Panax ginseng for Frailty-Related Disorders: A Review.

The short version

This narrative review of clinical trials, meta-analyses and systematic reviews asked whether Panax ginseng (also called Asian or Korean ginseng, a root used for centuries in East Asian medicine) has evidence for conditions that drive frailty. Frailty is a syndrome of unintended weight loss, exhaustion, weakness, slow walking and low activity, linked to sarcopenia (loss of muscle with age). The authors state that no study has tested ginseng on frailty itself. They therefore examined related problems: blood sugar control, fatigue, high blood pressure and heart disease, COPD (a chronic lung disease), kidney function, memory and thinking, and immune function. The authors searched PubMed, Ovid and the Cochrane Library for studies published from 1995 to February 2018. They included trials, meta-analyses and systematic reviews of oral Panax ginseng in any group of participants, with any kind of comparison group, and excluded other ginseng species. Two authors screened the studies separately and settled differences by discussion. The review reports no count of studies found, no formal quality scoring and no pooled calculation of its own. Instead it summarizes what earlier reviews and individual trials concluded for each area, then adds a safety section on side effects and drug interactions. For fatigue, a meta-analysis of 12 trials found no significant boost in physical performance, though an 80-patient trial of Korean red ginseng lowered fatigue scores in overweight people with fatty liver. Reviews reported lower blood pressure, but the trials were low quality and one found only a 0 to 4% drop. A pooled analysis of 18 trials rated ginseng-based medicines better than nitrates for angina (odds ratio 3.00, meaning about three times the odds of symptom relief). COPD reviews reported better lung function and quality of life. For Alzheimer's disease, four trials with 259 people gave inconclusive results. Glucose findings for Panax ginseng alone were also inconclusive. Side effects were mild, such as insomnia, headache and hot flashes, and a small drug-metabolism effect (about 7% inhibition of the enzyme CYP2D6) was not judged clinically relevant. The authors suggest that ginseng may have potential for aging-related symptoms such as fatigue and hypertension, and that Kampo formulas containing it may be relevant to frailty. Important limits apply: no frailty trials exist, most studies did not enroll older adults, samples were small, quality was poor, placebo controls were uncommon, and several results come from formulas or other ginseng species. The authors call for larger, well-designed trials in older adults, including placebo-controlled designs and clearly specified ginseng preparations and processing methods.

Key findings

• No study has directly tested Panax ginseng (Asian or Korean ginseng) on frailty (an age-related syndrome of exhaustion, weakness, slow walking and low activity), so this review gathered trials and reviews on related problems instead.
• The evidence is mixed: a 12-trial meta-analysis found no significant gain in physical performance, an 18-trial analysis rated ginseng-based medicines better than nitrates for angina (odds ratio 3.00, meaning about three times the odds of symptom relief), and evidence for Alzheimer's disease and blood sugar was inconclusive.
• The authors describe Panax ginseng as having a safe profile, with mild and short-lived effects such as insomnia, headache, nasal bleeding and hot flashes, and a small effect on a drug-processing enzyme (CYP2D6, about 7%) that they judged not clinically relevant.
• The studies reviewed were small, of poor methodological quality, rarely placebo-controlled and seldom in older adults, and many used ginseng-containing formulas or did not specify the preparation, so the evidence level is low.

Common questions