Bacopa Monnieri (BM), also called Water Hyssop, and Herb-of-Grace belongs to a family of plants called Scrophulariaceae. It can commonly be found in wet and damp marshy areas. BM has traditionally been used in Ayurveda and Indian medicine in the treatment of ulcers, inflammation, leprosy, cold, parasitic infections, depression and splenomegaly. It is commercially grown in India, Pakistan, Afghanistan, Nepal, Sri Lanka, subtropical US, tropical Asia, Africa and Australia.
Compared to previous articles, this one will be much shorter, which is simply due to a very small amount of good quality studies compared to, for example, ashwagandha or L-Theanine, where we have way more scientific evidence.
Bacopa & Cognitive Improvement
Cognitive performance can be defined by: the ability to focus effortlessly, information retention over short-term and long-term, speed of reaction, evaluation & judgement, rational thinking and critical executive thinking. People suffering from cognitive impairment often feel a deficiency in multiple of these areas, especially information retention and reaction speed.
The majority of human studies looking at BM have been looking to answer these questions.
Can BM improve cognition of elderly with mild cognitive impairment (first stage of dementia)?
Can BM improve the cognitive performance of healthy individuals?
So what do we know about the effect of BM on cognitive performance and cognitive improvement? Overall results are poor. BM appears to have little to no effect on cognitive performance in healthy volunteers and in people with mild cognitive impairment. A few smaller studies show some mild positive effects on memory and attention. However, once those results are pooled together, they remain unconvincing.
It is also possible that we simply do not have enough data, and with more time, funding and larger studies, some of those effects may become more obvious. For now, I cannot recommend using BM for those looking to improve their cognitive performance, such as attention, memory or reaction speed, at least not compared to other nootropics I have already reviewed in some of these blog posts.
One thing worth mentioning is that many of the BM trials were done on a product called KeenMind developed by a company called Flordis which presents a potential financial & research bias (but doesn't have to).
Anhedonia
One study aimed to investigate whether BM extract could be helpful for patients suffering from a form of depression called anhedonia (inability to experience pleasure). They divided 42 patients experiencing anhedonia into 19 taking BM and 23 taking citalopram (pharmaceutical antidepressant) for 4 weeks.
The group taking BM had:
A higher self-perceived enjoyment and pleasure in day-to-day life
A better score of self-perceived stress and depression
This was the only study of its kind, but it is safe to say that BM could potentially present a viable alternative for people suffering from the inability to experience pleasure and joy who are unwilling or unable to use standard pharmaceuticals. But we need more research to confirm the results.
ADHD
A small study from India recruited 31 children medically diagnosed with Attention-deficit hyperactivity disorder (ADHD), aged 6-12, with the onset of ADHD before year 7.
Children received 225mg BM extract daily for 6 months. This was a single-arm study, so there was no placebo group involved; however, with children at such young age who were already used to being medicated often, the risk of significant bias or placebo effect which would occur in adults was minimised simply by their age and lack of general life experience.
In the end, nearly all children showed improvement in restlessness, self-control, attention, learning ability, psychiatric problems and impulsivity. Social problems did not improve.
Moreover, while this was the single study of its type, it shows some early evidence of potential use of BM alongside standard ADHD treatment in children. More research is needed to confirm the results and to determine efficacy in adults.
Anxiety
A 2008 study (Calabrese et al) had looked at whether BM extract (300mg/d) could improve self-perceived anxiety & depression in the elderly. They compared the experimental (BM) group to a placebo for 12 weeks. The final results were slightly tilted towards the BM group, being somewhat helpful, but the difference between the control (BM group) and placebo group was very tiny. The BM group also had a slightly reduced heart rate compared to the placebo.
A study from Bangalore, India (Sathyanarayanan et al. 2013) recruited 72 participants divided into an experimental group (taking 450mg BM per day) and a placebo group for 12 weeks. Towards the end, the anxiety in BM group improved a tiny bit while it did not improve in the placebo group. The study was primarily interested in cognitive performance but was also looking at anxiety as a secondary measure.
As always, we would need more research but based on what is available right now, Bacopa does not seem particularly useful for anxiety considering we have herbs that are much more effective such as St John's Wort, Aswagandha, Gotu Kola and others. I will have future blogs and videos on this topic.
Summary & Key Findings
Most research on Bacopa Monnieri (BM) has predominantly focused on cognitive improvement in healthy adults and in the elderly with an ongoing cognitive impairment (first step of dementia). In this area, we have a good amount of human evidence, although in total, the results vary, and when put together, BM if often not better or more superior to placebo. Some small improvements to attention or reaction speed here and there have been seen, but the results are usually tiny and can be down to other factors.
For anxiety, BM appears to be slightly better than placebo, but the difference is minimal.
One study has found good benefits for children who have ADHD where there has been a vast improvement of nearly all behavioural and learning markers
One study found benefits for patients suffering from anhedonia (inability to experience pleasure), and at the end of the study, those taking BM felt better, happier and had an overall more positive life experience than those taking placebo
The typical dosage used varied between 225 – 600mg, and these dosages would be deemed safe.
Other than that, we don't have a lot of human-outcome data. Of course, lack of evidence does not mean evidence of absence. It simply means we need to be extra cautious when reading bold marketing claims looking to hype-up findings from in-vitro studies as is commonly done in the case of Lion's Mane, where claims and advertising way exceed anything that has ever been proven for LM. Natural products are often over-marketed or marketed solely based on anecdotal claims, traditional use or in-vitro (lab studies) evidence missing any significant human outcomes.
My personal take on BM is that for now, it is better to invest in something else, knowing that we have herbs that have way more research and seem to be more potent. Those looking to improve cognitive performance, mood or productivity may look into Theanine, Aswagandha, Ginkgo or Gotu Kola.
And finally, it is important that in our search of great health, we do not neglect the importance of diet, sleep, lifestyle and activity levels when it comes to maintenance of good mental health and brain performance as neglect in any of those parts is unlikely to be corrected by even the most expensive nootropic cocktail.
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SOURCES
Calabrese, C. et al. (2008) ‘Effects of a standardized Bacopa monnieri extract on cognitive performance, anxiety, and depression in the elderly: A randomized, double-blind, placebo-controlled trial’, Journal of Alternative and Complementary Medicine, 14(6), pp. 707–713.
Cicero, A. F. et al. (2017) ‘Short-Term Impact of a Combined Nutraceutical on Cognitive Function, Perceived Stress and Depression in Young Elderly with Cognitive Impairment: A Pilot, Double-Blind, Randomized Clinical Trial’, The journal of prevention of Alzheimer’s disease, 4(1), pp. 12–15.
Kongkeaw, C. et al. (2014) ‘Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract’, Journal of Ethnopharmacology, 151(1), pp. 528–535.
Mathew, J. et al. (2010) ‘Bacopa monnieri and Bacoside - A for ameliorating epilepsy associated behavioral deficits’, Fitoterapia. Elsevier B.V., 81(5), pp. 315–322.
Micheli, L. et al. (2020) ‘Bacopa monnieri as augmentation therapy in the treatment of anhedonia, preclinical and clinical evaluation’, Phytotherapy Research, 34(9), pp. 2331–2340.
Pase, M. P. et al. (2012) ‘The cognitive-enhancing effects of bacopa monnieri: A systematic review of randomized, controlled human clinical trials’, Journal of Alternative and Complementary Medicine, 18(7), pp. 647–652.
Roodenrys, S. et al. (2002) ‘Chronic effects of Brahmi (Bacopa monnieri) on human memory’, Neuropsychopharmacology, 27(2), pp. 279–281.
Sathyanarayanan. V. et al. (2013). ‘Brahmi for the better? New findings challenging cognition and anti-anxiety effects of Brahmi (Bacopa monniera) in healthy adults’, Psychopharmacology, 227 (2), pp.299-306.