Bacopa or Ginkgo: What's the Difference

Bacopa monnieri and Ginkgo biloba are the two best-known herbal remedies sold “for memory.” Yet they have different origins, different active compounds and different logic of action: bacopa works slowly and concerns primarily the assimilation of information, while ginkgo has historically been associated with microcirculation. The editorial team compared them by mechanisms, evidence and safety.

Origin and active substances

Bacopa monnieri (brahmi) is a small marsh plant that in Ayurvedic medicine was used for centuries as a remedy for “clarity of mind” and memory. The above-ground part of the plant is used, and the main active compounds are considered to be saponins — the bacosides, in particular bacoside A and B. The bacoside content is a key parameter for standardizing extracts.

Ginkgo biloba is a tree with a very ancient evolutionary history, often called a “living fossil.” In phytotherapy the leaves are used, from which an extract is obtained. The best-known and best-studied standardized extract is EGb 761, which contains about 24% flavonoid glycosides and 6% terpene lactones (ginkgolides and bilobalide).

An important detail for ginkgo is ginkgolic acids. These compounds have allergenic and potentially toxic potential, so in high-quality pharmaceutical extracts their content is limited to a very low level (on the order of a few parts per million). Raw material or cheap extracts without such purification do not meet pharmacopeial requirements.

The status of the remedies also differs. The standardized ginkgo extract is registered in many European countries as a herbal medicine, and there is a monograph of the EMA Committee on Herbal Medicinal Products for it. On the European market, bacopa mostly has the status of a dietary supplement.

Mechanisms of action

For bacopa several mechanisms have been described, mostly from preclinical work: antioxidant protection of neurons, modulation of the cholinergic system, effect on serotonergic transmission and on enzymes related to the stress response. In animals, bacosides were associated with changes in dendrite structure, which could explain the slow, cumulative nature of the effect.

Ginkgo acts differently. Ginkgolide B is an antagonist of platelet-activating factor (PAF), which theoretically affects blood clotting and inflammation. The flavonoids have an antioxidant effect, and the extract as a whole was studied as a means of improving microcirculation and the rheological properties of the blood. Bilobalide demonstrated neuroprotective properties in preclinical models.

Hence the difference in the “profile” of expected effects. Researchers link bacopa primarily with the assimilation and retention of new information, as well as processing speed. Ginkgo was studied mostly in elderly people with cognitive impairment and vascular problems — where blood supply to the brain is a limiting factor.

It is worth remembering: most of the mechanistic data were obtained in cells and animals. They explain why the plants are interesting, but do not guarantee that the effect in humans will be noticeable and clinically significant.

The evidence base: what studies have shown

For bacopa the key work was that of Stough and colleagues (2001): in healthy adults, 12 weeks of taking the standardized extract at a dose of 300 mg per day improved the speed of processing visual information and learning measures, whereas after 5 weeks there was still no effect. This is a pattern typical of bacopa — the effect appears only with prolonged intake.

A systematic review by Pase and colleagues (2012) concluded that bacopa may improve memory, in particular delayed free recall of words. The meta-analysis by Kongkeaw and colleagues (2014) found an improvement in attention and reaction speed. The studies are small and heterogeneous, but the direction of the results is fairly consistent.

For ginkgo the evidence base is larger but less optimistic for healthy people. In the study by Solomon and colleagues (2002) in JAMA, ginkgo did not improve the memory and attention of healthy people over 60 years old. The large GEM study (DeKosky et al., 2008) showed that the extract does not reduce the incidence of dementia in elderly people, and the GuidAge study (Vellas et al., 2012) also did not prove a preventive effect against Alzheimer's disease.

At the same time, some studies and meta-analyses point to a moderate symptomatic benefit of EGb 761 in patients with already diagnosed dementia or mild cognitive impairment. It is precisely on this that the medical use of ginkgo in Europe is based: it concerns patients, not healthy students or athletes.

Standardization, quality and safety

The most common side effects of bacopa are related to digestion: nausea, cramps, diarrhea, especially when taken on an empty stomach. Some people report drowsiness or a feeling of sluggishness. Taking it with food usually improves tolerability.

Ginkgo is generally well tolerated, but because of the antiplatelet properties of the ginkgolides it is theoretically linked with a risk of bleeding. Clinical data are contradictory, but the monographs advise caution when combining it with anticoagulants, antiplatelet agents and before surgical interventions.

• Both plants are not recommended during pregnancy and breastfeeding due to insufficient data.
• Ginkgo: stop taking it before surgery, discuss with a doctor if taking warfarin, aspirin, clopidogrel.
• Bacopa: theoretical interactions with drugs affecting the cholinergic and serotonergic systems, as well as with medications for the thyroid gland.

Product quality is critical for both plants. For bacopa the bacoside content and control of heavy metals are important (the plant grows on marshy soils and can accumulate them). For ginkgo — conformity to the standardized profile and a low content of ginkgolic acids.

Editorial conclusions

Bacopa and ginkgo are different tools. Bacopa is a slow-acting plant with a small but fairly consistent evidence base regarding memory and information-processing speed in healthy people. Ginkgo is a carefully standardized extract whose best data concern elderly people with cognitive impairment.

For healthy young people there is no convincing evidence of benefit from ginkgo, and for bacopa the effect is moderate and requires at least two or three months of intake.

The risks of both plants are moderate, but they exist: digestive disturbances for bacopa, a potential effect on blood clotting for ginkgo. The quality of the extract determines both effectiveness and safety.

We examined the practical choice between them in the article “Bacopa vs Ginkgo: Which to Choose and for Whom.” We also recommend our materials on Rhodiola rosea and on L-theanine.

References

1. Stough C, Lloyd J, Clarke J, et al. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl). 2001;156(4):481–484.
2. Pase MP, Kean J, Sarris J, et al. The cognitive-enhancing effects of Bacopa monnieri: a systematic review of randomized, controlled human clinical trials. J Altern Complement Med. 2012;18(7):647–652.
3. Kongkeaw C, Dilokthornsakul P, Thanarangsarit P, et al. Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract. J Ethnopharmacol. 2014;151(1):528–535.
4. Solomon PR, Adams F, Silver A, et al. Ginkgo for memory enhancement: a randomized controlled trial. JAMA. 2002;288(7):835–840.
5. DeKosky ST, Williamson JD, Fitzpatrick AL, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008;300(19):2253–2262.
6. Vellas B, Coley N, Ousset PJ, et al. Long-term use of standardised Ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 2012;11(10):851–859.
7. European Medicines Agency, Committee on Herbal Medicinal Products. Community herbal monograph on Ginkgo biloba L., folium.