Mickie Cathers
Berberine supplements have joined the weight-loss buzz with rumors that this herb can help patients slim down. Also advertised as a means to lower blood glucose levels and support the CV system and GI and immune function, berberine supplements are rising in popularity. But is there any truth behind these claims?
Background
Berberine is an isoquinoline alkaloid compound found in certain plants such as barberry, goldenseal, Oregon grape, and tree turmeric (not to be confused with regular turmeric). This dietary supplement has a long history in Ayurvedic medicine as treatment for GI issues, infections, and wounds.
Berberine has been studied in the prevention of atherosclerosis, T2D, obesity, CV complications, and cancer. There is some evidence that berberine positively contributes to improving the regulation of glucose and lipid metabolism as well as inhibiting mitochondrial function, activating the AMPK pathway. Berberine is also known to act as an anti-inflammatory and an antioxidant by reducing reactive oxygen species accumulation.
Is there a benefit?
Several studies have shown that berberine stimulates glycolysis, thereby improving insulin secretion, and inhibiting gluconeogenesis and adipogenesis in the liver. Berberine acts as an antisclerotic, lowering low-density lipoprotein (LDL), and testosterone levels as well as exhibiting an anti-inflammatory property by stalling the expression of COX-2 and PGE2. Berberine acts as an anticancer option by inducing apoptosis and influencing mitogen-activated protein kinase and transcription regulation. Berberine has been shown to prevent the development of atherosclerosis, T2D, and CV disorders, and the anti-obesity action of berberine is well-documented. However, high-quality, large clinical trials in humans are limited.
Hernandez and colleagues published results of a systematic review and meta-analysis of berberine’s impact on lipoprotein, triglycerides, and total cholesterol in the Journal of Dietary Supplements on May 14, 2023. The authors evaluated 42 randomized clinical trials including 4,838 patients over the course of 8 to 18 weeks of berberine therapy. Results showed berberine, alone or with other additives, significantly reduced total cholesterol and may provide a modest positive impact on lipid concentrations.
Another systematic review and meta-analysis of randomized clinical trials published in Frontiers in Pharmacology on April 26, 2021, reported on the efficacy and safety of berberine for several metabolic disorders. Ye and colleagues found a positive therapeutic effect of berberine on metabolic diseases. The authors concluded that berberine may affect obesity and improve hyperlipidemia by reducing triglycerides, total cholesterol, LDL, HDL, homeostasis model assessment-insulin resistance, and fasting glucose in both patients with metabolic disorders as well as in healthy participants.
However, despite the reported beneficial effects and high safety profile, berberine suffers from poor bioavailability, limiting its clinical application.
Dosage and availability
This low bioavailability may explain why berberine supplements are often combined with black pepper, Ceylon cinnamon, and turmeric. Other additives include MCT oil, artichoke leaf, and milk thistle. Berberine is available as capsules and gummies on store shelves and online. Dosages vary from 1,000 to 1,500 mg and upwards to 4,700 mg daily in some supplements.
What to tell your patients
While berberine is generally considered safe, it can interact with prescription medications due to its effects on specific enzymes in the blood. There is a potential for hypoglycemia in patients with diabetes, those taking metformin, and those on other medications that lower blood glucose levels. Those interested in supplementing with berberine should speak with their health care provider first. Remind patients that supplements are not FDA-regulated, and the safety, efficacy, and actual contents may not reflect what is on the label. ■