GINKGO BILOBA
Common Names

Ginkgo, Maidenhair tree
Botanical Name
Ginkgo biloba
Family
GINKGOACEAE (the one and only!)

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What is it?

Gingko comes from the oldest surviving family of trees on earth - its ancestors once lived and thrived in the age of the dinasaurs! A Gingko tree can live as long as a thousand years.

Ginkgo trees can grow to nearly 40 meters tall and they are often planted in city parks, streets and botanical gardens because of their beauty, long-life and incredible resistance to insects and pollution. In herbal medicine we use the characteristic 'bi-lobed' fan-shaped leaves of Ginkgo, usually as concentrates.


FLOWERS


NUT/SEED


CHOPPED

How has it been used?

Ginkgo nuts were used in traditional Chinese medicine for the treatment of respiratory illness such as asthma but there is no recorded historical use of the leaves and this is a marvellous, albeit somewhat rare, example of the medicinal properties of a herb being discovered in modern times by modern science.

Some of the main indications for using Ginkgo, based on the evidence, are for:
~ stroke of recent onset
~ as a tonic for older adults
~ for early stages of senile dementia or Alzheimer’s
~ for poor blood flow to the head and its related symptoms such as memory or cognitive impairment, dizziness, tinnitus, headaches and mental fatigue.
~ for dizziness or vertigo related to poor circulation
~ for altitude sickness or hypoxia (low oxygen levels)
~ enhancing cognitive function, including working and long-term memory, abstract reasoning, and processing speed in healthy individuals and particularly in older adults

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Science on Ginkgo biloba

~ With over 400 published studies and reports to its credit, Ginkgo biloba is one of the most frequently prescribed herbal medicines in the world today. A large German plant medicine company was the first to develop the standardised concentrate of Ginkgo, involving 27 different steps and requiring 50kgs of herb to produce 1 kg of extract and taking up to two weeks to complete!

~ Taking a standardised Ginkgo extract (120mg/day for 4 months) improved mood, sleep, and coping ability for daily activities in a randomised, placebo-controlled study involving 5028 free-living elderly volunteers (Cockle SM, Kimber S, Hindmarch I: Phytomed 7(supp 2):21, 2000)

~ A review of 40 clinical trials conducted from 1975 to 1991 on the clinical use of standardised Ginkgo extracts in patients with cerebral insufficiency and related conditions (primary degenerative dementia, dizziness associated with inner ear disorders, acute cochlear deafness, senile cognitive dementia, and tinnitus) found that all but one of the 40 trials showed positive results - the one inconclusive result was for senile dementia of vascular origin. (van Dongen MC et al: J American Geriatric Society 48(10):1183-1194, 2000)

~ Improvements in cerebral blood flow, motor recovery, intellectual performance, memory, mood, and behaviour were observed in recent stroke victims after treatment with standardised Ginkgo extract in both uncontrolled as well as randomised, double-blind, placebo-controlled and comparative trials.

~ For Alzheimer's disease a meta-analysis of four randomised, double-blind, placebo-controlled trials found a small but significant effect after 3-6 months treatment with 120-240 mg/day of standardised Ginkgo extract on objective measures of cognitive function. A subsequent randomised, double-blind, placebo-controlled multicentre trial in patients with mild to severe Alzheimer's disease or multi-infarct dementia found that, compared with baseline values, treatment with standardised Gingko extract (120 mg/day for 26 weeks) improved daily living and social behaviour and cognitive assessment. The placebo group showed a statistically significant worsening in all domains of assessment. Regarding safety, no differences between Ginkgo and placebo were observed. (Le Bars PL, Kieser M, Itil KZ: Dementia Geriatric Cognitive Discord 1 1(4):230-237, 2000)

~ A meta-analysis found no major difference between standardised Ginkgo extract and four cholinesterase inhibitors (tacrine, donepezil, rivastigmine, and metrifonate) for delaying symptom progression in Alzheimer's disease or response rate compared with placebo. The authors suggested that all treatments compared were equally helpful in treating mild to moderate Alzheimer dementia. (Wettstein A: Phytomed 6(6):393-0401, 2000)

Safety of Ginkgo biloba

Ginkgo is really a very safe herb that can be used by all ages and for extended periods however there are concerns about its potential interaction with such blood thinning drugs as warfarin, aspirin or other anti-coagulant or antiplatelet medications. It should be noted that these concerns are theoretical and are based on the observable effects of Ginkgo in clinical studies rather than in actual patients however the first rule of medicine remains 'firstly do no harm' so it is better to avoid Ginkgo if using such medications.


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Personal experiences

On a very personal level the Ginkgo is a tree that I simply love. Almost every day I go for a walk by the river Avon in Christchurch and at one point, usually at or near the end of my outward journey, there is a Ginkgo tree by the water that I always lean my whole body up against and take a moment or two to just be and to feel it supporting me. I admire this tree so much and I feel like I have become such good friends with it!

Way back in 1990 we tenderly placed the placentas of our recently born twins; Ben and Danielle, under a new Ginkgo sapling in the back yard of a house that backs on to a pine-tree reservation and from time to time I still go back there to peer over the fence at how the tree is growing - it's so beautiful!

I am well versed in the science on Ginkgo and, as you can see from even a glance at some of the snippets from the literature posted above; it's very impressive on paper. However what matters most to me as a clinician is what actually happens in practice and what I can say about Ginkgo, having used it for many hundreds of people over the years, is that whilst this is not a medicine that is going to make you super-smart or going to give you a better memory than you used to have, if you are aging badly in terms of your mental health then you simply have to take it; it really does make that much of a difference.

The other main reason I personally recommend Ginkgo is for people whose blood is clearly too sticky for their own good. With using a high powered microscope in my daily work I am in a position where I can honestly and objectively look at how well a person's blood stickiness responds to any kind of dietary or medical intervention and Gingko is something that I consistently trust to help reduce or clear sticky blood.

Dosages of Ginkgo do not have to be hugely high for its benefits to become certain. What is required is an extraction and concentration from about 6-8 grams of the dried herb into a product that should achieve that with no more than a couple of pills. Like anyone who is serious about Ginkgo I use a product that has been through all the standardisation that has been used to get the results in the clinical studies, it's not very old-school but it would be disingenuous to use a less processed product and expect the same effects. For some I will start with two tablets twice a day for a couple of weeks or a month at most but for the great majority it is just two pills a day for the long term and that is how you have to see the way to use this herb. What do I mean by long term? At least 6 months, and for some people who have been losing mental faculties from deteriorating blood flow to the brain, it needs to be taken indefinitely.

I have found that Ginkgo combines perfectly with Hawthorn leaf and berry for many people who need a medicine that is going to help them where they need it the most - their heart and circulation. It can also be very beneficial to use with Horsechestnut, Limeflowers and Yarrow to strengthen blood vessels and in some cases I will use it with Cayenne to make a more rapid and significant difference to improving the circulation.

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Constitutional note

Much of the information here about the use of Ginkgo is consistent with the model of thinking whereby one may treat problem A with plant B. There is value in this approach, especially in how it helps us pass on useful knowledge to one another, but it falls short in one vital area; and that is that people are not all cut from the same cloth! Something that works brilliantly for one person may do less for another -- why is this?

The reason is that people vary in their constitutions as to whether they are more hot or cool and at the same time more dry or damp; more info about this here.

There is an old wisdom in treating the person first and the condition second and in this light Ginkgo can particularly offer its benefits when an activation is needed in the 'cycle of healing' - something that is discussed here and shown in a chart here.

Further pharmacological notes on Ginkgo

The majority of the clinical trials on Ginkgo employed a daily dose of 120 to 160 mgs a day which equates to about 6 to 8 grams a day of original dried herb.

The 50:1 concentrated extract used in the studies was standardised to contain 22.5% to 25% flavanoid glycosides (ginkgo flavone glycosides) and 6% -8% terpenoids (ginkgolides and bilobalide). Those ginkolides are potent and specific blockers of platelet activating factor (PAF) and their effects are long lived and rapidly established after oral doses.

Prior oral dosing of standardised Ginkgo extract enhanced the performance of a tested task, indicating improved retrieval of the learned response Ginkgo limited free radical-induced oxidative stress throughout surgery in patients undergoing aortic valve replacement in a double-blind, placebo-controlled study. The dosage prescribed was 320 mg/day of standardised extract for 5 days before surgery; this would equate to about 12 grams of the dried herb per day.

Please understand that I cannot personally advise you, including on products or dosage, without seeing you in my clinic but ideas on how you might find a good herbalist in your area are here.
This living 'book' is my labour of love so, wherever you are, I wish you peace & good health!

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© 2011 R.J.Whelan Ltd