The following is a summary of an article written by Mark Moyad M.D., Jenkins/Pokempner Director of Complementary & Alternative Medicine at the University of Michigan Medical Center. It was published in the August 2016 issue of Prostate Insights from the Prostate Cancer Research Institute (PCRI). Cancer-related fatigue (CRF) can occur in as many as 60-90% of patients. It is the primary side effect of the approved prostate cancer drug Xtandi® and most other treatments such as Zytiga®, hormone therapy and of course, chemotherapy. In 2014, researchers at Mayo Clinic published the following in the Journal of Clinical Oncology (Ruddy et al, 2014;32:1865-1867). “For patients who want to try a pharmacologic product and physicians who are early adapters of new promising agents, the pure ground root American (or Panax) ginseng product as used in the above studies may be an option to consider.” Recent studies of the use of ginseng in breast, colon and prostate cancer involved 364 participants in 40 medical centers. After two months of receiving 2000 mg of Wisconsin ginseng (a high quality American ginseng), the study revealed a significant difference as ginseng was twice as effective as placebo in reducing fatigue. In the Phase 3 trial, Mayo researchers also found similar results administering 1000 mg (1 gram) per day in a trial of 290 cancer patients. The ground root ginseng was obtained from the Ginseng Board of Wisconsin. (See www.ginsengboard.com or www.ginseng-herbco-op.com.) In a study at M.D. Anderson Cancer Center, ginseng was found to also improve sleep, appetite and pain issues. Ginseng also appeared to reduce the inflammatory process associated with chronic fatigue. It may reduce cortisol thus reducing overall stress and improving energy. Whether or not the primary anti-fatigue effects are being derived from the standardized ginsengoside and/or polysaccharides content or another active compound in the supplement is a matter of research and debate. Ginseng produced no real side effects, had no real current strong drug interactions, and did not seem to interfere with major drug metabolism. Ginseng from water extraction or from pure ground root has been associated with the best results and safety. Ginseng extraction methods due to alcohol or methanol-based procedures could be less effective and some researchers believe toxic with long-term use. Ginseng can be ingested with or without food but with a meal gastrointestinal side effects like acid reflux could be reduced. Purchasing ginseng from the Ginseng Board of Wisconsin or from the herb-co-op (see above) eliminated potential quality control and contaminant issues that may arise when purchasing from a local health food store.