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11 Benefits and Side Effects of Ginkgo (18 Contraindications to Be Noted)[Updated Feb/2023]

Ginkgo biloba is the oldest seed plant that exists on the earth today, which can survive for more than a thousand years, existed on the earth hundreds of millions of years ago in the time of the dinosaurs, and can survive after drastic environmental changes, which shows its tenacious vitality

When it comes to ginkgo biloba health foods, most of them are ginkgo biloba extract, and in empirical medicine, what is the effect of using ginkgo biloba extract? Are there any side effects or contraindications? See text analysis for details

What is Ginkgo biloba extract?

Ginkgo biloba is the most medically valuable part of the ginkgo tree, and its extract is rich in terpenoids, flavonoids and proanthocyanidins, which have antioxidant, anti-inflammatory, vasodilating and platelet suppression effects, and have been widely used in the past hundred years to improve blood circulation disorders, tinnitus, dizziness and cognitive deterioration.

What are the proven benefits of Ginkgo biloba extract?

  1. Ginkgo is good for ischemic stroke

Stroke is the second most common cause of death and the third most common cause of disability in the world, with 68% of strokes being ischemic strokes and 32% hemorrhagic strokes.

The most important factor in the treatment of acute ischemic stroke is time, with patients losing 190,000 brain cells, 140,000 nerve connections and 12 km of nerve fibers per minute.

The brain ages by 3.6 years every hour it stops supplying blood, and there are two main treatment modalities for acute ischemic stroke, intravenous thrombolysis and mechanical thrombectomy.

A systematic literature review and meta-analysis (13 randomized controlled trials, 1260 patients with ischemic stroke) pointed out that adjuvant therapy with ginkgo biloba preparations had a positive effect on neurological function (as measured by the NIHSS), daily living ability (as measured by the Barthel index), and blood rheological indicators (plasma viscosity and fibrinogen).  Note 1

*Conclusion: For patients with ischemic stroke, adjuvant treatment with ginkgo biloba preparations may be of positive help, but due to small sample sizes and possible result bias, more large-sample high-quality trials are still needed for further validation

  1. Ginkgo is good for sudden deafness

Sudden sensorineural hearing loss (SSNHL) is an ear emergency defined as a loss of at least 30 dB in three frequencies in the audiogram over a three-day period (incidence ranging from 100 to 2 per 30 million adults) generally affected by the age of fifty or sixty, which can occur as part of a systemic disease or without any identifiable systemic or local abnormalities. The latter is called “idiopathic”.

Most patients present with unilateral hearing loss. However, as many as 2 to 3 percent of patients experience bilateral hearing loss, and about 4 to 8 percent are found to develop Meniere’s disease in subsequent years.

It has been observed that 32% to 65% of patients with idiopathic SSNHL recover spontaneously, with spontaneous recovery often occurring within the first two weeks. The likelihood of spontaneous recovery beyond 3 months is small.

A systematic literature review and meta-analysis (11 randomized controlled trials with 1069 participants in sudden deafness) noted that Compared with patients treated with corticosteroids alone, ginkgo biloba extract plus corticosteroids helped improve clinical cure rate and overall response rate, and related indicators such as: pure tone average, whole blood high shear viscosity, whole blood medium shear viscosity, whole blood low cut viscosity low shear viscosity), plasma viscosity and fibrinogen. Note 1

*Conclusion: Ginkgo biloba extract as an adjunct therapy may have a positive effect on sudden deafness, but more studies are needed to further validate due to the low methodological quality and high risk of bias of the samples included

  1. Ginkgo is beneficial for angina

Angina pectoris is a painful or contractile discomfort that usually occurs in the front of the chest (but may also radiate to the neck, shoulders, chin, or arms) and is common in people with stable ischemic heart disease.

It is the main symptomatic manifestation of myocardial ischemia and is usually caused by obstructive coronary artery disease, which limits the supply of oxygen to cardiomyocytes, and physical exertion or emotional pressure can trigger the disease.

A meta-analysis (41 randomized controlled trials with 4,462 angina patients) pointed out that the combination of Ginkgo damole injection and drugs can improve the overall response rate of treatment and ECG compared with drug treatment alone. Note 1

In addition, combination therapy can also reduce plasma viscosity, fibrinogen, whole blood low cut viscosity, whole blood high cut viscosity.

*Conclusion: Ginkgo injection and drug combination therapy have better treatment effect in patients with angina, but due to the limitation of method quality, more studies are still needed to further verify

  1. Ginkgo is beneficial for vertebrobasilar artery insufficiency

Vertebrobasilar insufficiency is ischemia of the brainstem, cerebellum, thalamus, or occipital cortex caused by stenosis or occlusion of the vertebrobasilar artery.

Dizziness, vertigo, headache, vomiting, diplopia, blindness, ataxia, and weakness on both sides of the body are the most common symptoms, bringing great pain and inconvenience to the patient’s life and work.

Factors include smoking, hypertension, age, sex, family history and genetics, and hyperlipidaemia.

A systematic literature review meta-analysis (including 20 randomized controlled trials, a total of 1710 patients with vertebrobasilar circulatory insufficiency) pointed out that Ginkgo injection (4 in total) as an adjunct to the drug can improve the overall response rate of clinical treatment, especially Ginkgo damole injection (GDs) is the most effective. Note 2

In addition, transcranial Doppler ultrasonography and blood viscosity related indicators were improved with Ginkgo biloba extract injection (EGb) and Shuxining injection (SXN) as the most effective, respectively.

*Conclusion: For patients with vertebrobasilar circulatory insufficiency, the use of Ginkgo injection add-on therapy can bring positive help, but due to the limited sample size and quality of the included trials, more large studies are needed to support this

  1. Ginkgo is beneficial for Alzheimer’s disease

Alzheimer’s disease, also known as Alzheimer’s disease, is the most common irreversible, progressive cause of dementia. It is characterized by progressive loss of memory and cognition, the most important risk factor is age, the prevalence increases exponentially after the age of 65, and the overall prevalence is expected to double within 20 years as the average life expectancy in developing countries increases.

Its pathology is characterized by amyloid plaques and tangles of nerve fibers, neuronal death, and loss of synapses in the intracellular environment, all of which lead to a gradual decline in cognitive performance.

A meta-analysis (7 double-blind randomized controlled trials with 939 Alzheimer’s patients) showed that Ginkgo biloba preparation (EGb 761) had an improved effect on cognitive function and global clinical assessment, and had a good safety profile. Note 1

*Conclusion: For Alzheimer’s disease, the use of ginkgo biloba preparations may bring positive help, but limited by the small sample size and the short duration of the intervention, more long-term large trials are needed to support this

  1. Ginkgo improves tinnitus

Tinnitus is the perception of sound without any external stimuli, and symptoms can be unilateral or bilateral, and may be accompanied by hearing loss, similar to hissing, whistling, buzzing, and chirping.

Epidemiological studies have found that most people have experienced tinnitus, 10% to 15% will have intermittent attacks, and the more common groups are the elderly (60 to 69 years old), body mass index above 30 kg/m2, smoking, diabetes, hypertension are common.

Even though most people can learn to ignore phantoms, tinnitus in about 3% of patients severely affects quality of life, potentially causing irritability, restlessness, stress, insomnia, anxiety, and depression.

A Cochrane Database of Systematic Reviews (4 randomized controlled trials, 1543 participants) found that the use of Ginkgo biloba extract preparations was not significantly helpful in patients with primary tinnitus. Note 1

However, for the tinnitus associated with vascular dementia and Alzheimer’s disease, the use of ginkgo extract may have a small but statistically significant improvement.

*Conclusion: To date, there is insufficient evidence to prove that Ginkgo biloba extract can improve primary tinnitus, and more studies are needed to further verify

  1. Ginkgo is beneficial for acute mountain sickness

Acute mountain sickness usually occurs at altitudes greater than 2500,8000 meters (about 4,24 feet), usually appears 4 to 24 hours after rising to new heights, and disappears within 2 to 3 days at the same altitude.

It is characterized by partial or total symptoms such as headache, weakness, fatigue, listlessness, nausea, insomnia, and loss of appetite.

A systematic literature review and meta-analysis (7 RCTs with 451 participants) noted that pooled analyses found that although ginkgo biloba extract may have a prophylaxis against AMS/HAS, the effect was not statistically significant (similar conclusions were shown in subgroup analyses). Note 2

*Conclusion: To date, data suggest that although ginkgo biloba extract may have a predisposition to prevent AMS/HAS, the evidence is insufficient and more large studies are needed

  1. Ginkgo prevents dementia

Dementia is a progressive disorder of memory loss and cognitive impairment, the most common type being Alzheimer disease, which accounts for about two-thirds of all cases.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV defines dementia as memory loss with impairment of at least one cognitive function, such as proficiency (limb aphics), speech (aphasia), or executive function (such as planning, attention, and abstract reasoning), and cannot be explained by other psychiatric disorders, such as mood disorders.

A systematic literature review and meta-analysis (4 randomized, placebo-controlled trials of 1628 patients with mild to moderate Alzheimer’s or vascular dementia) noted that Oral Ginkgo biloba extract (EGb 761) was helped to improve the Neuropsychiatric Inventory (NPI) and caregiver distress scores on indicators such as: depression, restlessness, anxiety, aggression, abnormal motor behavior, apathy, sleep, nocturnal behavior, anxiety, irritability, and lability, but psychotic symptoms such as delusions, hallucinations, and euphoria/ There was no significant improvement in euphoria. Note 1

In addition, with regard to preventive effects, a meta-analysis (2 studies, 5,889 participants) pointed out that ginkgo biloba extract did not prevent the occurrence of dementia. Note 2

The molecular mechanism of Ginkgo biloba extract against dementia may be related to its anti-free radical and neuroprotective properties, which have potential effects such as reducing the accumulation of β starch protein (beta-amyloid), improving mitochondrial function, reducing blood viscosity, and improving nerve conduction. Note 3

*Summary: Current evidence suggests that Ginkgo biloba extract cannot prevent dementia, but the use of Ginkgo biloba preparations may provide positive help to patients with pre-existing conditions

  1. Ginkgo improves memory and concentration (for those in good health)

As they get older, most people have the experience of forgetting things and forgetting things, it may be that they forgot to take the key, forgot what to say in the previous sentence, etc., such as thinking with their hearts or being reminded by others can mostly be remembered, this kind of phenomenon is mostly caused by weak memory capacity and speed, which is a normal phenomenon.

A good memory is an important weapon to maintain competitiveness, whether it is in study, work, life and social interaction.

A meta-analysis (10 studies, 2576 participants) found that the effect of ginkgo biloba extract on improving memory, executive performance, and concentration was close to zero in people in good health (the effect size was not associated with age, duration, dose, and formulation). Note 5

*Summary: Ginkgo biloba extract has no significant effect on improving memory and related cognitive abilities

  1. Ginkgo improves peripheral arterial disease: intermittent claudication

Intermittent claudication is mainly caused by blockage of arteries in the lower extremities, resulting in no blood flow to surrounding tissues.

Claudication usually occurs during exercise (especially walking) and is characterized by discomfort such as pain, cramps and fatigue in the calves, which will return after a period of rest.

Ginkgo biloba extract is thought to be helpful in peripheral arterial disease due to its circulatory promotive, vasodilating, and antiplatelet clotting effects.

A Cochrane Database of Systematic Reviews (14 randomized controlled trials, 739 patients with intermittent claudication) found that although taking Ginkgo biloba extract improved walking distance (64.5 m more), there was no significant difference in improvement compared with placebo. Note 6

*Summary: Ginkgo biloba extract has no clinically significant effect on improving intermittent claudication

  1. Ginkgo improves tardive dyskinesia

Tardive dyskinesia is a common side effect (about 20%-30% prevalence) after taking antipsychotic drugs, mainly causing involuntary twitching of muscles, with the muscles of the face and mouth most commonly affected, causing slurred speech or difficulty swallowing, severe and even affecting the respiratory tract, causing life danger.

A meta-analysis of 3 randomized controlled trials of 299 patients with schizophrenia with tardive dyskinesia suggested that Ginkgo biloba extract (optimal dose of 240 mg/day) in combination with drugs improved the severity and clinical symptoms of tardive dyskinesia (as measured by the AIMS scale) compared with medication alone or placebo. Note 1

The mechanism behind it is related to the free radical scavenging ability of ginkgo biloba extract, increasing the level of brain-derived neurotrophic factors, and reducing neurotoxicity.

*Conclusion: For antipsychotic-induced tardive dyskinesia, the combination of ginkgo biloba extract can reduce the severity of such phenomena

What are the side effects of Ginkgo?

Ginkgo biloba extract is safe for most people in moderation, but possible side effects or adverse reactions that have been reported are: diarrhea, stomach upset, stomach pain, headache, abnormal heartbeat, dizziness, constipation, rash.

In addition, eating raw ginkgo fruit or excessive consumption of cooked ginkgo fruit will cause poisoning, the main symptoms of poisoning are dyspnea, pulse weakness, seizures, nausea, vomiting, diarrhea, abdominal pain, confusion, shock and convulsions, which is because ginkgo fruit contains 4′-methoxypyridoxine and cyanogenic glycosides and other biotoxins, of which 4′-methoxypyridoxine will inhibit vitamin B6, GABA and the biosynthesis, metabolism and function of glutamate.

Safety precautions

1. Do not use if you are trying to conceive or pregnant women, it may cause difficulty in conception, premature labor or bleeding during childbirth

2. Do not use it in lactating women, because the relevant safety is unknown

3. Do not use for epilepsy patients, it may increase the incidence of disease

4. Ginkgo biloba and pulp can cause severe skin allergic reactions and mucosal irritation

5. People who have been allergic to poison ivy, poison oak, poison sumac, mango rind, or cashew shell oil may also have allergic reactions to ginkgo

6. Patients with glucose-6-phosphate dehydrogenase deficiency (also known as fava beanism or G6PD deficiency) should not use it, which may cause acute hemolytic anemia. Note 1

7. Please stop using ginkgo related products for two weeks before surgery, as ginkgo may delay blood clotting and increase the risk of bleeding during and after surgery

8. Do not use drugs with anticoagulant effect or abnormal coagulation function, which may increase the risk of bruising or bleeding, which is due to the anticoagulant effect of ginkgo biloba, common related drug names are: Aspirin, clopidogrel, diclofenac, ibuprofen, naproxen, dalteparin, Enoxaparin, heparin, warfarin

9. Do not combine with commonly used psychiatric drugs, may affect the efficacy of drugs, common related drug names are: Alprazolam, Buspirone

10. Do not combine with the drug Efavirenz against human immunodeficiency virus (also known as HIV), which may affect the efficacy of the drug

11. Do not interact with St. John’s wort and the antidepressant fluoxetine may cause hypomania (symptoms of irritability, nervousness, restlessness, and excitement). Note 2

12. Do not combine with drugs that need to be metabolized by Cytochrome P450 (cytochrome P450) enzyme, which may affect the efficacy of the drug, (Note 3) Common related drug names are as follows:

Clozapine, cyclobenzaprine, fluvoxamine, haloperidol, imipramine, mexiletine, olanzapine, pentazocine, propranolol, Takrine, Theophylline, Zileuton, Zolmitriptan

Amitriptyline, carisoprodol, citalopram, diazepam, lansoprazole, omeprazole, phenytoin, warfarin

Celecoxib, diclofenac, fluvastatin, glipizide, ibuprofen, irbesartan, losartan, piroxicam, tamoxifen, tolbutamide, Torsemide

Clozapine, Codeine, Desipramine, DonePezil, Fentanyl, Flecainide, Fluoxetine, Meperidine, Methadone, Metoprolol, olanzapine, ondansetron, tramadol, trazodone

Lovastatin, Clarithromycin, Cyclosporine, Diltiazem, estrogens, Indinavir, Triazolam

13. Do not use with hypoglycemic drugs, may affect the efficacy of drugs, common related drug names are as follows: glimepiride, glyburide (glycemic hormone), insulin, pioglitazone, rosiglitazone, chlorpropamide, glipizide, Tolbutamide

14. Do not use it in combination with the antidepressant Trazodone, there have been cases of coma. Note 4

15. Do not combine with drugs that increase the chance of seizures (e.g., anesthetics, theophylline, antiarrhythmics, antibiotics, antidepressants, antihistamines, immunosuppressants, stimulants), which may significantly increase the risk of seizures

16. Do not combine with anti-epileptic drugs, may affect the efficacy of the drug, related drug names are: phenobarbital, primidone, valproic acid, gabapentin, carbamazepine, phenytoin

17. Do not combine with the blood pressure lowering drug Hydrochlorothiazide, which may cause blood pressure to rise

18. Do not use in combination with peptic ulcer or reflux esophagitis medication Omeprazole, which may affect the efficacy of the drug

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