Journal of Herbal Medicine xxx (xxxx) xxx–xxx

Contents lists available at ScienceDirect

Journal of Herbal Medicine

journal homepage: www.elsevier.com/locate/hermed

Review article

The effect of ginger (Zingiber Officinale) as an ancient medicinal plant on

improving blood lipids
⁎
Tahereh Arabloua, Naheed Aryaeianb,
a
Research Center for Environmental Health Technology, Iran University of Medical Sciences and Department of Nutrition, School of Public Health, Iran University of
Medical Sciences, Tehran, Iran
b
Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, P.O. Box 14155-6171, Tehran, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: Ginger (Zingiber Officinale Roscoe) is a plant that is used as a popular spice in foods, desserts and drinks all
Ginger around the world. This plant is native to Asia and has been used since ancient times in the prevention and
Zingiber Officinale treatment of many diseases. To date, several properties of ginger such as antioxidant, anti-inflammatory and
Blood lipids anticoagulation activities have been studied and the effect of the plant to reduce pain and improve nausea and
Cholesterol
vomiting has been established. Among human and animal studies that have been carried out in recent years on
Triglyceride
the properties of ginger, some literature aimed to investigate the effect of this plant on blood lipids. In this
Diabetes
review, we consider those studies and their possible enzymatic and molecular mechanisms regarding the effect of
ginger on lipid profiles.

1. Introduction
Ginger, the rhizome of Zingiber officinale, is used as a spice all over
the world (Lantz et al., 2007). It is a member of the zingiberaceae plant
family and is native to Asia, although now grown in Africa, India and
other tropical regions (Singletary, 2010).
Ginger is a plant with thick roots and vertical, upright stems. This
perennial plant has nodal rhizomes with many divided swells. The
rhizome of ginger grows horizontally and its outer membrane can be
seen to be yellow or brown. The internal membrane of the rhizome is
yellowish brown and has numerous vessel elements and cells, con-
taining oleoresin. Ginger has an appealing odor and spicy taste, with
the dried powder, appearing a yellowish white to yellowish brown
(Arablou and Aryaeian, 2014).
To date, more than 400 different compounds have been identified in
ginger (Singh et al., 2010). The amount and quality of active compo-
nents of ginger depend on the region of cultivation, the cultivation and
processing method used, and whether used in fresh or dried form. The
odor of ginger depends on the amount of ginger oil present, the levels
usually varying between 1% and 3%. Over 50 components have been
identified in this oil, most of which are monoterpenoid and sesqui-
terpenoid compounds. The pungency of fresh ginger is due to the group
of phenolic compounds called gingerols, among which 6-gingerol is the
most abundant. There are other gingerols in ginger with different
length side chains. The shogaols that are responsible for the pungency
of dried ginger, are the dehydrated form of gingerols (Arablou and
Aryaeian, 2014; Wohlmuth et al., 2005). In fact, gingerols convert to
shogaols during the thermal process and the degradation rate depends
on environmental PH (Athari-Nikazm, 2009).
Other compounds found in ginger include 3-dihydroshogaols,
paradols, dihydroparadols, acetylated gingerol derivates, gingerdiols,
mono and diacetyl gingerdiol derivates, 1-dehydrogingerdiols, diaryl
heptanoids, epoxide diaryl heptanoids, methyl ether derivates, ferollic
acid derivates and terpenes such as zingerones and zingerols (Ali et al.,
2008; Singh et al., 2010).
Despite a widespread use of ginger, there is little information about
the bioavailability of its compounds, especially in human use.
Intravenous injection of ginger to rats in the amount of 3 mg per kg of
body weight, showed that its compounds were cleared rapidly from the
blood (t 1/2 = 7. 2 min) due to their metabolism in the liver (Ding
et al., 1991).
Also, oral administration of 6-gingerol (50 mg/kg) in rats leads to
the production of its glucuronide conjugates and their excretion
through the bile. Small amounts of its polar metabolites are also ex-
creted in the urine within 60 h (Nakazawa and Ohsawa, 2002). Similar
findings were observed by oral administration of zingerone and oleor-
esin of ginger in rats (Ahmed et al., 2000; Wang et al., 2009). Con-
jugation is done by UDP-glucuronosyltransferase enzyme in the liver
and the mucus of the small intestine. Also, after 10 min of oral ad-
ministration of 6-gingerol in the amount of 240 mg per kg of body

⁎
Corresponding author.
E-mail addresses: t.arablou@yahoo.com (T. Arablou), nah_arya2002@yahoo.com, aryaeian.n@iums.ac.ir (N. Aryaeian).

http://dx.doi.org/10.1016/j.hermed.2017.09.005
Received 13 September 2015; Received in revised form 28 May 2016; Accepted 20 September 2017
2210-8033/ © 2017 Published by Elsevier GmbH.

Please cite this article as: Arablou, T., Journal of Herbal Medicine (2017), http://dx.doi.org/10.1016/j.hermed.2017.09.005
T. Arablou, N. Aryaeian
weight in rats, its plasma concentration reached to 4.2 μg/ml. Its
amount reached to the maximum level in tissues 30 min following
consumption.
In one human study, healthy volunteers received different doses of
ginger from 100 mg to 2 g. The results showed that the main pungent
constituents of ginger root, 6-, 8-, 10-gingerol and 6-shogaol absorbed
quickly and were detected in the serum as glucuronide and sulfate
conjugates but not in their free forms. These constituents at con-
centrations normally found in the ginger root (0.5–2.5%), were de-
tectable in the serum starting at a 1.0 g dose with the exception of 6-
gingerol which is detectable at a 250 mg dose with maximum con-
centrations ranging from 0.1 to 1.7 μg/ml (Zick et al., 2008).
In another human study conducted by Yu et al., oral administration
of 2.0 g ginger extracts, led to the detection of free 10-gingerol and 6-
shogaol in plasma after 1 h, but no free 6-gingerol and 8-gingerol were
detected in plasma from 0.25 to 24 h. This study also indicated that
most of the 6-, 8-, and 10-gingerols and 6-shogaol existed in the form of
glucuronide or sulfate conjugates with 1–3 h half-lives in the human
plasma (Yu et al., 2011).
Ginger is known as a safe compound (Ali et al., 2008). The American
food and drug administration recognized ginger as a GRAS (Generally
Recognized As Safe) ingredient (Singletary, 2010). According to evi-
dence from human studies, very few side effects have been reported
after ginger consumption. Rare side effects include mild digestive dis-
orders, heartburn, and diarrhea (Singletary, 2010; Arablou et al.,
2014a,b). Clinical studies have shown that receiving ginger in the
amount of 2 g per day has negligible toxicity for humans (Singletary,
2010).
Ginger’s health properties were first documented more than 2000
years ago (Vasanthi and Parameswari, 2010). In the past, this plant was
used for alleviation and treatment of different symptoms such as vo-
miting, pain, indigestion and upper respiratory tract infection (White,
2007; Wang and Wang, 2005). Nowadays, ginger is used in dietary
supplements, drinks and food products like sweets, jams and soups
(Singletary, 2010).
The main pharmacological activities of ginger and its segregated
compounds include as an immune modulator, anti-tumorgenesis, anti-
inflammatory, anti-apoptosis, and anti-vomiting. The plant is effective
in improving nausea and vomiting induced by pregnancy, surgery,
chemotherapy and motion sickness (Singletary, 2010). Also, scientific
evidence shows that ginger has antioxidant and anticoagulation prop-
erties and can decrease pain (Li et al., 2012). Some studies have es-
tablished the effect of ginger on reducing inflammation, especially in
osteoarthritis (Naderi et al., 2015; Altman and Marcussen, 2001;
Srivastava and Mustafa, 1992).
Additionally, ginger consumption is effective in the prevention of
cancer (Singletary, 2010). This effect is attributable to the herb’s action
as a strong antioxidant that can prevent the damage caused by free
radicals and decrease their activity (Ali et al., 2008; Nicoll and Henein,
2007).
In recent years, numerous animal and human studies have in-
vestigated the effect of ginger consumption on metabolic status, gly-
cemia, blood lipids, and blood pressure. Most of these studies showed
that ginger can improve some parameters of lipid profile, especially in
diabetic patients (Arablou et al., 2014a,b; Khandouzi et al., 2015;
Mahluji et al., 2013). In this paper, we review some of the studies re-
garding the effect of ginger on blood lipids.
2. Methodology
The information in this narrative review is obtained based on the
results of the authors search in Pubmed, Google scholar, and Science
Direct databases by using the keywords “ginger and Zingiber officinale”
in combination with “lipid, cholesterol, triglyceride, and diabetes”
without considering any time limitation. All relevant human studies
(clinical trials) were included and discussed in this paper.
2
Journal of Herbal Medicine xxx (xxxx) xxx–xxx
2.1. The effect of ginger on lipid profile
2.1.1. Human studies
In a randomized double-blind placebo-controlled clinical trial con-
ducted by Khandouzi et al., 41 type 2 diabetic patients were assigned
randomly to the ginger or placebo groups and received 2 g/day of
ginger powder supplement or lactose as the placebo for 12 weeks.
Ginger supplementation significantly reduced the levels of apolipo-
protein B and apolipoprotein B/apolipoprotein A-I ratio (P
value = 0.000) in comparison to baseline, as well as the control group,
while it increased the level of apolipoprotein A-I (P value < 0.05)
(Khandouzi et al., 2015).
In the last randomized double-blind placebo-controlled clinical trial
uncovered in our literature search, 63 patients with type 2 diabetes
were supplemented with 1600 mg of ginger for 12 weeks. A significant
decrease in serum triglyceride and total cholesterol was observed in
comparison to the placebo group (P value < 0.001 and P value = 0.02
respectively). However, there was no significant effect on LDL-c and
HDL-c (P value < 0.05) (Arablou et al., 2014a,b).
Another clinical trial was conducted by Mahluji and colleagues on
patients with type 2 diabetes. The results showed that supplementation
with 2 g of ginger for 2 months reduced significantly serum triglyceride
(P value = 0.03) and LDL-c (P value = 0.04), compared with the
control group, but there were not significant changes in total choles-
terol (P value = 0.20) and HDL-c (P value = 0.28) (Mahluji et al.,
2013).
In Talaei’s study on 81 patients with type 2 diabetes, daily con-
sumption of 3 g of ginger powder for 8 weeks decreased serum LDL-c (P
value = 0.03) and increased APO A1 (P value < 0.005), but had no
effects on total cholesterol levels (P value = 0.47), triglyceride (P
value = 0.46), HDL-c (P value = 0.37), and APO B100 (P
value = 0.06) (Talaei et al., 2012).
Ayaz and Dabidi-Roshan’s conducted a study on the effect of a 6
week water-based intermittent exercise program with and without
ginger consumption on proinflammatory markers and blood lipids in
overweight women with breast cancer. Supplementation with 3 g of
ginger per day for 6 weeks resulted in only a statistically significant
reduction of triglyceride in water-based intermittent exercise and
water-based intermittent exercise + ginger groups (P value = 0.03 and
P value = 0.003 respectively). However, the water-base exercise
+ ginger treatment was more effective than the water-base exercise
treatment alone (Ayaz and DabidiRoshan, 2012).
Atashak et al. carried out another randomized, double-blind clinical
trial to evaluate the effect of ginger supplementation and resistance
exercise on cardiovascular disease risk factors and C-reactive protein in
obese men. Participants in the ginger groups received 1 g of ginger daily
for 10 weeks. Results showed that changes of triglyceride, HDL-c, LDL-c
and total cholesterol were not significant in all groups, only total cho-
lesterol decreased significantly in resistance exercise + ginger group (P
value < 0.05) (Atashak et al., 2011).
A further study was conducted by Alizadeh-Navaei to evaluate the
effect of ginger supplementation on blood lipids in 85 hyperlipidemic
patients. It was observed that consumption of 3 g of ginger per day after
45 days reduced serum triglyceride (P value = 0.03) and total choles-
terol (P value = 0.02) significantly compared with the controls.
However, differences in the levels of HDL-c (P value = 0.058), LDL-c (P
value = 0.09), VLDL (P value = 0.63), and lipoprotein a (P
value = 0.45) were not statistically significant between the control and
treatment groups (Alizadeh-Navaei et al., 2008) (Table 1).
2.1.2. In vivo studies
To date, several animal studies have been carried out on the effects
of ginger on blood lipids. In these studies, the effect of different doses of
ginger at different times was investigated in a variety of animal models,
especially diabetic rats, obese rats, and high-fat diet fed rats. According
to the results of most studies, ginger has improved lipid status,
T. Arablou, N. Aryaeian Journal of Herbal Medicine xxx (xxxx) xxx–xxx

Table 1
Human studies on the effect of ginger on blood lipids.

Author,date Participants characteristics Intervention Intervention Main results Author conclusion

duration

Khandouzi et al. (2015) 41 DM2 patients 2 g ginger powder 12 weeks Apolipoprotein B↓ Ginger may have a role in alleviating the risk of
Apolipoprotein B/ some chronic complications of diabetes.
apolipoprotein A-I↓
20–60 years Apolipoprotein A-I↑
Arablou et al. (2014a,b) 63 DM2 patients 1600 mg ginger 12 weeks Serum total cholesterol↓ Ginger can be considered as an effective treatment
powder Serum triglyceride↓ for prevention of diabetes complications.
Unchanged LDL-c
30–70 years Unchanged HDL-c
Mahluji et al. (2013) 64 DM2 patients 2 g ginger powder 8 weeks Unchanged serum total Ginger may be considered as a useful remedy to
cholesterol reduce the secondary complications of type 2
Serum triglyceride↓ diabetes.
LDL-c↓
38–65 years Unchanged HDL-c
Talaei et al. (2012) 81 DM2 patients 3 g ginger powder 8 weeks Unchanged serum total Ginger supplementation for type 2 diabetic
cholesterol patients would improve LDL-c and APO A1
Unchanged serum parameters.
triglyceride
LDL-c ↓
Unchanged HDL-c
APO A1↑
Unchanged APO B100
Ayaz and DabidiRoshan 40 overweight women with 3 g ginger powder 6 weeks Unchanged serum total Water-based exercise with Zingiber officinale
(2012) breast cancer [40 ≥ ] years cholesterol attenuated systemic inflammation and blood lipids
Serum triglyceride↓ in overweight women with breast cancer.
Atashak et al. (2011) 32 obese men 1 g ginger powder 10 weeks Serum total cholesterol↓ Ginger supplementation did not have any influence
18–35 years Unchanged triglyceride on the lipid profile at a dose of 1 g/day.
Unchanged LDL-c
Unchanged HDL-c
Alizadeh-Navaei et al. 85 hyperlipidemic patients 3 g ginger powder 45 days Serum total cholesterol↓ Ginger can cause significant reduction in serum
(2008) Serum triglyceride↓ cholesterol and play an important role in
Unchanged LDL-c prevention of atherosclerosis.
Unchanged HDL-c
Unchanged lipoprotein a

DM2: Diabetes Mellitus type 2, LDL-c: Low Density Lipoprotein-cholesterol, HDL-c: High Density Lipoprotein-cholesterol, APO A1: Apolipoprotein AI, APO B100: Apolipoprotein B100.

including decreased serum total cholesterol, triglyceride and LDL-c, and
increased serum HDL-c (Al-Assaf, 2012; ElRokh et al., 2010; Nammi
et al., 2010; Shirdel et al., 2009; Elshater et al., 2009). Since the ob-
jective of the present study was to review human studies on the effect of
ginger on the lipid profile, we have not explained animal studies in
details. A number of animal studies performed in this field are pre-
sented in Table S2 (Supplementary on-line data).
2.2. Mechanism of action
According to the results of most mentioned studies, ginger can
probably reduce serum triglycerides (Arablou et al., 2014a,b; Mahluji
et al., 2013; Ayaz and DabidiRoshan, 2012; Alizadeh-Navaei et al.,
2008); although, Talaei et al. and Atashak et al. did not observe any
significant effect of ginger on serum triglycerides. The possible ability
can be explained in this way: Ginger may increase intestinal peristalsis
and reduce fat absorption by inhibiting the lipase enzyme in the pan-
creas and intestine (Alizadeh-Navaei et al., 2008; Han et al., 2005).
Another possible mechanism of the plant to reduce serum triglycerides
is due to the increase in the expression and activity of the lipoprotein
lipase enzyme in the vessels. This enzyme increases the breakdown of
triglycerides in the blood vessels and reduces blood levels of trigly-
cerides (Shirdel et al., 2009). Ginger also inhibits hepatic fatty acid and
triglyceride synthesis by lowering key enzymes activity (Kalaiselvi
et al., 2015).
It appears that ginger decreases the gene expression of ChREBP
(Carbohydrate Response Element Binding Protein) in the liver. This
transcription protein is responsible for the regulation of fat and glucose
metabolism and conversion of extra carbohydrates into triglycerides.
Lowering the expression of this protein leads to a decrease in the gene
expression of glucogenic and lipogenic proteins, including ACC1
(Acetyl-CoA Carboxylase1), fatty acid synthase, SCD1 (Stearoyl- CoA
Desaturase-1), and glucose-6-phosphatase enzymes involved in glyco-
genolysis and gluconeogenesis, which results in the reduction of fat
accumulation in the liver, decreasing serum triglycerides and im-
proving insulin resistance (Gao et al., 2012).
Evidence from some of the mentioned studies revealed that ginger
reduced serum total cholesterol (Arablou et al., 2014a,b; Atashak et al.,
2011; Alizadeh-Navaei et al., 2008), but in other studies, ginger did not
affect serum total cholesterol significantly (Mahluji et al., 2013; Talaei
et al., 2012; Ayaz and DabidiRoshan, 2012). According to these con-
troversial results, we cannot be sure if ginger has a decreasing effect on
serum total cholesterol or not.
However, the possible effect of ginger in reducing serum total
cholesterol might be due to the effect of this plant on increasing the
activity of liver cholesterol 7-α-hydroxylase enzyme. As a result, it can
increase the conversion of cholesterol to bile acids and thus decrease
serum levels of cholesterol (Srinivasan and Sambaiah, 1991).
In addition to the effectiveness of ginger in increasing bile pro-
duction from cholesterol in the liver, increasing the excretion of cho-
lesterol and phospholipids in the stool after taking ginger can also be
considered as a potential mechanism for the effects of ginger in redu-
cing serum cholesterol levels (Arablou et al., 2014a,b). Similarly, ginger
may reduce VLDL production in the liver and consequently decrease
serum triglycerides and total cholesterol (Shirdel et al., 2009). It has
also been observed that various compounds in ginger can inhibit the
biosynthesis of cholesterol in the liver by down-regulation of HMG-COA
reductase protein expression (Nammi et al., 2010) and the compound
isolated from ginger (E)-8 beta, 17-epoxyllabed-12-ene-15, 16 dial in-
terferes with cholesterol biosynthesis in the liver (Tanabe et al., 1993).
According to the findings of most studies, ginger has no significant
effect on HDL-c levels, especially in humans (Arablou et al., 2014a,b;

3
T. Arablou, N. Aryaeian
Mahluji et al., 2013; Talaei et al., 2012; Atashak et al., 2011; Alizadeh-
Navaei et al., 2008). This is probably because the effect of dietary
components on serum HDL-c level changes is low. Meanwhile, in-
creased levels of serum insulin and triglyceride is associated with a
reduced size of HDL-c particles and decreased HDL2 (Pascot et al.,
2001). So, ginger increases levels of HDL2 and the size of HDL-c par-
ticles by reducing insulin and serum triglycerides, and thereby reduces
the risk of atherogenesis (Arablou et al., 2014a,b).
Mahluji et al. (2013) and Talaei et al. (2012) showed that con-
sumption of 2 and 3 g of ginger respectively per day for 2 months could
reduce serum LDL-c in patients with type 2 diabetes. In the previous
study, LDL-c decreased after ginger supplementation, but this change
was not statistically significant (Arablou et al., 2014a,b). In Atashak
et al. (2011) and Alizadeh-Navaei et al. (2008) studies, it was found
that ginger had no effect on LDL-c levels. Given the contradictory
findings of the studies, it is not clear how ginger affects serum LDL-c.
Ginger may increase the LDL-c particle size and possibly act as a sca-
venger of oxidized LDL-c to reduce its uptake by macrophages and
prevents atherogenesis (Fuhrman et al., 2000).
In some of the aforementioned studies (Khandouzi et al., 2015;
Talaei et al., 2012; Alizadeh-Navaei et al., 2008), ginger had incon-
sistent effects on human lipoprotein profiles. Ginger may improve hy-
percholesterolemia by modifying lipoprotein metabolism and enhan-
cing uptake of LDL-c by increasing LDL-c receptors (Nammi et al.,
2010).
However, the findings of the above studies on the effect of ginger on
blood lipids are controversial. The probable causes of the observed
incoherence in these clinical trials are due to the dissimilar study
groups, different compliance of supplements, or the effect of some ad-
ditional nutrient intake that confounds the findings. Likewise, con-
trolling the confounders is very difficult in human studies.
3. Conclusion
This paper aimed to address the question of whether ginger has a
reducing effect on blood lipids. Therefore, we discussed relevant human
studies on this effect and the possible explanatory mechanisms. In the
cited clinical trials, different doses of ginger powder (range 13 g) in
different time periods (range 45 days–12 weeks) were used.
According to our literature findings regarding the effect of ginger
consumption on lipid profile, it seems that ginger can be considered as a
valuable ingredient for modifying blood lipids, especially in diabetic
patients. This probable property might be due to its effective anti-
oxidants, including gingerols and shogaols. However, because of the
lack of clinical trials in this field, it is necessary to conduct further
human studies that examine the use of various amounts of ginger
during a longer period of time. Also, other experimental human studies
to characterize the possible mechanisms of the effect of ginger on blood
lipids are recommended.
Declaration of interest
The authors have declared no conflict of interest.
Funding
The paper has been prepared without any financial supports.
Appendix A. Supplementary data
Supplementary data associated with this article can be found, in the
online version, at http://dx.doi.org/10.1016/j.hermed.2017.09.005.
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