Lemon Balm —To Be Sharp but CalmCan High-Quality Lemon Balm Ease Dementia?
Winning herb improves cognitive function and mood in young and old
By Will Block
 
reathes there a person anywhere who doesn’t love the exquisite fragrance and taste of lemon? Whether lemons wind up in lemonade or lemon tea, or candy or cake or cookies, or candles or even furniture polish, we love our lemons (except when they’re our cars—and how did that perverse example of name-calling come about?). With their sunny yellow color and piquant nature, lemons seem to embody the joy of life. We even call their grated rinds “zest.”
Our love of lemons extends to any plant that smells or tastes like lemon, such as lemon grass (a favorite in Thai cuisine), lemon verbena (used to flavor teas and iced drinks), and the delightfully fragrant perennial herb lemon balm.* In common parlance, lemon balm (Melissa officinalis) refers to the fresh or dried leaves of the herb, as well as preparations made from the leaves, such as tea. The leaves are collected before flowering or before there is too much branching of the plant, which grows to about 2 feet tall. They are used fresh in cold drinks, fruit cups, salads, and fish dishes; the dried leaves impart a lemony perfume to sachets and potpourris.
Lemon Balm Has a Medicinal Heritage
 The name “balm” suggests, however, that there’s more to this herb than just a treat for our noses and tongues. Indeed, lemon balm has a long history of use in folk medicine for treating a variety of ailments, most notably nervous disorders such as agitation, anxiety, stress, gastrointestinal disturbances, and insomnia. (See the sidebar “A Brief History of Balm.”) Lemon balm has been found to function as a mild sedative; as a carminative (an agent that induces the expulsion of gas from the stomach or intestines); as an antispasmodic agent (one that relieves or prevents spasms, especially of smooth muscle); and even as an antibacterial and antiviral agent.
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A Brief History of Balm
The medicinal use of balm (aka lemon balm) goes back at least two millennia. In the first century A.D., balm was described and prescribed by the great Greek physician and botanist Dioscorides in his classic treatise, De Materia Medica (About Medical Substances). This was the world’s first really systematic pharmacopoeia, and it remained the final authority in botany and pharmacology for about 15 centuries. Its first printed edition was released in 1478, only 15 years before the birth in Switzerland of another giant of medical history, Paracelsus.
A brilliant but eccentric and irascible man who was often on the run from his many enemies, “Paracelsus” (his real name was Theophrastus Bombastus von Hohenheim) was a physician and alchemist who transformed both fields through his original thinking and intellectual courage. Although he clung throughout his life to much of the mystical nonsense of alchemy (as well as astrology), he nonetheless espoused one great, revolutionary idea about alchemy that tied it to medicine. He decided that the true purpose of alchemy was not to find ways of manufacturing gold from base elements, such as lead, but rather to find new ways of preparing medicines with which to treat disease—medicines that did not necessarily come from plant sources, but from mineral sources as well.
This marked a crucial step in the long, slow transition from medieval alchemy to modern chemistry, and it was the beginning of the vast and fertile field now known as medicinal chemistry. Although Paracelsus did not originate this idea—it had already been coming into fashion—it was his erudition and fiery enthusiasm that succeeded in bringing it to public notice.
Paracelsus made important discoveries in medicine, and he advanced the rational idea that mental diseases are organic, not the result of demonic possession. And despite his pioneering interest in non-plant-based medicines, he was a learned practitioner of traditional botanical remedies, as well as of new ones (he was the first, e.g., to use opium in medical practice). About balm, he wrote that it would completely revivify a man and that its use was indicated for “all complaints supposed to proceed from a disordered state of the nervous system.”
Over the centuries since the Middle Ages, people have regarded balm tea as being beneficial not only for the brain in general, owing to its well-known calming qualities, but also for specific aspects of memory function. And now, as the accompanying article shows, there appears to be scientific evidence to support that belief. Paracelsus would surely be pleased.
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In Germany, where herbal medicine is highly developed and widely practiced, lemon balm is approved and commonly prescribed for use in the treatment of nervous agitation and sleeping problems. There are no known health hazards or adverse side effects associated with its proper use in designated therapeutic amounts, which are typically in the range of 1.5–4.5 g (1500–4500 mg) per day.
Lemon Balm Stimulates Acetylcholine Receptors
Not only is lemon balm helpful in soothing nervous agitation (see the sidebar “Aromatherapy for Hurt Minds”), but it has for centuries also been regarded as being beneficial for memory. Recent studies indicating that lemon balm stimulates the brain’s acetylcholine receptors motivated some British researchers who had been investigating the effects of various herbs on cognitive function to look into this matter. Acetylcholine (ACh) is the primary neurotransmitter involved in brain activity related to cognitive functions, and deficits in ACh levels and activity are among the primary neurological factors in the development of Alzheimer’s disease.
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Aromatherapy for Hurt Minds
Balm—1a. “A chiefly Mediterranean perennial herb (Melissa officinalis) in the mint family, grown for its lemon-scented foliage, which is used as a seasoning or for tea. Also called lemon balm.” If we include part 1b (about related plants in the mint family, such as bee balm and horse balm), that’s the first of five definitions of “balm” in The American Heritage Dictionary of the English Language. Number 2 is about the resins exuded by plants such as the balm of Gilead; number 3 is “an aromatic salve or oil”; number 4 is “a pleasing aromatic fragrance”; and number 5 is “a soothing, healing, or comforting agent or quality.”
Bingo. Number 5 is how the concept of balm most commonly comes to mind. In Macbeth, Shakespeare wrote, in those famous lines about sleep: “Sleep that knits up the ravell’d sleave of care . . . Balm of hurt minds . . .”
Among the many “hurt minds” in the world are those suffering from the ravages of dementia (Alzheimer’s disease, vascular dementia, etc.). Common symptoms of dementia, mainly in the later stages, include agitation, aggression, shouting, depression, delusions, pacing, wandering, sleep disturbances, and hallucinations. Drugs sometimes help, but often with unpleasant or even dangerous side effects.
An alternative approach that shows some promise is calming, comforting aromatherapy, in which the active agent is delivered to the patient either by inhalation or by skin application through massage with aromatic oils. One problem is that it’s hard to tell whether the benefits obtained are due more to the biological activity of the agent in question or to the sheer pleasure of the experience. Placebo-controlled trials can be done, but foolproof double-blinding (and hence an objective conclusion) is difficult to achieve.
In one such study, performed in England, 72 severely demented patients with clinically significant agitation were treated by aromatherapy. The agent was essential oil of lemon balm in a base lotion, massaged into the skin (face and arms) twice daily for 4 weeks. Compared with placebo (sunflower oil), the lemon balm treatment caused the patients to exhibit markedly less agitation, to be less socially withdrawn, and to engage in more constructive activities. One wants to think that their hurt minds were hurting less.
- Ballard CG, O’Brien J, Reichelt K, Perry E. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial. J Clin Psychiatry 2002;63:553-8.
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The researchers speculated that lemon balm’s stimulation of ACh receptors might make it useful in the treatment of Alzheimer’s, especially in conjunction with its well known use as a mild sedative, which could be beneficial in helping to alleviate the nervous agitation often associated with severe dementia. As a bonus, the antioxidant properties of lemon balm suggest that it may also provide some protection against the free radical damage that is believed to be a causative factor in Alzheimer’s.
One Must Choose One’s Leaves Carefully
Prior experience had shown the researchers that the source of the lemon balm and the method of its preparation were very important factors in the biological activity observed, with some samples being much more effective than others. For the present study, they obtained eight high-quality commercial lemon balm samples (dried and powdered leaves) and tested alcoholic extracts of these leaves for two beneficial ACh-related activities:
- Inhibition of acetylcholinesterase, the enzyme that attacks and destroys acetylcholine (most anti-Alzheimer’s drugs are acetylcholinesterase inhibitors). None of the eight samples showed any such activity.
- Stimulation of acetylcholine receptors of both kinds—nicotinic and muscarinic—in samples of human brain tissue taken from the cerebral cortex at autopsy. The eight samples gave varying results in this regard, and the one that had the most favorable activity profile was selected for use in the study.
Testing Young People for Cognition and Mood
In a randomized, placebo-controlled, double-blind trial, 20 healthy young adults, aged 18–23, were tested with placebo or one of three amounts of dried lemon balm leaves: 600, 1000, or 1600 mg. The volunteers were required to participate on 5 separate days, spaced 7 days apart to ensure a sufficient “washout” of the biologically active agents from their systems between one session and the next.
 There was no treatment at the first session, but the volunteers were given a battery of 19 standardized cognitive function tests to familiarize them with the procedure. Most of these tests fell into four broad cognitive categories, called “quality of memory,” “speed of memory,” “speed of attention,” and “accuracy of attention” (these are among the mental capabilities that characteristically decline in age-related neurodegenerative diseases, such as mild cognitive impairment and Alzheimer’s disease). In addition, the volunteers were given standardized tests to evaluate three mood factors: alertness, calmness, and contentedness. On each of the four subsequent days of the trial, the volunteers were given the same tests to establish baseline values for that day; they were then given the placebo or lemon balm and tested again at 1, 3, and 6 hours after the treatment to determine its effect.
Mixed Results Can Be Hard to Interpret
Overall, the results were encouraging, although not as uniformly as one might have hoped. In the tests of quality (accuracy) of memory, the subjects showed significant improvement compared with placebo, especially with the highest amount of lemon balm used, 1600 mg. In the tests of speed of memory, on the other hand, there was a comparatively modest slowing effect due to lemon balm with all three amounts used. There was no effect on the speed of attention or accuracy of attention. On the mood tests, treatment with lemon balm showed improvement in calmness—again most strikingly with the 1600-mg amount—but it had no effect on either alertness or contentedness.
These results are in partial agreement and in partial disagreement with those of a similar study on lemon balm carried out previously by the same research group. The results of that study were also mixed—but in different ways, which makes interpretation of all the results that much more difficult.
A Tale of Two Studies
An important difference between the two studies is that the lemon balm used in the earlier one turned out not to have an appreciable effect on brain acetylcholine receptors—it had no effect on nicotinic receptors and little effect on muscarinic receptors (this was discovered only after the clinical portion of the study had been completed). Yet the treatment did have significant effects—some positive, some negative—on cognition and mood. This suggests that there is another mechanism involved in lemon balm’s biological activity, instead of or in addition to the proposed mechanism. This alternate mechanism may involve a neurotransmission system other than that mediated by ACh.
The authors discussed a possible reason for the striking contrast between the effects on ACh receptors (and the clinical effects observed in the volunteers) of the lemon balm samples used in the two studies. Unlike the dried and powdered leaves used in the later study, the lemon balm used in the earlier study was a commercially manufactured, high-quality, concentrated extract of lemon balm, produced using standard chemical extraction methods, of the kind used worldwide in the preparation of many herbal supplements for the consumer market. Although the extract probably contained many or most of the lemon balm’s biologically active agents, it apparently did not contain all of them—and even if it did, they would not necessarily exist in the same proportions as in the dried leaves.
One Must Know One’s Source, and the Properties
The sharp discrepancies observed between the two lemon balms—as well as the differences among the eight samples of leaves tested in the later study—underscore the vital importance of always knowing the source and the biological properties of the herbal product used, whether in the form of extract or dried leaves or whatever. In the authors’ words, “Indeed, the wider question of how the manufacturing process defines the active properties of herbal extracts, and thereby the behavioral consequences of their administration, is one that has ramifications for all herbal supplements.”
They go on to point out that the 1600-mg amount of lemon balm leaves used in the later study was the most beneficial amount in that study and that it “might have only just reached the therapeutic window in the M. officinalis dose-response curves,” i.e., it may represent a practical daily minimum amount for the use of this herb. This is consistent with the fact (as we saw above) that in Germany, lemon balm is generally prescribed in the range of 1500 to 4500 mg/day (of the dried and powdered leaves, not the more concentrated extract).
Lemon Balm May Help in Alzheimer’s Disease
The British authors concluded by saying, “On the broader question of a possible medicinal role for M. officinalis, it is notable that the results evinced here support the suggestion that M. officinalis may eventually have a role to play in the treatment of dementia.”
The subjects showed significant
improvement in quality (accuracy)
of memory, and in calmness,
especially with the highest amount
of lemon balm used, 1600 mg.
Indeed, a new study from the Tehran University of Medical Sciences in Iran seems to bear this suggestion out. Researchers there tested 42 elderly men and women, aged 65–80, with mild to moderate Alzheimer’s disease, in a randomized, placebo-controlled, double-blind trial of 4 months’ duration. The therapeutic agent was 60 drops/day of lemon balm in the form of an alcoholic extract. The results were encouraging: after 16 weeks of treatment with lemon balm, the patients showed significant benefits in cognition, as measured by two batteries of tests for such functions as attention, language, memory, orientation, judgment, and reasoning. There was also a significant reduction in agitation.
For the Love of Lemon!
Even though lemon balm doesn’t really come from lemons—it only smells that way—it wouldn’t be a bad idea to extend your love of the real thing to this lovely and venerable herb, which for thousands of years has comforted the afflicted with its soothing properties. How nice to know, too, that whether you’re young or old, in good health or not, lemon balm may make you a bit sharper upstairs—the better to expand your understanding of the myriad health benefits of nutritional supplements.
References
- PDR for Herbal Medicines, 2nd ed. Medical Economics Company, Montvale, NJ, 2000, pp 461-3.
- Coghan T. The Haven of Health. 1584. Cited in Perry EK, Pickering AT, Wang WW, Houghton PJ, Perry NSL. Medicinal plants and Alzheimer’s disease: from ethnobotany to phytotherapy. J Pharm Pharmacol 1999;51:527-34.
- Evelyn J. Acetaria. London, 1699. Cited in Le Strange RA, A History of Herbal Plants, Morrison & Gibb, London, 1997.
- Kennedy DO, Wake G, Savelev S, Tildesley NTJ, Perry EK, Wesnes KA, Scholey AB. Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties. Neuropsychopharmacology 2003;28:1871-81.
- Kennedy DO, Scholey AB, Tildesley NTJ, Perry EK, Wesnes KA. Modulation of mood and cognitive performance following acute administration of Melissa officinalis (lemon balm). Pharmacol Biochem Behav 2002;72:953-64.
- Akhondzadeh S, Noroozian M, Mohammadi M, Ohadinia S, Jamshidi AH, Khani M. Melissa officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double-blind, randomised, placebo-controlled trial. J Neurol Neurosurg Psychiatry 2003;74:863-6.
Will Block is the publisher and editorial director of Life Enhancement magazine. |