Ginseng, α-cyclodextrin of no help for glycaemic, cholesterol control

Taking hydrolysed ginseng or α-cyclodextrin supplements did not improve glycaemic control and total cholesterol levels, respectively, in overweight or obese people with prediabetes, according to a study.

“Although both supplements can be used with safety in otherwise healthy adults with prediabetes and overweight or obesity, these supplements cannot be recommended for diabetes prevention,” the researchers pointed out.

In the double-blind study with a 2x2 factorial design, 401 participants (mean age 53.5 years, 62 percent women, mean BMI 34.6) with prediabetes were randomized 1:1:1:1 to receive either hydrolysed ginseng plus α-cyclodextrin, hydrolysed ginseng or α-cyclodextrin alone, or placebo. [JAMA Netw Open 2020;doi:10.1001/jamanetworkopen.2020.23491]

Among the participants who received hydrolysed ginseng supplements (alone or in combination with α-cyclodextrin), there was no significant change in fasting plasma glucose after 6 months compared with those not taking ginseng supplements (ie, individuals assigned to α-cyclodextrin alone or placebo; p=0.95).

Similarly, total cholesterol levels did not change significantly after 6 months among individuals assigned to take α-cyclodextrin supplements (alone or in combination with hydrolysed ginseng) vs those not taking α-cyclodextrin (ie, either hydrolysed ginseng alone or placebo; -1.5 mg/dL; p=0.51).

When the analysis was limited to participants who completed the intervention programme (n=333), a greater reduction in total cholesterol level was seen vs the comparators who were not on α-cyclodextrin (-3.5 mg/dL; p=0.23), although the difference remained nonsignificant between groups.

“[This finding] suggests that α-cyclodextrin may have some metabolic effect even if it is not clinically relevant,” said the researchers.

“The consensus is that products able to lower LDL cholesterol levels by 10 percent or more are worthwhile for cardiovascular disease risk management, even if long-term efficacy for cardiovascular end points has not been established,” they explained.

Previously, complementary medicines including α-cyclodextrin and ginseng have shown promising results for lowering cholesterol and glycaemic control in several small studies. α-cyclodextrin is a soluble fibre derivative of corn starch which is able to bind to triglycerides up to nine times its weight, while the ginsenoside component compound K from ginseng is believed to have beneficial glycaemic effects.

“Complementary medicines are now a $5 billion industry in Australia,4 with people using these alternative treatments not only for preventive health but to manage chronic disease. However, quality evidence is lacking regarding the efficacy and safety,” noted the researchers.

The supplements used in the current study appeared to be safe in general. Constipation (p=0.006) and cough (p=0.02) occurred more frequently with the use of α-cyclodextrin, while rash and pruritus (p=0.006) were more common among those taking hydrolysed ginseng. Nonetheless, the rates of these adverse events were low, occurring in 9.2 percent of the participants overall.

“Although both supplements can be used with safety in otherwise healthy adults with prediabetes and overweight or obesity, these supplements cannot be recommended for diabetes prevention,” the researchers stated.