About the effects of ginger and natural drugs with prof. Bartůňková
Nature is a large chemical laboratory
You don´t have to introduce prof. MUDr. JIŘINA BARTŮŇKOVÁ, DrSc. to the specialists. The name of the head of the Institute of Immunology at the 2nd Faculty of Medicine of the Charles University and Motol University Hospital is closely linked to the very promising project of new cancer treatment using dendritic cell vaccines that play a significant role in our immunity and the recognition and elimination of harmful pathogens. From an ambitious project launched and led in 1996, the expert on human immunity rebounded to ginger, whose potential she decided to use to develop a new food supplement. "It's such a toy that has emerged from everyday practice when patients ask me what to do about immunity," explains the doctor. What is her opinion on natural medicine? What it was the ginger? And in which food supplements does (not) she believe and why?
Do you believe in natural medicine and its products?
I think we should not put the boundary between chemical medicine and natural medicines because 90% of medicines are based on natural compounds. We just do not eat the willow rods today, but we just swallow acylpyrin. Instead of repressing ten teas per dose of docetaxel (belongs to the cytostatics, ie substances that are used to treat cancer, such as breast cancer), we prefer to make it chemically. At the same time, we save nature, because in particular the use of docetaxel has led to the almost eradicatio of tis red in the USA. For classical medicine and natural medicines, I would certainly not build up like two controversial worlds, nature is one large chemical laboratory.
Is there any sort of natural healing substance different from chemically synthesized?
The difference is that the chemically produced drugs contain an exact amount of active substance, while the plants are also defined substances in the context of a complex mixture of natural substances. On the other hand, it seems that this is the advantage of some natural medicines. The effect of many of them is provided by the synergy of dozens of other substances, unlike when we only isolate them from one particular chemical. But with most natural products there is a major issue in dosing. If you brew tea from the coldsfoot, the active ingredients will be really minimal. This also applies to natural products in the form of food supplements. The active substance content is generally very low and one would have to eat the whole box at once to get a "pharmacological" dose of a particular active substance.
So are you skeptical about food supplements?
If there really is "something" in them, I believe in their effect. But it is a question of whether those on the market are really what they pretend to be doing. In 2015, a study was conducted in the US that showed that almost 80% of the food supplements on the market did not contain those substances that are declared on the packaging. This is one of the reasons why I started developing ginger capsules.
Do you personally believe in the effects of some specific natural-based food supplements?
There are many. Ginkgo biloba, which is used to improve blood flow, and chestnut routine preparations that have a positive effect on blood vessel firming. Previously, it was a registered drug that, years ago, like vitamin D, has gone into food supplements. Pharmaceutical companies have found that if certain substances are safe during normal use, it is easier to have them registered under the food supplements than under the medication, because even keeping a drug registration is a lot of money.
Are you taking any supplements yourself?
Yes, if I have information that they are of good quality. Currently, for more than a year, I have just ginger Eligin capsules, which I contributed to. And I have to say I feel very good. I'm practically avoiding infections, my joints do not hurt. And most importantly, I know what is in them.
What about your patients? Would not it be worth checking it out on them?
I have it planned, but rather just for myself, not for some serious research. I gradually collect this information, and I have some feedback from the first patients I gave the first test samples last fall. These patients were excluded from the available means of immune disorders that can be treated in a "classical" way, yet they complained of frequent infections or lighter forms of allergies. Most say they were not sick when using ginger capsules. But let's not forget that there is a placebo effect. If you do not have a classic controlled clinical trial, no conclusions can be drawn.
How does a doctor, who has a significant role in the birth of a very sophisticated and promising new method of fighting cancer, gets to develop a ginger-based food supplement?
In addition to a scientific work that includes research into anti-tumor immunity, I'm a practical clinical immunologist and allergologist. I have a number of patients in the outpatient clinic who have recurrent infections, and we do not find a major immune disorder that can be treated with "modern" medicine. And they ask us what they should take. Just because of the doubts about the quality of various food supplements, I thought it would be wrong to have at least one for which we can guarantee. I have been studying the medicinal effects of plants for a long time, and ginger has been the most interesting in this context. It's just my "toy" that just came out of everyday practice. But also the reaction to this, when I found out in the development of our anti-cancer vaccines how drug development is complex, expensive and long.
You have, I would say, a wealth of experience with a project of dendritic cell tumor vaccines (part of white blood cells) that you have been running since 1996.
We started at a time when this method was considered a healing process. So, like organ transplants or bone marrow, it could be introduced into medical practice without any other obstacles. But in 2002 European legislation changed, and our anti-cancer vaccine from dendritic cells became a category of medicinal products and the development began to fall under the Medicines Act. In practice, this means manufacturing in super clean rooms in accordance with good manufacturing practice, clinical development from Phase I to Phase III confirmatory phase according to GCP (Good Clinical Practice Standards) and then registration, reimbursement and treatment of patients. This is a development that costs hundreds of millions of crowns. At that time, however, we were relatively far away with the methodology, so we did not want to give up completely. We have subordinated to legislation, we have built super clean rooms with the support of the Faculty Hospital in Motol, we have developed meters of paper documents, on which basis SÚKL (State Institute for Drug Control) approved a Phase I study, we got financing with grant money, so we could legally administer the vaccine to patients. And our ultimate interest was finally taken by investors who took over the development of this vaccine. But that's another chapter.
However, this is still not closed because clinical trials are not over yet. Are these ginger capsules a kind of turning away for something that brings immediate results?
You are absolutely right. Another reason I turned to food supplements was the cost and length of development of medicines. I have also begun to look at the development of medicines from an economic point of view: a pharmaceutical company that develops a medicine according to current legislative requirements, of course wants financial returns to that terrible initial investment. And this is connected, among other things, with patents. Therefore, they must develop a patent-protected drug to guarantee certain exclusivity and financial returns. But to develop a cure based on whole plants so that it contains a complex of all the active substances? This can not be patented, and therefore no one pays for it, even if it is very effective. And so I said I could find a plant that has the GRAS safety label, which means "safe", while having some influence on immunity. From potential candidates, ginger came out to be the best.
Isn´t the development of ginger capsules just "carrying coals to Newcastle"? After all, there will be similar supplements in the market.
In development, we've been doing research on what's on the market. And, surprisingly, at least on the Czech market there was practically nothing. At Alibaba or Amazon you can buy several ginger products. But we do not know anything about their quality. About ours we know. We know what it contains and how much of it. It does not mean that other food supplements are not good. I just do not know what they are. If you want to compare the efficacy of different products, this means finding a suitable indication, setting appropriate dosages, reaching out to the hundreds of patients that need to be monitored, and ultimately evaluating it. Meanwhile, you will spend hundreds of millions. Why would anyone do it?
The development of ginger capsules was helped by colleagues from the Food Research Institute. Your cooperation, however, began much earlier ...
It is true. They helped to improve our vaccine. They inspired us to a new method of killing tumor cells by which we "feed" dendritic cells with high hydrostatic pressure used to sterilize vegetables and juices. We tested the pressure instead of the UV radiation we used to killing tumor cells by then, and it turned out that this new method was more appropriate. Tumor cells die by so-called immunogenic cell death, which means that the immune system becomes more visible, and he can then better recognize and deal with them. So we are in long-term contact with the Food Institute. I knew they were developing hops, lignans from the spruce, so it came to ginger once. And we agreed to do it together. First, we tried to produce snacks, but besides me, no-one liked it and they were too expensive for production.Together with Ing. Vokurka from a commercial company, we then focused on dried ginger, which could be "hidden" in the capsules. We organized import of different types of samples and the staff of the Academy of Sciences in České Budějovice helped us with the determination of active substances. Perform a variety of analysis of ginger rack from Asia and Africa. Ing. Vokurka then completed the entire project up to the form of a food supplement and its marketing.
I still wonder: why just ginger? Nothing against it, I like it myself, but there would be many candidates. Talk about the healing effect of sea buckthorn, ginseng, its time was very popular echinacea, and one could continue. Why, then, ginger?
You're right, there are more candidates. But one cannot do everything. Ginger is a plant that has been used in Eastern medicine for over 2,000 years, so scientists thought there might be something to it. As a result, most scientific publications are about ginger and about the active substances. On this basis, I decided for it. And also because I like it, as well as you and many other people.
Well, ginger tastes many people. But if you swallow it in the form of a pill, you will lose the taste. Or am I wrong?
True, ginger powder is coated with a special capsule. Thanks to this, it dissolves in the intestine after drinking, so it can also avoid its burning effect in the esophagus or stomach, which does not everyone like. On the other hand, anyone who likes the typical burning taste of ginger can pour out the contents of the capsule and use the extract alone, like a cocktail. Plus, you don't have to peel, grate, steal ... That has always delayed and annoyed me with ginger.
The most valuable substances in the case of ginger are 6-gingerol and 6-shogaol. What are they?
Plant polyphenols, substances that are responsible for the burning taste of ginger. It is generally argued that it is precisely hot substances, such as in pepper, that have a positive effect on health.
How specifically do these substances work? They say that it has a positive effect on immunity. Under this we can imagine a better defense against common diseases such as colds or virosis. What else it can do?
Gingerols and shogaols affect a number of metabolic processes in the cell. Experimental evidence suggests that they function similarly to non-steroidal anti-rheumatic drugs, such as brufen, but also as kinase inhibitors used as biological treatments for some tumors. Or as inhibitors of vomiting receptors. Therefore, they are used in motion sicknesses, including sea sickness, but also to improve nausea and vomiting in cancer chemotherapy - recommended in renowned American hospitals. One study in humans has shown a positive effect in reducing the symptoms of allergic hay fever, comparable to the use of conventional antihistamines. Thus, the mechanism of action of the substances in ginger is complex and depends on the experimental design, dose, and many other factors. Perhaps the most important effect, however, are anti-inflammatory and antioxidant effects, and thus ginger is also involved in the anti-tumor mechanism, since chronic inflammation can contribute to the development of cancer.
So long-term ginger consumption can also have an anti-cancer effect?
In theory, yes, but in practice it is difficult to verify that this effect in humans is speculative because no such studies have been conducted. Conversely, there are a number of animals, for example, a study in the mouse model of prostate cancer has shown that the main components of ginger - gingerols and shogaols, which were tested individually - have some effect in retarding tumor growth. However, their effect is considerably less than the extract of whole ginger, which contains a hundred chemical compounds. This is one of the evidence that isolated products may not be as effective as the entire plant complex. However, what dose this effect may have in humans is not entirely clear due to the lack of clinical studies. It is further reported that the anti-inflammatory effects of ginger should contribute to slowing down arthrosis but also atherosclerosis, Alzheimer's disease, type 2 diabetes and so on. But the important thing here is the conditional way "should", so we count on it theoretically. Animal studies exist, but there are very few relevant clinical studies in humans. Because no one will pay them.
Depending on what you know about ginger, can you tell if its effects are more preventive or curative?
For these complex substances of plant origin, preventive action seems to be most important. But again - there are no studies. Imagine that you want to show that using ginger will prevent Alzheimer's disease. You will need thousands of people, tens of years and milions of money. Do you think such a study would ever be carried out?
I guess not. But why actually eat ginger capsules when I can buy fresh ginger?
And that's it: we have tested a variety of ginger products from various supermarkets and many other sources around the world. And the content of active substances varies with variety, harvest time, storage and other factors. Tea that you brew in June from a ginger from one store will have a completely different content of active ingredients than the one you buy in the same or another store in winter. Because we wanted to control the content of active substances, we chose one variety for our capsules, which had the highest content of shogaol and gingerol.
Where is the ginger of "yours" come from?
From a supplier from Indonesia who grows it in organic quality and under organic farming.
So eco and organic quality have an influence on the amount of active substances?
This variety actually came out as the most suitable in terms of the content of gingerols and shogaols, but neither the eco-quality nor the organic-quality has a direct effect on the content of active substances. Rather, we were concerned about the content of environmental pollutants. We wanted to get a clean product that does not contain pesticides and herbicides or heavy metals, which we would then swallow together with the food supplement.
However, I have read that even the high content of active substances in the rhizome is not enough in itself and it is necessary to adjust the ginger in an appropriate way. As?
In principle, when exposed to a certain stress stimulus, plants change the content of active substances. There may be a number of such stimuli, but I would narrow it down to the fact that you just need to warm up the ginger so that the content of shogaol in particular increases. Therefore, it is also not worth eating ginger just grated "raw", but it is at least poured hot water. Thus, in this case, the stress stimulus is heating, at other times it may be the addition of oxidizing agents and the like.
Is it possible to overdo it with ginger? I read on the internet that in dried form we should not exceed a dose of one gram a day and we can enjoy a maximum of four grams of fresh ginger….
Someone once wrote this on the Internet and has been copying it over and over again, but I have never found a credible source for this claim. Individual tolerance is different, someone simply does not like this burning taste, and if he bothers peppers, maybe he will not do well even with ginger. However, when it comes to safety of use, human clinical studies have shown that ginger and its active ingredients do not accumulate in the body. This means that long-term delivery is safe. I can cite other scientific papers: a dose of 2 g daily dry ginger extract for 28 days showed no side effects in healthy volunteers, as well as a dose of 40 g boiled candied ginger for 2 weeks had no side effects and did not affect platelet function. In rats, 13 weeks of delivery of 500 mg / kg ginger oil had no toxic effect. Similarly, no toxic effect was administered by ginger alcohol extract for 30 days per day or every other day up to a dose of 5000 mg / kg. This is just a fraction of the studies that the US FDA considers ginger safe.
Speaking about the internet desinformations, is it truth that diabetics should avoid ginger consumption?
No, that´s not truth. In contrast, there are studies showing that the use of various ginger supplements in type 2 diabetics (patients who do not usually need insulin) improves the metabolism and vascular damage that is often associated with this disease. It regulates blood sugar and fat levels, which in turn protects the blood vessels from the long-term consequences of this type of diabetes.
Aren't you going to get another toy next to ginger capsules, based on another plant or herb?
Not yet. I am writing an immunology textbook for general practitioners and we are working with my colleagues to develop another form of immunotherapy. And besides, I enjoy my grandchildren.
Author: Silvie Králová
The interview was published in the magazine Téma 36/2018.