Ginkgo Biloba And Drug Induced Parkinsonism

[chartist]

Dr. Mischley has Ginkgo Biloba on her list of PD supplements, but we have not talked much about Ginkgo Biloba (GB) on this forum in relation to PD.

I was just looking at the following study which used GB in drug induced parkinsonism (DIP) at a dose of 240 mg/day of GB in three divided doses of 80 mg each. Here is a link to the study :

brieflands.com/articles/ijp...

Here are two relevant study quotes :

' According to the positive results of this study regarding the improvement of motor symptoms in general and the improvement of resting tremor intensity, bradykinesia, and rigidity as the primary and direct result of this study, the findings also revealed the positive effect on cognition in patients with psychiatric disorders, including psychotic disorders and mood disorders, with the most positive cognitive effect on working memory and recent memory. The improvement of cognitive status and especially recent memory and working memory of these patients as a secondary result of this study provides a good perspective on drug use in future studies, specifically in improving cognitive disorders in psychiatric patients with mood and psychotic disorders separately. '

' On the other hand, with the improvement of memory status and the complications of DIP in these patients, the executive and job performance of patients and, in general, the patient’s quality of life will be significantly improved. Therefore, in future studies, the quality of life of patients should be considered a secondary goal of studies. '

It seems like only a small handful of supplements offer these type of benefits.

These results in people with DIP, to me, makes GB a potential supplement worth serious consideration for testing by people with PD or DIP. The relatively low dose ( 240 mg/day) used in this study in relation to effectiveness seems impressive. The established safety profile of GB is also impressive.

Art

[Sydney75]

Put a tincture of ginko (Hawaiian Pharm) in hubby am drink, with tincture of green tea, schisandra and hibiscus. Less pills, must stop 2 weeks before any surgical procedure.

[chartist in reply to Sydney75]

Yes, green tea (GT) and Ginkgo Biloba (GB) have blood thinning effects and anyone on blood thinners definitely needs their doctor's approval and supervision if they are thinking of adding GB to their regimen.

Art

[Erniediaz1018]

thank you Art

[chartist in reply to Erniediaz1018]

You're welcome, Ernie!

Art

[MBAnderson]

Is there a significant difference in the cause between DIP and PD?

[chartist]

Hi Marc,

One of the main differences between the two is that DIP mainly causes motor symptoms while PD causes both motor and non motor symptoms. Another point of importance is that DIP often goes away once the offending drug is withdrawn, but not always.

Given that it is one of the higher rated supplements on Dr. Mischley's list and presents a very good safety profile, it seems like GB is worth consideration for testing by people with PD. At a bare minimum worth a discussion with your PD doctor.

As it's name implies, DIP is caused by certain drugs while the cause of PD has not been fully elucidated yet.

Art

[Grumpy77]

Thank you so much for enlightening us on Ginkgo Biloba 🙏🏿

[chartist in reply to Grumpy77]

You're welcome, Grumpy!

Art

[Smittybear7]

what is drug induced Parkinson’s?

[chartist in reply to Smittybear7]

Any medication that interferes with dopamine transmission may cause parkinsonism.

Art

[gaga1958]

Do you remember what dose Dr M uses of Ginkgo? I looked on her site but didn't see it. Just wondering if it's the same as this study?

[chartist in reply to gaga1958]

I just remembered that she reported that many of the people who took her survey reported using ginkgo biloba extract (GBE). The study dose was relatively low compared to manufacturer recommended dosing, which is often times in the 500 mg area.

Art

[Ghmac in reply to chartist]

I listen to a video by LM discussing her supplement list. She was surprised to find GB at the top. She commented about not suggesting it for her own patients, and that she should probably reconsider.

[chartist in reply to Ghmac]

I like that she is flexible in that sense.

I think she likes to see the human studies supporting use of GBE, but sometimes enough anecdotal evidence can also be useful in deciding whether to test it, such as in the use of B1 for PD. GBE having a very good safety profile is also helpful in deciding if you might test it for PD or AD or not.

Given the known effects and mechanisms of action of GBE, it appears that it should be beneficial for more than just PD and AD, it should also be useful against long covid based on those known methods of action.

Art

[lbrussell]

Thank for your excellent research, once again, chartist.

Here is a link to Dr Mischley’s recent published paper on nutraceuticals, including Gingko biloba: mdpi.com/2072-6643/15/4/802

Figure 2 shows that Gingko biloba is the top of the list of supplements with a -357 point average reduction in PRO-PD score. Very interesting, large (huge!) drop in score, but keep in mind that that is based only 19 people taking it of 1081 individuals in the study.

Some relevant text from the paper:

"After adjusting for age, gender, income and years since diagnosis, individuals reporting consistent use of the following supplements reported fewer PD symptoms statistically over time: Ginkgo biloba (β = −357, CI95%: −592–−122)..."

"Another limitation of this dataset is that some of the supplements were only being used by a small number of individuals, such as NAD+ (n = 19, 1.8%) and Ginkgo biloba (n = 16, 1.5%); statistical significance in these smaller samples should be interpreted with caution as skew and kurtosis can increase statistical significance inappropriately."

Also, do your research before adding to your stack. GB is not recommended for folks with alzheimer's disease or other dementia, bleeding problems, diabetes, high blood pressure, seizure disorder, those taking blood-thinner medications, and others as well.

[lbrussell in reply to lbrussell]

This study has a lot to say about Ginkgo: ncbi.nlm.nih.gov/pmc/articl...

[chartist in reply to lbrussell]

Interesting data from previous studies in that review that you linked to. That was done 6 years ago so there is likely more data on the effects of GBE currently available. GBE has also shown modest benefit for AD. Here is a little window into the GBE aspect of the review :

Source Compound Action mechanism Refs

Ginkgo biloba EGb761 Antioxidant, inhibited toxic effect of levodopa, inhibited MAO activity, ↓behavioural deficit, anti-apoptotic, maintain ΔΨm, ↑bcl-2, ↓caspase-3, ↓lipid peroxidation, ↓oxidative stress [9–15]

Ginkgo biloba Ginkgetin ↓ROS, maintain ΔΨm [16]

Ginkgo biloba Ginkgolide B and Bilobalide ↓α-synuclein, anti-apoptotic [17]

Ginkgo biloba Ginkgo biloba extract ↑SOD, ↑GHS, ↓malondialdehyde

Unfortunately the columns don't line up so here is a link to the graph :

ncbi.nlm.nih.gov/pmc/articl...

Here is a relevant quote from the review where it is discussing the effects of GBE in PD animal models :

' These effects have been observed in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine- (MPTP-) treated mouse model of PD, where chronic ingestion of EGb761 prevented MPTP-induced reduction in the dopaminergic nerve endings [9]. In addition, EGb761 administered before or after MPTP treatment protected against MPTP-induced dopaminergic neurotoxicity [10]. Moreover, EGb761 attenuated the neurotoxic effect of levodopa in the 6-hydroxydopamine (6-OHDA) model of PD, indicated that levodopa is neurotoxic and that EGb761 may decrease this toxicity [11]. The neuroprotective effects of EGb761 were demonstrated in the 6-OHDA rat model, as indicated by the reduction in the behavioural deficit in the rat [12]. Paraquat is a pesticide that has been linked to PD, and it has been demonstrated that EGb761 protects against paraquat-induced apoptosis of PC12 cells by increasing bcl-2 activation, maintaining of mitochondrial membrane potential (∆Ψm) and decreasing caspase-3 activation through the mitochondria-dependent pathway [13]. The neuroprotective effect of EGb761 against MPTP neurotoxicity is associated with the blockade of lipid peroxidation, reduction of oxidative stress, and attenuation of MPTP-induced neurodegeneration of the nigrostriatal pathway [14]. Also, it was demonstrated in an extensive review that EGb761 may exert therapeutic actions in an animal model of PD via the antioxidant effects [82]. '

While PD animal models are helpful in understanding the methods of action at play as regards GBE as it might relate to PD in people, they do not always translate to similar effects in humans. What seems important, from this review is that GBE seemed to display its beneficial effects when given before induction of PD symptoms by MPTP or after induction of PD symptoms by MPTP. Many tested substances can show benefit if given before induction of PD symptoms, but significantly less substances can be as effective if given after the symptoms are established.

Art

[chartist in reply to lbrussell]

What I was mainly trying to point out, was the study itself and the fact that Dr. Mischley has mentioned GBE in her videos, but our forum has not really discussed it at length yet. When it comes to PD and treatment, many PwP are often looking for alternative adjunctive treatments given the limitations of the standard prescribed medications. The safety profile of GBE also seems very relevant.

Art

[PDCyclist]

Great data, especially as I have a large Ginko Biloba tree in my garden!😃 Just need to wait a month or so for the leaves to come out, presumably it is the leaves one needs to take and I don't need to dig the thing up and get some roots?🤔

[chartist in reply to PDCyclist]

Keep in mind that most studies use ginkgo biloba extract (GBE) and some studies use the harder to find and more expensive EGb761 standardized extract version.

Art

[glenandgerry]

Thank you so much for posting this Art.I have tried many supplements over the years for my HWP but have never tried GB. Think I should try it but as gaga1958 mentioned, would like to know the dose.

[chartist in reply to glenandgerry]

Hi Gerry, it's been a while.

The dose used in the study was 240 mg / day in three divided doses of 80 mg each of Ginkgo Biloba Extract (GBE) but supplements seem to range between 120 mg and 250 mg per capsule and some supplements suggest 500 mg/day or more. There are a few supplements offering 80 mg per capsule as was used in the study and that seems like a reasonable place to start. Here is an example of an 80 mg per capsule supplement :

amazon.com/Vital-Nutrients-...

It would take three of these 80 mg capsules per day to reach the study dose of 240 mg/day.

Art

[glenandgerry in reply to chartist]

Yes Art, it has been a while. We're still hanging in there!

[glenandgerry in reply to glenandgerry]

Thanks so much for all this info Art and for putting so much effort into all your research.

[chartist]

This systematic review of human studies adds a bit more confirmation to the idea that Ginkgo Biloba has motor function improving effects :

tandfonline.com/doi/full/10...

Here is a relevant quote from the review :

' Only scientific studies and systematic reviews with humans published between January 2000 and November 2021 were reviewed, and 256 papers were included. Ginkgo biloba was the most relevant nootropic regarding perceptual and motor functions. '

Art