Research ArticleHyperthermic Effect of Ginger (Zingiber officinale)Extract-Containing Beverage on Peripheral Skin SurfaceTemperature in Women

Keiichiro Sugimoto 1 Hiroaki Takeuchi1 Kazuya Nakagawa1 and YasuhiroMatsuoka 2

1Research and Development Center Nagaoka Co Ltd 1-3-30 Itsukaichi Ibaraki Osaka 567-0005 Japan2Department of Food and Health Sciences Jissen Womenrsquos University 4-1-1 Osakaue Hino Tokyo 191-8510 Japan

Correspondence should be addressed to Yasuhiro Matsuoka matsuoka-yasuhirojissenacjp

Received 28 June 2018 Revised 25 September 2018 Accepted 26 September 2018 Published 8 October 2018

Academic Editor Haifa Qiao

Copyright copy 2018 Keiichiro Sugimoto et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Ginger is known to warm the body Therefore we conducted a placebo-controlled crossover trial to investigate the hyperthermiceffect of a palatable ginger-containing beverage in healthy women with cold-sensitive extremities Six women drank 280mL of007 ginger extract-containing or placebo beverage in a temperature-controlled room (21∘C) Their palm temperatures weremeasured as measure of surface body temperature using a thermographic camera before intake and every 10min after intake for60min Palm temperature increased immediately following intake of the ginger and placebo beveragesHowever palm temperaturefollowing intake of the ginger beverage increased for 20min while palm temperature following placebo intake decreased again after10minThe increased palm temperature following ginger intake was maintained significantly longer than after placebo intake (p lt005) In response to a questionnaire some subjects answered that their increased body temperaturewas maintained after drinkingthe ginger beverage Ginger extract-containing beverage may thus improve cold sensitivity

1 Introduction

Cold sensitivity of the extremities (hie-sho) is defined as beingaware of an abnormally cold sensation on specific parts ofbody even in an ambient temperature in which other partsof the body do not feel cold [1] This cold sensitivity iscommon in Japanese women According to surveys over 50of adult women complained of coldness of their peripheralextremities andor around their hips in winter or in an air-conditioned room [2 3] This condition is associated withan autonomic nervous system imbalance due to female hor-monal disorders such as menopause delivery menstruationor infertility [4ndash6] menstrual anemia diet restriction forweight reduction or diet disorders [6] Autonomic nervoussystem imbalance induces contraction of the peripheralvessels leading to insufficient blood flow and heat transfer tothe extremities [3 7] With regard to environmental factorswearing light clothing andor consuming cold drinks in anair-conditioned atmosphere either at home or in the office

are also possible reasons for hie-sho [6 8] Hie-sho has alsobeen reported in males [9] Severe hie-sho can affect thesuffererrsquos quality of life and may cause other symptoms suchas shoulder stiffness lumbar pain headache sleeplessness orconstipation [2 6 8] Improving the peripheral circulationand enhancing thermogenesis are considered as effectivemeans of alleviating cold sensitivity

Ginger (Zingiber officinale) is an annual plant originatingfrom tropical Asia The rhizome generally referred to asginger is widely used as a spice or folk medicine In tra-ditional Chinese medicine (Shennong Ben Cao Jing) driedginger is used to warm the body Ginger soup comprisinghot water with dried ginger powder or grated raw gingeris drunk to keep warm especially when a person has acold Ginger root contains pungent polyphenols known asgingerols such as 6-shogaol 6-gingerol and zingeron [10]These components have been reported to have thermogeniceffects by inducing adrenaline secretion via activation oftransient-receptor potential vanilloid 1 channels [11] Human

HindawiEvidence-Based Complementary and Alternative MedicineVolume 2018 Article ID 3207623 8 pageshttpsdoiorg10115520183207623

2 Evidence-Based Complementary and Alternative Medicine

trials have also reported elevation of body temperatures usingginger-containing capsules [12ndash14] bread [15] or tea [16]However ginger has a pungent flavor and tastes unpleasantwhen used in high doses

Therefore we developed a beverage containing gingerextract with an effective dose and acceptable taste Weinvestigated the hyperthermic effect of this beverage on skintemperature in the limbs in healthy Japanese women withcold sensitivity

2 Materials and Methods

21 Human Subjects Eight healthy Japanese female volun-teers with hie-sho (age 300 plusmn 61 years height 1610 plusmn 42 cmweight 530 plusmn 54 kg mean plusmn standard deviation [SD])were recruited from a consumer monitor database by IPSOSNihon-Toukeichousa Co Ltd (Tokyo Japan) according tothe criteria described below The selection criteria werewomen who were healthy but who experienced self-reportedcold sensitivity based on a questionnaire as reported byNagashima et al [17] with slight modifications Howevernone of the participants had a pathological diagnosis accord-ing to the diagnostic criteria of Terasawa [2] Participantsalso fulfilled the following criteria not receiving medicaltreatment notmenstruating not allergic to ginger not takinghealth supplements and a body mass index gt 85 and lt 250(kgm2)

The study was carried out in accordance with the Helsinkideclaration and all subjects provided written informed con-sent

22 Preparation of Ginger-Containing Beverages and SensoryEvaluation The ginger extract was prepared from gingerroots that were harvested in Vietnam dried in hot airand mixed with approximately 40 ethanol (ww) at 65∘Cfollowed by mixing with high-fructose corn syrups Themixture was filtered through filter paper and evaporated to75 degrees Brix To determine a palatable dose of the gingerextract three levels of ginger extract were blended to a basebeverage (40 kcal100mL) composed of 13 of high-fructosecorn syrup (Brix 75) 007 of citric acid 006 of ascorbicacid and 006 of caramel color

In a preliminary study a beverage containing 0116of ginger extract was the lowest concentration that had aslightly pungent taste A beverage that contained 035 ofginger extract was three times that of the lowest concentra-tion The highest concentration of ginger used was 0817extract which was reported by Natsuno and Hirayanagi[14] as the lowest total dosage of 6-gingerol and 6-shogaol(476mgserving) among previously reported trials A vol-ume of 280mL of the beverage was packed in plastic bottlesand sterilized by heating at 80∘C for 20min The threedifferent levels of ginger content beverages were evaluated forpalatability by 23 sensory panelists (22ndash65 years mean age433 plusmn 117 years 17 men and 6 women)

Evaluation was carried out between 900 am and 1230am before lunch time in a sensory evaluation room in whichthe environmental condition was the same as that of human

（3

（3

OHO

O

HO

HO

6-Gingerol

6-Shogaol

Figure 1 Chemical structures of 6-gingerol and 6-shogaol

trials The beverages were served to panelists at 55∘C andevaluated The three samples were coded by the alphabetand the serving order was randomly allocated A seven-pointhedonic scale test was carried out (test scales minus3 = stronglydislike minus2 = dislike minus1 = slightly dislike 0 = neither likenor dislike 1 = somewhat like 2 = like 3 = strongly like) ondrinking ease aftertaste pungency and overall judgementAnalytical evaluation was also performed by rating scalemethods (test scales minus3 = extremely weak minus2 = weak minus1= somewhat weak 0 = moderate 1 = somewhat strong 2 =strong 3 = extremely strong) for aftertaste pungency smellsweetness and sourness Panelists wrote their comments ona free description column

23 Quantification of 6-Gingerol and 6-Shogaol (Gingerols) inthe Beverage Standards for 6-gingerol and 6-shogaol (Fig-ure 1) were purchased from Wako Pure Chemical IndustriesLtd (Osaka Japan) A volume of 50mL of 007 ginger-containing beverage was loaded onto a Sep-pack Plus C18Short Cartridge (Waters Co Milford MA USA) condi-tioned with methanol followed by water After washing withwater the absorbed component was eluted with 2mL of100methanol The 25-fold concentrated elution was filteredthrough a 045 120583m membrane syringe filter (Millex-LH045120583m Philic PTFE 13mm Merck Darmstadt Germany)and the filtrate was recovered for high-performance liquidchromatography

The contents of 6-gingerol and 6-shogaol were deter-mined by reverse-phase high-performance liquid chromatog-raphy on an STR ODS-II column (150mm times 46mminternal diameter Shinwa Chemical Industries Ltd KyotoJapan) using an LC-10A system (Shimadzu Co Ltd KyotoJapan) at an absorbance of 282 nm with a UVvisible detec-tor SPD-10A (Shimadzu) The conditions were modifiedslightly as reported previously [18 19] The mobile phasewas aqueous methanol and the gradient conditions wereas follows 0ndash5min 30ndash60 methanol 5ndash10min 60methanol 10ndash13min 60ndash100 methanol and 13ndash18min100methanol The column temperature was 50∘CThe flowrate was 12mLmin which was increased to 15mLminat 15min The sample injection volume was 10 120583L Thechromatogram was recorded using a Chromatopac C-R7Aintegrator (Shimadzu)

Evidence-Based Complementary and Alternative Medicine 3

Ass

essm

ent b

y th

e ins

titut

iona

lre

view

boa

rd

Recr

uitin

g of

subj

ects

Expl

anat

ion

acqu

isitio

n of

info

rmed

cons

ent

and

entr

y

Group 1n = 4

Group 2n = 4

am

First day

Ingestion ofplacebo

Ingestion ofginger

Wash outfor 2 h pm

am

Ingestion ofginger

Ingestion ofplacebo

Wash outfor 2 h pm

am

Second day

Ingestion ofginger

Ingestion ofplacebo

Wash outfor 2 h pm

am

Ingestion ofplacebo

Ingestion ofginger

Wash outfor 2 h pm

Figure 2 Study schedule

24 Protocol for the Human Trial We conducted a placebo-controlled crossover trial over 2 days The base beveragedescribed in Section 22 was used as the placebo beverageand the base drink that contained 0116 of ginger extractwas used as the ginger beverage for the trials As shown inFigure 2 subjects were randomly divided into two groupsOn the first day group 1 drank the ginger beverage in themorning followed by the placebo beverage in the after-noon while group 2 drank the placebo in the morningfollowed by the ginger beverage in the afternoon On thesecond day the subjects in each group drank the beveragesin the reverse order The subjectsrsquo tympanic temperatureswere measured during the acclimatization period before thetrial using a Ken-on Kun MC-510 thermometer (OmronHealthcare Co Ltd Kyoto Japan) The crossover trial wascarried out in an air-conditioned room (temperature 210plusmn 10∘C humidity of 50 plusmn 10) with carpet (Figure 3(a))at 1000 and 1400 h local time to take into account diurnalvariation Subjects wore T-shirts and shorts had bare feetand were isolated from any other furniture in the test roombetween the morning and afternoon trials The tempera-ture in the middle of the subjectrsquos palm (Figure 3(b)) wasmeasured using a thermotracer TH-5100 (NEC San-ei CoTokyo Japan) at a distance of 33m Images were analyzedusing the image-processing software TH-5100 (NEC San-eiCo)

Subjects entered the test room 1 h before the trial andacclimated while sitting under resting conditions Bothbeverages were served as hot drinks at 55∘C and were coveredwith a holder to avoid exposing the subjectrsquos hand to the heatThe beverages were consumed over 3min After the trials thesubjects completed a free description questionnaire on bodilysensation

25 Statistical Analysis The results are expressed as mean plusmnSD Differences in the data of sensory evaluation between thethree beverages were analyzed by the Friedman test Palmtemperatures in themorning and afternoonwere analyzed forinteraction between beverage and time by two-way analysisof variance (ANOVA) Palm temperatures were comparedbetween the ginger and placebo treatments by paired t-tests Analyses were performed using SPSS Statistics v25

(IBM Armonk NY USA) and differences were consideredsignificant at p lt 005

3 Results and Discussion

31 Palatable Ginger Content in the Beverage Three levels ofginger extract content beverages were evaluated by a sensorytest The 0116 ginger extract beverage obtained the highestscore of preference of drinking ease and this score wassignificantly higher than that for the 0817 beverage (p =0018) but not for the 035beverage (p = 0768 Figure 4(a))The score of preference for aftertaste was not significantlydifferent between the 0116 and 035beverages (p = 0338)However the score of aftertaste for the 0817 beverage wassignificantly lower than that for the 0116or 035beverages(p = 0001 0022 resp) There was no significant differencein preference for pungency among the three beverages (p= 0063) For overall judgement of palatability the 0116and 035 beverages had significantly higher scores than didthe 0817 beverage (p = 0008 0027 resp) The analyticalsensory test showed that ginger content level tended to beproportional to the strength of aftertaste and pungency butthere was no significant difference between the 0116 and035 beverages (Figure 4(b)) Because of no significant dif-ference between the 0116 and 035beverages in preferencefor drinking ease and overall judgement we decided to use alower content (ie 0116 ginger extract beverage) for humantrials on the hyperthermic effect of ginger

32 Tympanic Temperature Tympanic temperature providesa precise indication of deep body temperature [20] Howeverwith cold exposure treatment changes in tympanic or rectaltemperatures are not significantly different between the hie-sho group and non-hie-sho group [17 21]Therefore wemon-itored the subjectsrsquo health on the trial days bymeasuring theirtympanic temperature during the acclimatization periodbefore the trial Among eight subjects two were excludedfrom the study because of marked changes in tympanictemperatures between the first and second daysThe other sixsubjects showed stable tympanic temperature within normallimits (changes within 05∘C) and the results of these subjectswere analyzedThemean tympanic temperatures for these six

4 Evidence-Based Complementary and Alternative Medicine

A

33 m32 m

07 m

(a)

Before ingestion After ingestion

(b)

Figure 3 Conditions of the test room (a) Measurement site of the thermographic examination (b)

minus3 minus2 minus1 0 1 2 3

Overalljudgment

Smell

Pungency

Aftertaste

Drinkingease

Score

01160350817

A B B

A B B

A B B

(a)

01160350817

minus3 minus2 minus1 0 1 2 3 4

Sourness

Sweetness

Smell

Pungency

Aftertaste

Score

A A

A A

A A

B

B

B

(b)

Figure 4 Hedonic (a) and sensory (b) evaluation of ginger-containing beverages Each value is expressed in terms of hedonic sensation(a) and sensory evaluation (b) among three types of ginger-containing beverages (a) was a measure of the overall hedonic perception ofthe drinks containing ginger extract and (b) was a measure of the flavor characteristics of the drinks The contents of gingerols including6-gingerol and 6-shogaol were 0116 (◼) 035 (Q) and 0817 (998771) and they are shown as mean plusmn SD (n = 23) Test scales were classifiedas (a) minus3 = strongly dislike minus2 = dislike minus1 = slightly dislike 0 = neither like nor dislike 1 = somewhat like 2 = like and 3 = strongly like and(b) minus3 = extremely weak minus2 = weak minus1 = somewhat weak 0 = moderate 1 = somewhat strong 2 = strong and 3 = extremely strong Valueswith different letters indicate a significant difference at p lt 005 (Friedman test)

Evidence-Based Complementary and Alternative Medicine 5

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

GingerPlacebo

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowast

lowast

(a)

GingerPlacebo

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowastlowast

lowast

lowast

(b)

Figure 5 Effects of drinking ginger or placebo beverages on palm temperature in women Six healthy women with cold sensitivity drankplacebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverages in the morning (a) or afternoon (b) Palm temperaturewas determined by thermographic measurement Values are shown as mean plusmn SD for the six women lowastp lt 005 versus the placebo treatmentat the same time point (paired t-test) There was a significant interaction between beverage and time (p = 0009 in the morning p = 0024 inthe afternoon) by two-way repeated measures ANOVA

subjects were 365plusmn 038∘C (morning on day 1) 366 plusmn 049∘C(afternoon on day 1) 364 plusmn 042∘C (morning on day 2) and364∘C plusmn 049∘C (afternoon on day 2)

33 Effect of Ginger Beverage on Skin Surface TemperatureThe trial of eight subjects was performed in the morning andafternoon in a crossover manner to account for any effectsof circadian variation However as described in Section 32palm temperature data for only six subjects were statisticallyanalyzed

Changes in mean palm temperature after drinking thebeverage in the morning trial are shown in Figure 5(a) Palmtemperature increased immediately until 10min after intakein both groups (+32∘C after ginger and +29∘C after placeboversus 0min) However palm temperature continued toincrease until 20min (up to +34∘C versus 0min) after gingerintake while palm temperature decreased after 10min (to+24∘C versus 0min) after placebo treatment Palm temper-ature then decreased in both groups but remained higher inthe ginger group compared with the placebo group ANOVAshowed a significant interaction between beverage and time(p = 0009) Paired t-tests showed that palm temperatureswere significantly higher in the ginger treatment comparedwith the placebo treatment at 20 (p = 0026) 30 (p = 0025)and 40min (p = 0038) after intake

Changes in mean palm temperature after drinking thebeverage in the afternoon trial are shown in Figure 5(b)A sample thermogram for Subject 4 is shown in Figure 6Palm temperature increased immediately and continued toincrease for 10min in the ginger and placebo groups (+33∘Cafter ginger and +23∘C after placebo versus 0min) Howeverpalm temperature after ginger intake continued to increaseuntil 20min (up to +46∘C versus 0min) while palm tem-perature after placebo intake decreased after 10min (+23∘C

versus 0min) Palm temperature after ginger treatment wasthen maintained until 40min while that in the placebogroup decreased (+19∘C versus 0min) At 60min palmtemperature in the ginger group had decreased to +34∘Cversus 0min while that in the placebo group had decreasedto +13∘C Repeated measures two-way ANOVA showeda significant interaction between beverage and time (p =0024) Paired t-tests showed that palm temperatures weresignificantly higher in the ginger treatment compared withthe placebo treatment at 20 (p = 0012) 30 (p = 0017) and40min (p = 0045) after intake

Both treatments maintained a higher palm temperaturein the afternoon than in the morning In subjects whodrank the ginger beverage palm temperature after 10minremained the same after 60min Mansour et al [22] reportedthat oral intake of dried ginger powder dissolved in hotwater enhanced diet-induced thermogenesis and speculatedthat 6-shogaol was the active component Because the after-noon trial was performed after taking lunch the prolongedhyperthermic response may have been due to the additionalstimulatory effect of ginger on diet-induced thermogenesis

Palm temperature increased immediately after intake ofeither beverage presumably because of the direct warmingeffect of the intake of hot liquid (55∘C) However the gingerbeverage increased palm temperature more than the placebobeverage in the morning and afternoon trials Previoustrials showed that ginger dissolved in water [15 23ndash26]and capsules taken with water [12 13] also led to elevatedbody temperature This evidence suggests that ginger extracthas a hyperthermic response regardless of the beveragetemperature

34 Subjective Evaluation Subjective symptoms were as-sessed by questionnaires after the trials The answers are

6 Evidence-Based Complementary and Alternative Medicine

Ingestion of ginger beverage

Ingestion of placebo beverage

0 20 40 60

Time after ingestion (min)

Figure 6 Sample thermograms of body surface temperature changes following ingestion of ginger and placebo beverages A healthy womanwith cold sensitivity (Subject 4) drank a placebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverage in the afternoonHer body surface temperaturewas measured by thermography Her palm temperaturewas higher at 20 40 and 60min after consumption ofthe ginger beverage compared with the placebo beverage

Table 1 Summary of responses to a questionnaire on the hyperther-mic effects of a ginger extract-containingbeverage (free description)(n = 6)

Comment ResponsesWarming continued 5Warming in fingers and toes 5Warming from within the body 3Warming in throat and face 1Warming in hands and both legs 1Increased blood flow and pulsation in thefingertips 1

shown in Table 1 Five subjects experienced obvious andlasting hyperthermic responses in their peripheral extrem-ities after drinking the ginger beverage However somesubjects who drank the placebo beverage answered that thehyperthermic response did not last and the warm feelingdisappeared quickly and they did not feel any hyperther-mic effect or felt no improvement in cold sensation Onesubject noted improved blood flow to her fingertips afterconsuming the ginger beverage (Table 1) Iwami et al [27]reported that ginger intake increased energy expenditure andshowed a thermogenic effect However Fujisawa et al [15]reported that a lower dosage of ginger did not affect oxygen

consumption but expanded the width of peripheral bloodvessels and increased blood flow Fujisawa et al speculatedthat even low dosage of gingerols which does not affectenergy metabolism may have a hyperthermic effect onperipheral skin by increasing the blood circulation

35 Dosage of 6-Gingerol and 6-Shogaol (Gingerols) ContentsGingerols including 6-gingerol and 6-shogaol have beenreported to be the effective hyperthermic components ofginger [15 28] 6-Gingerol converts to 6-shogaol by elimi-nation of a hydroxyl group as a result of treatments suchas heating [29] and this reaction is reversible in aqueoussolutions [12 30 31] Therefore we measured the 6-gingeroland 6-shogaol contents of a beverage containing 0116 ofginger extract as gingerols The overall gingerol content was242 ppm including 200 ppm 6-gingerol and 042 ppm 6-shogaol In this study the gingerol intake was 677120583g perserving (280mL) for the ginger beverage No gingerols weredetected in the placebo beverage

We found that a low dosage (677120583gserving) of gin-gerols that were consumed in a beverage stimulated ahyperthermic effect at the skin surface of the extremitiesHigher doses of gingerols have previously been reportedto have hyperthermic effects including gingerols in water(26mgserving) [23] in water (621mgserving) and bread(532mgserving) [15] in capsules (476 mgserving) [14] and

Evidence-Based Complementary and Alternative Medicine 7

in ginger koji (malted rice) powder (540mgserving) [12]Natsuno and Hirayanagi [14] reported that ingestion of acapsule that contained 476mg gingerols per serving resultedin no significant increase in temperature on the thumb butsignificantly accelerated energy consumption We speculatethat ginger extract in a beverage may increase temperaturein the peripheral extremities at a lower dose than in breador a capsule because of the lack of interference from othercomponents such as proteins or capsule material

All of our subjects reported that the ginger extract-containing beverage was easy to drink In the above-mentioned previous studies the flavor of the ginger wasmasked bymixing it in bread [15] capsules [12ndash14] or tea [16]No previous taste trials have investigated the taste of gingersamples dissolved in water or hot water [15 22ndash26] Howeverthe beverage in this study was drinkable without a pungentflavor Commercially available ginger drinks such as gingerale contain low levels of gingerols (data not shown)

4 Conclusion

A palatable beverage containing ginger extract has a hyper-thermic effect on the peripheral extremities in women suffer-ing frommild cold sensitivity even at a low dose of gingerolsTherefore this beverage may help to improve cold sensitivityin people suffering from hie-sho

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

This work was financially supported by Nagaoka Co LtdKeiichiro Sugimoto Hiroaki Takeuchi and Kazuya Naka-gawa are employees of Nagaoka Co Ltd

Acknowledgments

We would like to express our gratitude to the subjectswho enrolled at IPSOS Nihon-Toukeichousa Co Ltd forparticipation in this study We thank Susan Furness PhDfrom Edanz Group (wwwedanzeditingcomac) for editing adraft of this manuscript

References

[1] H Monobe ldquoProposal of quantification of sensibility to coldbased on psychological procedurerdquo Japanese Journal of Physi-ological Anthropology vol 14 no 2 pp 43ndash50 2009

[2] K Terasawa ldquoOn the recognition and treatment of hie-sho (coldsensitivity) in traditional kampoh medicinerdquo ShoyakugakuZasshi vol 41 no 2 pp 85ndash96 1987

[3] N Ushiroyama ldquoChill sensation pathological findings and itstherapeutic approachrdquo Igaku no ayumi vol 215 no 11 pp 925ndash929 2005

[4] F Miura K Nakai and H Matsuo ldquoThe modulation of Hieshoand menstruation related symptoms by autonomic nerve activ-ity in Japanese young womenrdquo Departmental Bulletin PaperKobe University Graduate School of Health Sciences vol 28 pp1ndash8 2012

[5] MKMelby ldquoFactor analysis of climacteric symptoms in JapanrdquoMaturitas vol 52 no 3-4 pp 205ndash222 2005

[6] S Nakamura ldquoldquoSensitivity to coldrdquo a concept analysisrdquo Journalof Japan Academy of Nursing Science vol 30 no 1 pp 62ndash712010

[7] YOgata K Kaneko KGoto K Kono and S Yamamoto ldquoPhys-iological mechanism of HieshomdashEvaluation by cardiovascularand autonomic Dynamicsrdquo Japanese Journal of Nursing Art andScience vol 15 no 3 pp 227ndash234 2017

[8] M Saga and M Imai ldquoStudy of painful chills and associatedfactors in female university studentsrdquo Ishikawa Journal ofNursing vol 9 pp 91ndash99 2012

[9] MNakagawa Y Yamane andK Kabeyama ldquoSensitivity to coldandhealth status in elementarymiddle high school and collegestudentsrdquo Annual Reports of Human Health Sciences GraduateSchool of Medicine Kyoto University vol 9 pp 7ndash10 2014

[10] R B Semwal D K Semwal S Combrinck and A M ViljoenldquoGingerols and shogaols Important nutraceutical principlesfrom gingerrdquo Phytochemistry vol 117 Article ID 11221 pp 554ndash568 2015

[11] Y Iwasaki A Morita T Iwasawa et al ldquoA nonpungent com-ponent of steamed gingermdash[10]minusshogaolmdashincreases adrenalinesecretion via the activation of TRPV1rdquoNutritional Neurosciencevol 9 no 3-4 pp 169ndash178 2006

[12] Y KawabataM Kanaoka C Bogaki et al ldquoEffects of ginger kojiintake on skin surface temperature for young women sensitiveto cold temperaturesrdquo Journal of the Brewing Society of Japanvol 108 no 10 pp 778ndash786 2013

[13] N Nakamura and S Kondo ldquoImprovement effect of ldquoGingerExtract Powder Srdquo on a cold constitutionrdquo Japanese Pharmacol-ogy andTherapeutics vol 43 no 10 pp 1441ndash1450 2015

[14] T Natsuno and K Hirayanagi ldquoThe effect of ginger extractintake on energy consumption in youngwomenwith the feelingof chillinessrdquoThe Japanese Journal of Ergonomics vol 45 no 4pp 236ndash241 2009

[15] F Fujisawa T Nadamoto and T Fushiki ldquoEffect of intake ofginger on peripheral body temperaturerdquo Journal of Japan Societyof Nutrition and Food Sciences vol 58 no 1 pp 3ndash9 2005

[16] T Aoki and Y Kuroki ldquoEnergy expenditure after tea or gingerteardquo Bulletin of Gifu City Womenrsquos College vol 65 pp 43ndash452013

[17] K Nagashima T Yoda T Yagishita A Taniguchi T Hosonoand K Kanosue ldquoThermal regulation and comfort during amild-cold exposure in young Japanese women complaining ofunusual coldnessrdquo Journal of Applied Physiology vol 92 no 3pp 1029ndash1035 2002

[18] D A Balladin O Headley I Chang-Yen and D R McGawldquoHigh pressure liquid chromatographic analysis of the mainpungent principles of solar dried west Indian ginger (zingiberofficinale Roscoe)rdquo Journal of Renewable Energy vol 13 no 4pp 531ndash536 1998

[19] C Chen M Kuo and C Ho ldquoHigh performance liquid chro-matographic determination of pungent gingerol compounds ofginger (zingiber officinale roscoe)rdquo Journal of Food Science vol51 no 5 pp 1364-1365 1986

Evidence-Based Complementary and Alternative Medicine 3

Ass

essm

ent b

y th

e ins

titut

iona

lre

view

boa

rd

Recr

uitin

g of

subj

ects

Expl

anat

ion

acqu

isitio

n of

info

rmed

cons

ent

and

entr

y

Group 1n = 4

Group 2n = 4

am

First day

Ingestion ofplacebo

Ingestion ofginger

Wash outfor 2 h pm

am

Ingestion ofginger

Ingestion ofplacebo

Wash outfor 2 h pm

am

Second day

Ingestion ofginger

Ingestion ofplacebo

Wash outfor 2 h pm

am

Ingestion ofplacebo

Ingestion ofginger

Wash outfor 2 h pm

Figure 2 Study schedule

24 Protocol for the Human Trial We conducted a placebo-controlled crossover trial over 2 days The base beveragedescribed in Section 22 was used as the placebo beverageand the base drink that contained 0116 of ginger extractwas used as the ginger beverage for the trials As shown inFigure 2 subjects were randomly divided into two groupsOn the first day group 1 drank the ginger beverage in themorning followed by the placebo beverage in the after-noon while group 2 drank the placebo in the morningfollowed by the ginger beverage in the afternoon On thesecond day the subjects in each group drank the beveragesin the reverse order The subjectsrsquo tympanic temperatureswere measured during the acclimatization period before thetrial using a Ken-on Kun MC-510 thermometer (OmronHealthcare Co Ltd Kyoto Japan) The crossover trial wascarried out in an air-conditioned room (temperature 210plusmn 10∘C humidity of 50 plusmn 10) with carpet (Figure 3(a))at 1000 and 1400 h local time to take into account diurnalvariation Subjects wore T-shirts and shorts had bare feetand were isolated from any other furniture in the test roombetween the morning and afternoon trials The tempera-ture in the middle of the subjectrsquos palm (Figure 3(b)) wasmeasured using a thermotracer TH-5100 (NEC San-ei CoTokyo Japan) at a distance of 33m Images were analyzedusing the image-processing software TH-5100 (NEC San-eiCo)

Subjects entered the test room 1 h before the trial andacclimated while sitting under resting conditions Bothbeverages were served as hot drinks at 55∘C and were coveredwith a holder to avoid exposing the subjectrsquos hand to the heatThe beverages were consumed over 3min After the trials thesubjects completed a free description questionnaire on bodilysensation

25 Statistical Analysis The results are expressed as mean plusmnSD Differences in the data of sensory evaluation between thethree beverages were analyzed by the Friedman test Palmtemperatures in themorning and afternoonwere analyzed forinteraction between beverage and time by two-way analysisof variance (ANOVA) Palm temperatures were comparedbetween the ginger and placebo treatments by paired t-tests Analyses were performed using SPSS Statistics v25

(IBM Armonk NY USA) and differences were consideredsignificant at p lt 005

3 Results and Discussion

31 Palatable Ginger Content in the Beverage Three levels ofginger extract content beverages were evaluated by a sensorytest The 0116 ginger extract beverage obtained the highestscore of preference of drinking ease and this score wassignificantly higher than that for the 0817 beverage (p =0018) but not for the 035beverage (p = 0768 Figure 4(a))The score of preference for aftertaste was not significantlydifferent between the 0116 and 035beverages (p = 0338)However the score of aftertaste for the 0817 beverage wassignificantly lower than that for the 0116or 035beverages(p = 0001 0022 resp) There was no significant differencein preference for pungency among the three beverages (p= 0063) For overall judgement of palatability the 0116and 035 beverages had significantly higher scores than didthe 0817 beverage (p = 0008 0027 resp) The analyticalsensory test showed that ginger content level tended to beproportional to the strength of aftertaste and pungency butthere was no significant difference between the 0116 and035 beverages (Figure 4(b)) Because of no significant dif-ference between the 0116 and 035beverages in preferencefor drinking ease and overall judgement we decided to use alower content (ie 0116 ginger extract beverage) for humantrials on the hyperthermic effect of ginger

32 Tympanic Temperature Tympanic temperature providesa precise indication of deep body temperature [20] Howeverwith cold exposure treatment changes in tympanic or rectaltemperatures are not significantly different between the hie-sho group and non-hie-sho group [17 21]Therefore wemon-itored the subjectsrsquo health on the trial days bymeasuring theirtympanic temperature during the acclimatization periodbefore the trial Among eight subjects two were excludedfrom the study because of marked changes in tympanictemperatures between the first and second daysThe other sixsubjects showed stable tympanic temperature within normallimits (changes within 05∘C) and the results of these subjectswere analyzedThemean tympanic temperatures for these six

4 Evidence-Based Complementary and Alternative Medicine

A

33 m32 m

07 m

(a)

Before ingestion After ingestion

(b)

Figure 3 Conditions of the test room (a) Measurement site of the thermographic examination (b)

minus3 minus2 minus1 0 1 2 3

Overalljudgment

Smell

Pungency

Aftertaste

Drinkingease

Score

01160350817

A B B

A B B

A B B

(a)

01160350817

minus3 minus2 minus1 0 1 2 3 4

Sourness

Sweetness

Smell

Pungency

Aftertaste

Score

A A

A A

A A

B

B

B

(b)

Figure 4 Hedonic (a) and sensory (b) evaluation of ginger-containing beverages Each value is expressed in terms of hedonic sensation(a) and sensory evaluation (b) among three types of ginger-containing beverages (a) was a measure of the overall hedonic perception ofthe drinks containing ginger extract and (b) was a measure of the flavor characteristics of the drinks The contents of gingerols including6-gingerol and 6-shogaol were 0116 (◼) 035 (Q) and 0817 (998771) and they are shown as mean plusmn SD (n = 23) Test scales were classifiedas (a) minus3 = strongly dislike minus2 = dislike minus1 = slightly dislike 0 = neither like nor dislike 1 = somewhat like 2 = like and 3 = strongly like and(b) minus3 = extremely weak minus2 = weak minus1 = somewhat weak 0 = moderate 1 = somewhat strong 2 = strong and 3 = extremely strong Valueswith different letters indicate a significant difference at p lt 005 (Friedman test)

Evidence-Based Complementary and Alternative Medicine 5

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

GingerPlacebo

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowast

lowast

(a)

GingerPlacebo

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowastlowast

lowast

lowast

(b)

Figure 5 Effects of drinking ginger or placebo beverages on palm temperature in women Six healthy women with cold sensitivity drankplacebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverages in the morning (a) or afternoon (b) Palm temperaturewas determined by thermographic measurement Values are shown as mean plusmn SD for the six women lowastp lt 005 versus the placebo treatmentat the same time point (paired t-test) There was a significant interaction between beverage and time (p = 0009 in the morning p = 0024 inthe afternoon) by two-way repeated measures ANOVA

subjects were 365plusmn 038∘C (morning on day 1) 366 plusmn 049∘C(afternoon on day 1) 364 plusmn 042∘C (morning on day 2) and364∘C plusmn 049∘C (afternoon on day 2)

33 Effect of Ginger Beverage on Skin Surface TemperatureThe trial of eight subjects was performed in the morning andafternoon in a crossover manner to account for any effectsof circadian variation However as described in Section 32palm temperature data for only six subjects were statisticallyanalyzed

Changes in mean palm temperature after drinking thebeverage in the morning trial are shown in Figure 5(a) Palmtemperature increased immediately until 10min after intakein both groups (+32∘C after ginger and +29∘C after placeboversus 0min) However palm temperature continued toincrease until 20min (up to +34∘C versus 0min) after gingerintake while palm temperature decreased after 10min (to+24∘C versus 0min) after placebo treatment Palm temper-ature then decreased in both groups but remained higher inthe ginger group compared with the placebo group ANOVAshowed a significant interaction between beverage and time(p = 0009) Paired t-tests showed that palm temperatureswere significantly higher in the ginger treatment comparedwith the placebo treatment at 20 (p = 0026) 30 (p = 0025)and 40min (p = 0038) after intake

Changes in mean palm temperature after drinking thebeverage in the afternoon trial are shown in Figure 5(b)A sample thermogram for Subject 4 is shown in Figure 6Palm temperature increased immediately and continued toincrease for 10min in the ginger and placebo groups (+33∘Cafter ginger and +23∘C after placebo versus 0min) Howeverpalm temperature after ginger intake continued to increaseuntil 20min (up to +46∘C versus 0min) while palm tem-perature after placebo intake decreased after 10min (+23∘C

versus 0min) Palm temperature after ginger treatment wasthen maintained until 40min while that in the placebogroup decreased (+19∘C versus 0min) At 60min palmtemperature in the ginger group had decreased to +34∘Cversus 0min while that in the placebo group had decreasedto +13∘C Repeated measures two-way ANOVA showeda significant interaction between beverage and time (p =0024) Paired t-tests showed that palm temperatures weresignificantly higher in the ginger treatment compared withthe placebo treatment at 20 (p = 0012) 30 (p = 0017) and40min (p = 0045) after intake

Both treatments maintained a higher palm temperaturein the afternoon than in the morning In subjects whodrank the ginger beverage palm temperature after 10minremained the same after 60min Mansour et al [22] reportedthat oral intake of dried ginger powder dissolved in hotwater enhanced diet-induced thermogenesis and speculatedthat 6-shogaol was the active component Because the after-noon trial was performed after taking lunch the prolongedhyperthermic response may have been due to the additionalstimulatory effect of ginger on diet-induced thermogenesis

Palm temperature increased immediately after intake ofeither beverage presumably because of the direct warmingeffect of the intake of hot liquid (55∘C) However the gingerbeverage increased palm temperature more than the placebobeverage in the morning and afternoon trials Previoustrials showed that ginger dissolved in water [15 23ndash26]and capsules taken with water [12 13] also led to elevatedbody temperature This evidence suggests that ginger extracthas a hyperthermic response regardless of the beveragetemperature

34 Subjective Evaluation Subjective symptoms were as-sessed by questionnaires after the trials The answers are

6 Evidence-Based Complementary and Alternative Medicine

Ingestion of ginger beverage

Ingestion of placebo beverage

0 20 40 60

Time after ingestion (min)

Figure 6 Sample thermograms of body surface temperature changes following ingestion of ginger and placebo beverages A healthy womanwith cold sensitivity (Subject 4) drank a placebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverage in the afternoonHer body surface temperaturewas measured by thermography Her palm temperaturewas higher at 20 40 and 60min after consumption ofthe ginger beverage compared with the placebo beverage

Table 1 Summary of responses to a questionnaire on the hyperther-mic effects of a ginger extract-containingbeverage (free description)(n = 6)

Comment ResponsesWarming continued 5Warming in fingers and toes 5Warming from within the body 3Warming in throat and face 1Warming in hands and both legs 1Increased blood flow and pulsation in thefingertips 1

shown in Table 1 Five subjects experienced obvious andlasting hyperthermic responses in their peripheral extrem-ities after drinking the ginger beverage However somesubjects who drank the placebo beverage answered that thehyperthermic response did not last and the warm feelingdisappeared quickly and they did not feel any hyperther-mic effect or felt no improvement in cold sensation Onesubject noted improved blood flow to her fingertips afterconsuming the ginger beverage (Table 1) Iwami et al [27]reported that ginger intake increased energy expenditure andshowed a thermogenic effect However Fujisawa et al [15]reported that a lower dosage of ginger did not affect oxygen

consumption but expanded the width of peripheral bloodvessels and increased blood flow Fujisawa et al speculatedthat even low dosage of gingerols which does not affectenergy metabolism may have a hyperthermic effect onperipheral skin by increasing the blood circulation

35 Dosage of 6-Gingerol and 6-Shogaol (Gingerols) ContentsGingerols including 6-gingerol and 6-shogaol have beenreported to be the effective hyperthermic components ofginger [15 28] 6-Gingerol converts to 6-shogaol by elimi-nation of a hydroxyl group as a result of treatments suchas heating [29] and this reaction is reversible in aqueoussolutions [12 30 31] Therefore we measured the 6-gingeroland 6-shogaol contents of a beverage containing 0116 ofginger extract as gingerols The overall gingerol content was242 ppm including 200 ppm 6-gingerol and 042 ppm 6-shogaol In this study the gingerol intake was 677120583g perserving (280mL) for the ginger beverage No gingerols weredetected in the placebo beverage

We found that a low dosage (677120583gserving) of gin-gerols that were consumed in a beverage stimulated ahyperthermic effect at the skin surface of the extremitiesHigher doses of gingerols have previously been reportedto have hyperthermic effects including gingerols in water(26mgserving) [23] in water (621mgserving) and bread(532mgserving) [15] in capsules (476 mgserving) [14] and

Evidence-Based Complementary and Alternative Medicine 7

in ginger koji (malted rice) powder (540mgserving) [12]Natsuno and Hirayanagi [14] reported that ingestion of acapsule that contained 476mg gingerols per serving resultedin no significant increase in temperature on the thumb butsignificantly accelerated energy consumption We speculatethat ginger extract in a beverage may increase temperaturein the peripheral extremities at a lower dose than in breador a capsule because of the lack of interference from othercomponents such as proteins or capsule material

All of our subjects reported that the ginger extract-containing beverage was easy to drink In the above-mentioned previous studies the flavor of the ginger wasmasked bymixing it in bread [15] capsules [12ndash14] or tea [16]No previous taste trials have investigated the taste of gingersamples dissolved in water or hot water [15 22ndash26] Howeverthe beverage in this study was drinkable without a pungentflavor Commercially available ginger drinks such as gingerale contain low levels of gingerols (data not shown)

4 Conclusion

A palatable beverage containing ginger extract has a hyper-thermic effect on the peripheral extremities in women suffer-ing frommild cold sensitivity even at a low dose of gingerolsTherefore this beverage may help to improve cold sensitivityin people suffering from hie-sho

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

This work was financially supported by Nagaoka Co LtdKeiichiro Sugimoto Hiroaki Takeuchi and Kazuya Naka-gawa are employees of Nagaoka Co Ltd

Acknowledgments

We would like to express our gratitude to the subjectswho enrolled at IPSOS Nihon-Toukeichousa Co Ltd forparticipation in this study We thank Susan Furness PhDfrom Edanz Group (wwwedanzeditingcomac) for editing adraft of this manuscript

References

[1] H Monobe ldquoProposal of quantification of sensibility to coldbased on psychological procedurerdquo Japanese Journal of Physi-ological Anthropology vol 14 no 2 pp 43ndash50 2009

[2] K Terasawa ldquoOn the recognition and treatment of hie-sho (coldsensitivity) in traditional kampoh medicinerdquo ShoyakugakuZasshi vol 41 no 2 pp 85ndash96 1987

[3] N Ushiroyama ldquoChill sensation pathological findings and itstherapeutic approachrdquo Igaku no ayumi vol 215 no 11 pp 925ndash929 2005

[4] F Miura K Nakai and H Matsuo ldquoThe modulation of Hieshoand menstruation related symptoms by autonomic nerve activ-ity in Japanese young womenrdquo Departmental Bulletin PaperKobe University Graduate School of Health Sciences vol 28 pp1ndash8 2012

[5] MKMelby ldquoFactor analysis of climacteric symptoms in JapanrdquoMaturitas vol 52 no 3-4 pp 205ndash222 2005

[6] S Nakamura ldquoldquoSensitivity to coldrdquo a concept analysisrdquo Journalof Japan Academy of Nursing Science vol 30 no 1 pp 62ndash712010

[7] YOgata K Kaneko KGoto K Kono and S Yamamoto ldquoPhys-iological mechanism of HieshomdashEvaluation by cardiovascularand autonomic Dynamicsrdquo Japanese Journal of Nursing Art andScience vol 15 no 3 pp 227ndash234 2017

[8] M Saga and M Imai ldquoStudy of painful chills and associatedfactors in female university studentsrdquo Ishikawa Journal ofNursing vol 9 pp 91ndash99 2012

[9] MNakagawa Y Yamane andK Kabeyama ldquoSensitivity to coldandhealth status in elementarymiddle high school and collegestudentsrdquo Annual Reports of Human Health Sciences GraduateSchool of Medicine Kyoto University vol 9 pp 7ndash10 2014

[10] R B Semwal D K Semwal S Combrinck and A M ViljoenldquoGingerols and shogaols Important nutraceutical principlesfrom gingerrdquo Phytochemistry vol 117 Article ID 11221 pp 554ndash568 2015

[11] Y Iwasaki A Morita T Iwasawa et al ldquoA nonpungent com-ponent of steamed gingermdash[10]minusshogaolmdashincreases adrenalinesecretion via the activation of TRPV1rdquoNutritional Neurosciencevol 9 no 3-4 pp 169ndash178 2006

[12] Y KawabataM Kanaoka C Bogaki et al ldquoEffects of ginger kojiintake on skin surface temperature for young women sensitiveto cold temperaturesrdquo Journal of the Brewing Society of Japanvol 108 no 10 pp 778ndash786 2013

[13] N Nakamura and S Kondo ldquoImprovement effect of ldquoGingerExtract Powder Srdquo on a cold constitutionrdquo Japanese Pharmacol-ogy andTherapeutics vol 43 no 10 pp 1441ndash1450 2015

[14] T Natsuno and K Hirayanagi ldquoThe effect of ginger extractintake on energy consumption in youngwomenwith the feelingof chillinessrdquoThe Japanese Journal of Ergonomics vol 45 no 4pp 236ndash241 2009

[15] F Fujisawa T Nadamoto and T Fushiki ldquoEffect of intake ofginger on peripheral body temperaturerdquo Journal of Japan Societyof Nutrition and Food Sciences vol 58 no 1 pp 3ndash9 2005

[16] T Aoki and Y Kuroki ldquoEnergy expenditure after tea or gingerteardquo Bulletin of Gifu City Womenrsquos College vol 65 pp 43ndash452013

[17] K Nagashima T Yoda T Yagishita A Taniguchi T Hosonoand K Kanosue ldquoThermal regulation and comfort during amild-cold exposure in young Japanese women complaining ofunusual coldnessrdquo Journal of Applied Physiology vol 92 no 3pp 1029ndash1035 2002

[18] D A Balladin O Headley I Chang-Yen and D R McGawldquoHigh pressure liquid chromatographic analysis of the mainpungent principles of solar dried west Indian ginger (zingiberofficinale Roscoe)rdquo Journal of Renewable Energy vol 13 no 4pp 531ndash536 1998

[19] C Chen M Kuo and C Ho ldquoHigh performance liquid chro-matographic determination of pungent gingerol compounds ofginger (zingiber officinale roscoe)rdquo Journal of Food Science vol51 no 5 pp 1364-1365 1986

4 Evidence-Based Complementary and Alternative Medicine

A

33 m32 m

07 m

(a)

Before ingestion After ingestion

(b)

Figure 3 Conditions of the test room (a) Measurement site of the thermographic examination (b)

minus3 minus2 minus1 0 1 2 3

Overalljudgment

Smell

Pungency

Aftertaste

Drinkingease

Score

01160350817

A B B

A B B

A B B

(a)

01160350817

minus3 minus2 minus1 0 1 2 3 4

Sourness

Sweetness

Smell

Pungency

Aftertaste

Score

A A

A A

A A

B

B

B

(b)

Figure 4 Hedonic (a) and sensory (b) evaluation of ginger-containing beverages Each value is expressed in terms of hedonic sensation(a) and sensory evaluation (b) among three types of ginger-containing beverages (a) was a measure of the overall hedonic perception ofthe drinks containing ginger extract and (b) was a measure of the flavor characteristics of the drinks The contents of gingerols including6-gingerol and 6-shogaol were 0116 (◼) 035 (Q) and 0817 (998771) and they are shown as mean plusmn SD (n = 23) Test scales were classifiedas (a) minus3 = strongly dislike minus2 = dislike minus1 = slightly dislike 0 = neither like nor dislike 1 = somewhat like 2 = like and 3 = strongly like and(b) minus3 = extremely weak minus2 = weak minus1 = somewhat weak 0 = moderate 1 = somewhat strong 2 = strong and 3 = extremely strong Valueswith different letters indicate a significant difference at p lt 005 (Friedman test)

Evidence-Based Complementary and Alternative Medicine 5

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

GingerPlacebo

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowast

lowast

(a)

GingerPlacebo

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowastlowast

lowast

lowast

(b)

Figure 5 Effects of drinking ginger or placebo beverages on palm temperature in women Six healthy women with cold sensitivity drankplacebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverages in the morning (a) or afternoon (b) Palm temperaturewas determined by thermographic measurement Values are shown as mean plusmn SD for the six women lowastp lt 005 versus the placebo treatmentat the same time point (paired t-test) There was a significant interaction between beverage and time (p = 0009 in the morning p = 0024 inthe afternoon) by two-way repeated measures ANOVA

subjects were 365plusmn 038∘C (morning on day 1) 366 plusmn 049∘C(afternoon on day 1) 364 plusmn 042∘C (morning on day 2) and364∘C plusmn 049∘C (afternoon on day 2)

33 Effect of Ginger Beverage on Skin Surface TemperatureThe trial of eight subjects was performed in the morning andafternoon in a crossover manner to account for any effectsof circadian variation However as described in Section 32palm temperature data for only six subjects were statisticallyanalyzed

Changes in mean palm temperature after drinking thebeverage in the morning trial are shown in Figure 5(a) Palmtemperature increased immediately until 10min after intakein both groups (+32∘C after ginger and +29∘C after placeboversus 0min) However palm temperature continued toincrease until 20min (up to +34∘C versus 0min) after gingerintake while palm temperature decreased after 10min (to+24∘C versus 0min) after placebo treatment Palm temper-ature then decreased in both groups but remained higher inthe ginger group compared with the placebo group ANOVAshowed a significant interaction between beverage and time(p = 0009) Paired t-tests showed that palm temperatureswere significantly higher in the ginger treatment comparedwith the placebo treatment at 20 (p = 0026) 30 (p = 0025)and 40min (p = 0038) after intake

Changes in mean palm temperature after drinking thebeverage in the afternoon trial are shown in Figure 5(b)A sample thermogram for Subject 4 is shown in Figure 6Palm temperature increased immediately and continued toincrease for 10min in the ginger and placebo groups (+33∘Cafter ginger and +23∘C after placebo versus 0min) Howeverpalm temperature after ginger intake continued to increaseuntil 20min (up to +46∘C versus 0min) while palm tem-perature after placebo intake decreased after 10min (+23∘C

versus 0min) Palm temperature after ginger treatment wasthen maintained until 40min while that in the placebogroup decreased (+19∘C versus 0min) At 60min palmtemperature in the ginger group had decreased to +34∘Cversus 0min while that in the placebo group had decreasedto +13∘C Repeated measures two-way ANOVA showeda significant interaction between beverage and time (p =0024) Paired t-tests showed that palm temperatures weresignificantly higher in the ginger treatment compared withthe placebo treatment at 20 (p = 0012) 30 (p = 0017) and40min (p = 0045) after intake

Both treatments maintained a higher palm temperaturein the afternoon than in the morning In subjects whodrank the ginger beverage palm temperature after 10minremained the same after 60min Mansour et al [22] reportedthat oral intake of dried ginger powder dissolved in hotwater enhanced diet-induced thermogenesis and speculatedthat 6-shogaol was the active component Because the after-noon trial was performed after taking lunch the prolongedhyperthermic response may have been due to the additionalstimulatory effect of ginger on diet-induced thermogenesis

Palm temperature increased immediately after intake ofeither beverage presumably because of the direct warmingeffect of the intake of hot liquid (55∘C) However the gingerbeverage increased palm temperature more than the placebobeverage in the morning and afternoon trials Previoustrials showed that ginger dissolved in water [15 23ndash26]and capsules taken with water [12 13] also led to elevatedbody temperature This evidence suggests that ginger extracthas a hyperthermic response regardless of the beveragetemperature

34 Subjective Evaluation Subjective symptoms were as-sessed by questionnaires after the trials The answers are

6 Evidence-Based Complementary and Alternative Medicine

Ingestion of ginger beverage

Ingestion of placebo beverage

0 20 40 60

Time after ingestion (min)

Figure 6 Sample thermograms of body surface temperature changes following ingestion of ginger and placebo beverages A healthy womanwith cold sensitivity (Subject 4) drank a placebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverage in the afternoonHer body surface temperaturewas measured by thermography Her palm temperaturewas higher at 20 40 and 60min after consumption ofthe ginger beverage compared with the placebo beverage

Table 1 Summary of responses to a questionnaire on the hyperther-mic effects of a ginger extract-containingbeverage (free description)(n = 6)

Comment ResponsesWarming continued 5Warming in fingers and toes 5Warming from within the body 3Warming in throat and face 1Warming in hands and both legs 1Increased blood flow and pulsation in thefingertips 1

shown in Table 1 Five subjects experienced obvious andlasting hyperthermic responses in their peripheral extrem-ities after drinking the ginger beverage However somesubjects who drank the placebo beverage answered that thehyperthermic response did not last and the warm feelingdisappeared quickly and they did not feel any hyperther-mic effect or felt no improvement in cold sensation Onesubject noted improved blood flow to her fingertips afterconsuming the ginger beverage (Table 1) Iwami et al [27]reported that ginger intake increased energy expenditure andshowed a thermogenic effect However Fujisawa et al [15]reported that a lower dosage of ginger did not affect oxygen

consumption but expanded the width of peripheral bloodvessels and increased blood flow Fujisawa et al speculatedthat even low dosage of gingerols which does not affectenergy metabolism may have a hyperthermic effect onperipheral skin by increasing the blood circulation

35 Dosage of 6-Gingerol and 6-Shogaol (Gingerols) ContentsGingerols including 6-gingerol and 6-shogaol have beenreported to be the effective hyperthermic components ofginger [15 28] 6-Gingerol converts to 6-shogaol by elimi-nation of a hydroxyl group as a result of treatments suchas heating [29] and this reaction is reversible in aqueoussolutions [12 30 31] Therefore we measured the 6-gingeroland 6-shogaol contents of a beverage containing 0116 ofginger extract as gingerols The overall gingerol content was242 ppm including 200 ppm 6-gingerol and 042 ppm 6-shogaol In this study the gingerol intake was 677120583g perserving (280mL) for the ginger beverage No gingerols weredetected in the placebo beverage

We found that a low dosage (677120583gserving) of gin-gerols that were consumed in a beverage stimulated ahyperthermic effect at the skin surface of the extremitiesHigher doses of gingerols have previously been reportedto have hyperthermic effects including gingerols in water(26mgserving) [23] in water (621mgserving) and bread(532mgserving) [15] in capsules (476 mgserving) [14] and

Evidence-Based Complementary and Alternative Medicine 7

in ginger koji (malted rice) powder (540mgserving) [12]Natsuno and Hirayanagi [14] reported that ingestion of acapsule that contained 476mg gingerols per serving resultedin no significant increase in temperature on the thumb butsignificantly accelerated energy consumption We speculatethat ginger extract in a beverage may increase temperaturein the peripheral extremities at a lower dose than in breador a capsule because of the lack of interference from othercomponents such as proteins or capsule material

All of our subjects reported that the ginger extract-containing beverage was easy to drink In the above-mentioned previous studies the flavor of the ginger wasmasked bymixing it in bread [15] capsules [12ndash14] or tea [16]No previous taste trials have investigated the taste of gingersamples dissolved in water or hot water [15 22ndash26] Howeverthe beverage in this study was drinkable without a pungentflavor Commercially available ginger drinks such as gingerale contain low levels of gingerols (data not shown)

4 Conclusion

A palatable beverage containing ginger extract has a hyper-thermic effect on the peripheral extremities in women suffer-ing frommild cold sensitivity even at a low dose of gingerolsTherefore this beverage may help to improve cold sensitivityin people suffering from hie-sho

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

This work was financially supported by Nagaoka Co LtdKeiichiro Sugimoto Hiroaki Takeuchi and Kazuya Naka-gawa are employees of Nagaoka Co Ltd

Acknowledgments

We would like to express our gratitude to the subjectswho enrolled at IPSOS Nihon-Toukeichousa Co Ltd forparticipation in this study We thank Susan Furness PhDfrom Edanz Group (wwwedanzeditingcomac) for editing adraft of this manuscript

References

[1] H Monobe ldquoProposal of quantification of sensibility to coldbased on psychological procedurerdquo Japanese Journal of Physi-ological Anthropology vol 14 no 2 pp 43ndash50 2009

[2] K Terasawa ldquoOn the recognition and treatment of hie-sho (coldsensitivity) in traditional kampoh medicinerdquo ShoyakugakuZasshi vol 41 no 2 pp 85ndash96 1987

[3] N Ushiroyama ldquoChill sensation pathological findings and itstherapeutic approachrdquo Igaku no ayumi vol 215 no 11 pp 925ndash929 2005

[4] F Miura K Nakai and H Matsuo ldquoThe modulation of Hieshoand menstruation related symptoms by autonomic nerve activ-ity in Japanese young womenrdquo Departmental Bulletin PaperKobe University Graduate School of Health Sciences vol 28 pp1ndash8 2012

[5] MKMelby ldquoFactor analysis of climacteric symptoms in JapanrdquoMaturitas vol 52 no 3-4 pp 205ndash222 2005

[6] S Nakamura ldquoldquoSensitivity to coldrdquo a concept analysisrdquo Journalof Japan Academy of Nursing Science vol 30 no 1 pp 62ndash712010

[7] YOgata K Kaneko KGoto K Kono and S Yamamoto ldquoPhys-iological mechanism of HieshomdashEvaluation by cardiovascularand autonomic Dynamicsrdquo Japanese Journal of Nursing Art andScience vol 15 no 3 pp 227ndash234 2017

[8] M Saga and M Imai ldquoStudy of painful chills and associatedfactors in female university studentsrdquo Ishikawa Journal ofNursing vol 9 pp 91ndash99 2012

[9] MNakagawa Y Yamane andK Kabeyama ldquoSensitivity to coldandhealth status in elementarymiddle high school and collegestudentsrdquo Annual Reports of Human Health Sciences GraduateSchool of Medicine Kyoto University vol 9 pp 7ndash10 2014

[10] R B Semwal D K Semwal S Combrinck and A M ViljoenldquoGingerols and shogaols Important nutraceutical principlesfrom gingerrdquo Phytochemistry vol 117 Article ID 11221 pp 554ndash568 2015

[11] Y Iwasaki A Morita T Iwasawa et al ldquoA nonpungent com-ponent of steamed gingermdash[10]minusshogaolmdashincreases adrenalinesecretion via the activation of TRPV1rdquoNutritional Neurosciencevol 9 no 3-4 pp 169ndash178 2006

[12] Y KawabataM Kanaoka C Bogaki et al ldquoEffects of ginger kojiintake on skin surface temperature for young women sensitiveto cold temperaturesrdquo Journal of the Brewing Society of Japanvol 108 no 10 pp 778ndash786 2013

[13] N Nakamura and S Kondo ldquoImprovement effect of ldquoGingerExtract Powder Srdquo on a cold constitutionrdquo Japanese Pharmacol-ogy andTherapeutics vol 43 no 10 pp 1441ndash1450 2015

[14] T Natsuno and K Hirayanagi ldquoThe effect of ginger extractintake on energy consumption in youngwomenwith the feelingof chillinessrdquoThe Japanese Journal of Ergonomics vol 45 no 4pp 236ndash241 2009

[15] F Fujisawa T Nadamoto and T Fushiki ldquoEffect of intake ofginger on peripheral body temperaturerdquo Journal of Japan Societyof Nutrition and Food Sciences vol 58 no 1 pp 3ndash9 2005

[16] T Aoki and Y Kuroki ldquoEnergy expenditure after tea or gingerteardquo Bulletin of Gifu City Womenrsquos College vol 65 pp 43ndash452013

[17] K Nagashima T Yoda T Yagishita A Taniguchi T Hosonoand K Kanosue ldquoThermal regulation and comfort during amild-cold exposure in young Japanese women complaining ofunusual coldnessrdquo Journal of Applied Physiology vol 92 no 3pp 1029ndash1035 2002

[18] D A Balladin O Headley I Chang-Yen and D R McGawldquoHigh pressure liquid chromatographic analysis of the mainpungent principles of solar dried west Indian ginger (zingiberofficinale Roscoe)rdquo Journal of Renewable Energy vol 13 no 4pp 531ndash536 1998

[19] C Chen M Kuo and C Ho ldquoHigh performance liquid chro-matographic determination of pungent gingerol compounds ofginger (zingiber officinale roscoe)rdquo Journal of Food Science vol51 no 5 pp 1364-1365 1986

Evidence-Based Complementary and Alternative Medicine 5

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

GingerPlacebo

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowast

lowast

(a)

GingerPlacebo

25

26

27

28

29

30

31

0 10 20 30 40 50 60Time after ingestion (min)

Chan

ges i

n pa

lm te

mpe

ratu

re (∘

C)

lowast

lowastlowast

lowast

lowast

(b)

Figure 5 Effects of drinking ginger or placebo beverages on palm temperature in women Six healthy women with cold sensitivity drankplacebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverages in the morning (a) or afternoon (b) Palm temperaturewas determined by thermographic measurement Values are shown as mean plusmn SD for the six women lowastp lt 005 versus the placebo treatmentat the same time point (paired t-test) There was a significant interaction between beverage and time (p = 0009 in the morning p = 0024 inthe afternoon) by two-way repeated measures ANOVA

subjects were 365plusmn 038∘C (morning on day 1) 366 plusmn 049∘C(afternoon on day 1) 364 plusmn 042∘C (morning on day 2) and364∘C plusmn 049∘C (afternoon on day 2)

33 Effect of Ginger Beverage on Skin Surface TemperatureThe trial of eight subjects was performed in the morning andafternoon in a crossover manner to account for any effectsof circadian variation However as described in Section 32palm temperature data for only six subjects were statisticallyanalyzed

Changes in mean palm temperature after drinking thebeverage in the morning trial are shown in Figure 5(a) Palmtemperature increased immediately until 10min after intakein both groups (+32∘C after ginger and +29∘C after placeboversus 0min) However palm temperature continued toincrease until 20min (up to +34∘C versus 0min) after gingerintake while palm temperature decreased after 10min (to+24∘C versus 0min) after placebo treatment Palm temper-ature then decreased in both groups but remained higher inthe ginger group compared with the placebo group ANOVAshowed a significant interaction between beverage and time(p = 0009) Paired t-tests showed that palm temperatureswere significantly higher in the ginger treatment comparedwith the placebo treatment at 20 (p = 0026) 30 (p = 0025)and 40min (p = 0038) after intake

Changes in mean palm temperature after drinking thebeverage in the afternoon trial are shown in Figure 5(b)A sample thermogram for Subject 4 is shown in Figure 6Palm temperature increased immediately and continued toincrease for 10min in the ginger and placebo groups (+33∘Cafter ginger and +23∘C after placebo versus 0min) Howeverpalm temperature after ginger intake continued to increaseuntil 20min (up to +46∘C versus 0min) while palm tem-perature after placebo intake decreased after 10min (+23∘C

versus 0min) Palm temperature after ginger treatment wasthen maintained until 40min while that in the placebogroup decreased (+19∘C versus 0min) At 60min palmtemperature in the ginger group had decreased to +34∘Cversus 0min while that in the placebo group had decreasedto +13∘C Repeated measures two-way ANOVA showeda significant interaction between beverage and time (p =0024) Paired t-tests showed that palm temperatures weresignificantly higher in the ginger treatment compared withthe placebo treatment at 20 (p = 0012) 30 (p = 0017) and40min (p = 0045) after intake

Both treatments maintained a higher palm temperaturein the afternoon than in the morning In subjects whodrank the ginger beverage palm temperature after 10minremained the same after 60min Mansour et al [22] reportedthat oral intake of dried ginger powder dissolved in hotwater enhanced diet-induced thermogenesis and speculatedthat 6-shogaol was the active component Because the after-noon trial was performed after taking lunch the prolongedhyperthermic response may have been due to the additionalstimulatory effect of ginger on diet-induced thermogenesis

Palm temperature increased immediately after intake ofeither beverage presumably because of the direct warmingeffect of the intake of hot liquid (55∘C) However the gingerbeverage increased palm temperature more than the placebobeverage in the morning and afternoon trials Previoustrials showed that ginger dissolved in water [15 23ndash26]and capsules taken with water [12 13] also led to elevatedbody temperature This evidence suggests that ginger extracthas a hyperthermic response regardless of the beveragetemperature

34 Subjective Evaluation Subjective symptoms were as-sessed by questionnaires after the trials The answers are

6 Evidence-Based Complementary and Alternative Medicine

Ingestion of ginger beverage

Ingestion of placebo beverage

0 20 40 60

Time after ingestion (min)

Figure 6 Sample thermograms of body surface temperature changes following ingestion of ginger and placebo beverages A healthy womanwith cold sensitivity (Subject 4) drank a placebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverage in the afternoonHer body surface temperaturewas measured by thermography Her palm temperaturewas higher at 20 40 and 60min after consumption ofthe ginger beverage compared with the placebo beverage

Table 1 Summary of responses to a questionnaire on the hyperther-mic effects of a ginger extract-containingbeverage (free description)(n = 6)

Comment ResponsesWarming continued 5Warming in fingers and toes 5Warming from within the body 3Warming in throat and face 1Warming in hands and both legs 1Increased blood flow and pulsation in thefingertips 1

shown in Table 1 Five subjects experienced obvious andlasting hyperthermic responses in their peripheral extrem-ities after drinking the ginger beverage However somesubjects who drank the placebo beverage answered that thehyperthermic response did not last and the warm feelingdisappeared quickly and they did not feel any hyperther-mic effect or felt no improvement in cold sensation Onesubject noted improved blood flow to her fingertips afterconsuming the ginger beverage (Table 1) Iwami et al [27]reported that ginger intake increased energy expenditure andshowed a thermogenic effect However Fujisawa et al [15]reported that a lower dosage of ginger did not affect oxygen

consumption but expanded the width of peripheral bloodvessels and increased blood flow Fujisawa et al speculatedthat even low dosage of gingerols which does not affectenergy metabolism may have a hyperthermic effect onperipheral skin by increasing the blood circulation

35 Dosage of 6-Gingerol and 6-Shogaol (Gingerols) ContentsGingerols including 6-gingerol and 6-shogaol have beenreported to be the effective hyperthermic components ofginger [15 28] 6-Gingerol converts to 6-shogaol by elimi-nation of a hydroxyl group as a result of treatments suchas heating [29] and this reaction is reversible in aqueoussolutions [12 30 31] Therefore we measured the 6-gingeroland 6-shogaol contents of a beverage containing 0116 ofginger extract as gingerols The overall gingerol content was242 ppm including 200 ppm 6-gingerol and 042 ppm 6-shogaol In this study the gingerol intake was 677120583g perserving (280mL) for the ginger beverage No gingerols weredetected in the placebo beverage

We found that a low dosage (677120583gserving) of gin-gerols that were consumed in a beverage stimulated ahyperthermic effect at the skin surface of the extremitiesHigher doses of gingerols have previously been reportedto have hyperthermic effects including gingerols in water(26mgserving) [23] in water (621mgserving) and bread(532mgserving) [15] in capsules (476 mgserving) [14] and

Evidence-Based Complementary and Alternative Medicine 7

in ginger koji (malted rice) powder (540mgserving) [12]Natsuno and Hirayanagi [14] reported that ingestion of acapsule that contained 476mg gingerols per serving resultedin no significant increase in temperature on the thumb butsignificantly accelerated energy consumption We speculatethat ginger extract in a beverage may increase temperaturein the peripheral extremities at a lower dose than in breador a capsule because of the lack of interference from othercomponents such as proteins or capsule material

All of our subjects reported that the ginger extract-containing beverage was easy to drink In the above-mentioned previous studies the flavor of the ginger wasmasked bymixing it in bread [15] capsules [12ndash14] or tea [16]No previous taste trials have investigated the taste of gingersamples dissolved in water or hot water [15 22ndash26] Howeverthe beverage in this study was drinkable without a pungentflavor Commercially available ginger drinks such as gingerale contain low levels of gingerols (data not shown)

4 Conclusion

A palatable beverage containing ginger extract has a hyper-thermic effect on the peripheral extremities in women suffer-ing frommild cold sensitivity even at a low dose of gingerolsTherefore this beverage may help to improve cold sensitivityin people suffering from hie-sho

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

This work was financially supported by Nagaoka Co LtdKeiichiro Sugimoto Hiroaki Takeuchi and Kazuya Naka-gawa are employees of Nagaoka Co Ltd

Acknowledgments

We would like to express our gratitude to the subjectswho enrolled at IPSOS Nihon-Toukeichousa Co Ltd forparticipation in this study We thank Susan Furness PhDfrom Edanz Group (wwwedanzeditingcomac) for editing adraft of this manuscript

References

[1] H Monobe ldquoProposal of quantification of sensibility to coldbased on psychological procedurerdquo Japanese Journal of Physi-ological Anthropology vol 14 no 2 pp 43ndash50 2009

[2] K Terasawa ldquoOn the recognition and treatment of hie-sho (coldsensitivity) in traditional kampoh medicinerdquo ShoyakugakuZasshi vol 41 no 2 pp 85ndash96 1987

[3] N Ushiroyama ldquoChill sensation pathological findings and itstherapeutic approachrdquo Igaku no ayumi vol 215 no 11 pp 925ndash929 2005

[4] F Miura K Nakai and H Matsuo ldquoThe modulation of Hieshoand menstruation related symptoms by autonomic nerve activ-ity in Japanese young womenrdquo Departmental Bulletin PaperKobe University Graduate School of Health Sciences vol 28 pp1ndash8 2012

[5] MKMelby ldquoFactor analysis of climacteric symptoms in JapanrdquoMaturitas vol 52 no 3-4 pp 205ndash222 2005

[6] S Nakamura ldquoldquoSensitivity to coldrdquo a concept analysisrdquo Journalof Japan Academy of Nursing Science vol 30 no 1 pp 62ndash712010

[7] YOgata K Kaneko KGoto K Kono and S Yamamoto ldquoPhys-iological mechanism of HieshomdashEvaluation by cardiovascularand autonomic Dynamicsrdquo Japanese Journal of Nursing Art andScience vol 15 no 3 pp 227ndash234 2017

[8] M Saga and M Imai ldquoStudy of painful chills and associatedfactors in female university studentsrdquo Ishikawa Journal ofNursing vol 9 pp 91ndash99 2012

[9] MNakagawa Y Yamane andK Kabeyama ldquoSensitivity to coldandhealth status in elementarymiddle high school and collegestudentsrdquo Annual Reports of Human Health Sciences GraduateSchool of Medicine Kyoto University vol 9 pp 7ndash10 2014

[10] R B Semwal D K Semwal S Combrinck and A M ViljoenldquoGingerols and shogaols Important nutraceutical principlesfrom gingerrdquo Phytochemistry vol 117 Article ID 11221 pp 554ndash568 2015

[11] Y Iwasaki A Morita T Iwasawa et al ldquoA nonpungent com-ponent of steamed gingermdash[10]minusshogaolmdashincreases adrenalinesecretion via the activation of TRPV1rdquoNutritional Neurosciencevol 9 no 3-4 pp 169ndash178 2006

[12] Y KawabataM Kanaoka C Bogaki et al ldquoEffects of ginger kojiintake on skin surface temperature for young women sensitiveto cold temperaturesrdquo Journal of the Brewing Society of Japanvol 108 no 10 pp 778ndash786 2013

[13] N Nakamura and S Kondo ldquoImprovement effect of ldquoGingerExtract Powder Srdquo on a cold constitutionrdquo Japanese Pharmacol-ogy andTherapeutics vol 43 no 10 pp 1441ndash1450 2015

[14] T Natsuno and K Hirayanagi ldquoThe effect of ginger extractintake on energy consumption in youngwomenwith the feelingof chillinessrdquoThe Japanese Journal of Ergonomics vol 45 no 4pp 236ndash241 2009

[15] F Fujisawa T Nadamoto and T Fushiki ldquoEffect of intake ofginger on peripheral body temperaturerdquo Journal of Japan Societyof Nutrition and Food Sciences vol 58 no 1 pp 3ndash9 2005

[16] T Aoki and Y Kuroki ldquoEnergy expenditure after tea or gingerteardquo Bulletin of Gifu City Womenrsquos College vol 65 pp 43ndash452013

[17] K Nagashima T Yoda T Yagishita A Taniguchi T Hosonoand K Kanosue ldquoThermal regulation and comfort during amild-cold exposure in young Japanese women complaining ofunusual coldnessrdquo Journal of Applied Physiology vol 92 no 3pp 1029ndash1035 2002

[18] D A Balladin O Headley I Chang-Yen and D R McGawldquoHigh pressure liquid chromatographic analysis of the mainpungent principles of solar dried west Indian ginger (zingiberofficinale Roscoe)rdquo Journal of Renewable Energy vol 13 no 4pp 531ndash536 1998

[19] C Chen M Kuo and C Ho ldquoHigh performance liquid chro-matographic determination of pungent gingerol compounds ofginger (zingiber officinale roscoe)rdquo Journal of Food Science vol51 no 5 pp 1364-1365 1986

6 Evidence-Based Complementary and Alternative Medicine

Ingestion of ginger beverage

Ingestion of placebo beverage

0 20 40 60

Time after ingestion (min)

Figure 6 Sample thermograms of body surface temperature changes following ingestion of ginger and placebo beverages A healthy womanwith cold sensitivity (Subject 4) drank a placebo or ginger (677120583g of gingerols including 6-gingerol and 6-shogaol) beverage in the afternoonHer body surface temperaturewas measured by thermography Her palm temperaturewas higher at 20 40 and 60min after consumption ofthe ginger beverage compared with the placebo beverage

Table 1 Summary of responses to a questionnaire on the hyperther-mic effects of a ginger extract-containingbeverage (free description)(n = 6)

Comment ResponsesWarming continued 5Warming in fingers and toes 5Warming from within the body 3Warming in throat and face 1Warming in hands and both legs 1Increased blood flow and pulsation in thefingertips 1

shown in Table 1 Five subjects experienced obvious andlasting hyperthermic responses in their peripheral extrem-ities after drinking the ginger beverage However somesubjects who drank the placebo beverage answered that thehyperthermic response did not last and the warm feelingdisappeared quickly and they did not feel any hyperther-mic effect or felt no improvement in cold sensation Onesubject noted improved blood flow to her fingertips afterconsuming the ginger beverage (Table 1) Iwami et al [27]reported that ginger intake increased energy expenditure andshowed a thermogenic effect However Fujisawa et al [15]reported that a lower dosage of ginger did not affect oxygen

consumption but expanded the width of peripheral bloodvessels and increased blood flow Fujisawa et al speculatedthat even low dosage of gingerols which does not affectenergy metabolism may have a hyperthermic effect onperipheral skin by increasing the blood circulation

35 Dosage of 6-Gingerol and 6-Shogaol (Gingerols) ContentsGingerols including 6-gingerol and 6-shogaol have beenreported to be the effective hyperthermic components ofginger [15 28] 6-Gingerol converts to 6-shogaol by elimi-nation of a hydroxyl group as a result of treatments suchas heating [29] and this reaction is reversible in aqueoussolutions [12 30 31] Therefore we measured the 6-gingeroland 6-shogaol contents of a beverage containing 0116 ofginger extract as gingerols The overall gingerol content was242 ppm including 200 ppm 6-gingerol and 042 ppm 6-shogaol In this study the gingerol intake was 677120583g perserving (280mL) for the ginger beverage No gingerols weredetected in the placebo beverage

We found that a low dosage (677120583gserving) of gin-gerols that were consumed in a beverage stimulated ahyperthermic effect at the skin surface of the extremitiesHigher doses of gingerols have previously been reportedto have hyperthermic effects including gingerols in water(26mgserving) [23] in water (621mgserving) and bread(532mgserving) [15] in capsules (476 mgserving) [14] and

Evidence-Based Complementary and Alternative Medicine 7

in ginger koji (malted rice) powder (540mgserving) [12]Natsuno and Hirayanagi [14] reported that ingestion of acapsule that contained 476mg gingerols per serving resultedin no significant increase in temperature on the thumb butsignificantly accelerated energy consumption We speculatethat ginger extract in a beverage may increase temperaturein the peripheral extremities at a lower dose than in breador a capsule because of the lack of interference from othercomponents such as proteins or capsule material

All of our subjects reported that the ginger extract-containing beverage was easy to drink In the above-mentioned previous studies the flavor of the ginger wasmasked bymixing it in bread [15] capsules [12ndash14] or tea [16]No previous taste trials have investigated the taste of gingersamples dissolved in water or hot water [15 22ndash26] Howeverthe beverage in this study was drinkable without a pungentflavor Commercially available ginger drinks such as gingerale contain low levels of gingerols (data not shown)

4 Conclusion

A palatable beverage containing ginger extract has a hyper-thermic effect on the peripheral extremities in women suffer-ing frommild cold sensitivity even at a low dose of gingerolsTherefore this beverage may help to improve cold sensitivityin people suffering from hie-sho

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

This work was financially supported by Nagaoka Co LtdKeiichiro Sugimoto Hiroaki Takeuchi and Kazuya Naka-gawa are employees of Nagaoka Co Ltd

Acknowledgments

We would like to express our gratitude to the subjectswho enrolled at IPSOS Nihon-Toukeichousa Co Ltd forparticipation in this study We thank Susan Furness PhDfrom Edanz Group (wwwedanzeditingcomac) for editing adraft of this manuscript

References

[1] H Monobe ldquoProposal of quantification of sensibility to coldbased on psychological procedurerdquo Japanese Journal of Physi-ological Anthropology vol 14 no 2 pp 43ndash50 2009

[2] K Terasawa ldquoOn the recognition and treatment of hie-sho (coldsensitivity) in traditional kampoh medicinerdquo ShoyakugakuZasshi vol 41 no 2 pp 85ndash96 1987

[3] N Ushiroyama ldquoChill sensation pathological findings and itstherapeutic approachrdquo Igaku no ayumi vol 215 no 11 pp 925ndash929 2005

[4] F Miura K Nakai and H Matsuo ldquoThe modulation of Hieshoand menstruation related symptoms by autonomic nerve activ-ity in Japanese young womenrdquo Departmental Bulletin PaperKobe University Graduate School of Health Sciences vol 28 pp1ndash8 2012

[5] MKMelby ldquoFactor analysis of climacteric symptoms in JapanrdquoMaturitas vol 52 no 3-4 pp 205ndash222 2005

[6] S Nakamura ldquoldquoSensitivity to coldrdquo a concept analysisrdquo Journalof Japan Academy of Nursing Science vol 30 no 1 pp 62ndash712010

[7] YOgata K Kaneko KGoto K Kono and S Yamamoto ldquoPhys-iological mechanism of HieshomdashEvaluation by cardiovascularand autonomic Dynamicsrdquo Japanese Journal of Nursing Art andScience vol 15 no 3 pp 227ndash234 2017

[8] M Saga and M Imai ldquoStudy of painful chills and associatedfactors in female university studentsrdquo Ishikawa Journal ofNursing vol 9 pp 91ndash99 2012

[9] MNakagawa Y Yamane andK Kabeyama ldquoSensitivity to coldandhealth status in elementarymiddle high school and collegestudentsrdquo Annual Reports of Human Health Sciences GraduateSchool of Medicine Kyoto University vol 9 pp 7ndash10 2014

[10] R B Semwal D K Semwal S Combrinck and A M ViljoenldquoGingerols and shogaols Important nutraceutical principlesfrom gingerrdquo Phytochemistry vol 117 Article ID 11221 pp 554ndash568 2015

[11] Y Iwasaki A Morita T Iwasawa et al ldquoA nonpungent com-ponent of steamed gingermdash[10]minusshogaolmdashincreases adrenalinesecretion via the activation of TRPV1rdquoNutritional Neurosciencevol 9 no 3-4 pp 169ndash178 2006

[12] Y KawabataM Kanaoka C Bogaki et al ldquoEffects of ginger kojiintake on skin surface temperature for young women sensitiveto cold temperaturesrdquo Journal of the Brewing Society of Japanvol 108 no 10 pp 778ndash786 2013

[13] N Nakamura and S Kondo ldquoImprovement effect of ldquoGingerExtract Powder Srdquo on a cold constitutionrdquo Japanese Pharmacol-ogy andTherapeutics vol 43 no 10 pp 1441ndash1450 2015

[14] T Natsuno and K Hirayanagi ldquoThe effect of ginger extractintake on energy consumption in youngwomenwith the feelingof chillinessrdquoThe Japanese Journal of Ergonomics vol 45 no 4pp 236ndash241 2009

[15] F Fujisawa T Nadamoto and T Fushiki ldquoEffect of intake ofginger on peripheral body temperaturerdquo Journal of Japan Societyof Nutrition and Food Sciences vol 58 no 1 pp 3ndash9 2005

[16] T Aoki and Y Kuroki ldquoEnergy expenditure after tea or gingerteardquo Bulletin of Gifu City Womenrsquos College vol 65 pp 43ndash452013

[17] K Nagashima T Yoda T Yagishita A Taniguchi T Hosonoand K Kanosue ldquoThermal regulation and comfort during amild-cold exposure in young Japanese women complaining ofunusual coldnessrdquo Journal of Applied Physiology vol 92 no 3pp 1029ndash1035 2002

[18] D A Balladin O Headley I Chang-Yen and D R McGawldquoHigh pressure liquid chromatographic analysis of the mainpungent principles of solar dried west Indian ginger (zingiberofficinale Roscoe)rdquo Journal of Renewable Energy vol 13 no 4pp 531ndash536 1998

[19] C Chen M Kuo and C Ho ldquoHigh performance liquid chro-matographic determination of pungent gingerol compounds ofginger (zingiber officinale roscoe)rdquo Journal of Food Science vol51 no 5 pp 1364-1365 1986

Evidence-Based Complementary and Alternative Medicine 7

in ginger koji (malted rice) powder (540mgserving) [12]Natsuno and Hirayanagi [14] reported that ingestion of acapsule that contained 476mg gingerols per serving resultedin no significant increase in temperature on the thumb butsignificantly accelerated energy consumption We speculatethat ginger extract in a beverage may increase temperaturein the peripheral extremities at a lower dose than in breador a capsule because of the lack of interference from othercomponents such as proteins or capsule material

All of our subjects reported that the ginger extract-containing beverage was easy to drink In the above-mentioned previous studies the flavor of the ginger wasmasked bymixing it in bread [15] capsules [12ndash14] or tea [16]No previous taste trials have investigated the taste of gingersamples dissolved in water or hot water [15 22ndash26] Howeverthe beverage in this study was drinkable without a pungentflavor Commercially available ginger drinks such as gingerale contain low levels of gingerols (data not shown)

4 Conclusion

A palatable beverage containing ginger extract has a hyper-thermic effect on the peripheral extremities in women suffer-ing frommild cold sensitivity even at a low dose of gingerolsTherefore this beverage may help to improve cold sensitivityin people suffering from hie-sho

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

This work was financially supported by Nagaoka Co LtdKeiichiro Sugimoto Hiroaki Takeuchi and Kazuya Naka-gawa are employees of Nagaoka Co Ltd

Acknowledgments

We would like to express our gratitude to the subjectswho enrolled at IPSOS Nihon-Toukeichousa Co Ltd forparticipation in this study We thank Susan Furness PhDfrom Edanz Group (wwwedanzeditingcomac) for editing adraft of this manuscript

References

[1] H Monobe ldquoProposal of quantification of sensibility to coldbased on psychological procedurerdquo Japanese Journal of Physi-ological Anthropology vol 14 no 2 pp 43ndash50 2009

[2] K Terasawa ldquoOn the recognition and treatment of hie-sho (coldsensitivity) in traditional kampoh medicinerdquo ShoyakugakuZasshi vol 41 no 2 pp 85ndash96 1987

[3] N Ushiroyama ldquoChill sensation pathological findings and itstherapeutic approachrdquo Igaku no ayumi vol 215 no 11 pp 925ndash929 2005

[4] F Miura K Nakai and H Matsuo ldquoThe modulation of Hieshoand menstruation related symptoms by autonomic nerve activ-ity in Japanese young womenrdquo Departmental Bulletin PaperKobe University Graduate School of Health Sciences vol 28 pp1ndash8 2012

[5] MKMelby ldquoFactor analysis of climacteric symptoms in JapanrdquoMaturitas vol 52 no 3-4 pp 205ndash222 2005

[6] S Nakamura ldquoldquoSensitivity to coldrdquo a concept analysisrdquo Journalof Japan Academy of Nursing Science vol 30 no 1 pp 62ndash712010

[7] YOgata K Kaneko KGoto K Kono and S Yamamoto ldquoPhys-iological mechanism of HieshomdashEvaluation by cardiovascularand autonomic Dynamicsrdquo Japanese Journal of Nursing Art andScience vol 15 no 3 pp 227ndash234 2017

[8] M Saga and M Imai ldquoStudy of painful chills and associatedfactors in female university studentsrdquo Ishikawa Journal ofNursing vol 9 pp 91ndash99 2012

[9] MNakagawa Y Yamane andK Kabeyama ldquoSensitivity to coldandhealth status in elementarymiddle high school and collegestudentsrdquo Annual Reports of Human Health Sciences GraduateSchool of Medicine Kyoto University vol 9 pp 7ndash10 2014

[10] R B Semwal D K Semwal S Combrinck and A M ViljoenldquoGingerols and shogaols Important nutraceutical principlesfrom gingerrdquo Phytochemistry vol 117 Article ID 11221 pp 554ndash568 2015

[11] Y Iwasaki A Morita T Iwasawa et al ldquoA nonpungent com-ponent of steamed gingermdash[10]minusshogaolmdashincreases adrenalinesecretion via the activation of TRPV1rdquoNutritional Neurosciencevol 9 no 3-4 pp 169ndash178 2006

[12] Y KawabataM Kanaoka C Bogaki et al ldquoEffects of ginger kojiintake on skin surface temperature for young women sensitiveto cold temperaturesrdquo Journal of the Brewing Society of Japanvol 108 no 10 pp 778ndash786 2013

[13] N Nakamura and S Kondo ldquoImprovement effect of ldquoGingerExtract Powder Srdquo on a cold constitutionrdquo Japanese Pharmacol-ogy andTherapeutics vol 43 no 10 pp 1441ndash1450 2015

[14] T Natsuno and K Hirayanagi ldquoThe effect of ginger extractintake on energy consumption in youngwomenwith the feelingof chillinessrdquoThe Japanese Journal of Ergonomics vol 45 no 4pp 236ndash241 2009

[15] F Fujisawa T Nadamoto and T Fushiki ldquoEffect of intake ofginger on peripheral body temperaturerdquo Journal of Japan Societyof Nutrition and Food Sciences vol 58 no 1 pp 3ndash9 2005

[16] T Aoki and Y Kuroki ldquoEnergy expenditure after tea or gingerteardquo Bulletin of Gifu City Womenrsquos College vol 65 pp 43ndash452013

[17] K Nagashima T Yoda T Yagishita A Taniguchi T Hosonoand K Kanosue ldquoThermal regulation and comfort during amild-cold exposure in young Japanese women complaining ofunusual coldnessrdquo Journal of Applied Physiology vol 92 no 3pp 1029ndash1035 2002

[18] D A Balladin O Headley I Chang-Yen and D R McGawldquoHigh pressure liquid chromatographic analysis of the mainpungent principles of solar dried west Indian ginger (zingiberofficinale Roscoe)rdquo Journal of Renewable Energy vol 13 no 4pp 531ndash536 1998

[19] C Chen M Kuo and C Ho ldquoHigh performance liquid chro-matographic determination of pungent gingerol compounds ofginger (zingiber officinale roscoe)rdquo Journal of Food Science vol51 no 5 pp 1364-1365 1986

8 Evidence-Based Complementary and Alternative Medicine

[20] T H Benzinger ldquoOn physical heat regulation and the sense oftemperature in manrdquo Proceedings of the National Acadamy ofSciences of the United States of America vol 45 no 4 pp 645ndash659 1959

[21] A Takagi M Yamaguchi S Wakisaka N Sakane T Moritaniand N Nagai ldquoResting energy expenditure and changes inbody temperaure and thermal sensation under thermoneutralenvironment in young women with or without consistentlyunusual coldnessrdquo Journal of Japanese Society of PsychosomaticObstetrics and Gynecology vol 17 no 2 pp 193ndash205 2012

[22] M S Mansour Y-M Ni A L Roberts M Kelleman A Roy-choudhury andM-P St-Onge ldquoGinger consumption enhancesthe thermic effect of food and promotes feelings of satiety with-out affectingmetabolic andhormonal parameters in overweightmenA pilot studyrdquoMetabolism -Clinical and Experimental vol61 no 10 pp 1347ndash1352 2012

[23] K Kimura and M Abe ldquoEffect of consuming ginger powdercontaining high levels of 6-shogaol and 6-gingerol on femaleskin temperaturerdquoThe Economic Review of Japan University ofEconomics vol 43 no 2 pp 425ndash432 2014

[24] K Kimura andM Abe ldquoEffects of consuming of 05 g of gingerpowder containing high levels of 6-shogaol and 6-gingerol onskin temperaturerdquo Hoken No Kagaku vol 56 no 10 pp 707ndash710 2014

[25] K Kimura G Hagiwara and M Abe ldquoEffects of consumingginger powder containing high levels of 6-gingerol and 6-shogaol on skin temperaturerdquo The Journal of Japan MibyouSystem Association vol 22 no 2 pp 1ndash6 2016

[26] K Kimura G Hagiwara and M Abe ldquoEffects of consuming of30 g of ginger powder containing high levels of 6-gingerol and6-shogaol on skin temperaturerdquo The journal of education andhealth science vol 62 no 2 pp 346ndash350 2016

[27] M Iwami S Terada M Sunahara R Shimooka and TShimazu ldquoEffects of ginger and its effective components onenergy expenditure in ratsrdquo Journal of Japan Society of Nutritionand Food Sciences vol 56 no 3 pp 159ndash165 2003

[28] T PD Eldershaw EQ Colquhoun KADora Z-C Peng andM G Clark ldquoPungent principles of ginger (Zingiber officinale)are thermogenic in the perfused rat hindlimbrdquo InternationalJournal of Obesity vol 16 no 10 pp 755ndash763 1992

[29] M S Baliga R Haniadka M M Pereira et al ldquoUpdate onthe chemopreventive effects of ginger and its phytochemicalsrdquoCritical Reviews in Food Science and Nutrition vol 51 no 6 pp499ndash523 2011

[30] S Bhattarai H van Tran and C C Duke ldquoThe stability ofgingerol and shogaol in aqueous solutionsrdquo Journal of Pharma-ceutical Sciences vol 90 no 10 pp 1658ndash1664 2001

[31] Y Masada T Inoue K Hashimoto M Fujioka and K ShirakildquoStudies on the pungent principles of ginger (Zingiber officinaleRoscoe) by GC MS (Japanese)rdquo Yakugaku Zasshi vol 93 no 3pp 318ndash321 1973

Stem Cells International

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Disease Markers

Hindawiwwwhindawicom Volume 2018

BioMed Research International

OncologyJournal of

Hindawiwwwhindawicom Volume 2013

Hindawiwwwhindawicom Volume 2018

Oxidative Medicine and Cellular Longevity

Hindawiwwwhindawicom Volume 2018

PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

Journal of

ObesityJournal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Computational and Mathematical Methods in Medicine

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OphthalmologyJournal of

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Research and TreatmentAIDS

Hindawiwwwhindawicom Volume 2018

Gastroenterology Research and Practice

Hindawiwwwhindawicom Volume 2018

Parkinsonrsquos Disease

Evidence-Based Complementary andAlternative Medicine

Volume 2018Hindawiwwwhindawicom

Submit your manuscripts atwwwhindawicom

Stem Cells International

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Disease Markers

Hindawiwwwhindawicom Volume 2018

BioMed Research International

OncologyJournal of

Hindawiwwwhindawicom Volume 2013

Hindawiwwwhindawicom Volume 2018

Oxidative Medicine and Cellular Longevity

Hindawiwwwhindawicom Volume 2018

PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

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Volume 2018Hindawiwwwhindawicom

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