Ginkgo Biloba

Ginkgo biloba is a deciduous tree and the only living member of the division Ginkgophyta, a group whose relatives first appeared hundreds of millions of years ago. It is dioecious, with separate male and female trees, and bears characteristic bilobed, fan-shaped leaves with radiating veins. Pharmacologically active preparations are made from the leaves rather than the seeds, and they concentrate two main groups of constituents: flavonoid glycosides such as quercetin, kaempferol, and isorhamnetin, and terpene trilactones, namely the ginkgolides and bilobalide. The best studied preparation is a standardized leaf extract known as EGb 761 ^[3].

Long thought extinct in the wild, ginkgo survived in refugia in China and was cultivated for centuries around temples; it is renowned for its longevity and hardiness, and several trees are recorded to have survived the 1945 atomic bombing of Hiroshima. In traditional Chinese medicine the leaves and seeds were used for a range of complaints, and the seeds remain a culinary ingredient in parts of East Asia despite their potential toxicity. The tree is now planted worldwide as an ornamental prized for its tolerance of urban conditions.

Modern interest centers on whether ginkgo leaf extract can preserve or improve cognition, and the results are mixed. A large, long-term randomized trial in older adults found that ginkgo did not reduce the incidence of dementia or Alzheimer disease compared with placebo ^[1]. By contrast, several meta-analyses of shorter trials in people who already have cognitive impairment or dementia report small improvements in cognition and daily functioning, particularly at higher standardized doses, with a safety profile similar to placebo ^[2][4]. Reviews emphasize that benefit in healthy people seeking cognitive enhancement is not well supported, and national health agencies note that ginkgo has not been conclusively proven effective for any condition ^[3].

Regulatory treatment varies by region. In the European Union, standardized ginkgo leaf extract is approved as an herbal medicine for symptoms of mild dementia, whereas in the United States it is sold as a dietary supplement and is not approved as a drug. It is available as capsules, tablets, standardized liquid extracts, and teas. Ginkgo is generally well tolerated, but it may increase bleeding risk and can interact with anticoagulant and antiplatelet drugs; raw or roasted seeds carry a separate risk of ginkgotoxin poisoning ^[3].

Ginkgo is legal and sold OTC everywhere. The main worry is its blood thinning side; by blocking PAF it raises bleeding risk, so be very careful alongside anticoagulants (warfarin, heparin), antiplatelet drugs (aspirin, clopidogrel), and NSAIDs, since that combo can cause serious or even life-threatening bleeding. Stop ginkgo at least 36 to 72 hours before any surgery. It also induces CYP3A4 and CYP2C19 and mildly shifts CYP1A2 and CYP2B6, which lowers blood levels of drugs like midazolam, theophylline, and bupropion; that matters most for narrow-margin medications. Avoid it in pregnancy.