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- Good Scientific Evidence:
[Ginkgo]: Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States. Multiple clinical trials have evaluated ginkgo for a syndrome called "cerebral insufficiency." This condition, more commonly diagnosed in Europe than in the United States, may include poor concentration, confusion, absent-mindedness, decreased physical performance, fatigue, headache, dizziness, depression, and anxiety. It is believed that cerebral insufficiency is caused by decreased blood flow to the brain. Some research reports benefits of ginkgo in patients with these symptoms, but most studies have been poorly designed without reliable results. Further research is needed.
- Bleeding has been associated with the use of ginkgo taken by mouth, and caution is advised in patients who have bleeding disorders or who take drugs, herbs, or supplements that may increase the risk of bleeding. Dosing adjustments may be necessary. Ginkgo should be stopped prior to some surgical or dental procedures. Reports of bleeding range from nose bleeds to life-threatening bleeding in several case reports. In some of these reports, ginkgo was used with other agents that may also cause bleeding.
- Unclear or Conflicting Scientific Evidence:
[Bupleurum]: Bupleurum (Bupleurum falcatum, Bupleurum fruticescens) has been widely used as a medicinal herb for more than 2,000 years in Asia. An herbal combination formula containing bupleurum has been used as a treatment for children with minimal brain dysfunction. Early studies are inconclusive and additional study is needed.
- Reported side effects include decreased appetite, nausea, reflux, abdominal distension, intestinal gas, and increased bowel movements following large doses of bupleurum.
[Choline]: Choline is an essential nutrient related to the water-soluble B-complex vitamins, folate, pyridoxine, and vitamin B12, and to the essential amino acid methionine. It is synthesized in the body as well as consumed in the diet. The largest dietary source of choline is egg yolk. Choline can also be found in high amounts in liver, peanuts, fish, milk, brewer's yeast, wheat germ, soy beans, bottle gourd fruit, fenugreek leaves, shepherd's purse herb, Brazil nuts, dandelion flowers, poppy seeds, mung and other beans, and a variety of meats and vegetables, including cabbage and cauliflower. Choline is a major building block of lecithin. Choline is a precursor to acetylcholine, a chemical used to transfer nerve impulses. Therefore, choline is believed to have neurological effects.
- Early treatment with choline alphoscerate (CA), a substrate of phosphatidylcholine and a carrier of choline, was shown to be safe. Additional study is needed to confirm these findings.
- It is best to avoid choline in individuals with a known allergy or hypersensitivity to choline, lecithin, or phosphatidylcholine.
[Peppermint]: Peppermint (Mentha piperita) is a flowering plant that grows throughout Europe and North America. Peppermint is widely cultivated for its fragrant oil. There is currently a lack of sufficient evidence to recommend for or against the use of peppermint oil to affect vigilance following brain injuries.
- Peppermint oil should be used cautiously because doses of the constituent menthol greater than one gram per kilogram of body weight may be fatal.
[Policosanol]: Policosanol is a cholesterol-lowering natural mixture of primary alcohols, isolated and purified from sugar cane wax. Policosanol is safe and well tolerated, even in populations with high use of concomitant medications. The effects of policosanol supplementation on reactivity and related brain activity have been examined. Although there is compelling early evidence, further research is necessary before a clear conclusion can be reached.
- Traditional or Theoretical Uses Lacking Sufficient Evidence:
- Integrative therapies used in brain disorders that have historical or theoretical uses but lack sufficient clinical evidence include: aromatherapy, art therapy, choline, codonopsis (Codonopsis pilosula), danshen (Salvia miltiorrhiza), kava (Piper methysticum), music therapy, noni (Morinda citrifolia), reiki, and traditional Chinese medicine (TCM).
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