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Herbs & Supplements > Herbs > Ginkgo (Ginkgo biloba L.)

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Ginkgo (Ginkgo biloba L.)

Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States.

Ginkgo is used for the treatment of numerous conditions, many of which are under scientific investigation. Available evidence demonstrates ginkgo's efficacy in the management of intermittent claudication, Alzheimer's/multi-infarct dementia, and "cerebral insufficiency" (a syndrome thought to be secondary to atherosclerotic disease, characterized by impaired concentration, confusion, decreased physical performance, fatigue, headache, dizziness, depression, and anxiety).

Although not definitive, there is promising early evidence favoring the use of ginkgo for memory enhancement in healthy subjects, altitude (mountain) sickness, symptoms of premenstrual syndrome (PMS), and reduction of chemotherapy-induced end-organ vascular damage.

Although still controversial, a recent large trial has shifted the evidence against the use of ginkgo for tinnitus.

The herb is generally well tolerated, but due to multiple case reports of bleeding, should be used cautiously in patients on anticoagulant therapy, with known coagulopathy, or prior to some surgical or dental procedures.

Evidence Table (Click Here to view Natural Standard evidence-based validated grading rationale™.)

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.	Grade
Claudication (painful legs from clogged arteries) Numerous studies suggest that Ginkgo biloba taken by mouth causes small improvements in claudication symptoms (leg pain with exercise or at rest due to clogged arteries). However, ginkgo may not be as helpful for this condition as exercise therapy or prescription drugs. Additional evidence is needed.	A
Dementia (multi-infarct and Alzheimer's type) The scientific literature overall does suggest that ginkgo benefits people with early stage Alzheimer's disease and multi-infarct dementia, and may be as helpful as acetylcholinesterase inhibitor drugs such as donepezil (Aricept®). Well-designed research comparing ginkgo to prescription drug therapies is needed.	A
Cerebral insufficiency Multiple clinical trials have evaluated ginkgo for a syndrome called "cerebral insufficiency." This condition, more commonly diagnosed in Europe than the United States, may include poor concentration, confusion, absent-mindedness, decreased physical performance, fatigue, headache, dizziness, depression, and anxiety. It is believed that cerebral insufficiency is caused by decreased blood flow to the brain due to clogged blood vessels. Some research reports benefits of ginkgo in patients with these symptoms, but most have been poorly designed without reliable results. Better studies are needed before a strong recommendation can be made.	B
Acute hemorrhoidal attacks In early study ginkgo was shown to be effective in the treatment of patients with acute hemorrhoidal attacks. Further research is needed to confirm these results.	C
Age-associated memory impairment (AAMI) Age-associated memory impairment (AAMI) is a non-specific syndrome, which may be caused by early Alzheimer's disease or multi-infarct dementia (conditions for which ginkgo has been shown to have benefit). There is preliminary research showing small improvements in memory and other brain functions in patients with AAMI, although some studies disagree. Overall, there is currently not enough clear evidence to recommend for or against ginkgo for this condition.	C
Altitude (mountain) sickness A small amount of poorly designed research reports benefits of ginkgo for the treatment of altitude (mountain) sickness. Additional study is needed before a recommendation can be made.	C
Asthma Ginkgo may reduce symptoms in patients with asthma. More study is needed to make a firm recommendation.	C
Cardiovascular disease Animal and limited human data suggest a role in heart blood flow. More research is needed in this area.	C
Chemotherapy side effects reduction In limited human study, ginkgo has been examined in addition to 5-fluorouracil (5-FU) in the treatment of pancreatic and colorectal cancer, to measure possible benefits on side effects. At this time, there is a lack of conclusive evidence in this area.	C
Chronic venous insufficiency Research is unclear in this area. However, a multi-ingredient product called Ginkor Fort® may aid in treatment of patients with lower limb chronic venous insufficiency. Further study is needed and recommendations cannot be made at this point.	C
Cocaine dependence It is not clear whether ginkgo is helpful in treating cocaine dependence. More study is needed.	C
Deafness (cochlear) Preliminary clinical study has been conducted on the effect of ginkgo in chronic cochleovestibular disorders. Further research is needed before a recommendation can be made.	C
Depression and seasonal affective disorder (SAD) Preliminary study of seasonal affective disorder (SAD) suggests that ginkgo is not effective in preventing the development of winter depression. Other research in elderly patients with depression shows possible minor benefits. Overall, there is not enough evidence to form a clear conclusion.	C
Diabetic neuropathy Research is unclear in this area. Ginkgo may help improve some laboratory parameters associated with diabetic neuropathy, but more study is needed to make a firm recommendation.	C
Dyslexia Ginkgo is traditionally used for improved memory or cognition and research supports a possible use for patients with dyslexia. More study is needed in this area.	C
Gastric cancer Ginkgo biloba exocarp polysaccharides (GBEP) capsule preparation has been studied for upper digestive tract malignant tumors of middle and late stage with positive results. However, further research is needed before a recommendation can be made.	C
Glaucoma It is not clear if ginkgo may improve intraocular pressure and blood flow in patients with glaucoma. Some study results conflict or have not been significant. Further research is needed before a recommendation can be made.	C
Graves' disease Ginkgo may decrease damage to cells caused by radioiodine therapy in patients with Graves' disease. Further study is needed.	C
Macular degeneration Preliminary research suggests that ginkgo may improve eye blood flow, although it remains unclear if macular degeneration is significantly affected by ginkgo. More research is needed in this area before a conclusion can be drawn.	C
Memory enhancement (in healthy people) It remains unclear if ginkgo is effective. Further well-designed research is needed as existing study results conflict.	C
Mood and cognition in post-menopausal women It remains unclear if ginkgo is effective for mood and cognition improvement. Further well-designed research is needed as existing study reports conflicting evidence.	C
Multiple sclerosis Based on laboratory study, it has been suggested that ginkgo may provide benefit in multiple sclerosis (MS). Human research is limited to several small studies, which have not found consistent benefit. Additional research is needed before a recommendation can be made.	C
Premenstrual syndrome (PMS) Initial study in women with premenstrual syndrome or breast discomfort suggests that ginkgo may relieve symptoms including emotional upset. Further well-designed research is needed before a recommendation can be made.	C
Pulmonary interstitial fibrosis Based on early study, ginkgo may be effective in treating pulmonary interstitial fibrosis. Further research is needed to confirm these results.	C
Quality of life Early studies suggest that ginkgo may aid in quality of life. More randomized controlled trials are needed before a conclusion can be made.	C
Raynaud's disease Results from one clinical trial suggest that Ginkgo biloba may be effective in reducing the number of Raynaud's attacks in patients suffering from Raynaud's disease. In order to confirm these results, further clinical trials are required.	C
Retinopathy (diabetes mellitus type 2) Early study suggests Ginkgo biloba extract may offer benefit to individuals with retinopathy. Further clinical trials are required to determine efficacy.	C
Ringing in the ears (tinnitus) There is conflicting research regarding the use of ginkgo for tinnitus. Additional well-designed research is needed in order to resolve this controversy.	C
Schizophrenia Based on ginkgo's proposed antioxidant effects, ginkgo has been studied in the treatment of schizophrenia. Although early study is promising, there is currently not enough scientific evidence to make a strong recommendation. .	C
Sexual dysfunction Ginkgo has been used and studied for the treatment of sexual dysfunction in men and women. In general, studies are small and not well designed. Additional research is needed before a recommendation can be made.	C
Stroke Laboratory studies suggest that ginkgo may be helpful immediately following strokes because of possible antioxidant or blood vessel effects. However, initial study of ginkgo in people having strokes found a lack of benefit. Further research is needed in this area.	C
Vertigo A small amount of poorly designed research reports benefits of ginkgo for the treatment of vertigo. Additional study is needed before a recommendation can be made.	C
Vitiligo Early study using oral Ginkgo biloba extract reports that ginkgo appears to arrest the progression of this disease. Better-designed studies are needed to confirm these results.	C
Mental performance (after eating) The results of one study investigating the effect of Ginkgo biloba on post-prandial mental alertness are unclear. Ginkgo may benefit some but not all endpoints. Further clinical trials are required before recommendations can be made.	D

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Allergy/hypersensitivity to Ginkgo biloba or members of the Ginkgoaceae family may occur. A severe reaction called Stevens-Johnson syndrome, which includes skin blistering and sloughing-off, has been reported with use of a combination product. There may be cross-sensitivity to ginkgo in people allergic to urusiols (mango rind, sumac, poison ivy, poison oak, cashews), and an allergic cross-reaction has been reported in a person allergic to poison ivy.

Side Effects and Warnings

Overall, ginkgo leaf extract (used in most commercial products) appears to be well tolerated in most healthy adults at recommended doses for up to six months. Minor symptoms including headache, nausea, and intestinal complaints have been reported.

Bleeding has been associated with the use of ginkgo taken by mouth, and caution is advised in patients with bleeding disorders or taking drugs/herbs/supplements that may increase the risk of bleeding. Dosing adjustments may be necessary. Ginkgo should be stopped prior to some surgical or dental procedures. Reports of bleeding range from nose bleeds to life-threatening bleeding in several case reports. In some of these reports, ginkgo has been used with other agents that may also cause bleeding.

Eating the seeds is potentially deadly, due to risk of tonic-clonic seizures and loss of consciousness.

Based on human study, ginkgo may theoretically affect insulin and blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary.

There have been uncommon reports of dizziness, stomach upset, diarrhea, vomiting, muscle weakness, loss of muscle tone, restlessness, racing heart, rash, and irritation around the mouth with the use of ginkgo. There is a case report of "coma" in an elderly Alzheimer's patient taking trazodone and ginkgo, although it is not clear that ginkgo was the cause. Based on laboratory and human research, ginkgo may decrease blood pressure, although there is one report of ginkgo possibly raising blood pressure in a person taking a thiazide diuretic ("water pill"). Based on theory, high concentrations of ginkgo may reduce male and female fertility. Contamination with the drug colchicine has been found in commercial preparations of Ginkgo biloba.

Ginkgo may affect the outcome of electroconvulsive therapy (ECT). Adverse effects on the eyes have also been reported.

Pregnancy and Breastfeeding

Use of ginkgo is not recommended during pregnancy and breastfeeding due to lack of reliable scientific study in this area. The risk of bleeding associated with ginkgo may be dangerous during pregnancy.

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2007 Apr 18;(2):CD003120. View Abstract

Carlson JJ, Farquhar JW, DiNucci E, et al. Safety and efficacy of a ginkgo biloba-containing dietary supplement on cognitive function, quality of life, and platelet function in healthy, cognitively intact older adults. J Am Diet Assoc 2007 Mar;107(3):422-32. View Abstract

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

Issing W, Klein P, Weiser M. The homeopathic preparation Vertigoheel versus Ginkgo biloba in the treatment of vertigo in an elderly population: a double-blinded, randomized, controlled clinical trial. J Altern Complement Med 2005;11(1):155-160. View Abstract

Kampman K, Majewska MD, 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. View Abstract

Kohler S, Funk P, 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. View Abstract

Lovera J, Bagert B, Smoot K, et al. Ginkgo biloba for the improvement of cognitive performance in multiple sclerosis: a randomized, placebo-controlled trial. Mult Scler 2007 Apr;13(3):376-85. View Abstract

Mazza M, Capuano A, Bria P, et al. 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 Sep;13(9):981-5. View Abstract

Napryeyenko O, Borzenko I; GINDEM-NP Study Group. Ginkgo biloba special extract in dementia with neuropsychiatric features. A randomised, placebo-controlled, double-blind clinical trial. Arzneimittelforschung 2007;57(1):4-11. View Abstract

Robertson SM, Davey RT, Voell J, et al. Effect of Ginkgo biloba extract on lopinavir, midazolam and fexofenadine pharmacokinetics in healthy subjects. Curr Med Res Opin 2008 Feb;24(2):591-9. View Abstract

Thomas M, Sheran J, Smith N, et al. AKL1, a botanical mixture for the treatment of asthma: a randomised, double-blind, placebo-controlled, cross-over study. BMC Pulm Med. 2007 Mar 20;7:4. View Abstract

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

Wang J, Zhou S, Bronks R, et al. Supervised exercise training combined with ginkgo biloba treatment for patients with peripheral arterial disease. Clin Rehabil 2007 Jul;21(7):579-86. View Abstract

Wolf HR. Does Ginkgo biloba special extract EGb 761 provide additional effects on coagulation and bleeding when added to acetylsalicylic acid 500 mg daily? Drugs R D 2006;7(3):163-72. View Abstract

Zeng X, Liu M, Yang Y, et al. Ginkgo biloba for acute ischaemic stroke. Cochrane Database Syst Rev 2005 Oct 19;(4):CD003691. View Abstract

Related Terms

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Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Natural Standard's methodology , editorial board , and grading scales.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

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Health Glossary

Ginkgo (Ginkgo biloba L.)

Background

Evidence Table (Click Here to view Natural Standard evidence-based validated grading rationale™.)

Tradition

Tradition Theory

Dosing

Safety

Interactions

Attribution

Bibliography

Related Terms