Introduction

Ginger has been reported as a pain relief for arthritis, muscle soreness, chest pain, low back pain, stomach pain, and menstrual pain. It can be used for treating upper respiratory tract infections, cough, and bronchitis. As an anti-inflammatory agent, it is recommended for joint problems. Fresh juice of ginger has been shown to treat skin burns. Active component of ginger is used as a laxative and antacid medication. It is also used to warm the body for boosting the circulation and lowering high blood pressure. Because of its warming effect, ginger acts as antiviral for treatment of cold and flu. Ginger is also used as a flavoring agent in foods and beverages and as a fragrance in soaps and cosmetics. Cardiovascular diseases and stroke are complication of hyperlipidemia, diabetes mellitus, hypertension [1]. Many hypolipidemic drugs have already been proved to be useful in lowering serum lipid levels in patients. However, its side effects in long term treatment were more reported and its prices were still expensive. Thus, efforts to develop effective and better hypolipidemic drugs had led to the discovery of natural medicinal herbs [2].  The beneficial uses of medicinal plants in traditional system of medicine of many cultures are extensively documented [3]. Several plants have been used as dietary adjuvant and in treating the number of diseases even without any knowledge on their proper functions and constituents [4]. Over 80% of the world population uses natural remedies as medicine and over 70% of doctors in Germany prescribe plant-based medicines [5]. Ginger (Zingiber officinale) is a natural dietary component, which has hypolipidemic, antiplatelet aggregation, antioxidant and anticarcinogenic properties [6]. Ginger is indigenous to southern China, spreading eventually to the Spice Islands, other parts of Asia and subsequently to West Africa and the Caribbean [7]. Ginger was exported to Europe via India in the first century AD as a result of the lucrative spice trade.  India remains the largest producer of ginger [8]. Hypolipidemic and antiplatelet therapy is an effective approach for preventing coronary heart disease [9]. Ginger components are suggested as a potential new class of platelet-activation inhibitors without the potential side effects of aspirin, which is most commonly used in this approach. In a comparison of gingerols and analogs with aspirin, ginger compounds were found to be less potent compared to aspirin in inhibiting arachidonic acid-induced platelet release and aggregation and COX activity. However, several analogs had a significant inhibitory effect, suggesting that further development of more potent gingerol analogs might have value as an alternative to aspirin therapy in preventing ischemic heart disease [10,11]. Mechanism by which ginger may lower cholesterol is well understood by scientists and other researchers. They explain that ginger activates an enzyme that increases  body's use of cholesterol and lowers it. Several studies show that ginger can lower experimentally induced high cholesterol in animals, but more studies on ginger's effect on humans with high cholesterol are needed before the substance can be touted as a treatment for high cholesterol [12].

Material And Method

Research study was conducted at Jinnah hospital Lahore Pakistan, from January 2014 to June 2014. Written consent was taken from sixty hyperlipidemic patients age range from 18 to 70 years. Both gender male and female patients were enrolled. Patients were randomly divided in two groups, 30 patients were on drug ginger pasted-powder advised to take 5 grams in divided doses with their normal diet for the period of three months. Thirty patients were on placebo pasted-wheat powder, with same color as of ginger powder, advised to take 5 grams in divided doses with their normal diet for the period of three months. Their base line lipid profile (for total serum cholesterol, LDL-cholesterol ) and body weight was recorded at start of treatment and were  advised to come for check-up, fortnightly. When duration of study was over, their lipid profile and body weight was measured and compared statistically with pre-treatment values. Serum total cholesterol was estimated by the enzymatic calorimatic method. Serum LDL-cholesterol was calculated by Friedwald formula 5 (LDL-Cholesterol = Total Cholesterol-(Triglycerides/5 +HDL-Cholesterol).  Body weight was determined by conventional method of usual weight machine  Data were expressed as the mean ± SD and paired “t” test was applied to determine statistical significance as the difference. A probability value of <0.05 was considered as non-significance and P<0.001 was considered as highly significant change in the results.

Results

Three months treatment with 5 grams of Ginger reduced LDL-cholesterol from 185.21±2.01 to 157.72±1.90 mg/dl, which is highly significant change in the parameter (p-value <0.001). Serum total cholesterol at baseline was 251.11±2.00 mg/dl, which reduced to 230.71±1.77 mg/dl. This change is highly significant statistically, with p-value <0.001. Mean body weight decreased from 79.01± kg to 77.32±2.61 kg in three months therapy. All changes are highly significant statistically, having p-value <0.001. In placebo group LDL-Cholesterol, serum total cholesterol and body weight reduction was 0.18, 0.77, and 0.22 % respectively. All these changes are non-significant (p-value >0.05). Detailed changes are shown in following tables:

Table 1: showing pretreatment, post treatment values, change in percentage and their statistical significance in DRUG GROUP (n=27)

Table 2: showing pretreatment, post treatment values, change in percentage and their statistical significance in PLACEBO GROUP (n=30)

KEY: ± indicates standard error of mean, p-value >0.05 indicates non significant and P<0.001 indicates highly significant change in lipid profile. LDL-C means low density lipoprotein cholesterol mg/dl, T-C means total serum cholesterol mg/dl, and body weight is measured in kg.

Discussion

In our research study ginger was used in thirty male and female hyperlipidemic patients for three months, which reduced LDL-cholesterol from baseline value of 185.21±2.01 mg/dl to 157.72 ±1.90 mg/dl. It is 17.4% change in this parameter, which is highly significant change statistically with p-value of <0.001. These results match with results of Bordia A et al [13] who mentioned that  nearly same effects of ginger may be achieved when the drug is used for three months. He has mentioned detailed explanations regarding effects of ginger in hyperlipidemic and hyperglycemic conditions. These results are in contrast with study results of Thomson M et al [14] who observed less effect on LDL-cholesterol, i.e.; from 179.57±2.29 mg/dl to 176.92±2.11 mg/dl when they used  three grams of ginger  for the period of 6 months in 82 hyperlipidemic subjects. These variations and too much contrast in these two comparable studies may be sample size, long duration of administration of chemical compound/drug. In our observation serum total cholesterol reduced from 251.11±2.00 mg/dl to 230.71±1.77 mg/dl. Vaes LP and Chyka PA [15] observed almost same changes in serum total cholesterol when they used 2 grams ginger powder, twice daily for the period of one month. Their results augment and support results of our research work. Our results in the parameter also match with results of study conducted by Chrubasek S et al [16] who observed same changes in serum total cholesterol. Five grams of ginger in our study reduced body weight of 30 male/female patients from 79.01± kg to 77.32±2.61 kg by 3  months therapy. Nurtjahja-Tjendraputra E et al [17] also observed same changes by their research study. This proves and augments our research results. Fuhrman B et al [18] described presence of various chemical ingredients in ginger which are responsible to decrease high levels of serum lipid levels and decreased blood pressure in hyperlipidemic patients. Our results are in contrast with study results of Guh J H et al [19] who proved that there is no significant effect on body weight when 2 grams of ginger powder daily was used for two months, in one hundred volunteers having secondary hyperlipidemia. Possible and guessed, scientific reason for this difference may be type of hyperlipidemia, ie; we included both primary and secondary hyperlipidemic patients, and they only included secondary hyperlipidemic patients.