What it is
It is the leaf of Ginkgo biloba. The European monograph grants it a well-established use, but only for one very specific standardised dry extract: improving age-associated cognitive impairment and quality of life in mild dementia. A traditional use also covers heavy legs and cold hands and feet.
The detail matters: the evidence belongs to the standardised extract, with a fixed content of flavonoids and terpene lactones and with the allergenic ginkgolic acids reduced to a minimum. Any leaf powder is not the same thing. And it does not prevent dementia in healthy people.
How it works
What is known about the extract:
- It improves circulation in small vessels and blood flow properties
- Ginkgolides inhibit platelet-activating factor: hence its bleeding risk
- It has antioxidant and neuroprotective effects in experimental studies
At the counter
When to recommend it
- Mild age-related memory complaints already assessed by a doctor
- As part of what the doctor decides in mild dementia
- Heavy legs or cold hands, as a traditional use
- People not taking anticoagulants or antiplatelets
When not to
- Treatment with anticoagulants or antiplatelets, or bleeding disorders
- Before surgery or a dental extraction
- Epilepsy, because of the reported risk of seizures
- Pregnancy, because of the bleeding risk
Warnings
- Important Bleeding risk: take care or avoid with anticoagulants, antiplatelets, NSAIDs and before surgery.
- Important Epilepsy: seizures have been reported; avoid in people with epilepsy.
- Caution It can lower efavirenz levels; with antiretroviral treatment, do not use without checking.
- Caution It can cause headache, stomach upset or skin reactions.
- Worth knowing Seeds and unprocessed leaf are not the studied extract.
How it is used
- Use the standardised extract at the monograph dose: 240 mg a day, in one or two doses.
- The effect is judged after several weeks; if there is no improvement at three months, there is no point continuing.
- Stop it a few days before surgery, telling the medical team.
- Not recommended under 18.
Standardised extract vs non-standardised leaf
| Aspect | Standardised extract | Non-standardised leaf |
|---|---|---|
| Clinical evidence | Yes, for cognitive impairment | No |
| Active content | Fixed and known | Variable |
| Ginkgolic acids (allergens) | Reduced to a minimum | May be present |
| Reference dose | 240 mg a day | No reference |
| Bleeding risk | Yes | Yes |
If ginkgo is recommended, make it the standardised extract. And with either, watch the bleeding risk.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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It inhibits platelet aggregation: it adds to bleeding risk with anticoagulants, antiplatelets and surgery.
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The evidence belongs to the standardised extract, with fixed actives and reduced ginkgolic acids.
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Seizures have been reported with ginkgo. In people with epilepsy, it is better avoided.
Training content. It does not replace the summary of product characteristics or clinical judgement.