In this article, we discuss the âEffects 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 Trialâ
![Research seeds Ginger](https://i.herbalreality.com/wp-content/uploads/2024/06/27134641/Research-seeds-Ginger.jpg)
Plant name and species
Ginger (Zingiber officinale Roscoe)
Aim of study
The aim was to assess the safety and efficacy of ginger on anthropometric and biochemical measurements, blood pressure and liver imaging (FibroScan) characteristics of patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD).
Study method
A randomised, double-blinded, placebo-controlled trial of patients with diabetes which was under control and NAFLD. Patients included men and women, 20 â 65 years of age. The study was carried out at the Diabetes Clinic of SUMS in Iran.
The following measures were made at the start and after 3 months.
- Anthropometric â height, weight, waist and hip circumferences
- Blood pressure
- Biochemical test after 12 hour fasting â a range of liver enzymes, blood sugars, lipids and inflammatory markers
- Insulin resistance using HOMA-IR on a fasting blood sample
- Liver imaging using FibroScan for scores of steatosis and fibrosis
Herbal preparation
The intervention was powdered ginger. Ginger rhizomes were authenticated using gas chromatography, washed, dried and powdered to make capsules containing 500mg. A placebo of 10:1 starch and ginger powder was prepared.
Patients were randomised to groups and received ginger or placebo (2g/day taken after breakfast and dinner) for 3 months.
Sample size
Ginger (38 patients, mean age 51 years) and placebo (38 patients, mean age 56 years).
Results of study
- Improvement in blood pressure â the mean systolic and diastolic blood pressures reduced significantly in the ginger compared to the placebo group.
- No change in anthropometric measures â height, weight, waist and hip circumferences were all reduced in the ginger group, but not significantly.
- No change in biochemical tests (liver enzymes, blood sugars, blood lipids, insulin resistance and inflammatory markers) between groups. All measures followed a similar trend in ginger and placebo group. The exceptions were HbA1C which increased in the ginger group (and decreased in the placebo) and triglycerides which increased in the placebo (and decreased for ginger), but these werenât significant.
- There was no change in the liver imaging tests between groups.
Four patients in the ginger group experienced mild digestive symptoms which resolved and the patients continued with the study.
Discussion
NAFLD and liver fibrosis are common in people diabetes and can lead to more serious liver conditions (1). This study was important because it looked at the role of ginger in supporting the liver in diabetic patients. They had a rigorous selection procedure to ensure that patients with similar levels of disease were selected.
![Ginger root (Zingiber offinalis)](https://i.herbalreality.com/wp-content/uploads/2020/08/21125817/ginger-2523758_1920-1200x800.jpg)
The study showed that 2g ginger a day in capsules for 3 months improved systolic and diastolic blood pressure, showed a tendency to improve weight and anthropometric measures although was not significant, and had no effect on blood biochemistry compared to a placebo. There were no changes to the fat of fibrotic nature of the liver.
There is a host of clinical research on the effects of ginger in diabetes and metabolic syndrome. For example one study saw improvements in blood glucose and lipids following 2g daily ingestion of ginger powder (2). It could be that the present study was perhaps underpowered (patient numbers were too low) or there was too much variation between the patient groups.
In the abstract of the paper they state that for the ginger group there were improvements in insulin resistance and HDL-cholesterol over time, although the data was not shown within the paper. There were equal proportions of men and women in the ginger group and proportionally far more females in the placebo group, and whether this would have affected the results is not clear.
Although the dietary intakes were recorded they were not reported, and it is not clear how detailed these were. As we know, a host of other herbs and spices like fenugreek and cinnamon (3) that influence metabolic function, so it is also possible that dietary intake may have influenced the results.
It is interesting to note that the ginger group tended to reduce their physical activity and increase calorific intake during the study, and the opposite was seen in the placebo group. Both physical activity or food intake should have been more tightly controlled, and certainly, future studies could look at the combination of ginger along with lifestyle improvements to improve metabolic health.
Ginger has anti-inflammatory properties but in this study did not alter systemic inflammatory markers like TNF alpha or produce any noticeable visible changes to the liver anatomy. Fibrosis is a slow progressing condition so it is likely that any improvement may not occur rapidly. Other studies have shown that ginger can significantly alter systemic inflammation, and a meta-analysis that pooled the results of 20 randomised-controlled trials found that CRP, TNF-alpha and IL-6 were all altered, with the doses of ginger ranging between 0.5 and 3 g per day for up to 3 months.
It was interesting to see in this paper that does of 1-2g of ginger for 2-3 months seemed to be an optimal duration, and results were more pronounced in older patients over 40 years of age compared to younger age groups. One might speculate that general inflammation is more pronounced in the older groups (4).
The final point of variation could be around the quality and composition of ginger. For this study fresh ginger was purchased at a local market in Iran and authenticated, showing 36.7% zingiberene and other volatile compounds. The drying and storage conditions can greatly alter the chemical composition of a herb (5). In the present study it did not state the drying temperature, but this may have altered the potency of the final preparation.
Conclusion
The authors were concerned with the health of diabetic patients with NAFLD. Ginger improved blood pressure over time but did not alter liver imaging characteristics. Further studies are needed with larger patient numbers and of longer duration. Perhaps dietary herb and spice intake should be monitored, and that patients do not alter their physical activity or food intakes during the study. Ginger produced mild digestive side effects but these were short-lived.
References
- Cusi, K. (2024). Nonalcoholic fatty liver disease in Diabetes: A call to action. Diabetes Spectrum, 37(1), 5â7. https://doi.org/10.2337/dsi23-0015
- Effects of ginger supplementation on anthropometric, glycemic and metabolic parameters in subjects with metabolic syndrome: a randomized, double-blind, placebo-controlled study. (2019, March 22). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582048/