Older athletes: is ginger the spice of life?

Of these phenolic compounds, gingerols are the most studied in terms of anti-inflammatory effects (although there’s also much interest in how gingerols also exert antioxidant and anticancer effects)^(16-18). When ginger is consumed as raw product, gingerols are the primary polyphenols found within the ginger root. However, when ginger is heated, gingerols can be converted into shogaols, paradols, and zingerone due to slight alterations in the molecular structures of these compounds. These compounds also exert anti-inflammatory effects albeit via slightly different biochemical pathways⁽¹⁹⁾.

In terms of clinical studies, several animal studies have shown that dried ginger or ginger extract can reduce acute inflammation, while in humans, several clinical studies support the value of ginger for the treatment of osteoarthritis, and in some cases, a significant reduction in knee pain has reported^(20-22). Some of these trials also found that ginger relieved pain and swelling to varying degrees in patients with osteoarthritis, rheumatoid arthritis, and muscular pain - without causing serious adverse effects even after long periods of use⁽²³⁾.

In one 2017 study, scientists demonstrated the anti-inflammatory power of ginger in humans undergoing dental treatment(24). The 67 subjects were dental patients who had to undergo a tooth extraction. Immediately following the extraction, the patients were randomly allocated into one of the three groups:

·        A 500mg capsule of ginger powder taken after surgery then at 6-hourly intervals

·        A 400mg Ibuprofen capsule taken at 6-hourly intervals

·        An inert placebo capsule taken 6-hourly

The subsequent degree of swelling, pain and need for paracetamol (when the pain became too uncomfortable) were recorded over the following days. The results showed that both the ginger and Ibuprofen resulted in less pain and swelling, with less need for paracetamol use. Also, the ginger was equally as effective as Ibuprofen at combating pain (see figure 2).

Figure 2: Ginger supplementation and pain

Why is a study into dental pain relevant to athletes with joint pain or stiffness I hear you ask? Well, that’s because the dental pain model is a widely employed, validated, and highly standardised acute pain model, and has been shown to be the most appropriate model to investigate the onset of analgesic action. It is often used as the reference clinical pain model for the investigation of analgesic drugs, and in this model, compounds with anti-inflammatory properties provide better pain relief than conventional painkillers.

New research

While there has been much research into the anti-inflammatory and general health benefits of ginger at the cellular level, clinical studies to investigate whether ginger supplementation can improve actual physical function in active people who suffer from inflammation-related pain are thin on the ground. However, a new study by a team of scientists from Texas A&M University has looked at this very question by investigating pain perception, functional capacity, and markers of inflammation in middle-aged otherwise active men and women with a history of inflammation-related mild to severe joint and muscle pain⁽²⁵⁾.

Published in the journal ‘Nutrients’ last month, this study examined the effects of supplementing the diet with a higher-potency ginger extract on perceptions of pain and markers of inflammation in individuals who experience mild joint pain in response to physical activity. The primary outcomes (ie what the researchers were most interested in) were ratings of muscle pain, functional capacity (measured by questionnaires), and markers of inflammation. Secondary outcomes included joint flexibility, perceived quality of life, the use of over-the-counter analgesics (ie whether and how much pain relief was needed), clinical blood markers of inflammation and any reported side effects.

What they did

Thirty men and women (average age 56 years) with a history of mild to severe joint and muscle pain as well as inflammation participated in a placebo-controlled, randomized study. In the first phase of the study underwent a familiarization and then baseline assessment. This consisted of:

·        Samples of blood taken to measure inflammatory markers.

·        Completion of questionnaires about their lifestyle and the degree of pain they experienced.

·        A rating of perceived pain in the thighs following application of a standardized pressure to the vastus medialis muscle of the quadriceps (outer thigh).

·        Exercise function tests where participants performed 3 sets of 10 repetitions of squats/deep knee bends, while holding 30% of their body mass (repeated on days 30, and 56 of the placebo or ginger intervention), with the above test repeated after two days of recovery – ie at days 2, 32 and 58.

In addition, tests were carried out to assess range of motion and flexibility measuring the flexion of the knee and hip, with the leg that of each participant experiencing most discomfort tested and used for future tests). For pain assessments in the thigh, the participants recorded perceptions of muscle soreness using a visual scale ranging from 0 (no pain), 1 (dull ache), 2 (slight pain), 3 (more than slight pain), 4 (painful), 5 (very painful), to 6 (unbearable pain). For knee pain, pain, joint stiffness, and disability in knee and hip osteoarthritis were assessed using the Western Ontario and McMaster University Osteoarthritis Index.

Following the familiarization and baseline procedures, the participants were randomly allocated to one of two groups:

·        Ginger – ingesting 125mgs per day of ginger (standardized to contain 10% total gingerols and no more than 3% total shogaols) for 58 days.

·        Placebo – ingesting a capsule of inert starch, which looked exactly the same shape and size.

The baseline tests above were then repeated on days 30 and 56, with the same measures being assessed again after two days’ of recovery (ie days 32 and 58). With regard to the exercise testing, the amount of weight lifted and the number of repetitions performed during each set were recorded. If a participant was unable to complete a set of 10 repetitions, the amount of weight was reduced to complete three sets of ten repetitions. The weight utilized for each set was summed to determine a total lifting volume. The overall study protocol is shown in figure 3.

Figure 3: Schematic of the study protocol

What they found

When the results from the ginger and placebo groups were statistically analyzed and compared, the main findings were as follows:

·        Compared to the group that took the placebo, those that took ginger supplementation had reduced levels of muscle pain in the vastus medialis during the standardized pressure test.

·        In the functional tests to assess range of motion at the knee, joint stiffness and functional capacity, those taking ginger had improved ratings of pain, stiffness, and functional capacity compared to the placebo group (see figure 4).

·        Supplementing ginger favourably affected levels of inflammatory markers (eg IL-6, INF-ϒ, TNF-α, and C-Reactive Protein concentrations), particularly during the two days of recovery following the resistance exercise (squat) challenge described above.

·        There was also evidence that ginger supplementation was associated with less frequent use of over-the-counter analgesics such as paracetamol and Ibuprofen, indicating that the ginger was helping to lessen pain, thereby reducing the need for NSAID medication. However, this effect (of less frequent NSAID use) did not quite meet the threshold for statistical significance, meaning that it might have arisen by chance. A larger sample size would likely have shown this effect to be significant.

·        Ginger supplementation was well tolerated with very few reported side effects.

 Figure 4: Range of motion in ginger vs. placebo-supplemented participants

Summary and recommendations

In summary, the researchers concluded that low-dose ginger supplementation of 125mgs per day providing 12.5mgs per day of the all-important active gingerols lessenes perceptions of pain, improves functional capacity, and reduces several markers of inflammation in individuals who experience mild to moderate joint and muscle pain. This is almost certainly due to the fact that the gingerols exert anti-inflammatory and immune-modulating effects, which can help reduce pain in individuals with chronic muscle and knee pain. Moreover, since the ginger supplementation was well tolerated, taking ginger may be an option for those who suffer with inflammation-related knee pain, and who want to reduce the reliance on and risks of over-the-counter pain medications.

For older athletes who struggle with intermittent or chronic joint pain/stiffness, there’s a good rationale for experimenting with ginger supplementation. It’s safe, has very few side effects, provides health benefits above and beyond reducing inflammation, and importantly, it’s relatively inexpensive. However, you need to be aware that not all ginger supplements are created equal. The species of ginger and the way that growers have cultivated it can affect the strength and effectiveness of its analgesic effects - primarily due to differences in the natural phytochemical composition, especially the concentrations of active compounds like [6]-gingerol, [6]-shogaol, [8]-gingerol, and [10]-gingerol. The key therefore is to choose a supplement with a standardized potency of gingerols. Choose a reputable brand too, preferably one that uses organic ginger and that can provide a certificate of analysis verifying the gingerol content. In the study above, this daily supplemental gingerol amount was 12.5mgs, which is the kind of amount you should look out for. Also, ginger supplements are best taken with food; a good time is in the morning after breakfast. Finally, don’t forget that diet matters too; keep your diet as whole and natural as possible, while minimizing your intake of ultra-processed foods. That won’t just help combat inflammation, but will likely enhance your performance too!

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