What is ginkgo?
Ginkgo, actually Ginkgo biloba, is a tree from China that is said to have various medicinal properties. In East Asia, it is not only important as a remedy, but also as a temple plant. The ginkgo extract obtained from the leaves is also used in Germany as a medicine for circulatory disorders or to improve memory.
What is ginkgo good for?
In Asia, especially in China, the “miracle tree” has long been used for beauty care and especially as a medicinal plant. The seeds or fruits, but also the roots, leaves and tree bark are used as medicine for asthma , bronchitis , circulatory disorders, skin diseases or urinary incontinence. In addition, ginkgo is said to prevent skin aging and have a positive effect on the psyche and the brain, including anxiety, but also lack of concentration and memory disorders. It is even said to be suitable for repelling insects.
For years, the plant has also had a firm place as a remedy for us – for example as a medicine for circulatory disorders or for ringing in the ears (tinnitus). But ginkgo preparations are also used to treat forgetfulness and attention disorders.
Big differences in preparations with ginkgo extract
In this country, ginkgo biloba is mainly offered in the form of extracts from dried ginkgo leaves (GBE), which, according to the pharmacopoeia, are obtained in multi-stage process steps. The secondary plant substances contained, the flavonoids  and terpenoids, which are only found in the ginkgo in this special form and composition as ginkgolides and bilobalides, are particularly effective.
There are two reasons why we use extracts instead of the leaves:
- The valuable ingredients of the leaves are difficult to dissolve in water and can therefore only be insufficiently utilized by the organism.
- In addition, eating the leaves can even be harmful because ginkgo also contains substances that can cause allergies  and other health problems (ginkgolic acids).
Medicines made from ginkgo therefore contain an extract to which the desired ingredients have been added and from which the undesirable substances have been removed.
A distinction must be made between medicinal products containing ginkgo and dietary supplements. Approved medicines contain only high-quality extracts that are manufactured according to the specifications and whose effectiveness has been scientifically proven for the respective application. On the other hand, dietary supplements can contain extracts produced in a different way, in which the ingredients are contained in different concentrations and for the effectiveness of which there is usually no evidence.
Effect of ginkgo extract
Ginkgo is said to have various mechanisms of action, but these have not yet been fully explored. The following effects are attributed to the ginkgo extract:
- It is intended to improve blood flow, i.e. the flow properties of the blood.
- The blood vessels should be expanded and the blood circulation in the arteries, veins and fine vessels (microcirculation) should be improved – and with it the oxygen and nutrient content of the “grey cells”.
- The aim is to prevent blood platelets from sticking together and thus reduce blood clotting (blood-thinning effect).
- Ginkgo is considered a so-called radical scavenger, i.e. aggressive molecules that attack the cells are intercepted.
- The nerve cells should be protected, because ginkgo should counteract the breakdown of nerve cells and increase the performance of the existing cells by improving the transmission of stimuli in the nerves.
What is ginkgo used for?
The various uses of ginkgo result from these mechanisms of action. Above all, these are diseases that are related to the disruption of blood circulation and the performance of the brain and which occur more frequently with increasing age. Among other things, ginkgo is said to:
- improve mental performance, increase concentration and help with memory problems
- prevent age-related dementia or improve or slow down the process that has already started
- improve the blood supply in the legs and enable pain-free walking, for example in the case of intermittent claudication  (PAD).
-  help with tinnitus or sudden hearing loss
- prevent the formation of blood clots
- help with dizziness
- Â prevent migraines
-  have a positive effect on cognitive limitations caused by multiple sclerosis
- relieve premenstrual symptoms ( PMS ) in women
- prevent altitude sickness
- Reduce the visual impairments associated with glaucoma (green star).
- lower high blood  pressure
Even if not all of these effects have been scientifically proven, there are drugs with ginkgo extract approved in Germany for the treatment of certain forms of dementia or brain disorders, poor concentration and memory, circulatory disorders and for the supportive treatment of tinnitus or dizziness. However, a preventive effect in dementia or an actual benefit in claudication, for example, is not considered proven.
Efficacy examined in studies
Numerous studies on the effectiveness of ginkgo have been carried out over the past decades. These could not always confirm the healthy effect of the plant.
Due to a lack of evidence, a meta-analysis of several clinical studies from 2009 came to the conclusion that the positive effects on dementia and memory disorders that had been repeatedly proven up to that point should be called into question. Nevertheless, there are also more recent reviews that paint a more positive picture, with the right dosage and the composition of the ingredients seeming to play a role, among other things.
The “Dementia” guideline published in 2016 attributes a possible effect to the special extract EGb 761® (Tebonin®). For certain forms of dementia, treatment with a daily dose of 240 milligrams can therefore be considered, while a dose of 120 milligrams is probably not sufficient. A preventive effect in relation to dementia is not considered to be proven.
Many of the other propagated effects are also scientifically controversial – for example in relation to dizziness or tinnitus. The study situation is often contradictory and does not come to any clear results.
Proper use of Ginkgo biloba
Ginkgo preparations are available in pharmacies without a prescription or can be bought on the Internet. However, certain products can also be prescribed on prescription.
Ready-to-use preparations made from ginkgo extract are used. Dosage forms include tablets, capsules, dragees , juices  and drops. The agents can differ in terms of the concentration and composition of the active ingredient. You are therefore on the safe side with approved medicines from the pharmacy. We advise against the use of ginkgo teas, as the active substances are not contained in sufficient quantities and the questionable ginkgolic acids may be present.
It is advisable to consult a doctor regarding the appropriate dose.
How Long Does Ginkgo Take to Work?
Ginkgo only develops its effect over time. The treatment should be carried out over a longer period of eight to twelve weeks.
Possible side effects of ginkgo
The following side effects can occur in rare cases, especially if the ginkgolic acid content is too high:
- Gastrointestinal problems such as nausea , vomiting or diarrhea
- allergic skin reactions such as itching  and redness
- headache
- cardiac arrhythmias
Excessive doses of ginkgolic acids can not only trigger allergies and inflammation of the gastric mucosa, they are also considered to be potentially cell-damaging and mutagenic. In medicines containing ginkgo, the content of these acids is therefore limited to 5 ppm (parts per million, corresponds to 1 microgram per gram) or 0.6 to 1.2 micrograms of ginkgolic acid daily. There is no comparable specification for dietary supplements, and the manufacturing process is not standardized.
The increased risk of bleeding has been known for a long time, especially when ginkgo is taken together with blood thinners (such as low-dose acetylsalicylic acid ) or NSAIDs (such as ibuprofen  or diclofenac ). A side effect, for example, can be retinal bleeding in the eyes. Ginkgo is also not suitable before an operation or for people with seizures ( epilepsy ).
Therefore, you should never take ginkgo preparations without consulting a doctor. Use is not recommended during pregnancy and breastfeeding.
Can I get a stroke from ginkgo?
Studies have provided evidence that taking ginkgo supplements could increase the risk of suffering a stroke or one of its precursors. However, the study situation on this is ambiguous. Other studies, on the other hand, even attest ginkgo a benefit after a stroke.
Ginkgo – a tree with many names
Ginkgo – or actually Ginkyo – has almost as many names as leaf colors: silver apricot, maidenhair tree, temple tree, duck foot tree, fan tree, fan leaf tree, elephant ear tree, forty dollar tree and grandfather-grandson tree are just a few of them.
The giant ginkgo tree with the fan-shaped, notched leaves comes from Asia and is one of the oldest plant species of all – its ancestors were already on earth 300 million years ago. Ginkgo biloba is the last of its kind – all its relatives of the plant family “Ginkgoaceae” became extinct thousands of years ago.
Ginkgos are usually dioecious – male and female flowers must be together to reproduce. However, because of the unpleasant smell of their fruit in the fall, female trees are less common. A specimen of the hardy ginkgo tree can grow up to 40 meters tall and hundreds of years old.
