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Ginkgo biloba

Definition

Ginkgo biloba is an herbal dietary supplement made from the leaves of the tree Gingko biloba.

Purpose

Ginkgo biloba, sometimes called bai guo, has been used in Traditional Chinese Medicine (TCM) for about 5,000 years to treat memory loss, mood, nerve, circulatory and many other health problems. Ginkgo biloba often is combined with ginseng to boost memory, improve the quality of life, and increase a sense of well being. The effectiveness of some TCM uses of gingko, such as relieving pain caused by clogged arteries in the leg (claudication), treating Alzheimer’s disease, and improving blood flow to the brain have been evaluated in well-designed studies and are generally accepted by practitioners of conventional medicine. Many other TCM uses of gingko biloba are currently being investigated.

Description

Gingko biloba is the last existing member of an ancient family of trees. The fossil record shows that gingko trees existed 200 million years ago. Gingko biloba is native to China, Japan, and Korea. The tree was introduced to North America in the 1700s. Ginkgo trees grow to a height of 65–115 ft (20–35 m). They are extremely resistant to disease and insect damage and can live for several hundred years. Female trees produce bad-smelling fruit-like bodies the size of an apricot that contains seeds. Herbal practitioners sometimes use the seeds in treatment. The much cleaner male ginkgo is a popular tree for urban landscaping

The fan-shaped leaves of the ginkgo are used for medicinal purposes. About twenty different compounds have been identified in ginkgo leaves, but the medically active ingredients appear to be flavenoids and terpe-noids. Flavenoids are antioxidants that help lower the level of free radicals in the body. Terpenoids are thought

KEY TERMS

Alternative medicine—A system of healing that rejects conventional, pharmaceutical-based medicine and replaces it with the use of dietary supplements and therapies such as herbs, vitamins, minerals, massage, and cleansing diets. Alternative medicine includes well-established treatment systems such as homeopathy, Traditional Chinese Medicine, and Ayurvedic medicine, as well as more-recent, fad-driven treatments.

Alzheimer’s disease—An incurable disease of older individuals that results in the destruction of nerve cells in the brain and causes gradual loss of mental and physical functions.

Antioxidant—A molecule that prevents oxidation. In the body antioxidants attach to other molecules called free radicals and prevent the free radicals from causing damage to cell walls, DNA, and other parts of the cell.

Claudication—Tiredness and pain in the leg muscles that occur when walking and disappear with rest. The cause is inadequate supply of oxygen to the muscle usually caused by clogged blood vessels.

Complementary medicine—Includes many of the same treatments used in alternative medicine, but uses them to supplement conventional drug and therapy treatments, rather than to replace conventional medicine.

Conventional medicine—Mainstream or Western pharmaceutical-based medicine practiced by medical doctors, doctors of osteopathy, and other licensed health care professionals.

Dietary supplement—A product, such as a vitamin, mineral, herb, amino acid, or enzyme, that is intended to be consumed in addition to an individual’s diet with the expectation that it will improve health.

Free radical—An unstable, highly reactive molecule that occurs naturally as a result of cellular metabolism, but can be increased by environmental toxins, ultraviolet and nuclear radiation. Free radicals damage cellular DNA and are thought to play a role in aging, cancer, and other diseases. Free radicals can be neutralized by antioxidants.

Traditional Chinese Medicine (TCM)—An ancient system of medicine based on maintaining a balance in vital energy or qi that controls emotions, spiritual, and physical well being. Diseases and disorders result from imbalances in qi, and treatments such as massage, exercise, acupuncture, nutritional and herbal therapy is designed to restore balance and harmony to the body.

to protect nerves from damage, reduce inflammation, and decrease blood clotting

In the United States, Gingko biloba is cultivated and the leaves are harvested and dried, then often used to make a standardized extract that contains 24–25% flavenoids and 6% terpenoids. U. S. law does not require the standardization of dietary supplements, so consumers should read all labels carefully. Ginkgo biloba is often sold as capsules and tablets. Dry and liquid ginkgo extract is added to other herbal remedies as well as teas, energy or health bars, and similar products. An injectable form of ginkgo biloba extract that was available in Europe has been withdrawn from the market because of adverse side effects. Most well-designed studies have been done using a total of 80– 240 mg of 50:1 standardized extract divided into 2 or 3 doses daily and taken by mouth.

Regulation of ginkgo biloba sales

Ginkgo biloba is one of the top selling herbal remedies in the United States and is even more popular in Europe. Under the 1994 Dietary Supplement Health and Education Act (DSHEA), the sale of ginkgo biloba is regulated by the U.S. Food and Drug Administration (FDA) as a dietary supplement. At the time the act was passed, legislators felt because many dietary supplements such as ginkgo biloba come from natural sources and have been used for hundreds of years by practitioners of complementary and alternative medicine (CAM), supplements did not need to be regulated as rigorously as prescription and over-the-counter drugs used in conventional medicine.

Health claims

Gingko biloba is one of the most promising traditional herbs investigated by Western medicine. The National Center for Complementary and Alternative Medicine (NCCAM), a government organization within the National Institutes of Health, is sponsoring clinical trials to determine safety and effectiveness of gingko biloba as a treatment for more than a dozen diseases and disorders. Individuals interested in participating in a clinical trial at no charge can find a list of open trials at <//www.clinicaltrials.gov>.

Some health claims for gingko biloba have already been evaluated in large, well-controlled studies that satisfy the proof of safety and effectiveness demanded by conventional medicine. There is good evidence that gingko biloba can cause short-term improvement in mental function in people with Alzheimer’s disease. In a well-designed study, ginkgo biloba was as effective as the prescription drug done-pezil (Aricept) in slowing the development of dementia in people with mild to moderate Alzheimer’s. Ginkgo biloba has also been shown to be effective in improving blood flow to the brain and in treating certain other dementias. The effect of ginkgo biloba on memory in healthy young adults and in people with age-related memory impairment is inconsistent, but strong enough to continue to study the effects of the herb in these populations.

In other rigorous studies, ginkgo biloba has improved symptoms of claudication. Claudication is leg pain that occurs during walking when insufficient oxygen reaches the leg muscles. It is usually caused by blocked arteries in the leg. Ginkgo biloba’s ability to reduce blood clotting (“thin the blood”) is thought to account for improving symptoms in people with claudication. However, exercise and prescription medication were more effective in reducing leg pain due to claudication than ginkgo biloba alone. Ginkgo biloba has also been used, especially in Europe, to treat Ray-naud’s disease. Raynaud’s disease causes the extremities of the body to feel cold in response to stress or cool temperatures. During an attack of Raynaud’s disease, the blood vessels to the affected area narrow and blood flow is reduced.

Several health claims for ginkgo biloba center on treating disorders of the eye, including glaucoma, age-related macular degeneration, and type 2 diabetes-related retinopathy. Ginkgo appears to increase blood flow to the eye, but additional studies need to be done to evaluate its effectiveness in helping to treat these disorders.

The terpenoids in ginkgo biloba are thought to help prevent nerve damage. Because of this, ginkgo has been suggested as a treatment for tinnitus (ringing of the ears), multiple sclerosis, cochlear deafness, and Huntingdon’s disease. Results of studies so far are inconsistent, and additional research is needed to determine the usefulness of ginkgo in nerve disorders.

Some researchers have suggested that ginkgo bilobais useful in treating depression, seasonal affective disorder, premenstrual syndrome, altitude sickness, vertigo (dizziness), premenstrual syndrome (PMS), gastric cancer, side effects of anti-cancer drugs, and pulmonary interstitial fibrosis, as well as generally improving quality of live and sense of well being. Further studies need to be done to evaluate these health claims.

Precautions

Ginkgo biloba seeds contain toxins that can cause vomiting, seizures, loss of consciousness, and death, especially in young children. Ginkgo biloba seeds are not safe and should be avoided.

Extracts of the leaf of Gingko biloba are generally safe and cause few side effects when taken at recommended doses for up to six months. People who are planning to have surgery should stop taking ginkgo biloba at least two days before their operation because of the risk of increased bleeding. The safety of gingko biloba in children and pregnant and breastfeeding women is still being studied.

Interactions

Ginkgo biloba has blood-thinning properties and is likely to increase the blood-thinning and anticoagulant effects of medicines such as warfarin (Coumadin), clopidogrel (Plavix), aspirin, and nonsteroidal anti-inflammatory drugs (e.g. Advil, Motrin). Individuals taking these drugs should not begin taking ginkgo biloba without consulting their health care provider.

Ginkgo biloba may also interact with mono-amine-oxidase (MAO) inhibitors used to treat certain kinds of depression and mental illness. Examples of MAOs include isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). Individuals taking MAOs along with ginkgo biloba may experience increased effects from the MAO.

Some reports suggest that ginkgo biloba lowers blood sugar levels. Individuals who are taking insulin or other medications that also lower blood sugar, and those with type 2 diabetes, should consult their health care provider before starting to take ginkgo biloba.

Complications

Serious side effects of ginkgo biloba are rare. The most common mild side effects are headache, dizziness, nausea, diarrhea, increased restlessness, and racing heart. Increased bleeding may occur. Allergic reactions to gingko are possible, but uncommon. In severe rare cases, the skin blisters and sloughs off, a condition called Stevens-Johnson syndrome. People who are allergic to sumac, mango rind, cashews, poison oak, and poison ivy are at slightly higher risk to have an allergic reaction to ginkgo biloba.

Parental concerns

Parents should be aware that the safe dose of many herbal supplements has not been establsihed for children. Accidental overdose may occur if children are give adult herbal supplements.

BOOKS

Cass, Hyla and Jim English. Basic Health Publications User’s Guide to Ginkgo biloba. North Bergen, NJ: Basic Health Publications, 2002

Fragakis, Allison. The Health Professional’s Guide to Popular Dietary Supplements Chicago: American Dietetic Association, 2003

PDR for Herbal Medicines, 3rd ed. Montvale, NJ: Thompson Healthcare, 2004

Pierce, Andrea. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: William Morrow, 1999

Tracy, Timothy S. and Richard L. Kingston, eds. Herbal Products: Toxicology and Clinical Pharmacology. Totowa, NJ, Humana Press, 2007

Wildman, Robert E. C., ed. Handbook of Nutraceuticals and Functional Foods, 2nd ed. Boca Raton, FL: CRC/ Taylor & Francis, 2007.

PERIODICALS

Akhondzadeh, S. and S. H. Abbasi. “Herbal Medicine in the Treatment of Alzheimer’s Disease.” American Journal of Alzheimer’s Disease and Other Dementias 21, no. 2 (Mar-April 2006):113–8

Dugoua, J. J., et al. “Safety and Efficacy of Ginkgo (Ginkgo biloba) During Pregnancy and Lactation.” Canadian Journal of Clinical Pharmacology 13, no. 3 (Fall, 2006):e277–84. <http://www.cjcp.ca/pdf/CJCP05-037_e277e284F.pdf>

Mazza, M. et al, “Ginkgo Biloba and Donepezil: A Comparison in the Treatment of Alzheimer’s dementia in a Randomized Placebo-controlled Double-blind Study.” European Journal of Neurology 13, no. 9 (September 2006):981–5

Oh, S. M. and K. H. Chung. “Antiestrogenic Activities of Ginkgo Biloba Extracts.” Steroid Biochemistry and Molecular Biology 100, nos. 4–5 (August 2006):167-76

Sierpina, Victor S., Bernd Wollschlaeger, and Mark Blu-menthal. “Ginkgo Biloba.” American Academy of Family Physicians. 68, (September 1, 2003):923–6. <http://www.aafp.org/afp/20030901/932.html>.

ORGANIZATIONS

Alternative Medicine Foundation. P.O. Box 60016, Potomac, MD 20859. Telephone: (301) 340-1960. Fax: (301) 340-1936. Website: <http://www.amfoundation.org>

National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gathersburg, MD 20898. Telephone: (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. Website: <http://nccam.nih.gov>

Natural Standard. 245 First Street, 18th Floor, Cambridge, MA 02142. Telephone: (617) 444-8629. Fax: (617) 444-8642. Website: <http://www.naturalstandards.com>/ bibcit.composed>

Office of Dietary Supplements, National Institutes of

Health. 6100 Executive Blvd., Room 3B01, MSC 7517, Bethesda, MD 20892-7517 Telephone: (301) 435-2920. Fax: (301)480-1845. Website: <http://dietarysupplements.info.nih.gov>.

OTHER

Mayo Clinic Staff. “Gingko (Gingko biloba L.).” Mayo Clinic.com, May 1, 2006. <http://www.mayoclinic.com/health/gingko-bilboa/NS_patient-gingko>

Maryland Medical Center Programs Center for Integrative Medicine. “Gingko Biloba.” University of Maryland Medical Center, 2002. <http://www.umm.edu/altmed/ConsHerbs/GingkoBilobah.html>

Medline Plus. “Gingko (Gingko biloba L.).” U. S. National Library of Medicine, November 1, 2006. <http://www.nlm.nih/gov/medlineplus/druginfo/natural/patneingingko.html>

National Center for Complementary and Alternative Medicine. “Gingko.” National Center for Complementary and Alternative Medicine, January 23, 2007. <http://nccam.nih.gov>

HOPES Project for Education at Stanford. “Gingko Bibloba: Disease Mechanism IV: Free Radical Damage.” Stanford University, December 3, 2004. <http://www.stanford.edu/group/hopes/sttools/hopes.html>

Tish Davidson, A.M.


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