Berberis aristata, also known as Indian barberry or tree turmeric, is a spiny shrub with a long history of medicinal use in traditional medicine systems like Ayurveda, traditional Chinese medicine, and Nepalese medicine. This article explores the benefits and side effects of Berberis aristata, drawing upon both traditional uses and scientific research.
Historical and Traditional Uses
Barberry has been used medicinally since the Middle Ages in Europe. In the Pacific Northwest, native elders of the Salishan tribe used Mahonia aquifolium to treat acne, and Native Americans utilized Mahonia berries to treat scurvy. The species B. aristata has been used for many years in traditional Chinese and Nepalese medicine and in the Ayurvedic medical system. In Turkey, the sundried fruits are eaten for antipyretic and diuretic effects. A decoction of the plant has been used to treat GI ailments and coughs. The alkaloid berberine was included as an astringent in eye drops, but its use has become rare. The edible fruits have been used to prepare jams, jellies, and juices. The use of the plant in traditional medicine has been limited by the bitter taste of the bark and root.
Botanical Information
Berberis aristata is a large, erect, deciduous spiny shrub that grows to a height of 2-3 meters. The twigs are whitish or pale yellowish brown in color. The bark is pale brown from the outside and deep yellow from the inside, deeply furrowed, and rough. The leaves are obovate or elliptic, entire or spinous toothed, approximately 4.9 cm long and 1.8 cm broad, arranged in tufts of five to eight, with a gradually narrowed base. They are glossy dark green above and light green beneath. The flowers are yellow and form racemose inflorescences. The plant is found in the Himalayan region at altitudes of 7000 - 10000 ft, and a south Indian variety is found in Kerala.
Chemical Composition
Plant parts include the stem, root, fruit, flowers, and leaves. Alkaloids, tannins, phenolic compounds, sterols, and triterpenes have all been described. The isoquinoline alkaloids are of primary interest and include berberine, berbamine, and oxycanthine, among numerous others. Variation in content exists among the different species. Berberine is a quaternary ammonium salt of isoquinoline alkaloid.
Key Benefits of Berberis Aristata
Antimicrobial Effects
Antimicrobial effects have been described for Berberis spp. and berberine. In mice, a topical 20% root bark extract application was effective against cutaneous leishmaniasis, while chickens with severe diarrhea fed B. vulgaris root bark extract fared better through anticoccidal activity. Older, limited clinical studies evaluated berberine for treating diarrhea caused by Eschericia coli and cholera, and against microbes such as giardia and trichomonas. Berberine accumulates in the cells of bacteria, attacking and damaging their DNA.
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Anti-inflammatory Properties
Alkaloids isolated from M. aquifolium exhibited anti-inflammatory and antiproliferative activity. Limited clinical studies have evaluated the efficacy of topical M. aquifolium in psoriasis. Efficacy was greater than with placebo but not as effective as with standard therapy; exacerbations have been described. Further studies are required. Pooled data from a 2019 meta-analysis of 5 randomized controlled trials (N=317) showed that a berberine dose ranging from 300 to 1,500 mg/day given for 1 month to 2 years significantly reduced plasma C-reactive protein levels, with no heterogeneity among trials. Patients included those with acute coronary syndrome, hypertension, type 2 diabetes, obesity and ischemic stroke. No significant effect was found in results for baseline CRP or trial duration in subgroup analyses.
Potential in Cancer Treatment
Induction of apoptosis and cell cycle arrest, interference with tumor signalling, and tumor inhibition have been shown in vitro by B. vulgaris and B. aristata extracts, and berberine and berbamine constituents. Berberine has "clear inhibitory effects" on colorectal, lung, ovarian, prostate, liver, and cervical cancers. Berberine may prevent the spread of cancer cells by controlling the cell cycle and causing cell death. Berberine alone has been evaluated as an adjunct to prevent adverse effects of radiation.
Cardiovascular Effects
Experiments have shown berberine to exhibit effects on the cardiovascular system, although the mechanisms remain poorly understood. Positive inotropic and negative chronotropic effects, as well as vasodilatory, antiarrhythmic, and hypotensive effects, have been described. Caution is warranted in the presence of cardiac arrhythmia. Results from 2 low-quality controlled trials (one translated from Chinese to English via Google translate) reported significant within-group improvements in diastolic and/or systolic blood pressure with administration of berberine to adults with primary hypertension. Dosage was 300 and 500 mg administered 3 times daily for 8 weeks and 3 months in patients with concomitant gout and newly diagnosed type 2 diabetes, respectively.
Central Nervous System (CNS) and Dementia
Anti-acetylcholinesterase activity has occurred for berberine and extracts of B. vulgaris in animal studies and in vitro experiments. In mice, neuroprotective effects have been demonstrated whereby berberine inhibited apoptosis in hippocampal tissue and prevented dopaminergic neuronal damage on histology. Improvements in short-term memory and enhanced motor balance and coordination were observed in a mouse model of Parkinson disease. An anticonvulsant effect was demonstrated in mice. Research shows that berberine might help prevent dementia by protecting against brain damage and improving mental skills. Early studies also suggest that it may one day be able to treat conditions like cognitive dysfunction and Alzheimer’s disease.
Diabetes Management
Studies in rodents both normotensive and with induced diabetes have consistently demonstrated improved glycemic control with administration of berberine and Berberis extracts. Inhibition of alpha-glucosidase activity has been demonstrated; however, the precise mechanism of action remains unclear. Berberine exerted a hypoglycemic action in a small trial of patients with type 2 diabetes. In women with metabolic-associated polycystic ovary syndrome, berberine taken over 3 months decreased fasting blood glucose levels. Small clinical trials examining the effect of consumption of the fruit in type 2 diabetes showed improvements in the lipid profile and glycemic control. A systematic review and meta-analysis exploring the use of barberry on glycemic indices identified 7 eligible placebo-controlled, randomized controlled trials (N=452) published up to 2020. All studies were conducted in Iran in overweight and obese adults, predominantly in those diagnosed with type 2 diabetes but also in those with non-alcoholic fatty liver disease, metabolic syndrome, and benign breast disease. Daily dosages ranged from 1 mg to 5 g given for 6 to 12 weeks. Most studies were of good quality. Barberry was not found to produce a significant effect on fasting blood sugar overall (6 studies, N=392; significant heterogeneity) or in any of the subgroup analyses related to patient age, treatment duration, or dose. Similarly, no significant effects for barberry supplementation were found for HbA1c or insulin resistance (3 studies for each). In contrast, a significant effect was seen with barberry for reducing insulin levels (P=0.04); although, heterogeneity was significant.
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Dyslipidemia
Studies in rodents have shown positive effects of berberine on the lipid profile. Berberine alone improved the lipid profile in dyslipidemia in several clinical trials among participants with differing conditions, including familial hypercholesterolemia, obesity, and diabetes. Barberry taken over 6 weeks improved the lipid profile and influenced C-reactive protein in a randomized clinical study in 106 patients with metabolic syndrome; effect on blood pressure or other cardiovascular outcomes was not reported. Small clinical trials have been conducted examining the effect of barberry consumption in type 2 diabetes and demonstrated improvements in the lipid profile and glycemic control. In 124 euglycemic, dyslipidemic patients intolerant to high doses of statins, administration of half the statin dose plus twice daily dosing of a B. aristata 588 mg/S. marianum 105 mg combination product significantly reduced fasting plasma glucose, insulin, insulin index and stabilized lipid levels compared to baseline and placebo in a 6-month double-blind, randomized, placebo-controlled trial. A systematic review and meta-analysis identified 5 randomized controlled trials (N=339; sample size ranged from 42 to 106) that investigated the impact of barberry on lipids. All trials were conducted in Iran in overweight or obese participants with a mean age of 39 to 56 years who had metabolic syndrome, type 2 diabetes, or non-alcoholic fatty liver disease. Barberry fruit, fruit juice, and fruit extract capsules were administered for 6 to 12 weeks and compared to controls (ie, placebo, apple cider vinegar, regular diet). All trials were good quality. Results from pooled data revealed that barberry significantly reduced total cholesterol (mean difference [MD] −23.58 mg/dL; P≤0.001), low-denity lipoprotein ([LDL]; MD −13.75 mg/dL; P≤0.001), and triglycerides (MD −29.16 mg/dL; P≤0.001) with low, no, and moderate heterogeneity, respectively.
Polycystic Ovary Syndrome (PCOS)
PCOS occurs when a female has high levels of certain male hormones. The syndrome is a hormonal and metabolic imbalance that can lead to infertility and other health issues. Berberine caused greater reductions in clinical, hormonal, and lipid parameters than metformin and myoinositol. The authors suggest berberine may be better than metformin at reducing the risk of cardiovascular disease in people with PCOS.
Other Potential Uses
Limited studies in rodents and when using homeopathic doses suggest B. vulgaris extracts possess activity against calcium oxalate deposition. B. aristata improved benign prostatic hyperplasia in rats possibly by inhibition of androgen and anti-inflammatory effects. A small clinical trial reported positive effects for B. vulgaris fruit extract in treating acne. The American Academy of Dermatology/American Academy of Dermatology Association guidelines of care for the management of acne vulgaris (2016) states that oral barberry has been reported to have value in the treatment of acne (limited; moderate).
Antioxidant Effects
Antioxidant effects have been documented. Berberine lowers inflammation in many ways. For example, it reduces oxidative stress, lowers production of inflammatory proteins, and promotes immune regulation. Its anti-inflammatory activity may mean it can treat inflammatory conditions like arthritis.
Gut Health
Berberine has been shown to protect the gut barrier from inflammation. It also kills harmful gut bacteria and encourages the growth of healthy bacteria, which may help treat conditions like diabetes and high cholesterol. Berberine has an antibacterial action that seems to remove the harmful bacteria in the gut and thus enhance the growth of healthy bacteria. Berberine does not kill good bacteria. A 2020 study found that while berberine can induce cell death of harmful intestinal bacteria, it also increases the number and species of beneficial bacteria in the gut.
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Potential Side Effects and Precautions
Caution is warranted in the presence of cardiac arrhythmia. Avoid use. Case reports are lacking; however, barberry exhibits anti-cytochrome P450 3A4 (CYP3A4) activity similar to that of grapefruit. GI symptoms (eg, nausea, vomiting, diarrhea), dizziness, and fainting have been reported. Effects on the cardiovascular system (eg, hypotension, decreased heart rate) and decreased respiration may occur with high dosages. The German Commission E reports that lower doses of berberine are well tolerated. Symptoms of poisoning are characterized by lethargy, stupor and daze, vomiting and diarrhea, and nephritis. A median lethal dose (LD50) for berberine was noted as 27.5 mg/kg in humans.
Berberine and related alkaloids are poorly absorbed when taken orally; in vitro and animal studies must be interpreted with care. In animals, Berberis exhibits anti-CYP3A4 activity similar to that of grapefruit. GI symptoms (e.g., nausea, vomiting, diarrhea), dizziness, and fainting have been reported.
General Safety Information
This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.
This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure.
Specific Precautions
It is essential to speak with a doctor before taking berberine or other supplements, as they may not be safe or suitable for everyone. Anyone who develops an allergic reaction to any herbal product should stop using it at once. Some herbal supplements may contain ingredients that are not on their label, so people should monitor their reaction after first taking them.
The NCCIH advises people not to use goldenseal, which contains berberine, during pregnancy or while breastfeeding. They also caution against giving it to infants. There may also be a potential for hypoglycemia from taking goldenseal, depending on whether someone is taking other hypoglycemic prescription medications. Goldenseal may also interact with prescription medications.
Potential Side Effects
Berberine can cause digestive side effects, such as:
- Upset stomach
- Constipation
- Nausea
- Rash
- Headache
In animal studies, scientists have noticed the following effects, depending on the type of animal, how much they consumed, and for how long:
- Diarrhea
- Vomiting
- Nausea
- Muscle tremors
- Gastric ulcers
- Liver and kidney enlargement
- A reduction in white blood cells
Interactions with Medications
Berberine may interact with metformin and affect blood sugar levels, making them harder to manage. In one study, taking goldenseal, an extract containing berberine, and metformin together led to a 25% drop in the impact of metformin.
As berberine may slow blood clotting, taking it alongside blood-clotting medications may increase the risk of bruising and bleeding. Also, as berberine lowers blood sugar, taking berberine alongside antidiabetic drugs may cause blood sugar levels to drop too low.
It’s generally recommended to stop taking herbal supplements like berberine 2 to 3 weeks before surgery to avoid negative reactions to anesthesia and side effects like excessive bleeding. Berberine’s effects on blood clotting and blood sugar levels in particular may impact the success of surgery and make recovery take longer.
Dosage and Administration
Barberry berries and root bark have been used as a source of berberine. Daily doses of 2 g of the berries and 1.5 to 3 g daily of dry bark have been used; however, there are limited clinical studies to substantiate barberry's varied uses. The suggested dose of berberine is 250 milligrams or 500 milligrams two or three times a day.
Daruharidra Formulations
- Daruhaldi powder: A natural and chemical-free powder prepared from the herb daruhaldi. This Ayurvedic formulation improves liver function and regenerates liver cells naturally. It also provides nourishment to the skin and regulates the metabolism of the body. This herbal supplement may possess various medicinal properties like anti-bacterial, antifungal, laxative and analgesic. It also boosts up the immune system naturally. In females, it is mostly given in uterine and menstrual related disorders. You can also apply the paste of this powder over eyelids to decrease conjunctivitis.
- Madhumehantak churna: An Ayurvedic formulation that is especially useful in type 1 and type 2 diabetes mellitus. This churna is a combination of various herbs like tulsi, babool, bilva patra, saptrangi, vijaysar, gurmaar, daruhaldi, methi, jamun, karela, sadabahar and neem patra. These herbs contain alkaloids that are helpful in controlling blood sugar levels.
- Navkarshik churna: A classical Ayurvedic formulation that has been used in Ayurveda since many ages for balancing the vata dosha in the body. This churna contains amalaki, bibhitaki, haritaki, neem, giloy, Vacha, katuki, daruhaldi and manjistha. This churna acts as a natural blood purifier and prevents skin infections. Being an immunomodulator it boosts up the immunity and prevents the body from infections. It also corrects the body’s metabolism and relives every type of pain.