What are the benefits and risks of using Ginkgo biloba for cognitive improvement?

Ginkgo Biloba Benefits for Cognitive Function

Ginkgo biloba is not recommended for cognitive improvement due to insufficient evidence of benefit and inconsistent research findings.

Evidence on Cognitive Benefits

Current clinical guidelines do not support the use of Ginkgo biloba for cognitive enhancement:

• The American Society of Clinical Oncology (ASCO) lists Ginkgo biloba among therapies with insufficient evidence to form clinical recommendations for cognition 1

• The 2019 review on dietary interventions for cognitive impairment found no firm guidance or recommendation can be offered about Ginkgo biloba for cognitive dysfunction 1

• The 2015 ESPEN guidelines on nutrition in dementia explicitly state: "We do not recommend any other nutritional product for persons with dementia to correct cognitive impairment or prevent further cognitive decline" 1

• The 2014 clinical practice guideline for tinnitus strongly recommends against Ginkgo biloba, stating: "Clinicians should not recommend Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus" 1

Research Evidence Quality

The research on Ginkgo biloba shows mixed and generally weak results:

• The Cochrane review concluded: "The evidence that Ginkgo has predictable and clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unconvincing" 2

• A psychological science review found that "at best, the effects seem quite modest" and questioned whether Ginkgo's effects, if present, are equal to conventional treatments 3

• While some meta-analyses suggest potential benefits, they acknowledge significant limitations:

  • "Due to limited sample size, inconsistent findings and methodological quality of included trials, more research are warranted to confirm the effectiveness" 4
  • Studies showing benefits often have methodological concerns and are of moderate to poor quality 5

Potential Mechanisms of Action

If Ginkgo biloba has any effects, they may work through:

• Vasodilation (increasing blood supply by dilating blood vessels)
• Reducing blood viscosity
• Modification of neurotransmitter systems
• Antioxidant properties (reducing oxygen free radicals)

Safety Profile

• Ginkgo biloba appears to have a relatively favorable safety profile with adverse events generally reported at placebo levels 6
• However, potential risks include:
  • Increased bleeding risk (due to antiplatelet effects)
  • Interactions with anticoagulant medications
  • Gastrointestinal symptoms

Alternative Approaches for Cognitive Enhancement

For those seeking cognitive improvement, guidelines suggest more evidence-based approaches:

• For mild cognitive impairment or dementia, FDA-approved medications like cholinesterase inhibitors (donepezil, rivastigmine, galantamine) have stronger evidence 1

• Non-pharmacological interventions with better evidence include:

  • Cognitive training/rehabilitation
  • Physical exercise
  • Brain stimulation techniques

Conclusion

While Ginkgo biloba continues to be studied for potential cognitive benefits, current clinical guidelines and high-quality research do not support its use for cognitive enhancement. The evidence remains inconsistent and unconvincing, with methodological limitations in many studies. Those seeking cognitive improvement should discuss evidence-based pharmacological and non-pharmacological options with their healthcare providers.