Brahmi, A Herb based Medicine with various effects

Brahmi (Bacopa monniera) is a common herbal drug used in ancient Indian (Ayurveda) and Chinese Medicine to treat several disorders. Brahmi exerts several pharmacologic effects including providing some memory boosting effects in the treatment of Alzheimer’s disease and Schizophrenia, anti-parkinsonian effects, anticonvulsant or antiepileptic and anti-stroke potentials.  In this article, I will do a brief summary of the available literature on Brahmi.

The significance of Brahmi in improving learning skills, memory and its potential influence on neurologic structure and function is well known in Ayurveda and Chinese medicine. In mainstream medical literature, a study published in 1982 reported on the significance of Brahmi to improve memory and learning skills and led to a renewed interest in the evaluation of Brahmi based on “modern scientific principles”.

The active fractions of this medicinal herb includes saponins called as Bacosides (Bacoside A and Bacoside B). The herb also includes several other phytochemicals such as alkaloids, glycosides, and flavonoids, to name a few.

The therapeutic effects of Brahmi are exerted primarily through the triterponoid saponins, especially Bacosides present in the plant extract.

What do the Bacosides do?

  1. Enhance nerve impulse transmission
  2. Promote repair of damaged neurons by upregulating neuronal synthesis and kinase activity
  3. Help with the restoration of synaptic activity that helps with nerve impulse transmission
  4. A healthy nerve impulse transmission has an important role to promote healthy cognitive functions like attention, focus, concentration, memory and learning.
  5. They also influence the synthesis and availability of the neurotransmitter, serotonin, and thus helps to maintain neurotransmitter balance.

Animal studies of Brahmi

Several studies on animals have explored the pharmacologic effects of Brahmi.

These studies have found

  1. Acquisition and Consolidation of Motor skills were improved and that newly acquired skills or behaviour was retained for a long period of time.
  2. Effects on amnesia or loss of memory were explored with a particular focus on Alzheimer’s Disease. The effect of amnesia induced by medications or amnesic agents like scopolamine, benzodiazepines, quinolone derivatives, and phenytoin (these cause amnesia by interrupting long term potentiation) was studied.
  3. Brahmi demonstrated a significant reversal of amnesic effects of diazepam, scopolamine, and phenytoin.
  4. Brahmi also improved spatial memory in mice models where spatial memory was affected by scopolamine.
  5. Brahmi also led to an increase in glutamate levels in the brain leading to an increase in platelet activating factors.
  6. It also played a role in maintaining levels of mitochondrial enzymes that got deviated due to morphine induction
  7. Studies also looked at a Schizophrenia model in mice and reported a significant improvement in the discrimination ratio (as a measure of cognitive ability) in mice that were administered Brahmi.
  8. An improvement in memory impairment in mice models of schizophrenia have also been reported with the use of Brahmi.
  9. Brahmi has also shown to reduce dopamine levels of dopaminergic neurons in the frontal cortex region of rat brain and thus have a potential anti-epileptic or anti-seizure property.
  10. Brahmi supplementation was also shown to improve intellectual impairment and oxidative damage in streptozocin animal models. The study showed a significant improvement in streptozocin induced deteriorated memory and learning skills in these animals. Streptozocin led to an altered antioxidant status in the hippocampus and a decrease of Zinc and Copper in the animals. These states were reversed with the use of Brahmi. The data showed that formation of free radicals and an increased rate of lipid peroxidation, induced by streptozocin, that was neurotoxic was reversed by the use of Brahmi.
  11. Brahmi was also found to increase levels of serotonin, trigger 5-HT3A receptors and CREB in the hippocampus of postpartum rats facilitating learning abilities. Brahmi was found to enhance hippocampus dependent contextual memory by modulating the expression of histone acetylated proteins and protein phosphates in the hippocampus.
  12. Studies on Parkinsonian models (animal models) have also showed some interesting results. These include an increased climbing ability as well as activity pattern, reduced oxidative stress, and apoptosis. These findings were dose dependent suggesting that Brahmi attenuates behavioural abnormalities, reduces oxidative stress and neuronal death.
  13. Models relating to the management of brain stroke have explored the effects on ischemia and reperfusion. Ischemic reperfusion induction leads to the increase of the infarct size and impairment of short term memory and motor balance. Administration of Brahmi in these mice significantly reduced the infarct size and attenuated effects on short term memory and motor balance.
  14. Brahmi was also shown to improve muscle coordination and catalase activity in rats exposed to ischemic insult. Levels of nitrite, nitrate and rate of lipid peroxidation were also significantly decreased.
  15. Brahmi was also found to increase cerebral blood flow by 25% in rats without affecting their blood pressure.
  16. Brahmi was also found to have a neuroprotective role in glutamate mediated excitotoxicity in pilocarpine induced epilepsy in animal models.
  17. Brahmi was also found to have a significant anticonvulsant activity like benzodiazepines in different convulsion inducing models.
  18. Brahmi was also found to have significant antidepressant properties in animal models, with effects on the frontal cortex and hippocampus. Brahmi was also found to inhibit the withdrawal effects of morphine induced depression
  19. Supplementation with Brahmi normalized the levels of corticosterone hormone that were imbalanced due to chronic stress induction in animal models
  20. The levels of 5-HT, noradrenaline, and dopamine were brought to normal in the cortex and hippocampus in acute and chronic unpredictable stress induced animals.
  21. Brahmi modulates the cholinergic system and produces metal chelating effects. Cognitive impairments produced by neurotoxins, colchicine and ibotenic acid were improved by Brahmi. A decrease in norepinephrine levels and an increase in 5-hydroxytryptamine levels were increased in the hippocampus, cerebral cortex and hypothalamus by Brahmi treatment.
  22. Higher doses of Brahmi led to a decrease in anxiety levels similar to that achieved by the use of Lorazepam, a standard drug used in the management of anxiety.
  23. Brahmi has also been reported as effective as an antioxidant and in regulating stress biomarker levels.
  24. Brahmi is also considered as a supplement in the treatment of different cancers or tumors. Brahmi has been found to recover enzyme levels to normal, supress lipid peroxidation and enhance antioxidant status in animal models of liver cancer. These improvements were also noticed in animal models of fibrosarcoma and sarcoma.
  25. Brahmi was also found to reverse antioxidant status and peroxidative damage in animal models of Diabetes. Blood glucose levels of the rats returned to normal and the weight was also recovered to normal. An increase in glycosylated haemoglobin was inhibited. Peripheral glucose utilization was improved, an effect similar to the use of Insulin.
  26. Brahmi was also shown to have anti diarrhoea properties, protection against ulcer properties and have a liver protective effect.
  27. Brahmi has shown an increased T4 hormone synthesis in animal models with T3 synthesis unaffected. Brahmi has also been shown to have an antifertility effect in the male mouse.
  28. Brahmi also has anti-inflammatory and pain killing properties through effects on prostaglandins.
  29. Brahmi also has a relaxing effect on smooth and cardiac muscles in animal models.

What do Clinical Trials on Humans tell us?

There are few human studies that have used a randomized placebo controlled double blind design. These trials have shown that

  1. Supplementation with Brahmi improved nervousness, concentration and memory in adults.
  2. A study on a small group of primary school children showed improved learning skills, perception, memory, and reaction times without any side effects
  3. A randomized clinical trial on children diagnosed with ADHD showed improvement in cognitive functioning and improvement in logical memory
  4. A study on “mentally retarded” children showed enhanced learning and better control of abnormal behavior
  5. A study on 76 adults showed better retention of information
  6. However, studies have not shown beneficial effects on attention, short term working memory, working memory, psychological states and retrieval of prior knowledge.
  7. Immediate changes (up to 2 hours after administration) are not found suggesting that the benefits occur with long term use.
  8. A trial on young healthy adults showed a significant increase in verbal learning and concentration compared to non-treated groups. These differences were NOT noticed at baseline or even 5 weeks after supplementation but were found at the end of 12 weeks.
  9. Studies on older humans have also reported significant improvement in memory function in apparently healthy adults, adults with Alzheimer’s disease and mild cognitive impairment.
  10. Human studies have also shown an effect on stress and mood swings in a double blind placebo controlled trial on 17 healthy volunteers. The study showed reduction in cortisol levels leading to reduced stress and alleviated mood swings.

 

What does all this mean?

Most of the evidence on Brahmi is based on animal models and a few human studies. Based on a currently acceptable “scientific evidence model”, we can state that more studies are needed.

If you are a doctor treating or managing individuals with these conditions,

  1. Recommend that you read up further on Brahmi and its effects and potential applications
  2. Recommend that you consider initiating human studies with appropriate safeguards and approvals and document the process and results so that a more robust pool of evidence can be developed

If you are an individual with these conditions or a caretaker,

  1. Do discuss with your treating physician if Brahmi can be added as a supplement to the existing treatment regime. Especially in conditions where there is an effect on the central nervous system leading to various impairments.
  2. If you are the parent or caretaker of a child diagnosed with learning disabilities, ADHD, memory issues, please discuss with your treating physician if Brahmi can be added as a supplement to the existing management regime.

Brahmi supplements are available as Tablets, Syrups and as a Ghritam (Ghee). I do recommend that you discuss with your physician before you add this as a supplement. The discussion can help determine dose, frequency and also help with documenting effects (or even lack of effects) and help improve our knowledge of the effectiveness of this herb.

Brahmi ( a perennial creeping herb) has also been used as part of the cuisine in south India especially Kerala and hill stations and Tamil Nadu and possibly some parts of Andhra Pradesh.  The use of this herb in cuisine over a long period is in itself like a large scale human trial…However, it probably does not fit the rigorous criteria of scientific evidence (maybe fits common sense evidence?)

Selected References

  1. Brahmi and Children with ADHD
  2. Neurocognitive effects
  3. Review of evidence on Brahmi

 

 

 

 

 

 

 

 

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