Accurate Education – Bacopa Monnieri

Bacopa Monnieri

Bacopa monnieri, also known as Brahmi, is an Ayurvedic herb prescribed for more than 1400 years and noted to improve memory and cognition. These traditional claims have been supported by extensive in research and clinical studies conducted over the last two decades.

 

Bacopa’s pharmacological activities include antiepileptic, anxiolytic, antidepressant, sedative, antioxidant and anti-inflammatory activities. Various mechanisms of action for its cognitive effects have been proposed including increased cerebral blood flow, acetylcholinesterase inhibition, β-amyloid reduction, antioxidant neuroprotection, neurotransmitter modulation (acetylcholine, serotonin (5-hydroxytryptamine or 5-HT), dopamine, and choline acetyltransferase activation).

 

A review of potential benefits of Bacopa follow, with emphasis on it’s postential benefit for improved memory and cognition, with particular emphasis on it’s potential benefit for managing the “brain fog” or cognitive impairment associated with fibromyalgia and other conditions.

 

See also:

Antioxidants

Alpha-Lipoic Acid (ALA)

Acetyl-L-Carnitine

SAMe

Fibromyalgia – CAM Treatment

 

 

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Bacopa Monnieri

 

Bacopa monniera, also referred to as Bacopa monnieri, Herpestis monniera, water hyssop, and “Brahmi,” has been used in the Ayurvedic (Indian) and Chinese system of medicine for centuries. Traditionally, it was used to enhance memory, learning, and concentration, and to help with anxiety or seizure disorders. Bacopa has also been used as a cardiac tonic, digestive aid, and to improve respiratory function in asthma. Recent research has focused primarily on Bacopa’s enhancement of cognitive function (thought processing), specifically memory, learning, and concentration, and recent research support the traditional Ayurvedic claims.

 

 

Potential Benefits from Supplementing with Bacopa:

 

Brain Function and Cognitive Effects

There is a lot of research demonstrating the benefits of Bacopa in improving brain function. Studies have evaluated short term and chronic use but have only found benefit with chronic use. A study that looked at a single dose use of 300mg provided no benefit in cognitive function. However, studies show that after 12 weeks of use there is significant improvement in verbal learning, memory consolidation, and speed of early information processing.

 

Clinical trials were conducted to determine the effect of Brahmi on memory function in people over the age of 55 years. At the end of 12 weeks, a significant enhancement in verbal learning and concentration was noted in the treatment group. Bacopa enhanced the ability to acquire, store and retain memory over time by use of Brahmi as a supplement.

 

Anecdotal evidence indicates there may be a benefit as well for the cognitive impairment and “brain fog” associated with fibromyalgia.

 

Because Bacopa may help protect brain and nerve tissue, it offers potential for the treatment of stroke, dementia and improving cognitive functions including memory, recall, focus and concentration. Preliminary research suggests that Bacopa may be beneficial in stroke patients, Parkinson’s Disease, Alzheimer’s Disease and schizophrenia.

 

It has been shown that Brahmi treated Alzheimer’s patients improved memory performance. The levels of inflammatory markers like homocysteine, C-reactive protein, and tumor necrosis factor alpha; oxidative stress markers like glutathione peroxidase, glutathione, thiobarbituric acid reactive substances and SOD showed a marked decline in Brahmi treated Alzheimer’s patients. This suggests the significance of the herb in managing cognitive decline associated with the aging process.

 

Pain

Bacopa has some preliminary research that suggests it has benefit in pain management. It has been shown that Bacopa has anti-inflammatory activity via its inhibition of the Cox-2 receptors similar to the non-steroid anti-inflammatory drugs (NSAIDs). In addition, there is some evidence to suggest Bacopa enhances opioid analgesia and, presumably through Bacopa’s inhibition of the NMDA receptors, Bacopa may reduce opioid hyperalgesia and the development of opioid tolerance.

 

 

Anxiety and Depression

Bacopa may provide a significant decrease in anxiety symptoms, including level of anxiety, level of disability, and mental fatigue. Animal studies show an increase in immediate memory span, unlike the use of benzodiazepines such as Xanax and Valium that are known to impair memory.

 

Recently, the acute effects of Brahmi (320 and 640mg doses) on stress and mood swings generated by multitasking were demonstrated in a double-blind, placebo-controlled clinical trial. Reduced stress associated with a reduction in cortisol levels and improved mood was noted in the participants. Bacopa has been shown to alter brain levels of dopamine, noradrenaline and serotonin, neurotransmitters associated with anxiety and depression although research does not yet offer definitive answers as to the effectivness of Bacopa in mood disorders.

  

Gastrointestinal Disorders

There is preliminary research to suggest that Bacopa may be helpful in the management of symptoms related to Irritable Bowel Syndrome (IBS) but more research is needed.

How Does Bacopa Work?

Bacopa has many compounds that are responsible for the pharmacological effects including alkaloids, saponins, and sterols. The constituents responsible for Bacopa’s cognitive effects are bacosides A and B which help repair damaged nerve cells and improve nerve impulse transmission. Nerve impulse transmission plays a vital role in promoting healthy cognitive functions like attention span, focus, concentration, learning and memory.

 

It has been shown that the bacosides present in the Bacopa can cross the blood-brain barrier (BBB) and its bioavailability in brain has been confirmed, including the activation of the cascade which participates in the memory enhancing mechanism.

 

Antioxidant

Based on animal studies, the bacosides appear to have antioxidant activity in areas of the brain including the hippocampus, frontal cortex, and striatum. Bacopa enhances certain enzymes including superoxide dismutase (SOD) and catalase involved in generation and scavenging of reactive oxygen species (ROS) such as free radicals in the brain  (see Antioxidants), possibly by NRF2 activation. Research has also shown that Bacopa has a protective effect against DNA damage in brain cells including astrocytes and human fibroblasts that contribute to cellular repair.

 

Animal studies in rats exposed to cigarette smoke resulting in the formation of free radicals and icreased oxidative stress benefitted from Bacopa with improvement in some of the pathological changes associated with the smoke exposure.

 

Activation of Neurotransmitter Systems by Bacoside

Bacopa interacts with various neurotransmitters such as acetylcholine (ACh), serotonin (5-hy- droxytryptamine,5-HT), catecholamine, ????-aminobutyric acid (GABA) and glutamate (Glu).

 

Acetylcholine

Acetylcholine level is regulated at the synapse by acetylcholine esterase (AChE), the enzyme that breaks down acetylcholine. Numerous studies have implicated the importance of acetylcholine in higher brain functions like learning and memory. Alterations in the acetylcholine metabolism are also involved in various neuropathological conditions like mild cognitive impairment (MCI), Alzheimer’s disease (AD), and dementia. It appears that Bacopa decreases AChE activity, prolonging the effects of acetylcholine, which may be at least one mechanism by which Bacopa improves cognitive processing, working memory and attention.

 

Serotonin

Bacopa also helps to maintain the balance of another neurotransmitter, serotonin, by increasing serotonin synthesis and regulating the reuptake serotonin, increasing the duration and intensity of serotonergic activity at the synapse. This could be one of the mechanisms that enhance learning and memory processing as well as it benefits in managing depression.

 

 NMDA Receptors (N-Methyl-D-aspartate receptors – see Neurobiology of Pain)

Recent evidence indicates that NMDA receptor activity is correlated with learning, memory, and cognition and have implicated possible role of NMDA receptors in cognitive impairment and various neurological disorders like seizures and Alzheimer disease.

 

In animal studies, the mechanism for memory impairment in schizophrenia appears to be mediated by upregulation of NMDA receptor. Bacopa has been shown in animal studies to  improve memory impairment by decreasing NMDA receptor activity in these brain areas.

 

Dosing and Side Effects of Bacopa

Traditional daily doses of Bacopa are 5-10 gms of non-standardized powder, 8-16 mL of infusion, and 30 mL daily of syrup (Brahmi). Dosages of a 1:2 fluid extract are 5-12 mL per day for adults and 2.5-6 mL per day for children ages 6-12.

 

When using standardized formulations of Bacopa extracts (usually containing 20-percent bacosides A and B), research suggests the dosage is 200-450 mg daily in divided doses for adults.

 

As recommended with starting any new medication or nutritional supplement: “Start Low, Go Slow.” Always begin with a low dose and slowly increase the dose as tolerated, based on effectiveness and, of course, your physician’s directions.

 

Choice of Bacopa Supplements

There appears to be a variety of supplements commercially available that include Bacopa along with other ingredients and at the current time there is no research available comparing the effectiveness of one supplement to another.

 

Side effects with Bacopa

Bacopa has been used safely in Ayurvedic medicine for hundreds of years. Adverse side effects of BM are rarely reported. The most commonly reported symptoms are nausea, abdominal cramps, and gastrointestinal upset.

 

The take home message:

There may be arguments that one Bacopa supplement has advantages over another – research is incomplete. If one Bacopa supplement is ineffective or associated with side effects, it would make sense to try another form before giving up. Remember to “Start Low, Go Slow.” The social implications of cognition-enhancing drugs are promising but must be appropriately tempered with ethical consideration as we enter this new world of brain enhancement.

 

 

Synergistic Benefits of Combining Bacopa with other Supplements

There is theoretical and research evidence that combining Bacopa with other supplements may provide a synergistic benefit, where the benefits of a combination would be greater than the individual supplements on their own. Other agents with evidence to suggest benefit in cognitive impairment include:

 

Acetyl-L-Carnitine

Alpha Lipoic Acid

 

Pregnancy

The safety of Bacopa hasn’t been established in pregnant or breastfeeding women.

 

References:

Bacopa monnieraOverviews

  1. Neuropharmacological Review of the Nootropic Herb Bacopa monnieri – 2013
  2. The cognitive-enhancing effects of Bacopa monnieri: a systematic review of randomized, controlled human clinical trials. 2012 – PubMed – NCBI
  3. Effects of a Standardized Bacopa monnieri Extract on Cognitive Performance, Anxiety, and Depression in the Elderly – 2008
  4. Molecular and Functional Characterization of Bacopa monniera – A Retrospective Review – 2015
  5. Molecular Docking of Bacosides with Tryptophan Hydroxylase – A Model to Understand the Bacosides Mechanism – 2014

  6. The Molecular Links of Re-Emerging Therapy – A Review of Evidence of Brahmi (Bacopa monniera) – 2016

 

Bacopa monnieraAnxiety, Stress and Depression

  1. An acute, double-blind, placebo-controlled cross-over study of 320 mg and 640 mg doses of Bacopa monnieri (CDRI 08) on multitasking stress reactivi… – PubMed – NCBI
  2. Natural products of relevance in the prevention and supportive treatment of depression – 2015

  3.  Brahmi for the better? New findings challenging cognition and anti-anxiety effects of Brahmi (Bacopa monniera) in healthy adults 2013

 

Bacopa monniera – Cognitive Impairment

  1. Trial of Omega-3 Fatty Acids and Alpha Lipoic Acid in Alzheimer’s Disease
  2. In Silico and In Vitro Analysis of Bacoside A Aglycones and Its Derivatives as the Constituents Responsible for the Cognitive Effects of Bacopa monnieri – 2015
  3. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. 2001 – PubMed – NCBI

 

Bacopa monniera – Memory

  1. Chronic Effects of Brahmi (Bacopa monnieri) on Human Memory – 2002

  2. Exploring the role of “Brahmi” (Bocopa monnieri and Centella asiatica) in brain function and therapy. 2011- PubMed – NCBIMeta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract. 2014 – PubMed – NCBI

 

Bacopa monniera – Oxidative Stress

  1. Bacopa monnieri as an Antioxidant Therapy to Reduce Oxidative Stress in the Aging Brain – 2015
  2. The antidepressant-like effect of bacopaside I: possible involvement of the oxidative stress system and the noradrenergic system. – PubMed – NCBI

 

Bacopa monnieraOpioids and Pain

  1. A Bacoside containing Bacopa monnieri extract reduces both morphine hyperactivity plus the elevated striatal dopamine and serotonin turnover. – PubMed – NCBI
  2. Effect of Bacopasides on acquisition and expression of morphine tolerance. – PubMed – NCBI
  3.  Exploring the possible mechanisms of action behind the antinociceptive activity of Bacopa monniera – 2011
  4. Preclinical profile of bacopasides from Bacopa monnieri (BM) as an emerging class of therapeutics for management of chronic pains. – PubMed – NCBI

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

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