Discussion
dysphagia, bloating, flatulence, diarrhea, abdominal pain, heartburn, dyspepsia, anorexia, constipation, nausea and constipation, nausea,, RRMS, Constipation
DYSPHAGIA, ANOREXIA
The findings of this study indicated that 1500 mg/d ginger supplementation for 12 weeks statistically significantly reduced the frequency and severity of nausea and constipation as well as the severity of bloating. In addition, supplementation with ginger caused statistically near-significant reductions in the frequency of bloating and the severity of abdominal pain in patients with RRMS. Nevertheless, ginger consumption showed no significant impact on the frequency and severity of dysphagia, diarrhea, belching, flatulence, heartburn, and anorexia and the frequency of abdominal pain. It is noteworthy that the side effects of ginger in this study were rare and mild, representing a very good safety profile.Interestingly, the highest reduction in GI symptoms after ginger supplementation belonged to constipation in this trial. Constipation is the most common GI problem in RRMS patients and is caused by prolonged colonic transit time and altered colonic compliance and basal tone [Consistent with our findings, previous studies have reported that ginger supplementation can improve constipation without causing diarrhea [The results of previous studies are controversial regarding the effect of supplementation with ginger on dyspepsia symptoms. Consistent with our findings, several trials reported positive effects of ginger on at least one dyspepsia symptom, such as nausea, bloating, and abdominal pain [In line with our results, a systematic review of 109 clinical trials has indicated that ginger has a very good safety profile [In the authors’ opinion, the management of prevalent GI problems such as constipation and dyspepsia in MS patients can improve their quality of life, well-being, daily functioning, and work ability. The prokinetic effects of ginger can alleviate constipation, and the stimulatory effects of ginger on digestive enzymes can relieve dyspepsia in long-term use [Finally, this trial has some strengths and limitations that should be acknowledged. The first strength is the novelty of the work. To the best of our knowledge, this study is the first one that investigated the effect of ginger supplementation on GI symptoms in patients with MS. The second strength is the assessment of key potential confounders including dietary intake and physical activity during the intervention. On the other hand, the first limitation is that this trial was conducted on RRMS patients; therefore, its findings may not be generalizable to other types of MS. The second limitation is that the frequency and severity of GI symptoms were mild to moderate in this study; therefore, it is unclear whether our results are applicable to more severe cases. These limitations need to be considered in the design of future clinical trials.