Ann M. Coulston and Carol J. Boushey
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 Several herbal supplements, such as those containing ginkgo biloba and bilberry, have been promoted to benefit the health of the retina. However, there are no scientific studies that support their benefit except one very small (20 persons) study of ginkgo biloba in patients with AMD, in which improvement in visual acuity was indicated in a preliminary report (recently reviewed [233]).
IV. DIABETIC RETINOPATHY
A. Overview
Diabetic retinopathy (DR) is a disease among people with diabetes that is considered to be the result of damage to the microvasculature of the retina. |
Bill Sardi
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 Quercetin
Quercetin, a natural substance found in red onions and the skin of red apples as well as ginkgo biloba, inhibits the p38 kinase enzyme and improves the survival of cells in laboratory experiments. [Kidney International 58: 1078-87, 2000; J Endotoxin Research 7: 431-38, 2001] Quercetin and ginkgo biloba both have been shown to inhibit the production of p38 kinase enzyme. [Biochem Pharmacology 62: 963-74, 2001]
6. Ginger
Ginger is a spice that possesses anti-inflammatory properties by virtue of its gingerol content. Ginger and its components are natural COX-2 inhibitors. |
Joerg Gruenwald, Ph.D.
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 Bosio E et al., ginkgo biloba L. and Vaccinium myrtillus L. extracts prevent photo-induced oxidation of low density lipoproteins. In: PM 62, Abstracts of the 44th Ann Congress of GA, 24. 1996.
Cignarella A, Bertozzi D, Pinna C, Puglisi L, Hypolipidemic activity of Vaccinium myrtillus leaves on an model of genetically hyperlipidemic rat. In: PM 58(Suppl. 7):A581. 1992.
Frohne D, Vaccinium myrtillus L.- Die Heidelbeere. In: ZPT 11(6):209-211. 1999.
Kyerematen G, Sandberg F, (1986) Acta Pharm Suec. 23:101. Sticher O et al, (1979) Planta Med 35:253. |
Steven V. Joyal
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 Varying levels of success have been found with other interventions, including nutraceuticals (such as Saint-John's-wort, L-tryptophan, ginkgo biloba), light therapy, exercise, stress-management techniques (covered in this chapter), prayer/spiritual guidance, and various mind-body therapies (for example, guided visualization, self-hypnosis, biofeedback). Please see the Suggested Reading List for resources that explore these other strategies for treating depression. |
Ann M. Coulston and Carol J. Boushey
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| Ginkgo biloba extract reduces endothelial progenitor-cell senescence through augmentation of telomerase activity. J. Cardiovasc. Pharmacol. 49, 111-115.
251. Yamamoto, Y., and Gaynor, R. B. (2004). IkappaB kinases: key regulators of the NF-kappaB pathway. Trends Biochem. Sci. 29, 72-79.
252. Farooqui, A. A., Horrocks, L. A., and Farooqui, T. (2007). Modulation of inflammation in brain: a matter of fat. J. Neurochem. 101, 577-599.
253. Beitner-Johnson, D., and Millhorn, D. E. (1998). |
Thomson Healthcare, Inc.
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| Intermittent Claudication
A 2004 review of the literature up to March 2002 identified 9 randomized, double-blind, placebo-controlled clinical trials that used oral forms of ginkgo biloba special extract EGb 761 for people with peripheral arterial occlusive disease rated stage 11 (not higher) and included analysis of such factors as pain-free walking distance. |
Elaine Magee
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 Quercetin, also found in onions, red wine, broccoli, tea, and ginkgo biloba, appears to influence some carcinogenic markers.
Savor the skins! In lab studies, researchers at Cornell University in Ithaca, New York, found that apple extract given together with apple skin worked better to prevent substances that protect against a variety of conditions and chronic diseases, including cancer, coronary heart disease, and cataracts. These nutrients are literally powerhouses of protection. |
J. Douglas Bremner
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 Damiana (Turnera diffusa) is a flowering shrub that was traditionally used as an aphrodisiac and as a treatment for various sexual disorders; there are no current studies to confirm its effectiveness, although it is apparently safe. ginkgo biloba increases arterial blood flow, which may have a positive effect on male sexual function. Muira puama (Ptychopetalum olacoides) is promoted for ED and lack of libido. There are no major toxicities, although there are no studies demonstrating efficacy. I would recommend saving your money instead of buying any of these remedies. |
| GINKGO
People have long believed that ginkgo biloba, a supplement derived from the ancient ginkgo tree of China, increases memory, energy, and concentration. It is used to treat tinnitus (ringing in the ears) and vascular disease, and is believed to be a neuroprotective agent and antioxidant. In Germany more than 5 million prescriptions are written for ginkgo every year, and sales in the U.S. are $240 million per year. |
Michael T. Murray
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 We would also recommend consulting your physician for proper wound care (even minor nicks or slivers need immediate attention) and using either ginkgo biloba or grapeseed extract to support optimal circulation.
Ginkgo biloba extract (GBE) is probably best known for its ability to improve blood flow to the brain, but it also improves blood flow to the hands and feet. The most common symptoms of peripheral arterial disease are numbness, tingling, and intermittent claudication—a painful cramp or tightness produced with exertion. Intermittent claudication usually affects the calf muscle. |
Jonny Bowden, Ph.D., C.N.S.
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 Journal of the American Medical Association (JAMA), 300 participants with Alzheimer's or dementia received either 40 mg of ginkgo biloba extract or a placebo three times a day. Compared to the placebo group, almost twice as many of the patients in the ginkgo group showed significant improvement on a rating scale that evaluates the severity of Alzheimer's disease. In Germany, physicians are so sure of ginkgo's benefits that it's hard to get them to perform scientific studies of the herb. |
| The most studied form of ginkgo biloba is an extract called EGB 761. Try to find a brand that has been standardized for that extract. (One such brand in the United States is Ginkgold by Nature's Way.) According to the Herb Research Foundation, you can also look for standardized extracts that have been standardized for 24 percent ginkgo flavone glycosides.
Some researchers suggest that the combination of ginkgo and Panax ginseng might be even more effective than either used alone.
You should give ginkgo at least a twelve-week trial, the length of time used in many studies. |
Craig Pepin-Donat
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 As an example, taking vitamin E, which most people consider very safe, along with ginkgo biloba in combination with Coumadin, heparin, or warfarin (all prescription drugs to help thin the blood) increases the risk for subdural hematomas, retinal hemorrhages and internal bleeding.7 The combination of vascular dilation and blood thinning drugs can prove to be deadly.
Another supplement that has certain proven benefits that have been overexploited and exaggerated by the supplement industry is St. John's Wort. It has been used for centuries to relieve ulcers and nausea. Today, St. |
| One of the top-selling herbs, ginkgo biloba, has been used for nearly 3,000 years. Amongst many claims, it has been touted as an herbal remedy that improves blood flow because of its ability to increase vascular dilation. The result is said to improve brain function in Alzheimer's patients, improve short-term memory and can even reduce retinal damage from diseases such as macular degeneration.6 Be certain to read the fine print telling you to "Contact your physician before taking this product," because combining ginkgo with prescription or over-the-counter drugs can be dangerous. |
Ann M. Coulston and Carol J. Boushey
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| However, there are no scientific studies that support their benefit except one very small (20 persons) study of ginkgo biloba in patients with AMD, in which improvement in visual acuity was indicated in a preliminary report (recently reviewed [233]).
IV. DIABETIC RETINOPATHY
A. Overview
Diabetic retinopathy (DR) is a disease among people with diabetes that is considered to be the result of damage to the microvasculature of the retina. It is the leading cause of new cases of blindness in working age U.S. adults (20-74 years) [234]. |
Joerg Gruenwald, Ph.D.
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| Kurz A, ginkgo biloba bei Demenzerkrankungen. In: Loew D, Rietbrock N (Hrsg.), Phytopharmaka. Steinkopff Verlag, Darmstadt 1995, S 145-149.
Nieder M, (1991) Pharmakokinetik der Ginkgo-Flavonole im Plasma. Munch Med Wschr 133:61-62.
Oberpichler-Schwenk H, Krieglstein J, (1992) Pharmakologische Wirkungen von Ginkgo-biloba-Extrakt und -Inhaltsstoffen. Pharmazie in unserer Zeit 21:224-235.
Pfister-Hotz G, Phytotherapie in der Geriatrie. In: ZPT 18(3):165-162. 1997.
Riederer P, Laux G, Poldinger W (Hrsg.), Neuropsychopharmaka. Band 5: Parkinsonmittel und Nootropika. |
Ann M. Coulston and Carol J. Boushey
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| Ginkgo biloba and neurodegenerative disorders. Front. Biosci. 9, 3091-3104.
4. Cabeza, R., Grady, C. L., Nyberg, L., et al. (1997). Age-related differences in neural activity during memory encoding and retrieval: a positron emission tomography study. J. Neu-rosci. 17, 391^100.
5. Small, S. A., Stern, Y., Tang, M., and Mayeux, R. (1999). Selective decline in memory function among healthy elderly. Neurology 52, 1392-1396.
6. Murphy, D. G., DeCarli, C, Schapiro, M. B., et al. (1992). |
Joerg Gruenwald, Ph.D.
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| Woerdenberg HJ, Van Beek T.A. ginkgo biloba. In: DeSmet PAGM, Keller K, Hansel R, Chandler RF, ed. Adverse Effects of Herbal Drugs. Springer-Verlag Berlin Heidelberg 1997; 3:51-66.
Further information in:
Hansel R, Keller K, Rimpler H, Schneider G (Hrsg.), Hagers Handbuch der Pharmazeutischen Praxis, 5. Aufl., Bde 4-6 (Drogen), Springer Verlag Berlin, Heidelberg, New York, 1992-1994.
Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, Nachdruck, Georg Olms Verlag Hildesheim 1979.
Schulz R, Hansel R, Rationale Phytotherapie, Springer Verlag Heidelberg 1996. |
| CONTRAINDICATIONS
The drug is contraindicated in patients known to be hypersensitive to ginkgo biloba preparations.
PRECAUTIONS AND ADVERSE REACTIONS
General: Health risks or side effects following the proper administration of designated therapeutic dosages are not recorded. Mild gastrointestinal complaints could occur as side effects. Allergic skin reactions have been observed on extremely rare occasions. The possible hypersensitivity reactions are: occurrence of spasms and cramps and, in cases of acute toxicity, atonia and adynamia. |
Tori Hudson, N.D.
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 Many forms and methods of preparation of ginkgo are available, although a high quality of ginkgo biloba extract is typically standardized to 24 percent ginkgo flavone glycosides and 6 percent terpene lactones. The actions of these constituents include improving blood flow to the brain70 and to the hands and feet.71' 72 Although ginkgo extract has not been specifically studied in menopausal women with memory or cognition problems, it has been used to improve memory. |
| Clinical studies have demonstrated the efficacy of ginkgo biloba extract (GBE) for the treatment of memory loss, depression, and disorientation associated with cerebrovascular insufficiency in geriatric patients.73-75 Two studies have shown gingko to be effective for patients with mild to moderate primary dementia of the Alzheimer's type or multi-infarct dementia.76'77 Patients who received ginkgo showed memory and attention improvements and significant improvement in cognitive function tests and depression. Relative differences for dementia were not observed. |
Joerg Gruenwald, Ph.D.
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| Dfeudis FV, ginkgo biloba extract (EGb 761): Pharmacological activities and clinical applications. In: Elsevier Editions Scientifiques Paris. 1991.
Dingermann T, Phytopharmaka im Alter: Crataegus, Ginkgo, Hypericum und Kava- Kava. In: PZ 140(23):2017-2024. 1995.
Dorn M, Braunig B, Gross HD, Ginkgo-Dragees bei zerebraler Leistungsschwache. In: ZPT 12(6):180. 1991.
Ermini-Fiinfschilling D, (1992) Moglichkeiten und Grenzen eines Gedachtnistrainings mit Patienten bei beginnender Demenz. Z Moderne Geriatrie 12:459-456. |
| Production: A dry extract from the dried leaf of ginkgo biloba is manufactured using acetone/water and subsequent purification steps without addition of concentrates or isolated ingredients. |
Jonathan V. Wright, M.D. and Alan R. Gaby, M.D.
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 Herbal Supplements
Ginkgo biloba
Extracts from the leaves of the ginkgo biloba tree have been shown to prevent or reverse some of the manifestations of aging, including memory loss, depression, impotence, and atherosclerosis. AMD is another age-related disorder that appears to respond to ginkgo. In a double-blind study of 10 patients with AMD, ginkgo was significantly more effective than a placebo, as demonstrated by improvement in long-distance visual acuity.15
Flavonoids
A group of chemically-related substances known as flavonoids are found in a wide variety of plants. |
Thomson Healthcare, Inc.
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| John's Wort, ginseng, or ginkgo biloba (abstract). Clin Pharmacol Ther; 69(2):P86. 2001.
Sonnenborn U, Proppert Y, Ginseng (Panax ginseng CA. Meyer). Z Phytotherapie 11:35-49. 1990.
Sorensen H, Sonne J. A double-masked study of the effects of ginseng on cognitive functions. Curr Ther /ta;57:959-968. 1996.
Sotaniemi E, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care Oct; 18(10): 1373-1375. 1995.
Sprecher E, Pflanzliche Geriatrika. In: ZP7/9(2):40. 1988.
Sprecher E, Phytotherapeutika als Wunderdrogen? Versuch einer Bewertung. In. |
| Leaves, Stem, and Root: ginkgo biloba is a 30- to 40-m high dioecious tree with a girth of about 4 m. The trees can live for hundreds of years. The bark is light to dark brown with rough grooves and reticulate fissures. The leaves are fan-shaped with bifurcated ribs. They are fresh green to golden yellow in autumn. The female trees are pointed and pyramid-shaped; the male trees are broad and sparer.
Characteristics: The seeds smell like butyric, capric, or valeric acid when ripe.
Habitat: Ginkgo is indigenous to China, Japan and Korea, and is also found in Europe and the U.S. |
| Clinical Management: Patients taking ginkgo biloba with omeprazole may require a higher dose of omeprazole to retain effectiveness.
Papaverine: Ginkgo may also increase the incidence of adverse effects when used with papaverine. Clinical Management: Caution is advised if Ginkgo is taken concurrently with papaverine. Monitor the patient for increased adverse effects of papaverine.
St. Johns Wort: Concurrent use may result in changes in mental status. |
| Nicardipine: ginkgo biloba extract reduced the hypotensive effect of nicardipine in rats, suggested to be due to induction 1 of cytochrome P450 (CYP) 3A2 (Shinozuka et al, 2002). Gingko increased expression of cytochrome P450 enzymes CYP2B1/2, CYP3A1, and CYP3A2 and did not affect CYP1A1, 1A2, 2C11, or 4A1 (Shinozuka et al, 2002). The effect of this interaction in humans is unknown. Clinical Management: Caution is advised if patients take Ginkgo with nicardipine. Monitor regularly for continued blood pressure control. |
| Buspirone: The addition of ginkgo biloba and/or St. John's Wort to therapy with buspirone and fluoxetine may have precipitated a hypomanic episode in a case report (Spinella & Eaton, 2002). Clinical Management: Caution patients taking buspirone to discuss the use of nonprescription medicines, herbs, and dietary supplements with their doctor or pharmacist. If a patient presents with hypomanic symptoms when taking buspirone, inquire about the use of nonprescription medicines, herbs, and dietary supplements. |
Mike Adams, the Health Ranger
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 Herbal interactions are listed, covering herbs like ginkgo biloba and St. John's Wort, among many others.
Over 540 brand-name drugs are listed in the NewsTarget DrugWatch database, including Amoxicillin, Celebrex, Prozac, Ibuprofen, Risperdal and others. Each health caution is backed by cited references. The data for this consumer guide was provided by Applied Health (www.AppliedHealth.com), a nutritional research and solutions company specializing in restorative nutritional therapies. |
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