The Effect of Ginseng Supplementation on Lipid Profile: GRADE-assessed Systematic Review and Dose-response Meta-analysis of Randomized Controlled Trials


Cite item

Full Text

Abstract

Background:This systematic review and meta-analysis aimed to evaluate the overall impact of Panax ginseng on lipid profile by synthesizing existing evidence. Cardiovascular Disease (CVD) is the leading cause of morbidity and mortality among the elderly population, and serum lipids play a crucial role in its development. Maintaining optimal levels of triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol is essential in reducing the risk of CVD. Ginsenosides, the active constituents in ginseng, have shown positive effects on lipid metabolism. This review aimed to provide a comprehensive understanding of the potential benefits of ginseng in managing dyslipidemia, which could have significant implications for the prevention and treatment of CVD.

Methods:A comprehensive analysis of 29 Randomized Controlled Trials (RCTs) was conducted to assess the effects of ginseng supplementation on lipid profile, including Triglyceride (TG), Total Cholesterol (TC), High-density Lipoprotein Cholesterol (HDL-C), and Low-density Lipoprotein Cholesterol (LDL-C) levels. A systematic search was done in online databases, such as MEDLINE, Scopus, and Clarivate Analytics Web of Science, using relevant keywords and MeSH terms to identify relevant studies until January 2024.

Results:The Weighted Mean Differences (WMD) and 95% Confidence Intervals (CI) for TG, TC, LDL-C, and HDL-C did not show significant changes with ginseng supplementation.

Conclusion:Taking into account the results, using ginseng did not have a statistically significant influence on lipid profile parameters in individuals with different health conditions. Further, well-designed RCTs focusing on specific diseases are needed to clarify the potential beneficial effects of ginseng and its derivatives on lipid profile.

About the authors

Seyyed Arabi

Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences

Email: info@benthamscience.net

Mostafa Shahraki-Jazinaki

Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences

Email: info@benthamscience.net

Maryam Nayyer Abadi

Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences

Email: info@benthamscience.net

Leila Bahrami

Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences

Email: info@benthamscience.net

Mahla Chambari

Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences

Email: info@benthamscience.net

Hossein Bahari

Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences

Email: info@benthamscience.net

Amirhossein Sahebkar

Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University

Author for correspondence.
Email: info@benthamscience.net

References

  1. Buizert PJ, van Schoor NM, Lips P, Deeg DJH, Eekhoff EM. Lipid levels: A link between cardiovascular disease and osteoporosis? J Bone Miner Res 2009; 24(6): 1103-9. doi: 10.1359/jbmr.081262 PMID: 19113906
  2. Gadó K, Szabo A, Markovics D, Virág A. Most common cardiovascular diseases of the elderly: A review article. Develop Heal Sci 2022; 4(2): 27-32. doi: 10.1556/2066.2021.00048
  3. Lee Y, Siddiqui WJ. Cholesterol levels. Treasure Island (FL): StatPearls Publishing 2019.
  4. You A. Scientific report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: US Departments of Agriculture and Health and Human Services, 2015. Adv Nutr 2015; 7(1): 202-4.
  5. Garber AJ, Handelsman Y, Grunberger G, et al. Consensus statement by the american association of clinical endocrinologists and american college of endocrinology on the comprehensive type 2 diabetes management algorithm–2020 executive summary. Endocr Pract 2020; 26(1): 107-39. doi: 10.4158/CS-2019-0472 PMID: 32022600
  6. Chiavaroli L, Viguiliouk E, Nishi S, et al. DASH dietary pattern and cardiometabolic outcomes: an umbrella review of systematic reviews and meta-analyses. Nutrients 2019; 11(2): 338. doi: 10.3390/nu11020338 PMID: 30764511
  7. Du K, Fan Y, Li D. Sulforaphane ameliorates lipid profile in rodents: An updated systematic review and meta-analysis. Sci Rep 2021; 11(1): 7804. doi: 10.1038/s41598-021-87367-9 PMID: 33833347
  8. Tackett KL, Jones MC. Complementary and alternative medicines for the treatment of diabetes. J Pharm Pract 2009; 22(6): 546-52. doi: 10.1177/0897190009332658
  9. Phutrakool P, Pongpirul K. Acceptance and use of complementary and alternative medicine among medical specialists: A 15-year systematic review and data synthesis. Syst Rev 2022; 11(1): 10. doi: 10.1186/s13643-021-01882-4 PMID: 35027078
  10. Wang N, Huang X, Li T, et al. Application of RRLC-QTOF-MS-based metabonomics and UPE for investigating Spleen-Qi deficiency syndrome with Panax ginseng treatment. J Ethnopharmacol 2020; 256: 112822. doi: 10.1016/j.jep.2020.112822 PMID: 32247146
  11. Kitts DD, Hu C. Efficacy and safety of ginseng. Public Health Nutr 2000; 3(4a): 473-85. doi: 10.1017/S1368980000000550 PMID: 11276295
  12. Jia L, Zhao Y, Liang X. Curr Med Chem: Current evaluation of the millennium phytomedicine-ginseng (II): Collected chemical entities, modern pharmacology, and clinical applications emanated from traditional Chinese medicine. Altern Med Rev 2009; 14(4): 411-2.
  13. Kim JH, Yi YS, Kim MY, Cho JY. Role of ginsenosides, the main active components of Panax ginseng, in inflammatory responses and diseases. J Ginseng Res 2017; 41(4): 435-43. doi: 10.1016/j.jgr.2016.08.004 PMID: 29021688
  14. Mittler R. Oxidative stress, antioxidants and stress tolerance. Trends Plant Sci 2002; 7(9): 405-10. doi: 10.1016/S1360-1385(02)02312-9 PMID: 12234732
  15. Kim S, Park K-S. Effects of Panax ginseng extract on lipid metabolism in humans. Pharmacol Res 2003; 48(5): 511-3. doi: 10.1016/S1043-6618(03)00189-0 PMID: 12967598
  16. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009; 151(4): 264-269, W64. doi: 10.7326/0003-4819-151-4-200908180-00135 PMID: 19622511
  17. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions, version 50 2. The Cochrane Collaboration, 2009. 2010.
  18. Rahnama I, Arabi SM, Chambari M, et al. The effect of Spirulina supplementation on lipid profile: GRADE-assessed systematic review and dose-response meta-analysis of data from randomized controlled trials. Pharmacol Res 2023; 193: 106802. doi: 10.1016/j.phrs.2023.106802 PMID: 37263369
  19. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: A new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Libr 2019; 10(10): ED000142. doi: 10.1002/14651858.ED000142 PMID: 31643080
  20. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta- analysis. Stat Med 2002; 21(11): 1539-58. doi: 10.1002/sim.1186 PMID: 12111919
  21. Crippa A, Orsini N. Dose-response meta-analysis of differences in means. BMC Med Res Methodol 2016; 16(1): 91. doi: 10.1186/s12874-016-0189-0 PMID: 27485429
  22. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315(7109): 629-34. doi: 10.1136/bmj.315.7109.629 PMID: 9310563
  23. de Andrade E, de Mesquita AA, de Almeida Claro J, et al. Study of the efficacy of Korean red ginseng in the treatment of erectile dysfunction. Asian J Androl 2007; 9(2): 241-4. doi: 10.1111/j.1745-7262.2007.00210.x PMID: 16855773
  24. Shin K-S, Lee J-J, Kim Y-I, Yu J-Y, Park E-S. Effect of Korean red ginseng extract on blood circulation in healthy volunteers: A randomized, double-blind, placebo-controlled trial. J Ginseng Res 2007; 31(2): 109-16. doi: 10.5142/JGR.2007.31.2.109
  25. Duan L, Liu Y, Li J, et al. Panax notoginseng saponins alleviate coronary artery disease through hypermethylation of the miR-194-MAPK pathway. Front Pharmacol 2022; 13: 829416. doi: 10.3389/fphar.2022.829416 PMID: 35784716
  26. Chung IM, Lim JW, Pyun WB, Kim HY. Korean red ginseng improves vascular stiffness in patients with coronary artery disease. J Ginseng Res 2010; 34(3): 212-8. doi: 10.5142/jgr.2010.34.3.212
  27. Shin SK, Kwon JH, Jeong YJ, Jeon SM, Choi JY, Choi MS. Supplementation of cheonggukjang and red ginseng cheonggukjang can improve plasma lipid profile and fasting blood glucose concentration in subjects with impaired fasting glucose. J Med Food 2011; 14(1-2): 108-13. doi: 10.1089/jmf.2009.1366 PMID: 21128827
  28. Kim HO, Park MJ, Han JS. Effects of fermented red ginseng supplementation on blood glucose and insulin resistance in type 2 diabetic patients. J Kor Soc Food Sci Nutr 2011; 40(5): 696-703. doi: 10.3746/jkfn.2011.40.5.696
  29. Ahn CM, Hong SJ, Choi SC, Park JH, Kim JS, Lim DS. Red ginseng extract improves coronary flow reserve and increases absolute numbers of various circulating angiogenic cells in patients with first ST-segment elevation acute myocardial infarction. Phytother Res 2011; 25(2): 239-49. doi: 10.1002/ptr.3250 PMID: 20641058
  30. Rhee MY, Kim YS, Bae JH, et al. Effect of Korean red ginseng on arterial stiffness in subjects with hypertension. J Altern Complement Med 2011; 17(1): 45-9. doi: 10.1089/acm.2010.0065 PMID: 21235416
  31. Kim SY, Seo SK, Choi YM, et al. Effects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women. Menopause 2012; 19(4): 461-6. doi: 10.1097/gme.0b013e3182325e4b PMID: 22027944
  32. Lee NH, Yoo SR, Kim HG, Cho JH, Son CG. Safety and tolerability of Panax ginseng root extract: A randomized, placebo-controlled, clinical trial in healthy Korean volunteers. J Altern Complement Med 2012; 18(11): 1061-9. doi: 10.1089/acm.2011.0591 PMID: 22909282
  33. Yoon JW, Kang SM, Vassy JL, et al. Efficacy and safety of ginsam, a vinegar extract from Panax ginseng, in type 2 diabetic patients: Results of a double-blind, placebo-controlled study. J Diabetes Investig 2012; 3(3): 309-17. doi: 10.1111/j.2040-1124.2011.00185.x PMID: 24843582
  34. Park BJ, Lee YJ, Lee HR, et al. Effects of Korean red ginseng on cardiovascular risks in subjects with metabolic syndrome: A double-blind randomized controlled study. Korean J Fam Med 2012; 33(4): 190-6. doi: 10.4082/kjfm.2012.33.4.190 PMID: 22916320
  35. Kwon DH, Bose S, Song MY, et al. Efficacy of Korean red ginseng by single nucleotide polymorphism in obese women: Randomized, double-blind, placebo-controlled trial. J Ginseng Res 2012; 36(2): 176-89. doi: 10.5142/jgr.2012.36.2.176 PMID: 23717118
  36. Cho YH, Ahn SC, Lee SY, et al. Effect of Korean red ginseng on insulin sensitivity in non-diabetic healthy overweight and obese adults. Asia Pac J Clin Nutr 2013; 22(3): 365-71. PMID: 23945406
  37. Oh MR, Park SH, Kim SY, et al. Postprandial glucose-lowering effects of fermented red ginseng in subjects with impaired fasting glucose or type 2 diabetes: A randomized, double-blind, placebo- controlled clinical trial. BMC Complement Altern Med 2014; 14(1): 237. doi: 10.1186/1472-6882-14-237 PMID: 25015735
  38. Bang H, Kwak JH, Ahn HY, Shin DY, Lee JH. Korean red ginseng improves glucose control in subjects with impaired fasting glucose, impaired glucose tolerance, or newly diagnosed type 2 diabetes mellitus. J Med Food 2014; 17(1): 128-34. doi: 10.1089/jmf.2013.2889 PMID: 24456363
  39. Jung DH, Lee YJ, Kim CB, Kim JY, Shin SH, Park JK. Effects of ginseng on peripheral blood mitochondrial DNA copy number and hormones in men with metabolic syndrome: A randomized clinical and pilot study. Complement Ther Med 2016; 24: 40-6. doi: 10.1016/j.ctim.2015.12.001 PMID: 26860800
  40. Park SY, Shin YK, Kim HT, et al. A single-center, randomized, double-blind, placebo-controlled study on the efficacy and safety of "enzyme-treated red ginseng powder complex (BG11001)" for antiwrinkle and proelasticity in individuals with healthy skin. J Ginseng Res 2016; 40(3): 260-8. doi: 10.1016/j.jgr.2015.08.006 PMID: 27616902
  41. Hong M, Lee YH, Kim S, et al. Anti-inflammatory and antifatigue effect of Korean red ginseng in patients with nonalcoholic fatty liver disease. J Ginseng Res 2016; 40(3): 203-10. doi: 10.1016/j.jgr.2015.07.006 PMID: 27616896
  42. Choi HS, Kim S, Kim MJ, et al. Efficacy and safety of Panax ginseng berry extract on glycemic control: A 12-wk randomized, double-blind, and placebo-controlled clinical trial. J Ginseng Res 2018; 42(1): 90-7. doi: 10.1016/j.jgr.2017.01.003 PMID: 29348727
  43. Baek JH, Heo JY, Fava M, et al. Effect of Korean red ginseng in individuals exposed to high stress levels: A 6-week, double-blind, randomized, placebo-controlled trial. J Ginseng Res 2019; 43(3): 402-7. doi: 10.1016/j.jgr.2018.03.001 PMID: 31308812
  44. Jung SJ, Hwang JH, Park SH, et al. A 12-week, randomized, double-blind study to evaluate the efficacy and safety of liver function after using fermented ginseng powder (GBCK25). Food Nutr Res 2020; 64: 64. doi: 10.29219/fnr.v64.3517 PMID: 32425736
  45. Hwang JH, Park SH, Choi EK, Jung SJ, Pyo MK, Chae SW. A randomized, double-blind, placebo-controlled pilot study to assess the effects of protopanaxadiol saponin–enriched ginseng extract and pectinase-processed ginseng extract on the prevention of acute respiratory illness in healthy people. J Ginseng Res 2020; 44(5): 697-703. doi: 10.1016/j.jgr.2019.01.002 PMID: 32913399
  46. Seong E, Bose S, Han SY, et al. Positive influence of gut microbiota on the effects of Korean red ginseng in metabolic syndrome: A randomized, double-blind, placebo-controlled clinical trial. EPMA J 2021; 12(2): 177-97. doi: 10.1007/s13167-021-00243-4 PMID: 34194584
  47. Chung TH, Kim JH, Seol SY, Kim YJ, Lee YJ. The effects of Korean red ginseng on biological aging and antioxidant capacity in postmenopausal women: A double-blind randomized controlled study. Nutrients 2021; 13(9): 3090. doi: 10.3390/nu13093090 PMID: 34578969
  48. Mahdy Hassanzadeh D, Hedayatollah F, Morteza M, et al. The effects of Panax ginseng on lipid profile, pro-oxidant: Antioxidant status and high-sensitivity C reactive protein levels in hyperlipidemic patients in Iran. Int J Prev Med 2013; 4(9): 1045-51.
  49. Hosseini SA, Ehsanpour A, Asgari M, Malihi R. Evaluation of standardized ginseng extract Panax (G115®) effect on fasting blood glucose levels, glycated hemoglobin and lipid profile in patients with diabetes type 2. Jundishapur J Chron Dis Care 2013; 2(3): e93793.
  50. Vuksan V, Xu ZZ, Jovanovski E, et al. Efficacy and safety of American ginseng (Panax quinquefolius L.) extract on glycemic control and cardiovascular risk factors in individuals with type 2 diabetes: A double-blind, randomized, cross-over clinical trial. Eur J Nutr 2019; 58(3): 1237-45. doi: 10.1007/s00394-018-1642-0 PMID: 29478187
  51. Jovanovski E, Smircic-Duvnjak L, Komishon A, et al. Effect of coadministration of enriched Korean red ginseng (Panax ginseng) and American ginseng (Panax quinquefolius L) on cardiometabolic outcomes in type-2 diabetes: A randomized controlled trial. J Ginseng Res 2021; 45(5): 546-54. doi: 10.1016/j.jgr.2019.11.005 PMID: 34803424
  52. Ziaei R, Ghavami A, Ghaedi E, Hadi A, Javadian P, Clark CCT. The efficacy of ginseng supplementation on plasma lipid concentration in adults: A systematic review and meta-analysis. Complement Ther Med 2020; 48: 102239. doi: 10.1016/j.ctim.2019.102239 PMID: 31987252
  53. Naseri K, Saadati S, Sadeghi A, et al. The efficacy of ginseng (Panax) on human prediabetes and type 2 diabetes mellitus: A systematic review and meta-analysis. Nutrients 2022; 14(12): 2401. doi: 10.3390/nu14122401 PMID: 35745129
  54. Park SH, Chung S, Chung MY, Choi HK, Hwang JT, Park JH. Effects of Panax ginseng on hyperglycemia, hypertension, and hyperlipidemia: A systematic review and meta-analysis. J Ginseng Res 2022; 46(2): 188-205. doi: 10.1016/j.jgr.2021.10.002 PMID: 35509826
  55. Goldenberg JZ, Day A, Brinkworth GD, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: Systematic review and meta-analysis of published and unpublished randomized trial data. BMJ 2021; 372: m4743. doi: 10.1136/bmj.m4743
  56. Lee SeoHyun LS, Lee MakSoon LM, Kim ChongTai KC. Ginsenoside Rg3 reduces lipid accumulation with AMP-activated protein kinase (AMPK) activation in HepG2 cells. Int J Mol Sci 2012; 13(5): 5729-39.
  57. Chong SKF, Oberholzer VG. Ginseng is there a use in clinical medicine? Postgrad Med J 1988; 64(757): 841-6. doi: 10.1136/pgmj.64.757.841 PMID: 3076665
  58. Lee YM, Yoon H, Park HM, Song BC, Yeum KJ. Implications of red Panax ginseng in oxidative stress associated chronic diseases. J Ginseng Res 2017; 41(2): 113-9. doi: 10.1016/j.jgr.2016.03.003 PMID: 28413314
  59. Wang HY, Qi LW, Wang CZ, Li P. Bioactivity enhancement of herbal supplements by intestinal microbiota focusing on ginsenosides. Am J Chin Med 2011; 39(6): 1103-15. doi: 10.1142/S0192415X11009433 PMID: 22083984
  60. Lee YS, Chung IS, Lee IR, Kim KH, Hong WS, Yun YS. Activation of multiple effector pathways of immune system by the antineoplastic immunostimulator acidic polysaccharide ginsan isolated from Panax ginseng. Anticancer Res 1997; 17(1A): 323-31. PMID: 9066672
  61. Kim KH, Lee YS, Jung IS, et al. Acidic polysaccharide from Panax ginseng, ginsan, induces Th1 cell and macrophage cytokines and generates LAK cells in synergy with rIL-2. Planta Med 1998; 64(2): 110-5. doi: 10.1055/s-2006-957385 PMID: 9525101
  62. Jin W, Li C, Yang S, et al. Hypolipidemic effect and molecular mechanism of ginsenosides: A review based on oxidative stress. Front Pharmacol 2023; 14: 1166898. doi: 10.3389/fphar.2023.1166898 PMID: 37188264
  63. Gao Y, Zhang S, Li J, et al. Effect and mechanism of ginsenoside Rg1-regulating hepatic steatosis in HepG2 cells induced by free fatty acid. Biosci Biotechnol Biochem 2020; 84(11): 2228-40. doi: 10.1080/09168451.2020.1793293 PMID: 32654591
  64. Shen L, Xiong Y, Wang DQH, et al. Ginsenoside Rb1 reduces fatty liver by activating AMP-activated protein kinase in obese rats. J Lipid Res 2013; 54(5): 1430-8. doi: 10.1194/jlr.M035907 PMID: 23434611

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2024 Bentham Science Publishers