Nootropics: Bacopa, Ginkgo, & Lion’s Mane

Brain support. Focus. Memory. “Nootropic.” Smart drugs… or smart marketing? Here’s what the studies actually suggest about benefits AND risks.

In this episode, NatMed editors Jeff Langford and Andrea Stafford share point-of-care counseling:

• What are “nootropics,” and how should clinicians define them for patients asking for memory/focus support? 
• What does the human evidence look like for bacopa, ginkgo, and lion’s mane—and how does it differ in healthy adults vs people with cognitive impairment? 
• What safety and interaction issues should trigger a “pause,” especially when patients bring multi‑ingredient brain blends?
• How should pharmacists triage a “brain support” supplement request?

We also cover bacopa: the bottom line on mixed benefit signals and tolerability (especially GI effects); ginkgo: the “3 Bs” interaction shortcut—bleeding, brain/neurotoxicity, blood glucose; and lion’s mane: why it’s popular, why benefit in healthy adults isn’t clear, and the key safety flags to keep on your radar.

🏷️ Our listeners can get 10% off a new or upgraded subscription with code natmed1026 at checkout. 

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NatMed / TRC Healthcare Editor Hosts: 

• Jeff Langford PharmD, BCPS, BCCP (Managing Clinical Editor)
• Andrea Stafford, PharmD (Assistant Editor)

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CE Information:

This podcast is sourced from the NatMed February 2026 Newsletter. To claim CE credit, subscribers should read the newsletter and click “Take the CE Quiz” link to take the quiz. 

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The clinical resources mentioned during the podcast are part of a subscription to NatMed: 

• 🌱 NatMed Pro
• 💊 TRC Healthcare
• Newsletter
• Monograph: Bacopa
• Monograph: Ginkgo
• Monograph: Lion's Mane Mushroom

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The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Natural Medicines: Evidence in Practice is a production of TRC Healthcare.

Transcript

This transcript is automatically generated. 

Introduction

00:00:04 Jeff Langford

You've seen these claims on a supplement label.

00:00:06 Jeff Langford

Brain support, focus, memory, nootropic.

00:00:10 Jeff Langford

When a patient hands you a bottle like that, what do you actually say?

00:00:14 Jeff Langford

Welcome back to Natural Medicines: Evidence in Practice.

00:00:17 Jeff Langford

I'm Jeff Langford, a pharmacist and managing editor at NatMed.

00:00:20 Andrea Stafford

And I'm Andrea Stafford, a pharmacist and assistant editor with NatMed.

00:00:25 Andrea Stafford

If you work with natural medicines or you're curious, you are in the right place.

00:00:30 Jeff Langford

On this show, we're going to cut through noise and trends to bring you practical, evidence-based guidance.

00:00:35 Andrea Stafford

And more specifically, in today's episode, we'll be discussing nootropics, what they are, what the evidence actually supports, and the safety and interaction issues that matter in day-to-day practice.

00:00:47 Jeff Langford

In a quick note, CE credit is available for our podcast through our monthly NatMed newsletter.

00:00:52 Jeff Langford

Check the show notes for how to claim it.

What are Nootropics?

00:00:55 Andrea Stafford

So to get us started, I will admit, I did not know the word nootropics at first.

00:01:01 Andrea Stafford

I did know about the products because patients ask for focus, memory, or brain boost supplements all the time.

00:01:08 Andrea Stafford

So Jeff, can you get us started with that definition?

00:01:11 Jeff Langford

Yeah, and I'll say, Andrea, I don't think you're alone there.

00:01:14 Jeff Langford

So I think that is a common dilemma with this term.

00:01:17 Jeff Langford

It's first probably fair to call out that this is a term that we will hear pronounced a lot of different ways, including no-o-tro-pic, new-tro-pic, new-tropic, and probably some other variations as well.

00:01:28 Jeff Langford

But regardless of how we say it, it's an umbrella term for smart drugs or cognitive enhancers that have the potential to support memory or learning.

00:01:36 Andrea Stafford

Thank you, Jeff, for that definition.

00:01:38 Andrea Stafford

And once we hear that, you can probably guess what happens next.

00:01:42 Andrea Stafford

We immediately start thinking of the usual suspects we hear for memory or focus.

00:01:48 Andrea Stafford

And you really want to know what works.

00:01:51 Andrea Stafford

So today we're going to zoom in or narrow in on three, bacopa, ginkgo, and lion's mane.

00:01:57 Andrea Stafford

What they are, what the research shows, and which safety or interaction flags should kind of make you pause and get additional information.

00:02:05 Andrea Stafford

As we go, we will take ingredient by ingredient.

00:02:08 Andrea Stafford

We'll use the same framework each time.

00:02:11 Andrea Stafford

And our first step is going to answer an important question.

00:02:16 Andrea Stafford

What is the ingredient and what's the rationale for why it might support cognition?

00:02:22 Jeff Langford

Yeah, and then we want to follow up by answering, do these really improve cognitive function in people?

00:02:27 Jeff Langford

Importantly, lots of different kinds of people might be interested in using a cognitive enhancing drug.

00:02:33 Jeff Langford

It could be students or healthy adults that just want a boost or an edge, perhaps patients with cognitive impairment, mild cognitive impairment, or Alzheimer's disease, that also would like to improve their function.

00:02:45 Jeff Langford

So where it's available, we're going to separate that evidence out for both healthy patients and those with different levels of impairment.

00:02:52 Andrea Stafford

Thank you for that clarification, Jeff.

00:02:54 Andrea Stafford

I think it's important to point out that the patient population these studies are in.

00:02:58 Andrea Stafford

From there, we will also review the safety piece, because for some of these, the risk of side effects or interactions could outweigh the potential benefit.

Bacopa

00:03:07 Jeff Langford

Perfect. So let's take it ingredient by ingredient and get started with bacopa.

00:03:12 Andrea Stafford

Yes. So starting with the basics, when we say bacopa, we mean Bacopa monnieri.

00:03:19 Andrea Stafford

It's an herb native to India with a long history of use in Ayurvedic medicine.

00:03:25 Andrea Stafford

You'll often hear it called Brahmi, but that name isn't exclusive to Bacopa.

00:03:30 Andrea Stafford

It's also sometimes used for Gotu Kola.

00:03:34 Andrea Stafford

So quick heads up, Bacopa is not the same as Gotu Kola.

00:03:39 Jeff Langford

Yeah, and there's interest in Bacopa for Alzheimer's disease, and some preliminary data seem encouraging.

00:03:45 Jeff Langford

So starting from this kind of, before we get to the people, we're going to think about animals or lab studies if they're there.

00:03:50 Jeff Langford

And for example, in an animal model of Alzheimer's disease, a Bacopa extract increases some measures of memory.

00:03:58 Andrea Stafford

And that's a great foundation, Jeff, because animal data can tell us something about its potential, but does that translate to humans?

00:04:07 Andrea Stafford

And as it pertains to human studies, Bacopa is one of the more studied memory supplements, but the results are mixed.

00:04:15 Andrea Stafford

In healthy adults, those without cognitive impairment, it hasn't consistently improved broad measures like working memory or learning rate.

00:04:23 Andrea Stafford

That said, some subgroup analyses have found improvements in more specific areas like reaction time or verbal learning.

00:04:33 Andrea Stafford

It's also important to note that the evidence remains mixed regardless of whether a patient takes it alone or in combination with other ingredients such as ginseng.

00:04:43 Andrea Stafford

So the next question we want to consider is what does the evidence say about people with cognitive impairment?

00:04:49 Jeff Langford

Yeah, so turning to that patient population, Andrea, the evidence is also somewhat mixed in those cases as well.

00:04:56 Jeff Langford

So for example, we have one clinical study in older adults with mild cognitive impairment, and that population, taking an oral bacopa extract for about two months, improved again some specific areas of cognition, like attention or verbal fluency, but not other areas like working memory.

00:05:16 Jeff Langford

This was compared to placebo.

00:05:18 Jeff Langford

So that was kind of a short-term piece of data.

00:05:20 Jeff Langford

We also had a study, a longer-term study, in patients with mild cognitive impairment or Alzheimer's disease, used Bacopa for about 12 months, so longer duration here, but it didn't improve measures of cognitive function compared to their baseline performance or to using a traditional drug like donepezil.

00:05:38 Jeff Langford

So we see some mixed results in our patients with cognitive impairment.

00:05:42 Jeff Langford

That could be due to the different kinds of patients that were in these studies, how long they were followed up, or other factors like the Bacopa doses that were studied.

00:05:50 Andrea Stafford

Okay, so if the benefits are inconsistent,

00:05:54 Andrea Stafford

The next practical question is, what do we need to watch for on the safety side?

00:06:00 Andrea Stafford

So Jeff, can you walk us through what to consider?

00:06:03 Jeff Langford

Yeah, so big picture, Bacopa is generally well tolerated, but it does have some common adverse effects, including GI upset and other adverse effects like flu-like symptoms, fatigue, and palpitations have been documented in some of these studies, but those things are fairly infrequent.

00:06:19 Jeff Langford

So I think our bottom line here, Andrea, on Bacopa is that the evidence for cognition is mixed.

00:06:24 Jeff Langford

Sometimes we might see small benefits in certain sub-domains or sub-measures of cognitive function, but that means often for many people, there's no meaningful change.

00:06:36 Andrea Stafford

So I think if someone wants to try it, we want to set expectations and then monitor for side effects, especially those GI issues like cramps, diarrhea, and nausea.

00:06:47 Jeff Langford

Agree.

Ginkgo

00:06:49 Andrea Stafford

So that's kind of wrapping up bacopa, and next up is ginkgo.

00:06:54 Andrea Stafford

This one's probably pretty familiar to most of us, either from patients asking about it or from seeing it on the shelves in stores.

00:07:02 Andrea Stafford

But before we get into the studies, let's start with the basics.

00:07:05 Andrea Stafford

What is ginkgo?

00:07:07 Jeff Langford

So ginkgo biloba is a large tree, has a distinctive fan-shaped leaf with a fruit and nut, and a long history of use in traditional Chinese medicine.

00:07:17 Jeff Langford

But I think the question I want to know about, Andrea, is why is there interest in ginkgo to enhance cognition?

00:07:23 Andrea Stafford

Yes, so that's where we talk about this preliminary data, specifically in vitro studies.

00:07:29 Andrea Stafford

They suggest that ginkgo leaf extract might be helpful for Alzheimer's disease and that it might help reverse the decline in certain brain receptor activity that occurs with aging.

00:07:40 Jeff Langford

Okay, with that backdrop, let's turn to what we see in human studies.

00:07:45 Jeff Langford

And we're going to start with the clinical research in our healthy adult patients.

00:07:48 Jeff Langford

And they show that taking ginkgo leaf extract daily for about 3 months might improve some measures of cognition.

00:07:54 Jeff Langford

That sounds a little bit familiar to what we were talking about with bacopa.

00:07:58 Jeff Langford

So we're seeing improvements in specific areas like immediate or delayed recall.

00:08:02 Jeff Langford

But other research shows no significant effect on cognition in healthy adults, regardless of the dose or the formulation that you used.

00:08:11 Jeff Langford

What about any data in people with cognitive impairment, Andrea?

00:08:15 Jeff Langford

What do we have there?

00:08:16 Andrea Stafford

Yes, so there is a clinical study in patients with mild cognitive impairment that shows taking a specific Ginkgo standardized extract for 24 months improved scores for cognitive decline and memory.

00:08:30 Andrea Stafford

However, it's important to note that these changes are compared to baseline, meaning we didn't have a comparator group to examine.

00:08:38 Andrea Stafford

And even though the changes were statistically significant, they may not have been large enough to be clinically important patients.

00:08:46 Jeff Langford

Okay, well, that brings us to the part that sometimes really drives our clinical decision-making when the efficacy is mixed, and that's pulling in our safety data.

00:08:54 Jeff Langford

So with Ginkgo, it's really important to pause and ask patients, what else are you taking?

00:08:59 Jeff Langford

What are their prescriptions, supplements, over-the-counter medications?

00:09:03 Jeff Langford

Because Ginkgo does have many potential interactions with other substances.

00:09:08 Jeff Langford

And I like this framework, Andrea, of thinking about 3 Bs, bleeding, brain or neurotoxic effects, and blood glucose effects.

00:09:17 Andrea Stafford

So I'll get us started with the first B for bleeding.

00:09:21 Andrea Stafford

You'll want to screen for interactions with anticoagulants and antiplatelet agents, since ginkgo may increase bleeding risk.

00:09:30 Andrea Stafford

More specifically, ginkgo has been reported to increase bleeding risk in some people when taken with warfarin, possibly due to its antiplatelet effects.

00:09:39 Andrea Stafford

And even though the evidence is less direct, it's also a reasonable concern with other anticoagulants like apixaban or Eliquis, and with antiplatelet drugs like clopidogrel.

00:09:52 Jeff Langford

Yeah, and our next B is for brain or neurotoxic effects.

00:09:55 Jeff Langford

That's because ginkgo seeds contain this ginkgotoxin, and large amounts of that toxin can lead to neurotoxicity and seizures.

00:10:03 Jeff Langford

So it's important to consider that potential interaction for patients using, for example, anticonvulsant meds for seizure disorders.

00:10:12 Andrea Stafford

And our last B is for blood sugar.

00:10:15 Andrea Stafford

In patients taking oral hypoglycemic agents, ginkgo has been associated with higher blood glucose after an oral glucose tolerance test, possibly because it increases hepatic metabolism of insulin.

00:10:29 Andrea Stafford

So it's worth being mindful of a potential interaction between ginkgo and other medications for diabetes and monitoring glucose more closely if someone wants to use it.

00:10:39 Jeff Langford

So those 3 B's kind of apply to some pretty common classes of medications, Andrea.

00:10:44 Jeff Langford

I think it's fair to say if we're considering ginkgo, let's review the med list carefully for interactions.

00:10:49 Andrea Stafford

Exactly. And our NatMed Pro is a great place to go for that.

00:10:54 Andrea Stafford

Our interaction checker is a powerful and practical way to input a patient's medication list and supplements of interest to identify any potential concerns.

00:11:04 Jeff Langford

So the bottom line here, evidence for ginkgo on cognitive function is mixed.

00:11:09 Jeff Langford

The bigger issue for many patients will be potential interactions.

00:11:13 Andrea Stafford

So that quick check using the three B's is important.

00:11:16 Andrea Stafford

Bleeding risk, brain seizure concerns, and blood sugar effects.

00:11:20 Andrea Stafford

So review that medication list before saying yes.

Lion’s Mane

00:11:23 Jeff Langford

All right, let's turn to our last supplement today, lion's mane.

00:11:27 Jeff Langford

This one seems to be increasing in popularity, especially online, and it's popping up in different herbal blends.

00:11:33 Jeff Langford

So give us the backstory on that, Andrea.

00:11:35 Andrea Stafford

Yes, so this one's kind of a fun one.

00:11:38 Andrea Stafford

Lion's mane mushroom is exactly what it sounds like.

00:11:42 Andrea Stafford

It's a mushroom.

00:11:43 Andrea Stafford

And it grows on dead hardwood trunks.

00:11:46 Andrea Stafford

The fruiting body has a long history as both a food and a traditional remedy in East Asia.

00:11:52 Andrea Stafford

And visually, it's hard to miss.

00:11:55 Andrea Stafford

It's white with this shaggy outer texture made-up of spines about 1/2 to 2 inches long, which is where it gets that classic lion's mane look.

00:12:05 Andrea Stafford

But again, we want to know why is there an interest in lion's mane for cognition?

00:12:10 Jeff Langford

Okay, well, let's take a quick look at some of the preliminary data.

00:12:13 Jeff Langford

And we have animal research in this case that suggests administering lion's mane mushroom as part of a diet for about 3 weeks can help prevent some of the learning and memory deficits that are caused by this amyloid beta.

00:12:26 Jeff Langford

And that's a protein that we believe to be the driver of Alzheimer's disease.

00:12:32 Andrea Stafford

Again, thank you, Jeff, for laying that groundwork on what this preliminary animal data shows.

00:12:37 Andrea Stafford

But unfortunately, that data in healthy humans hasn't been as promising.

00:12:42 Andrea Stafford

Not only are the clinical trials small, the results don't show a clear cognitive benefit, either acutely from a single dose or with routine use over about one to three months.

00:12:54 Andrea Stafford

And in one study, while the reaction time improved, word recall accuracy decreased and word recall errors increased.

00:13:04 Jeff Langford

Yeah, that's really interesting, Andrea.

00:13:05 Jeff Langford

And I think you call out something there that we haven't really talked about with these other studies, but sometimes people are interested in these cognitive boosters as a single dose.

00:13:14 Jeff Langford

So particularly if we're thinking about those students, for example, they may be looking for that edge for performance on testing or something like that.

00:13:20 Jeff Langford

And in this case, we're not finding that benefit.

00:13:23 Jeff Langford

Let's take a look at data in patients with cognitive impairment.

00:13:27 Jeff Langford

There's one study in older patients with mild cognitive impairment shows that lion's mane mushroom taken for about four months increased cognitive function, but the improvement wasn't maintained once the therapy was stopped.

00:13:41 Jeff Langford

We also have some research in patients with mild Alzheimer's disease shows that taking lion's mane mushroom for about a year does improve some performance on activities of daily living compared to placebo.

00:13:53 Jeff Langford

When they examine cognitive function, it improves scores on our mini mental status exam, but that improvement was only compared to baseline and not to placebo.

00:14:03 Jeff Langford

So overall, the message really is that there is some suggestion of benefit.

00:14:09 Jeff Langford

We're seeing some encouraging signals, but these studies really leave us with some key gaps in evidence for this to be something we could rely on or feel confident there's data for effectiveness at this point.

00:14:21 Andrea Stafford

So to kind of sum that up, in healthy adults, the evidence is lacking, but in some studies of mild cognitive impairment and mild Alzheimer's disease, there's at least a hint of potential benefit, even though the studies have important limitations.

00:14:35 Andrea Stafford

Which then brings us kind of to this practical question, if a patient still wants to try lion's mane, what should we be watching for?

00:14:42 Andrea Stafford

So Jeff, can you walk us through these again for safety and interaction concerns?

00:14:47 Jeff Langford

Sure.

00:14:48 Jeff Langford

For these patients, I think it's important to tell them that lion's mane is generally well tolerated.

00:14:53 Jeff Langford

Things like GI discomfort, nausea, and skin rash are possible adverse effects that have been documented.

00:14:59 Jeff Langford

And there are some theoretical drug interactions.

00:15:02 Jeff Langford

These are based really at this point on animal or test tube type data.

00:15:06 Jeff Langford

And so for example, with anticoagulant, antiplatelet drugs, lion's mane could increase the risk of bleeding.

00:15:13 Jeff Langford

With diabetes meds, we could have additive blood glucose lowering.

00:15:17 Jeff Langford

And with immunosuppressants, lion's mane seems to stimulate immune function, so that might interfere with the immunosuppressant drug or kind of counteract its effects to some degree.

00:15:29 Andrea Stafford

So just to confirm, you would advise caution for patients with autoimmune diseases like lupus due to potential disease exacerbation and in patients using blood thinners for atrial fibrillation, for example, due to increased risk of bleeding?

00:15:44 Jeff Langford

Yeah, those are great examples and exactly the kind of places I think we would want to press pause.

00:15:49 Jeff Langford

So our bottom line on lion's mane, despite the buzz, it doesn't seem beneficial in healthy adults.

00:15:54 Jeff Langford

And data are still preliminary with cognitive impairment.

00:15:58 Andrea Stafford

But if they still want to try it, it's generally well tolerated.

00:16:02 Andrea Stafford

But consider that GI upset or possibility of a rash and use caution in patients with autoimmune diseases or using certain medications such as blood thinners.

NatMed Pro

00:16:13 Jeff Langford

So, quick spotlight: If you want to take this guidance further, NatMed Pro gives you point-of-care tools that can help make counseling more efficient and effective.

00:16:22 Andrea Stafford

Particularly, a search tool to identify supplements and herbs with evidence regarding specific conditions.

00:16:28 Andrea Stafford

For example, you can search by cognitive function and review evidence in individual monographs.

00:16:34 Andrea Stafford

Also, an interaction checker, like we talked about earlier, to review drug supplement interactions in real time.

00:16:40 Jeff Langford

Plus, CE options and our monthly newsletter for ongoing updates and clinical pearls.

00:16:45 Andrea Stafford

And the best news of all, listeners can save 10% with code NATMED1026 at checkout.

00:16:53 Andrea Stafford

Links are in the show notes.

00:16:54 Andrea Stafford

Now back to the show.

Patient Case

00:16:58 Andrea Stafford

So let's make this a real-world consideration.

00:17:02 Andrea Stafford

A patient hands you a brain support blend that contains lion's mane and ginkgo, and they say, I'm on a blood thinner, but I want something for memory.

00:17:12 Andrea Stafford

Is this safe?

00:17:14 Jeff Langford

Yeah, so that's a moment to slow down and really assess what's in this blend, what medications are on board, and probably to gather some additional information about the patient as well.

00:17:24 Jeff Langford

We know with ginkgo, for example, that bleeding risk, especially with anticoags or antiplatelets, is a red flag.

00:17:30 Jeff Langford

And we have that based on human data.

00:17:33 Andrea Stafford

And then they're probably also curious of, does this work?

00:17:37 Andrea Stafford

And I think that's when we need to set some of these expectations where evidence for cognition is mixed.

00:17:43 Andrea Stafford

And for lion's mane, the data in healthy adults mostly doesn't support the benefit.

00:17:48 Jeff Langford

Okay, so from a practical perspective, if this patient still wants to try something, I would help him evaluate a single ingredient first and steer clear of these combination products, at least from the beginning.

00:18:01 Jeff Langford

So for instance, we may want to talk to this patient, and if we learn that his desire is just to sharpen cognition, but he doesn't have any baseline impairment, that info would lean away from ginkgo or lion's mane because we didn't have good evidence in that healthy population.

00:18:15 Jeff Langford

So we might have a conversation with him about Bacopa, sharing the fact that evidence there is really mixed.

00:18:21 Jeff Langford

He may still prefer to give it, for example, a short-term trial and see if he is, you know, in that small group of patients that might benefit.

00:18:28 Jeff Langford

So we could talk through pros and cons of that.

00:18:30 Jeff Langford

But whatever that decision is, I would definitely encourage him and any other patient to loop in all of their healthcare providers because these kind of interactions that can occur with supplements can matter even more than some of the hype that people hear about them.

00:18:45 Andrea Stafford

I think it's a great approach to kind of look at each ingredient individually versus it as a combination.

00:18:51 Andrea Stafford

And I also think this case is a good reminder that the idea of a cognitive boost is appealing, but for several nootropics, the evidence is still limited and inconsistent as we've seen today.

00:19:03 Andrea Stafford

So safety checks and then realistic expectations should kind of lead that conversation.

00:19:08 Jeff Langford

Exactly. And we can encourage our patients to focus on the basics to support good cognition.

00:19:13 Jeff Langford

That may be better sleep, balanced diet, regular physical activity.

00:19:17 Jeff Langford

Because when we're rested and feel good, our minds do work better.

A few more things…

00:19:21 Andrea Stafford

So on that note, let's wrap things up.

00:19:23 Jeff Langford

To claim CE, follow the instructions linked in our show notes.

00:19:27 Jeff Langford

We've also included links to these monographs in the newsletter article so that you can bring these tips straight to practice.

00:19:34 Andrea Stafford

Also, in the February newsletter, we cover another interesting and timely topic, cracking the code on eggshell membrane.

00:19:41 Andrea Stafford

And in our most recently published March newsletter, we dive into some quick takeaways regarding the new dietary guidelines and fibermaxxing for colorectal prevention, which is very timely since March is Colorectal Cancer Awareness Month.

00:19:56 Jeff Langford

So follow or subscribe to this show in your podcast app so the new episodes land automatically.

00:20:02 Andrea Stafford

And thanks for listening to Natural Medicines: Evidence in Practice, evidence, not hype.

00:20:08 Jeff Langford

See you next month.