The crosstalk between Korean Red Ginseng and gut microbiota: Current insights and future perspectives

The human gut microbiome plays a fundamental role in maintaining physiological homeostasis and modulating host immunity. Korean Red Ginseng (KRG) has been investigated for its pharmacological effects and its complex, bidirectional interactions with the gastrointestinal ecosystem. This review elucidates the dual role of KRG as both a modulator and a substrate within the gut. As a prebiotic-like modulator, KRG may enrich beneficial taxa, such as Akkermansia muciniphila and Lactobacillus , while stimulating the production of short-chain fatty acids. Conversely, the gut microbiota contributes to the biotransformation of primary ginsenosides into bioactive metabolites, most notably Compound K. Furthermore, this review explores the intricate molecular pathways underlying these interactions, including TGR5-mediated bile acid signaling and the integrated gut–brain–liver axis, through which gut-derived microbial, metabolic, endocrine, and immune signals may contribute to the systemic anti-inflammatory, neuroprotective, and metabolic effects of KRG. Despite these insights, significant inter-individual variability in ginsenoside metabolism−categorized into high-efficiency and low-efficiency phenotypes−remains a critical challenge for standardized application. By synthesizing current preclinical and clinical evidence, this review highlights the potential for personalized nutrition and medicine, advocating for the integration of multi-omics technologies to optimize the therapeutic use of KRG in treating chronic metabolic and neurodegenerative disorders.