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New research suggests ginkgo biloba extract may be helpful after a stroke. Marcel/Stocksy
  • A recent preliminary study highlights a promising development in stroke recovery treatment.
  • Researchers found that ischemic stroke patients—those experiencing strokes caused by blood clots—demonstrated improvements in cognitive function in the early recovery phase when administered intravenous injections of a ginkgo biloba extract within the first two weeks following their stroke.
  • This discovery underscores the potential of traditional remedies in modern medical practices and sparks a dialogue on integrating such treatments into stroke recovery protocols.

According to a preliminary study, presented at the 2024 International Stroke Conference, individuals experiencing ischemic stroke showed improved cognitive function in the early stages of recovery when treated with intravenous injections containing a mix of active components from ginkgo biloba in the initial two weeks following the stroke.

Extracted from the dried leaves and seeds of the ginkgo tree, which is among the oldest living tree species native to East Asia, ginkgo biloba is a herb celebrated in traditional Chinese medicine and also available as a dietary supplement in the United States.

In China, intravenous (IV) therapies utilizing the active compounds of ginkgo biloba are commonly employed for stroke treatment, attributed to its potential antioxidant properties that could safeguard neurons against damage.

However, the FDA has not sanctioned ginkgo biloba for any medical application, and, as per the National Center for Complementary and Integrative Health (part of the National Institutes of Health), there is not currently sufficient evidence to approve its use.

In this new study involving 3,163 individuals who had experienced mild to moderate blockage-related strokes, researchers investigated how their cognitive function recovered post-stroke.

These participants, who were, on average, 63 years old and 36% of whom were women, received treatment across 100 facilities in China.

Within the first 48 hours after their stroke, around half were randomly chosen to get a daily IV shot of 25 mg of a ginkgo biloba-derived mixture known as GDLM for two weeks. The rest were given a placebo shot daily for the same duration.

Researchers evaluated their mental abilities using the Montreal Cognitive Assessment (MoCA), a direct, 30-point test often used for stroke patients, at the start, after two weeks, and then after three months.

Initially, before any treatment and just after their stroke, the average mental capability score of these patients was moderately low, at 17 out of 30.

After two weeks, those who had received the ginkgo biloba extract shots showed more improvement in their mental function scores than those who had been given the placebo, with scores increasing by an average of 3.93 points compared to 3.62 points.

By the 90th day, the gap widened further, with the ginkgo biloba group showing a more significant increase in mental function scores, averaging a 5.51 point improvement, versus a 5.04 point increase in the placebo group.

The researchers explained that the group receiving GDLM saw a 20% higher rate of patients achieving a clinically meaningful level of cognitive improvement, suggesting that GDLM injections could enhance cognitive functions in those experiencing acute ischemic stroke.

They noted, however, that the study’s follow-up period was limited to 90 days, implying the necessity for more extended research to understand the long-term impacts of GDLM treatments.

Further elaborating on the benefits, the researchers mentioned that GDLM appears to offer neuroprotection through various mechanisms.

These include widening the brain’s blood vessels, enhancing the brain cells’ ability to withstand low oxygen levels, and boosting cerebral blood flow.

They also highlighted that GDLM possesses antioxidant, anti-inflammatory, and anti-apoptotic (preventing cell death) effects.

The 2022 American Heart Association Scientific Statement on the use of complementary and alternative medicines in heart failure management highlighted that while there may be benefits, there are also significant risks associated with these treatments, underscoring the importance of involving healthcare professionals in decision-making.

Experts emphasized that the recommendations for the cautious use of supplements in heart failure patients should similarly apply to the treatment of all cardiovascular diseases, including stroke.

They advise against stroke patients using gingko biloba or any supplements without consulting their healthcare providers.

While the research on ginkgo biloba might hold promise for post-stroke care in the future, its effectiveness and safety must be proven through clinical trials to meet the rigorous standards required for FDA approval.

Dr. José Morales, vascular neurologist and neurointerventional surgeon at Pacific Neuroscience Institute in Santa Monica, CA, who was not involved in this research, told Medical News Today that “Gingko biloba has a long history of associated effects on moderately boosting cognitive function.”

“The strength of this study lies in the study design (i.e., double-blind randomized clinical control trial) and in those with a sentinel event (i.e., acute ischemic stroke) that is known to affect cognition long-term,” he said.

“However, the effect size is not disclosed in this abstract, so more information is needed to evaluate the strength of the findings. In addition, the study is not an international trial, so the generalizability of the findings to diverse populations are in question,” he added.

Rachael Miller, a nutritionist, herbalist, and the founder of Zhi Herbals, who was also not involved in the study, told MNT that “it is well known that the terpene lactones in ginkgo are largely responsible for its ability to reduce inflammation and enhance mental acuity and memory.”

Miller pointed to previous research that supports ginkgo’s ability to protect damaged neurons after ischemia.

“This new study is exciting, and it aligns with the results of previous research done regarding ginkgo and ischemic damage.”
— Rachel Miller

Dr. Morales points out that “Ginkgo biloba has putative mechanisms of action that protect neurons against beta-amyloid neurotoxicity, hypoxemia, and oxidative stress.”

“The authors should be lauded for completing this trial and demonstrating clinically significant outcomes, which are often elusive even with plausible mechanisms of action. Future research should be conducted at multiple sites internationally with diverse populations to verify and validate these findings, as well as to determine the safest and most effective dose. Conducting international trials would boost credibility and facilitate approval to large clinical populations at need should the results be replicated at that scale.”
— Dr. José Morales

Miller notes that “the improvement in MoCa scores is significant and can offer hope to those [experiencing] the lasting results of acute ischemic stroke.”

“It would be difficult for a layperson to replicate the results at home, as the injection method is not accessible to most, and ginkgo supplements usually do not have their lactone content standardized or labelled. The content of ginkgo leaves varies greatly depending on how they are harvested,” Miller explained.

However, it’s important to note that Dr. Morales said, “patients and the public should wait for additional information from this trial and/or subsequent ones before adopting a regimen with over-the-counter gingko biloba supplements, particularly given known ginkgo-related safety issues and drug-drug interactions.”