The role of your cancer health professional is to create an environment of openness and trust, and to help in making informed decisions about alternative/ complementary therapies. Collaboration will improve the safe integration of all therapies during your experience with cancer. The "Summary" and "Professional Evaluation/ Critique" sections of this Unconventional Therapies manual are cited directly from the medical literature, and are intended to help in the objective evaluation of alternative/ complementary therapies.
Summary
There is insufficient evidence demonstrating that ginseng is a treatment for cancer.
Description/ Source/ Components
"Nothing about ginseng seems to be totally free from controversy. Even the proper name of the low-growing, shade-loving perennial herbs of the family Araliaceae that yield the highly valued roots is not agreed upon by all specialists." (Tyler)
"The term ginseng refers to any of 22 different plants, usually of the genus Panax, used as a tonic and restorative." (Koren)
Most botanists recognize three medicinal species, Panex ginseng (Chinese or Korean ginseng), Panex pseudo-ginseng (Japanese ginseng), and P. quinquefolium (American ginseng). (Awang)
"The main active constituents of Panax species are recognized to be triterpene saponins, termed ginsenosides or panaxosides, whose structures and distribution vary with species and variety." (Awang)
"Siberian or Russian ginseng, although claimed to exercise the same stimulant and tonic effects as the other ginsengs, is, in fact, an entirely different plant, Eleutherococcus senticosus. Commonly known as eleuthero or eleuthero ginseng." (Awang)
Ginseng comes from the root of the Panax ginseng, a perennial herb indigenous to Eastern Asia. P quinquefolium is found in Eastern U.S. and Canada; P pseudoginseng is found in India, China and Japan. (Merck)
"Fresh ginseng is less than four years old and can be consumed in the fresh state. The white ginseng is grown for four to six years, and then peeled and dried to reduce the water content to 12% or less. The red ginseng is harvested after six years, and then steamed and dried." (Yun 1990)
The principles believed to be responsible for ginseng's activity are triterpenoid saponins that exist in the root in large numbers. Again, the nomenclature of these compounds is extremely confusing and complex, for some of the same compounds were isolated by different groups of investigators and given different names. Then too, there are differences in composition between the Asian and American ginseng species. (Tyler)
History
"Ginseng has been used as a natural tonic in oriental countries, and its diverse pharmacological effects have been reported for over 2,000 years." (Yun 1990)
"Ginseng has been used by man for thousands of years, and Oriental folk medicine describes it as both a tonic for restoration of strength and a panacea." (Siegel)
"Although it was abundant in eastern North America, American ginseng is now considered threatened because of aggressive harvesting of the plant for commercial sales." (Fetrow)
Proponent/ Advocate Claims
"Ginseng has long been used to improve physical and mental performance and is taken in many forms such as teas, tablets, capsules and whole roots." (Ontario)
"A highly preventive effect of ginseng on cancer with a dose-response relationship was observed in humans. These results strongly support the hypothesis of preventive effects of ginseng suggested by earlier animal studies." (Yun 1990)
"Prositol, a component of ginseng extract, has been shown to be effective as an anticancer agent in surgically-treated cancer patients with lymph node metastasis." (Yun 1990)
The odds ratio of cancer was "lower among extracts or powder consumers compared to consumers of other forms of fresh and/or white ginseng." (Yun 1990)
"It is estimated that 5 million people in North America consume ginseng regularly because of its purported anti-fatigue, immunologic, and hormonal qualities." (Koren)
"It is widely used in contemporary Chinese medicine as a stimulant to increase metabolism and to regulate blood pressure and blood glucose. The only recognized medical use in the United States is as a demulcent (soothing medication) in skin ointments... Numerous popular books have promoted ginseng as a healthful tonic, stimulant, and aphrodisiac... I have estimated that there are 5 to 6 million ginseng users in the United States." (Siegel)
Proponents also claim that ginseng can "increase the general immune resistance or activate enzymatic processes in cancer patients" (Therapiewoche); and can stimulate recovery from radiation injury. (Takeda)
Tenbayashi reports that in a 26 year-old patient with chronic myelocytic leukemia "clinical symptoms have disappeared and laboratory findings are restored to the normal value except leucocyte number and LDH (lactate dehydrogenase, an enzyme) value. She has no hemorrhagic diathesis (abnormal arrest of blood flow) and never feels fatigue. These improvements of leukemia are due to the enhancement of the host-resistance." (Tenbayashi)
An investigation was carried out to evaluate the effects of ginseng in inhibition or prevention of carcinogenesis (cancer producing) induced by various chemical carcinogens (cancer producing substances). Effects of red ginseng on newborn mice are summarized as follows: "ginseng extract inhibits the incidence and the growth of lung adenomas induced by urethane, as well as by dimethyl benzanthracene; ginseng extract seems to have the tendency to inhibit the incidence of lung adenoma and hepatoma induced by aflatoxin B1. Thus, it might be concluded from these results that, by conducting systematic and active research in this field, it will be possible to use ginseng extract as a preventative or delaying agent for cancer induced by some environmental carcinogens." (Yun 1983)
"The antitumour effect of ginseng polysaccharides in tumour-bearing mice has been associated with an immunological mechanism of action. Ginseng polysaccharides have been reported to increase the life span of tumour-bearing mice and to inhibit the growth of tumour cells in vivo [in a living body], although cytocidal action was not seen in vitro [in an artificial environment]." (Newall)
A study testing the effect of ginseng's enhancement of host resistance against infections was carried out in mice:
"Treated mice responded with enhanced antibody formation to either a primary or a secondary challenge with sheep red cells. The effects were dose-dependent. At the highest dose regimen, the primary IgM response was increase by 50% and the secondary IgG and IgM (proteins capable of acting as antibodies) responses were increased by 50% and 100% respectively. An even more pronounced effect was obtained with natural killer cell activity which was enhanced between 44% and 150% depending on the effector-to- target cell ratios used in the assay." ..."Experiments in vitro showed two effects of [ginseng], an inhibition of lymphocyte proliferation and a moderate enhancement of immune interferon production." (Jie)
"The present study demonstrated that proliferation of human RCC [renal cell carcinoma] cell lines were inhibited by lipid soluble components of Panax ginseng roots by blocking cell cycle progression at G1 to S phase transition." [During S phase, important materials (eg. proteins and DNA) needed for cell division are synthesized by the cell.] (Sohn)
In a study done "to compare the anticarcinogenic effects of fresh, white, and red ginseng roots and their saponins", it was concluded that "long-cultivated ginseng and red ginseng contain a higher amount of anticarcinogenic components." (Yun 1996)
"Yun and Choi (Young 1995)) found a lower overall rate of several cancers, including lung cancer, hepatoma, and head and neck cancer, in people who took extracts or powdered ginseng but not in those who used fresh ginseng or ginseng tea." (Spencer)
Professional Evaluation/ Critique
There is no standardization for the purity and strength of ginseng, "as several different plants go by the same name." (Ontario)
"Although there is some human and animal data supporting a beneficial effect of ginseng on physical performance, lack of standardization of extracts, study methods and doses makes it difficult to draw conclusions regarding efficacy." (Lepik)
"The term ginseng can refer to any of 22 different plants. Some of these are members of the same family of plants; others... are unrelated to ginseng either botanically or chemically... Lack of standardization of active principles, a potential abuse syndrome and insufficiently tested clinical effects in human beings all speak against their indiscriminate use." (Tyler)
"Extolled for its virtues over many centuries, it has not yet been subjected to adequate scientific testing to document the circumstances under which it is effective and safe. Contradictory research has led to its sale to treat opposing symptoms, so that it is marketed both as a stimulant and as a depressant. Further analyses of fifty-four ginseng products indicated that 25 percent contained no ginseng at all, and 60 percent contained only trace amounts." (Cassileth)
Although the non-peer reviewed literature suggests limited immunomodulating effect, there is no evidence reported in the literature indicating any effect of ginseng improved outcome in cancer patients.
Toxicity/ Risks
Patients who take large doses of ginseng may suffer a "ginseng abuse syndrome," with symptoms including hypertension, insomnia, skin eruptions and diarrhea. (Lepik)
"Wichtl reports 'relatively rare' side effects, '...only with high doses and/or use over very long periods of time.' These include 'sleeplessness, nervousness, diarrhea (particularly in the morning), menopausal bleeding, and hypertony.'" (McGuffin)
"The use of red ginseng (processed by steaming) may potentiate the effects of caffeine and other stimulants. Unprocessed ginseng is not considered as stimulating." (McGuffin)
The report stating ginseng caused a baby to be born with hirsutism (thick hair over the entire forehead) (Koren) was refuted in another article by A. Skelly. (Skelly)
Ginseng may contain a hormone-like substance that can affect the baby during pregnancy and breast-feeding. (Ontario)
"Ginseng contains small amounts of estrogens and has been reported to cause swollen and painful breasts. Other substances may also be packaged and sold as ginseng, including mandrake root, which contains scopolamine (a poisonous hallucinogen) and reserpine (which can lower blood pressure)." (Herbert)
Costs
"The cost may range from $15 to $100 depending on the quality and form of the ginseng." (Ontario, 1994)
"Quality root is extremely expensive - the best grades of Korean Red (a specially "cured" root) retails at more than $20 an ounce. This relatively high cost plus lack of quality control in many areas of the "health food" industry have resulted in commercial ginseng products (teas, powders, capsules, tablets, extracts, etc.) of astounding variability." (Tyler, 1999)
References
Awang DVC. Maternal use of ginseng and neonatal androgenization [letter; comment]. JAMA 1991 Apr 10;265(14):1828.
Cassileth BR. Alternative medicine handbook: the complete reference guide to alternative and complementary therapies. New York: W. W. Norton & Co., 1998:33.
Fetrow CW, Avila JR. Professional's handbook of complementary and alternative medicines. Springhouse, Pennsylvania: Springhouse Corporation 1999:286.
Herbert V. Vitamins and "health" foods: the great American hustle. Philadelphia: George F. Stickley, 1981:168.
Jie YH, et al. Immunomodulatory effects of Panax ginseng C.A. Meyer in the mouse. Agents Actions 1984;15(3-4):386-391.
Koren G, et al. Maternal ginseng use associated with neonatal androgenization [letter]. JAMA 1990 Dec 12;264(22):2866.
Lepik K. Back to our roots: what every pharmacist should know about common herbal remedies. BC Pharmacy 1995 Mar:6-12.
McGuffin M, et al. Botanical safety handbook. New York: CRC Press, 1997:81.
Merck Index: an encyclopedia of chemicals, drugs and biologicals 10th ed. New Jersey: Rathway, 1983:632.
Newall CA, et al. Herbal medicine - a guide for health care professionals. London: Pharmaceutical Press, 1996:145-150.
Ontario Breast Cancer Information Exchange Project. Guide to unconventional cancer therapies. 1st ed. Toronto: Ontario Breast Cancer Information Exchange Project, 1994:65-68.
Siegel RK. Ginseng abuse syndrome. JAMA 1979;241(15):1614-1615.
Skelly A. The blooming of botanicals. Nutrition Post 1996 Summer:13.
Sohn J, et al. Effect of petroleum ether extract of Panax ginseng roots on proliferation and cell cycle progression of human renal cell carcinoma cells. Experimental & Molecular Medicine 1998; 30:47-51.
Spencer JW, Jacobs JJ. Complementary/alternative medicine: an evidence based approach. Toronto: Mosby, 1999:146.
Takeda A, et al. Substances stimulating recovery from radiation injury. Radioisotopes 1978;27(11):666-675.
Tenbayashi T. Enhancement of the host-resistance by Panax Ginseng (meeting abstract). Third International Symposium on Detection and Prevention of Cancer, 1976:242.
Therapiewoche (Anonymous). Tumors. Therapiewoche 1975;25(52):7869-7870.
Tyler VE, Foster S. Tyler's honest herbal: a sensible guide to the use of herbs and related remedies 4th Ed. New York: Haworth herbal press, 1999:187-193.
Yun TK, Choi, SY. A case control study of ginseng intake and cancer. International Journal of Epidemiology. 1990 Dec;19(4):871-876.
Yun TK, Choi SY. Preventive effects of ginseng intake against various human cancers: a case-control study on 1987 pairs. Cancer Epidemiol, Biomarkers, Prevention 1995;4:401.
Yun TK, Lee YS, Kwon HY, Choi KJ. Saponin contents and anticarcinogenic effects of ginseng depending on types and ages in mice. Acta Pharmacologica Sinica 1996;17:293-8.
Yun TK, Yun YS, Han IW. Anticarcinogenic effect of long-term oral administration of red ginseng on newborn mice exposed to various chemical carcinogens. Cancer Detection and Prevention 1983;6:515-525.
Revised February 2000