Faculty peer reviewed
Despite the numerous medications available for the treatment of nausea and vomiting, some patients and doctors insist that ginger ale will alleviate gastrointestinal symptoms. As early as the first century AD, the Greek physician Dioscorides praised ginger root because it “gently stimulates the gut and is profitable for the stomach” (4). During the 16th century, the physician Lonicerus similarly wrote, “Ginger does good for a bad stomach” (4). Ginger has long medicinal roots in both India and China and is still used in those countries as a remedy for nausea and vomiting. In the United States today, patients with abdominal complaints often report self-medicating with ginger ale at home. Even at Memorial Sloane Kettering Cancer Institute, chemotherapy patients recline in their rooms with multiple anti-emetics by the bedside, including metoclopramide, compazine, ondansetron, and usually a can of ginger ale as well.Several active ingredients in ginger have been hypothesized to relieve nausea and vomiting. Potent compounds, known as gingerols, and their dehydrated derivatives, shoagols, simultaneously enhance gastrointestinal peristalsis and suppress gastric contraction (1,2,5,7). Galanolactose produces an anti-emetic effect by interfering with serotonin signaling via competitive inhibition of 5-HT3 receptors and also by acting as an antioxidant that neutralizes the free radicals responsible for emesis (5). Some speculation exists that ginger may also exert a central nervous system effect through an unknown mechanism (2,6).
Studies examining the use of ginger as an adjunct to pharmacologic anti-emetics have produced mixed results. Ginger has been shown to reverse the inhibitory effect of cisplatin on gastric emptying in rats (7). However, a study in 162 oncology patients demonstrated no additional benefit of ginger in reducing the prevalence or severity of both acute and delayed chemotherapy-induced nausea and vomiting when given with serotonin receptor antagonists or the anti-emetic aprepitant (7). This finding correlates with a study in gynecologic oncology patients that showed no improvement in symptoms with ginger (5). Conversely, a randomized-controlled trial found ginger powder to be as successful as metoclopramide for the control of chemotherapy-induced nausea and vomiting (5, 7). More results favoring the use of ginger come from Borrelli et al., who conducted a systematic review of 33 studies examining the use of ginger as an anti-emetic in pregnant women. They found a total of six double-blind randomized-controlled trials. Four showed ginger to be superior to placebo. The other two showed ginger to be comparable to vitamin B6, which in previous studies has demonstrated efficacy in pregnancy-induced nausea (1). Unfortunately, the small sample size and variable findings in the above studies make it difficult to draw definitive conclusions regarding the use of ginger across a spectrum of settings. Double-blind clinical trials are currently underway to help clarify the role of ginger treatment in medicine (3).
What about the anti-emetic properties of a drink made from ginger extract? Studies have found effective doses anywhere from 250-mg to 1-g taken one to four times a day (1,6). Unfortunately, commercial ginger ale today does not contain ginger extract, but artificial flavoring. Ginger ale as a clinical treatment for nausea and vomiting can only be seen as a myth. Nevertheless, if my patients want ginger ale in addition to their medications, I will continue to prescribe it and simply take advantage of the placebo effect rather than the ginger effect.
Peer reviewed by Barbara Porter, MD MPH, Clinical Assistant Professor of Medicine, NYU Medical Center
Dr. Che is a second year resident in internal medicine at NYU Medical Center.
 Borrelli F., Capasso R., Aviello G., et al. Effectiveness and Safety of Ginger in the Treatment of Pregnancy-Induced Nausea and Vomiting. Obstetrics and Gyne¬cology, 2005; 105(4): 849-56.
 Ernst E., Pittler M., Efficacy of Ginger for Nausea and Vomiting: a Systematic Review of Randomized Clinical Trials. British Journal of Anaesthesia, 2000; 84(3): 367-371.
 Hickok, A., Roscoe, J., et al. Phase II/III Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Ginger (Zingiber officinale) for Nausea Caused by Chemotherapy for Cancer: A Currently Accruing URCC CCOP Cancer Control Study. Supportive Cancer Therapy, 2007; 4(4): 247-250.
 Langner, E., Greifenberg S., et al. Ginger: History and Use. Advances in Therapy, 1998; 15(1): 25-44.
 Manusirivithaya, S., Sripramote, M., Tangjitgamol, S., et al. Antiemetic Effect of Ginger in Gynecologic Oncology Patients Receiving Cisplatin. International Journal of Gynecological Cancer; 2004; 14: 1063-1069.
 White, B. Ginger: An Overview. American Family Physician, 2007; 75(11): 1689-1691.
 Zick S., Ruffin, M., Lee, J. et al. Phase II Trial of Encapsulated Ginger as a Treatment for Chemotherapy-Induced Nausea and Vomiting. Supportive Care in Cancer, 2009; 17: 563-572.