Each review contains information about the ingredient’s clinical applications, formulations, dosing & administration, adverse effects, and pharmacokinetics. Learn more about our critical appraisal research or contact us for initial guidance and more information.

Ginger (Zingiber officinale)

Zingiber officinale, or ginger, is a well-known herb that is used globally for it’s flavor and remedial health effects. It has been used traditionally for thousands of years in India and China and for more than 1,000 years in Europe. (136)

Containing more than 400 biological constituents, ginger has a broad spectrum of pharmacological effects including as an anti-emetic, anti-inflammatory, anti-microbial, anti-lipidemic, anti-hyperglycemic, anti-tumorigenic, anti-oxidant, and immunomodulator. (4)(8)(120)(136)

The primary constituents contributing to ginger’s wide array of biological activities, as well as its pungent aroma and flavor, are 6-gingerol and 6-shogaol. (84)(145) Gingerols are isolated from the plant’s rhizomes, whereas shogaols are produced when the rhizomes are heated or dehydrated. (145)

An exponential increase in the number of published trials was seen from 2000 to 2010, including a large number of systematic reviews and meta-analyses from 2008 onwards, indicating an increasing interest in ginger’s therapeutic benefits. (8)(91)

Main uses

Analgesic
Antiemetic for chemotherapy, pregnancy, or surgery
Anti-inflammatory and antioxidant
Cardiometabolic and anti-diabetic
Gastric motility
Menstrual regulation

Formulations

Formulation	Comparison
Foods/tea	Measures generally equivalent to 1,000 mg of dried ginger powder: One teaspoon of fresh grated raw rhizome; Two one-inch by ¼-inch pieces of crystalized ginger; Four cups (eight oz/cup) of commercial ginger tea or 1/2 teaspoon of grated ginger steeped for 5-10 minutes (26)
Ginger powders, capsules, or tablets	May contain raw rhizome powder or standardized extracts; Many standardized extracts range between 1-5% gingerol/shogaols, though some containing 20-25% may be found. Examples of standardized extract formulations found in research include: Eurovita extract 33 (EV.EXT 33): An ethanolic standardized extract containing 1.9% by weight of 6-, 8-, and 10-gingerol (166) Eurovita extract 35 (EV.EXT 35): A 12-20:1 standardized extract equivalent to 1,500-2,000 mg of dry ginger (37)(168) Eurovita extract 77 (EV.EXT 77): A mixture of extracts from ginger and Alpina galanga (blue ginger) standardized to contain >30 mg hydroxymethoxyphenyl compounds and acetoxychavicol acetate in 255 mg of mixed extract (52) Zintoma®: Dry root powder formulated as a 10:1 ethanolic (50%) extract standardized to contain 5.38 mg (2.15%) 6-gingerol, 1.8 mg (0.72%) 8-gingerol, 4.19 mg (1.78%) 10-gingerol, and 0.92 mg (0.37%) 6-shogaol (139) Zintona EC: Enteric-coated standardized extract containing 10 mg of 6-gingerol per 250 mg capsule (167)
Liquid extracts	Measures generally equivalent to 1,000 mg of dried ginger powder: Two droppers (two mL) of liquid extract (26)

Dosing & administration

Analgesia and recovery from exercise
General outcomes from A-level evidence	↓ muscular pain due to exercise and the exercise-induced inflammatory response (169) Note: Studies are limited to acute bouts of exercise, whereas little is known on the analgesic or recovery effects with chronic exercise (169)
Dosing & administration	2,000 mg per day for a minimum of five days starting before and continuing after an exercise bout
Outcomes	↓ muscular pain induced by eccentric resistance exercise and prolonged running (169)
Class of evidence	A
Dosing & administration	2,000 mg (as encapsulated raw or heated powder) per day for 11 days during eccentric exercise engagement to healthy participants
Outcomes	↓ in muscular pain (23-25%) 24 hours after exercise, compared with placebo (20)
Class of evidence	B
Dosing & administration	2,000 mg (as standardized extract with 4.3% gingerol) 24 and 48 hours post-eccentric exercise to healthy participants
Outcomes	↓ in muscular pain (13%) 48 hours post-exercise, while placebo group pain ratings did not change (21)
Class of evidence	C
Dosing & administration	4,000 mg (as encapsulated powder) per day for five days prior to resistance training exercise in untrained adults
Outcomes	↓ time to recover muscular strength (improved strength at 48 hours post-exercise), compared with placebo (104)
Class of evidence	C

Asthma
General outcomes from A-level evidence	No data currently available.
Dosing & administration	20 drops (as liquid extract containing 120 mg of ginger rhizome) every eight hours for two months to Px with asthma
Outcomes	↓ rate of wheezing, chest tightness, nocturnal cough, & need for concomitant asthmatic spray (55)
Class of evidence	B

Cardiometabolic profile and weight
General outcomes from A-level evidence	↓ total cholesterol (~12-18 mg/dl), LDL-C (~4.0-11.0 mg/dl), triglycerides (~15.0-38.0 mg/dl), fasting blood glucose (~25.2 mg/dl), HbA1C (~1.0%), (45)(106)(135) SBP (6.36 mmHg) & DBP (2.12 mmHg) (56) ↑ HDL-C (~44.8 mg/dl) (106) Note: some analyses show no effect observed on HDL-C; (45)(135) ginger’s weight lowering effects may be attributable to increased thermogenesis, lipolysis, suppression of lipogenesis, reduced fat absorption, and improved appetite control (39)
Dosing & administration	Up to 2,000 mg per day to adults
Outcomes	↓ total cholesterol (~12.26 mg/dl) & triacylglycerides (~38.42 mg/dl) Note: LDL-C may be reduced (~4.90 mg/dl), but no effect of dose observed (135)
Class of evidence	A
Dosing & administration	3,000 mg per day for up to eight weeks in adults younger than the age of 50 with type II diabetes, hyperlipidemia, or who are overweight
Outcomes	↓ SBP (6.36 mmHg) & DBP (2.12 mmHg) Note: greater reductions in SBP and DBP observed particularly in adults younger than 50 who use more than 3,000 g per day or in individuals supplementing for less than eight weeks (56)
Class of evidence	A
Dosing & administration	2,000-3,000 mg (as powder tablets) or 200 mg (as standardized ethanolic ginger extract containing 2.35-3.53 mg of 6-shogaol) per day for 12 weeks to healthy overweight or obese women
Outcomes	↓ appetite score, body mass index, body weight, waist circumference, hip circumference, waist:hip ratio, fat mass (arm), serum TGs, serum insulin, & insulin resistance, SBP, & DBP compared to placebo (38)(40)(119)(130)
Class of evidence	B
Dosing & administration	1,000 mg (as encapsulated powder) per day for ten weeks to Px on peritoneal dialysis
Outcomes	↓ serum TGs by 15% & glucose by 20% compared to placebo (62)(156)
Class of evidence	C
Dosing & administration	1,000 mg (as encapsulated powder) three times per day for 45 days to Px with hyperlipidemia
Outcomes	↓ TGs and total cholesterol compared to placebo (5)
Class of evidence	C
Dosing & administration	750 mg (as encapsulated powder) four times per day for six weeks to obese women with breast neoplasms
Outcomes	↓ IL-10 and hs-CRP compared with placebo and insulin, glucose, insulin resistance, LDL-C, & TGs when combined with exercise ↑ HDL-C & HDL-C:LDL-C ratio when combined with exercise (72)
Class of evidence	C

Cognitive function
General outcomes from A-level evidence	No data currently available.
Dosing & administration	400-800 mg (as standardized ethanolic extract containing 7.33% 6-gingerol and 1.34% 5-shogaol) per day for two months to healthy middle-aged women
Outcomes	Improved cognitive scores in domains including power, continuity, and accuracy of attention, & speed and quality of working memory (142)
Class of evidence	B

Dysmenorrhea and heavy menstrual bleeding
General outcomes from A-level evidence	↓ pain severity (visual analogue scale scores) compared to placebo (29)(33)(171) Note: may provide similar efficacy to NSAIDs (29)
Dosing & administration	750-2000 mg per day for the first 3-4 days of the menstrual cycle adolescent and young women with primary dysmenorrhea
Outcomes	↓ pain severity (visual analogue scale scores) compared to placebo Effects on pain severity was equivalent with NSAIDs (29)(33)
Class of evidence	A
Dosing & administration	250-500 mg (as encapsulated ginger powder) three times per day starting two days before and/or throughout the first three days for 1-2 cycles of the menstrual period to Px with dysmenorrhea
Outcomes	↓ severity and duration of pain compared with placebo ↑ likelihood of improved nausea compared with placebo (65)(75)(138)
Class of evidence	B
Dosing & administration	250-300 mg (as encapsulated ginger powder) three times per day starting the day before and throughout the first 3-7 days of the menstrual period for 2-3 cycles to adolescents or adults with heavy menstrual bleeding
Outcomes	↓ duration of menstruation & level of blood loss compared with placebo ↑ menorrhagia questionnaire QoL score compared with placebo (44)(74)
Class of evidence	B
Dosing & administration	250 mg (as Zintoma®) or 200 mg (as encapsulated ginger powder) four times per day for 2-3 days at the start of the menstrual period for two cycles to Px with primary dysmenorrhea
Outcomes	↓ pain severity equivalently to NSAIDS including Novafen, mefenamic acid, or ibuprofen (2)(124)(149)
Class of evidence	C

Dysphagia
General outcomes from A-level evidence	No data currently available.
Dosing & administration	200 mg (as dissolving tablets with 2-10 mg of ginger powder) to older adults with dysphagia or healthy adults
Outcomes	↑ salivary substance P & swallowing function score (1)(59)
Class of evidence	C

Galactagogue
General outcomes from A-level evidence	No data currently available.
Dosing & administration	500 mg (as encapsulated ginger) twice per day starting two hours after delivery for seven days post-partum to healthy mothers
Outcomes	↑ volume of produced breast milk within first three days of use (129)
Class of evidence	B
Dosing & administration	1,000-1,200 mg (as encapsulated ginger powder or powder in liquid suspension) single administration to healthy adults or Px with functional dyspepsia
Outcomes	↑ gastric emptying speed and antral contractions, & relaxes lower esophageal sphincter (contraction velocity) compared with placebo (60)(95)(170)
Class of evidence	B
Dosing & administration	1,000 mg (as encapsulated ginger powder) single administration to healthy adults in states of hyperglycemia
Outcomes	Prevents gastric dysrhythmias induced by hyperglycemia compared with placebo (49)
Class of evidence	C
Dosing & administration	120 mg (as ginger extract) added to enteral feeding three times per day to hospitalized Px with respiratory distress syndrome
Outcomes	↓ delayed-gastric emptying, reducing the need for transpyloric feeding & ventilation, possibly reducing associated nosocomial pneumonia compared with placebo (146)
Class of evidence	C

Inflammation and oxidative stress
General outcomes from A-level evidence	↓ serum CRP, hs-CRP, TNF-ɑ, IL-6, prostaglandin E2 (trend), & malondialdehyde across broad populations (64)(106)(109) Note: No effect on serum IL-6 or soluble intercellular adhesion molecule has also been noted (109)
Dosing & administration	1,000-3,000 mg per day for 2-3 months in Px with a variety of health statuses
Outcomes	↓ serum CRP (especially with 2,000-3000 mg/day), TNF-ɑ (especially with 1,000-2000 mg/day), IL-6, prostaglandin E2 (trend), & malondialdehyde ↑ total anti-oxidative capacity (especially with > 1,500 mg per day) (64)
Class of evidence	A
Dosing & administration	1,000 mg (as ginger extract standardized to 5% total gingerols) twice per day for four weeks to Px at increased risk for colorectal cancer
Outcomes	↓ colonic COX-1 expression & free arachidonic acid levels ↑ leukotriene B4 (68)(177)
Class of evidence	B
Dosing & administration	1,000 mg (as encapsulated ginger powder extract standardized to 5% total gingerols) twice per day for four weeks to healthy adults
Outcomes	↓ colonic PGE2 and 5-HETE inflammatory eicosanoids (178)
Class of evidence	C
Dosing & administration	750 mg (as encapsulated ginger powder) four times per day for six weeks to Px with breast cancer
Outcomes	↑ glutathione peroxidase (GPx) by ~14% when given alone, or GPx by ~30%, NO ~15%, & adiponectin by ~17% when given with an exercise intervention ↓ MDA by ~23% when given with an exercise intervention (73)
Class of evidence	C
Dosing & administration	250 mg (as Zintoma®) four times per day for ten weeks to obese men
Outcomes	↓ CRP (16)
Class of evidence	C
Dosing & administration	120 mg (as ginger extract provided during high-protein enteral feeding) three times per day for three weeks to Px with acute respiratory distress syndrome
Outcomes	↓ IL-1, IL-6, TNF-ɑ, duration of required mechanical ventilation, & length of ICU stay ↑ red blood cell glutathione & oxygenation (162)
Class of evidence	C
Dosing & administration	10 mg of 6-gingerol (standardized to 1.4% by weight from encapsulated ginger extract) twice per day starting three days before initiation of chemotherapy to the end of the fourth chemotherapy cycle to Px with cancer
Outcomes	↑ superoxide dismutase (SOD) and catalase (CAT) activity, & levels of glutathione peroxidase (GPx) and total glutathione (GSH/GSSG) ↓ malondialdehyde (MDA) and NO2−/NO3− lipid peroxidation products compared with placebo (34)
Class of evidence	C

Migraines
General outcomes from A-level evidence	No data currently available.
Dosing & administration	400 mg (as encapsulated ginger extract standardized to 5% gingerols) plus 100 mg of ketoprofen at the onset of headache to Px with episodic migraines with or without aura
Outcomes	↑ likelihood of clinical response, improvement in pain intensity, & functional capacity in 1-2 hours post-administration compared with ketoprofen alone (100)
Class of evidence	B
Dosing & administration	250 mg (as encapsulated ginger powder) at the onset of headache to Px with migraine without aura
Outcomes	↓ migraine severity to a similar extent to sumatriptan with fewer adverse effects (96)
Class of evidence	C

Motion sickness
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,000-2,000 mg (as encapsulated ginger powder) single administration to adults reporting seasickness or about to undergo activity that may cause motion sickness
Outcomes	↓ vomiting, cold-sweats, vertigo, nausea, nausea onset, nausea recovery time, tachygastria, & plasma vasopressin compared with placebo (50)(51)(94)(110)
Class of evidence	B

Nausea, vomiting, and fatigue related to chemotherapy
General outcomes from A-level evidence	↓ odds of acute vomiting by 42-60%, (28)(31) acute vomiting and nausea by 40%, and combined vomiting and/or nausea by 29% overall (28) ↓ severity of acute nausea in breast cancer therapy, (144) & odds of chemotherapy-induced fatigue by 80% (31) Note: There is also mixed, inconsistent, or lack of support for the use of ginger in chemotherapy-related nausea and vomiting, (101) including for the likelihood of overall or delayed vomiting, the likelihood or reduced severity of acute nausea, (28)(31)(88) & the incidence of nausea and incidence or frequency of vomiting in breast cancer Px (144)
Dosing & administration	Up to 1,000 mg per day for > three days in Px with cancer undergoing chemotherapy
Outcomes	↓ odds of acute chemotherapy-induced vomiting by 60% & fatigue by 80% (31)
Class of evidence	A
Dosing & administration	250-500 mg (as encapsulated liquid ginger extract with 8.5 mg gingerols, shogoal, zingerone) twice per day three days prior to and after the first day of chemotherapy to Px with cancer using a 5-HT3 receptor antagonist antiemetic
Outcomes	↓ severity of acute nausea on day one of chemotherapy & anticipatory nausea compared with 5-HT3 receptor antagonist antiemetic plus placebo (140)
Class of evidence	B
Dosing & administration	250-300 mg (as ginger extract standardized to 5% gingerols or Zintoma ®) four times per day starting three days before chemotherapy until 3-4 days post-chemotherapy for three cycles to Px with various cancers using routine antiemetic therapy
Outcomes	↑ QoL scores in nausea, nausea and vomiting, & global scores within the first cycle compared with routine therapy plus placebo ↓ incidence of fatigue & anticipatory, acute, and delayed vomiting within first cycle compared with routine therapy plus placebo (102)(172)
Class of evidence	B
Dosing & administration	80 mg (as encapsulated standardized ginger extract with 32 mg gingerols and 2.24 mg shogoals) twice per day for two chemotherapy cycles (approx. two months) to Px with cancer using routine antiemetic therapy
Outcomes	Improved Functional Living Index Emesis nausea score only in females and patients with head and neck cancer compared with routine therapy plus placebo (25)
Class of evidence	B
Dosing & administration	10 mg of 6-gingerol (standardized to 1.4% by weight from encapsulated ginger extract) twice per day starting three days before initiation of the chemotherapy and for 12 weeks after to Px with solid tumors using routine antiemetic therapy
Outcomes	↑ chemotherapy completion rate, appetite score, & QoL score compared with routine therapy plus placebo ↓ incidence of grade 3 fatigue compared with routine therapy plus placebo (83)
Class of evidence	B
Dosing & administration	500 mg (as encapsulated ginger powder) 2-4 times per day starting up to five days prior to and up to five days after chemotherapy to Px with cancer using routine antiemetic therapy
Outcomes	↓ acute nausea severity compared with routine therapy plus placebo or routine therapy alone, frequency of vomiting and nausea episodes compared with routine therapy alone, & incidence of nausea within the first 6-24 hours post-chemotherapy compared with routine therapy alone (13)(127)(143)(161)
Class of evidence	C
Dosing & administration	~340-800 mg (as encapsulated ginger powder and adjusted for body weight), in addition to routine antiemetic therapy, one hour before the start of chemotherapy and at three and eight hours after chemotherapy to children and young adults with bone sarcoma
Outcomes	↓ incidence of acute moderate-severe nausea and vomiting, & delayed moderate-severe nausea and vomiting compared with routine therapy plus placebo (132)
Class of evidence	C
Dosing & administration	1,000 mg (as encapsulated ginger powder) 20 minutes prior to chemotherapy and six hours post-chemotherapy to Px with cancer using low dose cyclophosphamide and drugs causing mild emesis
Outcomes	↓ incidence of nausea and vomiting to a similar extent to metoclopramide therapy but less efficacious than ondansetron (152)
Class of evidence	C

Nausea, vomiting, and pain related to surgery (post-operative)
General outcomes from A-level evidence	↓ relative risk of post-operative vomiting and nausea by 31%, post-operative vomiting alone by 39-63%, (27) post-operative nausea alone by 31%, (12) need for rescue antiemetic medications, (58) and post-operative pain severity (measured by visual analogue scale) (160) Note: The risk of post-operative vomiting and nausea and other antiemetic drug requirement by patients was not reduced with doses at or below 1,000 mg or higher than 1,500 mg (4 3)(58)(160)
Dosing & administration	1,000-1,500 mg one hour prior to anesthetic induction to Px undergoing laparoscopic or gynecological surgeries
Outcomes	↓ relative risk of post-operative vomiting and nausea by 31%, post-operative vomiting by 39%, & need for rescue medication (27)(58)
Class of evidence	A
Dosing & administration	1,000-1,500 mg (as encapsulated ginger powder) one hour before gynecological laparoscopy or major gynecological surgery
Outcomes	↓ incidence of nausea & severity of nausea within 4-6 hours & vomiting within six hours post-operation compared with placebo Similar effectiveness to reduce nausea and vomiting incidence with metoclopramide, but ginger further lowers the likelihood of requiring post-operative antiemetics (9)(23)(118)(131)(133)
Class of evidence	B
Dosing & administration	1,000 mg (as encapsulated ginger powder) 30 minutes prior to anesthesia induction for cesarean section and two hours post-surgery, with option to continue with 1,000 mg three times per day post-cesarean section for three days
Outcomes	↓ nausea and vomiting episodes during surgery with preoperative dosing, & abdominal distention when used daily post-cesarean section (70)(158)
Class of evidence	B
Dosing & administration	1,000 mg (as encapsulated ginger) combined with ondansetron one hour prior to ambulatory surgery
Outcomes	↓ post-operative nausea and vomiting frequency & severity within 1 to 12 hour time frame compared with ondansetron plus placebo (99)
Class of evidence	B
Dosing & administration	1,250 mg (as Zintoma®) one hour prior to laparoscopic cholecystectomy surgery
Outcomes	↓ post-operative nausea and vomiting severity, vomiting severity and frequency alone, nausea severity alone, & need for additional post-operative antiemetics (3)
Class of evidence	C
Dosing & administration	250 mg (as Zintoma®) per day for ten days prior to coronary angioplasty
Outcomes	↓ post-operative chest pain (57)
Class of evidence	C
Dosing & administration	500 mg (as encapsulated ginger) twice per day for ten days post-tonsillectomy in addition to routine antibiotics and acetaminophen
Outcomes	↓ pain within one day & rate of tonsil wound healing by day seven compared with control (82)
Class of evidence	C
Dosing & administration	1,000 mg before and after anesthesia prior to abdominal hysterectomy
Outcomes	↓ vomiting scores and nausea within first two hours post-surgery compared to dexmedetomidine (71)
Class of evidence	C

Nausea and vomiting related to antiretroviral medications
General outcomes from A-level evidence	No data currently available.
Dosing & administration	500 mg (as encapsulated powder) twice per day, 30 minutes before administration of antiretroviral dose for two weeks to Px with HIV
Outcomes	↓ frequency of mild to severe nausea and frequency of vomiting compared with placebo (32)
Class of evidence	B

Nausea and vomiting related to pregnancy
General outcomes from A-level evidence	↓ mild-moderate nausea (163) and vomiting (46)(107)(122)(126)(157) with similar efficacy to vitamin B6, (24)(36) however evidence is also noted to be inconsistent (105) Note: Ginger may be associated with improved control of vomiting with fewer adverse events compared with other therapies including acupuncture, chamomile, dimenhydrinate, doxylamine/vitamin B6, quince, & metoclopramide, as assessed by a network meta-analysis (153)
Dosing & administration	1000 mg per day (250 mg every four hours) for four days minimum to women experiencing nausea and vomiting in early pregnancy
Outcomes	↓ severity of nausea and vomiting frequency, with five-fold higher chance of improvement compared with placebo (36)(126)(155)(157)
Class of evidence	A
Dosing & administration	500-650 mg (as encapsulated ginger powder) 2-3 times per day or 250 mg 3-4 times per day (as encapsulated ginger powder or Zintoma®) for 3-4 days to pregnant women experiencing nausea or vomiting
Outcomes	↓ severity of nausea and frequency of vomiting with equal or greater extent than 30-80 mg of vitamin B6 per day & greater effectiveness than placebo or control (30)(42)(47)(54)(125)(141)(147)(154)(164)
Class of evidence	B
Dosing & administration	125 mg (as EV.EXT35) four times per day for four days to pregnant women experiencing daily morning sickness
Outcomes	↓ nausea within the first day & retching for the first two days compared with placebo (168)
Class of evidence	B
Dosing & administration	150-350 mg (as encapsulated ginger powder or ginger extract tablets) three times per day for three weeks to pregnant women experiencing nausea or vomiting
Outcomes	↓ nausea, retching, & vomiting to a similar extent to vitamin B6 or B6-doxylamine over the whole duration of therapy (19)(151)
Class of evidence	C
Dosing & administration	250 mg (in one tbsp of ginger syrup) four times per day for two weeks to pregnant women experiencing nausea or vomiting
Outcomes	↓ likelihood of improved nausea and reduced vomiting by day six compared with placebo (76)
Class of evidence	C
Dosing & administration	200 mg (as ginger essence capsules) three times per day for five days to women experiencing nausea or vomiting
Outcomes	↓ nausea and vomiting compared with placebo, & with similar efficacy to metoclopramide (108)
Class of evidence	C
Dosing & administration	500 mg (as encapsulated ginger powder) twice per day for one week to pregnant women experiencing nausea or vomiting
Outcomes	↓ nausea score with similar efficacy and therapeutic speed compared with dimenhydrinate, & number of vomiting episodes with similar efficacy to dimenhydrinate by the third day Ginger had lower rate of adverse effects than dimenhydrinate (134)
Class of evidence	C
Dosing & administration	250 mg (as encapsulated ginger powder) four times per day for four days to women hospitalized with hyperemesis gravidarum
Outcomes	↓ nausea severity and vomiting frequency patients preferred treatment during ginger therapy compared with placebo (48)
Class of evidence	C

Nonalcoholic fatty liver disease (NAFLD)
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,000 mg (as encapsulated ginger) twice per day for 12 weeks to Px with NAFLD
Outcomes	↓ alanine aminotransferase (ALT), γ-glutamyl transferase (GGT), TNF-α, hs-CRP, hip circumference, insulin resistance, & hepatic steatosis grade (37)
Class of evidence	C

Osteoarthritis
General outcomes from A-level evidence	↓ pain severity & disability compared to placebo (11)(17) Note: Mixed findings have also been observed, where no effect was observed to improve knee function, or pain, though data has been considered to be insufficient (11)(35)(87)
Dosing & administration	500-1000 mg per day for 3-12 weeks to Px with osteoarthritis
Outcomes	↓ pain severity and disability compared with placebo (11)(17)
Class of evidence	A
Dosing & administration	500-750 mg (as encapsulated ginger powder) twice per day for three months to Px with knee osteoarthritis
Outcomes	↓ serum TNF-α & IL-1β compared with placebo
Class of evidence	B
Dosing & administration	~250 mg (as EV.EXT 77 or Zintoma ®) twice per day for six weeks to Px with knee osteoporosis
Outcomes	↓ likelihood and severity of knee pain & morning stiffness and difficulty compared with placebo Note: Use of VAS or WOMAC scores may yield conflicting pain results (6)(173)
Class of evidence	B
Dosing & administration	170 mg (as EV.EXT 33 standardized extract) three times per day for three weeks to Px with hip or knee osteoarthritis
Outcomes	↓ pain compared with placebo, but to a lesser extent than ibuprofen (22)
Class of evidence	B
Dosing & administration	500 mg (as tablets containing 30 mg of standardized extract) per day for four weeks to Px with hip or knee osteoarthritis
Outcomes	↓ pain to a similar extent to ibuprofen compared with placebo (53)
Class of evidence	B
Dosing & administration	250 mg (as Zintona EC) four times per day for 12 weeks to Px with knee osteoarthritis
Outcomes	↓ pain compared with placebo (167)
Class of evidence	C
Dosing & administration	340 mg (as EV.EXT 35 standardized extract) per day for four weeks to Px with knee or hip osteoarthritis using 1000 mg of glucosamine sulfate
Outcomes	↓ pain with similar efficacy to the glucosamine plus diclofenac group ↓ severity of dyspepsia compared to the glucosamine plus diclofenac group ↑ gastrin 17, PGE1, PGE2, PGF2ɑ, & PGI2 markers showing reduced inhibition of digestive function compared to the glucosamine plus diclofenac group (37)
Class of evidence	C
Dosing & administration	1,000 mg (as topical with 5% by weight standardized extract of ginger with ~11% of 6-gingerol in a nanostructured lipid carrier) applied three times per day for 12 weeks to Px with knee osteoarthritis
Outcomes	Improved pain, stiffness, physical function, and global assessment with similar efficacy to 1% diclofenac gel, but a higher percentage of Px with >50% improvement observed with ginger (7)
Class of evidence	C
Dosing & administration	5 ml (as ginger oil) self-massaged into the knee twice per week for five weeks in addition to standard treatment to Px with knee osteoarthritis
Outcomes	Improved both VAS pain and WOMAC function scores after one and five weeks compared to standard treatment alone (159)
Class of evidence	C

Premenstrual syndrome (PMS)
General outcomes from A-level evidence	No data currently available.
Dosing & administration	250 mg (as encapsulated ginger) twice per day starting one week before menstruation to three days after for three cycles to healthy women
Outcomes	↓ total PMS, mood symptoms, & physical symptoms severity scores during each cycle (78)
Class of evidence	B

Rheumatoid arthritis
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,500 mg (as encapsulated ginger powder) per day for 12 weeks to Px with rheumatoid arthritis
Outcomes	↓ disease activity score & T-bet and RORγt genes (which regulate T-cell and cytokine production) expression compared with placebo ↑ FoxP3 gene (which regulates T-cell and cytokine production) expression compared with placebo (14)
Class of evidence	B

Tuberculosis
General outcomes from A-level evidence	No data currently available.
Dosing & administration	500 mg (as Zintoma®) 30 minutes prior to each dose of anti-tuberculosis medication for four weeks to Px with tuberculosis
Outcomes	↓ incidence of anti-tuberculosis-related nausea (41)
Class of evidence	B
Dosing & administration	250 mg (as ginger extract, equal to 1,500 mg whole ginger) twice per day with anti-tuberculosis medication for one month to Px with tuberculosis
Outcomes	↓ TNF-ɑ, ferritin, & MDA compared with anti-tuberculosis medication and placebo (NUM)
Class of evidence	C

Type II diabetes
General outcomes from A-level evidence	↓ HbA1C (0.46-1.0%), (61) fasting blood glucose (15.93-21.24 mg/dl), fasting insulin (1.62 μIU/ml), insulin resistance, TGs (8.84-24.8 mg/dl), total cholesterol (4.42-8.22 mg/dl), & LDL-C (6.66 mg/dl) (63)(175) ↑ HDL-C (1.34-2.87 mg/dl) (63)(175) Note: Other evidence showed no effect on fasting blood sugar or BMI (61)(175)
Dosing & administration	800-1,000 mg (as encapsulated ginger powder or ginger tablets) twice per day for 10-12 weeks to adults with type II diabetes
Outcomes	↓ FBG, HbA1C, insulin, insulin resistance, TGs, total cholesterol, LDL-C, LDL-C:HDL-C ratio, hs-CRP, PGE2, apolipoprotein B, apolipoprotein B/apolipoprotein A-I, & MDA compared with placebo ↑ insulin sensitivity & apolipoprotein A-I; compared with placebo Note: Effects on biomarkers may vary between trials. (10)(77)(97)(98)
Class of evidence	B
Dosing & administration	3,000 mg (as encapsulated ginger powder) per day for 8-12 weeks to adults with type II diabetes
Outcomes	↓ FBG, HbA1C, insulin, insulin resistance, hs-CRP, & MDA compared with placebo ↑ insulin sensitivity, paraoxonase-1, & total anti-oxidative capacity compared with placebo (112)(148)
Class of evidence	B

Ulcerative colitis
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,000 mg (as encapsulated ginger powder) twice per day for 12 weeks to Px with ulcerative colitis
Outcomes	↓ disease severity score (Simple Clinical Colitis Activity Index Questionnaire) & MDA compared with placebo ↑ QoL score from baseline (121)
Class of evidence	C

Adverse effects

Ginger is generally recognized as safe (GRAS) by the United States Food and Drug Administration (FDA). (84) Doses up to 6,000 mg may be applied with a low risk of mild adverse effects. (18) Heartburn appears to be documented regularly across trials, with the frequency of reports ranging between 3% to 27%. (169) Low incidences of gastrointestinal distress, nausea, and diarrhea may be reported but the prevalence is generally no greater than in controls. (8)(33)(101)(120)(163)(169)

Some studies show a higher frequency of minor gastrointestinal adverse events compared to a placebo. (6)(17) Other reports include low rates of headache (2%), cardiovascular symptoms (3.5%), respiratory symptoms (3.4%), flu-like symptoms (1.7%), intense feelings of needing to urinate (25%), and bruising, flushing or rash, but rates are generally no higher than those observed in control groups. (8)(101)

Meta-analyses and systematic reviews show no greater risk of adverse effects from ginger during pregnancy to the mother or the future offspring. (155)(163) While ginger has been described to inhibit platelet aggregation in vitro, theoretically increasing the risk of bleeding, evidence for this effect in humans remains equivocal, even with concomitant blood-thinning medications such as warfarin. (65)(67)(103)

Pharmacokinetics

Absorption

Gingerols may be extensively glucuronidated in the stomach, intestine, and liver prior to absorption into the bloodstream, contributing to low bioavailability.
(115)
(165)
Free 6-, 8-, and 10-gingerol and 6-shogaol are not detectable in plasma post-oral ingestion between doses of 100 to 2,000 mg of a standardized extract (5% gingerols) in healthy Px. (176)
Glucuronide and sulfate conjugates are rapidly found in the blood, appearing within 30 minutes post-oral ingestion, with max concentrations achieved between 45 to 120 minutes using a standardized extract (5% gingerols) in healthy Px. (176)
6-Gingerol and 6-shogaol were detectable with 2,000 mg of a suspension of red ginger (Z. officinale var. Rubrum), with max concentrations reached within ~30 to 40 minutes in healthy Px. (90)

Distribution

Conjugated gingerol and shogaol are proposed to enter tissues where they are deconjugated back into their free forms to exert their pharmacological effects. (115)
Gingerol and shogaol are widely distributed across tissues but particularly in the stomach, intestine, liver, lung, and kidney, as shown in rats. (92)(115)
Various constituents may pass the blood-brain barrier via passive diffusion, including 6- and 8-gingerol, 6-shogaol, and zingerone. (92)(115)(150)

Metabolism

Gingerols and shogaols may be primarily eliminated via phase II glucuronide conjugation, as shown in rats. (114)
Free gingerol and shogaols are mainly metabolized to glucuronide conjugates at doses up to 2,000 mg of a standardized extract (5% gingerols), though one third of 6-gingerol may be sulfate conjugates at this dose in humans. (176)
In vitro studies show an inconsistent inhibitory effect on numerous metabolic cytochromes, possibly reflecting variance in the concentration of specific constituents found in ginger products. (86)
Many individual constituents may or may not individually inhibit numerous cytochromes, (79)(86)(93)(174) but ginger extracts containing a natural mixture of constituents have shown in vitro inhibitory activity of CYP3A4, CYP2C9, and CYP2C19. (80)(81)
However, in vitro concentrations required to inhibit these enzymes by 50% are typically 2-4 times higher than observed ginger phenolic plasma concentrations, indicating low likelihood of clinically relevant interactions. (113)

Excretion

Half-life of 6-, 8-, and 10-gingerol and 6-shogaol glucuronide and sulfate conjugates ranged between 1.25-2.0 hours at the 2,000 mg dose of a standardized extract (5% gingerols) in healthy Px. (176)
Half-life of 6-gingerol and 6-shogaol were 5.5 and 2.5 hours, respectively, with 2,000 mg of a suspension of red ginger (Z. officinale var. Rubrum) in healthy Px. (90)
Conjugates are typically non-detectable in plasma after four hours in humans. (176)
6-Gingerol and 6-shogaol are primarily excreted in the bile, but can also be detected in urine, as shown in rats. (15)(117)

Ginger (Zingiber officinale)

Main uses

Formulations

Dosing & administration

Adverse effects

Pharmacokinetics

Absorption

Distribution

Metabolism

Excretion

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