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How Ginseng Works - Cancer Fatigue

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Radio National Health Report 25 June 2012 - Ginseng & Cancer fatigue

Norman Swan: Now to that story on ginseng - where a group at the Mayo Clinic in Rochester Minnesota has recently completed a trial using ginseng for a really debilitating aspect of living with cancer and afterwards. Debra Barton is Associate Professor of Oncology at the Mayo.

Debra Barton: Fatigue is a very common problem for patients that have been diagnosed with cancer and depending on the study of the incidence and prevalence of cancer related fatigue can be 90% to 100%. And when we say cancer related fatigue in general the fatigue that cancer survivors experience is not in proportion to their activity and it's not relieved by rest.

Norman Swan: What do they feel?

Debra Barton: Patients describe feeling overwhelmingly tired, difficulty putting one foot in front of the other, feeling like their limbs are extremely heavy, they have trouble thinking and processing information, get clumsy, lack of co-ordination, listless.

Norman Swan: So it's far more than physical?

Debra Barton: Far more than physical.

Norman Swan: And is it caused by chemo?

Debra Barton: That is a very good question. It's probably caused by a variety of things and research hasn't done a very good job of identifying all of the things that could contribute to fatigue. So for example during cancer treatment chemotherapy is definitely one cause but that's probably only one piece, they are probably psychological stress contributors during that time and for some people once treatment is done their fatigue gets better and they can go back to normal functioning. But for a good number of folks they never get back to their pre-treatment functioning. It's a very complicated problem that's not going to be easily solved and it's probably not going to be solved with one simple little pill or any kind of intervention.

Norman Swan: But talking about simple little pills where did you get the idea that ginseng might be beneficial?

Debra Barton: The first thoughts about ginseng in my exploration into it were really due to how traditional Chinese medicine described ginseng as an adaptogen.

Norman Swan: As an adaptogen?

Debra Barton: It's a term that is used for a certain number of plants, ginseng being one of them that is supposed to help the body relieve regularly physiologic processes during stressful times. And it just so happens that what ginseng is characterised as doing in animals and the lab is to help decrease inflammation and help regulate the stress hormone such as cortisol especially shown in animals and the little data that we do have on cancer related fatigue ties both of those things to the experience of fatigue in humans. And ginseng in animals and lab has shown to kind of calm all that down.
Norman Swan: So tell me about this randomised trial that you did.

Debra Barton: We actually did a pilot study several years ago to just see if there was any signals so we used three different doses of ginseng, 750, 1,500 and 2,000 milligrams versus a placebo and we did see for the two higher doses that fatigue was quite a bit ameliorated compared to the 750 and the placebo group. So that led to our phase 3 randomised trial that we just completed where we looked at 2000 milligrams of ginseng versus placebo and we looked at a more homogeneous group so it was patients who were being treated with curative intent for their cancer.

Norman Swan: And what did you find?

Debra Barton: We found that overall for the group as a whole at 8 weeks patients reported less fatigue if they were taking ginseng and this was statistically significantly different at 8 weeks. Now the patients getting cancer treatment actually had a better response and they had a significant reduction as early as 4 weeks on their fatigue on that general sub scale and this was maintained at 8 weeks as opposed to the patients who had completed treatment they did not see that benefit at 4 weeks. They actually had a different dimension of their fatigue at 8 weeks that had decreased as opposed to the general sub scale.

Norman Swan: And did the ginseng interact with the drugs that people were on, or have any side effects?

Debra Barton: The ginseng did not, at least by the way that we measured it, have any discernable side effects at all. In terms of whether it interfered with any chemotherapy for the patients getting treatment there weren't any additional, you know the side effect profiles that we saw with patients getting treatment was not different from what we would expect to see with patients getting chemotherapy. And there have been lab studies that have looked at ginseng interaction with some of the main chemotherapy agents like 5-FU, adriamycin, cytoxan, methotrexate, some of the very big most common ones and there has not been any indication that ginseng interferes with those drugs. And in fact in some animal and lab studies it looks like it could actually work with the drug.

Norman Swan: How do you find standardised ginseng? One of the problems is that you go into your average pharmacist and there are a lot of different products saying they've got ginseng in them, but you haven't got a clue really whether or not it is in the products that are saying it, it's very poorly regulated.

Debra Barton: Absolutely, it's not regulated at all, at least in our country. It's a very frustrating problem. What we did was we used pure ground roots that were actually supplied to us by a ginseng co-op in Wisconsin, I actually met the farmers that were growing the ginseng that was used in our study.

Norman Swan: It sounds like a Jack Daniels ad here, you know we go out and meet the guys who grow the grain.

Debra Barton: But that was important to me in terms of knowing that I could control the product obviously, but knowing how that product was grown and how it was processed and manufactured. Because another thing that you mention not only is it unknown whether you're actually even getting ginseng in things that you buy over the counter but ginseng can be processed in different ways that actually can change its characteristics. So for example ginseng extracts can be extracted with ethanol which actually makes the ginseng oestrogenic, which is not OK for breast cancer survivors and other patients with hormone sensitive cancers. So it was really important to me that I knew how that ginseng was being manufactured and processed and that it wasn't being extracted or manipulated in any way.

Norman Swan: So this is a problem for the general consumer.

Debra Barton: It is a problem for the general consumer. So what I tell patients in terms of buying products is there are some pharmaceutical companies that actually do have some dietary supplements and those companies that are well established and large they get good manufacturing practices and they are likely to follow those and they are likely to have very accurate labelling, because they have a lot to lose if they don't. Patients can buy the ginseng that we used, the pure ground root, through the Wisconsin Co-op website. I am looking for other suppliers who can provide pure ground root that is of good ginsenoside potency and so as we find out who those suppliers are we just continue to spread the word.

Norman Swan: Debra Barton is Associate Professor of Oncology at the Mayo Clinic.

Dr Debra Barton
Associate Professor Oncology
Nurse Administrator
Division of Nursing Research
Mayo Clinic
Rochester, Minnesota, USA

Note: You can find this study at

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