What it's actually good for
Ginkgo biloba is one of the oldest and most extensively studied herbal supplements in the world, with hundreds of clinical trials and several large-scale investigations. The evidence picture is genuinely mixed, which is why honest assessment matters here. On the positive side: standardized ginkgo extract (EGb 761, 120-240 mg/day) has shown modest improvements in cognitive processing speed, memory, and attention in smaller RCTs and meta-analyses, particularly in older adults already experiencing cognitive decline. It also has documented vasodilatory and antiplatelet effects that translate to modest improvements in peripheral circulation (intermittent claudication). On the negative side: the largest and most rigorous trial — the GEM study with over 3,000 participants — found that ginkgo did not prevent dementia or slow cognitive decline in healthy older adults over a median of 6 years. This is a critical result that tempers the enthusiasm from smaller studies. Ginkgo earns a B because the overall evidence base is large and the biological activity is real (improved blood flow, antioxidant effects), but the failure of the definitive prevention trial means we cannot claim it protects cognitive function in healthy people. It may be more appropriate for symptomatic management in populations with existing vascular or cognitive complaints than as a preventive nootropic.