ZINOPIN - ITS USE AS A FOOD SUPPLEMENT IN TRAVELLER'S THROMBOSIS, OEDEMA AND MOTION SICKNESS

European Bulletin of Drug Research.
Volume 13, 2005
ZINOPIN?- ITS USE AS A FOOD SUPPLEMENT IN TRAVELLER’S
THROMBOSIS, OEDEMA AND MOTION SICKNESS
J. H. Scurr
The Lister Hospital, Chelsea Bridge road, London, UK. E-mail: jscurr@uk-consultants.co.uk
Keywords: Zinopin®, economic class syndrome, DVT, travel, motion sickness, oedema.

ABSTRACT

We investigated the efficacy of a proprietary reported mild and transient symptoms. Adverse
formulation (Zinopin®), with standardized french effects did not occur in any passenger.
pine bark extract (Pycnogenol®) and standard-
We conclude that the Zinopin® regimen helps
ised ginger extract to help protect against protect against thrombotic events, counteracts
thrombosis, oedema and motion sickness in 167 swellings of the lower extremities and helps man-
healthy travellers on two long-haul flights each age the problems of motion sickness in passen-
within three weeks. This trial was conducted as gers travelling long-haul.
an initial, open investigation to explore the
health virtues of Zinopin® for travellers. A

previously established questionnaire was used to
INTRODUCTION
assess the occurrence of oedema, thrombosis and
In 1998 the term “economy class syndrome”
motion sickness on both flights, towards destina-
was coined to describe the association between
tion as well as the return flight, respectively.
air-travel and thrombotic events (Cruikshank et
The absence of thrombosis was diagnosed in al., 1988). Numerous studies have since then
all participating passengers ultrasonographically demonstrated that prolonged periods in sedentary
prior to the flight. Passengers received a regimen position favour the development of blood clots.
of one Zinopin® capsule one day prior to depar-
Already in 1856 Virchow described that blood
ture, another two capsules an hour before take-
stasis, such as when blood is pooling in leg veins
off and another capsule each of the following two in sedentary position, increases the risk of devel-
consecutive days after arrival. The regimen was oping blood clots. Air travel appears to signifi-
repeated on the return journey.
cantly increase the thrombosis risk because of the
hypobaric conditions and the common dehydra-
Evaluation of passengers showed absence of tion of passengers (Watson 2005).
deep vein thrombosis, superficial vein thrombo-
phlebitis and pulmonary embolism after flights in
Medium- to long-distance travellers have been
all cases. Twenty nine of the total 167 passengers ascribed a 2- to 4-fold increase in relative throm-
(frequency rate 17%) had a history of oedema on bosis risk compared to non-travellers. Apparently
previous long-haul flights and using Zinopin® there is no evidence that thrombosis is more
rendered 75.9% symptom-free, and all remaining likely in economy class than in business-or first-
others experienced symptom improvements. class passengers. It is understood that short-
Twenty eight passengers (frequency rate 16.7%) distance air travel or prolonged travel by car,
were usually affected by motion sickness on train or other means also involves an increased
flights. With Zinopin® 26 (92.8%) of these pas-
thrombosis risk (Gallus, 2005).
sengers no longer experienced any signs of mo-
In a previous investigation we found that the
tion sickness and the remaining two passengers incidence of symptom-less deep vein thrombosis
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Scurr Zinopin® in traveller’s thrombosis, oedema and motion sickness,
may be up to 10% in long-haul air travellers and inhibit thromboxane synthesis and a combi-
(Scurr et al., 2001). In many cases a developing nation with Pycnogenol® was previously de-
thrombus spontaneously dissolves again, often scribed to possess synergistic effects for throm-
when the passenger begins to walk around a little. bosis prevention (Scurr & Gulati, 2004). As an
Although simple advice, including exercise additional virtue ginger extracts is well known to
before, during and after travel, and sufficient hy-
ease the symptoms related to motion sickness
dration may be helpful for the majority of pas-
(Lien et al., 2003).
sengers the thrombosis risk remains eminent. A
The impetus for this study was to explore the
systematic review of clinical trials has suggested effectiveness of Zinopin® as a supplement for
that elastic compression stockings reduce the risk travellers, looking at thrombosis episodes, ankle
of air-travel related deep vein thrombosis, but not swelling and motion sickness. Because of the
for superficial vein thrombosis (Hsieh & Lee, very distinctive odour of the capsule we felt that
2005). Moreover, for a majority of passengers the we could not carry out a randomised double-blind
stockings are inconvenient and they refuse to controlled clinical trial at this stage. Zinopin®
wear them. Aspirin is well known for its benefits was therefore administered to passengers on
for thrombosis prevention. The beneficial effects long-haul flights and monitored the effects.
of taking Aspirin are offset by the dangers of pro-

longed bleeding time and many individuals do
MATERIALS AND METHODS
not tolerate the medication due to gastric irrita-
The aim of the study was to investigate the
tion, ulcers and haemorrhagic events (Bieder-
protective effects of Zinopin® from thromboses,
mann, 2005). More importantly, there is a con-
pulmonary embolism and oedema in subjects liv-
siderable group of individuals, statistics suggest ing at risk for these conditions during prolonged
10% and more of the population, who are aspirin periods of travelling. Furthermore, we hoped to
non-responders (Campbell & Steinhubl, 2005). gain information on improvements of motion
Medication with aspirin does not affect their sickness in the subgroup of passengers burdened
platelets and thus will not lower their thrombosis with this problem.
risk.
One hundred and eighty four subjects plan-
Realising the necessity and demand for alter-
ning a long-haul flight were recruited from a
natives to address travel related health conditions general surgical clinic, where many of the sub-
we formulated two bio-active natural compo-
jects had gone through treatment of their varicose
nents, Pycnogenol® and a standardised ginger veins or other vascular conditions. A full medical
extract, into the proprietary supplement Zinopin®. history was obtained from all subjects and a thor-
Pycnogenol® contains potent bioactive fla-
ough clinical examination involving duplex ultra-
vonoid species and has been demonstrated in sound imaging was carried out to exclude pa-
various clinical trials to yield diverse beneficial tients with residual superficial thrombo-phlebitis
activities particularly for the cardio-vascular sys-
or evidence of deep vein thrombosis. Patients
tem (Rohdewald, 2002). Pycnogenol® increased with grossly visible varicose veins and a history
endothelial nitric oxide synthesis and was shown of thrombo-embolic disease were excluded from
to improve blood circulation. Pycnogenol® participation. Patients medicating with aspirin or
strengthens capillaries and was shown to possess other anti-platelet drugs were excluded from the
significant anti-oedema effects. Pycnogenol® was study. Those patients who had gone through vas-
demonstrated in previous studies to dose-
cular surgery had to be convalescent for at least 6
dependently lower platelet activity and this appli-
weeks prior to participation in the study and had
cation is patent-protected (Pütter et al., 1998). to be diagnosed as healthy subjects during re-
Ginger constituents display fibrinolytic activity cruitment. Subjects wearing elastic compression
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Scurr Zinopin® in traveller’s thrombosis, oedema and motion sickness,
stockings on a regular basis were not excluded
The subjects who completed the trial con-
and were allowed to continue wearing them sisted of 75 men and 92 women within an age
throughout the study. A history of ankle swelling range of 26 to 79 years, mean age 59 ± 11 years.
and calf pain as well as history of motion sick-
Fifty six subjects wore elastic compression stock-
ness was recorded.
ings during flights. The duration of the flights
The inclusion criteria were adults with no re-
lasted between 6 hours and 26 hours for each
striction by gender, race or age. Subjects were onward and inward journey with an average of 13
required to be on a minimum five hour flight in ± 6 h.
each direction and passengers were required to
The outcome of the trial showed that none of
return within three weeks. Passengers were re-
the passengers developed any signs of deep vein
quested to fill out a questionnaire both before thrombosis or superficial vein thrombo-phlebitis
departure and after returning from their trip com-
and no signs of pulmonary embolism during the
prising two long-haul flights. The questionnaire flights.
allowed for evaluating swellings and motion
A subgroup of 29 passengers had a history of
sickness during flights. Possibly experienced ankle swelling on previous flights. In this trial 22
side-effects had to be recorded. Arrangements of the passengers with common oedema prob-
were made for every passenger with possible lems no longer experienced ankle swellings due
thromboses or pulmonary embolism to be inter-
to the Zinopin® regimen, they were symptom-
viewed upon arrival and examined for thrombosis free. Thus, Zinopin® statistical significantly re-
by ultrasonography.
duced the incidence of passengers suffering from
Subjects received one Zinopin® capsule one ankle swellings during long-haul flights by
day before the journey, two capsules one hour 75.9%. The remaining seven passengers in this
before departure and another capsule each of the subgroup noted milder forms of ankle swellings
two following days after arrival. Capsules were as compared to previous flights. Four of these
taken with 250 ml of water. The regimen was seven passengers were also wearing elastic com-
repeated on the return journey. Subjects were pression stockings two of which reported discom-
instructed to take usual precautions such as mild fort with the stockings.
exercise (standing and/or moving legs for 5 min-
In the study group passengers were asked
utes every hour during travelling), avoiding bag-
whether they had experienced travel motion sick-
gage between seats and drinking regularly (100 to ness in the past. Twenty eight patients (frequency
150 ml of water at frequent intervals).
rate of 16.7%) had a history of motion sickness
One Zinopin® capsule contains 100 mg french although not necessarily on all flights. Twenty
maritime pine bark extract Pycnogenol® (Hor-
six patients didn’t experience any signs of motion
phag Research Ltd.) and 150 mg standardised sickness after taking Zinopin®, corresponding to
ginger root extract. Zinopin® is a product of 92.9% of those otherwise affected with this prob-
Pynogin GmbH Switzerland.
lem. Only two passengers reported motion sick-

ness after taking Zinopin® and both related this to
RESULTS
the ginger taste of the capsule and the symptoms
were only transient.
One hundred and eighty four passengers were
initially enrolled for this study. Seventeen sub-

DISCUSSION
jects disqualified because they failed to take Zi-
nopin® according to instructions or they changed
This investigation was carried out in an open
their travel plans and did not return within the exploratory fashion to confirm the efficacy and
three weeks period.
dosage of Zinopin® for protecting against the risk
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Scurr Zinopin® in traveller’s thrombosis, oedema and motion sickness,
of thromboses, oedema and motion sickness on risk for superficial vein thrombosis or deep vein
long-haul flights. The results of this study have thrombosis), an incident of 3 thromboses cases
confirmed the proposed rationale which led to the would have been a realistic expectation in a
development of Zinopin® (Scurr & Gulati, 2004).
group of 167 travellers on two flights. Therefore,
The most important finding of this study is we strongly believe the absence of thromboses to
that Zinopin® appears to indeed defy the risk of be attributed to supplementation with Zinopin®.
developing thrombotic events on long-haul
One of the most commonly reported benefits
flights. The two active components in Zinopin®, of Zinopin® by passengers was the lack of ankle
the french maritime pine bark extract (Pycno-
swelling. While many passengers did not typi-
genol®) and a standardised ginger extract, were cally have problems with oedema on flights,
both previously demonstrated to inhibit platelet those passengers with a history of manifest ankle
aggregation. Pycnogenol® was shown to dose-
swellings on previous flights reported dramatic
dependently lower platelet activity in humans 2 improvements. The majority (75.8%) of affected
hours after oral supplementation, starting at a passengers were rendered symptom-less owing to
dose as low as 25 mg (Pütter et al., 1998). This supplementation with Zinopin®. This result was
effect was described to result from elevated endo-
expected as the Pycnogenol® in Zinopin® was
thelial nitric oxide synthase activity as well as shown to be effective for reducing oedema in
from lowering serum thromboxane levels more than 15 clinical trials made in venous dis-
(Araghi-Niknam et al., 1999). Ginger constitu-
orders (Gulati, 1999). The beneficial effects of
ents were shown to have a significant anti-
Zinopin® for preventing ankle swelling are now
platelet function, primary as a result thromboxane clearly demonstrable.
synthesis inhibition (Nurtjahja et al., 2003).
In a smaller subgroup limited to 28 of our
Though the participants in our study were subjects, typically affected by motion sickness,
generally healthy subjects, they had gone through the benefits of Zinopin® were manifest. All ex-
treatment of vascular disorders, such as varicose cept two of the passengers burdened with motion
veins, at our surgical clinic prior to air-travel. sickness were symptom-free. Only two passen-
These subjects would be expected to have a gers in the study actually reported some signs of
somewhat increased thrombosis risk. Even motion sickness and both of these occurred
though they travelled two long-haul flights we shortly after taking two capsules of Zinopin®.
found no clinical signs or symptoms for deep The passengers attributed their symptoms to the
vein thrombosis and pulmonary embolism. unexpected intensive ginger flavour. During the
Whilst recognising that it is possible to have mi-
course of the flight their symptoms abated and,
nor episodes of transient thrombo-embolic cases, on the contrary to before, both passengers were
the absence of deep vein thrombosis and pulmo-
convinced of Zinopin’s® benefits for their motion
nary embolism in the study is relevant. Even sickness problem on the return journey. The sen-
more relevant is the absence of superficial sation of nausea due to motion involves complex
thrombo-phlebitis, as it was shown that compres-
neural interactions between the central nervous
sion stockings are insufficient for its prevention system and the gastrointestinal tract. A recent
(Hsieh et al., 2005).
double-blind, placebo-controlled, crossover-
A very broad range of statistical thromboses designed clinical study has suggested that ginger
risks on long-haul flights has been proposed by ameliorates nausea associated with motion sick-
various authors (Scurr & Gulati, 2004). The true ness by preventing the development of gastric
frequency of thrombosis during long-haul air dysrhythmias and the elevation of plasma vaso-
travel remains unknown (Scurr et al., 2001). pressin (Lien et al., 2003).
Even when applying conservative statistics (1 %
In conclusion, our study demonstrates that Zi-
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Scurr Zinopin® in traveller’s thrombosis, oedema and motion sickness,
nopin® offers a range of benefits for travellers on Gulati OP. Pycnogenol® in venous disorders: A review. Eur
long journeys, which are not necessarily limited
Bull Drug Res 1999; 7: 8-13.
to air-travel. People suffering from ankle swell-
Hsieh HF, Lee FP. Graduated compression stockings as
ings commonly have this problem whenever they
prophylaxis for flight-related venous thrombosis: syste-
need to remain seated for prolonged periods of
matic literature review. J Adv Nurs 2005; 51: 83-98.
time. Likewise, many people have motion sick-
Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang
ness when driving a car. Moreover, the risk for
C. Effects of ginger on motion sickness and gastric
thrombosis does not exclusively prevail on long-
slow-wave dysrhythmias induced by circular vection.
haul flights but other modes of transport too (An-
Am J Physiol Gastrointest Liver Physiol 2003; 284: 481-
sari et al., 2005).
489.
This exploratory study has encouraged us to Nurtjahja-Tjendraputra E, Ammit AJ, Roufogalis BD, Tran
carry out a double-blind, placebo-controlled
VH, Duke CC. Effective anti-platelet and COX-1 en-
study to further substantiate the described bene-
zyme inhibitors from pungent constituents of ginger.
fits of Zinopin®, which is currently in prepara-
Thromb Res 2003; 111: 259-265.
tion.
Pütter M, Grotemeyer KHM, Würthwein G, Araghi-Niknam

M, Watson RR, Hosseini S, Rohdewald P. Inhibition of
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