Ginkgo Biloba for Tinnitus is a Scam
Here I’ll do my best to explain why Ginkgo biloba has no place in the treatment of tinnitus. Here are the topics I’ll cover:
- What is Ginkgo biloba?
- What does Ginkgo biloba do?
- Can Ginkgo biloba help chronic tinnitus?
- Is Ginkgo biloba effective for tinnitus?
- Does anything actually help tinnitus?
What is Ginkgo biloba?
Ginkgo biloba is a popular herbal medicine derived from the leaves of the Ginkgo biloba tree. It has a long history of use in traditional medicine, particularly in Chinese and Japanese herbal practices.
Ginkgo biloba extract is a concentrated form of compounds derived from the leaves of the Ginkgo tree. It’s produced through the extraction of active ingredients using solvents such as ethanol or water. The extract contains various bioactive compounds:
- Flavonoid: Found in fruits and vegetables; has antioxidant properties.
- Terpenoid: Organic compounds synthesized by plants; contributes to aroma.
- Ginkgolide: A specific terpenoid compound found in Ginkgo biloba leaves.
What does Ginkgo biloba do?
Despite thousands of patients taking Ginkgo biloba in clinical trials, the results for this herbal supplement for clinical practice are questionable:
| Supposed Ginkgo Benefits | Explaination |
|---|---|
| Anti-platelet action | In a laboratory setting, Ginkgo biloba affects platelets by inhibiting platelet activating factor (PAF). It has a slight effect in randomized clinical trials for stroke. However, the improvements are not clinically significant. |
| Anti-oxidant action | Ginkgo biloba does have antioxidant properties. It has a fairly high Oxygen Radical Absorbance Capacity (ORAC) score, meaning that it will decrease oxygen free radicals in a test tube. Ginkgo is a good antioxidant. |
| Anti-inflammatory action | Ginkgo biloba extracts have been shown to decrease inflammatory markers in blood samples. This does not include calcitonin gene receptor protein (CGRP), the most important marker in neurogenic inflammatory conditions (like migraine and tinnitus). |
| Dementia protection | Ginkgo biloba has been studied in dementia. Clinical studies show statistical improvement in dementia scores, but not clinical improvement (ie. they don’t reach MCID levels). A meta-analysis of randomized double-blind placebo controlled trials showed that Ginkgo had no benefit in preventing dementia [1]. |
The one standout benefit of ginkgo biloba is that it has a high ORAC score. However, the FDA recently removed ORAC scores from it’s website due to increasing evidence that ORAC metrics for antioxidant capacity hold no relevance to the clinical effects of individual bioactive compounds.
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Can Ginkgo biloba help chronic tinnitus?
There is no scientific evidence that Ginkgo biloba can help tinnitus. In fact, many of the common claims about its effect on the ear are false. Here are the supposed physiological benefits of Ginkgo biloba for tinnitus:
| Claim | True or False? |
|---|---|
| Improve Cochlear Blood Flow: Ginkgo is supposed to improve inner ear blood flow. | False: Experimental evidence that shows that Ginkgo has no effect on cochlear blood flow [2]. |
| Anti-anxiety effects: Ginkgo is supposed to have anti-anxiety effects. | False: The World Federation of Societies of Biological Psychiatry (WFSBP) Taskforce found no evidence to support the use of Ginkgo biloba for anxiety [3]. |
| Cellular protection: Ginkgo is supposed to protect the inner ear from damage. | True/False: Ginkgo biloba can be otoprotective due to its antioxidant properties. However, no human clinical trials have proven this; we’ve only seen it in gerbils. |
Is Ginkgo biloba for tinnitus effective?
Ginkgo biloba for tinnitus doesn’t work. When you look at studies with proper design (i.e. a double-blind clinical trial where Ginkgo biloba versus placebo is tested), Ginkgo is ineffective in treating tinnitus. Systematic reviews and meta-analysis studies reject Ginkgo as a tinnitus treatment. Here are some summary comments from five peer-reviewed academic papers:
➀ “We concluded the use of Ginkgo biloba probably does not decrease the severity of tinnitus. In addition, it does not reduce the intensity of tinnitus or improve the quality of life of patients” [4].
➁ “The limited evidence does not demonstrate that Ginkgo biloba is effective for tinnitus when this is the primary complaint” [5].
➂ “In conclusion, Ginkgo biloba does not benefit patients with tinnitus” [6].
➃ “There is uncertainty about the benefits and harms of Ginkgo biloba for the treatment of tinnitus when compared to placebo” [7].
➄ “There is overwhelming evidence that Ginkgo biloba may play no role in tinnitus” [8].
What is Ginkgo biloba extract EGB 761?
Ginkgo biloba extract EGB 761 is a proprietary formulation of Ginkgo biloba. This is one of the few Ginkgo products where you know what concentration you’re actually getting. However, the company is doing some shady things in their clinical trials of Ginkgo biloba for tinnitus:
- First, the vast majority of their positive results are in patients who have dementia.
- Second, their measure of tinnitus severity is a visual analog scale (VAS-that’s happy to sad faces on a scale of 0-10), rather than using a standard tinnitus questionnaire to evaluate tinnitus symptom severity.
- Third, they use a statistical “sleight-of-hand” to convey that Ginkgo is an effective tinnitus treatment, when in reality, it’s not.
Ginkgo Tinnitus Treatment Hoax
Let me explain the company’s ginkgo tinnitus treatment hoax. In one of the few randomized controlled trials of EGB 761 where the treatment groups were not dementia patients, they reported a “significant improvement” in tinnitus symptoms (i.e. VAS scores). Incidentally, they found it had no effect on improving tinnitus patients’ depression scale.
However, when you look at the results, the reduction in tinnitus severity was -0.41! That’s not even half of a smiley face! This is pretty much meaningless in terms of reducing tinnitus severity, even if it’s “statistically significant”. In the end, Ginkgo biloba extract EGB 761 is just another scam, despite the apparent legitimacy of the trials and “significant results”.
Does Ginkgo biloba have any adverse effects?
There are several known adverse effects of Ginkgo biloba:
- Increased risk of bleeding
- Allergic reactions
- Gastrointestinal disturbances
- Headache
- Dizziness and vertigo
- Increased seizure risk
- Interactions with medications
You always need to be cautious with herbal medicines to treat tinnitus, as they can interact unpredictably with medications. Here are some examples of drugs that interact with Ginkgo:
- Anticoagulants/antiplatelet drugs (e.g., warfarin, aspirin, clopidogrel)
- Antidepressants (e.g., SSRIs, MAOIs)
- Anticonvulsants (e.g., carbamazepine)
- Antipsychotics (e.g., haloperidol)
- Certain chemotherapy drugs
What supplement products use Ginkgo for tinnitus?
I hope that by now, you’re convinced that Ginkgo for tinnitus is pretty much worthless. If so, you may be surprised to know that some of the best-selling dietary supplements for tinnitus have Ginkgo biloba as the featured ingredient. Here are some of the products that I consider to be tinnitus scams:
- Arches Tinnitus Formula: Ginkgo, zinc, and some other vitamins, all ineffective for tinnitus.
- Arsicor Ear Drops: Gingko, ginseng, and other untested herbs, all ineffective for tinnitus.
- Quietum: Ginkgo, ginseng, and other untested herbs, all ineffective for tinnitus.
Are there any good dietary supplements for tinnitus?
There are no dietary supplements that “cure” tinnitus, but a few may help as part of a comprehensive tinnitus treatment program.
For instance, one dietary supplement that has good data and a strong rationale is vitamin D. Deficiency in vitamin D is linked to tinnitus loudness, and supplementation in deficient patients has been shown to reverse tinnitus in clinical trials. Magnesium can also be helpful in tinnitus for similar reasons.
Does anything actually help tinnitus?
Yes! Treatment of tinnitus is possible, but we have to lose the “quick-fix” mentality when it comes to tinnitus supplements. There is no magic pill that will make chronic subjective tinnitus go away. Dietary supplements do help tinnitus, but they must be complementary to a comprehensive rehabilitation program.
What does comprehensive tinnitus treatment entail? You have to incorporate features that will accomplish three goals.
- You need to reduce sensory hypersensitivity in the brain. This can be accomplished with a combination of prescription medications, dietary supplements, and sound therapy.
- You need to rewire the parts of the brain that perpetuate tinnitus. This includes things like modified tinnitus retraining therapy, cognitive behavioral therapy, mindfulness based interventions, and lifestyle changes.
- You need to learn to identify and manage tinnitus triggers. We’ve discovered that tinnitus is related to a migraine-like process in the brain that is triggered by certain environmental factors. You need to identify and manage these tinnitus triggers.
Conclusion: Ginkgo Biloba for Tinnitus Doesn’t Work!
Almost all of my tinnitus patients have tried dietary supplements before coming to see me. It’s the first stage of finding a solution to tinnitus loudness, and in some ways, a necessary one. Sometimes, people have to learn for themselves that tinnitus is a complex neurological problem with no “quick fix”.
I actually support natural and alternative treatments and incorporate them into my practice. But dietary supplements are only one part of effective tinnitus treatment.
Ginkgo Biloba for Tinnitus References
[1] Charemboon T, Jaisin K. Ginkgo biloba for prevention of dementia: a systematic review and meta-analysis. J Med Assoc Thai. 2015 May;98(5):508-13.
[2] Lamm K, Arnold W. The effect of blood flow promoting drugs on cochlear blood flow, perilymphatic pO(2) and auditory function in the normal and noise-damaged hypoxic and ischemic guinea pig inner ear. Hear Res. 2000 Mar;141(1-2):199-219.
[3] Sarris J, et al. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce. World J Biol Psychiatry. 2022 Jul;23(6):424-455.
[4] Kramer F, Ortigoza Á. Ginkgo biloba for the treatment of tinnitus. Medwave. 2018 Oct 17;18(6):e7295. English, Spanish.
[5] Hilton MP, Zimmermann EF, Hunt WT. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD003852.
[6] Rejali D, Sivakumar A, Balaji N. Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials. Clin Otolaryngol Allied Sci. 2004 Jun;29(3):226-31.
[7] Sereda M, Xia J, Scutt P, Hilton MP, El Refaie A, Hoare DJ. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev. 2022 Nov 16;11(11):CD013514.
[8] Karkos PD, Leong SC, Arya AK, Papouliakos SM, Apostolidou MT, Issing WJ. ‘Complementary ENT’: a systematic review of commonly used supplements. J Laryngol Otol. 2007 Aug;121(8):779-82.
