Berberine is a chemical found in several plants, including European barberry, goldenseal, goldthread, Oregon grape, phellodendron, and tree turmeric. This bitter-tasting, yellow-colored compound has a long history of use in traditional medicine. It is marketed as a supplement to support already normal glucose and lipid metabolism. While berberine has garnered attention for its potential health benefits, it's crucial to understand both its uses and potential side effects. The earliest records of the medicinal use of berberine date back more than 3,000 years, when people in China and South Asia cultivated the barberry plant and its relatives. People used the plant's stems, leaves, and bark in various ways. Evidence also shows the use of berberine-containing plants in South America, the Middle East, and Europe to treat different conditions.
What is Berberine?
Berberine is an alkaloid constituent active in a number of plant species including barberry (Berberis vulgaris), Chinese goldthread (Coptis chinensis), goldenseal (Hydrastis canadensis), tree turmeric (Berberis aristata), and Oregon grape (Berberis aquifolium). It has a deep yellow color with fluorescent properties and has long been used as a dye. Berberine is a natural compound called an alkaloid. Alkaloids are naturally occurring organic compounds that contain nitrogen and are extracted from a variety of plants. They’re known for their wide-ranging biological activities and significant pharmacological properties. Other well-known alkaloids include morphine, nicotine and caffeine.
Potential Benefits of Berberine
Berberine shares some issues with all other supplements. Because of this, medical professionals may shy away from taking a stand on a supplement, citing a lack of research. Berberine's possible health benefits stem from its effect on enzymes in the body. It binds to enzymes and parts of cells and changes how they work. It seems to affect several enzymes and even DNA and RNA.
- Diabetes Management: Taking berberine by mouth seems to slightly reduce blood sugar levels in people with diabetes. Research suggests that berberine may work as a diabetes treatment. For example, a 2019 literature review indicated that berberine was better than a placebo at lowering blood sugar, although factors such as treatment duration affected this. The same analysis suggests that a combination of berberine and blood-sugar-lowering drugs is more effective than the drugs alone. The researchers suggest that berberine may help to improve insulin resistance by lowering body mass index (BMI) scores and fasting blood insulin levels. Berberine appears to activate SIRT1 proteins, which are involved in cellular processes such as metabolism and inflammation, and AMP-activated protein kinase, which can help regulate how the body uses blood sugar. As a result, people with diabetes may find that berberine helps lower their blood sugar levels.
- Cholesterol Reduction: Taking berberine by mouth, alone or with other ingredients, might help lower total cholesterol, low-density lipoprotein (LDL or "bad") cholesterol, and triglyceride levels in people with high cholesterol. A 2021 systematic review highlights research suggesting that berberine may help lower LDL cholesterol and triglyceride levels. It may also help to increase high-density lipoprotein (HDL), or “good” cholesterol. It works differently from today’s standard cholesterol medications, so it may help treat people who are resistant to other cholesterol-lowering drugs.
- Blood Pressure Regulation: Taking 0.9 grams of berberine by mouth daily along with the blood pressure-lowering drug amlodipine reduces blood pressure better than taking amlodipine alone in people with high blood pressure. Research indicates that using both berberine and hypertension medication lowered blood pressure more than medication alone. Taking berberine may help lower your diastolic and systolic blood pressure (the bottom and top numbers of your blood pressure reading).
- Polycystic Ovary Syndrome (PCOS) Management: Taking berberine by mouth might lower blood sugar, improve cholesterol and triglyceride levels, reduce testosterone levels, and lower waist-to-hip ratio in people with PCOS. In some studies, berberine helped women with PCOS control their cholesterol, lower their waist-to-hip ratio, and increase their insulin response.
- Gut Health Improvement: 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 may help balance or regulate intestinal health by reducing harmful bacteria and encouraging good bacteria to grow. It also provides your gut with protection. Scientists have found links between the gut microbiome - bacteria colonies in the gut - and these conditions. Berberine has an antibacterial action that seems to remove the harmful bacteria in the gut and thus enhance the growth of healthy bacteria.
- Anti-inflammatory Effects: 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. Animal research highlights berberine’s anti-inflammatory properties, suggesting it may have therapeutic potential for inflammation-related health conditions.
- Potential Brain Benefits: 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.
- Other potential uses: Berberine is commonly used in traditional Chinese medicine (TCM), Ayurveda, and other medicinal traditions to treat infections, diarrhea, and inflammatory disorders. Preliminary data suggest some benefit for patients with irritable bowel syndrome and to improve metabolic and endocrine markers in women with polycystic ovary syndrome. In patients with non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, berberine reduced hepatic fat and improved metabolic and lipid profiles. Adjunctive use also reduced the risk of glycolipid metabolic disturbances in patients with schizophrenia and reduced inflammatory markers in patients with acute coronary syndrome following percutaneous coronary intervention. Berberine could be an effective antimicrobial agent. A 2022 study found that berberine helped inhibit the growth of Staphylococcus aureus.S. aureus can cause many health problems, including:sepsispneumoniameningitiscertain skin conditions. A 2019 review found that berberine has “clear inhibitory effects” on the following cancers:colorectal cancerlung cancerovarian cancerprostate cancerliver cancercervical cancer.
Potential Side Effects and Precautions
Despite its potential benefits, berberine is not without potential side effects.
Gastrointestinal Issues: Common side effects include diarrhea, constipation, gas, and upset stomach. These symptoms can range from mild to severe and are typically more pronounced at higher doses. The gastrointestinal system’s sensitivity to berberine is believed to stem from its potent antimicrobial properties, which can disrupt the gut flora balance.
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Drug Interactions: Berberine can inhibit certain enzymes in the liver, specifically cytochrome P450 enzymes, which play a crucial role in drug metabolism. This inhibition can lead to higher concentrations of co-administered drugs in the bloodstream, increasing the risk of side effects. For instance, berberine sulfate can potentiate the effects of medications like anticoagulants, antidepressants, and some antibiotics, potentially leading to toxic levels. Berberine can interact with multiple medications such as metformin, cyclosporine, omeprazole, losartan and others.
Blood Sugar Fluctuations: While berberine can be beneficial for individuals with type 2 diabetes or metabolic syndrome, it poses risks for those without these conditions. Healthy individuals or those on medications for diabetes should monitor their blood sugar levels closely, as berberine can cause hypoglycemia. Symptoms of hypoglycemia include dizziness, sweating, confusion, and even fainting.
Cardiovascular Effects: Although some studies suggest that berberine can improve lipid profiles and reduce blood pressure, there is also concern for individuals with existing heart conditions. Berberine can potentially lower blood pressure too much, leading to hypotension, characterized by dizziness, fainting, and an increased risk of falls and injuries.
Liver Toxicity: Some research indicates that high doses or prolonged use of berberine can cause liver enzyme elevations, indicating liver stress or damage. Symptoms of liver toxicity include jaundice, dark urine, fatigue, and abdominal pain.
Neurological Effects: Some users experience headaches, lethargy, or a general feeling of malaise.
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Pregnancy and Breastfeeding: It's likely unsafe to take berberine by mouth if you are pregnant. Berberine can cross the placenta and might cause harm to the fetus. Kernicterus, a type of brain damage, has developed in newborn infants exposed to berberine. It's likely unsafe to take berberine if you are breast-feeding. Berberine can be transferred to the infant through breast milk, and it might cause harm.
Use in Infants and Children: It's likely unsafe to give berberine to newborns. It can cause kernicterus, a rare type of brain damage that can occur in newborns who have severe jaundice. There isn't enough reliable information to know if berberine is safe in older children.
Interactions with other medications:
- Berberine might decrease how quickly the body breaks down cyclosporine, potentially increasing its effects and side effects.
- Combining berberine with pentobarbital, a medication that can cause sleepiness, might cause too much sleepiness.
- Berberine might slow down the body's ability to remove tacrolimus, leading to increased effects and side effects.
- Berberine might change how quickly the liver breaks down certain medications, potentially altering their effects and side effects.
- Berberine might slow blood clotting. Taking it with medications that also slow blood clotting could increase the risk of bruising and bleeding.
- Taking berberine along with diabetes medications might cause blood sugar to drop too low.
- Taking berberine along with medications that lower blood pressure might cause blood pressure to go too low.
- Taking berberine with sedative medications might cause breathing problems and/or too much sleepiness.
- Berberine might decrease how quickly the body breaks down dextromethorphan, potentially increasing its effects and side effects.
- Berberine might decrease how quickly the body activates losartan, which might decrease the effects of losartan.
- Berberine can decrease how quickly the body breaks down midazolam, potentially increasing its effects and side effects.
- Berberine might increase the amount of metformin in the body, potentially increasing its effects and side effects. This interaction seems to occur when berberine is taken around 2 hours before metformin.
Dosage and How to Use
Berberine has most often been used by adults in doses of 0.4-1.5 grams by mouth daily for up to 2 years. Berberine has also been used in eye drops and gels. The suggested dose of berberine is 250 milligrams or 500 milligrams two or three times a day. Typical dosing is 500 milligrams (0.5 grams) twice a day before meals. The dose can be up to 1,500 mg per day divided in three doses. To keep blood levels stable and benefit from berberine, spread the daily dosage (up to 1.5 grams or 1,500 milligrams daily) throughout the day. Berberine has a short half-life of several hours - which means half the dose will be metabolized and eliminated from your system within a few hours.
Berberine vs. Metformin and Ozempic
Doctors commonly prescribe metformin to lower blood sugar levels in people with type 2 diabetes. As berberine can also reduce blood sugar levels, some ask if it can be used instead of metformin. Compared to metformin, research is limited on how well berberine can lower blood sugar levels. The dietary supplement hasn’t been approved by the FDA for type 2 diabetes, whereas metformin has. Early research suggests that metformin may help manage diabetes better than berberine. A study on mice found that while berberine was better at reducing high cholesterol and obesity, metformin was better at controlling blood sugar levels.
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Although some call berberine “nature’s Ozempic,” the comparison may be exaggerated. The two also work in different ways. While Ozempic slows down digestion, berberine helps control how the body breaks down and uses energy. Unlike Ozempic, berberine is a dietary supplement that has not gone through the FDA approval processes for weight loss. This means that there is less evidence that berberine can help people lose weight than there is for Ozempic.
Important Considerations
- Consult a Healthcare Professional: It is crucial to consult with a healthcare provider before combining berberine sulfate with other medications. As with any health supplement, it’s best to consult your doctor before you start taking berberine. Always best to consult a doctor before starting to take berberine supplements, especially if you are pregnant, planning to become pregnant, or breastfeeding, have existing medical conditions, or are taking other medications.
- Monitor for Side Effects: Regular monitoring and awareness of side effects can help mitigate risks and enhance the overall benefits of this natural compound.
- Quality and Regulation: The Food and Drug Administration (FDA) does not regulate supplements. There is no guarantee of the safety or effectiveness of a supplement, and it is not always possible to verify the quality of the product. An older 2017 study found wide variation in the content of various berberine capsules, which could cause confusion about safety and dosages. The researchers did not find that a higher cost necessarily reflected a higher quality product. Dr. Tumah recommends choosing high-quality supplements that are third-party tested.
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