Effects of Ginger (Zingiber officinale Roscoe) on Type 2 Diabetes Mellitus and Components of the Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ginger: A Nutraceutical Supplement for Protection Against Various Cardiovascular Diseases in Clinical Trials

Cardiovascular diseases (CVDs) are increasing in prevalence, causing significant health issues and remaining one of the leading causes of death worldwide. Medical herbs continue to be used as an alternative treatment approach for several diseases, including various CVDs. Since ancient times, certain herbs have been safely used to alleviate the risk of developing CVD and control or improve the symptoms of medical conditions, such as in cases of congestive heart failure, angina, atherosclerosis, and systolic hypertension. Ginger is one of the medicinal herbs that neutral agents use to prevent and treat various CVDs. Ginger has antioxidant, anti-inflammatory, and immunomodulatory components and may improve cardiovascular risk factors. The natural components of ginger effectively inhibit inflammation, oxidative stress, and insulin resistance; may reduce fasting blood glucose, triglyceride, and low-density lipoprotein (LDL) levels; and prevent CVDs. Ginger can be an alternative that has lower side effects. Ginger's bioactive components may improve human blood lipid profile and decrease blood sugar levels. Further research is necessary to confirm ginger phytochemicals' efficacy and mechanism for various CVDs. The present review aims to summarize the effects of ginger's bioactive compounds on cardiovascular diseases.

Antioxidant and inflammatory-modulating properties of ginger and bitterleaf teas

The present study evaluated the effects of ginger and bitterleaf tea infusions on redox and inflammatory balance in rats. Twenty-four Wistar rats with weights of between 160 and 180 g were assigned into four (4) groups (n = 6). The control group received distilled water, while the remaining groups were administered tea infusions of ginger, bitterleaf, or a combination of both at 5 mg/mL, respectively. Bitterleaf and ginger teas elevated the levels of superoxide dismutase, catalase, glutathione peroxidase, and reduced glutathione in rat plasma and liver, while malondialdehyde levels decreased. Furthermore, ginger tea caused an increase in the expression of nuclear factor erythroid-2-related factor 2 (Nrf-2) and reduced tumor necrosis factor alpha (TNF-α). The GC-MS analysis of the teas identified 77 chemical compounds, among which gingerol and precocene I were predominant. Collectively, the findings indicate, in particular, that ginger tea may boost antioxidant and anti-inflammatory capacity by increasing Nrf-2 levels.

Plant-Based Diets and Phytochemicals in the Management of Diabetes Mellitus and Prevention of Its Complications: A Review

Diabetes mellitus (DM) is currently regarded as a global public health crisis for which lifelong treatment with conventional drugs presents limitations in terms of side effects, accessibility, and cost. Type 2 diabetes (T2DM), usually associated with obesity, is characterized by elevated blood glucose levels, hyperlipidemia, chronic inflammation, impaired β-cell function, and insulin resistance. If left untreated or when poorly controlled, DM increases the risk of vascular complications such as hypertension, nephropathy, neuropathy, and retinopathy, which can be severely debilitating or life-threatening. Plant-based foods represent a promising natural approach for the management of T2DM due to the vast array of phytochemicals they contain. Numerous epidemiological studies have highlighted the importance of a diet rich in plant-based foods (vegetables, fruits, spices, and condiments) in the prevention and management of DM. Unlike conventional medications, such natural products are widely accessible, affordable, and generally free from adverse effects. Integrating plant-derived foods into the daily diet not only helps control the hyperglycemia observed in DM but also supports weight management in obese individuals and has broad health benefits. In this review, we provide an overview of the pathogenesis and current therapeutic management of DM, with a particular focus on the promising potential of plant-based foods.

The Clinical Research on Ginger (Zingiber officinale): Insights from ClinicalTrials.gov analysis

Ginger (Zingiber officinale) has a rich history of traditional medicinal use and has attracted a global interest in its health benefits. This study aims to provide insights into the clinical research landscape on ginger, focusing on its pharmacological effects and studied health-related outcomes. The study design involves systematic analysis of data from clinical trials available on ClinicalTrials.gov and discussion of findings in the context of the existing scientific knowledge. A comprehensive analysis of clinical trials registered on ClinicalTrials.gov related to ginger was first conducted, and the scientific background related to specific ginger clinical research avenues was further evaluated through PubMed searches. A variety of trial designs were identified, including treatment, prevention, and supportive care objectives. A total of 188 studies were identified on ClinicalTrials.gov, of which 89 met the inclusion criteria. Among the 89 trials, treatment objectives were predominant (47.2%), and dietary supplements (40.4%) and drugs (27%) were the most prevalent intervention types. These trials covered various health outcomes, such as antiemetic activity, analgesic function, effects on health-related quality of life, blood pressure variation, energy expenditure, and reduction in xerostomia. This study analysis provides a comprehensive overview of the clinical trials landscape on ginger, focusing on its broad spectrum of potential health benefits. While individual trials show promising results, a significant gap in the available data with a low reporting rate of final results is identified, underscoring the need for further research to establish conclusive evidence of ginger's therapeutic potentials.

Beneficial Effects of Ginger Extract on Eye Fatigue and Shoulder Stiffness: A Randomized, Double-Blind, and Placebo-Controlled Parallel Study

This study aimed to assess ginger extract's impact on ocular and peripheral blood flow and its potential to alleviate eye fatigue and shoulder stiffness. This study included 100 healthy individuals aged 20-73 years with eye fatigue and shoulder stiffness. Participants were randomly assigned to receive either placebo capsules or ginger extract capsules daily for eight weeks. Ocular blood flow, peripheral blood flow, eye fatigue (visual analog scale [VAS]), shoulder stiffness (VAS), body warmth (VAS), and shoulder muscle stiffness were assessed at weeks 0, 4, and 8, respectively. No improvement in ocular blood flow was observed under the study conditions. Conversely, peripheral blood flow in deep areas was enhanced in females (p = 0.033). Subgroup analysis by age (≥51 or <51 years) revealed that ginger's effect on enhancing peripheral blood flow in deep vessels was restricted in females under 51 (p = 0.017). Similarly, subjective complaints of eye fatigue and shoulder stiffness were improved by ginger consumption in females under 51. Body warmth was favorably changed significantly in males ≥51 years due to ginger consumption. The muscle stiffness showed no statistically significant changes. In conclusion, ginger consumption reduces eye fatigue and shoulder stiffness by enhancing peripheral blood flow in relatively young females.

Herbal Products as Complementary or Alternative Medicine for the Management of Hyperglycemia and Dyslipidemia in Patients with Type 2 Diabetes: Current Evidence Based on Findings of Interventional Studies

Type 2 diabetes (T2D) is known as a major public health problem with a noticeable adverse impact on quality of life and health expenditures worldwide. Despite using routine multiple pharmacological and nonpharmacological interventions, including diet therapy and increasing physical activity, controlling this chronic disease remains a challenging issue, and therapeutic goals are often not achieved. Therefore, recently, other therapeutic procedures, such as using herbal products and functional foods as complementary or alternative medicine (CAM), have received great attention as a new approach to managing T2D complications, according to the literature. We reviewed the existing evidence that supports using various fundamental medicinal herbs, including cinnamon, saffron, ginger, jujube, turmeric, and barberry, as CAM adjunctive therapeutic strategies for T2D patients. The current review addressed different aspects of the potential impact of the abovementioned herbal products in improving glycemic indices and lipid profiles, including the effect size reported in the studies, their effective dose, possible side effects, herbs-drug interactions, and their potential action mechanisms.

Potential Benefit of Spices for Glycemic Control

The prevalence of hyperglycemia is increasing worldwide in large part due to the escalating prevalence of obesity. It can occur along with other disorders and diseases, contributing to escalating health costs and accumulating disabilities. Besides dietary approaches and availability of antidiabetic medications, other complementary approaches and adjunct therapies using biologically active botanical phytochemicals have received growing attention for managing type 2 diabetes mellitus. Spices are one source of these bioactive plant constituents, and considerable preclinical studies have investigated their possible health benefits. There also are an increasing number of human clinical trials assessing the ability of spices and their individual plant constituents to improve glucose homeostasis in those with type 2 diabetes mellitus and other dysglycemic conditions. This narrative review provides a summary of the human studies evaluating the effects of select spices on glucose homeostasis and highlights areas for future research.

Nutritional aphrodisiacs: Biochemistry and Pharmacology

In 2022, the global prevalence of erectile dysfunction (ED) was estimated to be at least 150 million cases. This number is greatly suspected to be underestimate as most men withhold information about ED. Also, about 15% of world population have infertility troubles, and male factors are responsible for almost half of these cases. Studies have shown that the quality of semen has decreased in the past several decades owing to various health factors and environmental toxicants. The current medical interventions involve the inhibition of phosphodiesterase 5 which suffer from serious side effects and costly. One of the popular and most sought interventions are the natural and nutritional remedies as they are foods in essence and potentially with no harm to the body. Therefore, the goal of this paper is to provide a review of the most common nutritional aphrodisiacs with increasing libido and fertility highlighting the potential active constituents as well as the underlying mechanisms.

Natural products for managing metabolic syndrome: a scoping review

Introduction

Metabolic syndrome comprises a collection of metabolic disorders stemming from factors like genetic predisposition, inadequate nutrition, stress, decreased physical activity, aging, and ethnicity. Although traditional pharmaceutical treatments exist for metabolic syndrome, their limited popularity is attributed to high costs and adverse effects. Consequently, natural products with fewer side effects have been explored for managing this condition. This literature review aims to explore the role of natural products including herbs, botanicals, vitamins, minerals, probiotics, and dietary supplements in managing metabolic syndrome.

Methods

This scoping review was conducted in five steps, involving the formulation of a research question, the retrieval and extraction of relevant studies, the selection of pertinent studies, the organization of information into tables, and the reporting of results. Data was collected from various databases including Embase, Science Direct, PubMed, Google Scholar, Scopus, and Web of Science, with a focus on studies published from 2010 to the present, available in English and with full-text accessibility.

Results

We identified 1,259 articles, screened their titles, abstracts, and full texts, ultimately incorporating 169 pertinent articles into this review (comprising 90 review articles, 32 trial articles, 6 in vitro articles, 38 in vivo articles, 1 experimental article and 2 observational articles). The study's outcomes revealed that natural products, encompassing plants and their derivatives, vitamins and supplements, as well as probiotics, can exert a beneficial influence on metabolic syndrome by regulating blood sugar, blood pressure, lipid profiles, obesity, and abnormal cholesterol and triglyceride levels.

Conclusion

The current study underscores the significance of natural products in addressing metabolic syndrome. Consequently, it is advisable to conduct further extensive research to assess the efficacy of these products, potentially integrating them into treatment regimens for individuals with metabolic syndrome.

Natural products for managing metabolic syndrome: a scoping review

Introduction

Metabolic syndrome comprises a collection of metabolic disorders stemming from factors like genetic predisposition, inadequate nutrition, stress, decreased physical activity, aging, and ethnicity. Although traditional pharmaceutical treatments exist for metabolic syndrome, their limited popularity is attributed to high costs and adverse effects. Consequently, natural products with fewer side effects have been explored for managing this condition. This literature review aims to explore the role of natural products including herbs, botanicals, vitamins, minerals, probiotics, and dietary supplements in managing metabolic syndrome.

Methods

This scoping review was conducted in five steps, involving the formulation of a research question, the retrieval and extraction of relevant studies, the selection of pertinent studies, the organization of information into tables, and the reporting of results. Data was collected from various databases including Embase, Science Direct, PubMed, Google Scholar, Scopus, and Web of Science, with a focus on studies published from 2010 to the present, available in English and with full-text accessibility.

Results

We identified 1,259 articles, screened their titles, abstracts, and full texts, ultimately incorporating 169 pertinent articles into this review (comprising 90 review articles, 32 trial articles, 6 in vitro articles, 38 in vivo articles, 1 experimental article and 2 observational articles). The study’s outcomes revealed that natural products, encompassing plants and their derivatives, vitamins and supplements, as well as probiotics, can exert a beneficial influence on metabolic syndrome by regulating blood sugar, blood pressure, lipid profiles, obesity, and abnormal cholesterol and triglyceride levels.

Conclusion

The current study underscores the significance of natural products in addressing metabolic syndrome. Consequently, it is advisable to conduct further extensive research to assess the efficacy of these products, potentially integrating them into treatment regimens for individuals with metabolic syndrome.

Bioactive Compounds Formulated in Phytosomes Administered as Complementary Therapy for Metabolic Disorders

Metabolic disorders (MDs), including dyslipidemia, non-alcoholic fatty liver disease, diabetes mellitus, obesity and cardiovascular diseases are a significant threat to human health, despite the many therapies developed for their treatment. Different classes of bioactive compounds, such as polyphenols, flavonoids, alkaloids, and triterpenes have shown therapeutic potential in ameliorating various disorders. Most of these compounds present low bioavailability when administered orally, being rapidly metabolized in the digestive tract and liver which makes their metabolites less effective. Moreover, some of the bioactive compounds cannot fully exert their beneficial properties due to the low solubility and complex chemical structure which impede the passive diffusion through the intestinal cell membranes. To overcome these limitations, an innovative delivery system of phytosomes was developed. This review aims to highlight the scientific evidence proving the enhanced therapeutic benefits of the bioactive compounds formulated in phytosomes compared to the free compounds. The existing knowledge concerning the phytosomes' preparation, their characterization and bioavailability as well as the commercially available phytosomes with therapeutic potential to alleviate MDs are concisely depicted. This review brings arguments to encourage the use of phytosome formulation to diminish risk factors inducing MDs, or to treat the already installed diseases as complementary therapy to allopathic medication.

From Gut to Glucose: A Comprehensive Review on Functional Foods and Dietary Interventions for Diabetes Management

BACKGROUND

In the realm of diabetes research, considerable attention has been directed toward elucidating the intricate interplay between the gastrointestinal tract and glucose regulation. The gastrointestinal tract, once exclusively considered for its role in digestion and nutrient assimilation, is presently acknowledged as a multifaceted ecosystem with regulatory supremacy over metabolic homeostasis and glucose metabolism. Recent studies indicate that alterations in the composition and functionality of the gut microbiota could potentially influence the regulation of glucose levels and glucose homeostasis in the body. Dysbiosis, characterized by perturbations in the equilibrium of gut microbial constituents, has been irrevocably linked to an augmented risk of diabetes mellitus (DM). Moreover, research has revealed the potential influence of the gut microbiota on important factors, like inflammation and insulin sensitivity, which are key contributors to the onset and progression of diabetes. The key protagonists implicated in the regulation of glucose encompass the gut bacteria, gut barrier integrity, and the gut-brain axis. A viable approach to enhance glycemic control while concurrently mitigating the burden of comorbidities associated with diabetes resides in the strategic manipulation of the gut environment through adapted dietary practices.

OBJECTIVE

This review aimed to provide a deep understanding of the complex relationship between gut health, glucose metabolism, and diabetes treatment.

CONCLUSION

This study has presented an exhaustive overview of dietary therapies and functional foods that have undergone extensive research to explore their potential advantages in the management of diabetes. It looks into the role of gut health in glucose regulation, discusses the impact of different dietary elements on the course of diabetes, and evaluates how well functional foods can help with glycemic control. Furthermore, it investigates the mechanistic aspects of these therapies, including their influence on insulin sensitivity, β-cell activity, and inflammation. It deliberates on the limitations and potential prospects associated with integrating functional foods into personalized approaches to diabetes care.

The Effects of Ginger (Zingiber Officinale Roscoe) on Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Randomized Double-Blinded Placebo-Controlled Clinical Trial

Nonalcoholic fatty liver disease (NAFLD) is a prominent etiological factor for liver cirrhosis worldwide. It is frequently associated with obesity, diabetes, dyslipidemia, and hypertension. The objective of this study is to assess the efficacy and safety of ginger (Zingiber officinale Roscoe) supplementation in patients with type 2 diabetes mellitus (T2DM) who have NAFLD. In a two-arm, double-blind, placebo-controlled clinical trial, seventy-six patients diagnosed with both T2DM and NAFLD were randomly assigned to receive either ginger powder capsules (1000 mg, twice daily) or placebo capsules (administered in the same manner) for a period of three months. Anthropometric measurements, blood pressure readings, biochemical profiles, and imaging parameters were assessed before and after the intervention. Safety measures were also evaluated. In both the ginger and placebo groups, there was a significant reduction in mean body mass index (BMI), waist and hip circumferences, as well as liver transaminase levels. Moreover, significant improvements in mean systolic and diastolic blood pressures were observed in the ginger group (p = 0.02 and < 0.0001, respectively). Within the ginger group, there was a decrease in serum insulin levels and insulin resistance (HOMA-IR) (p = 0.002 and 0.004, respectively). Furthermore, the ginger group exhibited an improvement in serum HDL-cholesterol level (p = 0.01). However, there were no significant changes in the assessed inflammatory markers or the indices obtained from fibroscan imaging, including steatosis percent and controlled attenuation parameter. This study demonstrates that ginger supplementation can significantly improve mean systolic and diastolic blood pressures. However, it does not have a significant impact on inflammatory markers or fibroscan imaging indices. Nonetheless, the three-month use of ginger improves serum insulin level, insulin resistance (HOMA-IR), and HDL-cholesterol level compared to baseline values. Further investigations with longer durations and larger sample sizes are recommended.

Association between dietary glycemic index and non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

Objective

Managing dietary glycemic index (GI) deserves further attention in the interplay between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). This study aimed to evaluate the relationship between dietary GI and the odds of NAFLD in patients with T2DM.

Methods

A cross-sectional study was carried out between April 2021 and February 2022, including 200 participants with T2DM aged 18-70 years, of which 133 had NAFLD and 67 were in the non-NAFLD group. Cardiometabolic parameters were analyzed using standard biochemical kits and dietary intake was assessed using a validated food frequency questionnaire. Binary logistic regression was applied to explore odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD according to tertiles of dietary GI.

Results

Highest vs. lowest tertile (< 57 vs. > 60.89) of energy-adjusted GI was not associated with the odds of having NAFLD (OR 1.25, 95% CI = 0.6-2.57; P-trend = 0.54) in the crude model. However, there was an OR of 3.24 (95% CI = 1.03-10.15) accompanied by a significant trend (P-trend = 0.04) after full control for potential confounders (age, gender, smoking status, duration of diabetes, physical activity, waist circumference, HbA1c, triglycerides, total cholesterol, dietary intake of total carbohydrates, simple carbohydrates, fat, and protein).

Conclusion

High dietary GI is associated with increased odds of NAFLD in subjects with T2DM. However, interventional and longitudinal cohort studies are required to confirm these findings.

Kombucha tea as an anti-hyperglycemic agent in humans with diabetes - a randomized controlled pilot investigation

Introduction

Kombucha is a popular fermented tea that has attracted considerable attention due, in part, to its suggested health benefits. Previous results from animal models led us to hypothesize kombucha may reduce blood sugar levels in humans with diabetes. The objective of this pilot clinical study was to evaluate kombucha for its anti-hyperglycemic activities in adults with diabetes mellitus type II.

Methods

The study was organized as a prospective randomized double-blinded crossover study at a single-center urban hospital system. Participants (n = 12) were instructed to consume either a kombucha product or a placebo control (each 240 mL) for 4 weeks. After an 8-week washout period, participants consumed the alternate product. Fasting blood glucose levels were self-determined at baseline and at 1 and 4 weeks during each treatment period. Secondary health outcomes, including overall health, insulin requirement, gut health, skin health, mental health, and vulvovaginal health were measured by questionnaire at the same time points. The kombucha microbiota was assessed by selective culturing and 16S rRNA gene (bacteria) and ITS (fungi) sequencing. Fermentation end products were assessed by HPLC. Statistical significance of changes in fasting blood glucose was determined using paired, two-tailed student's t-tests.

Results

Kombucha lowered average fasting blood glucose levels at 4 weeks compared to baseline (164 vs. 116 mg/dL, p = 0.035), whereas the placebo did not (162 vs. 141 mg/dL, p = 0.078). The kombucha microbiota, as assessed by cultural enumeration, was mainly comprised of lactic acid bacteria, acetic acid bacteria, and yeast, with each group present at about 106 colony forming units (CFU)/mL. Likewise, 16S rRNA gene sequencing confirmed that lactic acid and acetic acid bacteria were the most abundant bacteria, and ITS sequencing showed Dekkera was the most abundant yeast. The primary fermentation end products were lactic and acetic acids, both less than 1%. Ethanol was present at 1.5%.

Discussion

Although this pilot study was limited by a small sample size, kombucha was associated with reduced blood glucose levels in humans with diabetes. Larger follow-up studies are warranted.

Clinical trial registration

ClinicalTrials.gov, identifier NCT04107207.

Formulation of Phytosomes with Extracts of Ginger Rhizomes and Rosehips with Improved Bioavailability, Antioxidant and Anti-Inflammatory Effects In Vivo

The poor water solubility of natural antioxidants restricts their bioavailability and therapeutic use. We aimed to develop a new phytosome formulation with active compounds from extracts of ginger (GINex) and rosehips (ROSAex) designed to increase their bioavailability, antioxidant and anti-inflammatory properties. The phytosomes (PHYTOGINROSA-PGR) were prepared from freeze-dried GINex, ROSAex and phosphatidylcholine (PC) in different mass ratios using the thin-layer hydration method. PGR was characterized for structure, size, zeta potential, and encapsulation efficiency. Results showed that PGR comprises several different populations of particles, their size increasing with ROSAex concentration, having a zeta potential of ~-21mV. The encapsulation efficiency of 6-gingerol and β-carotene was >80%. 31P NMR spectra showed that the shielding effect of the phosphorus atom in PC is proportional to the amount of ROSAex in PGR. PGR with a mass ratio GINex:ROSAex:PC-0.5:0.5:1 had the most effective antioxidant and anti-inflammatory effects in cultured human enterocytes. PGR-0.5:0.5:1 bioavailability and biodistribution were assessed in C57Bl/6J mice, and their antioxidant and anti-inflammatory effects were evaluated after administration by gavage to C57Bl/6J mice prior to LPS-induced systemic inflammation. Compared to extracts, PGR induced a 2.6-fold increase in 6-gingerol levels in plasma and over 40% in the liver and kidneys, in parallel with a 65% decrease in the stomach. PGR treatment of mice with systemic inflammation increased the sera antioxidant enzymes paraoxonase-1 and superoxide dismutase-2 and decreased the proinflammatory TNFα and IL-1β levels in the liver and small intestine. No toxicity was induced by PGR either in vitro or in vivo. In conclusion, the phytosome formulation of GINex and ROSAex we developed resulted in stable complexes for oral administration with increased bioavailability, antioxidant and anti-inflammatory potential of their active compounds.

Renoprotective effects of the ginger (Zingiber officinale) on Diabetic kidney disease, current knowledge and future direction: a systematic review of animal studies

OBJECTIVE

Diabetic kidney disease affects approximately 40% of diabetic patients and is the leading cause of chronic kidney disease (CKD) worldwide. As a result, preventing renal complications in diabetic patients is critical. Ginger (Zingiber Officinale Rosco) is a popular spice and natral medicine. The present study was a systematic review focused on the existing evidence of the renoprotective effect of ginger extract on some features of diabetic kidney disease.

METHODS

The literature was searched in online databases such as PubMed, Scopus, EMBASE, ProQuest databases, and Google Scholar from inception to July 2022.

RESULTS

This review included 41 articles that met the eligibility criteria. Ginger supplementation was found to be associated with a significant decrease in blood glucose in 28 studies. Nine studies showed a significant reduction in malondialdehyde (MDA) after supplementation. Also, seventeen studies showed decreased serum levels of creatinine. Fifteen studies reported a decrease in total cholesterol (TC) and fourteen studies showed a lowered triglycerides (TG) concentrations. In twenty-six studies, ginger reduced renal injuries due to diabetes.

CONCLUSION

Ginger may improve blood sugar indices, lipid profile, some inflammatory markers, oxidative stress, and pathologic injuries in diabetic kidney disease. However, future well-designed clinical trials and meta-analyses are required for a solid consensus.

Clinical Application of Traditional Chinese Medicine Therapy for Type 2 Diabetes Mellitus: An Evidence Map

Type 2 diabetes mellitus (T2DM), a common disease with a complex etiology in the world, is an important risk factor for severe cardiovascular and cerebrovascular diseases. However, treatments of T2DM are mainly based on Western medicine, whose severe side effects make traditional Chinese medicine (TCM) therapy more appealing to patients and clinicians. The overall clinical evidence for different TCM therapies in the treatment of T2DM is still unclear. This study aimed to adopt the evidence-mapping method and integrate the evidence from various researches on this topic, to depict the whole picture of TCM therapies for T2DM. This review included searches of PubMed, Embase, Web of Science, and three major Chinese literature databases (CNKI, VIP, and Wanfang) from inception to November 18, 2021. Two independent reviewers screened the literature, extracted information, and evaluated the quality of all included studies. A systematic review was subsequently performed. In total, 47 studies were reviewed, of which 46 studies (97.9%) were from China and 1 (2.1%) was from Canada. The evidence map was conducted according to different TCM therapies, including herbs or herbal extracts, compounds, powders, decoctions, pills, external treatment, basic theories and treatment principles of TCM, proprietary Chinese medicines, and unspecified TCM integrated therapies. According to the AMSTAR-2 scoring results, 4 papers were rated as high quality, 11 were low quality, and 32 were very low quality. Outcome indicators mainly focused on FBG, HbA1c, 2-h PBG, TC, TG, LDL-C, etc. The results showed that different types of TCM treatment had different improvement effects on the outcome indicators of T2DM. More consistent benefits were observed in the improvement of FBG, HbA1c, and 2-h PBG with treatment regimens based on basic theories and treatment principles of TCM, decoctions and pills, and unspecified TCM integrated therapies. Among herbs, ginger and Coptis root showed more improvement in all outcomes. Compounds, powders, and external treatment showed relatively consistent beneficial effects on the improvement of FBG. No serious adverse events were reported. Overall, the current evidence map provided an intuitive overview of the beneficial effects of TCM therapies in the treatment of type 2 diabetes. This study can be used as a reference for the clinical application of traditional Chinese medicine in T2DM, but due to the low-quality level of the included studies, it should be treated with caution in clinical practices.

Zingiberaceae plants/curcumin consumption and multiple health outcomes: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials in humans

This umbrella review is to recapitulate and grade the available evidence of associations between consumption of Zingiberaceae plants/curcumin (Cur) and multiple health-related outcomes. This study included 161 meta-analyses of randomized controlled trials in 76 articles with 67 unique health outcomes. Data on heterogeneity and publication bias are considered to assess the quality of evidence. Based on the different impact of Zingiberaceae plants/Cur on human health, the advantages outweigh the disadvantages. Zingiberaceae plants/Cur can mainly improve metabolic syndrome, non-alcoholic fatty liver disease, cardiovascular disease, and some chronic inflammatory diseases, likewise, obviously relief the pain of osteoarthritis and related diseases. Ginger supplements have been shown to improve vomiting during pregnancy and to relieve nausea and vomiting caused by chemotherapy and surgery. The surgery is any type of surgery, including laparoscopic surgery, gynecological surgery and mixed surgery. Beneficial associations were found with Cur intervention in gastrointestinal, neurological and oral diseases. Zingiberaceae plants/Cur are generally safe and favorable for multiple health outcomes in humans. High-quality research is further needed to prove the observed associations.

The effects of ginger and its constituents in the prevention of metabolic syndrome: A review

Metabolic syndrome is a multifactorial disorder characterized by hyperglycemia, hyperlipidemia, obesity, and hypertension risk factors. Moreover, metabolic syndrome is the most ordinary risk factor for cardiovascular disease (CVD). Numerous chemical drugs are being synthesized to heal metabolic risk factors. Still, due to their abundant side effects, herbal medicines have a vital role in the treatment of these abnormalities. Ginger (Zingiber officinale Roscoe, Zingiberaceae) plant has been traditionally used in medicine to treat disorders, including CVD. The unique ginger properties are attributed to the presence of [6]-gingerol, [8]-gingerol, [10]-gingerol, and [6]-shogaol, which through different mechanisms can be beneficial in metabolic syndrome. Ginger has a beneficial role in metabolic syndrome treatment due to its hypotensive, anti-obesity, hypoglycemic, and hypolipidemic effects. It can significantly reduce atherosclerotic lesion areas, VLDL and LDL cholesterol levels, and elevate adenosine deaminase activity in platelet and lymphocytes. Also, it promotes ATP/ADP hydrolysis. In the current article review, the critical properties of ginger and its constituents' effects on the metabolic syndrome with a special focus on different molecular and cellular mechanisms have been discussed. This article also suggests that ginger may be introduced as a therapeutic or preventive agent against metabolic syndrome after randomized clinical trials.

Ginger for Healthy Ageing: A Systematic Review on Current Evidence of Its Antioxidant, Anti-Inflammatory, and Anticancer Properties

The world's population is ageing at an accelerated pace. Ageing is a natural, physiological but highly complex and multifactorial process that all species in the Tree of Life experience over time. Physical and mental disabilities, and age-related diseases, would increase along with the increasing life expectancy. Ginger (Zingiber officinale) is a plant that belongs to the Zingiberaceae family, native to Southeast Asia. For hundreds of years, ginger has been consumed in various ways by the natives of Asian countries, both as culinary and medicinal herb for the treatment of many diseases. Mounting evidence suggests that ginger can promote healthy ageing, reduce morbidity, and prolong healthy lifespan. Ginger, a well-known natural product, has been demonstrated to possess antioxidant, anti-inflammatory, anticancer, and antimicrobial properties, as well as an outstanding antiviral activity due to a high concentration of antiviral compounds. In this review, the current evidence on the potential role of ginger and its active compounds in the prevention of ageing is discussed.

The ginger extract could improve diabetic retinopathy by inhibiting the expression of e/iNOS and G6PDH, apoptosis, inflammation, and angiogenesis

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the retina. It is the result of damage to the small blood vessels and neurons of the retina. Ginger and its phytochemical compounds can improve oxidative damage and inflammation. However, the effects of this plant on ocular expression G6PDH and e/iNOS, eye cell apoptosis, and angiogenesis are not well known in this tissue. Therefore, the aim of this study was to evaluate the therapeutic potential of ginger extract on rats with type 2 diabetic retinopathy. Thirty-two Wistar rats were randomly divided into four controlled and treated groups. The serum level of metabolic factors such as lipid profiles, insulin and glucose, and the level of oxidative biomarkers along with the TNF-α level in eye tissue were measured. The expression of NF-κB, VEGF, BAX, Bcl-2, caspase-3, e/iNOS, and G6PDH in eye tissue was measured. Serum levels of lipid profiles, glucose, and insulin, oxidative and inflammatory markers were significantly increased in the diabetic group compared to control. While, treatment with ginger extract could significantly improve these factors in diabetic rats. Moreover, the ocular expression of e/iNOS, G6PDH, VEGF, NF-κB, and genes involved in apoptosis was changed in diabetic rats. However, treatment with ginger extract could ameliorate these changes in the diabetic-treated group. It can be concluded that ginger extract could improve diabetic retinopathy by inhibiting oxidative damage, inflammation, iNOS, VEGF, apoptosis, and improving eNOS and G6PDH. PRACTICAL APPLICATIONS: Microvascular complications of diabetes such as retinopathy can be one of the main causes of disability in people with diabetes. Chronic hyperglycemia, oxidative stress, inflammation, and apoptosis cause diabetic retinopathy through retinal damage. Ginger, on the other hand, is an available, inexpensive, and uncomplicated medicinal plant that contains more than 20 different phytochemicals, such as gingerol and shogaol, which have anti-inflammatory, antioxidant, antihypertensive, hypoglycemic, and hypolipidemic properties. The results of our study showed well that the ginger extract could improve diabetic retinopathy by inhibiting the expression of e/iNOS and G6PDH and oxidative damage, apoptosis, inflammation, and angiogenesis. Therefore, ginger and its compounds can be a good option to improve the complications of diabetes.

The effect of ginger supplementation on metabolic profiles in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

There is some evidence regarding the positive effects of ginger supplementation on metabolic profile in patients with type 2 diabetes (T2DM). However, they are conflicting. The present systematic review and meta-analysis aimed to summarize earlier findings for the effect of ginger supplementation on metabolic profile in patients with T2DM.

METHODS

Scopus, PubMed and Google Scholar databases were systematically searched up until September 2021 to collect all randomized clinical trials that evaluated the effect of ginger supplementation on FBS, HbA1c, TC, TG, LDL, HDL, SBP and DBP in patients with T2DM. We conducted our study according to the 2020 PRISMA guidelines. We included only English language publications. Pooled effect sizes were measured using a random-effects model and were reported as the weighted mean difference (WMD) and 95% CI. In addition, the Cochrane Collaboration's risk of bias tool was used to evaluate quality of the trials.

RESULTS

In overall, 10 articles were included in this systematic review and meta-analysis. Our pooled meta-analysis indicated a significant reduction in FBS following ginger supplementation by polling 8 effect sizes [weighted mean difference (WMD): - 18.81; 95% CI: - 28.70, - 8.92), I2 = 77.4%] and in HbA1C through 7 effect sizes (WMD: -0.57; 95% CI: -0.93, -0.20, I2 =88.6%). Pooling 5 effect sizes, we found a significant reduction in SBP (WMD: -4.20; 95% CI: -7.64, -0.77, I2 =97%) and DBP [WMD: - 1.61; 95% CI: - 3.04, - 0.18), I2 = 93.2%] after supplementation with ginger. However, our pooled meta-analysis indicated that ginger supplementation had no significant influence on lipid profile involving TG, TC, LDL and HDL.

CONCLUSIONS

We found significant reductions in FBS, HbA1C, SBP and DBP after supplementation with ginger in patients with T2DM compared to control group, with no significant changes in serum lipids. Further large RCTs are required to shed light on this issue.

Effects of medical plants from Zingiberaceae family on cardiovascular risk factors of type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

We performed a meta-analysis on randomized controlled trials (RCTs) to evaluate the efficacy of Zingiberaceae on cardiovascular risk factors in type 2 diabetes mellitus (T2DM). PubMed, Web of Science, Embase, The Cochrane Library, and Scopus were searched systematically until October 18, 2021. Thirty-four RCTs with 2154 patients met our inclusion. Pooled analysis indicated that Zingiberaceae can significantly improve body weight (BW) (WMD = -1.012, 95% CI: -1.673, -0.351, p = .003), fasting blood glucose (FBG) (WMD = -14.292, 95% CI: -18.588, -9.995, p < .001), glycosylated hemoglobin 1c (HbA1c) (WMD = -0.432, 95% CI: -0.607, -0.257, p < .001), serum insulin (WMD = -2.036, 95% CI: -2.857, -1.216, p < .001), homeostasis model assessment insulin resistance (HOMA-IR) (WMD = -0.886, 95% CI: -1.375, -0.398, p < .001), high density lipoprotein-cholesterol (HDL-C) (WMD = 0.850, 95% CI: 0.018, 1.682, p = .045), triglyceride (TG) (WMD = -17.636, 95% CI: -27.121, -8.151, p < .001), diastolic blood pressure (DBP) (WMD = -0.642, 95% CI: -1.148, -0.137, p = .013), C-reactive protein (CRP) (WMD = -0.623, 95% CI: -1.061, -0.186, p = .005), tumor necrosis factor-α (TNF-α) (WMD = -3.020, 95% CI: -4.327, -1.712, p < .001), and interleukin 6 (IL-6) (WMD = -1.147, 95% CI: -1.887, -0.406, p = .002). The supplementation of Zingiberaceae may be an effective adjunctive therapy in management of T2DM and prevention cardiovascular complications by decreasing BW, improving blood glucose control, insulin resistance, lipid profiles (HDL-C and TG), blood pressure (DBP), and reducing inflammation (CRP, TNF-α, and IL-6). PRACTICAL APPLICATIONS: Approximately half of the deaths of individuals with diabetes mellitus (DM) are attributable to cardiovascular disease (CVD), and individuals with T2DM have a two-fold increased risk of cardiovascular mortality than healthy individuals. Currently, T2DM is mainly treated with hypoglycemic medication such as sulfonylureas, thiazolidinediones, meglitinides, and biguanides. Nevertheless, most of them with long-term usage could cause side effects, including hypoglycemia and gastrointestinal troubles. Several species of the Zingiberaceae family are used in traditional herbal medicines, which have been widely used in traditional and complementary medicine. Proving the potential benefits of Zingiberaceae on T2DM and its cardiovascular complications has positive clinical implications for the use of this practical herb.

Zingiber officinale ameliorates diabetic nephropathy and hepatotoxicity in rats by preventing tissue injury and controlling liver/kidney function

BACKGROUND: Chronic hyperglycemia results in decrease glucose metabolism leading to nephropathy, hepatotoxicity and neuropathy. Diabetic complications are regarded globally as one of the leading cause of disability and mortality. OBJECTIVE: The study aims to evaluate the role of Zingiber officinale (ZO) on diabetic nephropathy and hepatotoxicity in rats. METHODS: Thirty diabetic rats and six non-diabetic rats were distributed into six groups (n = 6). Group 1 & 2 (nondiabetic and diabetic) received distilled water at 1 ml/kg. Groups 3–5 received (12.5, 25& 50) mg/kg of ZO respectively while group 6 received 100 mg/kg metformin. All treatments lasted for 28 days and rats were euthanized on day 29. Biochemical parameters, kidney and liver histology were evaluated. RESULTS: No significant change (P >  0.05) was noticed in blood glucose and creatinine levels of diabetic rats treated with 25 mg/kg ZO compared to control. The liver of 25 mg/kg ZO treated diabetic rats showed mild distortion of hepatocytes while kidneys of ZO treated diabetic rats showed mild distortion of renal tubules with few collagen deposits and intact Bowman’s capsule. CONCLUSIONS: ZO ameliorates diabetic complications by regulating biochemical parameters and preventing renal tubules and hepatocytes damage in rats.

Potential Role of Ginger (Zingiber officinale Roscoe) in the Prevention of Neurodegenerative Diseases

Ginger is composed of multiple bioactive compounds, including 6-gingerol, 6-shogaol, 10-gingerol, gingerdiones, gingerdiols, paradols, 6-dehydrogingerols, 5-acetoxy-6-gingerol, 3,5-diacetoxy-6-gingerdiol, and 12-gingerol, that contribute to its recognized biological activities. Among them, the major active compounds are 6-shogaol and 6-gingerol. Scientific evidence supports the beneficial properties of ginger, including antioxidant and anti-inflammatory capacities and in contrast, a specific and less studied bioactivity is the possible neuroprotective effect. The increase in life expectancy has raised the incidence of neurodegenerative diseases (NDs), which present common neuropathological features as increased oxidative stress, neuroinflammation and protein misfolding. The structure-activity relationships of ginger phytochemicals show that ginger can be a candidate to treat NDs by targeting different ligand sites. Its bioactive compounds may improve neurological symptoms and pathological conditions by modulating cell death or cell survival signaling molecules. The cognitive enhancing effects of ginger might be partly explained via alteration of both the monoamine and the cholinergic systems in various brain areas. Moreover, ginger decreases the production of inflammatory related factors. The aim of the present review is to summarize the effects of ginger in the prevention of major neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and multiple sclerosis.

Some Common Medicinal Plants with Antidiabetic Activity, Known and Available in Europe (A Mini-Review)

Diabetes is a metabolic disease that affected 9.3% of adults worldwide in 2019. Its co-occurrence is suspected to increase mortality from COVID-19. The treatment of diabetes is mainly based on the long-term use of pharmacological agents, often expensive and causing unpleasant side effects. There is an alarming increase in the number of pharmaceuticals taken in Europe. The aim of this paper is to concisely collect information concerning the few antidiabetic or hypoglycaemic raw plant materials that are present in the consciousness of Europeans and relatively easily accessible to them on the market and sometimes even grown on European plantations. The following raw materials are discussed in this mini-review: Morus alba L., Cinnamomum zeylanicum J.Presl, Trigonella foenum-graecum L., Phaseolus vulgaris L., Zingiber officinale Rosc., and Panax ginseng C.A.Meyer in terms of scientifically tested antidiabetic activity and the presence of characteristic biologically active compounds and their specific properties, including antioxidant properties. The characteristics of these raw materials are based on in vitro as well as in vivo studies: on animals and in clinical studies. In addition, for each plant, the possibility to use certain morphological elements in the light of EFSA legislation is given.

Ginger from Farmyard to Town: Nutritional and Pharmacological Applications

Ginger (Zingiber officinale) is one of the most widely used natural products consumed as a spice and medicine for treating diabetes, flatulent intestinal colic, indigestion, infertility, inflammation, insomnia, a memory booster, nausea, rheumatism, stomach ache, and urinary tract infections. To date, over 400 bioactive components, such as diarylheptanoids, gingerol analogues, phenylalkanoids, sulfonates, monoterpenoid glycosides, steroids, and terpene compounds have been derived from ginger. Increasing evidence has revealed that ginger possesses a broad range of biological activities, especially protective effects against male infertility, nausea and vomiting, analgesic, anti-diabetic, anti-inflammatory, anti-obesity, and other effects. The pharmacological activities of ginger were mainly attributed to its active phytoconstituents such as 6-gingerol, gingerdiol, gingerol, gingerdione, paradols, shogaols, sesquiterpenes, zingerone, besides other phenolics and flavonoids. In recent years, in silico molecular docking studies revealed that gingerol (6-gingerol, 8-gingerol, and 10-gingerol) and Shogaol (6-shogaol, 8-shogaol, 10-shogaol) had the best binding affinities to the receptor protein in disease conditions such as diabetes, inflammation, obesity, and SARS-CoV-2. Furthermore, some clinical trials have indicated that ginger can be consumed for alleviation of nausea and vomiting induced by surgery, pain, diabetes, obesity, inflammation, male infertility. This review provides an updated understanding of the scientific evidence on the development of ginger and its active compounds as health beneficial agents in future clinical trials.

Zingiber officinale (Ginger) hydroalcoholic extract improved avoidance memory in rat model of streptozotocin-induced diabetes by regulating brain oxidative stress

OBJECTIVES

Diabetes mellitus associated cognitive impairment is suggested to be due to oxidative stress. Considering the anti-diabetic, antioxidant, antihyperlipidemic, and anti-inflammatory effects of Zingiber officinale, the present study aimed to investigate its effect on memory and oxidative stress factors in streptozotocin (STZ)-induced diabetic rats.

METHODS

The rats were allocated into five groups: Control, Diabetic, Diabetic + Ginger 100, Diabetic + Ginger 200, and Diabetic + Ginger 400. Following diabetes induction by STZ (60 mg/kg), 100, 200, or 400 mg/kg Ginger was given for eight weeks. Passive avoidance test (PA) was done and thiol, malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) measurements were carried out in the brain.

RESULTS

The latency into the dark compartment decreased (p<0.001) and the number of entries and time spent in the dark chamber increased in the Diabetic group compared to the Control (p<0.001 for all). All three doses of extract improved performance of the rats in the PA test (p<0.001 for all). The hippocampal and cortical MDA level was higher (p<0.001) while CAT, SOD, and total thiol were lower (p<0.01-p<0.001) in the Diabetic group than the Control. Treatment with 200 and 400 mg/kg Z. officinale extract reduced hippocampal and cortical MDA (p<0.001) and improved CAT (p<0.001) while, just the dose of 400 mg/kg of the extract increased SOD and total thiol in hippocampal and cortical tissues (p<0.001) compared with Diabetic group.

CONCLUSIONS

Z. officinale extract could improve memory by reducing the oxidative stress in STZ-induced diabetes model.

p53 Rather Than β-Catenin Mediated the Combined Hypoglycemic Effect of Cinnamomum cassia (L.) and Zingiber officinale Roscoe in the Streptozotocin-Induced Diabetic Model

Background: The antioxidant, hypoglycemic, and insulin-enhancing effects of ginger and cinnamon were previously confirmed in experimental and human studies, while the combined effect of ginger and cinnamon was not thoroughly investigated until now.

Objectives: This study was designed to assess the antidiabetic effect of combined administration of ginger (Zingiber officinale Roscoe) and cinnamon (Cinnamomum cassia L.) in streptozotocin (STZ)-induced diabetic rats compared to metformin and to explain the mechanism behind this effect.

Materials and methods: STZ was utilized to induce diabetes mellitus in male Sprague–Dawley rats. Assessments of fasting blood glucose level (BGL), the total antioxidant capacity (TAC), serum insulin, HOMA-IR, and HOMA–β cells were performed. Pancreatic gene expression of β-catenin and p53 was assessed using RT-PCR. Assessment of histopathological alterations of pancreatic islet cells was performed using routine and immunohistochemical techniques.

Results: BGL significantly decreased (p = 0.01), while serum insulin and TAC significantly increased (p < 0.001) in both metformin- and ginger plus cinnamon–treated groups compared to the untreated diabetic group. HOMA–β cell index significantly increased (p = 0.001) in ginger plus cinnamon, indicating their enhancing effect on insulin secretion in diabetic conditions. p53 gene expression was significantly upregulated (p < 0.001), while β-catenin was insignificantly downregulated (p = 0.32) in ginger plus cinnamon–treated groups. Insulin immunoexpression in β cells significantly increased (p = 0.001, p = 0.004) in metformin- and ginger plus cinnamon–treated groups, respectively.

Conclusions: The combined administration of ginger and cinnamon has a significant hypoglycemic and antioxidant effect in STZ-induced diabetes mostly through enhancing repair of islet cells mediated via upregulation of pancreatic p53 expression. Therefore, testing this effect in diabetic patients is recommended.

Ginger (Zingiber officinale Roscoe) as a nutraceutical: Focus on the metabolic, analgesic, and antiinflammatory effects

Ginger (from the rizhome of Zingiber officinale Roscoe) has been widely used in ethnomedicine for the cure of several ailments. Main active ingredients include phenolic compounds named gingerols. In modern phytotherapy, ginger preparations are predominantly used to counteract nausea and vomiting in pregnant women. However, a number of other pharmacological actions of potential therapeutic interest, which might broaden the spectrum of its clinical use, have been reported. This focused review aims at giving a shot on the antinflammatory, analgesic, and metabolic actions of Zingiber officinale preparations, with a discussion on the clinical applications in knee osteoarthritis, dysmenorrhea, type‐2 diabetes, hyperlipidemia, overweight, and obesity.

Effectiveness of Ginger in the Treatment of Type 2 Diabetes Mellitus: A Pilot Study of the Randomized Clinical Trial Type

Objective: To analyze the effectiveness of ginger in the reduction of the glycemic, lipid and anthropometric levels in people with Type 2 Diabetes Mellitus. Materials and method: A double-blind pilot study of the randomized clinical trial type, conducted between October 2017 and January 2018. The inclusion criteria were as follows: individuals with type 2 diabetes, aged from 18 to 80 years old, using oral antidiabetic drugs, and with glycated hemoglobin values between 7 % and 10 %. The participants were randomized and allocated in two different groups. In the experimental group, the participants used 1.2 g of ginger and, in the control group, 1.2 g of placebo. The primary outcome was the reduction in blood glucose. The reduction in the lipid and anthropometric levels was the secondary outcome. The intervention lasted four weeks. Results: A total of 21 participants were included in the study. The use of 1.2 g of ginger resulted in noticeable reductions in the anthropometric and lipid levels in 30 days of follow-up, but it did not reduce the glycemic levels. Conclusions: In this study, it was shown that ginger capsules, in doses of 1.2 g a day, can help to reduce anthropometric measures and lipid levels in the population under study; however, it had no effect on the glycemic levels.

Ginger (Zingiber Officinale Roscoe) Extract Protects the Heart Against Inflammation and Fibrosis in Diabetic Rats

BACKGROUND

Fibrosis and inflammation in the heart of patients with diabetes mellitus alongside increased production of free radicals and collagen are together known as diabetic cardiomyopathy. Ginger rhizome has antidiabetic, antioxidant and anti-inflammatory effects. Thus, we investigated the effect of ginger extract on diabetes-induced cardiomyopathy in streptozotocin-induced diabetic rats.

METHODS

Animals were divided into 7 groups: control; diabetic; diabetic treated with different doses of ginger extract of 100, 200 and 400 mg/kg; metformin (200 mg/kg); and metformin-valsartan (200 and 30 mg/kg, respectively). Serum levels of glucose, aspartate aminotransferase, lactate dehydrogenase and creatine kinase-muscle/brain were measured. Fibrosis and inflammation were determined by histologic assessment. Gene expression of transforming growth factor (TGF)-β1, TGF-β3 and angiotensin II type 1 receptor was evaluated by real-time polymerase chain reaction in heart tissue.

RESULTS

Serum glucose level in all treated groups, except for the ginger extract 100-mg/kg group, was significantly lower than in the diabetic group. Serum levels of aspartate aminotransferase, lactate dehydrogenase and creatine kinase-muscle/brain were significantly reduced in all treated groups compared with the diabetic group. In the study of fibrosis, collagen amount in the heart tissue of all treated groups, except the ginger extract 100-mg/kg group, was significantly lower than in the diabetic group. Inflammatory cell infiltrates were decreased, and disarrangement was improved in cardiac tissues of all treated groups compared with the diabetic group. Expression of angiotensin II type 1 receptor and TGF-β1 and TGF-β3 genes in all treated groups downregulated compared with the diabetic group.

CONCLUSIONS

Treatment by ginger extract reduced myocardial fibrosis and inflammation in the course of diabetic cardiomyopathy, possibly through regulation of the expression of genes involved in the SMAD/TGF-β pathway.

Efficacy of Cinnamon as an Adjuvant in Reducing the Glycemic Biomarkers of Type 2 Diabetes Mellitus: A Three-Month, Randomized, Triple-Blind, Placebo-Controlled Clinical Trial

The major aim of this randomized, placebo-controlled, triple-blind clinical trial was to evaluate the efficacy of cinnamon as an adjuvant treatment in reducing glycemic levels in people with type 2 diabetes, compared to a placebo. The study was conducted between August and December 2019, with 160 people with type 2 diabetes, in five Primary Health Units, in Parnaíba, Brazil. Inclusion criteria were: persons of both genders using oral antidiabetic agents, with glycated hemoglobin ≥ 6.0%, and between 18 and 80 years of age. The primary outcome was change in glycated hemoglobin levels after 90 days of intervention. Other biomarkers evaluated were fasting blood glucose, insulin level, and HOMA-IR index. Participants were divided equally into two groups of 80 individuals each, and were given 3 g capsules of either cinnamon or placebo to be taken in combination with their usual oral antidiabetic agents. After 90 days, participants in the cinnamon group had statistically significant reductions of 0.2% of glycated hemoglobin and 0.55 mmol/L of fasting venous glucose, when compared with the placebo group. Cinnamon reduced the glycemic measures of persons with type 2 diabetes, albeit with modest reductions. TRIAL: RBR-2KKB6D.

Natural Bioactive Compounds Useful in Clinical Management of Metabolic Syndrome

Metabolic syndrome (MetS) is a clinical manifestation characterized by a plethora of comorbidities, including hyperglycemia, abdominal obesity, arterial hypertension, and dyslipidemia. All MetS comorbidities participate to induce a low-grade inflammation state and oxidative stress, typical of this syndrome. MetS is related to an increased risk of cardiovascular diseases and early death, with an important impact on health-care costs. For its clinic management a poly-pharmaceutical therapy is often required, but this can cause side effects and reduce the patient's compliance. For this reason, finding a valid and alternative therapeutic strategy, natural and free of side effects, could represent a useful tool in the fight the MetS. In this context, the use of functional foods, and the assumption of natural bioactive compounds (NBCs), could exert beneficial effects on body weight, blood pressure and glucose metabolism control, on endothelial damage, on the improvement of lipid profile, on the inflammatory state, and on oxidative stress. This review focuses on the possible beneficial role of NBCs in the prevention and in the clinical management of MetS and its comorbidities.

Effect of ginger (Zingiber officinale) supplementation on oxidative stress parameters: A systematic review and meta-analysis

A wide variety of antioxidant properties are attributed to ginger (Zingiber officinale) and several randomized controlled trials (RCTs) have investigated the effect of ginger intake on major oxidative stress (OS) parameters. We conducted a systematic review and meta-analysis to evaluate the effects of using ginger to improve OS levels. Medline, Scopus, ISI Web of Science, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched up until March 2020 to gather RCTs that evaluated the impact of ginger intake on the levels and activity of OS parameters in adult subjects. Means and standard deviations for relevant OS variables were extracted and evaluated to assess the quality of the trials based on the Cochrane risk-of-bias tool for randomized trials. The gathered data were pooled and expressed as standardized mean difference (SMD) with 95% Confidence Intervals (95% CI). Twelve trials were included in this review. Ginger intake was shown to significantly increase glutathione peroxidase (GPx) activity (SMD: 1.64; 95% CI: 0.43, 2.85; I2  = 86.8%) and total antioxidant capacity (TAC) (SMD: 0.40; 95% CI: 0.06, 0.73; I2  = 42.8%) and significantly decrease malondialdehyde (MDA) levels (SMD: -0.69; 95% CI: -1.26, -0.12; I2  = 85.8%) compared to control groups. Ginger supplementation also non-significantly associated with an increase in CAT activity (SMD: 1.09; 95% CI: -0.07, 2.25; I2  = 87.6%). This systematic review and meta-analysis presents convincing evidence supporting the efficacy of ginger supplementation on improving OS levels. PRACTICAL IMPLICATIONS: In health sciences, OS, due to its pivotal role in the pathophysiology of several chronic diseases, is a subject with a long history. Recent research strives for a safe, ideal, and effective antioxidant. Ginger is herbal medicine, which has been widely used in traditional and complementary medicine. Proving the antioxidant effect and potential benefit of ginger has positive clinical implications for the application of this practical herb.

Phytochemicals as Potential Epidrugs in Type 2 Diabetes Mellitus

Type 2 diabetes Mellitus (T2DM) prevalence has significantly increased worldwide in recent years due to population age, obesity, and modern sedentary lifestyles. The projections estimate that 439 million people will be diabetic in 2030. T2DM is characterized by an impaired β-pancreatic cell function and insulin secretion, hyperglycemia and insulin resistance, and recently the epigenetic regulation of β-pancreatic cells differentiation has been underlined as being involved. It is currently known that several bioactive molecules, widely abundant in plants used as food or infusions, have a key role in histone modification and DNA methylation, and constituted potential epidrugs candidates against T2DM. In this sense, in this review the epigenetic mechanisms involved in T2DM and protein targets are reviewed, with special focus in studies addressing the potential use of phytochemicals as epidrugs that prevent and/or control T2DM in vivo and in vitro. As main findings, and although some controversial results have been found, bioactive molecules with epigenetic regulatory function, appear to be a potential replacement/complementary therapy of pharmacological hypoglycemic drugs, with minimal side effects. Indeed, natural epidrugs have shown to prevent or delay the T2DM development and the morbidity associated to dysfunction of blood vessels, eyes and kidneys due to sustained hyperglycemia in T2DM patients.

Nutritional implications of ginger: chemistry, biological activities and signaling pathways

Ginger (Zingiber officinale Roscoe) has been used as a food, spice, supplement and flavoring agent and in traditional medicines due to its beneficial characteristics such as pungency, aroma, nutrients and pharmacological activity. Ginger and ginger extracts were reported to have numerous effects, such as those on diabetes and metabolic syndrome, cholesterol levels and lipid metabolism, and inflammation, revealed by epidemiological studies. To understand the beneficial characteristics of ginger, especially its physiological and pharmacological activities at the molecular level, the biological effects of ginger constituents, such as monoterpenes (cineole, citral, limonene and α/β-pinenes), sesquiterpenes (β-elemene, farnesene and zerumbone), phenolics (gingerols, [6]-shogaol, [6]-paradol and zingerone) and diarylheptanoids (curcumin), and the associated signaling pathways are summarized. Ginger constituents are involved in biological activities, such as apoptosis, cell cycle/DNA damage, chromatin/epigenetic regulation, cytoskeletal regulation and adhesion, immunology and inflammation, and neuroscience, and exert their effects through specific signaling pathways associated with cell functions/mechanisms such as autophagy, cellular metabolism, mitogen-activated protein kinase and other signaling, and development/differentiation. Estrogens, such as phytoestrogens, are one of the most important bioactive materials in nature, and the molecular mechanisms of estrogen actions and the assays to detect them have been discussed. The molecular mechanisms of estrogen actions induced by ginger constituents and related applications, such as the chemoprevention of cancers, and the improvement of menopausal syndromes, osteoporosis, endometriosis, prostatic hyperplasia, polycystic ovary syndrome and Alzheimer's disease, were summarized by a comprehensive search of references to understand more about their health benefits and associated health risks.

Effects of ultrafine grinding on physicochemical, functional and surface properties of ginger stem powders

BACKGROUND

Ginger stem (GS) is a by-product of ginger processing. It is not directly edible as a feed or food, which leads to it being discarded as waste or burned. Accordingly, it is very important to develop new functional products in the food or feed industry as a result of high nutritional and medicinal values. In the present study, the structures and physicochemical properties of GS powders of different sizes were evaluated after ultrafine grinding by a vibrating mill.

RESULTS

The ultrafine powders exhibited a smaller particle size and uniform distribution. Higher values in bulk density (from 1.07 ± 0.06 to 1.62 ± 0.08 g mL-1 ), oil holding capacity (from 3.427 ± 0.04 to 4.83 ± 0.03 g mL-1 ), and repose and slide angles (from 42.33 ± 1.52 to 54.36 ± 1.15° and 33.62 ± 0.75 to 47.27 ± 1.34°, respectively) of ultrafine GS powders were exhibited compared to coarse powders. With a reduced particle size, the solubility of ultrafine powders increased significantly (P < 0.05), whereas the water holding and swelling capacities decreased with a reduced particle size and then increased. Fourier transform infrared spectroscopy analysis showed that ultrafine grinding did not damage the main cellular structure of GS powder. The reduction of fiber length and particle size in GS was observed by light microscopy and scanning electron microscopy. The X-ray diffraction patterns demonstrated the crystallinity and the intensity of the peak in superfine GS powders.

CONCLUSION

The present study suggests that ultrafine grinding treatments influence the structures and physicochemical properties of GS powders, and such changes would improve the effective utilization of GS in the food or feed industry. © 2020 Society of Chemical Industry.

Effectiveness of ginger in reducing metabolic levels in people with diabetes: a randomized clinical trial

OBJECTIVE

to evaluate the effectiveness of ginge (Zingiber officinale) in reducing blood sugar and lipid levels in people with type 2 diabetes.

METHOD

a randomized and double-blind clinical trial conducted with people with type 2 diabetes in primary care facilities. The study included individuals aged between 20 and 80 years old, using oral antidiabetic drugs and with HbA1c levels between 6.0% and 10%. The participants were paired 1:1, allocated in two distinct groups, and randomized in blocks, based on their HbA1c levels. In the experimental group, the participants used 1.2g of ginger and, in the control group, 1.2g of placebo, daily for 90 days. The primary outcome was a reduction in fasting blood sugar and HbA1c, and the secondary outcome was a reduction in lipids and HOMA-IR. 103 individuals completed the study, 47 in the experimental group and 56 in the control group.

RESULTS

the participants in the experimental group showed a greater reduction in the blood glucose and total cholesterol values compared to the control group.

CONCLUSION

the use of ginger can help in the treatment of people with diabetes, and data support the inclusion of this herbal drug in the clinical practice of nurses. RBR-2rt2wy.

Essential Oils Downregulate Pro-Inflammatory Cytokines and Nitric Oxide-Mediated Oxidative Stress in Alloxan-Induced Diabetogenic Rats

INTRODUCTION

Hyperglycemia is associated with an elevated level of reactive nitrogen species (RNS) that leads to nitrosative stress and exacerbates the progression of diabetic complications.

METHODS

Present study was aimed to evaluate the therapeutic effects of essential oils (EOs) on increased serum levels of nitric oxide (NO) in diabetogenic rats. Diabetogenic rats were treated with EOs separately and/or in combination at the dose of 100 mg/kg, orally for one month. Blood sampling was done at the 1st, 15th and 30th day of the treatment period to investigate the effect of treatment on biomarkers of diabetic complications.

RESULTS

In diabetogenic rats, serum levels of NO, malondialdehyde (MDA) and pro-inflammatory cytokines were significantly increased when compared with that of the control group. Whereas, diabetogenic rats treated with EOs decreased serum levels of NO, MDA and pro-inflammatory cytokines up to a significant extent when compared with that diabetogenic rats treated with the standard antidiabetic drug. Moreover, EOs also increased insulin sensitivity in peripheral tissues and insulin secretion from β-cells of pancreatic islets more efficiently when compared with that of diabetogenic rats. Additionally, it was also found that EOs improved lipid profile and normal functions of kidney and liver as compared to that of diabetogenic rats.

CONCLUSION

Findings of this study indicate that EOs may reduce pro-inflammatory cytokine levels by modulating the expression of NO. EOs may also ameliorate the nitrosative stress and maintain glucose homeostasis that are major culprits of diabetic complications.

Ginger (Zingiber officinale) and turmeric (Curcuma longa L.) supplementation effects on quality of life, body composition, bone mineral density and osteoporosis related biomarkers and micro-RNAs in women with postmenopausal osteoporosis: a study protocol for a randomized controlled clinical trial

OBJECTIVES

Phytomedicine is widely suggested for the prevention of chronic disease, but evidence for a favorable effect on bone health is lacking. The present study will investigate the Zingiber officinale (ZO) and Curcuma longa L. (CL) supplementation effects on quality of life, body composition, bone mineral density (BMD) and osteoporosis related biomarkers and micro-RNAs in women with postmenopausal osteoporosis (PMO).

METHODS

This study protocol is designed as prospective triple-blind randomized controlled trial. One hundred and 20 patients with PMO will be enrolled in a 4 month, prospective, triple-blind, placebo-controlled trial and randomly assigned to four groups: ZO (500 mg b.i.d.) + CL (500 mg b.i.d.) (ZO + CL); ZO (500 mg b.i.d.) + placebo CL (b.i.d.) (ZO + P); placebo ZO (b.i.d.) + CL (500 mg b.i.d.) (CL + P); and placebo ZO (b.i.d.) + placebo CL (b.i.d.) (P + P). Quality of life, body composition and BMD will be defined as the primary endpoints and osteoporosis related serum biomarkers and circulating micro-RNAs will be defined as the secondary endpoints. The ANCOVA statistical method will be used to investigate the effect of the interventional variables on the response variable.

CONCLUSION

To our knowledge, this trial is the first clinical study exploring the effect of Ginger and turmeric on quality of life, body composition, BMD and osteoporosis related biomarkers and micro-RNAs in women with PMO. The findings of this trial could be the basis for the development of harmless and inexpensive preventive and therapeutic approaches for PMO.

Probiotics supplementation improves hyperglycemia, hypercholesterolemia, and hypertension in type 2 diabetes mellitus: An update of meta-analysis

Background: Although many studies have shown that consumption of probiotics is relevant to diabetes, the effects of probiotics improves clinical outcomes in type 2 diabetes have yielded conflicting results. The aim of this meta-analysis was conducted to assess the effects of probiotics supplementation on glycemic, blood lipids, pressure and inflammatory control in type 2 diabetes.Methods: PubMed, Web of science, Embase and the Cochrane Library databases were searched for relevant studies from February 2015 up to Janurary 2020, with no language restrictions. The pooled results were calculated with the use of a random-effects model to assess the impact of supplemental probiotics on glycemic, blood lipids, pressure and inflammatory control in type 2 diabetes. Additionally, subgroup analysis was conducted based on patients age, body mass index (BMI), country and duration of the probiotics supplement, respectively.Results: 13 studies were included in this meta-analysis, involving a total of 818 participants in 8 countries. Overall, compared with control groups, the subjects who received multiple species of probiotics had a statistically significant reduction in fasting blood sugar (FBS), homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), triglycerides (TG), systolic blood pressure (SBP), diastolic blood pressure (DBP) and tumor necrosis factor (TNF) -α [standardized mean difference (SMD): -0.89 mg/Dl, 95% CI: -1.66, -0.12 mg/dL; SMD: -0.43, 95% CI: -0.63, -0.23; SMD: -0.19 mg/dL, 95% CI: -0.36, -0.01 mg/dL; SMD: -0.23 mg/dL, 95% CI: -0.40, -0.05 mg/dL; SMD: -5.61 mmHg, 95% CI: -9.78, -1.45 mmHg; SMD: -3.41 mmHg, 95% CI: -6.12, -0.69 mmHg; and SMD: 6.92 pg/ml, 95% CI: 5.95, 7.89 pg/ml, respectively]. However, the subjects who received single-species of probiotic or probiotic with co-supplements in food only changed FBS, HOMA-IR, DBP and TG levels. Moreover, subgroup analyses revealed that the effects of probiotics supplementation on FBS, HMOA-IR, SBP and DBP are significantly influenced by patients age, body mass index (BMI), country and duration of the probiotics supplement.Conclusion: Our analysis revealed that glycemic, lipids, blood pressure and inflammation indicators are significantly improved by probiotic supplementation, particularly the subjects who ages ≤ 55, baseline BMI< 30 kg/m², duration of intervention more than 8 weeks, and received multiple species probiotic.

Zingiber officinale preserves testicular structure and the expression of androgen receptors and proliferating cell nuclear antigen in diabetic rats

The aim of this study was to assess the efficacy of Zingiber officinale, commonly referred to as ginger, in preserving the structural integrity of testis in streptozotocin (STZ)-induced diabetic rats compared to the efficacy of metformin, the traditional effective antidiabetic drug. STZ was utilised for the induction of diabetes mellitus in male Sprague Dawley rats. The study included five groups (n = 6 each), namely the normal control, ginger-treated normal, nontreated diabetic, metformin-treated diabetic and ginger-treated diabetic groups. Biochemical assessment of fasting blood glucose level (BGL) and total antioxidant capacity (TAC) was performed. Histopathological assessment of the testes was performed using routine and immunohistochemical techniques. Fasting BGL significantly (p = .01) reduced, whereas TAC significantly increased (p < .001) in metformin- and ginger-treated diabetic rats compared to those in untreated diabetic rats. Metformin and ginger reduced the degenerative changes observed in the testes of diabetic rats, significantly reduced (p < .001) caspase-3 immunoexpression, and significantly increased (p < .001) the immune-expression of androgen receptors and proliferating cell nuclear antigen. Ginger has antidiabetic effects and preserves testicular structural integrity and, thus, is recommended as an adjuvant therapy for male diabetic patients in the reproductive period.

Ginger and its bioactive component 6-shogaol mitigate lung inflammation in a murine asthma model

Asthma, a common disorder associated with airway inflammation and hyperresponsiveness, remains a significant clinical burden in need of novel therapeutic strategies. Patients are increasingly seeking complementary and alternative medicine approaches to control their symptoms, including the use of natural products. Ginger, a natural product that we previously demonstrated acutely relaxes airway smooth muscle (ASM), has long been reported to possess anti-inflammatory properties, although a precise mechanistic understanding is lacking. In these studies, we demonstrate that chronic administration of whole ginger extract or 6-shogaol, a bioactive component of ginger, mitigates in vivo house dust mite antigen-mediated lung inflammation in mice. We further show that this decrease in inflammation is associated with reduced in vivo airway responsiveness. Utilizing in vitro studies, we demonstrate that 6-shogaol augments cAMP concentrations in CD4 cells, consistent with phosphodiesterase inhibition, and limits the induction of nuclear factor-κB signaling and the production of proinflammatory cytokines in activated CD4 cells. Sustained elevations in cAMP concentration are well known to inhibit effector T cell function. Interestingly, regulatory T cells (Tregs) utilize cAMP as a mediator of their immunosuppressive effects, and we demonstrate here that 6-shogaol augments the Treg polarization of naïve CD4 cells in vitro. Taken together with previous reports, these studies suggest that ginger and 6-shogaol have the potential to combat asthma via two mechanisms: acute ASM relaxation and chronic inhibition of inflammation.

Steamed Ginger May Enhance Insulin Secretion through KATP Channel Closure in Pancreatic β-Cells Potentially by Increasing 1-Dehydro-6-Gingerdione Content

Ginger (Zingiber officinale Roscoe) and its active compounds (gingerols, shogaols and paradols) have been reported as having beneficial functions for several diseases, including diabetes. In this study, we revealed that the steaming process could enhance the anti-diabetic potential of ginger. To confirm the anti-diabetic effect of steamed ginger extract (GG03), we assessed pancreatic islets impaired by alloxan in zebrafish and demonstrated anti-hyperglycemic efficacy in a mouse model. The EC50 values of ginger extract (GE) and GG03 showed that the efficacy of GG03 was greater than that of GE. In addition, LC50 values demonstrated that GG03 had lower toxicity than GE, and the comparison of the Therapeutic Index (TI) proved that GG03 is a safer functional food. Furthermore, our data showed that GG03 significantly lowered hyperglycemia in a diabetic mouse model. HPLC was performed to confirm the change in the composition of steamed ginger. Interestingly, GG03 showed a 375% increase in 1-dehydro-6-gingerdione (GD) compared with GE. GD has not yet been studied much pharmacologically. Thus, we identified the protective effects of GD in the damaged pancreatic islets of diabetic zebrafish. We further assessed whether the anti-diabetic mechanism of action of GG03 and GD involves insulin secretion. Our results suggest that GG03 and GD might stimulate insulin secretion by the closure of KATP channels in pancreatic β-cells.

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

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.