The effects of ginger supplementation on common gastrointestinal symptoms in patients with relapsing-remitting multiple sclerosis: a double-blind randomized placebo-controlled trial

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Salivary concentrations of substance P and swallowing function scores improve after ginger supplementation.

“In addition, salivary concentrations of substance P and swallowing function scores have improved after ginger supplementation [17].”

• cites [17] Hirata A, Funato H, Nakai M, Iizuka M, Abe N, Yagi Y, et al. Ginger orally disintegrating tablets to improve swallowing in older people. Biol Pharm Bull. 2016;39(7):1107–11. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Gastrointestinal symptoms affect more than 80% of individuals with relapsing-remitting multiple sclerosis.

“Gastrointestinal (GI) symptoms affect more than 80% of individuals with relapsing-remitting multiple sclerosis (RRMS).”

• Also stated in: § Background · hedged

  “It seems that GI symptoms affect more than 80% of MS patients and are caused by disease complications, oral disease-modifying therapies, or both [4, 5].”

• cites [4] Khanna L, Zeydan B, Kantarci OH, Camilleri M. Gastrointestinal motility disorders in patients with multiple sclerosis: a single-center study. Neurogastroenterology & Motility. 2022;34(8):e14326. sourcePartly supported

  The Results (Demographics and Clinical Characteristics; GI Symptoms and Relationship to Gastrointestinal Transit Results) report constipation in 86 of 111 patients in the relapsing-remitting phase and fecal incontinence without constipation in another five—91 of 111, or about 82%. However, this was a selected group undergoing gastrointestinal evaluation, and the 111 included 11 patients with isolated syndromes rather than confirmed RRMS. The paper does not establish a prevalence above 80% among individuals with RRMS generally. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [5] Jivraj F, Kang S, Reedie S, Kapadia S, Strzok S, Elliott E, et al. The patient and clinician assessment of gastrointestinal (GI) related adverse events associated with oral disease-modifying therapies in multiple sclerosis: a qualitative study. Adv Therapy. 2022;39(11):5072–86. sourcePartly supported

  The Results (HCP and Patient Perspectives on Oral DMT Treatment for RRMS; page unavailable) describe GI symptoms reported by 12 interviewed patients taking oral disease-modifying therapies. The paper does not establish that GI symptoms affect more than 80% of people with RRMS; its selected qualitative sample cannot support that population-wide prevalence claim. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The visual analogue scale assessment tool has previously been applied and validated by Preziosi et al. to evaluate gastrointestinal symptoms in patients with multiple sclerosis.

“This assessment tool has previously been applied and validated by Preziosi et al. to evaluate GI symptoms in patients with MS [23].”

• cites [23] Preziosi G, Raptis DA, Raeburn A, Thiruppathy K, Panicker J, Emmanuel A. Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the Disease. Eur J Gastroenterol Hepatol. 2013;25(9):1044–50. sourcePartly supported

  In Symptoms assessments (page unavailable), Preziosi et al. used a 0–100 visual analogue scale to assess bowel-symptom severity in patients with MS. Results reports that patient-reported severity correlated with NBD scores, and Discussion says simple questioning was as accurate as a validated questionnaire. The paper does not say that the visual analogue scale itself was validated in patients with MS. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

During the trial, two patients in the control group and one patient in the intervention group dropped out due to COVID-19 infection.

“During the trial, two patients in the control group and one patient in the intervention group dropped out due to COVID-19 infection, a systemic disease with GI symptoms [27].”

• cites [27] Foshati S, Mirjalili F, Rezazadegan M, Fakoorziba F, Amani R. Antioxidants and clinical outcomes of patients with coronavirus Disease 2019: a systematic review of observational and interventional studies. Food Sci Nutr. 2022;10(12):4112–25. sourceCould not verify

  The Methods (Research question) and Results (Study characteristics and quality) describe studies of patients with COVID-19, but do not report the claimed trial dropouts. Searches for the two-control, one-intervention dropout count and withdrawals due to COVID-19 found no matching passage in our copy. In the citing sentence, [27] also appears immediately after the separate description of COVID-19, rather than directly after the dropout count. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Ginger consumption can relieve most symptoms of functional dyspepsia such as early satiety, fullness, belching, nausea, epigastric pain, and heartburn.

“For instance, ginger consumption can relieve most symptoms of functional dyspepsia such as early satiety, fullness, belching, nausea, epigastric pain, and heartburn [14].”

• cites [14] Ebrahimzadeh Attari V, Somi MH, Jafarabadi MA, Ostadrahimi A, Moaddab S-Y, Lotfi N. The gastro-protective effect of ginger (Zingiber officinale Roscoe) in Helicobacter pylori positive functional dyspepsia. Adv Pharm Bull. 2019;9(2):321–4. sourcePartly supported

  The Results report significant changes after ginger consumption in all six listed symptoms. However, the study involved only 15 patients with H. pylori-positive functional dyspepsia; the claim does not retain that population restriction. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Ginger consumption accelerates gastrointestinal motility and reduces food transit time, which may alleviate constipation.

“Also, ginger consumption has been reported to accelerate GI motility and reduce food transit time, which may alleviate constipation [15, 16].”

• cites [15] Yamahara J, Huang Q, Li Y, Xu L, Fujimura H. Gastrointestinal motility enhancing effect of ginger and its active constituents. Chem Pharm Bull. 1990;38(2):430–1. sourcePartly supported

  The opening summary (p. 1) reports that orally administered ginger extract and constituents increased charcoal-meal transport in mice, supporting an effect on gastrointestinal motility. The methods (p. 1) measured distance travelled by charcoal, not food transit time; the paper does not establish that consuming ginger reduces transit time or alleviates constipation. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [16] Platel K, Srinivasan K. Studies on the influence of dietary spices on food transit time in experimental rats. Nutr Res. 2001;21(9):1309–14. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Anorectal dysfunction and slow colonic transit leading to constipation are the most prevalent gastrointestinal problems in individuals with multiple sclerosis.

“In particular, anorectal dysfunction and slow colonic transit leading to constipation appear to be the most prevalent GI problems in individuals with MS [4].”

• cites [4] Khanna L, Zeydan B, Kantarci OH, Camilleri M. Gastrointestinal motility disorders in patients with multiple sclerosis: a single-center study. Neurogastroenterology & Motility. 2022;34(8):e14326. sourcePartly supported

  The Results (Gastrointestinal Transit Study; page not provided) identify constipation as the most common symptom, and the Conclusions link slow colonic transit and anorectal dysfunction to constipation. But the Discussion reports that delayed colonic transit and defecatory dysfunction occurred in a relatively small proportion of this selected cohort; it does not support calling those dysfunctions the most prevalent GI problems in individuals with MS. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Gastrointestinal symptoms such as abdominal pain, dysphagia, constipation, diarrhea, bloating, belching, flatulence, heartburn, anorexia, and nausea are common among patients with multiple sclerosis.

“Added to this burden, recent evidence has shown that gastrointestinal (GI) symptoms such as abdominal pain, dysphagia, constipation, diarrhea, bloating, belching, flatulence, heartburn, anorexia, and nausea are common among patients with MS [3].”

• cites [3] Levinthal DJ, Rahman A, Nusrat S, O’Leary M, Heyman R, Bielefeldt K. Adding to the burden: gastrointestinal symptoms and syndromes in multiple sclerosis. Multiple Scler Int. 2013;2013:319201. sourcePartly supported

  Results §3.3 reports that 66% of the MS cohort had at least one GI symptom and documents abdominal pain, dysphagia, constipation, bloating, belching, heartburn, and nausea. Results §3.4 reports functional diarrhea in 2% of patients, but the cited passages do not establish that diarrhea is common; they do not report flatulence or anorexia. The broad claim that GI symptoms are common is supported, but the full list is not. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

Ginger supplementation has beneficial effects on nausea, vomiting, dyspepsia, bloating, gastroenteritis, gastrointestinal malignancies, abdominal discomfort, gastric dysrhythmias, gastric ulcers, gastric emptying, intestinal motility, and swallowing function.

“In particular, supplementation with ginger has shown beneficial effects on nausea, vomiting, dyspepsia, bloating, gastroenteritis, GI malignancies, abdominal discomfort, gastric dysrhythmias, gastric ulcers, gastric emptying, intestinal motility, and swallowing function [12, 13].”

• cites [12] Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: a systematic review of clinical trials. Food Sci Nutr. 2019;7(1):96–108. sourcePartly supported

  The Nausea and Vomiting and Gastric Emptying and Dyspepsia sections report benefits for nausea, vomiting, motility and gastric emptying; the latter also reports improved bloating and epigastric pain with a ginger–artichoke combination. The Dysphagia and Gastrointestinal Malignancies sections describe narrower findings concerning swallowing in older adults and colorectal-cancer risk markers. The claim overstates the evidence for gastroenteritis, gastric dysrhythmias and gastric ulcers: the Gastroenteritis section examines gastrointestinal pain in patients with osteoarthritis, dysrhythmias appear only in a reference title, and the Introduction describes ulcer treatment chiefly as traditional use. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [13] Haniadka R, Saldanha E, Sunita V, Palatty PL, Fayad R, Baliga MS. A review of the gastroprotective effects of ginger (Zingiber officinale Roscoe). Food Funct. 2013;4(6):845–55. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Ghrelin stimulates GI motility in mammals.

“ginger may raise circulating concentrations of ghrelin, which stimulates GI motility in mammals [39, 40].”

• cites [39] Mansour MS, Ni Y-M, Roberts AL, Kelleman M, RoyChoudhury A, St-Onge M-P. Ginger consumption enhances the thermic effect of food and promotes feelings of satiety without affecting metabolic and hormonal parameters in overweight men: a pilot study. Metabolism. 2012;61(10):1347–52. sourceCould not verify

  The Discussion reports higher total ghrelin after ginger consumption, while the Introduction mentions ginger’s purported effect on peristalsis. Neither passage says that ghrelin stimulates GI motility in mammals; searches for ghrelin with motility and peristalsis found no such statement in our copy. Page numbers were not provided. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [40] Kitazawa T, Kaiya H. Regulation of gastrointestinal motility by motilin and ghrelin in vertebrates. Front Endocrinol. 2019;10:278. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Ginger has been reported to enhance circulating levels of gastrin.

“ginger has been reported to enhance circulating levels of gastrin, which its release seems to be impaired in patients with chronic constipation [37, 38].”

• cites [37] Drozdov VN, Kim VA, Tkachenko EV, Varvanina GG. Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip. J Altern Complement Med. 2012;18(6):583–8. sourceNot checked — no full text of the source
• cites [38] Preston D, Adrian T, Christofides N, Lennard-Jones J, Bloom S. Positive correlation between symptoms and circulating motilin, pancreatic polypeptide and gastrin concentrations in functional bowel disorders. Gut. 1985;26(10):1059–64. sourcePartly supported

  The Results section states that gastrin release was impaired in groups with constipation, supporting the second part of the citing sentence. The paper tested a water load, not ginger, and does not support the attributed claim that ginger enhances circulating gastrin. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Ginger may raise circulating concentrations of ghrelin.

“ginger may raise circulating concentrations of ghrelin, which stimulates GI motility in mammals [39, 40].”

• cites [39] Mansour MS, Ni Y-M, Roberts AL, Kelleman M, RoyChoudhury A, St-Onge M-P. Ginger consumption enhances the thermic effect of food and promotes feelings of satiety without affecting metabolic and hormonal parameters in overweight men: a pilot study. Metabolism. 2012;61(10):1347–52. sourceSupported
• cites [40] Kitazawa T, Kaiya H. Regulation of gastrointestinal motility by motilin and ghrelin in vertebrates. Front Endocrinol. 2019;10:278. sourcePartly supported

  The GHRL > Mammals > Human section (page unavailable) reports that ghrelin stimulates gastric motility and accelerates gastric emptying in healthy human volunteers. It does not address whether ginger raises circulating ghrelin; searches for ginger and ginger extract found no supporting passage. Thus the source supports the sentence’s ghrelin–motility clause, but not its ginger claim. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Gastrin release seems to be impaired in patients with chronic constipation.

“ginger has been reported to enhance circulating levels of gastrin, which its release seems to be impaired in patients with chronic constipation [37, 38].”

• cites [37] Drozdov VN, Kim VA, Tkachenko EV, Varvanina GG. Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip. J Altern Complement Med. 2012;18(6):583–8. sourceNot checked — no full text of the source
• cites [38] Preston D, Adrian T, Christofides N, Lennard-Jones J, Bloom S. Positive correlation between symptoms and circulating motilin, pancreatic polypeptide and gastrin concentrations in functional bowel disorders. Gut. 1985;26(10):1059–64. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Another trial revealed that ginger consumption caused a significant reduction in time to first defecation after cesarean section in women.

“another trial revealed that ginger consumption caused a significant reduction in time to first defecation after cesarean section in women [32].”

• cites [32] Tianthong W, Phupong V. A randomized, double-blind, placebo-controlled trial on the efficacy of ginger in the prevention of abdominal distention in post cesarean section patients. Sci Rep. 2018;8(1):6835. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Previous studies have reported that ginger supplementation can improve constipation without causing diarrhea.

“Consistent with our findings, previous studies have reported that ginger supplementation can improve constipation without causing diarrhea [31, 32].”

• cites [31] Ashraf H, Heydari M, Shams M, Zarshenas MM, Tavakoli A, Sayadi M. Efficacy of ginger supplementation in relieving persistent hypothyroid symptoms in patients with controlled primary hypothyroidism: a pilot randomized, double-blind, placebo-controlled clinical trial. Evidence-Based Complement Altern Med. 2022;2022:5456855. sourceSupported
• cites [32] Tianthong W, Phupong V. A randomized, double-blind, placebo-controlled trial on the efficacy of ginger in the prevention of abdominal distention in post cesarean section patients. Sci Rep. 2018;8(1):6835. sourcePartly supported

  The Introduction and Discussion say ginger can relieve constipation, and the Results report a shorter time to first defecation in the ginger group. But Table 3 records diarrhea in six ginger-group patients and three placebo-group patients; although overall side effects did not differ significantly, the paper does not establish that ginger improves constipation without causing diarrhea. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

A recent trial showed that ginger supplementation significantly relieved constipation in patients with hypothyroidism.

“a recent trial showed that ginger supplementation significantly relieved constipation in patients with hypothyroidism [31].”

• cites [31] Ashraf H, Heydari M, Shams M, Zarshenas MM, Tavakoli A, Sayadi M. Efficacy of ginger supplementation in relieving persistent hypothyroid symptoms in patients with controlled primary hypothyroidism: a pilot randomized, double-blind, placebo-controlled clinical trial. Evidence-Based Complement Altern Med. 2022;2022:5456855. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Dyspepsia is about four times more prevalent in MS patients than the general population.

“Evidence has shown that dyspepsia is about four times more prevalent in MS patients than the general population [3].”

• cites [3] Levinthal DJ, Rahman A, Nusrat S, O’Leary M, Heyman R, Bielefeldt K. Adding to the burden: gastrointestinal symptoms and syndromes in multiple sclerosis. Multiple Scler Int. 2013;2013:319201. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The analgesic, carminative, anti-nausea, antioxidant, and anti-inflammatory properties of ginger may further increase its efficacy in reducing GI symptoms.

“the analgesic, carminative, anti-nausea, antioxidant, and anti-inflammatory properties of ginger may further increase its efficacy in reducing GI symptoms [12].”

• cites [12] Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: a systematic review of clinical trials. Food Sci Nutr. 2019;7(1):96–108. sourceSupported

The quote only partly states this claim.

Compared with placebo, ginger supplementation resulted in a significant reduction in the frequency of nausea over 12 weeks (change -12.41 ± 3.75 vs. 3.75 ± 1.82, P < 0.001).

“the frequency (-12.41 ± 3.75 vs. 3.75 ± 1.82, P < 0.001) and severity (-13.43 ± 4.91 vs. 6.88 ± 2.69, P = 0.001) of nausea”

• AssumptionRests on an assumption: The corn placebo does not affect gastrointestinal symptoms.
• AssumptionRests on an assumption: Missing gastrointestinal symptom data are missing at random.

May combine two claims.

After constipation, the highest reduction in GI symptoms following ginger supplementation belonged to nausea and bloating, respectively.

“After constipation, the highest reduction in GI symptoms following supplementation with ginger belonged to nausea and bloating, respectively.”

May combine two claims.

In the treatment group, one patient experienced abdominal discomfort and another reported heartburn.

“In the treatment group, one patient experienced abdominal discomfort, and another patient reported heartburn.”

May combine two claims.

Ginger consumption showed no significant impact on the frequency and severity of dysphagia, diarrhea, belching, flatulence, heartburn, and anorexia, and on the frequency of abdominal pain.

“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.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the control group, one patient reported headache and two experienced heartburn.

“In the control group, one patient reported headache, and two participants experienced heartburn.”

May combine two claims.

Minor side effects were seen during the trial, with 7.7% in the ginger group and 11.5% in the placebo group.

“Minor side effects were seen during this clinical trial (7.7% in the ginger group vs. 11.5% in the placebo group).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The expectation-maximization algorithm was run to impute missing values in the intention-to-treat analysis.

“The expectation-maximization algorithm was run to impute missing values in ITT analysis [26].”

• cites [26] Dempster AP, Laird NM, Rubin DB. Maximum likelihood from incomplete data via the EM algorithm. J Roy Stat Soc: Ser B (Methodol). 1977;39(1):1–22. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Researchers, participants, care providers, and outcome assessors were blinded to group assignment until trial completion.

“The researchers, participants, care providers, and outcome assessors were blinded to group assignment until trial completion.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study was a 12-week double-blind parallel randomized placebo-controlled trial with a 3-week run-in period.

“This study was a 12-week double-blind parallel randomized placebo-controlled trial with a 3-week run-in period.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Forty-nine participants completed the study.

“Totally, 49 participants completed the study.”

Classified as probably not a substantial claim. May combine two claims.

Eligible relapsing-remitting multiple sclerosis patients were assigned to ginger and placebo groups using stratified permuted block randomization with an allocation ratio of 1:1 and block size of 4, stratified by gender.

“Eligible RRMS patients were assigned to ginger and placebo groups using stratified permuted block randomization (allocation ratio = 1:1, block size = 4). The stratification was performed according to gender.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The trial was approved by the Medical Ethics Committee at the Isfahan University of Medical Sciences under ethics code IR.MUI.RESEARCH.REC.1400.248.

“This trial was approved by the Medical Ethics Committee at the Isfahan University of Medical Sciences under the ethics code IR.MUI.RESEARCH.REC.1400.248.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The trial was prospectively registered at the Iranian Registry of Clinical Trials under registration number IRCT20180818040827N3 on 06/10/2021.

“This trial was prospectively registered at the Iranian Registry of Clinical Trials (www.irct.ir) under the registration number IRCT20180818040827N3 on 06/10/2021.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Energy and nutrient intakes and physical activity levels were not significantly different between the two groups.

“Moreover, energy and nutrient intakes as well as physical activity levels were not significantly different between the two groups (Table 2).”

Probably not a substantial claim: may not pass S3 (load-bearing).

After spasticity and incoordination, bowel dysfunction is rated by multiple sclerosis patients as the third most important factor limiting their ability to work.

“After spasticity and incoordination, bowel dysfunction is rated by MS patients as the third most important factor limiting their ability to work [6].”

• cites [6] Bauer H, Firnhaber W, Winkler W. Prognostic criteria in multiple sclerosis. Ann N Y Acad Sci. 1965;122(1):542–51. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Sequence generation, allocation concealment, and assignment of subjects to groups were implemented by different trained individuals.

“The sequence generation, allocation concealment, and assignment of subjects to the groups were implemented by different trained individuals.”

Classified as probably not a substantial claim.

Data analysis was performed according to the intention-to-treat principle on all 52 participants.

“Data analysis was performed according to the intention-to-treat (ITT) principle using IBM SPSS Statistics software (version 26, IBM Corporation, Armonk, New York, United States).”

• Also stated in: § Methods · plain

  “However, data analysis was performed on all 52 participants based on the intention-to-treat principle.”

Classified as probably not a substantial claim.

None of the participants were receiving gastrointestinal medications.

“None of the participants were receiving GI medications.”

May combine two claims.

Ginger and placebo tablets were identical in package, size, shape, and color, and a small amount of ginger powder was added to placebo bottles to give ginger odor.

“It is noteworthy that ginger and placebo tablets were exactly the same in package, size, shape, and color. Moreover, a very small amount of ginger powder was added to bottles containing placebo tablets to give ginger odor, as previously done by Mahluji et al. [21] and Ebrahimzadeh Attari et al. [22].”

• cites [21] Mahluji S, Attari VE, Mobasseri M, Payahoo L, Ostadrahimi A, Golzari SE. Effects of ginger (Zingiber officinale) on plasma glucose level, HbA1c and insulin sensitivity in type 2 diabetic patients. Int J Food Sci Nutr. 2013;64(6):682–6. sourceNot checked — no full text of the source
• cites [22] Ebrahimzadeh Attari V, Asghari Jafarabadi M, Zemestani M, Ostadrahimi A. Effect of Zingiber officinale supplementation on obesity management with respect to the uncoupling protein 1-3826A > G and ß3‐adrenergic receptor Trp64Arg polymorphism. Phytother Res. 2015;29(7):1032–9. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Between-group comparisons of gastrointestinal symptoms were done using analysis of covariance adjusted for baseline values.

“Between-group comparisons of GI symptoms were done using the analysis of covariance adjusted for the baseline values.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Physical activity and dietary intake can affect gastrointestinal symptoms.

“Physical activity and dietary intake can affect GI symptoms [24].”

• cites [24] Levy RL, Linde JA, Feld KA, Crowell MD, Jeffery RW. The association of gastrointestinal symptoms with weight, diet, and exercise in weight-loss program participants. Clin Gastroenterol Hepatol. 2005;3(10):992–6. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Ginger seems to decrease food transit time by about 30%.

“ginger seems to decrease food transit time by about 30% [16].”

• cites [16] Platel K, Srinivasan K. Studies on the influence of dietary spices on food transit time in experimental rats. Nutr Res. 2001;21(9):1309–14. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Constipation in RRMS is caused by prolonged colonic transit time and altered colonic compliance and basal tone.

“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 [28].”

• cites [28] Wiesel PH, Norton C, Glickman S, Kamm MA. Pathophysiology and management of bowel dysfunction in multiple sclerosis. Eur J Gastroenterol Hepatol. 2001;13(4):441–8. sourceNot checked — no full text of the source

May combine two claims.

Ginger consumption can improve constipation, nausea, bloating, and abdominal pain in patients with relapsing-remitting multiple sclerosis.

“Ginger consumption can improve constipation, nausea, bloating, and abdominal pain in patients with RRMS.”

• AssumptionRests on an assumption: The corn placebo does not affect gastrointestinal symptoms.
• AssumptionRests on an assumption: Missing gastrointestinal symptom data are missing at random.
• AssumptionRests on an assumption: The sample of relapsing-remitting multiple sclerosis patients recruited from Fars MS Association and Imam Reza Clinic is representative of relapsing-remitting multiple sclerosis patients generally.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

These complications may occur due to demyelinating lesions of the conus medullaris or more proximal lesions.

“These complications may be occurred due to demyelinating lesions of the conus medullaris or more proximal lesions [29].”

• cites [29] Taylor MC, Bradley WE, Bhatia N, Glick M, Haldeman S. The conus demyelination syndrome in multiple sclerosis. Acta Neurol Scand. 1984;69(2):80–9. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The results of previous studies are controversial regarding the effect of supplementation with ginger on dyspepsia symptoms.

“The results of previous studies are controversial regarding the effect of supplementation with ginger on dyspepsia symptoms.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Among dietary spices, ginger is the most potent one to reduce colonic transit time.

“Among dietary spices, ginger is the most potent one to reduce colonic transit time.”

• cites [16] Platel K, Srinivasan K. Studies on the influence of dietary spices on food transit time in experimental rats. Nutr Res. 2001;21(9):1309–14. sourceNot checked — no full text of the source

May combine two claims.

The side effects of ginger in this study were rare and mild, representing a very good safety profile.

“It is noteworthy that the side effects of ginger in this study were rare and mild, representing a very good safety profile.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Ginger has both GI prokinetic and relaxant effects which are mediated through cholinergic agonism and calcium antagonism, respectively.

“a mechanistic study has indicated that ginger has both GI prokinetic and relaxant effects which are mediated through cholinergic agonism and calcium antagonism, respectively [33].”

• cites [33] Ghayur MN, Gilani AH. Pharmacological basis for the medicinal use of ginger in gastrointestinal disorders. Dig Dis Sci. 2005;50(10):1889–97. sourceNot checked — no full text of the source

May combine two claims.

Ginger supplementation can improve constipation, nausea, bloating, and abdominal pain in patients with RRMS.

“Particularly, ginger supplementation can improve constipation, nausea, bloating, and abdominal pain in patients with RRMS.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Despite causing a significant reduction in food transit time, ginger supplementation has been shown to improve the digestion and absorption of macronutrients.

“Despite causing a significant reduction in food transit time, ginger supplementation has been shown to improve the digestion and absorption of macronutrients [46, 47].”

• cites [46] Prakash UN, Srinivasan K. Influence of dietary spices on protein digestibility and absorption in experimental rats. Food Digestion. 2013;4:69–75. sourceNot checked — no full text of the source
• cites [47] Prakash UN, Srinivasan K. Fat digestion and absorption in spice-pretreated rats. J Sci Food Agric. 2012;92(3):503–10. sourceNot checked — no full text of the source

May combine two claims.

The prokinetic effects of ginger can alleviate constipation, and the stimulatory effects of ginger on digestive enzymes can relieve dyspepsia in long-term use.

“The prokinetic effects of ginger can alleviate constipation, and the stimulatory effects of ginger on digestive enzymes can relieve dyspepsia in long-term use [33, 46, 47].”

• cites [33] Ghayur MN, Gilani AH. Pharmacological basis for the medicinal use of ginger in gastrointestinal disorders. Dig Dis Sci. 2005;50(10):1889–97. sourceNot checked — no full text of the source
• cites [46] Prakash UN, Srinivasan K. Influence of dietary spices on protein digestibility and absorption in experimental rats. Food Digestion. 2013;4:69–75. sourceNot checked — no full text of the source
• cites [47] Prakash UN, Srinivasan K. Fat digestion and absorption in spice-pretreated rats. J Sci Food Agric. 2012;92(3):503–10. sourceNot checked — no full text of the source

May combine two claims.

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.

“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.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study assessed key potential confounders including dietary intake and physical activity during the intervention.

“The second strength is the assessment of key potential confounders including dietary intake and physical activity during the intervention.”

Probably not a substantial claim: may not pass S4 (based).

This study is the first one that investigated the effect of ginger supplementation on GI symptoms in patients with MS.

“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.”