herbal+med+assign+2008

8/7/2019 Herbal+Med+Assign+2008

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THE UNIVERSITY OF NEW SOUTH WALES

SCHOOL OF BIOTECHNOLOGY AND BIOMOLECULAR SCIENCES

GENS6013 PLANTS AND PEOPLE: MURDER, MAGIC AND MEDICINE

HERBAL MEDICINE ASSIGNMENT 2008

Step 1Students are required to find a substantial advertisement or brochure that deals with the use of a

plant to treat a recognised medical condition or disease as a herbal remedy. This does not include

nutritional conditions nor a specific form of alternative medicine such as homeopathy or

acupuncture. A good source of material are pharmacies, health food shops and some magazines.

THE ORIGINAL ARTICLE MUST BE SUBMITTED AS PART OF YOUR REPORT AND SHOULD NOT COME

FROM THE INTERNET OR WWW.

Step 2

Use the INTERNET to find an appropriate amount of further information and/or claims about the

herbal treatment, for example a 'home page'.

Step 3

You then need to find scientific or other validarticles that attempt to establish whether or not the

herbal treatment actually works or is beneficial. Your choice in Steps 1 and 2 will to some extent be

influenced by what you can find in this category. Do not use the WWW as your primary source of

scientific information unless it is the full text of a scientific article, but you can use it as a source of

supplementary information (or mis-information).

Step 4

A written critique of the original article and the WWW claims for your plant with respect to themedical condition, using the "evidence" that you have found in Step 3. Your answer should include

comment on the language (words) used in the herbal claims, the way the herbal information is

presented, the validity of the actual scientific evidence and any claims or counterclaims regarding

the so called 'hard evidence'.

Your written critique should be typewritten if possible (word processor; double spaced; single side

of the page) and up to 1500 words in length. Evidence (References) should be properly cited in a

bibliography including WWW addresses at the end of your report. In some cases it may be

appropriate to attach them to your assignment.

This assignment is worth 25% of the assessment for this course.

Marks will be awarded for the "relevancy" of your submitted article, the nature, value and reliability

of your evidence for and against, and the quality of your written analysis of all the information you

present.

The declaration sheet (see the back of this sheet), properly filled in and signed, must be attached to

the frontof your assignment.

Please submit your declaration sheet and report securely stapled together.

The assignment is due into the BABS Student Office (Room 103 Biol Sci Bldg) on Friday 24th

October 2008 (Week 12) at 4:00 PM.


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THE UNIVERSITY OF NEW SOUTH WALES

SCHOOL OF BIOTECHNOLOGY AND BIOMOLECULAR SCIENCES

GENS6013 PLANTS AND PEOPLE: MURDER, MAGIC AND MEDICINE

2008

HERBAL MEDICINE ASSIGNMENT

DECLARATION SHEET

STUDENT NAME:

STUDENT NUMBER:

FACULTY:

COURSE:

DECLARATION

I have read the information concerning Academic Misconduct in the Course Structure

handout (page 4).

This assignment is the product of my own individual efforts.

Signed: Date:


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Bacopa(Bacopa monnieri)

Plant Part UsedLeaf

Introduction Back to Top

The leaf of bacopa, or water hyssop, has been used in the Indianmedical system of Ayurveda since the 6 th century A.D. to helpimprove mental performance. It is also considered the foremost

tonic for the nervous system in Ayurvedic medicine. It has beenused traditionally for epilepsy, mental illness, and to improve

memory and mental capacities. Today, scientists think bacopacontains compounds that may enhance nerve impulse

transmission, thereby strengthening memory and general

cognition.

Reported Uses Back to Top

Modern studies may lend credence to what Ayurvedic

practitioners have known for centuries about bacopa's ability toenhance mental function. One

such study suggested that bacopamay increase learning ability in

laboratory animals. Other studieson humans suggest bacopa mayimprove intellectual activity in children. In adults, bacopa maybe effective in reducing anxiety and increasing energy. This

effect, scientists suggest, may lead to improved memory andmental performance.(1) Other human studies have supportedthese findings.(2, 3)

In addition to these memory and mental performance enhancing

effects, bacopa may function as an antioxidant in the body. Morespecifically, it may reduce oxidation of fats in the blood stream,

which is a common risk factor for the developmentcardiovascular diseases.(4)

Finally, a study conducted in the 1960s suggested that bacopamay be useful in improving the symptoms and occurrence of

epileptic seizures.(5) A more recent study confirmed

improvement in memory and mental performance problemsgenerally experienced in patients with epilepsy taking certainanti-seizure medications.(6)

Dosage Info Back to Top

Dosage Range

Most Common

Dosage Standardization50-150mg(standardizedextract), 3 times aday.

100mg(standardizedextract), 2 times aday.

The most currentavailable medicaland scientificliterature indicatesthat this dietary

supplement shouldbe standardized to

20% bacosides Aand B per dose.

*Standardization represents the complete body of information and controls that

serve to enhance the batch to batch consistency of a botanical product, including

Interactions

Drug/Herb Interactions

Calcium channel blockers
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but not limited to the presence of a marker compound at a defined level or within

a defined range.(7)

Toxicities & Precautions Back to Top

Be sure to tell your pharmacist, doctor, or other health careproviders about any dietary supplements you are taking. Theremay be a potential for interactions or side effects.

General

This dietary supplement is considered safe when used inaccordance with proper dosing guidelines.

Pregnancy/Breast-FeedingTo date, the medical literature has not reported any adverseeffects related to fetal development during pregnancy or toinfants who are breast-fed. Yet little is known about the use ofthis dietary supplement while pregnant or breast-feeding.Therefore, it is recommended that you inform your healthcarepractitioner of any dietary supplements you are using whilepregnant or breast-feeding.

Age LimitationsTo date, the medical literature has not reported any adverse

effects specifically related to the use of this dietary supplementin children. Since young children may have undiagnosed allergies

or medical conditions, this dietary supplement should not beused in children under 10 years of age unless recommended by a

physician.

Footnotes Back to Top1 Kidd PM. A Review of Nutrients and Botanicals in theIntegrative Management of Cognitive Dysfunction. Altern Med

Rev. Jun1999;4(3):144-61.View Abstract2 Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW,

Rodgers T, et al. The chronic effects of an extract of Bacopamonniera (Brahmi) on cognitive function in healthy humansubjects. Psychopharmacology (Berl). Aug2001;156(4):481-4.View Abstract3 Roodenrys S, Booth D, Bulzomi S, Phipps A, Micallef C, SmokerJ. Chronic effects of Brahmi (Bacopa monnieri) on humanmemory. Neuropsychopharmacology. Aug2002;27(2):279-81.View Abstract4 Tripathi YB, et al. Bacopa monniera Linn. As An Antioxidant:Mechanism of Action. Indian J Exp Biol. Jun1996;34(6):523-26.View Abstract5 Mukherjee GD, et al. Clinical Trial on Brahmi. I. J Exp Med Sci.1966;10(1):5-11.6

Vohora D, Pal SN, Pillai KK. Protection from Phenytoin-inducedCognitive Deficit by Bacopa monniera, A Reputed Indian

Nootropic Plant. J Ethnopharmacol. Aug2000;71(3):383-390.View Abstract7 American Herbal Products Association. Use of MarkerCompounds in Manufacturing and Labeling Botanically Derived

Dietary Supplements. Silver Spring, MD: American HerbalProducts Association; 2001.

Copyright 2000-2008 NHIOnDemand, LLC All rightsreserved. www.nhiondemand.comThis information is educational in context and is not to be used to

diagnose, treat or cure any disease. Please consult your licensed

health care practitioner before using this or any medicalinformation.

http://content.nhiondemand.com/psv/monoAll-style.asp?

objID=100165&ctype=ds&mtyp=1

Ginkgo(Ginkgo biloba)
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Plant Part Used

Leaf

Introduction Back to Top

Ginkgo is among the oldest living plant species on earth and hasbeen used extensively as a medicinal agent worldwide for

centuries. Today, it is the most frequently prescribed medicinal

herb in Europe. Ginkgo has been the subject of hundreds ofscientific studies that have reported positive effects in a widerange of health areas. The remedy has been popularized for its

use in the support of mental function. There are many other,less publicized, applications. The leaf of the ginkgo tree is usedto derive a standardized extract.

Reported Uses Back to Top

Ginkgo has been extensivelyresearched for its possible

benefits to the elderly. Studiesindicate ginkgo has the ability to

increase circulation which can leadto enhanced memory. (1, 2) Thiseffect can in turn delay the onsetof Alzheimers and reduce theeffects of senile dementia,tinnitus, and vertigo.(3, 4, 5, 6) Studies indicate that ginkgo'ssupport of healthy brain function is related to its ability toincrease blood flow to the brain, thus improving delivery of

nutrients and disposal of waste products.(7)

The effectiveness of ginkgo in treating dementia is debated.

Numerous studies have been completed evaluating numerouspatients with various types of demetia, including Alzheimer's

disease. These studies have had very differing results. In a studyinvolving over 200 patients, a standardized ginkgo preparation(40mg three times a day) was compared to placebo. The ginkgowas reported safe and capable of stabilizing and improvingmental and social functioning for up to a year.(8) Another trialinvolving over 200 patients, compared the same ginkgo

preparation with placebo and reported no advantage with thegingko when used for 24 weeks.(9) A third trial compared 115

people over 60 years old using ginkgo to 115 people over 60years old using placebo. The study evaluated these participants

using 15 different tests for memory and learning. The results ofthis study showed no improvement in the tests for both the

ginkgo and the placebo group.(10)

Four commonly used medications for dementia (tacrine,donepezil, rivastigmine, and metrifonate) were compared to astandardized ginkgo extract and a placebo for their use inAlzheimer's disease. The authors concluded that second-generation cholinesterase inhibitors (donepezil, rivastigmine, andmetrifonate) and the standardized ginkgo extract should beconsidered equally effective in the treatment of mild to moderate

Alzheimer's disease.(11)

Because of its effects on the circulatory system, ginkgo may also

ease the leg pain that arises from intermittent claudication andsimilar disorders.(12, 13) One study even found that ginkgo

performed as well as a leading prescription medication fortreating intermittent claudication.

Ginkgo's ability to support healthy circulation and brain functionhas applications in younger populations as well. Disorders it mayimprove include diabetes and various circulatory conditions

Interactions

Drug/Herb Interactions

Anticoagulant medications

Nonsteroidal anti-inflammatorymedications (NSAIDs)

MAO inhibitors

Antiplatelet medications
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including cyanosis and Raynaud's Syndrome.(14)

Ginkgo has also been used to treat impotence, especially whenassociated with antidepressant therapy.(15, 16) Ginkgo may alsobe involved in a chemical process that reduces the potential forclot formation in the blood by inhibiting platelet activating factor

(PAF).(17) Scientists think this function, along with a potentialability to dilate blood vessels, accounts for its record of use in

treating asthma in China for thousands of years.

Finally, ginkgo is an antioxidant, giving it the ability to help rid

the body of free radicals and thus lessen the risk of chronicdegenerative diseases.(18) Also due to the antioxidant activity ofginkgo, it may help treat macular degeneration(19) and decreasethe damaging effects of radiation, chemotherapy,(20) and certainmedications.(21)

Dosage Info Back to Top

Dosage RangeMost CommonDosage Standardization

40-80mg(standardizedextract), 3 times aday.

40mg (standardizedextract), 3 times aday.

The most currentavailable medicaland scientificliterature indicatesthat this dietarysupplement should

be standardized to24% ginkgo

flavoglycosides and6% triterpenes per

dose; alsostandardized to 27%

flavoglycosides 7%triterpenes per dose.*Standardization represents the complete body of information and controls that

serve to enhance the batch to batch consistency of a botanical product, includingbut not limited to the presence of a marker compound at a defined level or within

a defined range.(22)

Toxicities & Precautions Back to Top

Be sure to tell your pharmacist, doctor, or other health careproviders about any dietary supplements you are taking. There

may be a potential for interactions or side effects.

General

This dietary supplement is considered safe when used inaccordance with proper dosing guidelines.

Fresh seeds of the ginkgo tree should not be eaten because theymay be toxic.

If you are planning to have any type of surgery or dental work,stop using this dietary supplement for at least 14 days prior to

the procedure.(23)

Allergy

Some individuals experience an allergic skin reaction whentaking this dietary supplement. Although extremely rare, call

your doctor or seek medical attention if you have fast orirregular breathing, skin rash, hives or itching.(24)

Health ConditionsIf you have a bleeding disorder, talk to your doctor before takingthis dietary supplement.(25)

Side EffectsSide effects are possible with any dietary supplement. Although
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extremely rare, this dietary supplement may cause

gastrointestinal distress or headache.(26) Tell your doctor ifthese side effects become severe or do not go away.

Pregnancy/Breast-FeedingTo date, the medical literature has not reported any adverse

effects related to fetal development during pregnancy or toinfants who are breast-fed. Yet limited information exists

regarding the use of this dietary supplement while pregnant or

breast-feeding. Therefore, it is recommended that you informyour healthcare practitioner of any dietary supplements you areusing while pregnant or breast-feeding.(27, 28)

Age LimitationsTo date, the medical literature has not reported any adverseeffects specifically related to the use of this dietary supplementin children. Since young children may have undiagnosed allergiesor medical conditions, this dietary supplement should not beused in children under 10 years of age unless recommended by a

physician.

Footnotes Back to Top

1 Kleijnen J, et al. Ginkgo biloba for Cerebral Insufficiency. Br JClin Pharm. 1992;34:352-58.View Abstract2 Kleijnen J, et al. Ginkgo biloba. Lancet. 1992;340(8828):1136-39.3 Maurer K, et al. Clinical Efficacy of Ginkgo biloba Special Extract

EGb 761 in Dementia of the Alzheimer Type. J Psychiatr Res.1997;31(6):645-55.View Abstract4 Kanowski S, et al. Proof of Efficacy of the Ginkgo biloba Special

Extract EGb 761 in Outpatients Suffering from Mild to ModeratePrimary Degenerative Dementia of the Alzheimer Type or Multi-

infarct Dementia. Pharmacopsychiatry. 1996;29:47-56.View Abstract5 Meyer B. Multicenter Randomized Double-blind Drug versusPlacebo Study of Ginkgo biloba Extract in the Treatment ofTinnitus. Presse Med. 1986;15:1562-64.View Abstract6 Odawara M, et al. Ginkgo biloba. Neurology. 1997;48(3):789-90.7 Ernst E. Ginkgo biloba in the Treatment of IntermittentClaudication. A Critical Review. Fortschritte der Medizin.

1996;114(8):85-87.View Abstract8 Le Bars PL, Katz MM, Berman N, et al. A Placebo-controlled,Double-blind, Randomized Trial of an Extract of Ginkgo biloba for

Dementia. North American EGb Study Group. JAMA.Oct1997;278(16):1327-32.View Abstract9 Van Dongen MC, van Rossum E, Kessels AG, et al. The Efficacy

of Ginkgo for Elderly People with Dementia and Age-associatedMemory Impairment: New Results of a Randomized Clinical Trial.J Am Geriatr Soc. Oct2000;48(10):1183-94.View Abstract10 Solomon PR, Adams F, Silver A, Zimmer J, DeVeaux R. Ginkgofor memory enhancement: a randomized controlled trial. JAMA.Aug2002;288(7):835-40.View Abstract11

Wettstein A. Cholinesterase Inhibitors and Gingko Extracts--Are They Comparable in the Treatment of Dementia?Comparison of Published Placebo-controlled Efficacy Studies of atLeast Six Months' Duration. Phytomedicine. Jan2000;6(6):393-

401.View Abstract12 Kleijnen J, et al. Ginkgo biloba. Lancet. 1992;340(8828):1136-
http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#fn100135%23fn100135http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#fn112996%23fn112996http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#fn115832%23fn115832http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#top%23tophttp://content.nhiondemand.com/psv/view-abs.asp?fnid=100189&absid=100558http://content.nhiondemand.com/psv/view-abs.asp?fnid=100204&absid=100564http://content.nhiondemand.com/psv/view-abs.asp?fnid=100213&absid=100567http://content.nhiondemand.com/psv/view-abs.asp?fnid=100219&absid=100568http://content.nhiondemand.com/psv/view-abs.asp?fnid=100228&absid=100559http://content.nhiondemand.com/psv/view-abs.asp?fnid=110350&absid=104882http://content.nhiondemand.com/psv/view-abs.asp?fnid=110351&absid=104883http://content.nhiondemand.com/psv/view-abs.asp?fnid=114807&absid=107235http://content.nhiondemand.com/psv/view-abs.asp?fnid=110352&absid=104884http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#fn100135%23fn100135http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#fn112996%23fn112996http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#fn115832%23fn115832http://content.nhiondemand.com/psv/monoAll-style.asp?objID=100060&ctype=ds&mtyp=1#top%23tophttp://content.nhiondemand.com/psv/view-abs.asp?fnid=100189&absid=100558http://content.nhiondemand.com/psv/view-abs.asp?fnid=100204&absid=100564http://content.nhiondemand.com/psv/view-abs.asp?fnid=100213&absid=100567http://content.nhiondemand.com/psv/view-abs.asp?fnid=100219&absid=100568http://content.nhiondemand.com/psv/view-abs.asp?fnid=100228&absid=100559http://content.nhiondemand.com/psv/view-abs.asp?fnid=110350&absid=104882http://content.nhiondemand.com/psv/view-abs.asp?fnid=110351&absid=104883http://content.nhiondemand.com/psv/view-abs.asp?fnid=114807&absid=107235http://content.nhiondemand.com/psv/view-abs.asp?fnid=110352&absid=104884


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Steven Foster

On this page

Introduction

What It Is Used For

How It Is Used

What the Science Says

Side Effects and Cautions

Sources

For More Information

Introduction

This fact sheet provides basic information about theherbA plant or part of a plant used for its flavor, scent, or potentialtherapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots.ginkgo--common names, uses,potential side effects, and resources for more information. The ginkgo tree is one of the oldest types of trees in the world.Ginkgo seeds have been used in traditional Chinese medicine for thousands of years, and cooked seeds areoccasionally eaten.

Common Namesginkgo, Ginkgo biloba, fossil tree, maidenhair tree, Japanese silver apricot, baiguo, bai guo ye, kewtree, yinhsing (yin-hsing)

Latin NameGinkgo biloba

Top

What It Is Used For

Ginkgo leaf extract has been used to treat a variety of ailments and conditions, including asthma, bronchitis,fatigue, and tinnitus (ringing or roaring sounds in the ears).

Today, people use ginkgo leaf extracts hoping to improve memory; to treat or help prevent Alzheimer's diseaseand other types of dementia; to decrease intermittent claudication (leg pain caused by narrowing arteries); and totreat sexual dysfunction, multiple sclerosis, tinnitus, and other health conditions.

How It Is Used

Extracts are usually taken from the ginkgo leaf and are used to make tablets, capsules, or teas. Occasionally, ginkgoextracts are used in skin products.

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What the Science Says

Numerous studies of ginkgo have been done for a variety of conditions. Some promising results have been seenfor Alzheimer's disease/dementia and intermittent claudication, among others, but larger, well-designed researchstudies are needed.

Some smaller studies for memory enhancement have had promising results, but a trial sponsored by theNational Institute on Aging of more than 200 healthy adults over age 60 found that ginkgo taken for 6 weeks did notimprove memory.

NCCAM is conducting a large clinical trial of ginkgo with more than 3,000 volunteers. The aim is to see if theherb prevents the onset of dementia and, specifically, Alzheimer's disease; slows cognitive decline and functionaldisability (for example, inability to prepare meals); reduces the incidence of cardiovascular disease; and decreasesthe rate of premature death.

Other NCCAM-funded research includes studies on ginkgo for asthma, symptoms of multiple sclerosis, vascularfunction (intermittent claudication), cognitive decline, sexual dysfunction due to antidepressants, and insulinresistance. NCCAM is also looking at potential interactions between ginkgo and prescription drugs.

Side Effects and Cautions

Side effects of ginkgo may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skinreactions. More severe allergic reactions have occasionally been reported.

There are some data to suggest that ginkgo can increase bleeding risk, so people who take anticoagulant drugs,have bleeding disorders, or have scheduled surgery or dental procedures should use caution and talk to a health

care provider if using ginkgo. Uncooked ginkgo seeds contain a chemical known as ginkgotoxin, which can cause seizures. Consuming largequantities of seeds over time can cause death. Ginkgo leaf and ginkgo leaf extracts appear to contain littleginkgotoxin.

Tell your health care providers about any complementary and alternative practices you use. Give them a fullpicture of what you do to manage your health. This will help ensure coordinated and safe care.

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http://nccam.nih.gov/health/ginkgo/#intro%23introhttp://nccam.nih.gov/health/ginkgo/#intro%23introhttp://nccam.nih.gov/health/ginkgo/#uses%23useshttp://nccam.nih.gov/health/ginkgo/#uses%23useshttp://nccam.nih.gov/health/ginkgo/#how%23howhttp://nccam.nih.gov/health/ginkgo/#how%23howhttp://nccam.nih.gov/health/ginkgo/#science%23sciencehttp://nccam.nih.gov/health/ginkgo/#science%23sciencehttp://nccam.nih.gov/health/ginkgo/#cautions%23cautionshttp://nccam.nih.gov/health/ginkgo/#cautions%23cautionshttp://nccam.nih.gov/health/ginkgo/#sources%23sourceshttp://nccam.nih.gov/health/ginkgo/#sources%23sourceshttp://nccam.nih.gov/health/ginkgo/#info%23infohttp://nccam.nih.gov/health/ginkgo/#info%23infohttp://nccam.nih.gov/health/ginkgo/#top%23tophttp://nccam.nih.gov/health/ginkgo/#top%23tophttp://nccam.nih.gov/health/ginkgo/#top%23tophttp://nccam.nih.gov/health/ginkgo/#intro%23introhttp://nccam.nih.gov/health/ginkgo/#uses%23useshttp://nccam.nih.gov/health/ginkgo/#how%23howhttp://nccam.nih.gov/health/ginkgo/#science%23sciencehttp://nccam.nih.gov/health/ginkgo/#cautions%23cautionshttp://nccam.nih.gov/health/ginkgo/#sources%23sourceshttp://nccam.nih.gov/health/ginkgo/#info%23infohttp://nccam.nih.gov/health/ginkgo/#top%23tophttp://nccam.nih.gov/health/ginkgo/#top%23tophttp://nccam.nih.gov/health/ginkgo/#top%23top


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Sources

Solomon PR, Adams F, Silver A, et al.Ginkgo for memory enhancement: a randomized controlled trial.Journalof the American Medical Association. 2002;288(7):835840.

Ginkgo biloba. In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. NewYork, NY: Marcel Dekker; 2005:249257.

Ginkgo. Natural Medicines Comprehensive Database Web site. Accessed on July 2, 2007.

Ginkgo (Ginkgo biloba L.). Natural Standard Database Web site. Accessed on June 28, 2007.

Ginkgo biloba leaf extract. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: ExpandedCommission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:359366.

De Smet PA.Herbal remedies.New England Journal of Medicine. 2002;347(25):20462056.

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For More Information

What's in the Bottle? An Introduction to Dietary Supplements

Herbal Supplements: Consider Safety, Too

NCCAM ClearinghouseToll-free in the U.S.: 1-888-644-6226TTY (for deaf and hard-of-hearing callers): 1-866-464-3615E-mail:[email protected]

CAM on PubMedWeb site: nccam.nih.gov/camonpubmed/

NIH Office of Dietary SupplementsWeb site: ods.od.nih.gov

NIH National Library of Medicine's MedlinePlusGinkgo Listing: www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html

http://nccam.nih.gov/health/ginkgo/Ginkgo biloba

Also listed as: Fossil tree; Kew tree; Maiden hair tree; Ginkgo biloba

Overview

Plant Description

What's It Made Of?

Medicinal Uses and Indications

Available Forms

How to Take It

Precautions

Possible Interactions

Supporting Research

OverviewGinkgo ( Ginkgo biloba ) is one of the oldest living tree species and its leaves are among the mostextensively studied botanicals in use today. Unlike many other medicinal herbs, ginkgo leaves are

not frequently used in their crude state, but rather, in the form of a concentrated, standardized

ginkgo biloba extract (GBE). In Europe and the United States, ginkgo supplements are among the
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12186600&query_hl=1http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12186600&query_hl=1http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12186600&query_hl=1http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12490687&query_hl=3http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12490687&query_hl=3http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12490687&query_hl=3http://nccam.nih.gov/health/ginkgo/#top%23tophttp://nccam.nih.gov/health/bottle/http://nccam.nih.gov/health/bottle/http://nccam.nih.gov/health/supplement-safety/http://nccam.nih.gov/health/supplement-safety/mailto:[email protected]:[email protected]://nccam.nih.gov/camonpubmed/http://ods.od.nih.gov/http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.htmlhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Overview%23Overviewhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Overview%23Overviewhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Plant%20Description%23Plant%20Descriptionhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Plant%20Description%23Plant%20Descriptionhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#What's%20It%20Made%20Of?%23What's%20It%20Made%20Of?http://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#What's%20It%20Made%20Of?%23What's%20It%20Made%20Of?http://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Medicinal%20Uses%20and%20Indications%23Medicinal%20Uses%20and%20Indicationshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Medicinal%20Uses%20and%20Indications%23Medicinal%20Uses%20and%20Indicationshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Available%20Forms%23Available%20Formshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Available%20Forms%23Available%20Formshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#How%20to%20Take%20It%23How%20to%20Take%20Ithttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#How%20to%20Take%20It%23How%20to%20Take%20Ithttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Precautions%23Precautionshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Precautions%23Precautionshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Possible%20Interactions%23Possible%20Interactionshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Possible%20Interactions%23Possible%20Interactionshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Supporting%20Research%23Supporting%20Researchhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Supporting%20Research%23Supporting%20Researchhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12186600&query_hl=1http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12490687&query_hl=3http://nccam.nih.gov/health/ginkgo/#top%23tophttp://nccam.nih.gov/health/bottle/http://nccam.nih.gov/health/supplement-safety/mailto:[email protected]://nccam.nih.gov/camonpubmed/http://ods.od.nih.gov/http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.htmlhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Overview%23Overviewhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Plant%20Description%23Plant%20Descriptionhttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#What's%20It%20Made%20Of?%23What's%20It%20Made%20Of?http://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Medicinal%20Uses%20and%20Indications%23Medicinal%20Uses%20and%20Indicationshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Available%20Forms%23Available%20Formshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#How%20to%20Take%20It%23How%20to%20Take%20Ithttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Precautions%23Precautionshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Possible%20Interactions%23Possible%20Interactionshttp://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm#Supporting%20Research%23Supporting%20Research


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best-selling herbal medications and 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 lend support to these traditional uses. Emerging evidence

suggests that GBE may be particularly effective in treating ailments associated with decreased blood

flow to the brain, particularly in elderly individuals. Laboratory studies have shown that GBE

improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets.

Ginkgo leaves also contain two types of chemicals (flavonoids and terpenoids) believed to have

potent antioxidant properties. Antioxidants are substances that scavenge free radicals -- damaging

compounds in the body that alter cell membranes, tamper with DNA, and even cause cell death.

Free radicals occur naturally in the body, but environmental toxins (including ultraviolet light,

radiation, cigarette smoking, and air pollution) can also increase the number of these damaging

particles. Free radicals are believed to contribute to a number of 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 neutralize free radicals and may reduce or even help prevent some of the

damage they cause.

Plant Description

Ginkgo biloba is the oldest living tree species. A single tree can live as long as 1,000 years andgrow to a height of 120 feet. It has short branches with fan-shaped leaves and inedible fruits that

produce a strong odor. The fruit contains an inner seed, and there has been a report of a human

poisoning from ingesting the seed.

Although Chinese herbal medicine has used both the ginkgo leaf and seed for centuries, modern

research has focused on the standardized Ginkgo biloba extract (GBE), which is prepared from thedried green leaves. This standardized extract is highly concentrated and seems to be clinically more

effective in treating health problems (particularly circulatory ailments) than the non-standardizedleaf alone.

What's It Made Of?

More than 40 components isolated from the ginkgo tree have been identified, but only two are

believed to be responsible for the herb's beneficial effects in humans -- flavonoids and terpenoids.

Flavonoids (such as quercetin and rutin) have potent antioxidant effects. Laboratory and animal

studies have shown that flavonoids protect the nerves, heart muscle, blood vessels, and retina from

damage. Terpenoids (such as ginkgolides) improve blood flow by dilating blood vessels and

reducing the stickiness of platelets.

Medicinal Uses and Indications

Based on studies conducted in laboratories, animals, and humans, many health care professionals

may recommend ginkgo for the following health problems:

Dementia and Alzheimer's Disease

Ginkgo is widely used in Europe for treating dementia. It use is primarily due to its ability to

improve blood flow to the brain and because of its antioxidant properties. The evidence that ginkgo

may improve thinking, learning, and memory in people with Alzheimer's disease (AD) has been

highly promising.

Clinical studies suggest that ginkgo may provide the following benefits for people with AD:

Improvement in thinking, learning, and memory (cognitive function)


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Improvement in activities of daily living

Improvement in social behavior

Fewer feelings of depression

Several studies have found that ginkgo may be as effective as leading AD medications in delaying

the symptoms of dementia in people with this debilitating condition. In addition, ginkgo is

sometimes used preventively because it may delay the onset of AD in someone who is at risk for

this type of dementia (for example, family history).

Eye problems

The flavonoids found in ginkgo may help halt or lessen some retinal problems (that is, problems to

the back part of the eye). Retinal damage has a number of potential causes, including diabetes and

macular degeneration. Macular degeneration (often called age-related macular degeneration or

ARMD) is a progressive, degenerative eye disease that tends to affect older adults and is the number

one cause of blindness in the United States. Studies suggest that gingko may help preserve vision in

those with ARMD.

Intermittent Claudication

Because ginkgo is reported to improve blood flow, this herb has been studied in people with

intermittent claudication (pain caused by inadequate blood flow to the legs). People with

intermittent claudication have difficulty walking without suffering 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 leading medication

in improving pain-free walking distance. However, regular walking exercises are more beneficial

than ginkgo in improving walking distance.

Memory Impairment

Ginkgo is widely touted as a "brain herb." Researchers recently reviewed all of the high-qualitypublished studies on ginkgo and mild memory impairment (in other words, people without

Alzheimer's or other form of dementia), and concluded that ginkgo was significantly more effective

than placebo in enhancing memory and cognitive function. Ginkgo is commonly added to nutrition

bars, soft drinks, and fruit smoothies to boost memory and enhance cognitive performance, although

there is debate over whether the small amounts of ginkgo found in these products are effective.

Tinnitus

Given that nerve damage and certain blood vessel disorders can lead to tinnitus (the perception of

ringing, hissing, or other sound in the ears or head when no external sound is present), some

researchers have investigated whether ginkgo relieves symptoms of this hearing disorder. Althoughthe quality of most studies was poor, the reviewers concluded that ginkgo moderately relieves the

loudness of the tinnitus sound. However, a well-designed study including 1,121 people with tinnitus

found that ginkgo (given 3 times daily for 3 months) was no more effective than placebo in

relieving symptoms of tinnitus. Given these conflicting findings, the therapeutic value of ginkgo for

tinnitus remains uncertain. In general, tinnitus is a very difficult problem to treat.

Other uses

In addition to these health problems, health care professionals may also recommend ginkgo for a

variety of other ailments, including altitude sickness, asthma, depression, disorientation, headaches,

high blood pressure, erectile dysfunction, and vertigo.

A clinical study found that a standardized ginkgo extract may reduce the side effects ofmenopause as well as risk factors for osteoporosis and cardiovascular disease. Women are becomingmore reluctant to use pharmaceutical hormone replacement therapy (HRT) due to its undesirable sideeffects, such as irregular bleeding and an increased risk of breast cancer. Several human studies havereported that a standardized ginkgo extract has estrogenic activity and might be suitable as analternative to HRT.


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A standardized ginkgo extract was reported to significantly improve functional measures (such ascoordination, energy level, strength, mental performance, mood, and sensation) in 22 individuals withmultiple sclerosis (MS).

Available Forms

Standardized extracts containing 24 - 32% flavonoids (also known as flavone glycosides or

heterosides) and 6 - 12% terpenoids (triterpene lactones)

Capsules

Tablets

Liquid extracts (tinctures, fluid extracts, glycerites)

Dried leaf for teas

How to Take It

Pediatric

Ginkgo is not routinely used in children by the medical community. Therefore, it is not currently

recommended to use ginkgo in children under 12.

Adult

Initial results often take 4 - 6 weeks, but should continue to accumulate 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 to240 mg daily, in 2 or 3 divided doses, may be necessary.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs,

however, contain components that can trigger side effects and interact with other herbs,

supplements, or medications. For these reasons, herbs should be taken with care, under the

supervision of a health care provider qualified in the field of botanical medicine.

GBE is considered to be safe, and side effects are rare. In a few cases, gastrointestinal upset,headaches, skin reactions, and dizziness were reported.

Because gingko decreases platelet aggregation (stickiness), there is some concern that it may

increase risk of intracranial (brain) hemorrhage. In fact, there have been several reports of bleeding

complications associated with ginkgo use. However, it is not clear whether ginkgo or another factor

(such as the combination of ginkgo and blood-thinning medications including aspirin and non-

steroidal anti-inflammatory agents such as ibuprofen) caused the bleeding complications. One

human study found that a ginkgo extract significantly prolonged bleeding time when given along

with cilostazol (Pletal), a commonly used medication that inhibits platelet aggregation.

Pregnant and breastfeeding women should avoid using ginkgo preparations. In addition, ginkgo use

should be discontinued at least 36 hours prior to surgery due to the risk of bleeding complications.

Do not ingest Ginkgo biloba fruit or seed.


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Possible 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 decrease the effectiveness of

anticonvulsant therapy, such as carbamazepine (Tegretol) or valproic acid (Depakote), in controlling

seizures.

Antidepressant medications -- Taking ginkgo along with selective serotonin reuptake inhibitor

(SSRIs) antidepressants -- including fluoxetin (Prozac), sertraline (Zoloft), paroxetine (Paxil), and

escitalopram (Lexapro) -- may cause serotonin syndrome. This condition is characterized by

rigidity, tachycardia (fast heart rate), hyperthermia (high body temperature), restlessness, and

diaphoresis (sweating). Ginkgo may enhance the effects (both good and bad) of antidepressant

medications known as MAOIs, such as phenelzine (Nardil).

Antihypertensive medications -- Ginkgo may decrease blood pressure, so use of ginkgo along with

prescription antihypertensive medications should be monitored by a health care provider. There has

been a report of an interaction between ginkgo and nifedipine (Procardia), a calcium channel

blocking drug used for blood pressure and arrhythmias.

Blood-thinning medications -- Ginkgo has blood-thinning properties and therefore should not be

used if you are taking anticoagulant (blood-thinning) medications, such as aspirin, clopidogrel

(Plavix), dipyridamole (Persantine), heparin, ticlopidine (Ticlid), or warfarin (Coumadin). There has

been bleeding in the brain reported when using a ginkgo product and ibuprofen (Advil), a non-

steroidal antiinflammatory drug (NSAID).

Blood sugar lowering medications -- Ginkgo was reported to increase insulin levels in healthy

subjects and to decrease insulin levels in diabetic patients. Use ginkgo supplements under the

supervision of a health care provider if you are diabetic and taking insulin or oral blood sugar

lowering drugs.

Cylosporine -- Ginkgo biloba may help protect the cells of the body during treatment with the

immunosuppressive (decreases immunity) drug cyclosporine.

Thiazide diuretics -- Although there has been one literature report of increased blood pressure

associated with the use of ginkgo during treatment with thiazide diuretics, this interaction has not

been verified by clinical trials. Nevertheless, you should consult with your health care provider

before using ginkgo if you are taking thiazide diuretics.

Trazodone -- There has been a report of an adverse interaction between ginkgo and trazodone

(Desyrel), an antidepressant medication that resulted in an elderly patient going into a coma.

Supporting Research

Adams LL, Gatchel RJ, Gentry C. Complementary and alternative medicine: applications and

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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].

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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scientific evidence. Altern Ther Health Med. 1999;5(4):40-49.


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Barth SA, Inselmann G, Engemann R, Heidemann HT. Influences of Ginkgo biloba on cyclosporin

A induced lipid peroxidation in human liver microsomes in comparison to vitamin E, glutathione

and N-Acetylcysteine. Biochem Pharmacol. 1991;41(10):1521-1526.

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.

Birks, J., Grimley, E. V., and Van Dongen, M. Ginkgo biloba for cognitive impairment and

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Blumenthal M, Busse WR, Goldberg A, et al., ed. The Complete German Commission EMonographs: Therapeutic Guide to Herbal Medicines . Boston, Mass: Integrative MedicineCommunications; 1998.

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.

Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, Ore: Eclectic Medical;1998:76-77.

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

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

Cieza, A., Maier, P., and Poppel, E. Effects of Ginkgo biloba on mental functioning in healthy

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Cupp MJ. Herbal remedies: adverse effects and drug interactions. Am Fam Physician .1999;59(5):12391244.

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

Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical

indications. Arch Phys Med Rehabil. 2000;81:669-678.

Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo

controlled trial. BMJ. 2001;322(7278):73.

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.

Ernst E. The risk-benefit profile of commonly used herbal therapies: ginkgo, St. John's wort,

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Ernst E, Pittler MH. Ginkgo biloba for dementia: a systematic review of double-blind, placebo-

controlled trials. Clin Drug Invest. 1999;17:301-308.

Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol. 1999;24(3):164-167.

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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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.

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

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by Ginkgo biloba extract (Egb 761) in type 2 diabetes mellitus complicated with retinopathy.

Clin.Nutr. 2004;23(4):615-621.

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.

Kidd PM. A review of nutrients and botanicals in the integrative management of cognitive

dysfunction. Alt Med Rev . 1999;4(3):144-161.

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.

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.

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.

Kleijnen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. [Review]. Br J Clin Pharmacol.1992;34(4):352-358.

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.

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

Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF. A placebo-controlled,

double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA . 1997;278:13271332.

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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ginkgo biloba on the pharmacokinetics of digoxin. Am.J Ther 2003;10(4):247-251.

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 JNeurol. 2006;13(9):981-5.

Meisel, C., Johne, A., and Roots, I. Fatal intracerebral mass bleeding associated with Ginkgo biloba

and ibuprofen. Atherosclerosis. 2003;167(2):367.

Miller LC. Herbal medicinals: selected clinical considerations focusing on known or potential drug-

herb interactions. Arch Intern Med. 1998;158(9):22002211.

Mix JA, Crews WD. An examination of the efficacy of Ginkgo biloba extract Egb 761 on the

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intermittent claudication: a meta-analysis of randomised trials. Drugs . 2000;59(5):1057-1070.

Nathan, P. J., Harrison, B. J., and Bartholomeusz, C. Ginkgo and memory. JAMA . 2-5-

2003;289(5):546-548.

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

Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in

Alzheimer disease. Arch Neurol. 1998;55:1409-1415.

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.

Peters H, Kieser M, Holscher U. Demonstration of the efficacy of Ginkgo biloba special extract Egb

761 on intermittent claudication a placebo-controlled, double-blind trial. Vasa . 1998;27:105110.

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.

Rai GS, Shovlin C, Wesnes KA. A double-blind, placebo controlled study of Ginkgo biloba extract

('tanakan') in elderly outpatients with mild to moderate memory impairment. Curr Med Res Opin1991;12(6):350-355.

Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract.

N Engl J Med. 1997;336:1108.

Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas associated with chronic ginkgo.Neurol. 1996;46:17751776.

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.

Sikora R, Sohn M, Deutz F-J, et al. Ginkgo biloba extract in the therapy of erectile dysfunction. JUrol. 1989;141:188A.

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 oldervolunteers. Phytother Res . 2004;18(7):531-537.

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 ClinEpidemiol. 2003;56(4):367-376.


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Japanbaum, Japanese silver apricot, kew tree, kung sun shu, LI 1370, maidenhair tree,

noyer du Japon, oriental plum tree, pei kuo, pei-wen, Pterophyllus, Pterophyllus

salisburiensis , Rokan, R Kan, salisburia, Salisburia adiantifolia , Salisburia

macrophylla , Seredin, silver apricot, sophium, tanakan, tanakene, tebofortan, tebonin,

tempeltrae, temple balm, tramisal, valverde, vasan, vital, ya chio, yin-guo, yin-hsing.

EvidenceReturn to top

These uses have been tested in humans or animals. Safety and effectiveness have not alwaysbeen proven. Some of these conditions are potentially serious, and should be evaluated by aqualified healthcare provider.

Uses based on scientific evidence 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 Europethan 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

C
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the treatment of patients with acute hemorrhoidal

attacks. Further research is needed to confirm

these results.

Age-associated memory impairment (AAMI)

Age-associated memory impairment (AAMI) is a

non-specific syndrome, which may be caused byearly 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) sicknessA 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

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

Cognition

It remains unclear if ginkgo is effective for

cognition improvement. Further well-designed

research is needed as existing study reports

conflicting evidence.

C

Deafness (cochlear)

Preliminary clinical study has been conducted on

the effect of ginkgo in chronic cochleovestibular

disorders. Further research is needed before a


C

Depression and seasonal affective disorder

(SAD)

Preliminary study of seasonal affective disorder

(SAD) suggests that ginkgo is not effective in

C


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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.

Gastric cancer

Ginkgo bilobaexocarp 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 beensignificant. Further research is needed before a


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 mayimprove 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

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


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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 inquality 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 thiscontroversy.

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


C

StrokeLaboratory 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


C

Vitiligo C


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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.

Cocaine dependence

One small study reports no benefit of ginkgo forcocaine independence.

D

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

Mood and cognition in post-menopausal

women

Based on early study of chronic administration,

Gincosan appears to have no beneficial effects

on mood, anxiety, or sleepiness in post-

menopausal women.

D

*Key to grades

A: Strong scientific evidence for this use;

B: Good scientific evidence for this use;

C: Unclear scientific evidence for this use;D: Fair scientific evidence against this use;

F: Strong scientific evidence against this use.

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been

thoroughly tested in humans, and safety and effectiveness have not always been proven.

Some of these conditions are potentially serious, and should be evaluated by a qualified

healthcare provider.

Acidosis, aging, alcoholism, allergies, angina, anti-bacterial, anti-fungal, anti-inflammatory,antioxidant, anti-parasitic, anti-rheumatic, anti-tumor, anxiety, asthma, attention deficithyperactivity disorder, autoimmune disorders, bladder disorders, blood vessel disorders, bloodclots, body fat reducer (cellulite), brain damage, breast disease, breast tenderness, bronchialasthma, bronchitis, cancer, cataracts, chest pain, chilblains (inflammation of toes, fingers, ears,or face with exposure to cold), chronic rhinitis, cochleovestibular impairment (vascularvestibular disorders, vestibular organ peripheral lesion syndrome), colorectal cancer,congestive heart failure, cough, cyanosis, degenerative diseases (prevention), dermatitis,diabetes, diabetic nerve damage (neuropathy), digestion, dizziness, dysentery (bloodydiarrhea), eczema, edema, encephalopathy (circulatory), fatigue, fibromyalgia, freckle-removing, genitourinary disorders, headache, heart attack, hepatitis B, high cholesterol, highblood pressure, hypoxia (lack of oxygen), immunomodulator, insomnia, labor induction,menstrual pain, migraine, mouth cancer, respiratory tract illnesses, scabies (ginkgo cream),

schizophrenia, seizures, sepsis, skin sores (ginkgo cream), spermicide, swelling, traumatic braininjury, ulcer (trophic lesions), ulcerative colitis, vaginal dryness, varicose veins, vision (color).
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DosingReturn to top

The below doses are based on scientific research, publications, traditional use, or expertopinion. Many herbs and supplements have not been thoroughly tested, and safety andeffectiveness may not be proven. Brands may be made differently, with variable ingredients,even within the same brand. The below doses may not apply to all products. You should readproduct labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)

80 to 240 milligrams of a 50:1 standardized leaf extract taken daily by mouth in 2 to 3divided doses has been used and studied (standardized to 24% to 25% ginkgo flavone

glycosides and 6% terpine lactones). Other forms used include tea (bags usually contain

30 milligrams of extract), 3 to 6 milliliters of 40 milligrams per milliliter extract daily in

three divided doses, and "fortified" foods. Ginkgo seeds are potentially toxic and should

be avoided. The German ginkgo product Tebonin, given through the veins (IV), was

removed from the German market due to significant side effects.

Children (under 18 years old)

There is not enough scientific evidence to recommend use of ginkgo in children.

SafetyReturn to top

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. Thereis no guarantee of strength, purity or safety of products, and effects may vary. You shouldalways read product labels. If you have a medical condition, or are taking other drugs, herbs, orsupplements, you should speak with a qualified healthcare provider before starting a newtherapy. Consult a healthcare provider immediately if you experience side effects.

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 becross-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
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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.

InteractionsReturn to top

Most herbs and supplements have not been thoroughly tested for interactions with other herbs,supplements, drugs, or foods. The interactions listed below are based on reports in scientificpublications, laboratory experiments, or traditional use. You should always read product labels.If you have a medical condition, or are taking other drugs, herbs, or supplements, you should

speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Overall, controlled trials of ginkgo report few adverse effects and good tolerance, with

rates of complications similar to placebo. However, use of ginkgo with drugs that may

cause bleeding may further increase the risk of bleeding, based on multiple case reports

of spontaneous bleeding in patients using ginkgo alone, with warfarin (Coumadin), or

with aspirin. One case report documents a possible increase in bleeding risk with

ticlodipine (Ticlid) and ginkgo. Examples of drugs that may increase the risk of

bleeding include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin)

or heparin, anti-platelet drugs such as clopidogrel (Plavix), and non-steroidal anti-

inflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Naprosyn,

Aleve). However, not all studies agree with the existence of this risk, and it is not clear

if particular types of patients may be at greater risk.

Based on preliminary research, ginkgo may affect insulin and blood sugar levels. Caution

is advised when using medications that may also lower blood sugar. Patients taking

drugs for diabetes by mouth or insulin should be monitored closely by a qualified

healthcare professional. Medication adjustments may be necessary.

Ginkgo has been found to decrease blood pressure in healthy volunteers, although some

studies disagree. Theoretically, ginkgo may add to the effects of medications that alsolower blood pressure, although raised blood pressure has been reported in a patient

taking a thiazide diuretic ("water pill") with ginkgo. It has been suggested that Ginkgo

biloba leaf extract (GBE) and nifedipine should not be ingested at the same time.

Monoamine oxidase (MAO) inhibition by ginkgo was reported in one animal study, but

has not been confirmed in humans. In theory, if taken with MAOI drugs, such as

isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate), additive

effects and side effects may occur. Based on laboratory research, ginkgo may also add to

the effects of SSRI antidepressants such as sertraline (Zoloft), with an increased risk of

causing serotonin syndrome, a condition characterized by stiff muscles, fast heart rate,hyperthermia, restlessness, and sweating.

Based on human use, ginkgo may decrease side effects of antipsychotic drugs, although

scientific information in this area is limited. There is a case report of "coma" in an elderly

Alzheimer's patient taking trazodone and ginkgo, although it is not clear that this

reaction was due to ginkgo. In theory, ginkgo may increase the actions of drugs used for
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erectile dysfunction such as sildenafil (Viagra).

There may be a risk of seizure when taking ginkgo, particularly in people with a history of

seizure disorder. Although most reports of seizures have been due to eating ginkgo

seeds (not leaf extract which is found in most products), an animal study found that the

anti-seizure properties of sodium valproate or carbamazepine were reduced by giving

ginkgo. In theory, drugs such as donepezil (Aricept) and tacrine (Cognex) may have

an additive effect when used at the same time as ginkgo, potentially increasing

cholinergic effects (such as salivation and urination).

5-fluorouracil induced side effects and cyclosporine kidney toxicity may in theory be

improved by ginkgo, although evidence is not conclusive in these areas. Colchicine has

been found in commercial preparations of ginkgo, and may increase blood

concentrations in patients using colchicine.

Ginkgo may alter the way the liver breaks down certain drugs.

Interactions with Herbs and Dietary Supplements

Use of ginkgo with herbs or supplements

herbal+med+assign+2008

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