GINKGO BILOBA
Drugs in Pregnancy and Lactation.
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Name: GINKGO BILOBA
Class: Herb
Risk Factor: C
Fetal Risk Summary
Ginkgo biloba (scientific name) is a popular herbal preparation. The dioecious ginkgo tree may live as long as several hundred to a thousand years. It is the sole survivor of the family Ginkgoaceae that dates back more than 200 million years. The tree, which may grow to a height of 30 to 40 meters (approximately 98 to 131 feet), has fan-shaped leaves and is indigenous to China, Japan, and Korea (1,2 and 3). Commercial plantations of ginkgo trees in the United States, however, are pruned to shrub height to allow mechanical picking of the leaves (4).
The medicinal parts of ginkgo are the fresh and dried leaves, and the seeds separated from their fleshy outer layer (2). Ginkgo leaf extract, however, is the most commonly used form of this herb (3). Numerous uses have been recommended for the various IV (not available in United States) and oral preparations of ginkgo leaf extract, some of which are: symptomatic relief of organic brain syndrome (e.g., cerebral insufficiency, anxiety and stress, memory impairment, headache, dementias, etc), intermittent claudication and other circulatory disorders, asthma, and vertigo and tinnitus of vascular origin (1,2,3,4 and 5).
Ginkgo seed, although not commercially available in the United States, is used orally as an antitussive and expectorant, as an aid for digestion, to prevent drunkenness, in asthma and bronchitis, and for genitourinary complaints (3). Topical uses include scabies and skin sores. Roasted seeds with the pulp removed are eaten for food in Japan and China (3).
The content of active compounds in ginkgo leaves may vary widely depending upon the season (1,6). Seasonal and other factors, such as location and method of harvest, may result in a variance as much as 300% in the concentrations of active compounds (6). Ginkgo leaf extract is prepared using an acetone-water extraction process and subsequent purification steps without adding concentrates or isolated ingredients (2,3,4 and 5). A number of chemical constituents have been identified in the extract (percentages refer to German Commission E standards): 22%–27% flavanone glycosides (flavonoids consisting of monosides, biosides, and triosides of quercetin, kaempferol, isorhamnetins, and 3'-O-methylmyristicins); 5%–7% terpene lactones (terpenoids) (2.8%–3.4% ginkgolides A, B, C, and M [trilactonic diterpenes], 2.6%–3.2% bilobalide [trilactone sesquiterpene]); and less than 5 ppm of ginkgolic acids (1,2,3,4 and 5). Other chemical constituents found in the leaf before processing, in addition to those identified in the extract, include amino acid 6-hydroxykynurenic acid, bioflavonoids (dimeric bioflavones: amentoflavone, bilobetin, ginkgetin, isoginkgetin, 5- methoxybilobetin, sciadopitysin) (about 40 different bioflavonoids have been identified), terpene lactone (ginkgolide J), steroids (sitosterol, stigmasterol), polyprenols, organic acids (shikimic, vanillic, ascorbic, p-coumaric), benzoic acid derivatives, carbohydrates, straight chain hydrocarbons, alcohol, ketones, and 2-hexenol (1). A 1993 Reference detailed the chemical structures of the active ingredients (flavonoids and terpene lactones) (7).
The seed contains 38% carbohydrate, 4% protein, and less than 2% fat (1). This part of the tree is not marketed in the United States, but may contaminate other ginkgo products (8). Chemicals found in the seed are alkaloids (e.g., ginkgotoxin), amino acids, cyanogenetic glycosides, and long-chain phenols (e.g., anacaric acid, bilobol, and cardanol) (1).
Reproduction studies in animals have revealed no mutagenic or teratogenic effects (1). No teratogenicity was observed in pregnant rats given oral doses up to 1600 mg/kg/day (1).
In a sperm penetration assay, zona-free hamster oocytes were incubated for 1 hour with two concentrations of ginkgo biloba, 0.1 mg/mL and 1.0 mg/mL, dissolved in HEPES-buffered synthetic human tubal fluid (modified HTF) (9). Fresh human donor sperm was suspended in the modified HTF and then mixed with the oocytes for 3 hours. Modified HTF served as the control. At the 0.1 mg/mL concentration, three of nine oocytes were penetrated, whereas at 1.0 mg/mL, zero (0 of 8) penetration occurred. The decrease in penetration was not associated with a decrease in sperm motility (9). In the second part of the study, sperm were incubated with the herbal solutions for 7 days (9). Neither concentration caused significant sperm DNA denaturation or mutation of a selected sperm sentinel gene (BRCA1 exon 11 gene), but the higher concentration reduced sperm viability compared with controls. Extrapolation of these data to the reproductive risk of ginkgo biloba in males is difficult, in part because the concentration of the herb in semen or sperm has not been studied (9). Moreover, although the doses used in this study are small fractions of the actual recommended human dose, usually expressed in milligrams of ginkgo, there is no published evidence that the adverse effects observed have occurred in vivo.
Although some ginkgo preparations may be standardized, the standardization of any herbal product as to its constituents, concentrations, and the presence of contaminants is generally lacking. Consumption of these products during pregnancy may result in fetal exposure to unintended chemicals and doses.
In summary, no reports describing the use of ginkgo biloba during human pregnancy have been located. No mutagenicity in animals or human sperm was observed and no teratogenicity occurred in one animal species, but the data and details of the animal studies are very limited. Moreover, a large number of chemicals have been identified from this herb and none have undergone rigorous reproductive testing. However, because ginkgo is an ancient herb and its use is widespread, it is doubtful that a major teratogenic effect or other significant reproductive toxicity would have escaped notice. More subtle or low-incidence effects, however, including structural and behavioral teratogenicity, the induction of abortions, and infertility may have escaped detection, and further study is required before human reproductive risk or safety can be assessed.
Because of the uncertainties described above, various sources can be found that either state there are no restrictions against its use in pregnancy (5), or that the herb is contraindicated during gestation (1,3,10). The safest course is to avoid ginkgo products during pregnancy.
Breast Feeding Summary
No reports describing the use of ginkgo biloba during lactation have been located. Although one source states that there are no restrictions to its use during lactation (5), other sources consider the use of the herb during lactation to be contraindicated (1,3,10). The latter course is the safest because of the large number of chemical compounds in the herb and the complete lack of information on the effects of exposure to these substances in a nursing infant.
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References
- Ginkgo. The Review of Natural Products. St. Louis, MO:Facts and Comparisons. March, 1998.
- Ginkgo Biloba. PDR for Herbal Medicines. Montvale, NJ:Medical Economics. 1998:871–3.
- Ginkgo Leaf, Ginkgo Leaf Extract, Ginkgo Seed. Natural Medicines Comprehensive Database. Stockton, CA:Therapeutic Research Faculty. 1999:377–81.
- Robbers JE, Tyler VE. Tyler's Herbs of Choice. The Therapeutic Use of Phytomedicinals. Binghamton, NY:Haworth Press. 2000:141–6.
- Ginkgo Biloba Leaf Extract. Blumenthal M, Senior Editor. The Complete German Commission E Monographs. Therapeutic Guide to Herbal Medicines. Austin, TX:American Botanical Council. 1998:136–8.
- Product information. BioGinkgo 27/7. Pharmanex, 1998.
- Sticher O. Quality of Ginkgo preparations. Planta Medica 1993;59:2–11.
- Boullata JI, Nace AM. Safety issues with herbal medicine. Pharmacotherapy 2000;20:257–69.
- Ondrizek RR, Chan PJ, Patton WC, King A. An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Fertil Steril 1999;71:517–22.
- Wong AHC, Smith M, Boon HS. Herbal remedies in psychiatric practice. Arch Gen Psychiatry 1998;55:1033–44.
Q&A about Ginkgo Biloba
Can anyone take Ginkgo Biloba.
I already take a complete supplement, can I take a Ginkgo supplemtent at the same time?
I've been taking ginkgo biloba for memory for about two weeks and I noticed something strange. I have rheaumatoid arthritis and my pain is almost gone. Even aleve didn't help me before. Is there a connection here?
Ginkgo biloba should not be taken at the same time as heparin (a blood thinner) Some websites state that Kombucha contains heparin and others say that it does not. How can I find out for sure and, if it does contain heparin, would it be in such a small amount that it wouldn't matter? I've done several searches and cannot find what I am looking for. Thanks.
Wishing you good health!
Lisa J
I've just started to take ginkgo biloba to better my memory. I was just wondering how long before I see it's effects, if any.
thanks
When I started taking it, I didn't even realize it for 4-5 weeks. It dawned on me one day that I hadn't had trouble remembering as many things for the past few weeks before then, and I've been taking it ever since (with a MUCH improved memory). LOL!
How much do I have to take 'Ginkgo Biloba' each day?
If you do know what Ginkgo Biloba is.
I wouldn't advise you to take more than 120mg per day, so that depends on how much is in the capsule you are already taking. 60mg morning and evening should do it.
Ginkgo Biloba is an extract of the Ginkgo Biloba leaf. It's a large diciduous tree that comes from China.The Ginkgo tree is also refered to as a Maidenhair tree because the leaves resemble the Maidenhair fern.
Ginkgo extract contain a flavonoid called Ginkgo Flavone Glycoside and Terpine Lactone. Flavonoids are considered as antioxidants and protects against oxidative and free radical damage to cells. In this way Ginkgo Biloba helps maintain a healthy blood flow to the brain for mental clarity and memory retention. Vinpocetine is added to most extracts to support brain function and activation of the cerebral metabolism.
Ginkgo side effects and cautions include possible increased risk of bleeding, gastrointestinal discomfort, nausea, vomiting, diarrhea, headaches, dizziness, and restlessness if taken in large quantities.
Here is a website from the Maryand Medical Center: http://www.umm.edu/altmed/ConsHerbs/Gink...
As a side note: The Ginkgo survived the atomic blast at Hiroshima, Japan. Four trees growing between 1–2 km were among the few living things to survive the blast.
I understand that the herbal supplement Ginkgo Biloba assists in easing depression and promoting mental acuity. Information I'd reserached even supported taking the herb during pregnancy to encourage prenatal brain development. I had been taking 2 capsules (120mg) regularly prior to my pregnancy, but recently, I cautiously took only one and only once. Now I'm finding information that actually cautions against taking the herb during pregnancy. What major harm and/or symptoms typically result from taking Gingko Biloba while pregnant? Could I have already done any irreparable damage? Thanks.
You should be careful about taking herbs and herbal teas during pregnancy as many herbs that seem safe can be detrimental.
Congratulations on your pregnancy!
I am thinking about taking Ginkgo Biloba to help control my asthma symptoms and I am for people that had success doing this and how much Ginkgo Biloba they took?
Don't waste your time.
I can not find much on the internet about Ginkgo Biloba, but I found that it is one of the 5 herbs that are most benifical to help people with depression. I just need to know a little more about it and how much to take per day.
any advice will help. I am hoping a lot of people will help me with this because I really need help improving my memory and people seem to be taking this to help focus better and I dunno if should take it at this age. Have any of you around my age taken ginkgo biloba and it has helped improve your memory and focus better? If i do take it how should I take it and how many should i take? any side effects?I heard it thins your blood or something like that? thanks.
I'm 23 and I take it to try to help combat the side effects of birth control. Within the time of taking the pill, I have noticed a sharp decline in my mental acuity, and yes, this is a listed side effect.
Some pointers: 120mg per day, divided into two doses (60mg in the morning, 60mg at night). When buying the supplement, look for 24% ginkgoflavonglycosides. Give the supplement 6-8 months before deciding whether or not to continue taking it.
Research of your own is also advised to tailor to any specific conditions that you may have, or any prescription meds you might be taking, etc.
Dr. Mercola's website also has lots of articles with pointers to help with mental acuity. This might be worth checking out as well (www.mercola.com).
Is anybody taking ginkgo biloba and does it help enhance memory lower blood pressure, cholesterol and improve blood circulation?
It's known to enhance metal alertness and brain function, improve memory, regulate the heart and improve blood circulation through the blood vessels. It can also help with hearing loss, Asthma, Dementia, Impotence caused by use of Prozac and similar antidepressnts, Premenstrual syndrome, Vision loss related to aging and inner-ear disorders.
