Ginseng side effects, safety, danger, risk, is it safe?
High dosages of ginseng can cause overstimulation, restlessness, rapid heart beat, anxiety, headache, and insomnia. Just with any medication or supplement, the right dosage can be quite helpful while an excessive amount can lead to unpleasant adverse effects. Discuss with your doctor before using a ginseng product if you have a heart condition, are taking blood pressure pills, hormone medications, anti-depressants, or have a serious health condition.
   Insomnia is a common side effect from ginseng overuse, particularly Asian ginseng—especially when it’s combined in high doses with other herbs or nutrients that cause alertness. Althea, a 38 year-old owner of a garden shop in Maui, says, "I took ginseng that was recommended by a Chinese physician for fatigue. I took it for two weeks. I felt really better emotionally, mellow, and with increased energy. Then I started to have increased sleep problems and insomnia. I went three days being so mentally and physically overstimulated that I hardly got any sleep. I imagine this is what being on "speed" must feel like. I stopped taking the ginseng and within two days I slowly returned to my normal state."
   This story confirms my recommendations that dosages of nutrients and herbs have to be constantly evaluated since they can build up in the system.
   Patients being treated with the blood-thinning drug Coumadin (warfarin) should probably avoid using ginseng, since ginseng seems to reduce the drug's effects. Ginseng use for two weeks was tied to a significant reduction in the INR, meaning that the blood was now less thin and more prone to clotting.
   Ginseng should be used cautiously in those with heart disease. Keep the dosage low in order to prevent heart racing or high blood pressure.

Will a multi vitamin supplement taken along with panax ginseng make you shaky? Several years ago I tried it and it made my shaky.
   Yes, too much ginseng can cause side effects including nervousness and anxiety.

Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction.
Asian J Androl. 2007.
A total of 60 patients presenting mild or mild to moderate erectile dysfunction were enrolled in a double-blind, placebo-controlled study in which the efficacies of Korean Red Ginseng and a placebo were compared. The patients received either 1,000 mg (3 times daily) or a placebo. Our data show that Korean Red Ginseng can be an effective alternative to the invasive approaches for treating male erectile dysfunction.

A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report.
J Urol. 2002.
We investigated the efficacy of Korean red ginseng for erectile dysfunction. A total of 45 patients with clinically diagnosed erectile dysfunction were enrolled in a double-blind, placebo controlled, crossover study (8 weeks on treatment, 2 weeks of washout and 8 weeks on treatment) in which the effects of Korean red ginseng and a vehicle placebo were compared using multiple variables. The ginseng dose was 900 mg. 3 times daily. Mean International Index of Erectile Function scores were significantly higher in patients treated with Korean red ginseng than in those who received placebo. Scores on penetration and maintenance were significantly higher in the ginseng than in the placebo group. In response to the global efficacy question 60% of the patients answered that Korean red ginseng improved erection. Our data show that Korean red ginseng can be an effective alternative for treating male erectile dysfunction.

Ginseng, sex behavior, and nitric oxide.
Ann N Y Acad Sci. 2002.
Both Asian and American forms of ginseng enhance libido and copulatory performance. These effects may not be due to changes in hormone secretion, but to direct effects, or its ginsenoside components, on the central nervous system and gonadal tissues. There is good evidence that ginsenosides can facilitate penile erection by directly inducing the vasodilatation and relaxation of penile corpus cavernosum. The effects on the corpus cavernosum appear to be mediated by the release and/or modification of release of nitric oxide from endothelial cells and perivascular nerves. Animal studies lend growing support for the use of ginseng in the treatment of sexual dysfunction and provide increasing evidence for a role of nitric oxide in the mechanism of ginsenoside action.

Email
I’m 74, in excellent health, exercise a lot, jog, windsurf, kayak, swim, although I notice my endurance in jogging is considerably less than even a few years ago. I tried Panax Ginseng for some time, without noticeable results. I read about Siberian Ginseng and I decided to try it. I started out a few days ago with 2 x 450 mg caps per day, product purchased from iHerb. Surprisingly, the 2nd day I got an unexpected and quite pleasant erection in bed and I tend to have morning erections, which I don’t usually have. My erections over the last few years are no longer as they used to be. At 74 I am not overly concerned about enhancing sexual performance and I have come to accept this as a part of life, but I’d certainly welcome an energy boost for general, everyday life’s purposes. Surprisingly and unexpectedly, though, all this has stopped after a few days and I do not feel more energetic than usually. Could it be that I should wait a bit longer to see the results? But then, why this immediate sexual arousal? The Siberian Ginseng I am taking is manufactured by Nature’s Way, sold in Canada by iHerb.
   A. Often, with aphrodisiac herbs, the benefits sometimes dissipate after regular use but return once the product is stopped for a week or two and then resumed. These aphrodisiac herbs are not meant to be used all the time.

Reproduction
Spermatogenesis. 2013. Ginseng and male reproductive function. Ginseng is often referred to as the King of all herbs, and is found to be a promising agent to improve general well-being. Ginseng has also been reputed as an aphrodisiac, and is used to treat sexual dysfunction as well as to enhance sexual behavior in traditional Chinese medical practices. Data from animal studies have shown a positive correlation among ginseng, libido, and copulatory performances, and these effects have been confirmed in case-control studies in human. In addition, ginseng is found to improve the sperm quality and count of healthy individuals as well as patients with treatment-related infertility. These actions are mostly attributed to ginsenosides, the major pharmacological active components of ginseng. This review compiles the current knowledge about the multifaceted effects of ginseng on male reproductive function, and also focuses on its mechanisms of action that may represent novel therapeutic strategies for the treatment of male reproductive diseases or disorders.

Benefits - laboratory and human studies
Let’s examine some of the studies done with ginseng to find out in what conditions this root herb is of benefit or not helpful.

Antiinflammatory
Pharmacogn Mag. 2013. Sterols isolated from seeds of Panax ginseng and their antiinflammatory activities.

Athletic performance - no significant benefit for sports performance
Ginseng supplementation does not change lactate threshold and physical performances in physically active Thai men.
J Med Assoc Thai. 2007.
Ginseng has been one of the most popular herbs said to improve human exercise performance. The purpose of the present study was to investigate the effect of ginseng supplementation on lactate threshold in physically active young men. Sixty men from the Naval Medical Corps, Royal Thai Navy, aged 17- 22 years old, were randomized into either the ginseng or placebo group. The ginseng group took 3 grams of 100% ginseng orally, while the placebo group took an equal amount of lactose powder each day, for 8 weeks. Daily administration of 3 g of ginseng for an 8-week period did not improve lactate threshold nor did it affect physical performances. Therefore, ginseng supplementation did not exert an ergogenic property on aerobic fitness enhancement in well-fit individuals.

Cancer patients
Association of Ginseng Use with Survival and Quality of Life among Breast Cancer Patients.
Am J Epidemiol. 2006. Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN.
The authors evaluated the associations of ginseng use as a complementary therapy with survival and quality of life in a cohort of 1,455 breast cancer patients who were recruited to the Shanghai Breast Cancer Study in Shanghai, China. Approximately 27% of study participants were regular ginseng users before cancer diagnosis. Compared with patients who never used ginseng, regular users had a significantly reduced risk of death. Ginseng use after cancer diagnosis, particularly current use, was positively associated with quality of life scores, with the strongest effect in the psychological and social well-being domains.

J Natl Cancer Inst. August, 2013. Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. Data support the benefit 2000 mg daily, on CRF over an 8-week period. There were no discernible toxicities associated with the treatment. Studies to increase knowledge to guide the role of ginseng to improve CRF are needed.

Most people have had family members or friends or coworkers who have had treatment for cancer in the form of chemotherapy and/or radiation. Perhaps you, yourself, have had such treatment. During and after such chemotherapy most patients feel tired or sluggish. Many survivors attempt different regimens to combat and reverse this condition. In a recent trial, investigators divided 364 people with cancer-related fatigue into two groups. People in one group took 2,000 milligrams of ginseng daily for eight weeks; those in the other group took placebo capsules. After eight weeks, the ginseng group reported a significant improvement compared to the placebo group. Journal of the National Cancer Institute, online July 13, 2013.

Cholesterol, and blood lipids
The administration of several grams of ginseng daily increases the ability of the body to maintain its antioxidant status. Furthermore, lipid levels such as LDL cholesterol are lowered.

Effects of Panax ginseng extract on lipid metabolism in humans.
Pharmacol Res. 2003.
The purpose of this study was to examine the effects on lipid metabolism in humans by measuring cholesterol, malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT). Serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and plasma MDA levels were decreased by administration of ginseng extract for 8 weeks (6 g per day), however, high density lipoprotein (HDL) was increased. Those results suggest that lipid lowering effect of ginseng is associated with a decrease in TC, TG, LDL, MDA levels and an increase in HDL. These findings support scientific claims that ginseng has lipid lowering potential. Administration of ginseng extract increased SOD and CAT activities while decreased MDA level indicating that antioxidant potential of PGE might induce hypolipidemic effect as one of action mechanism.
       
Cognitive functioning
Various tests of mental performance were carried out in a group of sixteen healthy male volunteers given a standardized preparation of Asian ginseng (100 mg twice a day for twelve weeks of a product called G 115). A similar group was given identical placebo capsules under double-blind conditions. A favorable effect of ginseng was observed in attention, mental arithmetic, logical deduction, and auditory reaction time.         
   Researchers at the Cognitive Drug Research Ltd., Beech Hill, Reading, in the United Kingdom evaluated the effects of a Ginkgo biloba / ginseng combination on cognitive function. The study lasted ninety days and was performed in a double blind, placebo-controlled manner with sixty-four healthy volunteers (aged 40 to 65 years) who had mild fatigue and low mood. The treatment was well tolerated by all volunteers. There were improvements noted in memory and overall cognitive functioning.
   Ginseng root saponin at a dose of 50 mg three times a day was given for two months to 358 middle and old age individuals. The results showed that the herb improved memory and immunity.

Certain active substances in ginseng appear to combat degenerative brain disease in rats. The various commercial preparations are generally made from the roots of one of several plant species, including Panax ginseng and Panax quinquefolius. A whole-root preparation of American ginseng was not beneficial in helping degeneration in the brains of rats. But a partially purified extract of some of the herb's active chemicals, known as ginsenosides, did. The study focused on brain damage that, in rats, mimics the degenerative process seen in Huntington's disease, an inherited disorder of the central nervous system that progressively impairs movement and mental function. But the findings suggest that certain ginseng components have potential for treating other degenerative conditions, such as Parkinson's. The partial purification of American ginseng boosted the concentration of three ginsenosides known as Rb1, Rb3 and Rd. Animals that were given the extract before receiving a brain-cell-damaging toxin called 3-NP showed less movement impairment than animals that received 3-NP alone, and none died. Annals of Neurology, May 2005.

Diabetes, blood vessel health, dilation of blood vessels, circulation improvement
J Ethnopharmacol. 2013. Effect of American ginseng (Panax quinquefolius) on arterial stiffness in subjects with type-2 diabetes and concomitant hypertension. Substantial pre-clinical and some clinical data are available showing that Asian ginseng (Panax ginseng C.A. Meyer) varieties or its particular ginsenosides exert a vasodilatating effect, thus may modulate vascular function. Addition of AG extract to conventional therapy in diabetes with concomitant hypertension improved arterial stiffness and attenuated systolic BP, thus warrants further investigation on long-term endothelial parameters before recommended as an adjunct treatment.

Lung disease, COPD
Ginseng improves pulmonary functions and exercise capacity in patients with COPD.
Arch Chest Disease. 2002.
The purpose of this study was to evaluate the effects of ginseng extract (G115) on Pulmonary Function Tests (PFTs), Maximum Voluntary Ventilation (MVV), Maximum Inspiratory Pressure (MIP) and Maximal Oxygen Consumption (VO2max) in patients with moderately-severe Chronic Obstructive Pulmonary Disease (COPD). Ninety-two adults were randomly divided into the experimental (Ginseng 100 mg bid for three months) and placebo-control groups. Ginseng extract 100 mg bid for three months, but not placebo, improved PFTs, MVV, MIP and VO2 max in patients with moderately-severe COPD with no side effects.

Combination with prescription drugs
Ginseng may interact with a number of prescription medications, for instance warfarin or Coumadin.

Brief communication: American ginseng reduces warfarin's effect in healthy patients: a randomized, controlled Trial.
Ann Intern Medicine. 2004.
People using prescription medication often concurrently take herbal supplements. In a case report, the anticoagulant effect of warfarin decreased after patients consumed ginseng. To evaluate the interactions between American ginseng and warfarin. In this 4-week study, 20 patients received warfarin for 3 days during weeks 1 and 4. Beginning in week 2, patients were assigned to receive either American ginseng or placebo. International normalized ratio (INR) and plasma warfarin level. The peak INR statistically significantly decreased after 2 weeks of ginseng administration compared with placebo. American ginseng reduces warfarin's anticoagulant effect. When prescribing warfarin, physicians should ask patients about ginseng use.

Can I take Korean ginseng with hypertension medication?
   There are dozens of different hypertension drugs. We have not seen any research regarding its combination with such medications, so we can't say. Chances are low dosages would not have much of an influence but we suggest you avoid high dose ginseng supplements if you are taking blood pressure medications.

Can I take ginseng with cholesterol medication such as a statin drug?
    There are many different cholesterol drugs. We have not seen any research regarding its combination with various such cholesterol lowering medications, so we can't say.

Blood pressure
Why is it that panax ginseng is contraindicated in hypertension, when it is also a known vasodilator due to its tendency to increase nitric oxide production? This is really confusing me. I have done a lot of internet searching, but cannot find the answer to this question. I did find some sites which stated that Korean Ginseng might be useful in treating hypertension, but in general, the consensus is that ginseng is a stimulant and should not be used by hypertensive patients. How can it be both a vasodilator and a vasoconstrictor at the same time? (I'm assuming that the stimulant aspect of ginseng involves vasoconstriction and that that is the mechanism in causing hypertension.
   This is a good question. We are not sure completely but we will take an educated guess. Each herb, including ginseng, has many, many components. Some of these substances may cause dilation of blood vessels, but other chemicals in ginseng may stimulate heart tissue to beat faster and stronger thus increasing blood pressure. Various forms may act in different ways, and also the way the ginseng is made into powder, and various extract forms determines the final constituents. So, different preparations may have a different effect.

Quality of life
The aim of this study was to compare the quality-of-life parameters in subjects receiving multivitamins plus ginseng with those found in subjects receiving multivitamins alone (Caso Marasco 1996). The study was randomized and double-blind, and it involved 625 patients of both sexes divided into two groups taking one capsule per day for twelve weeks. Group A received vitamins, minerals, trace elements and ginseng extract while group B received vitamins, minerals and trace elements only. By the end of the study, both the group-A and the group-B tested positively on a questionnaire evaluating quality of life, but Group A had a higher score.
      
Constituents, what's in it?
The roots of Asian and American ginseng contain polysaccharides, ginsenosides, peptides, polyacetylenic alcohols, fatty acids, etc. They have several saponins named ginsenosides that are believed to contribute to the adaptogenic properties. They are used in traditional Chinese medicine to improve stamina and combat fatigue and stress. Saponins are interesting natural compounds found in many plants, herbs, roots, and beans. Saponins have potential in the prevention and treatment of diseases of the heart and circulatory system. For instance, they inhibit the formation of lipid peroxides (fat oxidation) in cardiac muscle or in the liver, they influence the function of enzymes contained in them, they decrease blood coagulation, cholesterol, and sugar levels in blood, and they stimulate the immune system. Some saponins may even have anti-tumor properties.

Availability of ginseng supplements
Countless varieties and dosages of ginseng are available. One option is to buy a ginseng product that has a standardized extract of 3 to 7 percent ginsenosides but some products are as high as 90 percent ginsenosides. Use 100 mg of this extract in the morning a few times a week. You may require 500 to 2,000 mg of he dried ginseng root to feel the effects. It’s best to cycle the use of ginseng. For instance, you can take ginseng for two or three weeks and then take off a few weeks.

Mechanisms of action, how it works
The roots of Chinese and American ginseng contain several saponins named ginsenosides. These are interesting natural compounds found in many plants, herbs, roots, and beans. They are used in traditional Chinese medicine to improve stamina and combat fatigue and stress. They inhibit the formation of lipid peroxides (fat oxidation) in cardiac muscle and in the liver, influence the function of enzymes, decrease blood coagulation, cholesterol, and sugar levels in the blood, and stimulate the immune system. Some saponins may even have anti-tumor properties. Both the Asian and American forms of ginseng enhance libido and copulatory performance. These effects of ginseng may not be due to changes in hormone secretion, but to the direct effects of ginseng, or its ginsenoside components, on the central nervous system and gonadal tissues. There is good evidence that ginsenosides can facilitate penile erection by directly inducing the vasodilatation and relaxation of penile corpus cavernosa. Moreover, the effects of ginseng on the corpus cavernosa appear to be mediated by the release of nitric oxide from endothelial cells and from nerves that surround the vessels. Treatment with American ginseng also affects the central nervous system and has been shown to significantly alter the activity of hypothalamic catecholamines, such as dopamine and norephinephrine, involved in the facilitation of copulatory behavior and hormone secretion. According to recent findings, that ginseng treatment decreases prolactin secretion, which also suggests a direct effect of ginseng at the level of the pituitary gland. High levels of prolactin inhibit libido. Studies sometimes have provided contradictory results, perhaps because the ginsenoside content of ginseng root or root extracts can differ depending on the species, method of extraction, subsequent treatment, or even the season of collection.

Review and summary
Many people who take ginseng find this herb to be a good overall energizer and cognitive enhancer. Due to the tremendous variety of ginseng products sold, it is difficult to give definite dosage recommendations. You could certainly try a few ginseng products to see which one(s) give you a positive effect. In practical and simple terms, Asian ginseng raises body temperature and is more stimulating while American ginseng is more calming. The effects of Siberian ginseng fall somewhere between these two.

Dr. Sahelian's experience
The sexual effects from ginseng are subtle but definitely present. I have tried Asian ginseng on numerous occasions. Most of my trials have been with root powder at a dosage ranging from 500 to 1,000 mg. I notice an enhancement in alertness, motivation, focus, and mood, along with a mild sexual stimulation. The effects seem to improve on subsequent days of use. I find high doses to cause anxiety and interfere with sleep. Use a dose that does not cause you insomnia.