On the Shelf
Mickie Cathers
Berberine supplements are making waves as an appetite suppressant and metabolic support. Berberine’s benefits may extend beyond weight loss, offering improved heart health, cholesterol management, and blood glucose levels. As awareness grows, patients may wonder if berberine is safe for them.
Background
Berberine has long been a staple in traditional Chinese medicine as an antimicrobial to treat dysentery and infectious diarrhea. The roots, rhizomes, bark, and stems of plants such as barberry, goldenseal, and Oregon grape are particularly high in the alkaloid berberine. More recent research focuses on berberine’s effect on cardiovascular disorders.
Is there a benefit?
Many studies have shown that berberine offers hepatoprotective, nephroprotective, and immunomodulatory effects, along with safeguarding the nervous and cardiovascular systems. Berberine has been found to offer anti-inflammatory, antidiabetic, antihyperlipidemic, antitumor, antibacterial, and antidiarrheal properties.
Berberine influences metabolism, body fat composition, and appetite by activating AMP-activated protein kinase, a key enzyme in cellular energy regulation. Berberine decreases glucose production in the liver and decreases insulin resistance by making insulin more effective. It has been found to increase glycolysis and slow the breakdown of carbohydrates in the gut. By promoting glucose uptake and improving insulin sensitivity, berberine can help minimize fat accumulation and improve overall metabolic health.
Authors of a parallel, double-blind, placebo-controlled, randomized clinical trial published in the February 2025 issue of the European Journal of Nutrition investigated the efficacy and safety of berberine in combination with cinnamon in patients with T2D.
Patients with T2D were randomized into two groups: a berberine (1,200 mg) and cinnamon (600 mg) or placebo group. Mansour and colleagues found that, at the end of the 12-week study, fasting blood glucose and A1C were significantly lower in participants taking berberine plus cinnamon in comparison with those taking placebo capsules. The results of this study also indicated a significant difference in the level of low-density lipoprotein cholesterol, while no difference was observed in the levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides between the study groups.
Berberine supplements may also help patients with weight loss and reduce inflammation. A 2020 systematic review and meta-analysis published in Clinical Nutrition ESPEN highlighted berberine’s effect on obesity, inflammation, and liver function enzymes. Asbaghi and colleagues found that supplementing with berberine led to moderate but significant reductions in body weight, BMI, waist circumference, and C-reactive protein, a marker of inflammation. While berberine positively impacted weight-related metrics, it showed no significant effect on levels of liver enzymes ALT and AST. This suggests berberine’s potential as a complementary treatment without adversely affecting liver function.
Dosage and availability
Berberine is available on store shelves and online in various forms such as capsules, powders, liquid drops, and gummies. Studies have shown that berberine is safe in doses up to 1.5 grams daily over a period of 6 months to 2 years. However, many products on the market exceed recommended doses, offering up to 3 grams daily. Common dosages include 500 mg of berberine three times per day and before meals.
What to tell your patients
Berberine shows promise in the management of metabolic issues and weight loss. It is generally considered safe for most adults but poses risks for children and patients who are pregnant or breastfeeding, as it can cross the placenta and potentially harm the fetus. Berberine exposure has been linked to increased bilirubin levels, which can cause brain damage in infants.
Common adverse effects include constipation, diarrhea, gas, and upset stomach. Berberine may slow blood clotting, affect how the liver breaks down medications, lower blood glucose levels, and cause sleepiness and slowed breathing. Berberine may interact with certain medications. Caution patients to avoid berberine in combination with cyclosporine, anticoagulants, sedatives, and medications changed by the liver. ■