Name: Gingko biloba
Active compounds: gingkolides, bilabolide, flavonoids
Number of scientific references: 38
Level of Evidence: Level II What is this?
Note: Gingko biloba extract offers neuroprotection and relieves nerve pain in peripheral neuropathy. Further research in well-designed clinical trials is needed to confirm its efficacy and safety.
Peripheral neuropathies occur as a complication of various disorders, as a result of infectious conditions, exposure to neurotoxins and some medications etc.; many causative factors and associations have been identified.
Most peripheral neuropathies involve oxidative stress as a major factor that contributes to declining of nerve health. In diabetic neuropathy, high blood sugar levels create an environment of oxidative stress that damage the nerve tissue.
Other comorbid conditions may add to this damaging environment. In an animal model of type 2 diabetes, it was observed that presence of hypertension worsened diabetic neuropathy by causing a higher degree of myelin thinning (myelin sheath is the insulating covering around nerve cells, and its degeneration indicates damage and loss of nerve functioning).
Herbs and medicinal plants demonstrate a multi-targeted action in most health conditions, and this makes them viable add-on or even standalone therapeutic agents. For example, Gingko Biloba is identified as a potential therapeutic agent for managing diabetic hypertension and is also a neuroprotective agent.
Gingko Biloba is an ancient medicinal tree native to China. Apparently, the word ‘Gingko’ is derived from a wrong transcription of Japanese word Yin-Kwo (silver fruit), and biloba refers to the bilobed shape of leaves.
It is considered as a ‘living fossil’ since the species have existed for 270 million years without any changes and is resistant to environmental stress and microbial attacks. Traditionally it has been used to treat a cough, asthma, hypertension etc.
Research has proven that gingko has neuroprotective, antioxidant, anti-cancer, anti-thrombotic, analgesic, anti-inflammatory and many other pharmacological properties. The leaf extract of the tree has multiple components, but the most researched ones are ginkgolides and bilabolides.
As per pre-clinical research, Gingko biloba helps in peripheral neuropathy by reducing neuropathic pain, inflammation and oxidative stress. It offers neuroprotection and aids in nerve regeneration.
Let’s explore these benefits in detail.
Suggested Gingko Biloba Supplements For Peripheral Neuropathy
Please consult a health practitioner before taking any health supplements.
There are many gingko biloba supplements available in the market but not all meet the standards set by German Commission E monograph.
The standardised content of pharmaceutical quality supplements contains 22-27% flavone glycosides and 5-7%terpenlactones, 2.8-3.4% ginkgolides A, B, C and 2.6-3.2% bilobalide. Also, they should contain less than 5 ppm gingkolic acid.
I have listed one pharmaceutical grade supplement and other dietary supplements that provide Gingko extracts close to these standards.
Tebonin Egb 761
EGb 761 is a patented standardised Gingko extract that is also referred to as Tebonin or Tanakan. It was developed by Dr Willmar Schwabe Group.
It has been used in clinical studies for several health conditions and is used to treat diabetes and diabetic neuropathies in France and Russia. It is an expensive supplement; however in some European countries it is available as an over the counter drug.
Tebonin Gingko EGb761: Buy from Amazon
Image Credit: Schwabe Pharma
Standardised Gingko Biloba Supplements
Here are some good quality standardised gingko extracts available as dietary supplements.
|Nature’s Way Ginkgold Max||Life Extension Gingko Biloba||Doctor’s Best Extra Strength Gingko|
|Image Credit: Nature’s Way Brands LLC||
Image Credit: Life Extension
Image Credit: Doctors Best
|Contains 120mg patented Ginkgo extract (leaf) standardized to 24% Ginkgo flavone glycosides (28.8 mg) and 6% terpene lactones (7.2 mg)||Contains 120mg certified Ginkgo extract (leaf) standardized to 24% Ginkgo flavone glycosides (28.8mg), 6% terpene lactones (7.2 mg) and less than 1ppm ginkgolic acid||Contains 120mg Ginkgo extract (leaf) standardized to Ginkgo flavone glycosides (28.8mg), terpene lactones (7.2 mg) and less than 5ppm ginkgolic acid|
|Buy from Amazon (US, UK, Canada)
Buy from iHerb (Global)
|Buy from Amazon (US, UK, Canada)
Buy from iHerb (Global)
|Buy from Amazon (US, Canada)
Buy from iHerb (Global)
4 Potential Benefits Of Gingko Biloba In Peripheral Neuropathy
The benefits of Gingko for peripheral neuropathy have been observed in animal models; only a few human studies have been conducted, but each of them has reported positive effects. Let’s have a look at the research.
1.Gingko biloba can help in reducing symptoms of diabetic neuropathy
Gingko biloba extract has anti-hyperglycemic or blood sugar lowering effect in diabetes. In addition to improving blood sugar control, it also reduces psychological stress in type 2 diabetes patients.
Table of Contents
- 1 Suggested Gingko Biloba Supplements For Peripheral Neuropathy
- 2 4 Potential Benefits Of Gingko Biloba In Peripheral Neuropathy
- 3 Dosage of Gingko Biloba For Peripheral Neuropathy
- 4 Precautions with Gingko Biloba Use
- 5 Conclusion
The protective effect of the medicinal plant in diabetic neuropathy was proven by Kim et al. in 2000. In the animal study, it was observed that the leaf extract protected peripheral nerve degeneration and function by boosting antioxidant defences.
A few human studies have also been conducted to assess the effect of gingko in diabetic neuropathy.
A group of Chinese researchers explored the effect of combined therapy with gingko and methylcobalamin in diabetic neuropathy. Methylcobalamin and other vitamins in the B complex group help in alleviating neuropathy by offering neuroprotection.
144 patients were enrolled in the study which lasted for 12 weeks. They were assigned to three groups and were treated as follows:
- Gingko Biloba tablets and methylcobalamin
- Epalrestat ( a medication prescribed for diabetic neuropathy) and methylcobalamin
Gingko and methylcobalamin treatment was found to be significantly better than placebo; The treatment reduced physical symptoms and improved nerve function.
Gingko biloba leaf extract EGb 761 is a standardised formulation that is prepared to ensure uniformity of constituents of the herb extract and to make it free of allergens that are naturally present in the plant.
Numan et al. conducted a study wherein 156 patients with diabetic neuropathy were treated EGb 761 or placebo for six months. The treatment dose was 120mg of EGb 761 extract per day.
Gingko significantly reduced pain intensity and improved sense of touch within six months of treatment. In the placebo group, the sensory domain related parameters worsened.
No improvement in electrophysiological parameters was observed in Gingko group when compared with placebo. The most common side effects reported were somnolence and mouth dryness.
The researchers concluded that Gingko extract EGb 761 is a safe and effective therapeutic agent for reducing symptoms of diabetic sensorimotor polyneuropathy.
Quick Gist: Human studies have reported that Gingko biloba can help relieve symptoms of diabetic neuropathy. It possibly acts by improving blood sugar levels and strengthening antioxidant studies; further research in the form of robust clinical trials is required to confirm these findings.
2.It benefits from chemotherapy-induced peripheral neuropathy
Since there is no curative therapy for chemotherapy-induced peripheral neuropathy, scientists are exploring the potential of medicinal plants and herbs to assist in nerve regeneration, reduce neuropathic pain and to protect nerve health.
Cisplatin is an anti-cancer drug which also has side effects such as neurotoxicity. Individuals who complete the full course of cisplatin chemotherapy are likely to develop sensory neuropathy.
Gingko extract EGb 761 is proven to ameliorate cisplatin-induced peripheral neuropathy in an animal model.
Cisplatin administration leads to alterations in nerve conduction velocity, changes in the structure of the neurons and even inhibited the growth of axons. But treatment with EGb 761 prevented such alterations and effectively protected from cisplatin-induced neuropathy.
Park and his colleagues have also demonstrated how gingko extract reduces neuropathic pain and increased pain sensitivity in vincristine-induced neuropathy.
Gingko exerts a neuroprotective effect by reducing oxidative stress and stimulating antioxidant defences. Additionally, it also has an anti-cancer activity which helps halt tumour growth.
Keeping these two properties in mind, researchers from Georgetown University, Washington DC decided to investigate the therapeutic potential of Gingko biloba in oxaliplatin-induced neuropathy.
17 patients with metastatic colorectal cancer treated with oxaliplatin were involved in the study. Gingko extract at a dose of 120 mg twice per day was added to their regimen.
11 out of 17 patients started Gingko therapy at cycle 1 or 2 of chemotherapy. Two patients experienced grade 1 acute neuropathy which lasted for six days while nine patients experienced neuropathy for 2-3 days.
The rest six patients started Gingko after cycle 2. Five out of 6 patients reported a decrease in intensity and duration of neuropathy. No side effects were observed.
Researchers concluded that Gingko biloba reduces intensity and duration of oxaliplatin-induced peripheral neuropathy and may have a synergistic anti-cancer effect. Further, they are conducting a phase II clinical trial to corroborate these findings.
Quick Gist: Animal studies have confirmed that concurrent treatment with gingko protects from chemotherapy-induced peripheral neuropathy. A study in humans has confirmed that gingko extract protects from oxaliplatin-induced neurotoxicity and reduces intensity and duration of peripheral neuropathy.
3.It relieves neuropathic pain
Neuropathic pain is the most debilitating symptoms of peripheral neuropathy. Many mechanisms are involved in the development of nerve pain such as the multiple neurotransmitter systems. This could be one of the reasons why neuropathic pain also leads to the development of mood disorders and sleep disturbances.
Nerve pain increases pain sensitivity and reduces pain bearing threshold. Exposure to extreme temperatures or mechanical pressure causes painful sensations in patients with peripheral neuropathy. Allodynia is a state where one perceives or senses pain from a stimulus that is not likely to cause pain.
A study published in Anaesthesia and Analgesia, 2009 reveals that Gingko biloba reduces neuropathic pain. EGb 761 extract exerted anti-allodynic effect and reduced pain sensitivity when exposed to extreme temperatures and mechanical stimulus.
Multiple animal studies have confirmed that Gingko helps in nerve pain and these studies have described possible mechanisms of action:
- It reduces oxidative stress and raises antioxidant enzymes to relieve pain in diabetic neuropathy.
- It scavenges reactive oxygen species that otherwise cause tissue damage and contribute to neuropathic pain.
- It reduces the level of inflammation causing agents and activates the endogenous opioid system to relieve nerve pain.
Quick Gist: Gingko biloba is proven to reduce neuropathic pain in animal models. It relieves nerve pain by reducing oxidative stress and inflammation. It also activates our internal opioid system to produce natural analgesia.
4.Gingko supports nerve regeneration and offers neuroprotection
Gingko extract EGb 761 interacts with the central nervous system in various ways: regulates antioxidant defences, reduces stress and enhances cognition, prevents age-related disturbances in the brain receptors, protects parts of the brain dealing with memory, protects from neuronal cell death etc.
Neurotoxins are agents that cause toxicity to the brain and nervous system. Neurotoxicity can occur as a result of exposure to environmental toxins, viruses and even certain medications. An experimental study reveals that gingko extract protects from environmental toxins induced neurotoxicity by preserving the blood-nerve barrier.
HIV infection, as well as its treatment, can cause potential neurotoxicity. Researchers from Indiana University School of Medicine, USA have proven that EGb 761 protects from HIV induced neurotoxicity by reducing inflammation, oxidative stress and preventing neuronal cell death.
These findings could be beneficial for HIV associated peripheral neuropathy.
Gingko’s neuroprotective effect prevents cell death and facilitates repair of damaged nerves.
Multiple animal studies have confirmed that gingko extract supports peripheral nerve regeneration, stimulates neurite outgrowth and assists in peripheral nerve repair. Bilabolide is one of the active compounds in the medicinal plant that aids in nerve regeneration.
Quick Gist: Gingko biloba has several therapeutic benefits that can protect from nerve damage and also assist in restoring nerve function.
It offers neuroprotection, prevents nerve cell death, helps in nerve regeneration and protects from neurotoxicity. If confirmed by human studies, these properties of gingko can assist in restoring nerve function in peripheral neuropathy.
Dosage of Gingko Biloba For Peripheral Neuropathy
Gingko biloba is available in the form of standardised extracts, liquid extracts, whole herb capsules, dried leaf for teas. The standardised extracts have been prepared from the leaves.
Very few human studies have investigated the effect of Gingko extract on peripheral neuropathy. These studies have utilised a standardised extract EGb 761, and the dose used in the studies is 120 mg 1-2 times a day.
Please consult a health practitioner before taking Gingko biloba supplements.
Precautions with Gingko Biloba Use
Gingko is well tolerated. The most common side effects, which are mild, include gastric side effects, dizziness, mouth dryness, headaches, skin rashes. These are usually rare, mild and transient; in case you experience severe side effects, please discontinue the use of gingko.
Since ginkgolides inhibit the action of Platelet Activating Factor, the most common concern is its interaction with blood thinners like warfarin, coumadin and aspirin.
Gingko supplements should be discontinued two weeks before surgery.
The safety of gingko supplements in pregnancy and lactation is not ascertained yet.
It should not be combined with other herbs that have an anti-platelet activity such as feverfew, garlic, ginseng, dong quai, red clover, and other natural coumarins.
The herb could possibly interact with antidepressants, antiepileptics, hypertension medications, diuretics, trazodone, alprazolam, ibuprofen, blood sugar lowering medicines, cyclosporine etc.
Please consult your health practitioner before taking Gingko supplements.
Research has identified many benefits of gingko for neurological conditions. Similarly, it can exert a neuroprotective action and assist in the repair of peripheral neuropathy.
As per animal studies, it boosts antioxidant defences and activates pain relief pathways to relieve nerve pain. A few human studies have been conducted on this aspect, and they have reported gingko to be beneficial in reducing symptoms of peripheral neuropathy.
More robust clinical trials are required to identify an effective dose and its safety as an adjunct to conventional therapy for neuropathy.
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