Dr Rupy: Today we are going to be talking about the science behind the health benefits of ginger. And I'm going to talk to you about three main reasons why I think you should be eating more ginger, from gut health to blood sugar levels. I personally love cooking with ginger. You will know through watching me online and my cookbooks, I generally have ginger quite a bit. I add it to curries, stews, teas, there are so many ways in which I incorporate ginger, not because of its health effects, but also because of its distinctive flavour. And as we look more into the science and discover more about the health benefits, I think you're going to be really inspired to use it more regularly in your diet too. So, benefit number one, improved digestion and reduced nausea. So if anyone who has been pregnant or knows someone who has been pregnant, you've probably been told that ginger tea is good for morning sickness. Now, ginger has been a go-to remedy for not just morning sickness, but for other digestive complaints for centuries, probably millennia actually. Everything from bloating to indigestion, constipation, there appears to be a cultural benefit to having some ginger in your daily life. I mean, when I was growing up, my family would always whip up a warm cup of ginger tea whenever I got an upset stomach. And traditional medical systems like Chinese medicine, Ayurvedic medicine, ginger has been a trusted ally for flatulence, indigestion, GI spasms. But what does modern medicine have to say about all of this? Overall, the evidence is related to nausea relief. So, for example, if we look at one study looking at pregnant women, there is a meta-analysis that gathered results from 13 trials totalling over 1,000 pregnant women, and they concluded that ginger supplementation significantly reduced nausea compared to placebo. Looking at a number of different people undergoing cancer treatment, there was one trial from the University of Rochester Medical Centre where they assigned over 500 people with cancer to take either placebo, 0.5 grams to 1.5 grams of ginger capsules every day for six days, and they found that all doses of ginger from 0.5 grams to 1.5 grams significantly reduced the severity of nausea induced by their treatment, induced by chemotherapy, compared to the placebo. For other GI symptoms, there is less evidence, but there was a recent trial in people with relapsing-remitting multiple sclerosis. Multiple sclerosis is an autoimmune condition where your immune system attacks the fatty layers around your neurons. And researchers gave participants 1.5 grams of ginger per day along with main meals, and they found that it actually improved the symptoms of constipation, nausea, bloating, and abdominal pain compared to controls. So the question is, I get that it can impact nausea in pregnant women, it potentially has a role in other conditions where nausea is the predominant symptom. How does it do this? Well, it comes down to special plant compounds that are found in ginger, and these are called gingerols and shogaols. These are the specific chemicals that are of note and things that we are most interested in from the perspective of nausea. When we eat ginger, these polyphenols and all the other compounds found in ginger, of which there are over 200, can improve digestive health in two key ways. Number one is by improving the movement of food through the GI tract, also known as gastric motility. So in the lab, researchers have uncovered something fascinating. The active compounds in ginger seem to act within the gut to speed up the journey of food through your digestive tract, reducing what we call food transit time. So this requires a little bit of background of what actually food transit time refers to. So there's whole gut transit time and regional transit time. Whole gut transit time refers to the amount of time it takes for food to travel through the whole gut. So that's from your mouth to your oesophagus, all the way through the large intestine and out the other side through the anus. Gastric emptying refers specifically to the first part of the gut, i.e. your mouth, oesophagus, stomach. This is generally around two to five hours. Small transit time, small bowel transit time is around two to six hours. Colonic transit time, i.e. the large bowel, is anywhere between 10 and 59 hours. The whole gut transit time is 10 to 73 hours. The normal transit times for any individual can be widely different from person to person. Now, it's important to know because disturbances in motility and transit are common in functional gastrointestinal disorders such as irritable bowel syndrome, functional dyspepsia, bloating, or even chronic constipation. You can also do something called the sweetcorn test as a rough measure. So you eat some sweetcorn, it's kind of not very nice to think about, but you eat some sweetcorn and you observe in your stools when you go to the bathroom, how long it's taken from the moment you ate that sweetcorn until it's expelled out the other side. And that gives you a rough measure. There are obviously more accurate ways of doing this in investigations. So we have a number of different ways. You can swallow a smart pill that actually travels through the digestive tract and it times exactly how long it's taken from certain areas in your gut. And then there are other radiological measures as well of actually ingesting some radiopaque materials and then it can, you can follow it essentially through some x-rays and determine how long it's taking at various parts of your digestive tract. So ginger, specifically, bringing it back to ginger, can potentially help food move along more effectively and certainly in the upper part of your digestive tract. So it doesn't linger as long in the gut, which can bring relief to a range of symptoms like nausea, constipation, and indigestion. So this very simple fact can explain why in traditional medical systems, stomach ache, feeling of fullness or bloating has been traditionally treated with ginger and every different types of ginger preparation. So dried ginger, ginger powder, ginger tea, etc. There is more to the story. So the second thing is that ginger compounds can also silence nerves that trigger your vomiting reflex. So researchers found that these bioactive compounds in ginger can attenuate serotonin. So attenuate is a funky word for muting or just turning down the volume on serotonin. Serotonin, if you look at any paper or even the side of some supplement bottles, will be referred to as 5-HT3. That is 5-HT3. And these receptors, along with dopamine receptors as well, can control or be involved in the control of the vomiting centre of the brain. And ginger can work on these receptors to just mute them down. It works very similarly to the way 5-HT3 receptor antagonists also work. And these are drugs that we give for people who are experiencing nausea, particularly during cancer therapy. You might have heard of some drugs called ondansetron or granisetron or palonosetron. We use these commonly in cancer conditions. And if you look at this diagram that will flash up on the screen now on YouTube if you're watching this, but I'll just explain it for those of you listening on audio. There is a picture of a brain and then you have receptors in that schematic of the brain. DA refers to the dopamine receptor and 5-HT refers to the serotonin. So ginger acts on that by attenuating that, so muting that down. And there are other targets in the gut where ginger can also reduce that vomiting reflex as well. Fascinating stuff. Does it work as effectively as some of those more targeted drugs? Probably not, but in a way, it is beneficial because it is a natural way of reducing it, just slightly muting it down rather than having to endure drugs if you don't have to. Obviously, for certain people, it is very necessary to have those more targeted approaches with drugs. All right, let's move on to benefit number two. There is evidence suggesting that ginger can keep your blood sugar levels in check. Now, remember we've talked about why improving blood sugar levels can be a good thing in previous podcasts. I've talked about the need for keeping blood sugar levels stable, why wild oscillations in your blood sugar level by having a really high carb meal and then that corresponding crash can lead to more cravings, to lead to overeating. Generally, having a steady glucose level is a good thing, but it shouldn't be gamified to the point where all you do is eat according to your blood sugar levels because that would basically mean you just eat pure fat or pure meat or protein. So everything needs to be taken with a pinch of salt here. But ginger appears to have some blood sugar regulating capabilities. There was a systematic review of randomised control trials that found that ginger supplementation significantly reduced fasting blood sugar levels. It also reduced levels of a marker called HBA1c, so that's a general marker of how well your sugar has been controlled over the preceding three months. Plus, it also had some extra benefits in blood pressure, reducing both systolic and diastolic blood pressure measurements in patients specifically with type two diabetes. So I just want to caveat this right from the start. This particular study was looking at ginger supplementation in people who already had impaired sugar levels, i.e. type two diabetes. So this is only really appropriate for someone who has metabolic issues that are pre-existing, not a normal healthy population. The doses, this is still interesting though, the doses of ginger that were supplemented with ranged from 1,200 to 3,000 milligrams. So that's 1.2 grams to 3 grams. So how might this work? There are potential ways that the compounds found in ginger can act to regulate sugar metabolism. The first one is by reducing the activity of specific enzymes that break down carbohydrates into their constituent parts. So if you remember, you've got a large carbohydrate, something like a sweet potato or some white rice, that's broken down into its constituent parts, sugars, the very simple sugars, things like sucrose, fructose, glucose, and the enzymes responsible for that include alpha-glucosidase and alpha-amylase. Now, this reduction in the enzyme activity can slow down the digestion of carbohydrates and then consequently reduce what's called postprandial plasma glucose levels. You've probably heard me say this again before, but I'm going to repeat myself and explain exactly what that means. Postprandial just means after, post, prandial, eating, plasma glucose level is the plasma level, the sugar level in your blood. So if you imagine after you're eating and you have a steady glucose level, and then it goes up and then it comes corresponding down. What happens when you're having ginger potentially in this study looking at diabetic patients only, is the rate at which that sugar level, the rate at which sugar goes into your bloodstream is muted slightly. And there are similarities between how fibre does that as well. When you eat fibre, it coats the inner lining of your intestines and so the absorption of sugars across that intestinal lining is slowed. So it's a very similar way, but obviously using a different mechanism by working on those enzymes that break down carbohydrates in the first place. So the second way that ginger can potentially help with blood sugar levels is by encouraging muscle cells to absorb glucose from the bloodstream without using insulin or without relying on insulin as much. And this is via activating something called GLUT4 transporters, the expression of GLUT4 transporters. These are on the surface of muscle cells, as well as other cells as well, including the liver. Now if you look at the diagram that, if you're watching this on YouTube, you'll see it here. But if you're listening on audio, I'll just explain it to you. Insulin usually stimulates what's called the translocation from intracellular locations of GLUT4 to the cell membrane. So there's a lot of funky words there. I'm just going to explain it. Insulin, which is released from the pancreas in response to a carbohydrate-rich meal, let's say, goes to your muscle cell, or goes to many different cells, but we're going to use the muscle cell as an example. Goes to your muscle cell and says, hey, we've got some blood sugar levels that are rising, we need you to take some of that sugar load. And so when insulin attaches to that cell, it stimulates the signal to GLUT4 and they move GLUT4, which is the transporter, from somewhere inside the cell to the surface of the cell, almost like a straw. They drag this straw to the surface of the cell and that straw sucks up sugar from the bloodstream into the cell where it can be utilised or stored at a later date. That's essentially what insulin does. Ginger potentially, or the molecules within ginger, potentially acts to do a similar thing. It leads ultimately to the increase of glucose uptake from the bloodstream into the cell where it can be packaged, stored or utilised for energy. That's the basic mechanism and that's what you can see on the diagram if you're watching on YouTube. Some caveats to this claim, because I don't want anyone to start thinking that they can replace their insulin shots or their diabetic medications with ginger alone. This particular study was only looking at diabetic patients. It is not great to extrapolate that information that was used specifically for diabetic patients to healthy individuals. And there are other things like exercise that will have a far greater effect on your metabolic health other than just relying on ginger. It is not going to prevent diabetes, but it is really interesting to look at some of these mechanisms that can explain why supplementation with certain foods like ginger can lead to these potential effects. So I just want to make that caveat really, really clear that this is not a replacement for all the big, big things that will massively reduce the risk of type two diabetes. Okay, so we've talked about two main benefits so far, digestive health, potentially blood sugar regulation. Benefit number three is to reduce inflammation. Ginger contains compounds with anti-inflammatory and antioxidant properties. So it can benefit inflammatory related conditions such as osteoarthritis, which is a degenerative condition of your joints, and potentially even autoimmune conditions as well. There are four key findings that we see in research that lead to this conclusion that it is anti-inflammatory. Number one, there are reduced inflammatory markers. In clinical trials, ginger supplementation was shown to reduce markers of inflammation that include CRP, this is called C-reactive protein, it's a very common blood marker that we measure in clinical practice, and also TNF-alpha and interleukin-6. These are very commonly measured in research settings as a marker of circulating inflammation. Number two, we also see improved osteoarthritis pain. In people with osteoarthritis, ginger supplementation was found to improve pain and stiffness. We've also seen reduced menstrual pain as well. There was one study that gave women doses of either ginger or non-steroidal anti-inflammatory drugs. So NSAIDs, you've probably heard of diclofenac or ibuprofen, Nurofen, these are all non-steroidal anti-inflammatory. Non-steroidal because they're not steroids and anti-inflammatory because they're anti-inflammatory drugs. And for the first three days of their menstrual cycle, they found that ginger reduced the pain just as effectively as non-steroidal anti-inflammatory. And finally, viral infections. So there was a study that found ginger supplementation reduced the length of hospitalisation in people with COVID-19, which was attributed to ginger's broad anti-inflammatory properties. So overall, there does appear to be some evidence, not great evidence, but some evidence linking ginger to improved levels of inflammation. So putting all of this into context, we've got digestive health, blood sugar levels, inflammation. Is this something that you should be supplementing with? How do we apply this new information to daily life? Are ginger supplements worth it? It's a common question I get. And whilst most of the studies that I've just talked about use ginger in supplemental form to control the dosage more precisely and ensure consistency among participants, I don't actually think that means that ginger supplements are necessary. I actually recommend enjoying fresh or dried ginger instead of swallowing a ginger pill every single day. And there are reasons for that. It may contain other unnoted ingredients. It may contain contaminants. The supplement industry is not well regulated, so it can be really hard to know the exact quantity and quality than with added ingredients, like if you were just going to grate this ginger that I've got in front of me into a tea or a curry or a stew. I think it's far easier to understand exactly the quantity of ginger that you're putting into your daily diet rather than relying on supplements alone. With supplements, it's also a lot easier to take very high doses that are unnatural to what you would tend to put in the diet as well. And that may have side effects. So whenever you're taking a ginger supplementation or a ginger supplement, you really have to be cognisant of medications you might be on and interactions with other elements as well in your diet. The third thing is cost. I mean, focusing on supplements that I feel have more evidence, things like vitamin D, plus K2, which you've probably heard me talk about in previous episodes, iron, B vitamins, omega-3, those are supplements that I think are worth the investment. Supplementing with ginger, perhaps less so, unless you're specifically trying to help manage a condition. It might be menstrual pain, it might be osteoarthritis, it could even be things like blood sugar levels if you're diabetic and you don't want to go to ever increasing amounts of anti-diabetic medications. But that is definitely a consideration I would put in there that supplements that have greater evidence are probably worth the investment. Buying ginger. Now, ginger is usually grown in South and Southeast Asia, tropical parts of Africa as well, parts of Central and South America and Australia. Generally, it's very easy to get in the UK, but you can also grow it yourself in a conservatory. We'll link to a resource in the captions. And I always hasten to add that if you're going to eat the skin of ginger, you do want to make sure it is organic. It's very easy to get contaminants and pesticides. I tend to like eating the skins of my fruits and vegetables, and ginger, it is very easy to eat the skins and a lot of those phytochemicals that we've just talking about actually concentrate in the skin too. Both are completely fine. You can actually have the skins as well as the flesh itself, but I do go for organic as I am going to be eating the skins and I know that it's very easy to overconsume pesticides. And we've done a whole other podcast on organic and pesticides as well. Dried, you'll see in front of me if you're watching on YouTube that we've got some dried powdered ginger and I've got some fresh ginger here. Both are good and complement each other. Gingerols that are the major components in the fresh ginger rhizome, this is called a rhizome, that's where you're going to have more of that particular polyphenol, whereas shogaols, particularly six-shogaol, are concentrated more in the in the dried version. So there are abundance of of different polyphenols, the processing method changes that composition of the product. So my advice is to get variety. Hence I use dried ginger powder when I'm cooking or maybe I'm putting it in some baking, and then I'll use minced ginger in a curry or even a tea as well. Ginger shots are really popular these days. I don't have anything against ginger shots. I would be a little bit cautious for two main reasons. Number one, fresh ginger can actually exacerbate gastritis. So if you suffer from gastroesophageal reflux disease, GORD, or you're prone to getting gastritis, you want to be careful about taking ginger shots because that can make it quite worse. It's quite an abrasive taste. And the other thing is, and this kind of leans on my interest in the ancient world of Ayurvedic medicine, ginger is a very heat-giving spice. It warms you up. There's a reason why we use it in colder months, for example. And I think it's quite easy to overconsume ginger and that can lead to issues like gastroesophageal reflux, but there is some suggestion that it can exacerbate things like arrhythmias, heart murmurs, it can overstimulate your system, let's say. I can't point to any specific research looking at that, but certainly from anecdote and the way traditional medical systems respect ginger, particularly fresh ginger, I think it just would be pertinent to not overconsume it and use it in moderation as well. You can also freeze fresh ginger for later use. This is something that my family do. We'll get a whole big block of ginger like you'll see here, grate it all and then put it into a ziplock bag and then press it flat and then put it into the freezer and you can flick through your bags of ginger and garlic and chilli, almost like if you remember like a record folder, and just break off a piece of ginger when you need it, throw it into whatever you're cooking. It's a really easy way of using ginger on the cuff, off the cuff, and not wasting it as well. My favourite ways to enjoy ginger include adding it to soups and stews. So I add just a little bit of ginger to add a tanginess that pairs really well with sweet, earthy root vegetables, things like roasted carrots, for example. I also use it as a salad dressing. So finely grated with a little bit of olive oil, lime juice, soy sauce, a bit of garlic, just to jazz up any salad. That's a wonderful way of just adding a little bit of ginger. And then sauerkraut, red cabbage, grated carrots, apple, a bit of ginger, like just gives that little zing, and that will, you know, keep in your fridge for months and months. In fact, we've got some in the Doctor's Kitchen that we just, you know, add a little bit of kraut to whenever we're having a diversity bowl or something like that. And then the easiest way is just chopping up some ginger, again with the skins on if it's organic, popping it in with some hot water, a bit of cinnamon, and then you have a ginger tea and just sipping on that. I think it's a really, really easy way. There are some companies that do dried ginger that you can buy online. The only, and I think those are great and you're going to have more of those six-shogaol polyphenols that are particularly good for nausea. The only issue with those is that sometimes they add a lot of sugar to that because this is quite a strong taste if you're just chewing on it and it's dried. So to mellow the taste, a lot of companies add sugar and they add things like glucose syrups, high fructose corn syrup, all the different names of sugar, processed, processed sugar. So it's very easy to overconsume a lot of that sugar if you're having quite large amounts. So just something to be aware of as well. So I hope you've enjoyed that little dive into ginger. You understand the polyphenols, the complex milieu of those 200-something compounds, the different ways in which you can include ginger, supplementation, the general doses are between 1.5 to 3 grams of ginger, which is quite easily achievable through getting dried ginger in your cooking, for example. But if you wanted to be a lot more targeted, then you could experiment with supplementation if you wished. I personally don't think it's necessary. I think the best way to enjoy it is through food, through using some of the recipes. Check out some of the ones that we've got on the app and on the Doctor's Kitchen website and go enjoy some ginger.
