Bottom Line/HEALTH: Are you getting a little bit forgetful? The midlife brain cells aren’t working so well? One of the best things you might want to think about is ginkgo biloba.

I’m Sarah Hiner, president of Bottom Line Publications, and this is our Conversation With the Experts, where we get the answers to your tough questions from our leading experts.

Today I’m speaking to Dr. Andrew Rubman, a leading naturopathic physician and the medical director of the Southbury Clinic in Southbury, Connecticut. Dr. Rubman is also a contributing medical editor to Bottom Line. Welcome, Andy.

Dr. Andrew Rubman: Hi, Sarah.

Bottom Line: So ginkgo. We talk a lot about the benefits of ginkgo. Let’s outline with ginkgo can do for people.

Dr. Rubman: It seems to improve memory, both short-term, primarily, and also long-term. It seems to improve cognitive and abstract function…and it seems to play a part in improving and maintaining brain circulation.

Bottom Line: Are these benefits experienced when you just have, I’ll call it, your basic middle-age mom brain? Or is it also effective on people who have been diagnosed with some more serious form of dementia?

Dr. Rubman: It should be useful for many people with many different problems, because the important thing to remember about ginkgo is that it enhances normal function. So with a myriad of different pathological changes—maybe it’s transient changes of midlife challenges or changes involving pathophysiology like dementia or Alzheimer’s—it may be helpful.

I have a relative who is in his 80s on ginkgo, and it seems to be working for him, and he has mild cognitive challenges at this point.

Bottom Line: There have been some studies, though, that have shown that ginkgo doesn’t work. So what’s the truth?

Dr. Rubman: The truth is that it works for some people some of the time. We’re still trying to tease out what populations, with what diseases, with what lifestyle can allow us to figure out if it’s going to more likely than not work. We don’t have a good handle on that yet. But since it’s so inexpensive, doesn’t seem to have very many, if any, side effects. Why not give it a try?

Bottom Line: What are the chances that it’s really a placebo effect that’s occurring? How do we know that’s not going on?

Dr. Rubman: The tests that have shown efficacy have been blinded with placebo, so there is enough clinical evidence to anticipate that if it’s going to work, it would work beyond placebo.

Bottom Line: So the truth of the matter is, it is working, but there may be other cofactors that nobody knows in terms of the biochemistry of the individual.

Dr. Rubman: Right. A lot of the mechanism of why it works is being speculated on. We don’t really have that nailed down well, but it has been used over time by many populations for those issues that we discussed. I think it’s worth giving it a try.

Bottom Line: Can it be used preventively?

Dr. Rubman: Possibly yes, but it’s difficult to know. Because if you use it and you don’t develop a problem, how do you know if it’s taking the ginkgo or you’re just abundantly healthy?

Bottom Line: The old “if the tree falls, how do you know?”

Dr. Rubman: There you go.

Bottom Line: All right, so who should take it, and when should they take it?

Dr. Rubman: People who are beginning to experience senior moments. People who find themselves doing odd things, like trying to make an outgoing call on the microwave. Folks like that. Take it and see if you stop being such a spacer and you can focus yourself and perform a little bit more like you would expect yourself to.

Bottom Line: How do you know, though, if it’s just—again, I joke about myself all the time in terms of the “mom moments,” except for the fact that I know how much I’m juggling and how much sleep I get, etc. So at what point do you say, “Maybe it’s memory” versus “Oh by the way, maybe I should perhaps go to bed a little bit earlier, and maybe I should meditate a few minutes every day?”

Dr. Rubman: Look for the obvious in your life. Things that you’ve relied on that have decreased over time as you take on more and more. And then little by little, add in those things which are interventions, which are new to you. Thought about not sleeping as much as you had in the past, that’s a wonderful place to start.

Bottom Line: Like with other herbs, is there any specific types of ginkgo that you need to select off the shelf? Is there a whole product versus root versus leaf, or does it really not matter?

Dr. Rubman: I think the whole products are going to be equally useful. The species of ginkgo is called biloba. I think that’s the only one that’s used, and it’s sufficiently commonplace and inexpensive that the industry seems to be fairly uniform in their harvesting practices. So it doesn’t make too much difference, I don’t believe.

Bottom Line: And is there any risk to taking…

Dr. Rubman: Haven’t seen any.

Bottom Line: Is there anybody that needs to watch out for it because of other medicine they’re on or any other conditions that they have?

Dr. Rubman: Good point. People with chronic conditions, people who are taking polypharmacy, strong drugs, etc., should speak with their provider before they start taking ginkgo.

Bottom Line: Anything in particular?

Dr. Rubman: Things that affect the liver’s function. The statins, proton pump inhibitors, antimicrobials, biologics for autoimmune pathology like antirheumatoid drugs, things like that. So if you have a really bad problem, make sure you check with your provider first.

Bottom Line: Great. Thank you, Dr. Andy. The bottom line on ginkgo biloba? If you’re getting a little bit forgetful, having a little bit more challenge with some of your mental function, ginkgo biloba is a very real possibility. It’s safe. It’s been used for many, many years with many people. It doesn’t’ work for everybody, so try it, but it may or may not work for you.

If you’re taking any kind of other medications or have any other kind of diseases that you’re being treated for, then be sure to talk to your medical provider before starting to take any kind of medication. This is Sarah Hiner with Bottom Line.