SIBO & Ginger

SIBO & GINGER

The response to the Facebook post (Ginger Nanoparticles Could Be Inexpensive, Nontoxic IBD Treatment) that I shared in 2017 was incredible! Researchers at the Atlanta VA Medical Center revealed that nanoparticles derived from fresh ginger root may be an effective treatment for Crohn’s Disease and Ulcerative Colitis.

Many people commented on multiple areas about ginger so I’ve shared insights about ginger from my contribution to the Prokinetic Prevention of SIBO presentation at the 2015 SIBO Symposium and add any new pertinent research on ginger.

THE CHEMICAL BREAKDOWN: GINGEROLS AND SHOGAOLS

The rhizomes of Zingiber officinale (ginger) have been used since ancient times as a traditional remedy for gastrointestinal complaints.

The most active ingredients in ginger are the pungent principles, particularly gingerols and shogaols. The major chemical constituents of ginger are:

[6]-gingerol

[8]-gingerol

[10]-gingerol, and

[6]-shogaol.

6-gingerol was the most abundant compound found in the fresh ginger extract, followed by 10-gingerol. The significant anti-neuroinflammatory capacity that fresh ginger extract exhibited was largely owed to 10-gingerol and not 6-gingerol.

Shogaols are a series of major constituents in dried ginger with the most abundant being [6]-, [8]-, and [10]-Shogaol. The shogaol chemical constituents show much higher anti-cancer potencies than gingerols.

THE ACTION: MOTILITY AND GINGER

Small intestine motility dysfunction is an issue in small intestine bacterial overgrowth (SIBO). Agents that promote stomach emptying can also be helpful in treating SIBO and preventing the relapse of SIBO.

Ginger accelerates gastric emptying and stimulates antral contractions in healthy volunteers. These effects could potentially be beneficial in symptomatic patient groups. Gingerols bind type 3 (5-HTP3) receptors in the enteric nervous system and the brain stem. And also modulate serotonin signaling in the gut by 5-HTP4 stimulation.

Resolor (Procalopride), used as a prokinetic agent in preventing SIBO, is a high affinity 5-HTP4 receptor agonist. Resolor is known to promote multiple migrating motor complex (MMC) waves in the small intestine vs. ‘low dose’ erythromycin (50mg is also used in SIBO relapse prevention) which stimulates one MMC wave.

The effect of a ginger extract (200 mg) was studied in 12 healthy volunteers during fasting and after a meal to look at the gastroduodenal motility with stationary manometry. The results from the gastroduodenal manometry showed antral motility was significantly increased by ginger during phase III of the migrating motor complex (MMC). The volunteers also had a significantly increased motor response to a test meal. A trend to an increased motor response during ginger treatment was seen in all other regions of interest.

THE RESEARCH: GINGER AND IBS

Ginger is one of the most commonly used herbal medicines for irritable bowel syndrome (IBS) yet limited research exists about its effectiveness in humans. Only one double blind randomized controlled pilot trial completed at University of North Carolina, Chapel Hill, North Carolina is available on pubmed.gov.

Forty-five IBS patients were randomly assigned to three groups: placebo, 1 gram of ginger, and 2 grams of ginger daily for 28 days. This double blind randomized controlled pilot study suggested ginger is well tolerated but did not perform better than placebo.

I happened to find it quite interesting however that the side effects reported were (35.7%) in the placebo group and (16.7%) in the ginger groups. Of course larger trials are needed before any definitive conclusions can be drawn.  

There is a new design and formulation to evaluate a medicated ginger chewing gum. What they found is the release pattern of the formulations with different gum bases and sweeteners demonstrated almost 100% release of the gingerols which may be advantageous in motion sickness.

However, we have to be very careful with chewing gum in SIBO / IBS. Chewing gum mimics eating a meal, as it contains calories and the action of chewing delays the migrating motor complex. This is a major disadvantage in SIBO / IBS especially if you have a positive IBSChek blood test i.e. (+) CdtB and / or Vinculin antibodies.

In best health,

Dr. Melanie Keller

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References

1.  Food Chem. 2013 Dec 1;141(3):3183-91. doi: 10.1016/j.foodchem.2013.06.010. Epub 2013 Jun 11. Anti-neuroinflammatory capacity of fresh ginger is attributed mainly to 10-gingerol. Ho SC1, Chang KS, Lin CC.

2. Mol Nutr Food Res. 2013 Mar;57(3):447-58. doi: 10.1002/mnfr.201200679. Epub 2013 Jan 16. Characterization of thiol-conjugated metabolites of ginger components shogaols in mouse and human urine and modulation of the glutathione levels in cancer cells by [6]-shogaol. Chen H1, Soroka DN, Hu Y, Chen X, Sang S.

3. Eur J Gastroenterol Hepatol. 2008 May;20(5):436-40. doi: 10.1097/MEG.0b013e3282f4b224. Effects of ginger on gastric emptying and motility in healthy humans. Wu KL1, Rayner CK, Chuah SK, Changchien CS, Lu SN, Chiu YC, Chiu KW, Lee CM.

4. Int J Clin Pharmacol Ther. 1999 Jul;37(7):341-6. Effects of ginger on gastroduodenal motility. Micklefield GH1, Redeker Y, Meister V, Jung O, Greving I, May B.

5. Complement Ther Med. 2014 Feb;22(1):17-20. doi: 10.1016/j.ctim.2013.12.015. Epub 2014 Jan 8. Is ginger effective for the treatment of irritable bowel syndrome? A double blind randomized controlled pilot trial. van Tilburg MA1, Palsson OS2, Ringel Y2, Whitehead WE2.

6. Adv Biomed Res. 2016 Jul 29;5:130. doi: 10.4103/2277-9175.187011. eCollection 2016. Design, formulation, and evaluation of ginger medicated chewing gum. Aslani A1, Ghannadi A2, Rostami F1.