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      Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials

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          Abstract

          Clinical applications of ginger with an expectation of clinical benefits are receiving significant attention. This systematic review aims to provide a comprehensive discussion in terms of the clinical effects of ginger in all reported areas. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline, randomized controlled trials on the effects of ginger were investigated. Accordingly, 109 eligible papers were fully extracted in terms of study design, population characteristics, evaluation systems, adverse effects, and main outcomes. The reporting quality of the included studies was assessed based on the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials and integrated together with studies that investigated the same subjects. The included studies that examined the improvement of nausea and vomiting in pregnancy, inflammation, metabolic syndromes, digestive function, and colorectal cancer’s markers were consistently supported, whereas other expected functions were relatively controversial. Nevertheless, only 43 clinical trials (39.4%) met the criterion of having a ‘high quality of evidence.’ In addition to the quality assessment result, small populations and unstandardized evaluation systems were the observed shortcomings in ginger clinical trials. Further studies with adequate designs are warranted to validate the reported clinical functions of ginger.

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          Most cited references78

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          Ginger--an herbal medicinal product with broad anti-inflammatory actions.

          The anti-inflammatory properties of ginger have been known and valued for centuries. During the past 25 years, many laboratories have provided scientific support for the long-held belief that ginger contains constituents with antiinflammatory properties. The original discovery of ginger's inhibitory effects on prostaglandin biosynthesis in the early 1970s has been repeatedly confirmed. This discovery identified ginger as an herbal medicinal product that shares pharmacological properties with non-steroidal anti-inflammatory drugs. Ginger suppresses prostaglandin synthesis through inhibition of cyclooxygenase-1 and cyclooxygenase-2. An important extension of this early work was the observation that ginger also suppresses leukotriene biosynthesis by inhibiting 5-lipoxygenase. This pharmacological property distinguishes ginger from nonsteroidal anti-inflammatory drugs. This discovery preceded the observation that dual inhibitors of cyclooxygenase and 5-lipoxygenase may have a better therapeutic profile and have fewer side effects than non-steroidal anti-inflammatory drugs. The characterization of the pharmacological properties of ginger entered a new phase with the discovery that a ginger extract (EV.EXT.77) derived from Zingiber officinale (family Zingiberaceae) and Alpina galanga (family Zingiberaceae) inhibits the induction of several genes involved in the inflammatory response. These include genes encoding cytokines, chemokines, and the inducible enzyme cyclooxygenase-2. This discovery provided the first evidence that ginger modulates biochemical pathways activated in chronic inflammation. Identification of the molecular targets of individual ginger constituents provides an opportunity to optimize and standardize ginger products with respect to their effects on specific biomarkers of inflammation. Such preparations will be useful for studies in experimental animals and humans.
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            Ginger and Its Constituents: Role in Prevention and Treatment of Gastrointestinal Cancer

            Gastrointestinal (GI) cancer, a cancer of different organs of the digestive system, is one of the most common cancers around the world. The incidence and death rate of some of these cancers are very high. Although a large variety of chemotherapeutic agents have been introduced since the last few decades to combat GI cancer, most of them are very expensive and have side effects. Therefore, the compounds derived from natural sources, which are considered to be safe and cost effective, are needed. Ginger (Zingiber officinale) is one of the most widely used natural products consumed as a spice and medicine for treating nausea, dysentery, heartburn, flatulence, diarrhea, loss of appetite, infections, cough, and bronchitis. Experimental studies showed that ginger and its active components including 6-gingerol and 6-shogaol exert anticancer activities against GI cancer. The anticancer activity of ginger is attributed to its ability to modulate several signaling molecules like NF-κB, STAT3, MAPK, PI3K, ERK1/2, Akt, TNF-α, COX-2, cyclin D1, cdk, MMP-9, survivin, cIAP-1, XIAP, Bcl-2, caspases, and other cell growth regulatory proteins. In this review, the evidences for the chemopreventive and chemotherapeutic potential of ginger extract and its active components using in vitro, animal models, and patients have been described.
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              The effect of ginger consumption on glycemic status, lipid profile and some inflammatory markers in patients with type 2 diabetes mellitus.

              To assess the effect of ginger consumption on glycemic status, lipid profile and some inflammatory markers in patients with type 2 diabetes mellitus.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                06 January 2020
                January 2020
                : 12
                : 1
                : 157
                Affiliations
                [1 ]College of Pharmacy, Seoul National University, Seoul 08826, Korea; 2018-23140@ 123456snu.ac.kr (N.H.A.); danielkim27@ 123456snu.ac.kr (S.J.K.); phuoclong@ 123456snu.ac.kr (N.P.L.); mje0107@ 123456snu.ac.kr (J.E.M.); yunyochl@ 123456snu.ac.kr (Y.C.Y.); piggypet@ 123456snu.ac.kr (E.G.L.); alsdk@ 123456snu.ac.kr (M.K.); joont@ 123456snu.ac.kr (T.J.K.); yyyang95@ 123456snu.ac.kr (Y.Y.Y.); dmldud3110@ 123456snu.ac.kr (E.Y.S.); supercanboy@ 123456snu.ac.kr (S.J.Y.); snuhmkim04@ 123456snu.ac.kr (H.M.K.)
                [2 ]School of Medicine, Vietnam National University, Ho Chi Minh City 70000, Vietnam; ncdiem.stu15@ 123456medvnu.edu.vn
                Author notes
                [* ]Correspondence: swkwon@ 123456snu.ac.kr ; Tel.: +82-2-880-7844
                Author information
                https://orcid.org/0000-0002-4678-0546
                https://orcid.org/0000-0001-7161-4737
                Article
                nutrients-12-00157
                10.3390/nu12010157
                7019938
                31935866
                0d4fcaff-4e81-4633-b60e-0d6a3f98bc4d
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 04 December 2019
                : 31 December 2019
                Categories
                Review

                Nutrition & Dietetics
                ginger,human health,randomized controlled trials,systematic review
                Nutrition & Dietetics
                ginger, human health, randomized controlled trials, systematic review

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