This Research Article has been supervised by Nutritionist/Food Expert Anum Nazir).She is Lecturer in School of Nutritional sciences At University of Faisalabad).
Researcher And Writer
Supervised By Anum Nazir
Department of Nutritional Sciences
University Of Faisalabad,Pakistan.
Context: Chinese herb “Ginkgo Biloba” helps to maintain blood pressure through its cardio protective properties. Through many clinical trial it was found that it enhances NO2 activity and in result cause vasodilation. Moreover, this traditional herbs have a potential for improving cognitive capability.
Objective: To analyze the effectiveness of ginkgo on decreasing the prevalence of dementia and improving blood pressure.
Methods and materials: The review analyzed the effect of ginkgo in reducing the dominance of dementia and hypertension. The literature was reviewed in era from June 2000 to December 2019 and was searched by the websites Embase, Medline PubMed, google scholar and The Cochrane Library. Results: Collectively 4 studies on dementia shows healthful human effect. However, some studies show no beneficial effect in reducing the incidence of ginkgo. on the other hand, review of 16 studies shows the antihypertensive effect of ginkgo where else, some studies indicate no blood pressure lowering effect.
It is one of the most overall regular illness answerable for cerebrum dysfunctioning, weakening of memory and cognizance. It fundamentally targets learning capacity and judgment. (WHO,2019) The significant manifestations incorporate distraction, trouble in perceiving article, spot and time. Anyway significant side effects incorporate memory misfortune and forceful conduct. (WHO,2019) Dementia has numerous structures, the significant type of dementia is Alzheimer which have a commonness pace of 60-70%, in addition frontotemporal dementia, dementia happen because of gathering of lewy bodies inside nerve cells and vascular dementia likewise add to different structures. (WHO,2019)
As indicated by late looks into it has been uncovered that dementia influences 50 million individuals around the world. It has been reasoned that 60% of the living in low and center salary nations are influenced by dementia. It is additionally finished up by a few analysts that 10million individuals are determined to have dementia consistently. Numerous investigations uncover, that in 2030,82 million individuals will be influenced and in 2050,152 million individuals will be influenced. (WHO,2019)
It is the exertion of force of blood circulating in the arteries against the walls of blood vessels. The systolic blood pressure is referred as the pressure at which heart contracts and diastolic indicate the rate of pressure at which the heart relaxes between the beats. The value of blood pressure at which patient is diagnosed with hypertension is >140mmhg reading for systolic and >90mmhg reading for diastolic. (WHO ,2019)
High consumption of salt, trans and saturated fats and low workout and low consumption of healthy food lead toward the high risk of hypertension and obesity. (WHO,2019) Commonly hypertension is also referred as silent killer due to its unique quality of showing no sign and symptoms. Many clinical studies explain that occurrence of headache, chest pain, anxiety, nausea and confusion are the symptoms of hypertension. (WHO,2019).
EFFECT OF GINKGO BILOBA ON DEMENTIA AND HYPERTENSION
It is concluded that improper treatment of hypertension can lead to heart attack and arrhythmia leading to low oxygen supply and deterioration of heart muscle. Moreover, kidney failure and kidney damage can also occur due to hypertension. (WHO,2019)
Many studies revealed that in African region the prevalence rate of hypertension is 27% however American has lower rates of hypertension which is usually 18%. It has been deduced that the hypertension in adult increases from 1975 which was 594 million people to 1.135 billion people in 2015. Moreover, it has been seen that mostly low income and middle income countries are affected. (WHO,2019)
This is an oldest living tree is about 3500-year-old native species located in china which is also known as “living fossil”, was brought in 1784 to US. This class of specie belong to the family of ginkgoacea, it has been claimed that the extract of gingko leaves has been used as herbal medicines to enhance memory and to improve blood flow in arteries. (Triplett et al.,2004)
The family of Ginkgoaceae was found 200 million years ago and it was found that individual trees grow to a height of approximately 38m. The leaves of ginkgo are renowned by fan shaped leaves. In the late autumn, yellow brown and plump like drupe fall produced by female adult leaves. More than 20-year-old male trees blossom in the spring. The anatomical studies explain the physical characteristics of pulp of ginkgo which often produce offensive odor. However, fleshly layer can also cause contact dermatitis. Moreover, the seeds of ginkgo are edible and just look like almond. (USDA,2018; WHO,1999)
Biological active compound
The major part of the ginkgo plant used as medicine is leaf. As the meta analysis studies indicated that leaf of ginkgo contains flavonoids and terpene. Kaempferol and isorhamnetin and quertin are the three major flavonoids. Moreover, the major terpene trilactone are ginkgolides and bilobalide anyhow other terpenes include A, B, C, J and M. Other flavonoids including dehydrocatechins (proanthocyanidins),catechins and flavones for example bilobetin, amentoflavone, ginkgetin, sciadopitysin) have been identified. Other active compounds such as shikimic, vanillic, ascorbic and p-coumaric acids. polyprenols, benzoic acid derivatives, alcohol, carbohydrates,2-hexenol.
EFFECT OF GINKGO BILOBA ON DEMENTIA AND HYPERTENSION
straight chain hydrocarbons, ketones and the steroids sitosterol and stigmasterol are also identified as a leaf constituent of ginkgo. Highest proportion of active compounds are found in autumn season.(Liu et al., 2015; Ude et al., 2013 and van Beek et al., 2009)
Ginkgo seeds contain Less than 2% fats, 38% carbohydrate and 4% protein. The experimental studies have revealed that bilobol, anacaric acid, and cardanol known as long-chain phenols, Ginkgotoxin, cyanogenetic glycosides are also present in ginkgo seeds. It has been reviewed from the lipid fraction that alkylphenols and Ginkgolic acid are also present. The foul aroma of the seed is caused byincrease concentrations of hexanoic acids and butanoic. 4-O-methylpyridoxine has been extracted from the seeds.(Liu et al., 2015 ; Ude et al .,2013 ; USDA, 2018 and van Beek et al.,2009) According to some animal experimental studies it has been revealed that colorectal. Stomach and oral cavity cancer are reduced by the beneficial effect of ginkgo leaf extract. (Ahmad HH et al., 2017; Chen et al.,2005 and Kim,2005).
Benefits of ginkgo biloba
Age related memory problems like Alzheimer and dementia are commonly treated by an herb known as EGb 761 extract of ginkgo leafs. Meta-analysis of clinical studies discovered the hepatoprotective effect and photo protective effect. It also enhances the repairing mechanism of DNA and also reveal the free radical scavenging and anti-inflammatory effect. It also inhibits the formation of cancer. (TK et al.,2014)
Studies indicated positive effect of ginkgo extract on peripheral vascular disease (Kuller, 2010). Improvements in cognition and neuro psychiatric measures is seen through use of ginkgo extract. ( Gavrilova et al .,2014 ; Ihl et al.,2011). In a study, induced periodontitis rats shows positive result after administration of ginkgo biloba extract. (Freires et al., 2018). 30 days of administration of ginkgo extract in rats induced osteoporosis shows improvement in bone mineral density (Lucinda et al., 2017).it has been revealed through several studies that antioxidant activity and vascular effect of ginkgo extract play a preventive role in glaucoma. (Hirooka et al.,2004 and Wimpissinger et al., 2007)
Experimental trials indicated that EGB 761 is given to patients suffering from cognition and cardiovascular disorder in a standardized daily dose from 120 to 240mg. (De koskey et al., 2008). According to pharmacokinetic studies it was revealed that oral administration of ginkgo in fasting state shows its highest bioavailability. However, ginkgo can be found in form of teas, sprays, tablets, syrups, capsules, extract and bars. (Ude et al.,2013; Woelkart et al.,2010)
- The main of this review is to demonstrate the effectiveness of ginkgo EGB on the decreasing the incidence of Alzheimer, dementia and hypertension.
- The analyze the antioxidant and free radical scavenging activity of ginkgo in reducing the prevalence of nerve damage
- To investigate the NO2 activity of ginkgo on reducing high blood pressure.
Review of Effect of Ginkgo biloba on dementia
Positive clinical findings
GBEs have been shown to have ant oxidative properties, to build resilience to hypoxia, and to improve blood rheology by expanding the adaptability of cell blood segments, subsequently upgrading microcirculation, influencing synapse levels, improving neuroplasticity, counteraction of edema in brain and neuroprotection.(DeFeudis and Drieu, 2000; Fehske et al., 2009; Yoshitake et al., 2010 and Altamura et al., 2016).
EGb761 at 240 mg/day can balance out or slow decrease in insight, capacity, conduct, and worldwide change at 22–26 weeks in subjective hindrance and dementia, particularly for patients with neuropsychiatric manifestations. (Tan, Meng-Shan et al.,2015)
Ginkgo extract has possibly advantageous impacts for individuals with dementia when it is controlled at portions more prominent than 200 mg/day for at any rate of 5 months. (Yuan et al.,2017) In the Impact of Cholinergic Treatment Use (ICTUS) find out about (N=828), 96.5% of sufferers obtained only cholinesterase inhibitor remedy and 3.5% obtained ginkgo in mixture with cholinesterase inhibitors. Improvements in Mini Mental State Examination (MMSE) rating had been discovered in the aggregate remedy group. (Canvelli et al.,2014)
The study explores the impacts of Ginkgo biloba extricates (EGb) in the treatment of dementia. Results recommend that the main EGb extricate that had powerful alpha-improving impacts and that might be named a subjective activator was Ginkgold. The alpha movement and reduction in EEG may have hugeness in the treatment of dementia. (Itil and Martorano,1995)
Negative clinical findings
The study revealed that Ginkgo biloba at 120 mg two times every day was not compelling in decreasing either the general rate pace of dementia or AD rate in old people with ordinary insight or those with MCI. (DeKosky et al.,2008)
In a review study, results were thought about in 80 years old 189 sufferers of Alzheimer who had utilized either donepezil or homogenized solution of Ginkgo biloba extricate (EGb 761) for a year. No alteration was noted in cognitive decay, as estimated by MMSE. (Rapp et al.,2018)
The impact of G. biloba on psychological capacity in sound people was analyzed in a deliberate review and meta-examination in 2012, which inferred that no beneficial outcome was apparent for memory, decision-making capacity. (Laws et al.,2012)
In the examination, which was directed at five clinical focuses somewhere in the range of 2000 and 2008, 3,069 individuals age 75 or more established who had intellectual hindrance were arbitrarily doled out to take twice-day by day dosages of either 20 milligrams of G. biloba extract. They were reevaluated at regular intervals for dementia utilizing a few settled mental status tests. On the off chance that changes were discovered that surpassed the normal “ordinary” changes in maturing, a progressively broad assessment, including neuroimaging, was performed. The analysts found no factual distinction in dementia or Alzheimer’s malady rates between the groups. Among those taking G. biloba, 277 created dementia. Among those people consuming extract of ginkgo biloba, 246 created dementia. Death rates likewise were comparative. (DeKosey et al.,2008)
Many trials reported that effect of ginkgo biloba on individuals suffering from dementia is unpredictable. Moreover, the analysis of patient suffering from Alzheimer also do not show any beneficial effect of ginkgo on Alzheimer. (Berks et al.,2009)
Effect of ginkgo biloba on Hypertension:
Positive Clinical Findings:
Clinical discoveries examined that debilitated eNOS activity has been found in various sorts of diseases, for instance, hypertension (Chou et al., 1998), cardiovascular hypertrophy (Ozaki et al., 2002; Champion et al., 2004), myocardial tissue necrosis and ischemia-reperfusion injury (du Toit et al., 2007; Nakata et al., 2008), and cardiovascular breakdown (Couto et al., 2015).
Remarkably, GBE has been in like manner seemed to improve eNOS development and, hence, NO bioavailability in human endothelial cells (Koltermann et al., 2007) it has been cardio protective property of GBE against Adriamycin-started exceptional cardiotoxicity have been represented by rule of provocative and NO hailing pathways (El-Boghdady, 2013).
As per these revelations, GBE causes dilation of vessels on different vascular beds (Satoh and Nishida, 2004), being in like manner related with the recovery of debilitated endothelial subordinate vasodilation in hypertensive rodents (Kubota et al., 2006; Koltermann et al., 2007).
Interestingly, ginkgo biloba has huge BP-bringing down impacts in hypertensive rats, the study found that in pre-hypertensive individuals of 21 to 57 yrs., the administration of ginkgo biloba in proportion of 120 mg/day for 3 months prompted a 6% and 21% decrease in systolic and diastolic BP, individually. (Kudolo,2002)
Major and equivalent lessening of diastolic BP was seen in the two groups toward the end of experiment visit. In both groups systolic blood pressure diminished in normal days. Despite that, in ordinary night BP diminished by 6.9% in the chief group and by 3.8% just in control group. Ginkgo biloba extricate is constituted with antihypertensive properties, is all around endured and ought to be incorporated into treatment program of patients. (Okipniak, Iryna; Ilashchuk, Tetiana; Bachuk-Ponych, Nataliia ,2018).
Negative Clinical Findings:
Ginkgo biloba was not powerful in diminishing BP or the rate of hypertension in older people in the GEM study. (Brinkley et al.,2010) A study reported no substantial differences in systolic or diastolic BP in the individual with mean age of 23-year-old, who are provided with 240 mg/day of gingko extract for a week compared to the control group (Kalus et al.,2003)
Likewise, in another study is was revealed that no differences in BP in a individuals of 32 years was seen by administrating 28.8 mg ginkgo flavonglucoside and 7.2 mg terpenlactones/day for 6 weeks. (Mehlsen et al.,2002) Studies on rats shows that ginkgo biloba has no impact on BP in normotensive controls. (Saski et al.,2002; Zhang et al.,2000)
A study on young hypertensive rats. 5–10 weeks’ old shows a significant blood pressure lowering effect of gingko biloba. However, it was found by one study on rats of 50-week old show no significant lowering of blood pressure after administration of ginkgo biloba for 4 weeks. (Tada et al.,2008)
It was recommended that in senior citizens suffering from hypertension, long haul ginkgo biloba supplementation may not be helpful in improving cardiovascular capacity. Without a doubt, it is conceivable that the antihypertensive impacts of ginkgo biloba may not be apparent in old people, especially those with delayed presentation to high BP. In addition, an ongoing investigation in the study showed that among people with uncomplicated hypertension, those with the most elevated aortic arduousness had the littlest BP decrease. (Protogerou et al.,2009.
- Ahmed HH, El-Abhar HS, Hassanin EAK, Abdelkader NF, Shalaby MB. Ginkgo biloba L. leaf extract offers multiple mechanisms in bridling N-methylnitrosourea – mediated experimental colorectal cancer. Biomed Pharmacother. 2017; 95:387-393.28858737
- Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD003120. DOI: 10.1002/14651858.CD003120.pub3.
- Brinkley TE, Lovato JF, Arnold AM, et al. Effect of Ginkgo biloba on blood pressure and incidence of hypertension in elderly men and women. Am J Hypertens. 2010;23(5):528–533. doi:10.1038/ajh.2010.14
- Couto, G. K., Britto, L. R. G., Mill, J. G., and Rossoni, L. V. (2015). Enhanced nitric oxide bioavailability in coronary arteries prevents the onset of heart failure in rats with myocardial infarction. J. Mol. Cell. Cardiol. 86, 110–120. doi: 10.1016/j.yjmcc.2015.07.017
- Champion, H. C., Georgakopoulos, D., Takimoto, E., Isoda, T., Wang, Y., and Kass, D. A. (2004). Modulation of in vivo cardiac function by myocyte-specific nitric oxide synthase-3. Circ. Res. 94, 657– 663. doi: 10.1161/01.RES.0000119323.79644.20
- Chou, T. C., Yen, M. H., Li, C. Y., and Ding, Y. A. (1998). Alterations of nitric oxide synthase expression with aging and hypertension in rats. Hypertension 1979, 643–648. doi: 10.1161/01.HYP.31.2.643
- Canevelli M, Adali N, Kelaiditi E, Cantet C, Ousset PJ, Cesari M; ICTUS/DSA Group. Effects of Ginkgo biloba supplementation in Alzheimer’s disease patients receiving cholinesterase inhibitors: data from the ICTUS study. Phytomedicine. 2014;21(6):888-892.24548724
- Chen, X., Chen, W. Recent pharmacological progress ofGinkgo biloba extract for cardiovascular and neuronal diseases. CJIM 2, 300–304 (1996). Chen SH, Liang YC, Chao JC, et al. Protective effects of Ginkgo biloba extract on the ethanol-induced gastric ulcer in rats. World J Gastroenterol. 2005;11(24):3746-3750.15968732
- Du Toit, E. F., Genade, S., Carlini, S., Moolman, J. A., Brunner, F., and Lochner, A. (2007). Efficacy of ischaemic preconditioning in the eNOS overexpressed working mouse heart model. Eur. J. Pharmacol. 556, 115–120. doi: 10.1016/j.ejphar.2006.11.004
- DeKosky et al. Ginkgo biloba for Prevention of Dementia. JAMA, 2008;300(19):2253-2262
- DeKosky ST, Williamson JD, Fitzpatrick AL, et al; Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial [published correction appears in JAMA. 2008;300(23):2730]. JAMA. 2008;300(19):2253-2262.19017911
- El-Boghdady, N. A. (2013). Increased cardiac endothelin-1 and nitric oxide in adriamycin-induced acute cardiotoxicity: protective effect of Ginkgo biloba extract. Indian J. Biochem. Biophys. 50, 202– 209.
- Folium Ginkgo. In: WHO Monographs on Selected Medicinal Plants. Vol 1. Geneva, Switzerland: World Health Organization; 1999. Freires IA, Santaella GM, de Cássia Orlandi Sardi J, Rosalen PL. The alveolar bone protective effects of natural products: A systematic review. Arch Oral Biol. 2018;87: 196-203.2930677710.1016/j.archoralbio.2017.12.019
- Gavrilova SI, Preuss UW, Wong JW, Hoerr R, Kaschel R, Bachinskaya N; GIMCIPlus Study Group. Efficacy and safety of Ginkgo biloba extract EGb 761 in mild cognitive impairment with neuropsychiatric symptoms: a randomized, placebo-controlled, double-blind, multi-center trial. Int J Geriatr Psychiatry. 2014;29(10):1087-1095.24633934