Ginkgo

Botanical Description & Habitat

Ginkgo biloba

Family
Ginkgoaceae

Common Names:

Ginkyo
Maidenhair Tree
Yinhsing

Habitat
Native of China. It is widely cultivated for ornamental purposes.

Bai Gou or Pai Kuo (in Chinese = Ginkgo Seeds)

Description
Individual trees may live as long as 1,000 years, growing to a height of 100-122 feet and with a trunk diameter of 3-4 feet. The Ginkgo has short horizontal branches with short shoots bearing leaves measuring 2-4 in. across. The leaf resembles a fan or the maidenhair fern. Because of this, the Ginkgo has also been called the "maidenhair tree." It bears a foul-smelling, non-edible fruit and an ivory-colored inner seed resembling an almond. The seed is edible and is sold in the Orient.

Medicinal Parts
The leaves, subjected to a purified, concentrated extraction procedure. The roots and seeds (nuts) are also used, in Chinese medicine.

Historical Properties & Uses

The Ginkgo biloba tree has been called "the doyen of trees," because of its antiquity. It is believed to pre-date the ice age. Individual trees are believed capable of living 2000 to 4000 years, and some extant are dated to over a 1000 years. It is the sole remaining species of the so-called Ginkgophyte botanical division which, according to fossil records, once flourished on the earth. Hence, Ginkgo is also often called "a living fossil."

The tree is basically native to China and Japan (though there is evidence it was native to Europe at some ancient date), but has been extensively cultivated throughout the world due to its hardy nature. Ginkgo biloba is remarkably resistant to all kinds of pollution, virus and fungi. It has a unique history, unique life cycle, and extremely unique biochemistry.

Asian cultures have used the kernel of Ginkgo medicinally for hundreds of years. The body of folklore surrounding this practice is quite extensive.

The nuts are considered to be: antibacterial, antifungal, antitussive, astringent, expectorant, and sedative.

The nuts are used for asthma, bladder irritation, cancer, catarrh, diabetes, diphtheria, dysentery, weak kidneys, incontinence, typhoid, tinnitis, tuberculosis, frequent urination, vaginal infection, and peripheral vascular disease.

However, the modern Western use of ginkgo is limited almost exclusively to the leaf extract. Since very little folk medicine has had a chance to develop concerning the leaf (the use of which begins seriously as recently as the early 1970's), the modern use of Ginkgo is somewhat of an anomaly in herbal medicine, being almost completely without a body of historical experiential data upon which to build an experimental science. It is almost as if the modern scientific body of information on Ginkgo sprang up overnight.

Ginkgo biloba extract is a complex product or compound, whose method of preparation has become very well-defined and exacting (there are, however, just a few labs in the world with the capability and know-how to do it). The green leaves of the tree are usually harvested from trees growing in plantations in South Korea, Japan and France. Growing, harvesting and extracting are perfectly standardized and controlled, insuring all undesirable substances are eliminated and certain levels of active constituents are obtained.

Ginkgo biloba leaf extract has approval status by the German Commission E for dementia, peripheral arterial occlusive disease, as well as vertigo and tinnitus of vascular and involutional origin.

Ginkgo biloba leaf, itself, is unapproved. Either there was insufficient evidence in favor, or a contraindication.

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Method of Action

Active constituents in Ginkgo leaves are flavoglycosides (heterosides), and quercetin, as found in the leaf
However, the use of whole leaf is of little efficacy. The product is only effective when extracted and concentrated. In addition to the guaranteed potency constituents, a substantial amount of pharmacologically active terpene derivatives (ginkgolides and bilobalides) should also be present.

Alzheimer's disease

In reviewing the available research, one scientist concluded Ginkgo extract showed exceptional promise as the drug of choice "in all types of dementia, and even in patients suffering from cognitive disorders secondary to depression, because of its beneficial effects on mood. Of special concern are people who are just beginning to experience deterioration in their cognitive function. Ginkgo biloba extract might delay deterioration and enable these subjects to maintain a normal life and escape institutionalization.

In addition, Ginkgo biloba extract appears to be a safe drug, being well tolerated, even in doses many times higher than those usually recommended.

Cerebro-vascular effects

Microscopic particles were injected into the carotid artery of rats to mimic arterial blockage. The administration of Ginkgo biloba successfully protected the animals against the destructive effects of this procedure. Under the influence of Ginkgo, increased levels of glucose and ATP occur, which helps to maintain energy levels within individual cells. The damage begins with just small molecules passing the barrier, but progresses until increasingly larger substances cross over.

In later stages, considerable swelling (edema) of cerebral tissues becomes evident. The administration of Ginkgo, initially, prevents the later stages by stabilizing the membranes involved in the blood-brain barrier. Other studies have shown stabilization takes place through direct action on the ionic potential across the membranes and indirectly, through action on intracellular (mitochondrial) respiration. These actions result in diminution of cerebral edema and complete restoration of function.

Free radical inhibitor

Ginkgo demonstrates an ability to neutralize free radicals.

The flavonoids of Ginkgo, including quercetin, are extremely potent oxygen scavengers. Possessing a particular affinity for the central nervous system (as well as the adrenal and thyroid glands) Ginkgo is ideally suited for use in protecting the heart, blood vessels and brain.

Free radical inhibition by Ginkgo has been reported in a number of petri dish models. Ginkgo not only destroys existing free radicals, but also inactivates their formation, and inhibits membrane lipid peroxidation (a destructive effect for which free radicals are partly responsible).

Ginkgo significantly prevents the onset and severity of visual impairment due to diabetes, probably because of its effect on free radicals.

Ginkgo significantly improves long distance visual acuity in human patients suffering from senile macular degeneration (macula refers to an opacity of the pupil occurring in the elderly). Free oxygenated radicals are thought to be the cause of this condition.

Ginkgo has displayed a protective effect against argon laser blast-induced lesions of retinal cells.

Inner ear

Both structural and functional disturbances of the inner ear have been successfully treated with Ginkgo. These problems all stem from some underlying vascular defect.

In one study Ginkgo was given to patients suffering from hearing loss due to old age (presbyacusia), patients with persistent ringing in the ears, and patients with vertigo. Improved hearing was experienced by 40% of the presbyacusia patients; those who didn't respond were assumed to have irreversible lesions of the sensory structures of the inner ear. Most of those patients with ringing in the ear experienced significant improvement within 10-20 days. The action of Ginkgo on cerebral circulation resulted in swift and complete disappearance of vertigo. Ginkgo should also be used for prevention of otorhinolaryngeal problems.

An 88% success rate was obtained in a study involving 49 patients suffering variously from hearing loss, ringing, vertigo and labyrinthine syndrome.

In recent deafness, following head injuries or sonic damage, the results were very good in more than 60% of the cases. Ringing in the ear improved significantly, even in very severe cases, at a rate of 74%.

Almost all patients with vertigo reported significant improvement.

In one study of vertigo, 70 patients were given Ginkgo or placebo over a 3 month period. The effectiveness of the Ginkgo on the intensity, frequency and duration of the disorder was statistically significant. At the end of the trial, 47% of the patients receiving Ginkgo were completely free of their symptoms (18% of the placebo group recovered). Other studies have essentially replicated the findings of this one.

Mental and behavioral effects

In a 12 week study, elderly patients expressing no particular complaint were selected to receive Ginkgo (120mg) or placebo on a daily basis. EEG readings were taken daily and certain behavioral and psychometric tasks were engaged in. The Ginkgo produced definite improvements in alertness measures in persons in whom there was room for improvement but induced no change in the persons whose initial performance was already at a high level. In comparison to controls, the experimental subjects showed a substantial increase in vigilance as measured by simple reaction time tests and multiple choice reaction tests.

Ginkgo increases the rate of information processing at neuronal levels, not only in geriatric persons with deteriorating mental function but even in young individuals.

In another study, 8 healthy female volunteers were administered variable doses of Ginkgo one hour before being subjected to a battery of tests, including critical flicker fusion (when do two flickers look like one), choice reaction time, subjective rating scale, and the Sternberg memory scanning test (a measure of short term memory). A 600 mg dose produced significant differences in scores on the Sternberg test; the first 3 measures were not affected.

These results differentiate Ginkgo from sedative and stimulant drugs (which would affect the first 3 tests) and suggest a selective effect of Ginkgo on the memory process.

Utilizing the EEG, it was found the EEG tracings correlated well with the psychometric tests employed. The results confirmed those of other clinical trials and especially highlighted the ability of Ginkgo to enhance alertness in the human subjects.

Not many long term studies exist, given the short history of Ginkgo research but one such study was recently reported. Using 166 patients, researchers tracked the effects of Ginkgo on a battery of behavioral, clinical and physiological measures (such as those discussed elsewhere) of cerebral disorders due to aging. Differences between control and treatment groups became clearly apparent after just three months. Over the ensuing months, the differences increased - a dramatic demonstration of benefits available from the use of Ginkgo extract.

Neurotransmitters

Pretreatment with Ginkgo significantly increases blood flow to the brain and also produces a significant rise in dopamine synthesis, a neurotransmitter critical to the transfer of information and electrochemical impulses between nerves and other nerves, and between nerves and muscles, glands, organs, blood vessels and other structures of the body.

Studies on the contractile action of Ginkgo on isolated rabbit aorta have found this action is probably due to other neurotransmitters: the catecholarnines, namely epinephrine and norepinephrine.

Because of its capacity to release catecholamines, Ginkgo could affect the functioning of the entire network of catecholaminergic, glandular, cardiovascular and nervous systems of the body (perhaps the most extensive network upon which depends the most important functions of life). Ginkgo exerts a specific effect on the noradrenergic system (noradrenergic is the name of the nervous system depending primarily on the presence of norepinephrine), as well as on beta-receptors. Beta receptor sites, when activated, produce among other things dilation of airways in the lung, and dilation of peripheral blood vessels - i.e., those going to muscles, etc. The best description of the effect of Ginkgo on the noradrenergic system is "reactivation."

By reactivating the noradrenergi'c system of the cerebral cortex, Ginkgo promises to be an important substance in the prevention of premature aging.

Ginkgo also affects the cholinergic aspect of the nervous system. The decline in function of this system is also implicated in the aging process and the onset of dementia. Using rats as a model, researchers have found Ginkgo significantly increases cholinergic receptor sites in the brain. Rather than having a direct effect on transmitter substances, in this instance, the compound works by proliferating sites that can be activated by cholinergic neurotransmitters. The end result is the same: revitalization of decreasingly effective cerebral tissue.

Platelet aggregation

Ginkgo has an inhibitory effect on blood platelet aggregation, effectively reducing the tendency of blood components to stick together; therefore, it prevents dangerous clots, or thrombi. This implies, of course, that Ginkgo is effective in preventing coronary thrombosis and in recovery from strokes and heart attacks, etc.

Proctology

Patients suffering from acute and chronic hemorrhoids have received great relief from the use of Ginkgo. One early study reported good or very good results in 86% of several dozen patients with hemorrhoids in a more or less advanced stage. The compound was particularly effective in individuals with congestive conditions and bleeding. Ginkgo appears to have less effect on fissures, but is very good at relieving pain and stopping rectal bleeding.

Vascular effects (humans)

Patients with organic and neurological angiopathy were observed for changes in several physiological parameters resulting from exercise, after using Ginkgo. It was concluded Ginkgo treatment should be considered in any case of central and peripheral vascular disease. Ginkgo should be an effective treatment for diabetic angiopathy as it decreases the consumption of insulin.

In persons recovering from thrombosis (blood clot in artery of heart), it was found Ginkgo lowered blood pressure and dilated peripheral blood vessels, including the capillaries.

Ginkgo has been found to affect the microcirculation of the conjunctiva in elderly patients suffering from disturbances in cerebral blood supply.

These studies have found a consistent increase in capillary and venous blood flow to the head resulting from decreased resistance to flow. The reduction in flow was not accompanied by hypotension or any appreciable variations in blood pressure.

Ginkgo Biloba avoids another common complication of orthodox hypotensive medications: it increases peripheral blood flow without sacrificing cerebral circulation.

A common side-effect of standard peripheral vasodilators is blood tends to accumulate in the expanded vessels rather than circulate to the veins feeding the central nervous system, whose supporting vascular micro-structure is not affected by the drug. Ginkgo avoids this complication by simultaneously increasing blood flow to the periphery and to the brain.

Of 20 subjects experiencing a lack of adequate blood supply to the brain (cerebral circulatory insufficiency) due to age and arteriosclerosis 15 responded dramatically with much improved cerebral hemodynamics.

In a study in patients with peripheral arterial insufficiency, Ginkgo was able to produce significant improvement in all experimental measures, including measures of ability to walk long distances without pain, and on blood flow to the legs. The experimenters describe the results as not only statistically significant, but as clinically remarkable.

Administered to patients with Parkinson's disease secondary to cerebral arteriosclerosis, Ginkgo increased blood supply to the brain and improved its nutritional status.

Many other studies of improved vascular flow could be reviewed here. Instead, we will summarize some of the more important results as follows (over 95% of the following studies were double-blind placebo controlled trials):

65% successful treatment of 30 patients with focal or diffuse cerebral vascular disease.

80% successful treatment of 47 patients with cerebral circulatory insufficiency, measured as improvement in mental functioning, EEG parameters, and cerebral angiogram. This study was a good demonstration of the potential benefit of Ginkgo in the treatment of disease with both neural and circulatory components.

80% success rate in 60 patients with chronic cerebral insufficiencies measured by improvement in functional symptoms such as vertigo, headache, etc.

Successful treatment of 60 patients with cerebral insufficiency as measured by ECG, EEG, computer tomography of the skull, and psychological tests.

92% success rate in patients with cerebrovascular insufficiency in which all pathological findings disappeared after 18 days of treatment.

80% success in treating headache and lesser percent success in case of migraine, though still highly significant considering subjects had complained of migraine for a long time and had already received other treatments - authors conclude Ginkgo should be considered as one of the most effective drugs against migraine. 23 of 30 cases of dystrophy following venous insufficiency and is a complication of varicose disease or post-phlebitic disease - successfully treated.

40% success in the treatment elderly patients with peripheral arteriopathy (arterial insufficiency of lower limbs), some with angiopathy complicating senile diabetes mellitus, as measured by improvement in general psychophysical performance and in capacity to adapt to the environment.

72% success in the treatment of chronic vasculopathies normally treated with vasodilators which unfortunately end by lowering vascular tone rather than restoring it; Ginkgo acts by toning the arterioles to produce the vasodilator effect.

Significant reduction of pain in patients with obstructive arteriopathy.

Drug Interactions & Precautions

Possible Interactions
The estrogen in this herb may raise the blood glucose levels enough to alter insulin requirements in the diabetic.

The antiarrhythmic agent, quinidine, may increase the hypoprothrombinemic effect of this herb.

Ginkgo also inhibits platelet aggregation.

Ginko Monograph. In: Burnhan TH, Hagemann RC, Threlkeld DS (eds.) The Lawrence Review of Natural Products. St. Louis: Facts and Comparisons. 1994.

Comments
Due to the presence of blood serum platelet aggregation inhibitors, such as linolenic acid, this herb may potentiate the effects of anticoagulant drugs such as heparin or warfarin (coumadin). Concurrent use of Ginkgo biloba may require close supervision, since its properties are potentially counteractive: cerebral insufficiency and intermittent claudication. Spontaneous bleeding has also been reported.

In the absence of other hard data, it may still be assumed observable interactions may occur between the many central nervous system drugs and the psychoactive principles in ginkgo.

The psycho- and physicostimulant property of this herb may be assumed to interact in presently unknown ways with other psychoactive central and peripheral nervous system stimulants and depressants.

Safety Factors & Toxicity

Before Ginkgo was ever approved for human consumption it had been extensively tested for potential side effects. Virtually none were found.

Some people have reported mild gastrointestinal upset, headache or skin rash probably allergic in nature, but that's it. Even doses many times in excess of the recommended therapeutic amount have not produced significant toxicity.

One long term study was carried out to determine if very large doses of Ginkgo had any influence on delicate endocrine balances. The results of all hormonal and blood assays were negative.

The German Commission E status of the leaf is "null" or neutral i.e. while it is not approved, there is no documented risk. There may also be some concern over the claims made by manufacturers i.e. they are unproven.

The extract, on the other hand, is the top-selling phytopharmaceutical in Germany! At $211 million it dwarfs the next six combined, or the last fifteen (5 - 20) combined!

The German Commission E recommends a limited duration for the use of this herbal extract varying with its purpose, as follows:

Cognitive	at least 8 weeks
Intermittent claudication	not less than 6 weeks
Vertigo and tinnitus	longer than 6 - 8 weeks has no therapeutic value

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Preparation & Administration

Capsule
Twice daily. 60mg (containing 14.4mg (24%) flavoglycosides, of which 6m or 10% should be quercetin and other flavonoids).

This herb has approval status by the German Commission E.

Recommended daily dosages in Germany are as follows:

In dementia: 120 - 240 mg dry extract in 2 or 3 doses.
For peripheral vascular disease: 120 - 160 mg dry extract in 2 or 3 doses.
For vertigo or tinnitus: 120 - 160 mg dry extract in 2 or 3 doses.

The German Commission E recommends a limited duration for the use of this herbal extract varying with its purpose, as follows:

Cognitive	at least 8 weeks
Intermittent claudication	not less than 6 weeks
Vertigo and tinnitus	longer than 6 - 8 weeks has no therapeutic value

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Note: This Herbal Preparation information is a summary of data from books and articles by various authors. It is not intended to replace the advice or attention of health care professionals.

Abstracts

References

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Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

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Ginkgo biloba

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