Ginkgo

Updated | 2017-11-30


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Ginkgo


Overview

Botanical Name: Ginkgo biloba


Order: Ginkgoales


Family: Ginkgoaceae


Considered a living fossil. The leaves of ginkgo are used for medicine. Supplements containing ginkgo leaves should contain at least 24% flavone glycosides (or ginkgo glycosides) and 6% terpene lactones (or ginkgolides-bilobalide), the proposed active compounds. Most human clinical trials with ginkgo have been done with a standardized extract called EGb761.



Evidence

Strong:

-

Good:

  • Cognitive Ability, no effect on brain tumor, chemotherapy, MS, or post-menopausal patients [1-38]
    • Ginkgo appears to increase blood flow to the brain; though mainly short-term affects
    • Ginkgo with Codonopsis, royal jelly / ginseng, phosphatidylserine, or ginseng alone may be more effective; however, ginkgo with Bacopa may NOT be effective
  • Schizophrenia, including a combination of ginkgo with olanzapine or haloperidol [39-43]

Promising:

  • Glaucoma, including a combination of ginkgo and bilberry [44-48]
  • Microcirculation (potentially due to ginkgo’s anti-oxidant properties) [49-52]
  • Migraines, ginkgo with coenzyme-Q 10 / vitamin B2 or magnesium seems to be effective [53-56]
  • Peripheral Artery Disease [57-64]
  • Vertigo, one study found that a homeopathic product might be slightly better than ginkgo [65-67]

Conflicting (Unclear):

  • Alzheimer’s, ginkgo with royal jelly or donepezil may be more effective [68-80]
    • A large (3,069 participants) study, the Ginkgo Evaluation of Memory (GEM) Study, found that ginkgo was not effective at treating Alzheimer’s in individuals 75 and older
  • Anti-Platelet Aggregation, ginkgo with ticlopidine, and ginkgo for people with diabetes may be more effective [89-95]
  • Cardiovascular Disease / Coronary Artery Disease [96-104]
  • Dementia, ginkgo with royal jelly / ginseng may be more effective [105-120]
    • The same large (3,069 participants) study, the Ginkgo Evaluation of Memory (GEM) Study, also found that ginkgo was not effective at treating dementia in individuals 75 and older

Limited Evidence:

  • Anti-Thyroid Cancer Genotoxicity from Radioiodine Therapy [130-131]
  • Anxiety / Stress [132-133]
  • Cold Exposure [134]
  • Colon Cancer, ginkgo with 5-flurourcacil [135]
  • Diabetes [136]
  • Diabetic Nephropathy, including patients undergoing dialysis [137-138]
  • Dyslexia [139]
  • Endurance, ginkgo in combination with Rhodiola crenulata [140]
  • Gastric Cancer (ginkgo fruit skin) [141]
  • Lowers Cholesterol [142]
  • Meniere’s Disease [143]
  • Mild Cognitive Impairment (MCI) [144-146]
  • Mood, ginkgo with ginseng may be more effective [147-148]
  • Multiple Sclerosis (MS), less fatigue [149]
  • Nasal Spray for Post-viral Loss of Smell [150]
  • Neurofibromatosis Type 1 [151]
  • Pancreatic Cancer, ginkgo with 5-flurourcacil [152]
  • Piles, ginkgo in combination with ginseng or troxerutin / heptaminol [153-154]
  • Premenstrual Syndrome (PMS) [155]
  • Post-Traumatic Child with Dyskinesia [156]
  • Radiation [157-158]
  • Raynaud Phenomenon [159-161]
  • Sexual Health, including people on anti-depressant drugs [162-166]
  • Skin Damage from Breast Radiotherapy, ginkgo with aloe [167]
  • Sleep [168-169]
  • Sudden Deafness [170-171]
  • Tardive Dyskinesia, including those who have Schizophrenia [172-173]
  • Topical Treatment of Allergic Reactions [174-175]
  • Venous Disorder, ginkgo with troxerutin / heptaminol [176]
  • Vitiligo [177-178]
  • Wrinkle Cream [179]

No Evidence:


No Clinical Research:

All other conditions.


Side Effects
Side effects may include:
  • Diarrhea
  • Dizziness
  • Gas
  • Gastrointestinal Discomfort
  • Headache
  • Heart Palpitations
  • Nausea
  • Skin Irritation
Precautions and Adverse Events:
  • Avoid if you have had a history of nosebleeds, seizures, allergic reactions to ginkgo, are epileptic, have hypertension are planning a surgical operation, or after a surgical operation. Ginkgo can increase and prolong bleeding. Contact a licensed healthcare practitioner, if you had a seizure, changes in blood pressure, and have unusual bleeding or bruising while taking ginkgo.
  • Do NOT eat ginkgo nuts and fruit, especially young children and infants. Ginkgo nuts and fruits contain an anti-vitamin B6 neurotoxin.
    • Boiling ginkgo nuts and fruits first may remove the toxic compounds.
    • Ginkgo nuts and fruit can cause contact dermatitis.
    • Symptoms associated with ginkgo nut and fruit allergic reactions may include: intense itching, edema, papules, and pustules; usually subsiding within 7-10 days.
    • Ginkgo nuts and fruits can cause seizures and even death.
    • Symptoms associated with ginkgo nut poisoning may include: convulsions, vomiting, and nausea.
  • A few cases of bleeding occurred due to ginkgo use, including iris bleeding, bleeding after liver transplant, cerebral hemorrhaging, and bleeding after postoperative laparoscopic cholecystectomy.
  • Although some have reported that ginkgo does not cause a higher risk of bleeding, many more have reported that ginkgo does cause a higher risk bleeding or increased bleeding time.
  • Although withdrawn, do not inject ginkgo because it may causes allergic reactions, changes in blood pressure, circulatory disturbances, and inflammation of the veins.
  • Hypersensitive reactions of ginkgo supplements may consist of spasms and cramps and, in cases of acute toxicity, atonia and adynamia.
  • A case of someone with glucose-6-phosphate dehydrogenase (G6PD) deficiency developed acute hemolytic anemia.
  • A rare case of acute generalised exanthematous pustulosis (AGEP) occurred after someone took ginkgo.
  • Applying ginkgo extracts to the skin or mucus membranes may cause irritation and blistering.
  • Ginkgo supplements should not contain 5ppm (mcg/g) of ginkgolic acids, a known allergen.
  • Chronic ginkgo use caused cerebral bleeding and a case of retrobulbar hemorrhage.
  • Ginkgo caused epileptic seizures in people who had their seizures under control.
  • A case of Stevens-Johnson syndrome (SJS) occurred while someone took ginkgo.
  • There was a case of ventricular arrhythmias associated with ginkgo.
  • Avoid ginkgo at least 2 weeks before surgery.
  • Pollen from ginkgo is a strong allergen.
[196-222]


Pregnant or Nursing

Do NOT use ginkgo around labor, it may prolong bleeding after birth. Overall, there is not enough research on the use of supplements containing ginkgo during pregnancy and breast-feeding, so consult a licensed healthcare practitioner before use or avoid use. However, based on expert opinion, ginkgo should NOT be taken during pregnancy and breast-feeding. Ginkgo may be toxic to oocytes. [196-222]



Interactions

Major

  • A ginkgo/St. John’s wort combination with Buspirone and Fluoxetine caused a case of hypomania; though this may have been due to the St. John’s wort
  • A fatal seizure occurred when ginkgo was combined with Depakote and Dilantin
  • Ginkgo combined with Trazodone caused a coma
  • Anti-Coagulant/Anti-Platelet Drugs
  • Anti-Consultants/Anti-Epileptics
  • Anti-Thrombolytic Agents
  • Aspirin
  • Buspirone
  • Cilostazol
  • Clopidogrel
  • Depakote (Valproic Acid)
  • Dilantin
  • Dipyridamole
  • Diuretics
  • Fluoxetine
  • Heparin
  • Ibuprofen
  • Naproxen
  • Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Phenytoin
  • Risperidone
  • Rofecoxib
  • Schizophrenia Drugs
  • Selective Serotonin Reuptake Inhibitors
  • Thiazide Diuretics
  • Ticlopidine
  • Trazodone
  • Warfarin
[223-239]

Moderate

  • Alprazolam
  • Anti-Hypertensives
  • Benzodiazepines
  • Cyclosporine
  • Digoxin
  • Drugs changed by Cytochrome P450s (CYPs) in the liver
  • Haloperidol
  • Midazolam
  • Nifedipine
  • Omeprazole
  • Propranolol
  • Proton Pump Inhibitors
  • Ritonavir
  • Sulfonylureas
  • Tolbutamide
[223-239]

Potential

  • Insulin
  • Efavirenz
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Nicardipine
  • Papaverine
  • Theophylline
  • Ginkgo may NOT interact with Metformin
[223-239]


Dosage

Ginkgo is not a "drug", the best doses have not been thoroughly established. Make sure to follow the specific product instructions and take as directed on the label, or consult a licensed healthcare practitioner before use.



Compounds
Ginkgo compounds


References

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