Ginseng has been used in traditional medicine for thousands of years, particularly in China and Korea. The root does look oddly human-shaped, which probably contributed to its mystique. Today you’ll find it in everything from teas to capsules to energy drinks.

But what does the research actually say? I’ve gone through the clinical evidence to separate genuine effects from marketing hype.

What is ginseng?

Ginseng is a perennial plant in the Araliaceae family. When people say “ginseng” without qualification, they usually mean Asian ginseng (Panax ginseng), also called Korean ginseng. This is different from American ginseng (Panax quinquefolium) and Siberian ginseng (which isn’t actually ginseng at all, but a related plant called Eleutherococcus senticosus).

The active compounds in ginseng are called ginsenosides, along with polysaccharides, peptides, and various fatty acids. These are thought to be responsible for whatever effects ginseng may have.

Ginseng gets classified in several ways:

By origin: Changbai ginseng (Chinese), Korean ginseng

By cultivation: Wild ginseng (increasingly rare and expensive) or garden ginseng (commercially grown)

By processing: Fresh ginseng, white ginseng (peeled and dried), red ginseng (steamed and dried), or raw ginseng

Red ginseng undergoes a steaming process that changes the chemical composition and is often considered more potent in traditional medicine.

What does the research show?

Here’s the honest truth about ginseng research: it’s messy. Different studies use different types of ginseng, different preparations, different doses, and different durations. Many trials are small and poorly controlled. So take everything below with appropriate scepticism.

1. Erectile dysfunction

Erectile dysfunction affects roughly one in five men, and it gets more common with age. The underlying cause is usually vascular, since erections depend on proper blood flow and nitric oxide signalling.

A 2021 Cochrane review looked at nine randomised controlled trials involving 587 men with mild to moderate erectile dysfunction [1]. The studies mostly used Korean red ginseng. Compared to placebo, ginseng showed a slight positive effect on erectile function scores using standard assessment tools (IIEF-5 or IIEF-15). Men also reported improved ability to have intercourse.

The catch? The evidence quality was low. The improvements were statistically significant but modest. Still, for a supplement, “modest but real” isn’t bad.

2. Liver function

A 2020 meta-analysis of 14 randomised controlled trials (992 participants) found that ginseng didn’t significantly affect liver enzymes like ALT, AST, GGT, ALP, or albumin levels [2].

One concerning finding: when unhealthy individuals took more than 3 grams of ginseng daily, bilirubin levels actually increased. So higher doses aren’t necessarily better, and may cause problems for people with existing liver conditions.

I wouldn’t use ginseng hoping it’ll improve liver function. The evidence simply isn’t there.

3. Male fertility

Sperm quality has been declining globally over recent decades. This may be due to environmental factors, diet, sedentary lifestyles, or a combination.

A 2020 systematic review looked at five studies on ginseng and semen quality [3]. One randomised controlled trial found Korean red ginseng improved sperm parameters in infertile men. The other studies found nothing, whether in healthy men or those with fertility problems.

One positive trial out of five isn’t compelling. The sample sizes were small, and there’s potential for publication bias. I’d wait for better evidence before recommending ginseng for fertility.

4. Mild cognitive impairment

Mild cognitive impairment sits between normal ageing and dementia. Some people with MCI remain stable or even improve, but others progress to Alzheimer’s disease.

A 2020 randomised, double-blind, placebo-controlled trial gave 90 volunteers with MCI either ginseng powder (3 grams daily) or placebo for six months [4]. Those taking ginseng showed improved scores on immediate recall and 20-minute delayed recall tests.

This is genuinely interesting, though one trial with 90 participants isn’t enough to draw firm conclusions. The mechanism might involve ginsenosides’ effects on acetylcholine, the neurotransmitter that’s depleted in Alzheimer’s disease.

5. C-reactive protein (inflammation marker)

C-reactive protein is produced by the liver in response to inflammation. Elevated CRP is associated with cardiovascular disease, infections, and autoimmune conditions.

A 2019 meta-analysis of seven randomised placebo-controlled trials (420 participants) found ginseng didn’t reduce CRP overall [5]. However, in subgroup analysis, ginseng did lower CRP when baseline levels were above 3 mg/dL.

So ginseng probably won’t do much if your inflammation markers are normal. But if they’re already elevated, there might be a modest effect. Not exactly a ringing endorsement.

6. Blood lipids

A 2019 meta-analysis looked specifically at people with metabolic syndrome and found ginseng reduced total cholesterol and LDL cholesterol compared to placebo [6]. It didn’t affect HDL cholesterol or triglycerides.

For context, metabolic syndrome involves a cluster of risk factors including high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol. If you have metabolic syndrome, ginseng might provide a small additional benefit alongside proper medical treatment and lifestyle changes.

7. Blood sugar control in diabetes

Type 2 diabetes has increased dramatically over the past few decades, largely due to obesity and sedentary lifestyles. Managing blood sugar is the central challenge.

A meta-analysis of eight studies found ginseng improved fasting blood glucose, post-meal insulin, and insulin resistance in people with type 2 diabetes or glucose intolerance [7]. The effect was most pronounced in people not already taking diabetes medications or insulin.

The mechanism may involve how ginsenosides affect insulin secretion and glucose metabolism. According to the NHS, people with diabetes should discuss any supplements with their healthcare provider, as they may interact with medications [8].

If you’re managing diabetes through diet and lifestyle alone, ginseng might provide modest additional benefit. If you’re on medication, be cautious about potential interactions and hypoglycaemia risk.

8. Angina (chest pain from heart disease)

Angina occurs when the heart muscle doesn’t get enough oxygen-rich blood, usually due to narrowed coronary arteries. It typically causes chest pressure or discomfort during physical activity or stress.

A meta-analysis of 18 randomised controlled trials involving 1,549 angina patients found ginseng-based prescriptions produced better symptom improvement and ECG changes than nitrates [9].

I should note these were traditional Chinese medicine formulations containing ginseng alongside other herbs, not pure ginseng. So we can’t isolate ginseng’s specific contribution. Still, the results are intriguing enough to warrant further study.

9. Acute respiratory infections

A 2012 randomised, double-blind trial gave 100 healthy adults either Korean red ginseng extract or placebo for 12 weeks during cold and flu season [10].

Those taking ginseng had fewer respiratory infections. Duration and severity of symptoms were also lower, though these differences didn’t reach statistical significance.

One trial isn’t definitive, but the results suggest ginseng might help prevent colds and flu. This aligns with research suggesting ginseng has immune-modulating properties.

10. Cancer risk

A meta-analysis of nine studies involving 334,544 participants and 7,436 cancer cases found ginseng intake was associated with a 16% reduction in overall cancer risk compared to non-users [11].

For specific cancers, the risk reductions were: colorectal cancer 23%, lung cancer 19%, stomach cancer 17%, and liver cancer 23%.

These are observational studies, not randomised trials. People who take ginseng may differ from non-users in many ways, diet, health consciousness, socioeconomic status, that could affect cancer risk. The association is interesting but doesn’t prove causation.

11. Fatigue and physical performance

Fatigue has many causes: insufficient sleep, stress, medical conditions, or simply working too hard. Ginseng has long been promoted as an energy booster.

A 2016 meta-analysis of 12 randomised controlled trials (630 participants) found ginseng supplements reduced fatigue scores compared to placebo [12]. However, there was no improvement in physical performance measures.

So ginseng might help you feel less tired, but it won’t make you run faster or lift more weight. The fatigue reduction could be real, or it could be a placebo effect from taking something you believe will help.

12. Menopausal symptoms

Menopause typically occurs between ages 45 and 55. The hormonal changes cause hot flashes, mood swings, sleep problems, and other symptoms that can significantly affect quality of life.

A systematic review of 10 randomised controlled trials found ginseng improved sexual function, arousal, and hot flash severity in menopausal women [13]. However, it didn’t reduce hot flash frequency, affect hormone levels, or change endometrial thickness.

The Mayo Clinic notes that while some women report benefit from ginseng for menopausal symptoms, the evidence remains mixed [14].

13. Alzheimer’s disease

Alzheimer’s disease accounts for about 75% of dementia cases. It’s progressive and currently incurable, though medications can slow symptom progression.

A meta-analysis of four randomised controlled trials (259 participants) found inconsistent results for ginseng in Alzheimer’s patients [15]. The studies were small, methodologically weak, and some lacked proper placebo controls.

I can’t recommend ginseng for Alzheimer’s based on current evidence. The trials were simply too flawed to draw conclusions.

Side effects

Ginseng is generally well tolerated when used short-term at standard doses. According to the NHS, side effects can include [8]:

Insomnia
Headaches
Digestive upset, including diarrhoea
Changes in blood pressure (increases or decreases)
Rapid heartbeat
Breast pain
Mood changes
Allergic reactions (rash, itching)

These side effects become more likely at higher doses or with prolonged use. Some traditional practitioners recommend cycling ginseng, taking it for several weeks, then taking a break.

Who should avoid ginseng

1. Pregnant or breastfeeding women. Safety hasn’t been established.

2. Infants and young children. No safety data exists for this population.

3. People with liver or kidney disease. Ginseng is metabolised by these organs, and impaired function could lead to accumulation.

4. Those with autoimmune conditions. Ginseng may stimulate the immune system, potentially worsening conditions like multiple sclerosis, lupus, or rheumatoid arthritis.

5. People with bleeding disorders or taking anticoagulants. Ginseng may have blood-thinning properties and could increase bleeding risk. This includes those taking warfarin, aspirin, or other anticoagulants.

6. Women with hormone-sensitive conditions. Ginseng may have weak oestrogenic effects. Those with breast cancer, ovarian cancer, endometriosis, or uterine fibroids should avoid it.

7. People with diabetes on medication. Ginseng may lower blood sugar, potentially causing hypoglycaemia when combined with diabetes drugs.

8. Organ transplant recipients. Ginseng might interfere with immunosuppressant medications.

9. Those with unstable blood pressure or heart conditions. Don’t use if you have uncontrolled hypertension (systolic above 140 mmHg), are in the acute phase of stroke, or have unstable coronary artery disease.

10. People taking MAOIs or with bipolar disorder. Ginseng may trigger manic episodes or interact with monoamine oxidase inhibitors.

11. Coffee drinkers in excess. The combination may worsen side effects like palpitations, sweating, or nervousness.

References

Borrelli F, et al. Ginseng for erectile dysfunction. Cochrane Database Syst Rev. 2021;4(4):CD012654. https://pubmed.ncbi.nlm.nih.gov/33871063/
Lim DW, et al. Effects of ginseng on liver function: A systematic review and meta-analysis. J Ethnopharmacol. 2020;259:112872. https://pubmed.ncbi.nlm.nih.gov/32379697/
Leisegang K, et al. A Systematic Review of Herbal Medicine in the Clinical Treatment of Benign Prostatic Hyperplasia. Phytomedicine. 2020;32:100032. https://www.ncbi.nlm.nih.gov/pubmed/32009310
Kim HJ, et al. Effects of Korean Red Ginseng on Cognitive Function in Patients with Mild Cognitive Impairment: A Randomized, Double-blind, Placebo-controlled Study. J Ginseng Res. 2020;44(1):113-121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989239/
Mohammadi H, et al. Effects of ginseng on C-reactive protein level: A systematic review and meta-analysis of clinical trials. Complement Ther Med. 2019;45:98-103. https://www.ncbi.nlm.nih.gov/pubmed/31331589
Naseri K, et al. Effect of ginseng on lipid profile in patients with metabolic syndrome: a systematic review and meta-analysis. Phytother Res. 2019;33(9):2250-2260. https://www.ncbi.nlm.nih.gov/pubmed/31315027
Shishtar E, et al. The effect of ginseng (the genus Panax) on glycemic control: a systematic review and meta-analysis of randomized controlled clinical trials. PLoS One. 2014;9(9):e107391. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753873/
NHS. Herbal medicines. https://www.nhs.uk/conditions/herbal-medicines/
Wang G, et al. Ginseng-containing traditional Chinese medicine for angina pectoris: A systematic review and meta-analysis. Medicine (Baltimore). 2012;91(5):e1-e18. https://www.ncbi.nlm.nih.gov/pubmed/22500665
Lee CS, et al. Korean red ginseng for preventing acute respiratory illness: A randomized, placebo-controlled, clinical trial. J Ginseng Res. 2012;36(4):354-358. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524425/
Jin X, et al. Ginseng consumption and risk of cancer: A meta-analysis. J Ginseng Res. 2016;40(3):269-277. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005362/
Bach HV, et al. Efficacy of Ginseng Supplements on Fatigue and Physical Performance: a Meta-analysis. J Korean Med Sci. 2016;31(12):1879-1886. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102849/
Lee HW, et al. Ginseng for the treatment of menopausal symptoms: a systematic review of randomized controlled trials. Menopause. 2013;20(5):598-607. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659624/
Mayo Clinic. Panax ginseng. https://www.mayoclinic.org/drugs-supplements-panax-ginseng/art-20362572
Lee MS, et al. Panax ginseng for cognitive performance in Alzheimer disease: A systematic review. J Alzheimers Dis. 2015;48(2):387-394. https://www.ncbi.nlm.nih.gov/pubmed/26268331