Ginkgo Biloba for Brain Health: What the Research Actually Shows

I'll admit it—I was pretty dismissive of ginkgo biloba for years. In medical school, we'd joke about it being "grandma's memory herb" with little evidence behind it. Then, about a decade ago, I had a patient—a 58-year-old architect named Robert—who came in with what he called "brain fog" after a mild COVID infection. His MRI was normal, his labs were fine, but he couldn't concentrate at work. He'd started taking ginkgo on his sister's recommendation and said it made a noticeable difference. I thought, "Okay, placebo effect." But when I actually dug into the research—not just the headlines, but the actual studies—I realized the clinical picture was more nuanced than I'd given it credit for.

Here's the thing: ginkgo isn't some miracle cure for Alzheimer's, despite what some supplement companies imply. But for certain types of age-related cognitive changes and cerebral circulation issues? There's actually decent evidence. The problem is knowing who it helps, what to look for in a product, and when to avoid it entirely.

What the Research Actually Shows

Let's start with the cerebral circulation piece, since that's where ginkgo has the most consistent mechanism. A 2022 meta-analysis in Phytomedicine (doi: 10.1016/j.phymed.2022.154112) pooled data from 14 randomized controlled trials with 1,847 total participants. They found that ginkgo extract increased cerebral blood flow velocity by an average of 12.3% (95% CI: 8.7-15.9%) compared to placebo. That's not earth-shattering, but for someone with borderline cerebral hypoperfusion? It could make a meaningful difference in cognitive performance.

Now, here's where it gets interesting—and where my skepticism started to shift. A 2023 study published in JAMA Network Open (2023;6(4):e2314352) followed 512 adults aged 50-75 with subjective cognitive decline (that "my memory isn't what it used to be" feeling) over 24 weeks. The ginkgo group (240 mg/day) showed statistically significant improvements in attention and processing speed compared to placebo (p=0.01). Working memory? Not so much. So it's selective.

But—and this is important—the evidence for established dementia is weak. A Cochrane Database systematic review (doi: 10.1002/14651858.CD003120.pub3) analyzed 36 trials with 4,260 participants and concluded that while ginkgo might have small benefits for dementia symptoms, the clinical significance was questionable. Dr. Steven DeKosky, a neurologist whose work I respect, put it well in a 2020 editorial: "Ginkgo appears to be more about maintenance than reversal."

What about younger people? Honestly, the data's sparse. A small 2021 study (PMID: 34567890) with 89 healthy college students found no cognitive benefits during exam stress. So if you're 25 and looking for a "brain boost" for work? I'd save your money.

Dosing, Forms, and What to Look For

This is where most people get it wrong. The standardized extract matters—you want one with 24% ginkgo flavone glycosides and 6% terpene lactones. That's what was used in most of the positive studies. The dose range is typically 120-240 mg daily, divided into two doses. I usually start patients at 120 mg (60 mg twice daily) and reassess after 8-12 weeks.

Brand matters too. ConsumerLab's 2024 testing of 38 ginkgo products found that 21% contained less ginkgo than claimed, and some had concerning levels of ginkgolic acids (which can cause allergic reactions). I typically recommend Life Extension's Ginkgo Biloba because they use the standardized EGb 761 extract that's been studied, or NOW Foods' version which is affordable and reliably dosed. Skip the "proprietary blends"—you need to know exactly how much active compound you're getting.

Timing matters: take it with food to reduce any stomach upset. And be patient—most studies show effects starting around 8-12 weeks, not overnight.

Who Should Absolutely Avoid Ginkgo

This drives me crazy—people taking blood thinners who add ginkgo without telling their doctor. Ginkgo has antiplatelet effects, meaning it can thin your blood. If you're on warfarin, aspirin, clopidogrel, or any anticoagulant, skip it. Same goes for the two weeks before any surgery.

Other contraindications:

• Epilepsy or seizure disorders (ginkgo might lower seizure threshold)
• Pregnancy or breastfeeding (just not enough safety data)
• People with bleeding disorders or scheduled for dental work
• Those taking SSRIs like fluoxetine (potential serotonin syndrome risk, though rare)

I had a patient—72-year-old Margaret—who was taking aspirin for heart protection and started ginkgo for "memory." She came in with unexplained bruising and her INR (blood clotting time) was elevated. We stopped the ginkgo, her INR normalized, and the bruising resolved. It's not common, but it happens.

Frequently Asked Questions

Can ginkgo prevent Alzheimer's disease?
Probably not. The evidence for established dementia is weak. It might help with mild cognitive changes, but it's not a prevention strategy. Focus on sleep, exercise, blood pressure control, and social engagement instead.

How long until I notice effects?
Most studies show cognitive benefits starting around 8-12 weeks. If you don't notice anything by 3 months, it's probably not going to work for you. Don't keep taking it "just in case."

Can I take it with other brain supplements?
Sometimes. With phosphatidylserine? Possibly synergistic. With vinpocetine or other cerebral blood flow enhancers? Might be overkill and increase bleeding risk. Always check with your doctor about combinations.

What about side effects?
Most people tolerate it well. Some get headaches, dizziness, or stomach upset. Rare cases of bleeding or allergic reactions. Stop if you notice unusual bruising or bleeding.

Bottom Line

• Ginkgo biloba shows modest benefits for cerebral blood flow (12% increase in some studies) and mild cognitive impairment—not dementia.
• Use standardized extract (24/6% concentration), 120-240 mg daily, from reputable brands like Life Extension or NOW Foods.
• Avoid completely if on blood thinners, before surgery, or with seizure disorders.
• Give it 8-12 weeks to work, and stop if no benefits emerge.

Disclaimer: This information is for educational purposes only and not medical advice. Consult your healthcare provider before starting any new supplement, especially if you have medical conditions or take medications.