Ginger supplementation improves GI symptoms in RRMS patients – new trial

Multiple Sclerosis (MS) is a chronic neurodegenerative disease often results in persistent disability and diminished quality of life due to impaired communication between the brain and the body. This disease manifests in four clinical course patterns, RRMS being the most prevalent.

Recent evidence shown that over 80% of individuals with MS experience gastrointestinal (GI) symptoms, stemming from disease complications, oral disease-modifying therapies, or a combination of both.

Ginger supplementation has demonstrated positive effects on various GI-related symptoms, promoting increased GI mobility, and reducing food transit time, potentially easing issues like constipation.

Against this backdrop, a 12-week double blind parallel randomised placebo-controlled trial involving 52 participants was conducted to explore the impact of ginger supplementation on the frequency and severity of common GI symptoms in RRMS patients.

Before randomly allocating 26 participants to the intervention group and the remaining 26 to the control group, a uniform 3-week run in period was implemented.

During this phase, participants refrained from consuming ginger and its derivatives while maintaining their regular physical activity and dietary habits.

Subsequently, the intervention and control groups were administered 500 milligrams of ginger and placebo (corn) tablets respectively, thrice daily with main meals over the 12-week experimentation period.

At the start and end of the clinical trial, the visual analogue scale (VAS) was employed to assess the frequency and severity of constipation, dysphagia, abdominal pain, diarrhoea, bloating, belching, flatulence, heartburn, anorexia, and nausea ranging from 0 mm (none) to 100 mm (worst possible).

Weekly physical activity levels were gauged using the International Physical Activity Questionnaire, while dietary intakes were recorded through three-day food records (two weekdays and one weekend day). Energy and nutrient intake per day were then determined using Nutritionist IV software tailored for Iranian foods.

Efficacy of ginger supplementation ​

Following ginger supplementation, there was a significant decrease in the frequency of nausea (P​ = 0.003), bloating (P​ = 0.046), and constipation (P​ < 0.001) compared to baseline.

Conversely, in the control group, the frequency of nausea (P​ = 0.043), belching (P​ = 0.018), and constipation (P​ < 0.001) significantly increased at the end of the study in comparison to the baseline.

Moreover, although not statistically significant, the frequency of abdominal pain exhibited a marginal significant increase (P​ = 0.078) at the 12th week in the control group.

Researchers also observed a significant reduction in the severity of heartburn (P​ = 0.016), nausea (P​ = 0.005), bloating (P​ = 0.032), and constipation (P​ < 0.001) in the intervention group.

On the other hand, the severity of nausea (P​ = 0.004) and constipation (P​ = 0.002) shown a significant increase in the control group.

Overall, ginger supplementation significantly reduced the frequency (-12.41 ± 3.75 vs. 3.75 ± 1.82, P​ < 0.001) and severity (-13.43 ± 4.91 vs. 6.88 ± 2.69, P​ = 0.001) of nausea compared to placebo.

Furthermore, constipation frequency (-23.63 ± 5.36 vs. 14.81 ± 2.78, P​ < 0.001) and severity (-24.15 ± 5.10 vs. 11.39 ± 3.23, P​ < 0.001) decreased significantly in the intervention group.

The same group also experienced a significant reduction in bloating severity (-11.57 ± 5.09 vs. 3.97 ± 3.99, P​ = 0.047) and a marginally significant reduction in bloating frequency (-9.31 ± 4.44 vs. 1.56 ± 4.05, P​ = 0.098) compared to the placebo group.

Notably, constipation, nausea, and bloating showed the most improvement respectively. The severity of abdominal pain was near-significantly lower following ginger supplementation compared to those in the control group (-5.69 ± 3.66 vs. 3.43 ± 3.26, P​ = 0.069).

At the same time, researchers observed minor side effects (7.7% in the ginger group vs. 11.5% in the placebo group). In the treatment group, one patient reported abdominal discomfort, and another experienced heartburn.

In the control group, one patient reported a headache, and two participants experienced heartburn.

Further trials required for generalisation ​

The present study revealed that a daily dosage of 1500 milligrams daily of ginger over 12 weeks significantly reduced the frequency and severity of nausea and constipation, along with a significant reduction in bloating severity.

Additionally, ginger supplementation showed a statistically near-significant impact on reducing bloating frequency and abdominal pain severity in RRMS patients.

However, no significant effects were observed on the frequency and severity of dysphagia, diarrhoea, belching, flatulence, heartburn, and anorexia, as well as the frequency of abdominal pain.

Ginger also found to have rare and mild side effects, highlighting its excellent safety profile.

Interestingly, in this trial, the most substantial alleviation of GI symptoms through ginger supplementation was observed in cases of constipation. Among RRMS patients, constipation stands out as the most prevalent GI issue, attributed to prolonged chronic transit time and alternations in colonic compliance and basal tone.

These complications may arise from demyelinating lesions, either in the conus medullaris or more proximal regions. On top of constipation, ginger supplementation also significantly reduced nausea and bloating.

In RRMS patients, these symptoms, along with abdominal pain, often stem from dyspepsia or indigestion, which is approximately four times more prevalent as compared to the general population.

It is noteworthy that the trial’s observed improvements in constipation, nausea, and bloating exceeded the minimum clinically important difference, set at 10 mm for the VAS of GI symptoms. However, the amelioration in the severity of abdominal pain did not reach clinical significance.

“The management of prevalent GI problems such as constipations and dyspepsia in MS patients can improve their quality of life, well-being, daily functioning, and work ability,”​ researchers wrote.

“The prokinetic effects of ginger can alleviate constipation, and the stimulatory effects of ginger on digestive enzymes can relieve dyspepsia in long term use. Also, the analgesic, carminative, anti-nausea, antioxidant, and anti-inflammatory properties of ginger may further increase its efficacy in reducing GI symptoms. Therefore, we suggest ginger as a safe complementary therapy for MS patients with GI complications.”​
Nevertheless, researchers acknowledged that the results from this study cannot be generalised to broader MS population as it exclusively focused on RRMS patients. Moreover, the mild to moderate frequency and severity of GI symptoms in this study raise questions about the applicability of the findings to more severe cases.

Source: BMC Complementary Medicine and Therapies

The effects of ginger supplementation on common gastrointestinal symptoms in patients with relapsing-remitting multiple sclerosis: a double-blind randomized placebo-controlled trial​

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605938/​

Authors: Sahar Foshati, Maryam Poursadeghfard, Zahra Heidari, and Reza Amani