Sense and Nonsense of Dietary Supplements

Scientific evaluation of Cardiovascular health benefits of dietary supplements

Panax_Ginseng_Root_Extract

Panax Ginseng

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Ginseng is a well-known medical herb with a long list of acclaimed health benefits. Ginsenosides, known as ginseng saponins, are the major components of ginseng. Ginseng also contains several valuable nonsaponin components, including essential oils, antioxidants, polyacetylenic alcohols, peptides, amino acids, polysaccharides, and vitamins. A very elaborate overview of ginseng’s medical applications is given by Jae Joon Wee et al. ( 1 ).

One of the most important health effects is protection of neurons, which leads to improved learning and memory and prevention of Alzheimer’s disease. However these effects have not yet been confirmed in human trials. In case-control studies, the chance of cancer of the lip, oral cavity and pharynx, larynx, lung, oesophagus, stomach, liver, pancreas, ovary, and colorectum were significantly reduced after using ginseng supplements ( 2, 3 ). In addition ginseng has been suggested to be effective in improving psychomotor function, cognitive functioning ( 4, 5 ), erectile function ( 6 ), and pulmonary disease ( 7 ). The following in depth information will be limited to ginseng’s acclaimed health benefits for cardiovascular disease prevention.


Vasodilation (relaxing of the vessel wall), ischemic heart disease and angina pectoris (heart related chest pain)

 

Ginseng-based medicines and nitrates are commonly used in treating ischemic heart disease (IHD) and angina pectoris in China. Hundreds of randomized controlled trials reported in Chinese language claimed that ginseng-based medicines can relieve the symptoms of IHD by vasodilation of the coronary arteries. A systematic review containing eighteen randomized placebo controlled trials with 1549 participants investigating ginseng versus nitrates in treating IHD, demonstrated evidence that ginseng is more effective than nitrates for treating angina pectoris ( 8 ). These are highly promising results as nitrates are an accepted treatment in western countries for angina pectoris. This effect is attributed to the vasodilator function of ginseng, which has been shown in several animal studies and two small clinical trials ( 9, 10 ). The vasodilator function might also help to reduce blood pressure, but very limited evidence is available and seemingly high doses of ginseng are needed ( 9, 11, 12 ).


Antioxidant, reduction of oxidized LDL and anti-inflammation

 

A very recent  randomized controlled trial to the antioxidant activity of ginseng showed strong antioxidant effects in humans ( 13 ). Plasma superoxide dismutase (SOD), plasma glutathione peroxidase (GPx) and catalase activity were significantly higher after 8-week ginseng treatment. Furthermore, the DNA tail length and tail moment, both measures for DNA damage by oxidative stress were significantly reduced. More importantly, plasma levels of oxidized LDL, a major constituent to cardiovascular disease development, were reduced as well. Unfortunately study duration was short and sample size limited, making it hard to translate the study outcome to the general population.

The anti-inflammatory effects of Ginseng appear to be limited to men. A recent epidemiological study in 9,947 subjects showed that taking ginseng supplements is associated with a reduction of the inflammation risk marker for cardiovascular disease HS-CRP by 16% in men. While ginseng supplements had no effect in women ( 14 ). It is interesting to note that in a large 18 year long cohort study of 6282 subjects, Yi et al. reported an inverse association between ginseng use and total mortality, an association which was similarly limited to men ( 15 ).


Diabetes

 

Several human randomized controlled clinical trials investigating the effect of red ginseng on type 2 diabetes have been performed but remain inconclusive ( 16 ). Clinical studies with small sample sizes (10-16 patients) have reported that American ginseng lowers postprandial blood glucose in diabetic and non-diabetic patients ( 17, 18 ). Animal studies clearly show protective effects of ginseng and its components against insulin resistance and diabetes. However, confirmation in human trials is lacking ( 16 ). Therefore, more studies are required to confirm that ginseng administration decreases the dietary glycaemic index and is preventive of insulin resistance.


Cholesterol

 

A recent study in postmenopausal women showed significant improvements (Kupperman index and menopause rating scale) and reduction of total cholesterol and LDL after taking American Red Ginseng ( 19 ). To achieve these effects a large dose of 3 grams per day had to be taken. Notably, no changes in cholesterol or triglycerides were detected in a study in hypertensive patients that consumed the same dose of Korean Red Ginseng ( 12 ).

Conclusion

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Ginseng supplements can be recommended as vasodilator. This function can help to reduce heart related chest pain (Angina Pectoris) and might be beneficial for people with starting peripheral artery disease or high blood pressure.

 

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In addition, the antioxidant function and its effect on reducing the amount of oxidized LDL in the blood are very promising. Also the reported protective effects against cancer might warrant taking ginseng supplements. Unfortunately evidence for these health benefits remains limited and it is too early to definitely recommend ginseng supplements ( 20 ). 

The scientific evidence that is available, is convincing and promising. Since no side effects have been reported taking ginseng supplements can be supported from a scientific point of view.

Accepted EFSA Claims

  • No health claims have been authorized by the European Food Safety Authorisation
Names: Panax Ginseng, CA Meyer, Red Ginseng
Diseases:     Cardiovascular disease, cancer, angina pectoris, ischemic heart disease, peripheral artery disease, high blood pressure, diabetes 

Reference List

  1. Wee JJ et al. , in Herbal Medicine: Biomolecular and Clinical Aspects, IFF Benzie, S Wachtel-Galor, Eds. (Boca Raton (FL), 2011).
  2. Yun TK, Experimental and epidemiological evidence on non-organ specific cancer preventive effect of Korean ginseng and identification of active compounds. Mutation research 523-524 , 63-74 (Feb-Mar, 2003).
  3. Yun TK, Panax ginseng--a non-organ-specific cancer preventive? The lancet oncology 2 , 49-55 (Jan, 2001).
  4. Geng J et al. , Ginseng for cognition. Cochrane database of systematic reviews , CD007769 (2010).
  5. Lee MS et al. , Ginseng for cognitive function in Alzheimer's disease: a systematic review. Journal of Alzheimer's disease : JAD 18 , 339-44 (2009).
  6. Jang DJ et al. , Red ginseng for treating erectile dysfunction: a systematic review. British journal of clinical pharmacology 66 , 444-50 (Oct, 2008).
  7. An X et al. , Oral ginseng formulae for stable chronic obstructive pulmonary disease: a systematic review. Respiratory medicine 105 , 165-76 (Feb, 2011).
  8. Jia Y et al. , Could ginseng-based medicines be better than nitrates in treating ischemic heart disease? A systematic review and meta-analysis of randomized controlled trials. Complementary therapies in medicine 20 , 155-66 (Jun, 2012).
  9. Sung J et al. , Effects of red ginseng upon vascular endothelial function in patients with essential hypertension. The American journal of Chinese medicine 28 , 205-16 (2000).
  10. Jovanovski E et al. , Effects of Korean red ginseng (Panax ginseng C.A. Mayer) and its isolated ginsenosides and polysaccharides on arterial stiffness in healthy individuals. American journal of hypertension 23 , 469-72 (May, 2010).
  11. Han KH et al. , Effect of red ginseng on blood pressure in patients with essential hypertension and white coat hypertension. The American journal of Chinese medicine 26 , 199-209 (1998).
  12. Rhee MY et al. , Effect of Korean red ginseng on arterial stiffness in subjects with hypertension. Journal of alternative and complementary medicine 17 , 45-9 (Jan, 2011).
  13. Kim JY et al. , Beneficial effects of Korean red ginseng on lymphocyte DNA damage, antioxidant enzyme activity, and LDL oxidation in healthy participants: a randomized, double-blind, placebo-controlled trial. Nutrition journal 11 , 47 (2012).
  14. Kantor ED et al. , Association between use of specialty dietary supplements and C-reactive protein concentrations. American journal of epidemiology 176 , 1002-13 (Dec 1, 2012).
  15. Yi SW et al. , Association between ginseng intake and mortality: Kangwha cohort study. Journal of alternative and complementary medicine 15 , 921-8 (Aug, 2009).
  16. Kim S et al. , Red ginseng for type 2 diabetes mellitus: a systematic review of randomized controlled trials. Chinese journal of integrative medicine 17 , 937-44 (Dec, 2011).
  17. Vuksan V et al. , American ginseng (Panax quinquefolius L.) attenuates postprandial glycemia in a time-dependent but not dose-dependent manner in healthy individuals. The American journal of clinical nutrition 73 , 753-8 (Apr, 2001).
  18. Vuksan V et al. , American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Archives of internal medicine 160 , 1009-13 (Apr 10, 2000).
  19. Kim SY et al. , Effects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women: a double-blind randomized controlled trial. Menopause 19 , 461-6 (Apr, 2012).
  20. Karmazyn M et al. , Therapeutic potential of ginseng in the management of cardiovascular disorders. Drugs 71 , 1989-2008 (Oct 22, 2011).

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