What do more than 100 clinical trials on red ginseng, white ginseng, and American ginseng show?
The Benefits and Side Effects of Ginseng
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Ginseng root is a popular herbal medicine. Like the word panacea, ginseng’s Latin name, panax, is derived from the Greek for “cure-all.” It can extend the lives of fruit flies and microscopic worms, but not mice. What about people?
Well, there have been more than 100 clinical trials using various ginseng formulations, but the results have been underwhelming. A meta-analysis of randomized, double-blind, placebo-controlled trials found ginseng did not appear to significantly affect the duration of illness, but did appear to reduce the risk of developing acute upper respiratory infections in the first place. Digging deeper, however, the preventive benefit appears limited to Asian ginseng, which cut infection risk in half compared to placebo––as opposed to American ginseng that only reduced risk 16 percent, which did not reach statistical significance.
Asian ginseng can then be further divided up by processing method. “White” ginseng is Asian ginseng root that’s simply been washed and dried, whereas “red” ginseng is the same root, but undergoes an additional step of steaming before drying. Red ginseng is often used for male erectile dysfunction. While it doesn’t appear to help with female sexual dysfunction, a meta-analysis of a half-dozen randomized controlled trials found that 4 to 12 weeks of 1.8 to 3 grams a day of Korean red ginseng can improve erectile disfunction, compared to placebo. Fifty-eight percent of men experienced an improvement in sexual function, compared to 20 percent of men in the placebo group. This may be due to an improvement in artery function demonstrated within three hours of consumption.
Of course, this is assuming there’s actually ginseng in your “ginseng.” Ginseng is a multibillion-dollar industry, and, as such, suffers from intentional contamination with cheaper filler substitutes––some of which may not be benign. If your “ginseng” supplement turns out to just be powdered soybeans, then you’ve just wasted your money. But, for example, if it’s been spiked with illicit horse painkiller, it’s worse than a waste. A study of the more than 500 ginseng products sold in a dozen countries across six continents found that 24 percent were adulterated. This is consistent with so-called “immune-boosting” supplements in general. A 2022 analysis found most such products failed to match what was on their labels.
Maybe it’s good there’s no ginseng in your ginseng? From an oxidative stress standpoint, American, Chinese, and Korean ginseng all have been shown to acutely protect against free radical-induced DNA damage within hours of consumption. But one longer-term trial raised red flags. Although four weeks of Korean ginseng reduced levels of oxidative stress, four months of American ginseng (about a quarter-teaspoon a day of whole root powder) caused an uptick in DNA damage. Until it can be shown that chronic intake of other ginsengs isn’t also DNA-damaging, I’d recommend steering clear.
Approximately 10 percent of users suffer from what’s been termed ginseng abuse syndrome, which manifests as high blood pressure, nervousness, sleeplessness, skin eruptions, and morning diarrhea. Of course, it may not actually be from ginseng itself, but rather adulterants in some supposed ginseng product.
What if you randomize people to ginseng that’s been officially authenticated? In a multicenter, double-blind, randomized, placebo-controlled safety trial, a thousand people were randomized to two grams a day of red ginseng or placebo for six months. In the ginseng group, 345 adverse events were recorded. But the placebo group had 389 adverse events. Each of the top five “side effects” were documented more often in the placebo group.
Outside of a clinical trial, though, it’s hard to know what you’re going to get. Aside from the abuse syndrome symptoms, there have been case reports of manic psychosis, estrogenic effects, and increased surgical bleeding. And so, some recommend ginseng should be avoided in those expected to undergo surgery, those with a predisposition to mania, estrogen-dependent disease, hypertension, or hyperthyroidism.
Please consider volunteering to help out on the site.
- Antonelli M, Donelli D, Firenzuoli F. Ginseng integrative supplementation for seasonal acute upper respiratory infections: A systematic review and meta-analysis. Complement Ther Med. 2020;52:102457.
- Carabin IG, Burdock GA, Chatzidakis C. Safety assessment of panax ginseng. Int J Toxicol. 2000;19(4):293-301.
- Chan PC, Fu PP. Toxicity of Panax genseng - An herbal medicine and dietary supplement. J Food Drug Anal. 2020;15(4):416-427.
- Mihalov JJ, Marderosian AD, Pierce JC. DNA identification of commercial ginseng samples. J Agric Food Chem. 2000;48(8):3744-3752.
- Ichim MC, de Boer HJ. A review of authenticity and authentication of commercial ginseng herbal medicines and food supplements. Front Pharmacol. 2020;11:612071.
- Siegel RK. Ginseng abuse syndrome. Problems with the panacea. JAMA. 1979;241(15):1614-1615.
- Song SW, Kim HN, Shim JY, et al. Safety and tolerability of Korean Red Ginseng in healthy adults: a multicenter, double-blind, randomized, placebo-controlled trial. J Ginseng Res. 2018;42(4):571-576.
- Kim SO, Kim MK, Lee HS, Park JK, Park K. The effect of Korean red ginseng extract on the relaxation response in isolated rabbit vaginal tissue and its mechanism. J Sex Med. 2008;5(9):2079-2084.
- Ghorbani Z, Mirghafourvand M. A meta-analysis of the efficacy of panax ginseng on menopausal women’s sexual function. Int J Women's Health Reprod Sci. 2018;7(1):124-133.
- Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. 2008;66(4):444-450.
- Wang H, Zhang S, Zhai L, et al. Ginsenoside extract from ginseng extends lifespan and health span in Caenorhabditis elegans. Food Funct. 2021;12(15):6793-6808.
- Kim MS. Korean red ginseng tonic extends lifespan in d. Melanogaster. Biomol Ther (Seoul). 2013;21(3):241-245.
- Jovanovski E, Peeva V, Sievenpiper JL, et al. Modulation of endothelial function by Korean red ginseng (Panax ginseng c. A. Meyer) and its components in healthy individuals: a randomized controlled trial. Cardiovasc Ther. 2014;32(4):163-169.
- Bittles AH, Fulder SJ, Grant EC, Nicholls MR. The effect of ginseng on lifespan and stress responses in mice. Gerontology. 1979;25(3):125-131.
- Norelli LJ, Xu C. Manic psychosis associated with ginseng: a report of two cases and discussion of the literature. J Diet Suppl. 2015;12(2):119-125.
- Viviano A, Steele D, Edsell M, Jahangiri M. Over-the-counter natural products in cardiac surgery: a case of ginseng-related massive perioperative bleeding. BMJ Case Rep. 2017;2017:bcr2016218068.
- Kakisaka Y, Ohara T, Tozawa H, et al. Panax ginseng: a newly identified cause of gynecomastia. Tohoku J Exp Med. 2012;228(2):143-145.
- Crawford C, Avula B, Lindsey AT, et al. Analysis of select dietary supplement products marketed to support or boost the immune system. JAMA Netw Open. 2022;5(8):e2226040.
- Szeto YT, Lee LKY. Rapid but mild genoprotective effect on lymphocytic DNA with Panax notoginseng extract supplementation. J Intercult Ethnopharmacol. 2014;3(4):155-158.
- Dickman JR, Koenig RT, Ji LL. American ginseng supplementation induces an oxidative stress in postmenopausal women. J Am Coll Nutr. 2009;28(2):219-228.
- Kim HG, Yoo SR, Park HJ, et al. Antioxidant effects of Panax ginseng C.A. Meyer in healthy subjects: a randomized, placebo-controlled clinical trial. Food Chem Toxicol. 2011;49(9):2229-2235.
- Lee TK, Johnke RM, Allison RR, O’Brien KF, Dobbs LJ. Radioprotective potential of ginseng. Mutagenesis. 2005;20(4):237-243.
- Szeto YT, Ko AW. Acute genoprotective effects on lymphocytic DNA with ginseng extract supplementation. J Aging Res Clin Pract. 2013;2(2):174-177.
- Szeto YT, Sin YSP, Pak SC, Kalle W. American ginseng tea protects cellular DNA within 2 h from consumption: results of a pilot study in healthy human volunteers. Int J Food Sci Nutr. 2015;66(7):815-818.
- Fan S, Zhang Z, Su H, et al. Panax ginseng clinical trials: Current status and future perspectives. Biomed Pharmacother. 2020;132:110832.
- Khera M, Goldstein I. Erectile dysfunction. BMJ Clin Evid. 2011;2011:1803.
- West E, Krychman M. Natural aphrodisiacs-a review of selected sexual enhancers. Sex Med Rev. 2015;3(4):279-288.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Ginseng root is a popular herbal medicine. Like the word panacea, ginseng’s Latin name, panax, is derived from the Greek for “cure-all.” It can extend the lives of fruit flies and microscopic worms, but not mice. What about people?
Well, there have been more than 100 clinical trials using various ginseng formulations, but the results have been underwhelming. A meta-analysis of randomized, double-blind, placebo-controlled trials found ginseng did not appear to significantly affect the duration of illness, but did appear to reduce the risk of developing acute upper respiratory infections in the first place. Digging deeper, however, the preventive benefit appears limited to Asian ginseng, which cut infection risk in half compared to placebo––as opposed to American ginseng that only reduced risk 16 percent, which did not reach statistical significance.
Asian ginseng can then be further divided up by processing method. “White” ginseng is Asian ginseng root that’s simply been washed and dried, whereas “red” ginseng is the same root, but undergoes an additional step of steaming before drying. Red ginseng is often used for male erectile dysfunction. While it doesn’t appear to help with female sexual dysfunction, a meta-analysis of a half-dozen randomized controlled trials found that 4 to 12 weeks of 1.8 to 3 grams a day of Korean red ginseng can improve erectile disfunction, compared to placebo. Fifty-eight percent of men experienced an improvement in sexual function, compared to 20 percent of men in the placebo group. This may be due to an improvement in artery function demonstrated within three hours of consumption.
Of course, this is assuming there’s actually ginseng in your “ginseng.” Ginseng is a multibillion-dollar industry, and, as such, suffers from intentional contamination with cheaper filler substitutes––some of which may not be benign. If your “ginseng” supplement turns out to just be powdered soybeans, then you’ve just wasted your money. But, for example, if it’s been spiked with illicit horse painkiller, it’s worse than a waste. A study of the more than 500 ginseng products sold in a dozen countries across six continents found that 24 percent were adulterated. This is consistent with so-called “immune-boosting” supplements in general. A 2022 analysis found most such products failed to match what was on their labels.
Maybe it’s good there’s no ginseng in your ginseng? From an oxidative stress standpoint, American, Chinese, and Korean ginseng all have been shown to acutely protect against free radical-induced DNA damage within hours of consumption. But one longer-term trial raised red flags. Although four weeks of Korean ginseng reduced levels of oxidative stress, four months of American ginseng (about a quarter-teaspoon a day of whole root powder) caused an uptick in DNA damage. Until it can be shown that chronic intake of other ginsengs isn’t also DNA-damaging, I’d recommend steering clear.
Approximately 10 percent of users suffer from what’s been termed ginseng abuse syndrome, which manifests as high blood pressure, nervousness, sleeplessness, skin eruptions, and morning diarrhea. Of course, it may not actually be from ginseng itself, but rather adulterants in some supposed ginseng product.
What if you randomize people to ginseng that’s been officially authenticated? In a multicenter, double-blind, randomized, placebo-controlled safety trial, a thousand people were randomized to two grams a day of red ginseng or placebo for six months. In the ginseng group, 345 adverse events were recorded. But the placebo group had 389 adverse events. Each of the top five “side effects” were documented more often in the placebo group.
Outside of a clinical trial, though, it’s hard to know what you’re going to get. Aside from the abuse syndrome symptoms, there have been case reports of manic psychosis, estrogenic effects, and increased surgical bleeding. And so, some recommend ginseng should be avoided in those expected to undergo surgery, those with a predisposition to mania, estrogen-dependent disease, hypertension, or hyperthyroidism.
Please consider volunteering to help out on the site.
- Antonelli M, Donelli D, Firenzuoli F. Ginseng integrative supplementation for seasonal acute upper respiratory infections: A systematic review and meta-analysis. Complement Ther Med. 2020;52:102457.
- Carabin IG, Burdock GA, Chatzidakis C. Safety assessment of panax ginseng. Int J Toxicol. 2000;19(4):293-301.
- Chan PC, Fu PP. Toxicity of Panax genseng - An herbal medicine and dietary supplement. J Food Drug Anal. 2020;15(4):416-427.
- Mihalov JJ, Marderosian AD, Pierce JC. DNA identification of commercial ginseng samples. J Agric Food Chem. 2000;48(8):3744-3752.
- Ichim MC, de Boer HJ. A review of authenticity and authentication of commercial ginseng herbal medicines and food supplements. Front Pharmacol. 2020;11:612071.
- Siegel RK. Ginseng abuse syndrome. Problems with the panacea. JAMA. 1979;241(15):1614-1615.
- Song SW, Kim HN, Shim JY, et al. Safety and tolerability of Korean Red Ginseng in healthy adults: a multicenter, double-blind, randomized, placebo-controlled trial. J Ginseng Res. 2018;42(4):571-576.
- Kim SO, Kim MK, Lee HS, Park JK, Park K. The effect of Korean red ginseng extract on the relaxation response in isolated rabbit vaginal tissue and its mechanism. J Sex Med. 2008;5(9):2079-2084.
- Ghorbani Z, Mirghafourvand M. A meta-analysis of the efficacy of panax ginseng on menopausal women’s sexual function. Int J Women's Health Reprod Sci. 2018;7(1):124-133.
- Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. 2008;66(4):444-450.
- Wang H, Zhang S, Zhai L, et al. Ginsenoside extract from ginseng extends lifespan and health span in Caenorhabditis elegans. Food Funct. 2021;12(15):6793-6808.
- Kim MS. Korean red ginseng tonic extends lifespan in d. Melanogaster. Biomol Ther (Seoul). 2013;21(3):241-245.
- Jovanovski E, Peeva V, Sievenpiper JL, et al. Modulation of endothelial function by Korean red ginseng (Panax ginseng c. A. Meyer) and its components in healthy individuals: a randomized controlled trial. Cardiovasc Ther. 2014;32(4):163-169.
- Bittles AH, Fulder SJ, Grant EC, Nicholls MR. The effect of ginseng on lifespan and stress responses in mice. Gerontology. 1979;25(3):125-131.
- Norelli LJ, Xu C. Manic psychosis associated with ginseng: a report of two cases and discussion of the literature. J Diet Suppl. 2015;12(2):119-125.
- Viviano A, Steele D, Edsell M, Jahangiri M. Over-the-counter natural products in cardiac surgery: a case of ginseng-related massive perioperative bleeding. BMJ Case Rep. 2017;2017:bcr2016218068.
- Kakisaka Y, Ohara T, Tozawa H, et al. Panax ginseng: a newly identified cause of gynecomastia. Tohoku J Exp Med. 2012;228(2):143-145.
- Crawford C, Avula B, Lindsey AT, et al. Analysis of select dietary supplement products marketed to support or boost the immune system. JAMA Netw Open. 2022;5(8):e2226040.
- Szeto YT, Lee LKY. Rapid but mild genoprotective effect on lymphocytic DNA with Panax notoginseng extract supplementation. J Intercult Ethnopharmacol. 2014;3(4):155-158.
- Dickman JR, Koenig RT, Ji LL. American ginseng supplementation induces an oxidative stress in postmenopausal women. J Am Coll Nutr. 2009;28(2):219-228.
- Kim HG, Yoo SR, Park HJ, et al. Antioxidant effects of Panax ginseng C.A. Meyer in healthy subjects: a randomized, placebo-controlled clinical trial. Food Chem Toxicol. 2011;49(9):2229-2235.
- Lee TK, Johnke RM, Allison RR, O’Brien KF, Dobbs LJ. Radioprotective potential of ginseng. Mutagenesis. 2005;20(4):237-243.
- Szeto YT, Ko AW. Acute genoprotective effects on lymphocytic DNA with ginseng extract supplementation. J Aging Res Clin Pract. 2013;2(2):174-177.
- Szeto YT, Sin YSP, Pak SC, Kalle W. American ginseng tea protects cellular DNA within 2 h from consumption: results of a pilot study in healthy human volunteers. Int J Food Sci Nutr. 2015;66(7):815-818.
- Fan S, Zhang Z, Su H, et al. Panax ginseng clinical trials: Current status and future perspectives. Biomed Pharmacother. 2020;132:110832.
- Khera M, Goldstein I. Erectile dysfunction. BMJ Clin Evid. 2011;2011:1803.
- West E, Krychman M. Natural aphrodisiacs-a review of selected sexual enhancers. Sex Med Rev. 2015;3(4):279-288.
Motion graphics by Avo Media
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The Benefits and Side Effects of Ginseng
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