Should I take ginger to help manage nausea during chemotherapy? Part 1

Key messages:

·       Ginger is reasonably safe with the main side effect being increased risk of reflux

·       Greater than 3 days of ginger supplementation may help prevent or decrease nausea and vomiting

·       It is unclear what the best dose is but 1-1.2 g of standardized ginger a day appears promising

·       We are currently conducting the SPICE trial with Cancer Council-Queensland support to help address these research gaps

·       Always discuss with your healthcare team before starting a supplement during treatment for cancer

I first became interested in the topic of ginger for people with cancer receiving chemotherapy over 10 years ago. Nurses and family would sometimes recommend ginger tea or ale to help with nausea but no one seemed clear on what products were best, how much, how often or if there were any side effects. I became curious (you will find this is a common theme in my research career!!) to see if ginger for the relief of nausea was just an old wife’s tale or if there was research evidence to support it.

Ginger has been used for thousands of years to help with nausea and even pain management. There is evidence to support its benefits for motion sickness, nausea associated with surgery and morning sickness. However, there are less studies demonstrating its benefits for nausea during chemotherapy. The existing studies weren’t always well designed and the results were conflicting1. There was enough evidence to raise my curiosity so together with Professor Sandie McCarthy https://unidirectory.auckland.ac.nz/profile/alexandra-mccarthy we attracted a promising research student, Wolf Marx to undertake a Phd on this topic. Wolf performed a nice pilot study in 51 people receiving chemotherapy. There were two groups; both groups continued their anti-nausea medication. One group was randomized to also take the ginger supplements and the other group took a placebo. Neither the patients nor their doctors knew which supplements they were taking. Those taking ginger had less fatigue and better quality of life in terms of nausea impacting how they could perform activities of daily living. It appears that particular compounds in ginger such as gingerols and shogaols block receptors in the gut which may trigger nausea.

I believe in a food first approach and encourage people to try and obtain nutrients from the diet rather than going straight to supplements. Ginger is low kilojoule and full of phytonutrients. Ginger can be incorporated in cooking, salads and in teas. Crystalised ginger and ginger beer (usually made by ginger companies not just flavoured ginger ale also appear to contain reasonable amounts of gingerols4. However, in terms of getting predictable and consistent results it appears that having standardized ginger supplements may be preferable. This is because the beneficial compounds of ginger vary by species, where it has been grown and how it has been processed so unless taken in a standardized supplement form it is very hard to predict how much of the beneficial components have been consumed4.

 The work from Wolf’s PhD has contributed towards successful Cancer Council Queensland funding for the SPICE study which is a study investigating the impact of ginger (in addition to standard anti-nausea medication) on chemotherapy-induced nausea and vomiting in a larger sample of people with cancer receiving chemotherapy.

Dr Marx is now doing a further research on nutraceuticals and fatigue with Professor Felice Jacka of  Deakin’s Food and Mood Centre (who are doing a lot of interesting work in the area of diet and mood -more details  https://foodandmoodcentre.com.au/about/meet-the-team/).

Another PhD student, Megan Crichton https://www.researchgate.net/profile/Megan_Crichton4 under the excellent supervision of Dr Skye Marshall https://research.bond.edu.au/en/persons/skye-marshall

has continued to build on our previous work in ginger, conducting a larger trial, exploring patient experiences with ginger and other complementary therapies during chemotherapy and how the microbiome is impacted during chemotherapy. We will be completing these studies in the next 2 years.

 So, we’ve discussed the potential benefits of ginger but are there any potential side effects? The most common side effect is ginger-tasting burping and increased reflux. It has been reported that ginger may affect platelet aggregation and that it is not suitable with in people with Thrombocytopenia but this is unclear from human trials3. None-the-less it is always important to discuss with your health care team before taking any supplements, especially during treatment as they best know your medical and treatment history and whether or not it would be advisable to do so.

This blog covers the overview of our research program involving ginger for patients receiving chemotherapy. The proposed mechanism of ginger and more detailed research studies will be discussed in Part 2 of this Blog. For other blogs or to request a blog topic please view https://www.lincnutrition.com.au/linc-blogvlog

References

1. Marx W et al., Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review. Nutrition Reviews. 2013; 71: 245-254.

2. Marx W et al., The effect of a standardized ginger extract on chemotherapy-induced nausea related quality of life in moderately or highly emetogenic chemotherapy: a double blind, randomized, placebo-controlled trial. Nutrients. 2017; 9, 867; doi:10.3390/nu9080867

3. Marx et al., The effect of ginger on platelet aggregation: a systematic literature review. Plos One. 2015; https://doi.org/10.1371/journal.pone.0141119

4. Marx W et al., Determination of the concentration of major active anti-emetic constituents within commercial ginger food products and dietary supplements. EJIM. 2017; 19-24