Nausea, Leaky-Gut & GI Disturbances - Ginger Ameliorates All | May Be the Perfect Addition to Your Workout Nutrition

You will find dozens of ginger + lemon water recipes on the internet - all of them can pimp your peri-workout drinks and make your tummies "exercise proof".
As a regular here at the SuppVersity you know about the beneficial health effects of ginger. It has potent anti-oxidant and anti-inflammatory effects without the usual side-effects of COX-inhibitors (Mashhadi. 2013), has been shown to have anti-cancer effect on it's own (Kim. 2005), as well as to be a perfect adjunct for conventional cancer therapy (Sontakke. 2003).

Ginger has also been shown to exert cardioprotective effects (Ghayur. 2005; Singletary. 2010), strengthens the immune system (Butt. 2011) and significant beneficial effects on the health of the digestive system - including the make-up of your microbiome (Sutherland. 2009).
One thing that should be in your peri-workout (best post-workout) regimen is creatine 

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Now, it is out of question almost all of these effects would be beneficial to athletes, too. The one I want to focus on, today, though, is directly related to the last-mentioned effect: the beneficial effect on the gut. It is well-known that athletes, in general, and endurance athletes, in particular, are having a hard time keeping their tummy from "leaking" (learn more about the link between exercise and leaky gut). With ginger - that's at least what a recent study from the School of Life Sciences at the Heriot-Watt University in Edinburgh suggests. The scientists went from the observations that
  1. the frequency of upper and lower gastrointestinal disturbance as a function of exercise is reported to be between 30 and 70%
  2. the severity of symptoms ranging from mild stomach discomfort to severe diarrhoea and 
  3. the consumption of beverages either before or during exercise may increase the incidence rate by over 25%
to the hypothesis that spiking said beverages with an agent that has previously been shown to reduce the symptoms of nausea and vomiting could be of great benefit for athletes.
Addendum: Are there pesticides in ginger? Oliver Klettner wants to know if there's a risk that you're intoxicating yourself with ginger. Unfortunately, the data on this subject is scarce. According to an older study in the Journal of Agricultural and Food Chemistry, ginger is yet one of the imported spices that contain relatively little DDT, PCB, Dieldrin, Endrin and BHC residues. The ginger from Nigeria in particular has almost no DDT and BHC, while the products from India contained measurable, but probably uncritical amounts (Sullivan. 1980). Similar and even lower levels were detected more recently by Srivastava et al. (2001) in important ginger powder from India. Data on Chinese ginger, which is what Oliver asked about, in particular, is not available in the literature. What is available, though, is data on commercial ginger powders sold in Germany in the late 1970s. The products of undisclosed origin Boppel (1979) tested contained both lead and cadmium, albeit in low doses (1.9 parts per million and 0.35 ppm). Also, in view of the epidemiological evidence in favor of the health benefits of ginger, it appears rather unlikely that (probably existing) pesticide and heavy-metal residues are a general problem. The average ginger consumer is after all ingesting it with a certain amount of these compounds. If that was a sign. health problem, the health benefits should not exist.
In the present study, this agent was ginger that was added to an isotonic beverage 40 recreational athletes (23 male, 17 female) who had volunteered to participate in the study consumed on one out of three test drinks containing 450 ml of either water or beverage A or beverage B in two 225ml servings before and after their workout:
  • Study Underlines Real World Benefits of 2g/day of Ginger for Type II Diabetics - Effects Almost on Par W/ Metformin | more
    Beverage A contained 7·5% glucose, 10 mM NaCl, citric acid, K sorbate and 62·5 ml of ginger root extract per 1 L.
  • Beverage B was identical to beverage A but the ginger was replaced with 62·5 ml of carrot extract. 
  • The control drink contained nothing but plain water.
During each of the three sessions the volunteers completed a 5 km run around the same course. To minimize unwanted interferences due to the test-drinks or fatigue, the sessions were spaced at least 7 days apart (and the subjects were asked not to change training or lifestyle during the study period).
What's the mechanism behind the exercise induced gastrointestinal disturbances? With exercise it's the reduction in gastrointestinal integrity that's driving the increase in gastrointestinal symptoms. Studies show, the harder you exercise, the more the gut integrity suffers and the more susceptible you become to intestinal disturbances. It's not clear how exactly ginger protects your gut from becoming leaky, but it would appear to be most likely that it's a result of its potent anti-inflammatory effects.
The same 5 item questionnaire that has been successfully used Pfeiffer et al. to probe the effects on nutritional intake on gastrointestinal problems during competitive endurance events in 2012 was used to assess the upper and lower gastrointestinal (GI) symptoms before and after exercise. In said test, the subjects hat to place a mark a 10 cm line to rate the severity / occurrence of symptoms anywhere between 0 (low / never) and 10 (high  / always). 
"Section 1 addressed upper abdominal problems (reflux / heartburn, belching, bloating, stomach cramps/pain, nausea, vomiting); section 2 addressed lower abdominal problems (intestinal/lower abdominal cramps, flatulence, urge to defecate, side ache/stitch, loose stool, diarrhea, intestinal bleeding); and section 3 addressed systemic problems (dizziness, headache, muscle cramp, urge to urinate)" (Pfeiffer. 2012). 
The evaluation of the showed a significnat increase in the incidence of upper GI disturbance (P < 0·05) in response to exercise; stomach problems increased from pre-exercise 1.7 (0.1–6.3) to 2.0 (0.1–8.4) during exercise and nausea increased from pre-exercise 1.1 (0.1–4.5) to 2.0 (01–7.6) during exercise. 
Figure 1: The addition of the ginger root extrac lead to a sign. amelioration of the almost 200% increase of the incidence of gastrointestinal symptoms in the 40 recreational athletes who participated in the study (Ball. 2015).
All other measures of GI disturbance were similar between pre-during and post-exercise and the general consumption of beverages did not exacerbate the GI symptoms during exercise. 

What the ginger containing beverage did, however, was that it reduced the prevalence of stomach problems (4.6 (0.3–6.6)) and nausea (4.5 (0.3–9) decreased significantly (P < 0.05) - an effect that was not observed with either beverage B or water, which were without noticeable effects on stomach problems (5 (0.2–8.2)) and nausea (5 (0.2–7)).  
Bottom line: Overall, the data from the study at hand is the first piece to a puzzle of evidence that could eventually prove the usefulness of ginger as a functional ingredient in pre- and post-workout beverages for endurance athletes - even if it does only ameliorate, not block the dramatic (>100%) increase in gastrointestinal problems.

Ginger is also on the list of supps in this SV Classic: "Supplements to Improve & Restore Insulin Sensitivity - Installment #4" | more
What is still missing, though, are (a) long(er) term studies in larger study populations, (b) evidence that the benefits occur in (1) higher-intensity exercise / longer duration exercise (I am thinking along the lines of Ironman training) and (2) anaerobic exercises like resistance training or sprinting which are similar prone to inducing (temporal) gastrointestinal problems and last but not least (c) insights into the mechanism(s) behind the beneficial effect of ginger - effects of which Ball et al. (2015) speculate that they may be, linked to the antagonist effects on serontonergic 5HT receptors, as they have been suggested by Sontakke et al. in a chemotherapy study (2003) | Comment on Facebook!
  • Ball, D., G. Ashley, and H. Stradling. "Exercise-induced gastrointestinal disturbances: potential amelioration with a ginger containing beverage." Proceedings of the Nutrition Society 74.OCE3 (2015): E186.
  • Boppel, B. "[Lead-and cadmium-content of foodstuffs 1. Lead-and Cadmium-content of spices and table salt (author's transl)]." Zeitschrift Fur Lebensmittel-Untersuchung Und-Forschung 160.3 (1975): 299-302.
  • Butt, Masood Sadiq, and M. Tauseef Sultan. "Ginger and its health claims: molecular aspects." Critical reviews in food science and nutrition 51.5 (2011): 383-393.
  • Ghayur, Muhammad Nabeel, and Anwarul Hassan Gilani. "Ginger lowers blood pressure through blockade of voltage-dependent calcium channels." Journal of cardiovascular pharmacology 45.1 (2005): 74-80.
  • Kim, Eok-Cheon, et al. "[6]-Gingerol, a pungent ingredient of ginger, inhibits angiogenesis in vitro and in vivo." Biochemical and biophysical research communications 335.2 (2005): 300-308.
  • Mashhadi, Nafiseh Shokri, et al. "Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: review of current evidence." International journal of preventive medicine 4.Suppl 1 (2013): S36.
  • Singletary, Keith. "Ginger: An Overview of health benefits." Nutrition Today 45.4 (2010): 171-183.
  • Sontakke, S., V. Thawani, and M. S. Naik. "Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: a randomized, cross-over, double blind study." Indian journal of pharmacology 35.1 (2003): 32-36.
  • Srivastava, L. P., Roli Budhwar, and R. B. Raizada. "Organochlorine pesticide residues in Indian spices." Bulletin of environmental contamination and toxicology 67.6 (2001): 856-862.
  • Sullivan, James H. "Pesticide residues in imported spices. A survey for chlorinated hydrocarbons." Journal of agricultural and food chemistry 28.5 (1980): 1031-1034.
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