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Does anyone have any experience with ginkgo bilboa for AMS?

Original Post
Tucker M · · Washington · Joined Apr 2020 · Points: 0

Me and my partner are heading to Alaska to climb Denali. I have been doing research on altitude sickness treatments. It appears diamox is great minus the diuretic side affects. I have noticed some people take ginko bilboa. the research I've read says that sometimes it works and sometimes it doesn't. Does anyone have experience with ginko bilboa to treat altitude sickness? what are you takeaways? are there brands that work and brands that don't?

Steve McGee · · Sandpoint, ID · Joined Aug 2021 · Points: 795

I haven't tried that, but believe it or not cigarettes had a positive effect (and quitting before the trip or climb had a negative effect) on two different people doing the same route 6 times.

In other words, smoking helped with AMS up to 18,500 feet or so.

Allen Sanderson · · On the road to perdition · Joined Jul 2007 · Points: 1,100

Do not conflate taking something prophylactically to prevent AMS and taking something to treat AMS. Diamox and Ginkgo biloba (note the spelling) are taken prophylactically to help prevent AMS. Your post notes treating AMS which is very different.

That said, I have not used Ginkgo biloba but I have used Diamox prophylactically. But not on Denali. Just in the Sierras when we would be going from sea level to 10k - 14k over a weekend. If one is doing Denali via the West Butt the ascent is at a slow enough place that for most people AMS is not problematic. To me the key is spending some quality time at 14k before going up higher. That and staying hydrated. Drink enough so your pee is clear.

Chris C · · Seattle, WA · Joined Mar 2016 · Points: 407

Some people take ginko for acclimatization. I’ve taken it a few times, hard to say if it has an effect. I’ve never heard of it for treatment though. 

Dexamethasone and nifedipine are used to treat acute illness. Diamox, as you noted, is used frequently for moderate situations, but also has diuretic issues that some individuals may struggle with more than others. One of my close climbing partners was prescribed Viagra instead of Diamox due to really significant diuretic issues with Diamox. I’ve used Viagra at high altitude as well, and I can definitely attest to it giving me a performance bump (not talking about sexually…lol). Often a baby aspirin works very well for light sickness. 

But for “treatment”, dexamethasone and nifedipine are really the big ones. 

Really, you should talk to a doctor for all of this. 

Brian in SLC · · Sandy, UT · Joined Oct 2003 · Points: 22,419

I've tried ginko a few times.  Never really felt there was much of an effect...but...hard to know.

Have used Diamox a few times (between ascents and post HAPE in Peru...likely pretty foolish to go back up high after HAPE...ahh...youth).  Worked well for me.  Tingling in my hands and having to pee wasn't a huge deterrent to me.

Have seen nifedipine work on a person with HAPE (amazing recovery and I made him promise to descend...).  Took it prior to a trip at 11k just to see if I had a reaction to it.  Didn't notice any issues.  It'd be in my kit for sure.  Have carried dex, never used nor seen used so can't say.

Allen's right...stay hydrated and don't overexert (don't get dehydrated from especially over exertion).

Didn't use Diamox on my last trip to Denali.  No issues and summitted.  Really helped to not push down low and spend time at 11k and 14k.  Rest, stay rested, stay hydrated, don't overexert until summit day.

Yeah, find a doc to talk to.  You'll need prescriptions for the goods anyhow.  Helpful to find one with altitude/climbing experience.

Bryan · · Minneapolis, MN · Joined Apr 2015 · Points: 482

My hypothesis is that cordyceps mushrooms could be good for this but I'm not an alpinist. 

Cluster One · · Huntsville, AL · Joined Aug 2020 · Points: 0

Big fan of this, seems to work better than diamox, with no noticable side effects.  Has ginko....  https://www.altitude-adjustment.com/

Isaac Mann-Silverman · · Oakland Ca · Joined Nov 2020 · Points: 0

Back when the Chinese had just occupied Tibet, they bussed boatloads of people up from sea level to the Tibetan Plateau. This gave them an excellent opportunity to try various herbal drugs for altitude adjustment, and they eventually settled on Siberian and Chinese ginsengs as being the good stuff for acclimatization. 

I've given ginseng and ginseng formulas to several people traveling up into the Andes and the Sierra Nevada to good effect, as well as for myself. This is all prophylactic use, often starting a week or two before ascending. I'd bet it'd work even better if you can combine it with some fresh coca leaves...

Robert Young · · Sedona, AZ · Joined Jul 2021 · Points: 0

I used it one on a 19er. Not sure if it worked but no altitude problems.

Li Hu · · Different places · Joined Jul 2022 · Points: 55
Isaac Mann-Silverman wrote:

Back when the Chinese had just occupied Tibet, they bussed boatloads of people up from sea level to the Tibetan Plateau. This gave them an excellent opportunity to try various herbal drugs for altitude adjustment, and they eventually settled on Siberian and Chinese ginsengs as being the good stuff for acclimatization. 

I've given ginseng and ginseng formulas to several people traveling up into the Andes and the Sierra Nevada to good effect, as well as for myself. This is all prophylactic use, often starting a week or two before ascending. I'd bet it'd work even better if you can combine it with some fresh coca leaves...

Siberian and Chinese Ginseng (typically grown in Wisconsin) do the opposite things in Chinese medicine I believe? At least that’s what my wife says. I drink them in teas on occasion when she says I need it?

Ginkgo seems to open my arteries? Though this could be completely a placebo effect? Maybe if it’s not placebo, that could be why it helps? L-arginine also opens arteries?

In the past, I never had issues with AMS, but maybe now that I’m old who knows? Maybe I’ll be asking for more tips here?

Ben Crowell · · Fullerton · Joined Jan 2013 · Points: 331
Tucker M wrote:

the research I've read says that sometimes it works and sometimes it doesn't.

There is a fairly recent meta-analysis that is in an open-access journal: Tsai et al., 2017, "Ginkgo biloba extract for prevention of
acute mountain sickness: a systematic review and meta-analysis of randomised, controlled trials," https://bmjopen.bmj.com/content/bmjopen/8/8/e022005.full.pdf A search on Google Scholar for citations of that paper doesn't turn up anything that looks like a more recent study of ginkgo biloba for this purpose.

I wouldn't summarize it by saying that sometimes it works and sometimes it doesn't. A better summary would be that the studies all either gave negative results, were too small, or had design flaws, so that if there is any effect, we don't have evidence of it. Here's the table from the paper that I think is the most helpful.

If you look at the graphic, every point is drawn with error bars that extend to the left and the right, showing an estimated range of error with 95% confidence. Notice how almost every single set of error bars overlaps the vertical line that would indicate no effect at all. The only exception is the one at the top by Roncin, but if you look at table 3 in the Tsai review, they identify a long list of design flaws in that study that make for a high risk of bias. I think it's telling that when the Gertsch group did a second, improved study, increasing the sample size and eliminating sources of bias, the hints of an effect went away.

Tucker M wrote:

Does anyone have experience with ginko bilboa to treat altitude sickness? what are you takeaways? are there brands that work and brands that don't?

This is just not a sensible way to treat scientific data. The scientific studies at least tried to get rid of biases and tried to get decent-sized samples. You're asking people to report their own anecdotal evidence (sample size of 1) in a situation where there is a massive potential for bias (placebo effect).

AFAIK the evidence really supports two things: (1) use diamox; (2) don't go cold-turkey off of caffeine if you already have a caffeine habit. And of course, don't ascend too fast.

The second Gertsch study seems powerful enough to rule out any really strong benefit from ginkgo biloba when it's used the way they used it in that study. In that study, the way they were able to recruit a decent-sized sample of people was that they enrolled people who were already on a high-altitude trek between villages in the Himalayas, and then they caught them all and interviewed them again at a higher village on the trek. (Other studies had major problems with getting people to follow through with the study.) But the design that allowed them to get the larger sample size also meant that they were studying people who only started using the ginkgo biloba once they were already at altitude. So if there's any wiggle room left for the possibility that it works, it would probably have to be the case that you need to start taking it at low elevation. So you could do that, and conceivably it would help. But it seems like it would be wasted effort and money based on the pretty negative evidence. And with any herbal medicines, you have potential problems with safety, purity, and whether or not it really contains what the manufacturer claims -- lab analysis of herbal remedies shows that these issues are extremely common and serious.

Isaac Mann-Silverman · · Oakland Ca · Joined Nov 2020 · Points: 0
Li Hu wrote:

Siberian and Chinese Ginseng (typically grown in Wisconsin) do the opposite things in Chinese medicine I believe? At least that’s what my wife says. I drink them in teas on occasion when she says I need it?

Ginkgo seems to open my arteries? Though this could be completely a placebo effect? Maybe if it’s not placebo, that could be why it helps? L-arginine also opens arteries?

In the past, I never had issues with AMS, but maybe now that I’m old who knows? Maybe I’ll be asking for more tips here?

I wouldn't say Siberian and Chinese ginseng are opposites, though there are certainly differences. Perhaps you are thinking of American ginseng, which is quite different.

Anyway, like any science coming out of China, I would take those studies I mentioned with a grain of salt, but their methodology and numbers were good enough for me to give the ginseng a whirl on my friends and family. They seem to have good results overall.

The nice thing about placebo, as long as it works for you it still works, often with fewer side effects than actual medicine.

HughC · · Fort Collins, CO · Joined Jul 2015 · Points: 60

A personal anecdote.  I tended to suffer from altitude sickness, which definitely affected my stoke for alpine pursuits. I started using a combination of eleuthero and beet juice extract, both encapsulated and it has greatly mitigated signs and symptoms. I dont go above 13, 000 feet, but find I have no problems at that height anymore.

duncan... · · London, UK · Joined Dec 2014 · Points: 55
Ben Crowell wrote:

I wouldn't summarize it by saying that sometimes it works and sometimes it doesn't. A better summary would be that the studies all either gave negative results, were too small, or had design flaws, so that if there is any effect, we don't have evidence of it

Thanks Ben. This is a great example of a body of research where the better the study quality, the less likely the study will find a positive result. Even the anecdotal reports upthread are pretty unconvinced. I'm almost certain Ginkgo biloba has no role in AMS. 

Guideline #1: Don't be a jerk.

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