Acta Otolarvngol (Stockh) 1988: 105: 45-49

Ginger Root Against Seasickness

A Conctrolled Trial on the Open Sea
AKSEL GRONTVED, TORBEN BRASK, JORGEN KAMBSKARD3 and ERWIN HENTZER
From the Departments o Oto-Rhino-Laryngology, Svendborg Hospital, Svendborg, f University Hospital, Odense, and Training-ship Danmark, Directorate for Maritime Education, Copenhagen, Denmark

Acta Otolaryngol Downloaded from informahealthcare.com by Yonsei University on 09/14/11 For personal use only.

Gr@ntvedA, Brask T, Kambskard J, Hentzer E. Ginger root against seasickness. A controlled trial on the open sea. Acta Otolaryngol (Stockh) 1988; 105:4549. In a double-blind randomized placebo trial, the effect of the powdered rhizome of ginger (Zingiber officinale) was tested on seasickness. Eighty naval cadets, unaccustomed to sailing in heavy seas reported during voyages on the high seas, symptoms of seasickness every hour for 4 consecutive hours after ingestion of 1 g of the drug or placebo. Ginger root reduced the tendency to vomiting and cold sweating significantly better than placebo did (p<0.05). With regard to vomiting, a modified Protection Index (PI)=72% was calculated. Remarkably fewer symptoms of nausea and vertigo were reported after ginger root ingestion, but the difference was not statistically significant. For all symptom categories, PI=38 % was calculated. Keywords: motion sickness, kinetosis, Zingiber officinale,field
trial. A. Grontved, Vibekevej 24, DK-5250 Odense SV, Denmark.

Many drugs (mostly antihistamines, parasympatholytics, and sympathomimetics) have proved effective against the symptoms of kinetosis (motion sickness) (1-3) which is often a problem experienced by people unaccustomed to travelling by sea, air, or in space (4, 5). The drugs have also been shown effective in laboratory experiments (2-6). Unfortunately, al the effective drugs in general use have side effects, viz. sedation or l visual disturbances (4-7) which to a greater or lesser extent render them unsuitable for persons whose occupations require that they be alert. This problem has been most troublesome for air pilots and astronauts (5,7) and has had a considerable influence on the planning and accomplishment of spaceflights (7). In two controlled laboratory trials, the powdered rhizome of ginger (Zingiber officinalel showed a significantly better effect on the symptoms of kinetosis than did placebo (8, 9). All over the world ginger root is used as a flavouring or as a gastrointestinal regulating agent (10, 11). No side effects of ginger root have been documented. Therefore, it would be of the greatest interest if the agent proved effective against the embarrassing symptoms of kinetosis. The purpose of this investigation was to test whether, under controlled conditions, ginger root would have any effect on the symptoms of kinetosis in people unaccustomed to sailing on the high seas. MATERIAL AND METHODS The subjects were a homogeneous group of 80 healthy naval cadets on board a full-rigged training-ship (790 G.R.T.) during the autumn cruise of 1985. Their median age was 17 (range 16-19) years. None of the subjects was accustomed to the high seas and none of them was especially susceptible to motion sickness. A few days after the cruise had started, as the ship met heavy seas for the first time, the

46

A.Gr@ntvedet al.

Acta Otolaryngol (Stockh) 105

SYMPTOM SCORE

O'

Fig. I. The total sum of sympActa Otolaryngol Downloaded from informahealthcare.com by Yonsei University on 09/14/11 For personal use only.

.
NAUSEA VERTIGO VOMITING
COLD SWEATING

SYMPTOMS

tom scores arranged according to the category of symptom.

trial was carried out in a double-blind randomized design. Position: the Skagerrak. Wind force: 10 m/s. Height of sea and swell: 3 4 m. Under the supervision of the ship's doctor 40 of the cadets each received 1 g of powdered ginger root and the other 40 each received 1 g of lactose (placebo). The drugs were contained in sealed, coloured, tasteless capsules and were swallowed by the cadets immediately. Nobody on board had any knowledge of the drug code. Every hour for the next 4 h the cadets noted on individual scorecards the following symptoms of seasickness: 1) nausea, score &3; 2) vertigo, score 0-3; 3) vomiting, score 0-2; 4) cold sweating, score 0-1. Other symptoms or side effects had to be noted as well. The cadets performed their normal tasks during the trial. After 4 h the scorecards were collected. The cadets were not required to report any other specified symptoms than the four mentioned. Professional statisticians assisted in the statistical analysis of the collected data. The trial was conducted in accordance with the Helsinki Declaration I1 and had been registered with the regional Committee of Scientific Ethics. RESULTS The 79 cadets (40 in the ginger group and 39 in the placebo group) out of 80, who had correctly completed their scorecards, were included in the trial and formed the basis for the statistical analysis. The ship's doctor observed a general tendency to scoring lower than would have been expected, considering the severity of the objective signs of seasickness. A total of 48 cadets (61%) had noted symptoms of seasickness; 16 in the ginger and 15 in the placebo group reported no symptoms at all. In each symptom category and in every hour the scoring was higher in the placebo group (Figs. 1 and 2). Five subjects in the placebo group vomited two or more times but none in the ginger group vomited more than once. In a distribution made according to the severity of symptoms (Table I) a X2-test (d.f. =2) showed ginger root to be significantly (0.025<p<0.05) better than placebo in reducing the frequency of vomiting and cold sweating. Modifying the equation of Holling et al. (12), a vomiting Protection Index (PI): placebo score-drug score X 100 = 72% placebo score could be calculated.

Acta Otolaryngol (Stockh) 105

SYMPTOM

Ginger root against seasickness

47

SCOFIE
70

50
40

30

20
10

Acta Otolaryngol Downloaded from informahealthcare.com by Yonsei University on 09/14/11 For personal use only.

0
1

HOURS m
2 3
4

R DRUG INTAKE

Fig. 2. Score sum of all symptom categories every hour during the trial.

During hours 1 to 3 a difference between ginger root and placebo could be seen (Fig. 2) but this was not significant. At hour 4 (Table I) a X2-test (d.f.=3) revealed a significant difference between the two substances (O.OV<p<O.O5). The symptoms of nausea and vertigo in a X2-test showed no significant difference between the drugs (nausea: 0.4cp<0.5; vertigo: 0.6cp<0.7). For all categories of symptoms a modified PI=38 % could be calculated. No side effects or symptoms were reported, other than what could be ascribed to seasickness. No statistical analysis was made other than those mentioned above. DISCUSSION Vertigo, nausea, cold sweating, and vomiting are well known symptoms of kinetosis. These motion-provoked neurovegetative and sensory symptoms are thought to be the result of a mismatch between what the person expects according to his experience and the signals from his vestibular, visual, and mechano receptors ( 4 , 13). Kinetosis is an unpleasant experience which can seriously interfere with the performance of important tasks. This is an unsolved problem for air pilots and especially astronauts ( 5 , 7 ) . In a controlled rotatory trial using susceptible subjects, Mowrey & Clayson (8) demonstrated that the gastrointestinal symptoms of kinetosis were alleviated significantly better by ginger root than by antihistamines or placebo. In their opinion the effect of the drug was Table I. Subjects arranged according to severity of symptoms
No. of subjects

Vomiting Symptom score 0 I 2 3 4 5 Sum Ginger

35 5 0
0

Cold sweating Placebo

32 2 2 1 2 0 39

At hour 4 Ginger
30 3 6 1 0 0
40

Ginger
35 5 0 0 0 0
40

Placebo
32 2 2 2
1

Placebo
21 10 3 3 0 2 39

0 0
40

0 39

48

A.Gr+ntved et al.

Acta Otolaryngol (Stockh) 105

Acta Otolaryngol Downloaded from informahealthcare.com by Yonsei University on 09/14/11 For personal use only.

due to a local effect on the gastrointestinal tract. In a similar trial with normal subjects, Stott et al. (14) found that ginger root had no effect on either the signs or symptoms of kinetosis. In that study, however, the types of symptoms were not specified, and vomiting was not reported. Perhaps the stimulus had not been strong enough for an effect to be apparent. In a controlled trial with cross-over Grgntved & Hentzer (9) found ginger root significantly better than placebo in reducing vertigo following calorical stimulation of the vestibular apparatus; no effect on the elicited nystagmus could be shown. So far, four controlled trials have been carried out, using four different methods to assess the effect of ginger root on the symptoms of kinetosis. This present study and another (8) have shown ginger root to have an effect on vomiting; in one trial the drug reduced vertigo (9), and in the last one no effect was shown (14). This first field trial on the effect of ginger root on the symptoms of kinetosis supports the assumption that the drug is effective. However, it was only with regard to vomiting and cold sweating that the effect proved statistically significant. A tendency however to ameliorate nausea and vertigo was seen (Figs. 1 and 2). The drug did reduce the severity of seasickness rather than reducing the number of subjects suffering symptoms (Table I). A larger dose may have shown a better effect. The principal constituents of ginger are starch, essential oil (aroma), and resin (pungency). More than 20 different biochemical components have been identified (15). It is not known which component could be of value in kinetosis. When swallowed, the pure ginger root powder has a strong (pepperlike) local irritant effect in the mounth and throat. Symptoms of local gastrointestinal irritation have not been reported when the encapsulated drug has been ingested, but a dose-dependent irratant effect has to be expected. Therefore, in future investigations it is proposed to isolate and test those constituents of the drug which are expected to act on the symptoms of kinetosis. The pharmacokinetics of ginger are completely unknown. The component presumably acting on kinetosis seems to be active from 25 min (8) to at least 4 h after ingestion. The sites of action are presumed to be autonomic centres of the CNS (9) but a local effect on the gastrointestinal tract blocking nausea feedback has also been proposed (8). This trial and two others mentioned above have shown that the powdered rhizome of ginger, in field and laboratory conditions alike, has at least some effect on the symptoms of kinetosis. These findings are promising and justify further biochemical and pharmacological investigations to establish what the effective component in ginger root is. Contrary to all the conventionally used anti-motion sickness drugs, no side effects of ginger root have been reported. Should this be the case, then the drug could be of great value for persons required to carry out skilled tasks in unaccustomed cirumstances of motion. ACKNOWLEDGEMENTS
Thanks are due to the staff and cadets of the training-ship Dunmurk for good cooperation and to the staff of the Dispensary at Odense University Hospital for preparing the drugs and randomizing the subjects. This study was partially supported by a grant from the National Council of Medical Research.

REFERENCES
I . Brand JJ, Perry WLM. Drugs used in motion sickness. Pharmac Rev 1966; 18:895-924. 2. Wood CD, Kennedy RE, Graybiel A, Trumbull R, Wherry RJ. Clinical effectiveness of antimotion sickness drugs. JAMA 1966; 198: 1155-8. 3. Graybiel A, Wood CD, Knepton J, Hoche JP, Perkins GF. Human assay of motion sickness drugs. Av Space Envir Med 1975; 46: 1107-12. 4. Reason JT, Brand JJ. Motion sickness. London: Academic Press, 1975.

Acta Otolaryngol (Stockh) 105

Ginger root against seasickness

49

5. Benson AJ, King PS. The ears and nasal sinuses in the aerospace environment. In: Balantyne J, Groves, J, eds. Scott-Browns Disease of the ear, nose, and throat. London: Butterworths, 1979. 6. Wood CD, Graybiel A. Evaluation of sixteen anti motion sickness drugs under controlled laboratory conditions. Aerospace Med 1968; 39: 13414. 7. Homick JL, Reschke MF, Vanderploeg JM. Space adaption syndrome: Incidence and operational

8. 9.
10.

Acta Otolaryngol Downloaded from informahealthcare.com by Yonsei University on 09/14/11 For personal use only.

11. 12. 13.

14.

15.

implications for the space transportation program. Advisory Group for Aerospace Research and Development. Conference Proceedings 372 1984; 36: 1-6. Mowrey DB, Clayson DE. Motion sickness, ginger, and psychophysics. Lancet 1982; i: 655-7. Gr@ntved Hentzer E. Vertigo-reducing effect of ginger root. A controlled clinical study. ORL A, 1986; 48: 282-6. Reynolds JEF. Comp. Martindale. The extra pharmocopoeia, 28th ed. London: Pharmaceutical Press, 1982. Lewis WH, Lewis MP. Medical botany: Plants affecting mans health. New York: Wiley, 1977. Holling HE, McArdle B, Trotter WR. Prevention of seasickness by drugs. Lancet 1944; i: 127-9. Miller AD, Wilson VJ. Neurophysiological correlates of motion sickness: Role of vestibulocerebellum and vomiting center reanalyzed. Advisory Group for Aerospace Research and Development. Conference Proceedings 372, 1984; 21: 1 . Stott JRR, Hubble MP, Spencer MB. A double-blind comparative trial of powdered ginger root, hyosine hydrobromide, and cinnarizine in the prophylaxis of motion sickness induced by cross coupled stimulation. Advisory Group for Aerospace Research and Development. Conference Proceedings 372, 1984; 39: 1-6. Pravatoroff N: Ginger. The properties and chemistry of some natural spicy compounds. Mfg Chem 1%7; 38: 4 6 1 .

4 -888401