Ginkgo

Nutrient group: plant extracts & active ingredients

Sources and physiological effects

Dietary sources
The tree Ginkgo biloba L. has long been used in traditional Chinese medicine. It is the only surviving member of the family (Ginkgoaceae) and the order (Ginkgoales). For some years leaf, extracts have been used in phytomedicine worldwide for the treatment of cerebral dysfunctions and circulatory disorders, among other uses. Special extracts are classified by the WHO as antidementives. As a foodstuff, the plant is only used in China and Japan, where the kernal of the seeds are cooked as an accompaniment to various dishes or roasted for nibbling.
Physiological effects
Antioxidant	Reduction of lipid peroxidation
Cardiovascular system	Reduction of platelet aggregation Reduction of whole blood viscosity Increase in vasodilation by release of the “endothelial-derived relaxing factors“ Stabilization of capillary permeability
Brain metabolism	Promotion of oxygen and glucose uptake Increase in cerebral hypoxia tolerance

Detailed information

Ingredients and physiological effects of ginkgo leaf

Ginkgo biloba, which is revered as a temple tree in Asia, plays an important role in Western pharmacology. The active ingredients contained in the ginkgo leaf are successfully used in phytotherapy for the treatment of various disorders and diseases due to their multivalent therapeutic effects. Ginkgolides A, B and C, which belong to the terpene lactones, as well as flavone glycosides are primarily responsible for the pharmacological results.

Its main effects are to reduce platelet aggregation, reduce whole blood viscosity, increase vasodilation by releasing the endothelial-derived relaxing factor, stabilize capillary permeability, prevent pathological lipid peroxidation through antioxidant properties, promote oxygen and glucose uptake into tissues, especially the brain, and increase cerebral hypoxia tolerance. In addition, neuroprotective, antihemorrhagic and anti-edematous properties have been demonstrated. (1)

Ginkgo – Antixoidants

Ginkgo biloba has pronounced antioxidant effects. In animal experiments, the processes of lipid peroxidation as well as the number of free radicals could be limited by ginkgo supplementation, whereby an increased in active protection of the cell membranes was detectable (2).

Ginkgo biloba in cerebral ischemia

The use of ginkgo in the symptomatic treatment of cerebro-organic performance disorders has long been scientifically established. The main reason for the observed general improvements in the health status are presumably due to the recognized effects of ginkgolides and bilobalide on platelet aggregation and the reduction of whole blood viscosity. This significantly increases the blood circulation in the peripheral tissues (1). Improving local cerebral blood flow also benefits brain tissue, which explains the success of Ginkgo biloba in increasing cognitive performance and treating brain disorders (3).

A placebo-controlled double-blind study showed that 120 mg of Ginkgo biloba can significantly improve concentration and visual short-term memory in healthy individuals after 4 hours (4). Ginkgo extracts proved to be just as effective as cholinesterase inhibitors in therapeutic applications for Alzheimer's diseases (5).

Various studies show an improvement in symptoms, especially in older people (3). An increase in the quality of life for the patient is accompanied by lower treatment costs and a reduction in the psychological and physical strain on relatives and nursing staff (6).

Ginkgo in cardiovascular diseases and diabetic polyneuropathies

More and more studies show an effective preventive use of Ginkgo biloba in cardiovascular diseases. Ginkgo biloba is particularly suitable for targeted curative and restorative use in the treatment of thrombosis, arterial disorders and venous insufficiency due to its antithrombotic and antioxidant properties (7).
Use in stage II peripheral arterial occlusive disease (intermittent claudication) as part of a physical-therapeutic treatment shows good results in terms of lengthening the walking distance while reducing the intensity of pain (8). In diabetic polyneuropathies, a significant increase in nerve conduction velocity was observed after 4 weeks (1).

Ginkgo in macular degeneration

Supplementation with Ginkgo biloba extract shows good results in the prevention and accompanying therapy of age-related macular degeneration (AMD). Clinical studies show an improvement of the visual abilities after 4 weeks. Hypothetically, a long-term improvement in blood circulation in the retina will increase visual acuity. The proportion of patients with positive results was doubled with the use of high-dose preparations. (9)

Ginkgo for dizziness and tinnitus

Ginkgo also has a positive effect on depressed mood, dizziness, tinnitus and headaches. A dizziness symptoms with unclear etiology genesis could be eliminated after 3 months of therapy with Ginkgo extract in more than half of the affected patients. (1)
Therapeutic studies of chronic tinnitus aurium showed not only significant improvements but also good tolerability after 3 months of use. Both the intensity and the time to the disappearance of the tinnitus were significantly reduced compared to a placebo. (1)
Ginkgo biloba can also be used in the treatment of altitude sickness. Pulmonary edemas are not prevented, but the severity of the symptoms is demonstrably reduced. (10)

Indications

Effect	Indication	Dosage
Physiological effects at a low intake	For symptomatic treatment of cognitive perfomance disorders inclucding symptomes with relating to attention, memory and concentration disorders	500 – 700 mg/d
	Complementary therapy for degenerative and vascular demonic diseases and their mixed forms	500 – 700 mg/d
	Complementary therapy for peripheral arterial circulatory disorders and occlusive diseases	500 – 700 mg/d
	Preventive and concomitant therapeutic for cardiovascular diseases	250 – 500 mg/d
	For Vertigo and tinnitus aurium	500 – 700 mg/d
	Age-related macula degeneration	500 – 700 mg/d
	Accompanying with diabetic polyneuropathies	500 – 700 mg/d

Administration

General mode of administration
When	Ginkgo should be taken with meals.
	Notes: Ginkgo must be taken for at least 8 weeks for brain disorders and for at least 6 weeks for circulatory disorders.
Side effects
No side effects known to date.
Contraindications
No contraindications known to the best of our knowledge. However, due to lack of evidence, it should not be used during pregnancy, breastfeeding and in infants.

Interactions

Drug interactions
None	No interactions are known to date.
Nutrient interactions
None	No interactions are known to date.

References

1) Wagner, H., Wiesenauer, M. Phytotherapie. Phytopharmaka und pflanzliche Homöopathika. 2003.
2) Boveris, A. D. et al. 2007. In vivo supplementation with Ginkgo biloba protects membranes against lipid peroxidation. Phytother Res. 21(8):735-40
3) Curtis-Prior, P. et al. 1999 Therapeutic value of Ginkgo biloba in reducing symptoms of decline in mental function. J Pharmacol. 51(5):535-41
4) Elsabagh, S. et al. 2005. Differential cognitive effects of Ginkgo biloba after acute and chronic treatment in healthy young volunteers. Psychopharmacology (Berl).
5) Wettstein, A. 2000. Cholinesterase inhibitor and Ginkgo extracts – are they comparable in the treatment of dementia? Phytomedicine. 6(6):393–401
6) Heinen-Kammerer, T. et al. 2005. The situation of patients with dementia may be rectified by Ginkgo biloba. Results of a health services research study concerning the ability of patients with dementia, quality of life of the nursing family members and total treatment costs. MMW Fortschr Med. 147 Suppl.3 :127-33
7) Zhou, W. et al. 2004. Clinical use and molecular mechanism of action of extract of Ginkgo biloba leaves in cardiovascular diseases. Cardiovasc Drug Rev. 22(4):309-19
8) Pittler, M. H., Ernst, E. 2000. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 108(4):276-81
9) Fies, P., Dienel, A. 2002. Ginkgo extract in impaired vision- treatment with special extract EGb 761 of impaired vision due to dry senile macular degeneration. Wien Med Wochenschr. 152(15-16):423-6
10) Berg, J. T. 2004. Ginkgo biloba extract prevents high altitude pulmonary edema in rats. High Alt Med Biol. 5(4):429-34

References Interactions:

Stargrove, M. B. et al. Herb, Nutrient and Drug Interactions: Clinical Implications and Therapeutic Strategies, 1. Auflage. St. Louis, Missouri: Elsevier Health Sciences, 2008.
Gröber, U. Mikronährstoffe: Metabolic Tuning –Prävention –Therapie, 3. Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2011.
Gröber, U. Arzneimittel und Mikronährstoffe: Medikationsorientierte Supplementierung, 3. aktualisierte und erweiterte Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2014.