(I hope my little grousing will be forgiven)

I originally began the trial expecting no symptomatic relief whatsoever. The research that has been done made a good case for ginseng as a possible GDNF generator and I was hoping to do an end run on Amgen. Figured it would be at least six months before I had a clue.

So you can see why I was startled at the effect. As to what is actually going on, and this is strictly a guess, I suspect that it is working on the receptors and making them more sensitive and thus increasing the punch of a given dose. The pattern that seems to work best for me is to start the day with most of the day's meds taken by lunch along with 500 mg of ginseng about 8:00 AM/ Then nothing until another ginseng at 4:00 PM. About half the time I will have half a sinemet CR after supper but often nothing until the next morning. That's 18 hours without meds!!! I was on a two hour schedule before this and not doing well on that!

So, I would think that if dopamine levels were being increased the pattern would be different. But if the receptors were making a given amount go further that it would be more like I am seeing.

One other point touched on in the next message is the matter of dyskinesias. That is the only problem that I have encountered and I have been able to control them by manipulating the sinemet spacing and by breaking tablets. This, too, makes more sense if the receptors are being resensitized.

All I know for sure is that without it I can barely walk at times and with it I am nearly normal.

As to when to use it, if I had known what I know now I would have started it with the first tremor. The research indicates a strong protective action for it and I might never have needed anything else.

Remember that because this is one of the more expensive supplements that quality is a problem. Stick to trusted brands and don't give up without trying three or four different ones.
-Rick

(someday I am going to learn how to spell that darned word)
Yes, I have encountered them too but have managed to control them with manipulating the dosing. Strictly trial and error. Don't be afraid to break a tablet but don't crush it. It isn't a coating but instead is a "polymer matrix" so most of it still makes it through. And don't drop it too much too soon, of course. A third is a pretty big jump. And please post once you find the happy medium. I'd really like to know.

-Rick

Query - I seem to recall the Gingseng began with royal jelly. I checked Vitacost (where I get supplements) and the "Chinese Red Gingseng" is in bottles together with royal jelly. No dosage appears. Is this the same stuff? It is about $18.00 for 30 bottles with one bottle being one dose. Any hints as to source, price, brand? Does it come in capsules? Thanks. pacempassim@gmail.com

The two are offered mixed but I found that the amino acids in the royal jelly did a bangup job of blocking the sinemet (protein problem) and I've been taking it separately at night in a very haphazard fashion. Brands I myself prefer in general are Jarrow and NOW both having excellent reputations. I currently take two 500 mg caps a day

I am considering adding ginseng to my supplement list and wondered if it was still giving good results to those taking it. I take sinemet and zandopa but have difficulty with wearing-off dyskinesia. When I reduce my dosage the meds don't seem to work. Thought I would try ginseng to see if it would help with the reduced dosage. Up to now the trade off seems to be dyskinesia or extreme tremor. Would appreciate any thoughts and experiences from others who have tried ginseng please.

Thank you,
Sunflower

It definitely has a major effect for me. I take two capsules (400 mg ea <to be confirmed>) with the morning meds and sometimes take a similar dose in the evening.

Traditionally one would periodically drop it to allow the body to "reset" itself and I try to skip a day every now and then.

There is definitely more than a neuroprotective action at work in that there is a noticeable short term action on symptoms. As to what is actually going on, I will hazard a guess but that is all it is -

Ginseng has a reputation as an "adaptogen" which is just what the name implies. It helps you adapt to stressors upon the system. That means an effect on the HPA stress centers which translates into stabilizing the fight or flight merry go round and the steroids that go with that. The steroids are a long term danger but they and their breakdown products are also neuroactive and act as neurotransmitters like dopamine, serotonin, etc do. That's why stress knocks us out - along with dopamine being used for producing some of the stress hormones as well. Ginseng stabilizes the whole structure somehow. I repeat, that is a hazardous guess

Another thing that I ran across just an hour ago that may be relevant to that explanation is that blacks with asthma are much less responsive to the steroids that are used to treat it. It is also known that blacks are much less likely to develop PD. It could be that their lower sensitivity protects them from PD and in whites a heightened sensitivity to steroid hormones increases our vulnerability.

If that is all true, then adaptogens make sense.

compelling data on Ginseng in these threads. I have not been able to purchase the U.S. brand "Panax" here in Aotearoa (NZ). The brand available here is "Siberian" originally out of Russia and made in Australia. The brands have their differences.

What I have noticed since introducing the "Siberian" brand to my myriad of herbs and vitamens is the quick kick in time. (30 mins instead of one hour)

I will continue to search out for the "Panax" brand. May have to purchase from the U.S.


Panax ginseng

DAVID KIEFER, M.D., and TRACI PANTUSO, B.S.
University of Arizona College of Medicine, Tucson, Arizona

The herbal remedies referred to as "ginseng" are derived from the roots of several plants. One of the most commonly used and researched of the ginsengs is Panax ginseng, also called Asian or Korean ginseng. The main active components of Panax ginseng are ginsenosides, which have been shown to have a variety of beneficial effects, including anti-inflammatory, antioxidant, and anticancer effects. Results of clinical research studies demonstrate that Panax ginseng may improve psychologic function, immune function, and conditions associated with diabetes. Overall, Panax ginseng appears to be well tolerated, although caution is advised about concomitant use with some pharmaceuticals, such as warfarin, oral hypoglycemic agents, insulin, and phenelzine. Panax ginseng does not appear to enhance physical performance. Products with a standardized ginsenoside concentration are available. (Am Fam Physician 2003;68:1539-42. Copyright© 2003 American Academy of Family Physicians.)

Herbal remedies known as "ginseng" are based on the roots of several distinct species of plants, mainly Korean or Asian ginseng (Panax ginseng), Siberian ginseng (Eleutherococcus senticosus), and American ginseng (Panax quinquefolius). All of these species are in the Araliaceae plant family, but each has its own specific effects on the body.

Ginseng products are popularly referred to as "tonics," a term that has been replaced by "adaptogens" in much of the alternative medicine literature. The term "adaptogen" connotes an agent that purportedly "increases resistance to physical, chemical, and biological stress and builds up general vitality, including the physical and mental capacity for work." 1(p236) Over-the-counter Panax ginseng products include Celestial Seasonings Ginseng, Centrum Herbals Ginseng, Korean Ginseng Extract from Nature's Way, Nature Made's Chinese Red Panax Ginseng, Pharmaton's Ginsana, and PhytoPharmica's Ginseng Phytosome.

Panax ginseng is one of the most commonly used and highly researched species of ginseng. This species, which is native to China, Korea, and Russia, has been an important herbal remedy in traditional Chinese medicine for thousands of years, where it has been used primarily as a treatment for weakness and fatigue. 2

Pharmacology

The main active agents in Panax ginseng are ginsenosides, which are triterpene saponins. The majority of published research on the medicinal activity of Panax ginseng has focused on ginsenosides. 3 These are the compounds to which some ginseng products are now standardized.

Research reviews 2,4 postulate that extracts of Panax ginseng affect the hypothalamus-pituitary-adrenal axis and the immune system, which could account for many of the documented effects. Animal models and in vitro studies mentioned in these reviews 2,4 indicate that Panax ginseng enhances phagocytosis, natural killer cell activity, and the production of interferon; improves physical and mental performance in mice and rats; causes vasodilation; increases resistance to exogenous stress factors; and affects hypoglycemic activity.

Efficacy

Panax ginseng is used primarily to improve psychologic function, exercise performance, immune function, and conditions associated with diabetes (Table 1) . Traditional Chinese medicine and many current research studies 5-8 often use products that combine ginseng with other herbal medicines or vitamins. Because of the use of combination products and the limitations of some studies on ginseng (e.g., poor methodologic quality, research focusing on healthy volunteers, small sample size, unstandardized ginseng preparations, varying doses), it is difficult to draw conclusions about some of the clinical effects of ginseng. Many research trials have been performed on the standardized Panax ginseng extract Ginsana (G115).


TABLE 1
Key Points About Panax ginseng

--------------------------------------------------------------------------------

Efficacy Psychologic functioning: effective; conflicting evidence
Physical performance: ineffective
Immune system: effective
Diabetes: modest effect; evidence limited
Adverse effects Nausea, diarrhea, euphoria, insomnia, headaches, hypertension, hypotension, mastalgia, vaginal bleeding, blood pressure abnormalities
Interactions Caution advised about concomitant use with phenelzine (Nardil), warfarin (Coumadin), oral hypoglycemics, insulin, or caffeine, and about use in patients with hypertension or bleeding
Dosage Standardized extract: 200 mg per day
Dry root (tea form or chewed): 0.5 to 2 g per day
Cost $15 to $20 for a one-month supply at a dosage of 200 mg per day
Bottom line A safe, well-tolerated herbal medicine that may be used for a variety of medical conditions


EFFECTS ON PSYCHOLOGIC FUNCTION

Trials investigating the effects of Panax ginseng on various psychologic parameters have shown positive effects, no effects, or both. In one study 9 of 112 healthy volunteers older than 40 years, the administration of 400 mg per day of the standardized ginseng product Gerimax for eight weeks resulted in better and faster simple reactions and abstract thinking, but no change in concentration, memory, or subjective experience.

The results of two small studies, 10,11 each including about 30 young, healthy volunteers who received 200 mg of G115 daily for eight weeks, showed improvement in certain psychomotor functions (i.e., better attention, processing, and auditory reaction time), social functioning, and mental health. However, some of the effects present at the fourth week disappeared by the eighth week. 11

A study of 384 postmenopausal women who were randomized to receive placebo or ginseng for 16 weeks showed improvements in three subsets of a Psychological General Well-Being index. 12 [Evidence level A, randomized controlled trial (RCT)] In addition, a small study 7 of 20 healthy young volunteers who received a single 400-mg dose of ginseng found improvement in cognitive performance, secondary memory performance, speed of performing memory tasks, and accuracy of attentional tasks. However, another study 13 showed no effect on positive affect, negative affect, or total mood disturbance in 83 young healthy volunteers who took 200 to 400 mg per day of G115 for eight weeks.

EFFECTS ON PHYSICAL PERFORMANCE

Most of the clinical studies investigating the value of Panax ginseng in enhancing physical performance have shown no clinical effect. 14 One study 15 on the use of 200 mg per day of G115 in 19 healthy adult women showed no change in physical work performance, energy metabolic responses, or oxygen uptake.

Similarly, a study of 31 healthy men who took 200 or 400 mg of G115 daily for eight weeks found no change in physiologic or psychologic responses to submaximal or maximal exercise. 16 [Evidence level B, lower quality RCT] In another study, 17 a different product standardized to 7 percent ginsenosides and administered at 200 mg per day was given to 28 healthy young adults for 21 days. No ergogenic effects were demonstrated, including no change in maximal oxygen consumption, exercise time, workload, plasma lactate level, hematocrit, or heart rate.

EFFECTS ON IMMUNE SYSTEM

A study 18 of 227 healthy volunteers demonstrated that daily administration of 100 mg of G115 for 12 weeks enhanced the efficacy of polyvalent influenza vaccine. The patients who received ginseng had a lower incidence of influenza and colds, higher antibody titers, and higher natural killer cell activity levels. Another study 19 in 60 healthy volunteers showed enhanced chemotaxis, phagocytosis, increased total lymphocyte count, and increased numbers of T helper cells in those who received G115 in a dosage of 100 mg twice daily for eight weeks. In a study of
75 patients with acute exacerbation of chronic bronchitis who were treated with antibiotics or antibiotics plus ginseng, those in the ginseng group showed faster bacterial clearance. 20

EFFECTS ON DIABETES

The effects of Panax ginseng, given in a dosage of 100 or 200 mg per day for eight weeks, were studied in 36 patients with newly diagnosed non-insulin-dependent diabetes. 21 The study showed improved fasting blood glucose levels, elevated mood, and improved psychophysical performance on a numbered diagram test. The 200-mg dose also resulted in improved hemoglobin A 1C values.

ADDITIONAL USES

In 45 patients with erectile dysfunction, use of ginseng improved erectile function, sexual desire, and intercourse satisfaction. 22

Panax ginseng also appears to have anti-cancer effects. In a prospective cohort study 23 of 4,364 persons older than 40 years, the risk of cancer was shown to be lower in those who used ginseng (relative risk: 0.40).

Adverse Effects, Drug Interactions, and Contraindications

Interpretation of documented adverse effects and drug interactions can be difficult because of the variety of available ginseng formulations, and because the exact amount of ginseng in these products may not be identified.

Panax ginseng generally is well tolerated, and its adverse effects are mild and reversible. 24 Associated adverse effects include nausea, diarrhea, euphoria, insomnia, headaches, hypertension, hypotension, mastalgia, and vaginal bleeding. 4,24,25

Panax ginseng may interact with caffeine to cause hypertension, and it may lower blood alcohol concentrations. It also may decrease the effectiveness of warfarin (Coumadin). Concomitant use of Panax ginseng and the monoamine oxidase inhibitor phenelzine (Nardil) may result in manic-like symptoms. 4,23

Contraindications to the use of Panax ginseng include high blood pressure, acute asthma, acute infections, and nose bleeds or excessive menstruation. These effects appear to occur primarily with high dosages or prolonged use. 26

Ginseng also causes hypoglycemic activity, and caution should be exercised in using ginseng products in patients with diabetes because of possible interactions with oral hypoglycemic agents and insulin. One source 2 recommends avoiding the use of ginseng products in children and in women who are pregnant or lactating, until more rigorous studies prove safety in these groups.

Dosage

Most published research studies have used a standardized Panax ginseng extract in a dosage of 200 mg per day. Other sources 2,23,27 recommend 0.5 to 2 g of dry root per day on a short-term basis, with the ginseng taken in tea form or chewed. Capsule formulas are generally given in a dosage of 100 to 600 mg per day, usually in divided doses.

Standardization is to the ginsenoside content, which is usually recommended to be 1.5 to 7 percent. 2 According to one source, 28 4 percent is an important standard level.

Ginseng is commonly taken for long periods. 1,29 One source 1(p239) recommends a two-week ginseng-free period every two to three weeks for some persons.

The authors indicate that they do not have any conflicts of interests. Sources of funding: none reported.

The Authors

DAVID KIEFER, M.D., is a fellow in the Program in Integrative Medicine at the University of Arizona College of Medicine, Tucson. Dr. Kiefer received his medical degree from the University of Wisconsin Medical School, Madison, and completed a family practice residency at Swedish Family Medicine, Seattle.

TRACI PANTUSO, B.S., is a volunteer at the Program in Integrative Medicine. She graduated from Loyola Marymount University, Los Angeles.

Address correspondence to David Kiefer, M.D., Program in Integrative Medicine, University of Arizona College of Medicine, P.O. Box 245153, Tucson, AZ 85724 (e-mail: dskseat@aol.com) Reprints are not available from the authors.

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on "Siberian" Ginseng

Siberian ginseng
Also listed as: Acanthopanax senticosus Eleuthero; Eleutherococcus senticosus Ginseng - Siberian

Overview
Siberian ginseng, also known as eleuthero, has been used for centuries in Eastern countries, including China and Russia. Although a distant relative of American ( Panax quinquefolius ) and Asian ginseng ( Panax ginseng ), with some overlap in its uses, Siberian ginseng is a distinct plant with different active chemical components. Prized for its ability to restore vigor, increase longevity, enhance overall health, and stimulate both a healthy appetite and a good memory, it is widely used in Russia to help the body adapt to stressful conditions and to enhance productivity.

In Chinese medicine, it is valued for its beneficial effects on "qi" and its ability to treat "yang" deficiency in the spleen and kidney. Like Panax ginseng , Siberian ginseng is considered to be an adaptogen. This means it helps in stressful circumstances and also helps return the body to a normal balance. For example, an adaptogen might lower blood pressure in someone who has high blood pressure, but it might raise blood pressure in someone who has low blood pressure. The active ingredients in Siberian ginseng, called eleutherosides, are thought to increase stamina and to stimulate the immune system.

Until recently, most scientific research on Siberian ginseng was conducted in Russia. This research has largely supported its use to maintain health and strengthen the system rather than to treat particular disorders. Siberian ginseng may help the body deal with physically and mentally stressful exposures, such as heat, cold, physical exhaustion, viruses, bacteria, chemicals, extreme working conditions, noise, and pollution. By strengthening the system, it may also help prevent illness.

Research on Siberian ginseng has included studies on the following:

Immune system

A 4-week study in healthy subjects found that those who received Siberian ginseng extract had improvements in a number of measures that reflect the functioning of the immune system. Several combination supplements containing Siberian ginseng and other herbs have reported benefits in patients with colds and the flu. Laboratory studies also support the use of Siberian ginseng to improve immunity.

Mental performance

A 3-month human study of Siberian ginseng among middle aged volunteers found that there was a significant improvement in memory and concentration as compared to placebo.

Another popular but unproven use of Siberian ginseng is to maintain or restore mental alertness.

Physical performance

Although Siberian ginseng is frequently used to enhance physical stamina and increase muscle strength, studies have shown mixed results for these purposes. Other studies support the use of Siberian ginseng to decrease symptoms of fatigue.

Male fertility

Siberian ginseng has a long history of folkloric use for male infertility. Animal studies suggest that Siberian ginseng may be helpful in increasing reproductive capacity.

Elderly quality of life

One study found Siberian ginseng use in elderly patients improved their quality of life including aspects of mental health and social functioning after 4 weeks of therapy. When the ginseng was stopped, the improvements decreased.

Herpes viral infection

A 6-month study of 93 people with herpes simplex virus type 2 (which can cause genital herpes lesions) found that Siberian ginseng reduced frequency, severity, and duration of outbreaks. Talk to your doctor about whether it is safe or appropriate for you to use Siberian ginseng as a supplement to prevent herpes outbreaks.

Plant Description
Siberian ginseng is a shrub that grows 3 - 10 feet high. Its leaves are attached to a main stem by long branches. Both the branches and the stem are covered with thorns. Flowers, yellow or violet, grow in umbrella-shaped clusters, and turn into round, black berries in late summer. The root itself is woody and is brownish, wrinkled, and twisted.

What's It Made Of?
Siberian ginseng supplements are made from the root. The root contains a mixture of components, common to many plants but occurring together in Siberian ginseng, called eleutherosides. Among the other ingredients are chemicals called polysaccharides, which have been found to boost the immune system and lower blood sugar levels in laboratory studies using animals.

Available Forms
Siberian ginseng is available as liquid extracts, solid extracts, powders, capsules, and tablets, and as dried or cut root for tea.

It is important to note that there is a wide variation in the quality of many herbal supplements, including Siberian ginseng. Previous evaluations of commercial products claiming to have Siberian ginseng found that as many as 25% had no measurable ginseng at all. Plus, many formulas for sale were contaminated with contents not marked on the label. Care should be taken to purchase Siberian ginseng and all herbal products from reputable manufacturers. Ask your pharmacist.

How to Take It
Pediatric

This herb is generally not recommended for use in children.

Adult

Dried root: The recommended dose is 500 - 3,000 mg, daily (tea, or in capsules).
Tincture: (herb and alcohol; or herb, alcohol, and water), 1/2 - 1 tsp, 2-3 times daily
Standardized extract: 100 - 200 mg, 2 times daily, standardized to contain 0.8 - 1 % eleutherosides Band E
For long-term conditions, such as fatigue or stress, Siberian ginseng can be taken for 3 months, followed by 2 - 3 weeks off. These cycles can be repeated, but this should be done under the supervision of a health care provider.

Precautions
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Siberian ginseng is safe when used as directed. However, it should not be taken by those with high blood pressure, obstructive sleep apnea, narcolepsy, or by women who are pregnant or breastfeeding.

There has been one case report of a baby developing excessive hair growth, including in the pubic region. This was attributed to the mother who was taking Siberian ginseng while breastfeeding. Later, it was discovered that the product she was taking probably did not contain Siberian ginseng, but rather a contaminant. More common side effects include:

High blood pressure
Insomnia
Drowsiness
Vomiting
Headache
Confusion
Irregular heart rhythm
Nosebleed


Possible Interactions
If you are being treated with any of the following medications, you should not use Siberian ginseng without first talking to your health care provider:

Digoxin -- Siberian ginseng may raise blood levels of digoxin, a medication used to treat heart conditions. This can increase the risk of adverse side effects from this medication.

Sedatives for insomnia -- Caution should be taken when considering use of Siberian ginseng with sedatives, primarily barbiturates (a class of medications including pentobarbital used to treat sleep problems or seizures).

Supporting Research
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Asano K, Takahashi T, Miyashita M, et al., Effect of Eleutherococcus senticosus extract on human physical working capacity. Planta Med . 1986;(3):175-7.

Blumenthal M, ed. The Complete German Commission E Monographs . Boston, Mass: Integrative Medicine Communications; 1998:124-125.

Bucci LR. Selected herbals and human exercise performance. Am J Clin Nutr. 2000;72(suppl):624S-636S.

Cicero AF, Derosa G, Brillante R, et al. Effects of Siberian ginseng (Eleutherococcus senticosus maxim.) on elderly quality of life: a randomized clinical trial. Arch Gerontol Geriatr Suppl. 2004;(9):69-73.

Dasgupta A, Wu S, Actor J, et al. Effect of Asian and Siberian ginseng on serum digoxin measurement by five digoxin immunoassays. Significant variation in digoxin-like immunoreactivity among commercial ginsengs. Am J Clin Pathol . 2003;119(2):298-303.

Davydov M, Krikorian AD. Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look. J Ethnopharmacol . 2000;72(3):345-93.

Eschbach LF, Webster MJ, Boyd JC, et al. The effect of Siberian ginseng (Eleutherococcus senticosus) on substrate utilization and performance. Int J Sport Nutr Exerc Metab . 2000;10(4):444-51.

Fugh-Berman A. Herb-drug interactions . Lancet. 2000;355:134-138.

Glatthaar-Saalmuller B, Sacher F, Esperester A. Antiviral activity of an extract derived from roots of Eleutherococcus senticosus . Antiviral Res . 2001;50(3):223-8.

Goulet ED, Dionne IJ. Assessment of the effects of eleutherococcus senticosus on endurance performance. Int J Sport Nutr Exerc Metab . 2005;15(1):75-83.

Gyllenhaal C, Merritt SL, Peterson SD, et al. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Med Rev . 2000;4(2):229-251.

Harkey MR, Henderson GL, Gershwin ME, et al. Variability in commercial ginseng products: an analysis of 25 preparations. Am J Clin Nutr. 2001;73:1101-1106.

Hartz AJ, Bentler S, Noyes R, et al., Randomized controlled trial of Siberian ginseng for chronic fatigue. Psychol Med . 2004;34(1):51-61.

Kelly GS. Nutritional and botanical interventions to assist with the adaptation to stress. Alt Med Rev. 1999;4(4):249-265.

Kupin VI, Polevaia EB. [Stimulation of the immunological reactivity of cancer patients by Eleutherococcus extract]. Vopr Onkol . 1986;32(7):21-6.

Koren G, Randor S, Martin S, et al. Maternal ginseng use associated with neonatal androgenization [letter]. JAMA. 1990;264(22):2866.

Kropotov AV, Kolodnyak OL, Koldaev VM. Effects of Siberian ginseng extract and ipriflavone on the development of glucocorticoid-induced osteoporosis. Bull Exp Biol Med . 2002;133(3):252-4.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH:LexiComp; 2000: 444-445.

McRae S. Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. Can Med Assoc J . 1996;155:293–295.

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Review Date: 1/25/2007
Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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