Is it safe for an adult patient with mild to moderate ulcerative colitis (UC) to supplement with ginsenoside Rg1?

Ginsenoside Rg1 Supplementation in Ulcerative Colitis

Ginsenoside Rg1 is not recommended for the treatment of mild to moderate ulcerative colitis, as it is not included in any evidence-based treatment guidelines and lacks human clinical trial data demonstrating safety or efficacy for this indication.

Guideline-Based Treatment Recommendations

The most recent AGA and BSG guidelines provide no support for ginsenoside Rg1 use in UC management 1. Established first-line therapies for mild-to-moderate UC include:

For Mild-to-Moderate Disease:

• Standard-dose mesalamine (2-3 grams/day) or diazo-bonded 5-ASAs are recommended as first-line therapy 1
• Combined oral and rectal mesalamine should be considered for extensive or left-sided disease to improve remission rates 1
• High-dose mesalamine (>3 grams/day) with rectal mesalamine for suboptimal response to standard dosing 1
• Oral prednisolone 40 mg daily for patients requiring prompt response or those failing mesalamine 1

For Moderate-to-Severe Disease:

The AGA strongly recommends advanced therapies including infliximab, golimumab, vedolizumab, tofacitinib, upadacitinib, ustekinumab, ozanimod, etrasimod, risankizumab, and guselkumab over no treatment 1.

Evidence on Ginsenoside Rg1

All available evidence for ginsenoside Rg1 comes exclusively from animal studies, with no human clinical trials:

• Preclinical studies show Rg1 reduced colonic inflammation in DSS-induced mouse colitis models by modulating gut microbiota and tryptophan metabolism 2
• Animal data suggest Rg1 regulates M1/M2 macrophage polarization and reduces inflammatory cytokines 3
• Mouse studies demonstrated reduced disease activity indices and colonic damage scores 4

Critical limitations:

• Zero human clinical trials exist evaluating safety or efficacy in UC patients
• Unknown drug interactions with standard UC therapies (5-ASAs, corticosteroids, immunomodulators, biologics)
• No established dosing, safety profile, or quality control standards for human use
• Risk of delaying proven effective therapy, potentially leading to disease progression or complications 1

Clinical Pitfalls to Avoid

The use of unproven supplements in UC carries significant risks:

1. Delayed appropriate treatment can lead to disease progression, increased complications, and potentially irreversible bowel damage 1
2. False reassurance from using "natural" products may prevent patients from seeking evidence-based care
3. Unknown interactions with immunosuppressive therapies could compromise treatment efficacy or increase toxicity
4. The AGA explicitly makes no recommendation for probiotics, curcumin, or FMT in mild-moderate UC due to evidence gaps, emphasizing that their use risks delaying proven therapy 1

Recommendation

Patients with mild-to-moderate UC should be treated with guideline-concordant therapies including mesalamine-based regimens as first-line, with escalation to corticosteroids or advanced therapies based on disease severity and response 1. Ginsenoside Rg1 should not be used outside of properly designed clinical trials, as there is no human evidence supporting its safety or efficacy, and its use may delay appropriate treatment with established therapies that have demonstrated benefits for morbidity and quality of life outcomes.