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Ginko Biloba
Overview

Ginkgo is one of the oldest living tree species and its leaves are among the most extensively studied botanicals in use today. In Europe and the United States, ginkgo supplements are among the best-selling herbal medications. It consistently ranks as a top medicine prescribed in France and Germany.

Ginkgo has been used in traditional medicine to treat circulatory disorders and enhance memory. Scientific studies throughout the years have found evidence to support these uses. Ginkgo may be especially effective in treating dementia (including Alzheimer's disease) and intermittent claudication (poor circulation in the legs). It also shows promise for enhancing memory in older adults. Laboratory studies have shown that ginkgo improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets.

Ginkgo leaves contain two types of chemicals (flavonoid and terpenoid) believed to have potent antioxidant properties. Antioxidants are substances that scavenge free radicals compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body and grow in number as we age. But environmental toxins (including ultraviolet light, radiation, cigarette smoking, and air pollution) can also increase the number of free radicals. Free radicals are believed to contribute to health problems including heart disease and cancer as well as Alzheimer's disease and other forms of dementia. Antioxidants such as those found in ginkgo can help neutralize free radicals and may reduce or even help prevent some of the damage they cause.

What is Ginkgo biloba ?
Ginkgo Biloba is an herb derived from the maidenhair tree. It is well known for its Antioxidant and detoxifying properties.
It has been used for many years as a remedy for various conditions. The leaves are used as an extract to provide the supplement Ginkgo Biloba. The trees leaves have been used more and more in the expanding market for the use of alternative medicines. In the past the seeds were used more often as a source of extract for the remedy.

Ginkgo is the most widely used phytomedicine that is being sold in Europe, and is one of the top 10 best selling alternative medicines in America. Ginkgo is also a neroprotective agent which is believed to be where it's actions come from for its benefits as well as its antioxidant properties.

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Benefits / uses
Dementia and Alzheimer's disease
Ginkgo is widely used in Europe for treating dementia. It was used originally because it improves blood flow to the brain. Now further study suggests it may work directly to protect nerve cells that are damaged in Alzheimer's disease. A number of studies have found that gingko has a positive effect on memory and thinking in people with Alzheimer's or vascular dementia.

Clinical studies suggest that ginkgo may provide the following benefits for people with Alzheimer's disease:

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Improvement in thinking, learning, and memory (cognitive function)
 
 
Improvement in activities of daily living
 
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Improvement in social behavior
 
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Fewer feelings of depression

Several studies have found that ginkgo may be as effective as prescription Alzheimer's medications in delaying the symptoms of dementia. However, one of the longest and best-designed studies found ginkgo was no better than placebo in reducing Alzheimer's symptoms. In a 2008 study, 176 people in the United Kingdom with Alzheimer's took either ginkgo or placebo for 6 months. At the end of the study there was no difference in cognitive function or quality of life between the groups.

Intermittent Claudication
Because ginkgo improves blood flow, it has been studied in people with intermittent claudication (pain caused by reduced blood flow to the legs). People with intermittent claudication have a hard time walking without feeling extreme pain. An analysis of eight published studies revealed that people taking ginkgo tend to walk roughly 34 meters farther than those taking placebo. In fact, ginkgo has been shown to be as effective as a prescription medication in improving pain-free walking distance.

Glaucoma
One small study found that people with glaucoma who took 120 mg of ginkgo daily for 8 weeks had improvements in their vision.

Memory Enhancement
Ginkgo is widely touted as a "brain herb." It has been studied to see whether it can improve memory in people with dementia, and some studies found it did help. The most effective dose seems to be greater than or equal to 240 mg per day. Ginkgo is commonly added to nutrition bars, soft drinks, and fruit smoothies to boost memory and enhance cognitive performance.

Macular Degeneration
The flavonoids found in ginkgo may help stop or lessen some retinal problems (problems with the back part of the eye). Macular degeneration (often called age-related macular degeneration or ARMD) is an eye disease that affects the retina. It is a progressive, degenerative eye disease that tends to affect older adults and is the number one cause of blindness in the United States. Some studies suggest that gingko may help preserve vision in those with ARMD.

Doses
Pediatric
Ginkgo is not generally used in children.
Adult
Initial results often take 4 - 6 weeks, but should grow stronger beyond that period.
Memory impairment and cardiovascular function: Generally, 120 mg daily in divided doses, standardized to contain 24 - 32% flavone glycosides (flavonoids or heterosides) and 6 - 12% triterpene lactones (terpenoids). If more serious dementia or Alzheimer's disease is present, up to 240 mg daily, in 2 or 3 divided doses, may be necessary.
Intermittent claudication: 120 - 240 mg per day

Possible Side effects / Precautions / Possible Interactions:
GBE is generally considered to be safe, and side effects are rare. In a few cases, gastrointestinal upset, headaches, skin reactions, and dizziness were reported.
If you take gingko, you should stop taking it at least 36 hours prior to surgery or dental procedures due to the risk of bleeding complications.
People who have epilepsy should not take gingko, because there is concern that it might cause seizures.
Pregnant and breastfeeding women should not take gingko.

Do not eat Ginkgo biloba fruit or seed.

Interactions:
Ginkgo may alter the metabolism and effectiveness of some prescription and non-prescription medications. If you are being treated with any of the following medications, you should not use ginkgo without first talking to your health care provider:

Anticonvulsant medications -- High doses of ginkgo could make drugs to control seizures, such as carbamazepine (Tegretol) or valproic acid (Depakote), less effective.

Antidepressants -- Taking ginkgo along with selective serotonin reuptake inhibitor (SSRIs) antidepressants may increase the risk of serotonin syndrome, a potentially fatal condition. Ginkgo may enhance the effects (both good and bad) of antidepressant medications known as MAOIs, such as phenelzine (Nardil). SSRIs include:
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)

Antihypertensive (blood pressure) medications -- Ginkgo may lower blood pressure. For that reason, if you take medication to lower your blood pressure you should ask your doctor before taking gingko. There has been a report of an interaction between ginkgo and nifedipine (Procardia), a calcium channel blocker used for blood pressure and arrhythmias.

Blood-thinning medications -- Ginkgo has blood-thinning properties and should not be used if you are taking anticoagulant (blood-thinning) medications. There has been bleeding in the brain reported when using a ginkgo product and ibuprofen (Advil), a non-steroidal anti-inflammatory drug (NSAID). Blood-thinners include:
Aspirin
Clopidogrel (Plavix)
Heparin
Warfarin (Coumadin)

Medications to lower blood sugar -- Ginkgo may increase insulin levels in healthy subjects and decrease insulin levels in people with diabetes. If you have diabetes, you should not use gingko without first talking to your doctor.

Cylosporine -- Ginkgo biloba may help protect the cells of the body during treatment with the drug cyclosporine, which suppresses the immune system.

Thiazide diuretics(water pills) -- There is one report of a person who took a thiazide diuretic and gingko experiencing high blood pressure. If you take thiazide diuretics, ask your doctor before taking gingko.

Trazodone -- There is one report of an elderly Alzheimer's patient going into a coma after taking ginkgo and trazodone (Desyrel), an antidepressant medication

Research studies / References

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Adams LL, Gatchel RJ, Gentry C. Complementary and alternative medicine: applications and implications for cognitive functioning in elderly populations. Altern Ther HealthMed. 2001;7(2):52-61.


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Aruna D, Naidu MU.Pharmacodynamic interaction studies of Ginkgo biloba with cilostazol and clopidogrel in healthy human subjects. Br J Clin Pharmacol. 2006 Sep 29; [Epub ahead of print].


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Ashton, A. K., Ahrens, K., Gupta, S., and Masand, P. S. Antidepressant-induced sexual dysfunction and Ginkgo Biloba. Am J Psychiatry. 2000;157(5):836-837.


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Benjamin J, Muir T, Briggs K, Pentland B. A case of cerebral haemorrhage-can Ginkgo biloba be implicated? Postgrad Med J. 2001;77(904):112-113.



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Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD003120. Review.


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Bridi, R., Crossetti, F. P., Steffen, V. M., and Henriques, A. T. The antioxidant activity of standardized extract of Ginkgo biloba (EGb 761) in rats. Phytother Res 2001;15(5):449-451.


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Cheuvront, S. N. and Carter, R., III. Ginkgo and memory. JAMA. 2-5-2003;289(5):547-548.


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Christen Y. Oxidative stress and Alzheimer's disease. Am J Clin Nutr. 2000;71(suppl):621S-629S.


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Choi WS, Choi CJ, Kim KS, Lee JH, Song CH, Chung JH, et al. To compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud's phenomenon in South Korea; Korean Raynaud study (KOARA study). Clin Rheumatol. 2009 Jan 22. [Epub ahead of print]


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Cieza, A., Maier, P., and Poppel, E. Effects of Ginkgo biloba on mental functioning in healthy volunteers. Arch Med Res. 2003;34(5):373-381.


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Davydov L and Stirling AL. Stevens-Johnson syndrome with Ginkgo biloba. J Herbal Pharmacother. 2001;1(3):65-69.


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DeKosky ST, Williamson JD, Fitzpatrick AL, Kronmal RA, Ives DG, Saxton JA, et al; Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008 Nov 19;300(19):2253-62. Erratum in: JAMA. 2008 Dec 17;300(23):2730.



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Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil. 2000;81:669-678.


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Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. BMJ. 2001;322(7278):73.


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Engelsen, J., Nielsen, J. D., and Hansen, K. F. [Effect of Coenzyme Q10 and Ginkgo biloba on warfarin dosage in patients on long-term warfarin treatment. A randomized, double-blind, placebo-controlled cross-over trial]. Ugeskr.Laeger. 4-28-2003;165(18):1868-1871.


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Ernst E. The risk-benefit profile of commonly used herbal therapies: ginkgo, St. John's wort, ginseng, echinacea, saw palmetto, and kava. Ann Intern Med. 2002;136:42-53.


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Fong, K. C. and Kinnear, P. E. Retrobulbar haemorrhage associated with chronic Gingko biloba ingestion. Postgrad.Med.J. 2003;79(935):531-532.


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Galluzzi S, Zanetti O, Binetti G, Trabucchi M, Frisoni GB. Coma in a patient with Alzheimer's disease taking low dose trazodone and Ginkgo biloba. J Neurol Neurosurg Psychiatry. 2000;68:679-683.


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Hartley, D. E., Elsabagh, S., and File, S. E. Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and cognition of 6 and 12 weeks' treatment in post-menopausal women. Nutr Neurosci. 2004;7(5-6):325-333.


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Hilton, M. and Stuart, E. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev. 2004;(2):CD003852.


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Horsch, S. and Walther, C. Ginkgo biloba special extract EGb 761 in the treatment of peripheral arterial occlusive disease (PAOD)--a review based on randomized, controlled studies. Int.J Clin Pharmacol Ther. 2004;42(2):63-72.


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Huang, S. Y., Jeng, C., Kao, S. C., Yu, J. J., and Liu, D. Z. Improved haemorrheological properties by Ginkgo biloba extract (Egb 761) in type 2 diabetes mellitus complicated with retinopathy. Clin.Nutr. 2004;23(4):615-621.


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Johnson SK, Diamond BJ, Rausch S, Kaufman M, Shiflett SC, Graves L. The effect of Ginkgo biloba on functional measures in multiple sclerosis: a pilot randomized controlled trial. Explore (NY). 2006;2(1):19-24.


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Kampman, K., Majewska, M. D., Tourian, K., et al., A pilot trial of piracetam and ginkgo biloba for the treatment of cocaine dependence. Addict Behav. 2003;28(3):437-448.


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Kenney C, Norman M, Jacobson M, and et al. A double-blind, placebo-controlled, modified crossover pilot study of the effects of Ginkgo biloba on cognitive and functional abilities in multiple sclerosis. American Academy of Neurology 54th Annual Meeting. April 13-20 2002;P06.081.



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Kim YS, Pyo MK, Park KM, et al. Antiplatelet and antithrombotic effects of a combination of ticlopidine and Ginkgo biloba ext (EGb 761). Thromb Res. 1998;91:33-38.


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Kohler, S., Funk, P., and Kieser, M. Influence of a 7-day treatment with Ginkgo biloba special extract EGb 761 on bleeding time and coagulation: a randomized, placebo-controlled, double-blind study in healthy volunteers. Blood Coagul.Fibrinolysis. 2004;15(4):303-309.


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LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:441-442.


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Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo-controlled trial of the Ginkgo biloba extract EGb761 in dementia. Dement Geriatr Cogn Disord. 2000;11:230-237.


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Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy and tolerability. CNS Drugs. 2000;13:201-213.


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Mauro, V. F., Mauro, L. S., Kleshinski, J. F., Khuder, S. A., Wang, Y., and Erhardt, P. W. Impact of ginkgo biloba on the pharmacokinetics of digoxin. Am.J Ther 2003;10(4):247-251.


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May BH, Lit M, Xue CC, Yang AW, Zhang AL, Owens MD, et al. Herbal medicine for dementia: a systematic review. Phytother Res. 2008 Dec 11;23(4):447-459.


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May BH, Yang AW, Zhang AL, Owens MD, Bennett L, Head R, et al. Chinese herbal medicine for Mild Cognitive Impairment and Age Associated Memory Impairment: a review of randomised controlled trials. Biogerontology. 2009 Apr;10(2):109-23. Epub 2008 Aug 21.


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Mazza M, Capuano A, Bria P, Mazza S. Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer's dementia in a randomized placebo-controlled double-blind study. Eur J Neurol. 2006;13(9):981-5.


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McCarney R, Fisher P, Iliffe S, van Haselen R, Griffin M, van der Meulen J, Warner J. Ginkgo biloba for mild to moderate dementia in a community setting: a pragmatic, randomised, parallel-group, double-blind, placebo-controlled trial. Int J Geriatr Psychiatry. 2008 Dec;23(12):1222-30.


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Meisel, C., Johne, A., and Roots, I. Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis. 2003;167(2):367.


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Moher D, Pham B, Ausejo M, Saenz A, Hood S, Barber GG. Pharmacological management of intermittent claudication: a meta-analysis of randomised trials. Drugs. 2000;59(5):1057-1070.


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Nathan, P. J., Harrison, B. J., and Bartholomeusz, C. Ginkgo and memory. JAMA. 2-5-2003;289(5):546-548.


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Oh SM, Chung KH. Antiestrogenic activities of Ginkgo biloba extracts. J Steroid Biochem Mol Biol. 2006;100(4-5):167-76.


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Persson, J., Bringlov, E., Nilsson, L. G., and Nyberg, L. The memory-enhancing effects of Ginseng and Ginkgo biloba in healthy volunteers. Psychopharmacology (Berl) 2004;172(4):430-434.


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Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 2000;108(4):276-281.


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Schneider LS, DeKosky ST, Farlow MR, Tariot PN, Hoerr R, Kieser M. A randomized, double-blind, placebo-controlled trial of two doses of Ginkgo biloba extract in dementia of the Alzheimer's type. Curr Alzheimer Res. 2005;2(5):541-51.



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Trick, L., Boyle, J., and Hindmarch, I. The effects of Ginkgo biloba extract (LI 1370) supplementation and discontinuation on activities of daily living and mood in free living older volunteers. Phytother Res. 2004;18(7):531-537.


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Van Dongen, M., van Rossum, E., Kessels, A., Sielhorst, H., and Knipschild, P. Ginkgo for elderly people with dementia and age-associated memory impairment: a randomized clinical trial. J Clin Epidemiol. 2003;56(4):367-376.


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Vellas, B., and Grandjean, H. Association of Alzheimer's disease onset with ginkgo biloba and other symptomatic cognitive treatments in a population of women aged 75 years and older from the EPIDOS study. J Gerontol A Biol.Sci.Med Sci. 2003;58(4):372-377.