Ginkgo biloba for memory-a dream that did not materalize

Just a quick post about Ginkgo biloba. Some of my patients use Ginkgo biloba extract as a supplement to enhance memory and prevent neurodegenerative conditions like Alzhemier’s dementia. The data that it is indeed effective has always been inconclusive. I always feel that if  a drug is truly effective for a condition then we seldom need studies to prove it. It is only when the evidence is insufficient to suport a recommendation that studies are needed. Many of these are funded by the drug manufacturer (large pharmaceutical companies).

Recently results were made available from a big study looking at whether Ginkgo biloba extract actually aided in preventing Alzheimer’s dementia. The study found that Ginkgo biloba did not prevent or delay dementia or Alzhemier’s disease. In simple words, the study showed that it does not work. Further there is some data to show that it may actually be dangerous to take this extract as it increases the risk of hemorrhagic strokes (bleeding in the brain).

My advise to my readers would be to avoid taking this supplement till we have more conclusive data on its effectiveness. Especially avoid taking supratherapeutic doses (large doses).


Nitin Sethi, MD

Nourishing and nurturing your brain: from the things we eat to the things we do

Nourishing and nurturing your brain: from the things we eat to the things we do



Nitin K. Sethi, MD































Address for Correspondence:


Nitin K. Sethi, MD

Department of Neurology

NYP-Weill Cornell Medical Center

525 East, 68th Street

New York, NY 10021 (U.S.A.)


            The human brain is indeed complex made of millions of small cells called neurons working in close harmony with each other. Its capacity far exceeds that of any supercomputer designed as of yet by man. This fist full of about 1500 grams of tissue is the seat of our emotions, our memory, our senses and serves as the motherboard for all other body systems. This delicate supercomputer of ours is enclosed in a resilient bony skull able to withstand significant trauma. Our brain like our body needs to be nurtured and nourished.


Nourishing the brain: brain foods and more


            What we eat does to an extent determine the health of our brain. Recently the concept of brain foods has come into vogue. This refers to foods that have been postulated to boost brain power, improve memory and functioning of the brain. So what are these foods that have been postulated to help keep the brain young?


Omega 3- fatty acids: belong to the family of unsaturated fatty acids. The important ones among them include alpha linolenic acid, eicosapentaenoic acid and docosahexaenoic acid. Fatty acids form an important constituent of cell membranes. They thus perform important roles in various cell functions including cell to cell transmission and help maintain stability of cell membranes. A growing body of work has shown the beneficial effects of omega 3-fatty acids in prevention of atherosclerosis. The data showing a beneficial effect of fish oils is more robust for the cardiovascular system while no consisting relationship between fish consumption and stroke reduction has been documented. So while the data may not be robust, it probably makes sense to increase the omega 3-fatty acid content in your diet. I would advise replacing some of the saturated fats with polyunsaturated fatty acids rich in omega -3s like canola oil, walnut and olive oil.


Numerous other foods have been touted to promote brain heath. Some of these include avocado, various legumes (rich source of protein for vegetarians), oatmeal, peas, soybeans (again a good source of protein for vegetarians), wheat germ, fish like tuna, yogurt, brown rice, brussels sprouts and eggs among others. The brain just like any other organ of the human body needs a balanced nutritious diet consisting of the right mix of carbohydrates, proteins, fats, vitamins and minerals.


Role of Ginkgo biloba in enhancing memory: the extract of the Ginkgo leaves has been used for medicinal purposes for years. It contains flavonoid glycosides and terpenoids and is thought to enhance memory and concentration. Studies though have yielded conflicting results. While some studies on patients with Alzheimer’s dementia showed a benefit, others did not and benefits were attributed to a placebo effect. Ginkgo biloba affects the coagulation of blood and can interfere with other anticoagulants like warfarin and aspirin. It might be reasonable for people who have dementia or an early stage of dementia called mild cognitive impairment (MCI) to take Ginkgo biloba. Its use in healthy young adults as a memory enhancer is probably ill advised.


Role of vitamins and minerals in promoting brain health: Vitamins and minerals are also referred to as micronutrients. The body needs them albeit in small amounts for its well being. Vitamins and minerals are involved in diverse cellular functions. Deficiency of certain vitamins has been implicated in causing neurological diseases. Vitamin B1 also called thiamine is a water soluble vitamin. Deficiency of vitamin B1 causes a disease caller Beriberi. It presents clinically as a peripheral neuropathy (the peripheral nerves get involved). Deficiency is commonly seen in alcoholics and those with marginal diets like the elderly. Thiamine deficiency in heavy alcoholics may cause other neuro-psychiatric problems. Wernicke’s encephalopathy and Korsakoff psychosis occur in alcoholics and present clinically with confusion, gait, balance and memory problems. Foods that are rich in vitamin B1 include whole-grain cereals, bread, red meat, legumes, green leafy vegetables and brown rice. I would recommend vitamin B1 supplementation in the elderly and those who drink heavily. Ideally all people who drink a moderate amount on a regular basis should take one multi-vitamin a day.

Vitamin B12 deficiency can occur in people who have pernicious anemia or inflammatory bowel diseases like Crohn’s. Deficiency of B12 also called cyanocobalamine may present with neuropsychiatric manifestations (referred to as megaloblastic madness). It may also cause loss of vision (amblyopia) and weakness of the legs due to involvement of the spinal cord (the spinal cord involvement is referred to as sub-acute combined degeneration of the spinal cord). Meat and meat products like liver, beef, mutton, fish and egg are rich sources of B12. Hence vitamin B12 deficiency occurs mostly in pure vegetarians. In these groups, yes, vitamin B12 indeed does nourish the brain and in fact is vital for it to function normally.

Vitamin E is much in vogue today and has been aggressively touted as an anti-oxidant important for everything from aging gracefully to preventing cancer. Again there is yet no scientific evidence that it indeed does help in all this. Vitamin E deficiency causes ataxia and balance problems (ataxia of vitamin E deficiency). Deficiency occurs in people who for some reason cannot absorb the vitamin from the gut. Wheat germ, vegetable oils, whole grains and nuts are good sources of this vitamin. No one knows what the ideal dose of this vitamin should be. Even giving supratherapeutic doses (mega doses of 1000 IU and above) of vitamin E to patients who had neurodegenerative conditions like Alzheimer’s dementia did not result in any observable benefit.

This is a good time to talk about the role of various anti-oxidants in promoting and maintaining brain health. A variety of anti-oxidants are nowadays been marketed as a visit to any of the health stores shall reveal. These have been touted for their anti-cancerous properties as well as their cardiovascular and cerebrovascular benefits. Among them coenzyme Q10 and alpha lipoic acid are popular. There has been no proven benefit of coenzyme Q 10 when controlled trials have been done in patients with Parkinson’s disease or even in ALS. My personal view is that if someone has a strong family history of Alzheimer’s dementia, Parkinson’s disease or ALS, it may be reasonable to advice supplementation as these preparations are relatively safe with no major side-effects. Studies have shown that when you give them to patient’s who already have an advanced neurodegenerative condition like Parkinson’s disease they seem to be ineffective, no one though knows that if you take these supplements from a young age (before the onset of the disease), would they lessen the chances of developing Parkinson’s disease or dementia in the later life. Meaning do they actually promote brain health? I usually do recommend alpha lipoic acid supplementation in my diabetic patients with neuropathy. In health men and women, I would recommend taking them in moderation as there is no proven benefit.



Role of exercise in promoting brain health: “ The brain too needs to jog everyday” exercise is a natural aphrodisiac for the brain. It promotes the release of endorphins and other feel good neurotransmitters. The benefits of regular exercise in promoting brain heath have been documented repeatedly. Even people who have neurodegenerative conditions like Alzheimer’s dementia and Parkinson’s disease seem to do well if they exercise as compared to those that don’t. These patients are less prone to fall and have improved assessments on care-giver rating scales. My personal belief is that exercise promotes brain healing and improves synaptic transmission. Recently cognitive exercises have come into vogue. Brushing with your left hand (if you right handed), playing mind-games like crossword puzzles and scrabble have been documented in some studies to slow down the progression of dementia and improve memory and concentration. People who are high functioning and use their brain regularly like lawyers and teachers have a lower incidence of developing later life cognitive problems as compared to a construction worker whose job is more manual and does not involve the use of these higher mental functions. “ Use it or lose it!!!”



 “ Do not just exercise your body, exercise your brain too”



The mind-brain connection: How to keep your mind healthy


One should not only have a healthy brain but a healthy mind too. Inner peace, calmness, introspection, tranquility are essential qualities that nurture the mind and help to maintain its internal equilibrium. Meditation, been spiritual and doing yoga are ways by which that elusive inner peace can be obtained ensuring a healthy mind as well as brain. One should never forget the healing powers of the mind. Some cancer patients and patients who have had a devastating stroke have been able to overcome their illness and disability due to the healing power of their minds. One should harness this power in a positive direction because the mind can be your best friend as well as your worst enemy. Protect your mind against depression as attacks of major depression make one prone to later life dementia. Have healthy relationships that nurture and nourish your mind.


Someone once rightly said and I quote “ Your mind is your best friend, do not hurt him for whomsoever or whatsoever”.