israel I. Brekhman became interested in the herb prior to World War II, he came up with a new idea about ginseng: He decided that it was an adaptogen.

    The term adaptogen refers to a hypothetical treatment described as follows: An adaptogen should help the body adapt to stresses of various kinds, whether heat, cold, exertion, trauma, sleep deprivation, toxic exposure, radiation, infection, or psychological stress. Furthermore, an adaptogen should cause no side effects, be effective in treating a wide variety of illnesses, and help return an organism toward balance no matter what may have gone wrong.

    Perhaps the only indisputable example of an adaptogen is a healthful lifestyle. By eating right, exercising regularly, and generally living a life of balance and moderation, you will increase your physical fitness and ability to resist illnesses of all types. Whether there are any substances that can do as much remains unclear. However, Brekhman felt certain that ginseng produced similarly universal benefits.

    Interestingly, traditional Chinese medicine (where ginseng comes from) does not entirely agree. There is no one-size-fits-all in Chinese medical theory. Like any other herb, ginseng is said to be helpful for those people who need its particular effects, and neutral or harmful for others. But in Europe, Brekhman's concept has taken hold, and ginseng is widely believed to be a universal adaptogen.

    In the 1940s, Brekhman decided that a much less expensive herb, Eleutherococcus senticosus, is just as good as ginseng. A thorny bush that grows much more rapidly than true ginseng, this later received the misleading name of "Siberian" or "Russian ginseng." Contrary to some reports, its chemical makeup is completely unrelated to that of Panax ginseng.
    What Is Ginseng Used for Today?

    If Brekhman is right, ginseng (whether Eleutherococcus or Panax) should be the right treatment for most of us. Modern life is tremendously stressful, and if an herb could help us withstand it, it would be a terrifically useful herb indeed. Ginseng is widely used for this purpose in Russia and Eastern Europe. However, the scientific basis for this use is largely limited to animal studies.

    There have been a few studies of ginseng for certain more specific purposes: strengthening immunity against colds and flus and other infections (including herpes), helping to control diabetes, stimulating the mind, increasing a general sense of well-being, and improving physical performance capacity (sports performance), with some positive results.

    Ginseng is also said to help prevent cancer, fight chemical dependency, and improve sexual performance, but there is as yet little direct evidence that it really works. Highlpreliminary evidence suggests that American ginseng might help breast cancer chemotherapy drugs work better.

    However, Panax ginseng does not appear to be helpful for menopausal symptoms.

    What Is the Scientific Evidence for Ginseng?

    Adaptogenic Effects

    Numerous studies have evaluated the effects of oral ginseng on animals under conditions of extreme stress. The results suggest that ginseng increases physical endurance and causes physiological changes that may help the body adapt to adverse conditions. In addition, studies in mice found that consuming ginseng before exposure to a virus significantly increased the survival rate and the number of antibodies produced. Evidence from human trials are discussed under the separate headings below.

    Immune Stimulation

    A double-blind placebo-controlled study suggests that Panax ginseng can improve immunity.This trial enrolled 227 participants at three medical offices in Milan, Italy. Half were given ginseng at a dosage of 100 mg daily, the other half placebo. Four weeks into the study, all participants received influenza vaccine.

    The results showed a significant decline in the frequency of colds and flus in the treated group compared to the placebo group (15 versus 42 cases). Also, antibody measurements in response to the vaccination rose higher in the treated group than in the placebo group.

    Two other studies found evidence that ginseng increases the number of immune cells in the blood, although a third did not.

    In two double-blind placebo-controlled studies enrolling a total of over 200 individuals, an herbal combination treatment containing both Eleutherococcus and andrographis was found to significantly reduce cold symptoms.

    Diabetes

    A double-blind study evaluated the effects of Panax ginseng (at dosages of 100 mg or 200 mg daily) on 36 people with adult-onset diabetes. The results showed improvements in blood sugar control. The authors attributed this benefit to a spontaneously increased level of physical activity in the ginseng group.

    Improved blood sugar control was also seen in two small double-blind placebo-controlled trials using American ginseng (Panax quinquefolius). One study suggests that ginseng with low ginsenoside content is not effective.

    Mental Function

    A double-blind placebo-controlled study found that Panax ginseng can improve some aspects of mental function. Over a period of 2 months, 112 healthy, middle-aged adults were given either ginseng or placebo. The results showed that ginseng improved abstract thinking ability. However, there was no significant change in reaction time, memory, concentration, or overall subjective experience between the two groups.

    Another double-blind placebo-controlled study of 50 men found that 8-week treatment with a ginseng extract improved ability in completion of a detail-oriented editing task.

    In addition, a double-blind trial of 16 healthy males found favorable changes in ability to perform mental arithmetic in those given ginseng for 12 weeks.

    A double-blind placebo-controlled trial of 60 elderly individuals found that 50 or 100 days of treatment with Panax ginseng produced improvements in numerous measures of mental function, including memory, attention, concentration, and ability to cope. Benefits were still evident at the 50 day follow-up. However, virtually no improvement was seen in the placebo group, a result that is highly unusual and raises doubts about the accuracy of the study.

    Another study looked at the effects of ginkgo combined with ginseng. This 3-month double-blind placebo-controlled trial evaluated various doses of the two herbs combined in 64 individuals complaining of neurasthenia (fatigue and tiredness). The highest dose worked the best. Participants given 200 mg of Panax ginseng and 120 mg of ginkgo daily showed improvements in memory and other aspects of mental function. Strangely, however, this effect appeared to be temporary. Several hours after the dose, memory and mental function actually worsened compared to those given placebo. Researchers speculate that there may be a "payback" for temporarily increased mental function caused by this combination treatment. However, more research is necessary to determine whether this is true.

    Herpes Infection

    A 6-month double-blind trial of 93 men and women with recurrent herpes infections found that treatment with Eleutherococcus (2 g daily) reduced the frequency of infections by almost 50%.

    Sports Performance

    The evidence for Panax ginseng as a sports supplement is mixed. An 8-week double-blind placebo-controlled trial evaluated the effects of Panax ginseng with and without exercise in 41 individuals.The participants were given either ginseng or placebo, and then underwent exercise training or remained untrained throughout the study. The results showed that ginseng improved aerobic capacity in individuals who did not exercise, but offered no benefit in those who did exercise. In a 9-week double-blind placebo-controlled trial of 30 highly trained athletes, treatment with Panax ginseng or Panax ginseng plus vitamin E produced significant improvements in aerobic capacity. Another double-blind placebo-controlled trial of 37 individuals also found some benefit.

    A double-blind placebo-controlled study of 120 individuals found that ginseng gradually improved reaction time and lung function over a 12-week treatment period among those 40 to 60 years old. No benefits were seen in younger individuals.

    However, negative results were seen with Panax ginseng in an 8-week double-blind trial that followed 31 healthy men in their 20s. Negative results have been seen in other small trials of Panax ginseng as well.

    A double-blind study of 20 endurance athletes over an 8-week period found that a standard Eleutherococcus formulation produced no improvement in physical performance. Another small double-blind crossover trial also found Eleutherococcus ineffective
    General Well-Being

    A double-blind study compared the effects of a nutritional supplement with and without ginseng extract on the feeling of well-being in 625 people, whose average age was just under 40 years old. Quality of life was measured by a set of 11 questions. People taking the ginseng-containing supplement reported significant improvement compared to those taking the nonginseng supplement (the control group). Similar findings were reported in a double-blind placebo-controlled study of 36 people newly diagnosed with diabetes.After 8 weeks, participants who had been taking 200 mg of ginseng daily reported improvements in mood, well-being, vigor, and psychophysical performance that were significant compared to the reports of control participants. In addition, a 12-week double-blind placebo-controlled study of 120 individuals found improvement in general well-being among women aged 30 to 60 years and men aged 40 to 60 years, but not among men aged 30 to 39 years.However, a 60-day double-blind placebo-controlled trial of 83 adults in their mid-20s found no effect on mood or psychological well-being.

    Preventing Cancer

    A recent observational study on ginseng and cancer prevention has been widely publicized, but a close look at the data arouses some suspicions. This study was performed in South Korea and followed a total of 4,587 men and women aged 39 years and older from 1987 to 1991. People who regularly consumed Panax ginseng were compared with otherwise similar individuals (matched in sex, age, alcohol use, smoking, and education and economic status) who did not.

    The reported results were impressive. Those who used ginseng showed a 60% decrease in risk of death from cancer. Lung cancer and gastric cancer were particularly reduced. The more ginseng consumed, the greater the effect.

    However, there is something a bit fishy about this study. Use of ginseng less than three times per year caused a 54% reduction in risk. It seems difficult to believe that so occasional a use of ginseng could reduce cancer mortality by more than half!

    Menopause

    A double-blind placebo-controlled study of 384 postmenopausal women found no significant benefit and no evidence of hormonal effects.

    Dosage

    The typical recommended daily dosage of Panax ginseng is 1 to 2 g of raw herb, or 200 mg daily of an extract standardized to contain 4 to 7% ginsenosides. In one study of American ginseng (Panax quinquefolius) for diabetes, the dose used was 3 g. Eleutherococcus is taken at a dosage of 2 to 3 g whole herb or 300 to 400 mg of extract daily.

    Ordinarily, a 2- to 3-week period of using ginseng is recommended, followed by a 1- to 2-week "rest" period. Russian tradition suggests that ginseng should not be used by those under 40.

    Finally, because Panax ginseng is so expensive, some products actually contain very little of it. Adulteration of ginseng supplements with other herbs and even caffeine is not unusual.

    Safety Issues

    The various forms of ginseng appear to be nontoxic, both in the short and long term, according to the results of studies in mice, rats, chickens, and dwarf pigs. Ginseng also does not seem to be carcinogenic.

    Side effects are rare.
    Occasionally women report menstrual abnormalities and/or breast tenderness when they take ginseng. However, a large double-blind trial found no estrogen-like effects.Another double-blind trial found no effects on estrogen or testosterone.

    Unconfirmed reports suggest that highly excessive doses of ginseng can cause insomnia, raise blood pressure, increase heart rate, and possibly cause other significant effects. Whether some of these cases were actually caused by caffeine mixed in with ginseng remains unclear. Ginseng allergy can also occur, as can allergy to any other substance.

    In 1979, an article was published in the Journal of the American Medical Association claiming that people can become addicted to ginseng and develop blood pressure elevation, nervousness, sleeplessness, diarrhea, and hypersexuality. This report has since been thoroughly discredited and should no longer be taken seriously However, there is some evidence that ginseng can interfere with drug metabolism, specifically drugs processed by an enzyme called "CYP 3A4." Ask your physician or pharmacist whether you are taking any medications of this type. There have also been specific reports of ginseng interacting with MAO inhibitor drugs and also with a test for digitalis, although again it is not clear whether it was the ginseng or a contaminant that caused the problem. There has also been one report of ginseng reducing the anticoagulant effects of Coumadin (warfarin).

    Safety in young children, pregnant or nursing women, or people with severe liver or kidney disease has not been established. Interestingly, Chinese tradition suggests that ginseng should not be used by pregnant or nursing mothers.

    Interactions You Should Know About

    If you are taking

  • Drugs processed by an enzyme called "CYP 3A4": Ginseng might interfere. Ask your physician or pharmacist whether you are taking any medications of this type.
  • MAO inhibitor drugs or digitalis: It is possible that ginseng might cause problems.
  • Insulin or oral hypoglycemics: Ginseng may reduce your dosage need.
  • Coumadin (warfarin): Ginseng might decrease its effect.
  • Influenza vaccine: Ginseng might help it work better.


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