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Type 2 diabetes is a metabolic disorder resulting from the body’s inability to properly use insulin, the hormone that helps regulate the metabolism of carbohydrate foods the body uses for energy. It is the most common form of diabetes, accounting for 90 to 95 percent of all cases. Type 2 diabetes is nearing epidemic proportions in the United States, primarily the result of a greater prevalence of obesity and sedentary lifestyles. The upswing is also due to the increasing number of older people in the population.
Treating diabetes effectively relies on regular monitoring of blood sugar in order to keep levels in the target range. If this can’t be achieved with a healthy diet and regular exercise, medication may be prescribed.
Berberine is a naturally occurring compound found in a number of plants, including goldenseal, Oregon grape, goldthread and European barberry. The Chinese have used berberine-containing herbal remedies for some 3,000 years to treat infections, diarrhea and stomach problems. More recently, it has been studied in the U.S. for cholesterol control, although most studies have been in animals, not humans. Other studies – many from China – indicate that berberine can help reduce high blood sugar in people with diabetes.
Research indicates that taking 500 mg of berberine two to three times daily for up to three months might help control blood sugar as well as as the drugs metformin (Glucophage) or Rosiglitazone (Avandia). There are some safety issues, however. If you take berberine when you’re on medications to reduce blood sugar, the combination could push your sugar levels too low. Because berberine also can lower blood pressure, it should be used cautiously by anyone who has low blood pressure. Berberine is considered unsafe for pregnant women and nursing mothers. During pregnancy it may cross the placenta; some newborns exposed to berberine developed a type of brain damage. It also can be transferred to babies through breast milk, presenting a risk of harm. In addition, Berberine can interact with a number of medications, increasing the risk of adverse reactions.
Berberine-containing plants are not among the botanicals I recommend to help control blood sugar. The natural products I’ve found most effective are bitter melon (Momordica charantia) and prickly-pear cactus (Opuntia spp) in standardized extract form. Follow the dosage directions on the products. You can find more of my recommendations for dealing with type 2 diabetes here.
Andrew Weil, M.D.
- Berberine and Metformin for Longevity
- What Is Berberine?
- What Is Metformin?
- Comparing Berberine vs Metformin
- Using Berberine and Metformin
- Thrivous Vitality Geroprotector
- Everything you need to know about berberine
- Berberine in Diabetes
- Can Berberine Help Prevent or Treat Type 2 Diabetes?
- Research About Whether Berberine Can Treat Type 2 Diabetes
- Science-Backed Benefits of Berberine for Preventing Type 2 Diabetes
- Side Effects and Interactions of Berberine and Diabetes Meds
- Groups That Shouldn’t Take Berberine Because of Health Risks
- One Last Thing About Using Berberine to Manage Type 2 Diabetes
Berberine and Metformin for Longevity
Aging and shortening of life result from the body’s decreasing ability to refresh and repair itself over time. As the human body ages, it becomes less capable of rebuilding bone and muscle. And it becomes less capable of suppressing oxidation and clearing away unhealthy cellular contents (autophagy). By maintaining the body’s ability to repair itself, it may be possible to extend life.
There are various ways to support the body’s repair function and adopt a longevity lifestyle. They include changes to exercise and diet. According to anti-aging research, substances known as “geroprotectors” may also support the body’s repair function. They include the supplement Berberine and the drug Metformin.
What Is Berberine?
Berberine is a natural compound found in various plants such as the barberry shrub.
What does Berberine do? Berberine benefits have been shown to include support for healthy blood sugar. And Berberine supplements have also been observed to support healthy heart function. Some people use it for weight loss or PCOS.
How does Berberine work? It may work by slowing a metabolic pathway that causes inflammation and increasing activity of the AMPK enzyme.
Berberine reviews typically note that the compound may not be well absorbed when taken as an oral supplement. And that may contribute to Berberine side effects related to digestive discomfort.
Studies are being done to improve absorption. Methods to increase absorption include:
- additives such as Milk Thistle
- encapsulation in nanotubes
- water soluble derivatives
Is Berberine anti-aging? Berberine has increased lifespan in flies. This has motivated researchers to explore the use of Berberine to combat aging in humans.
What Is Metformin?
Metformin (sometimes misspelled “metaformin”) is a synthetic compound derived from French lilac.
What does Metformin do? Although some people use Metformin for weight loss or PCOS, the most common Metformin use is related to blood glucose control. Therefore, most of the human research on Metformin includes participants with type 2 diabetes.
How does Metformin work? Like Berberine, Metformin may increase activity of the AMPK enzyme.
Metformin reviews typically note that the most common Metformin side effects are related to digestion. They may include abdominal discomfort, lack of appetite, bloating, and diarrhea.
Is Metformin anti-aging? Researchers have observed that Metformin treatment may decrease mortality in people with type 2 diabetes. Metformin has been shown to improve healthspan and lifespan in mice. And the TAME study (Targeting Aging with Metformin) is testing the potential to extend healthy years of life for humans.
Comparing Berberine vs Metformin
As noted above, Berberine and Metformin may both support healthy blood sugar. They are also similar in their mechanisms of action and cellular level effects.
Both compounds appear to increase AMPK enzyme activity. AMPK is activated when there is a deficit of energy, like during fasting or exercise.
Cells activate AMPK to increase their access to energy. This facilitates glucose and fatty acid uptake from the blood. It also increases fat and glycogen breakdown, and inhibits both glucose and fat storage.
AMPK acts in at least two ways. First, it directly phosphorylates enzymes, resulting in an immediate effect. And second, it phosphorylates the transcription factors of enzymes, resulting in a longer lasting effect.
Metformin and Berberine may also increase glucose consumption. They can each inhibit complex 1 of the electron transport chain. When they do that, the process becomes less efficient at producing ATP. And that results in a use of energy that mimics a restricted calorie diet.
Scientists have done research to compare Berberine and Metformin. For example, some have found that “the hypoglycemic effect of berberine was similar to that of metformin.” And others have observed that “metformin and berberine share many features in actions despite different structure.”
Can you take Berberine and Metformin together? Although some may consider Berberine to be a Metformin alternative, the two may actually complement each other. For example, when using Berberine with Metformin, Berberine may support healthy levels of lactic acid. It helped in mice, at least, when using Berberine and Metformin together.
In summary, reviewing Berberine compared to Metformin, the two compounds share some general effects, while varying in mechanisms of action. Both are worth including in studies related to human longevity. And both are worth considering for their anti-aging potential.
Using Berberine and Metformin
More research is required to confirm the extent to which Berberine and Metformin may contribute to healthy life extension. However, they appear to be among the most promising geroprotectors presently available. And clinical studies demonstrate they may support healthy body function in the near term.
Metformin is a drug that requires a prescription in the United States. Metformin dosage varies, but people commonly take Metformin 500 mg once or twice per day. Brands include Glucophage, Glumetza, and Fortamet. If you’re interested in using them, talk with your doctor.
Berberine supplements are readily available on the market without a prescription. People usually take Berberine HCl 500 mg one to four times per day. When selecting a Berberine supplement, look for one that incorporates a method to increase absorption. And buy it from a company that responsibly seeks out quality suppliers.
Thrivous Vitality Geroprotector
Thrivous developed Vitality Geroprotector to promote better aging. It is formulated to support healthy blood sugar and protect cells and DNA from oxidation.
Vitality provides a clinical dose of Berberine, paired with Milk Thistle for better absorption. It also provides clinical doses of Blueberry anthocyanin and Coenzyme Q10. The benefits of each nutrient and dose are backed by multiple human studies. You may download study summaries from the product webpage.
Like all Thrivous products, Vitality has an open source formula with all nutrients and doses fully disclosed on its label. We also publish all quality control documents from suppliers, manufacturing, and third-parties. They are available for download from the product webpage. This is an exceptional practice in the supplement industry.
Vitality Geroprotector is available to purchase online. Get yours today.
Berberine is an alkaloid found in many plants, most notably in goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), Oregon grape (Berberis aquifolium), and goldthread (Coptis chinensis). These plants have a long history of use for several health conditions. Clinical studies with isolated berberine have shown significant success in the treatment of acute diarrhea, irritable bowel syndrome, type 2 diabetes, high blood pressure, elevated blood lipids, Alzheimer’s disease and cancer. Here’s more about how berberine can assist in these conditions.
Berberine for acute diarrhea
Berberine has been found to be effective against diarrheas caused by a number of organisms. These results indicate that berberine appears to be effective in treating the majority of common gastrointestinal infections with results comparable to standard antibiotics in most cases. In fact, results were better in several studies.
The advantage of berberine over conventional antibiotics is that it exerts selective antimicrobial action as it targets a wide range of disease-causing organisms including Candida albicans, yet exerts no action against health-promoting bacterial species such as Lactobacilli and Bifidobacter species.
Berberine for SIBO and IBS
Berberine has been shown to be effective in treating irritable bowel syndrome (IBS) and several preliminary studies suggest berberine may also be effective in small intestinal overgrowth (SIBO). IBS is associated with some combination of:
- Abdominal pain or distension
- Altered bowel function, constipation, or diarrhea
- Hypersecretion of colonic mucus
- Dyspeptic symptoms (flatulence, nausea, anorexia)
- Varying degrees of anxiety or depression
SIBO often exhibits other associated symptoms including:
- Brain “fogginess”
- Joint pain
- Skin issues such as acne, eczema, rashes or rosacea
- Weight loss
In a 2015 study, patients with diarrhea-predominant IBS were randomized to receive either berberine or a placebo twice a day for eight weeks. The berberine group reported significant improvement in diarrhea and less urgency and frequency in defecation. The berberine group also experienced a 64.6 percent reduction in abdominal pain compared with initial scores at the end of the study. Berberine significantly decreased the overall IBS symptom score, anxiety score and depression score. Lastly, and not surprisingly, berberine was associated with an increased quality of life score in patients while no such change was seen in the placebo group.
Berberine’s effects on blood sugar, lipids and hypertension
Berberine has been extensively studied in clinical trials for lowering blood sugar, lipids and hypertension. Recently, the Journal of Ethnopharmacology published a detailed review of the 27 clinical studies done to review berberine’s effects on these disorders, which provided clear answer questions on its safety and efficacy.
Results showed quite convincingly that in the treatment of type 2 diabetes mellitus, berberine (500 mg 2-3 times daily) along with lifestyle intervention lowered the level of fasting blood sugar levels, after-meal blood sugar levels and glycosylated hemoglobin (HbA1c) more than lifestyle intervention alone or placebo. When berberine was compared to drugs used in type 2 diabetes like metformin, glipizide and rosiglitazone, there was no statistical significance between the effects of berberine and these drugs. In other words, the clinical results seen with berberine are on par with the drugs, but with no significant side effects.
The same sort of comparative results seen in type 2 diabetes were found in the treatment of elevated blood lipids (cholesterol and triglycerides) and high blood pressure. In regards to its effects on blood lipids, not only does it lower total and LDL cholesterol, unlike statins, berberine also lowers blood triglycerides and raises beneficial HDL cholesterol. Berberine has also been shown to lower apolipoprotein B by 13-15 percent, which is another very important risk factor to reduce heart disease.
Berberine also promotes insulin sensitivity by increasing the number and activity of available insulin receptors. This allows the same concentration of insulin to be more effective at moving glucose out of the bloodstream. Using insulin more efficiently is a foundation for successfully supporting healthy blood sugar levels.
Berberine for weight loss
Berberine has also been examined as a weight loss aid. In one study, 37 men and women with metabolic syndrome were given 300 mg of berberine three times per day for three months. The body mass index (BMI) levels dropped roughly 13 percent. In another study, 500 mg of berberine three times per day caused an average of 5 pounds of weight loss over a 12-week period. There were also improvements in insulin sensitivity and fat-regulating hormones.
Recommended adult dose
One 500 mg capsule before meals with a glass of water, 2-3 times daily.
(Available at Pharmaca from top brands like Integrative Therapeutics, Natural Factors and Thorne Research)
Berberine is generally well tolerated at recommended dosage levels. In clinical studies at 500 mg 2-3 times daily, side effects were generally mild but included nausea, diarrhea, constipation, abdominal distension and/or abdominal pain. Berberine and berberine-containing plants are not recommended for use during pregnancy.
Berberine may interfere with the absorption of tetracycline and related antibiotics. Berberine produces significant inhibition of CYP3A enzymes in humans. Because most drugs are metabolized by these enzymes, berberine may decrease the clearance of many medications, thereby potentiating their effect.
Berberine-containing plants may enhance the effects of oral hypoglycemic drugs through its multitude of anti-diabetic effects. People on oral hypoglycemic drugs should monitor blood glucose levels if taking berberine. Adjustment of drug dosage may be required.
Supplement and Food Interactions
Animal research has shown that berberine may be able to inhibit platelet aggregation. Taking berberine with other herbs and supplements with anticoagulant and antiplatelet effects, such as clove, garlic, angelica, and Panax ginseng, may increase the risk of bleeding.
Research has also suggested that berberine has hypoglycemic effects. Taking berberine with herbs and supplements that can lower blood glucose, such as guar gum, Panax ginseng, fenugreek, and ginger, may increase the risk of hypoglycemia.
Berberine may also have hypotensive effects, which may combine with the effects of other herbs and supplements that can lower blood pressure, like lycium, stinging nettle, and theanine, increasing the risk of hypotension.
Additionally, using berberine with herbs with sedative effects, such as valerian, kava, catnip, and hops, may ehance both the therapeutic and adverse effects of those herbs.
- The correct dosage of any supplement requires a comprehensive analysis of many factors including your age, sex, health conditions, DNA, and lifestyle.
- For the treatment of type II diabetes, Berberine 0.5g has been taken orally twice daily for three months. Berberine hydrochloride 0.5g has been taken twice daily for two months or three times daily for thirteen weeks. In diabetic patients with comorbid non-alcoholic fatty liver disease, 0.6g berberine has been taken twice daily for twelve weeks.
- For treating drug addiction, levo-tetrahydropalmatine (l-THP), a derivative of tetrohydorprotoberberine, has been used in heroin addicts in doses of 30mg twice daily for one month.
- To treat H. pylori infection, 300mg of berberine has been taken three times daily for six weeks.
- To treat hypercholesterolemia, berberine 0.5g has been taken twice daily for three months. Berberine hydrochloride 500mg has been taken once daily for four weeks. Three hundred milligrams of berberine has been taken three times daily in addition to standard therapy following percutaneous coronary intervention (PCI) for 30 days.
- For the treatment of infectious diarrhea, berberine sulfate 400mg has been taken as a single dose.
- For diabetic patients with comorbid non-alcoholic fatty liver disease, 0.6g berberine has been taken twice daily for twelve weeks.
- To treat obesity, 500mg of berberine has been taken three times a day for twelve weeks.For polycystic ovarian syndrome, berberine hydrochloride 500mg has been taken three times daily for three months.
- For radiation-induced damage, berberine 20mg/kg has been taken once daily for six weeks to investigate its protective effects on lung specific injuries.
- For acute intestinal symptoms, berberine 300mg has been taken three times daily for five weeks.
- For the teatment of thrombocytopenia, berberine bisulfate 5mg has been taken three times daily (twenty minutes before meals) for fifteen days.
- Berberine infusion 0.2mg/kg per minute has been given intravenously for thirty minutes for heart failure.
- Eyedrops containing 2.5mg berberine hydrochloride in addition to 2.5mg tetryzoline in 10mL polyvinylpyrrolidone solution have been used (placebo eyedrops contained 2.5mg tetryzoline in 10mL polyvinylpyrrolidone solution) for glaucoma.
- Berberine 0.2% has been used in eye drops for eight weeks for trachoma.
Berberine is a supplement which is known to be highly effective when used medicinally. However, it is not eaten.
Everything you need to know about berberine
The following are conditions that berberine may help treat, according to research.
Share on Pinterest Berberine, which is a compound in tree turmeric, is an effective antimicrobial agent.
Berberine could be an effective antimicrobial agent. A laboratory study found that berberine helped inhibit the growth of Staphylococcus aureus.
S. aureus can cause many health problems, including sepsis, pneumonia, meningitis, and a range of skin conditions.
Another study found that berberine has the ability to damage the DNA and protein of certain bacteria.
Inflammation is a key factor in several health conditions, including heart disease and diabetes.
Some research suggests that berberine has anti-inflammatory properties, which means that it could help treat diabetes and other inflammation-related health conditions.
Research has shown that berberine may work as a diabetes treatment. Studies have found that it can have positive effects on blood sugar, triglycerides, and insulin.
One meta-analysis indicated that berberine was better than a placebo at lowering blood sugar.
The same analysis found that a combination of berberine and blood sugar lowering drugs is more effective than the drugs alone.
According to other research, berberine shows promise as a potential diabetes treatment, especially for those who cannot take existing antidiabetic drugs, due to heart disease, liver failure, or kidney problems.
Another meta-analysis found that berberine combined with lifestyle changes worked better to lower blood glucose than lifestyle changes alone.
Berberine appears to activate AMP-activated protein kinase, which can help regulate how the body uses blood sugar. Researchers believe that this activation can help treat diabetes and related health issues, such as obesity and high cholesterol.
However, scientists need to conduct more large, double-blind studies to fully determine berberine’s safety and efficacy.
Speak with a doctor before taking berberine for diabetes. It may not be right for everyone and could interact with other medications.
High levels of low density lipoprotein (LDL) cholesterol and triglycerides may increase the risk of heart disease and stroke.
Some evidence suggests that berberine could help lower LDL cholesterol and triglyceride levels. According to one review, studies in both animals and humans indicate that berberine has cholesterol lowering effects.
It may help reduce LDL, or “bad,” cholesterol and increase high density lipoprotein, or “good,” cholesterol.
A meta-analysis found that berberine combined with lifestyle changes works better than lifestyle changes alone in treating high cholesterol.
Furthermore, a study in hamsters observed that berberine helps move excess cholesterol to the liver, where the body can process and remove it. This, in turn, helps lower total cholesterol and triglyceride levels.
Researchers believe that the effects of berberine might be similar to those of drugs that reduce high cholesterol, while berberine does not cause the same side effects.
High blood pressure
High blood pressure is a leading cause of heart disease.
A meta-analysis found that berberine combined with a blood pressure lowering drug was more effective than the drug alone.
Also, results of a study in rats indicate that berberine could delay the onset of high blood pressure and, when it did develop, help reduce its severity.
Obesity is a common condition that can increase the risk of type 2 diabetes, heart disease, high blood pressure, and high cholesterol.
One review reported that people who took 750 milligrams (mg) of barberry twice a day for 3 months had a significant decrease in weight. Barberry is a plant that contains high amounts of berberine.
Also, a double-blind study found that individuals with metabolic syndrome who took 200 mg of barberry three times a day experienced decreases in their body mass index readings.
The team behind another study observed that berberine may activate brown adipose tissue. This tissue helps the body turn food into body heat, and increased activation may help treat obesity and metabolic syndrome.
Some research suggests that berberine works similarly to the drug metformin, which doctors often prescribe to treat type 2 diabetes. In fact, berberine may have the ability to change the bacteria in the gut, which could help treat both obesity and diabetes.
Polycystic ovary syndrome
Share on PinterestA person with PCOS may have high blood pressure.
Polycystic ovary syndrome (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.
PCOS is linked with many issues that berberine may help address. For example, a person with PCOS may also have:
- high levels of insulin, diabetes, or both
- high blood pressure
- high cholesterol
- more body weight
Doctors sometimes prescribe metformin, a diabetes drug, to treat PCOS. As berberine appears to have similar effects to metformin, it may also be a good treatment option for PCOS.
A meta-analysis and systematic review found that berberine has promise as a treatment for PCOS with insulin resistance. However, the authors state that confirming these effects will require further studies.
Berberine can create changes within the molecules of cells, and this could have another potential benefit: fighting cancer.
One review concludes that berberine has “clear inhibitory effects” on the following cancers:
- colorectal cancer
- lung cancer
- ovarian cancer
- prostate cancer
- liver cancer
- cervical cancer
Another study states that berberine helps treat cancer by interfering with its progression and its typical life cycle. It may also play a role in killing cancer cells.
Based on this evidence, the authors state, berberine is “highly expected to be effective, safe, and affordable” as a cancer fighting agent.
However, it is important to remember that researchers have only studied berberine’s effects on cancer cells in a laboratory, not in people.
Berberine in Diabetes
It seems the search for novel therapies in diabetes is a never-ending quest. Just as new heroes are found, old stalwarts are discovered to have health risks of their own and become relegated to out-of-print medical textbooks. Frustrating as this is for researchers, many patients also know therapies simply quit being effective for them over time. Given the challenging nature of finding effective therapies, researchers continue to explore the plant world for glucose-lowering agents that have few side effects and might offer therapeutic longevity.
In recent years, the herbal compound berberine has been explored as a possible therapy in diabetes. Berberine-containing herbs such as Goldenseal (Hydrastis canadensis) and Oregon Grape (Berberis aquifolium) are readily available on the US Market, and are most commonly marketed for immune enhancement, antibacterial and antiparasitic effects, and gastrointestinal health (largely owing to the antimicrobial effects). The Chinese herb Coptis chinensis is also a significant source of berberine, though it is less widely known in the US. Most of the studies on berberine for diabetes have been conducted in China, and have consequently used extracts from Coptis. Few US manufacturers market any of the berberine-containing herbs for blood sugar control.
How Might it Work?
Laboratory studies typically involving rodent studies or cultured human cells have found a number of possible mechanisms for the beneficial effects of berberine on blood sugar control. Several studies have found berberine leads to an upregulation of insulin receptor activity, while other trials also found effects on blood sugar may be related to berberine’s antimicrobial effects.
Researchers in China have studied berberine’s effects on different types of human cells, including liver, colon, immune, and pancreas cells. They have consistently found increased insulin receptor expression and glucose metabolism in these cell lines. 1,2 Further supporting an insulin receptor-related mechanism was the finding that rats with type 2 diabetes (associated with reduced insulin sensitivity) had improvements in their blood sugar, but rats with type 1 diabetes (a deficiency of insulin) had minimal change in their blood glucose after treatment with berberine.
Another hypothesis, with some early supporting evidence, is that berberine’s glucose-lowering effect might be related to activity in the gut. One small trial in animal models of diabetes found berberine led to a decreased activity of the sugar-digesting enzymes located in the cells of the intestinal wall.3 Another group has hypothesized berberine’s favorable effects on blood sugar may be a side effect of its antimicrobial effects. They hypothesize berberine may kill off certain intestinal bacteria that contribute to increased inflammation and insulin resistance.4
Clinical Trials of Berberine in Diabetes
It seems clear berberine has a significant blood glucose-lowering effect, whatever the mechanism (or, more likely, mechanisms) may be. Several clinical trials have now been conducted to examine how much berberine lowers glucose in humans, as well as to assess overall safety and tolerability. These early studies have found berberine is as potent as other medications for diabetes, and may also lower cholesterol and improve blood flow beneficial effects most diabetes drugs don’t have. Granted, the available research is limited, and the results may not be generalizable to people in the United States. Regardless, the findings to date are provocative.
In a randomized trial of 116 patients with newly-diagnosed with type 2 diabetes, Yifou Zhang et. al. examined the effects of berberine (500mg, twice daily) compared to placebo.5 After three months, study participants receiving berberine had significant reductions in hemoglobin A1c (HbA1c, reducing from 7.5% to 6.6%), total cholesterol, LDL-cholesterol, triglycerides, and systolic blood pressure. Of 57 people in the berberine group, five reported constipation and two of these had to reduce their dose to 250mg, twice daily. No other adverse effects were reported.
Yin’s research group reported on two clinical trials in the same paper.6The first trial compared berberine (500mg, three times daily) to metformin in 36 newly-diagnosed patients. After thirteen weeks, berberine performed as well as metformin in reducing HBA1c, but had beneficial effects on total cholesterol and triglycerides (though not LDL or HDL) that metformin did not exhibit. This group’s second trial added berberine to conventional care in 48 patients with poorly-controlled type 2 diabetes, and found berberine reduced HBA1c over the thirteen week study period (from 8.1% to 7.3%), as well as improved insulin sensitivity and lipid status. Adverse effects included mild gastrointestinal symptoms, which typically resolved after dose reduction.
Hao Zhang et. al. completed a three-armed trial of a commercially available berberine product compared to metformin and rosiglitazone.2 In this two-month trial of 97 patients with type-II diabetes, Zhang’s group found berberine reduced HBA1c comparable to rosiglitazone (from 8.3% to 6.8% after two months, values true for both groups). Oddly, the metformin group started with a much higher HBA1c (9.4%), which reduced to 7.2% during the trial period. Apart from its glucose-lowering effects, berberine also reduced triglycerides much greater extent than either rosiglitazone or metformin. The researchers reported no significant adverse effects in any of the patients treated with berberine.
In 2010, Hao Zhang’s group also reported on a smaller trial of 35 patients with diabetes and either hepatitis B (HBV) or hepatitis C (HCV).2 After successfully treating their diabetes with berberine (1000mg/day) for two months, the berberine group also had lower levels of enzymes from the liver (higher liver enzymes are associated with worse disease in hepatitis). These findings are especially exciting because several medications used to treat diabetes may cause liver toxicity and are used cautiously in people with diabetes patients with concurrent liver disease. If further research supports the safety of berberine in people with liver disease, it may become a regular part of care for people suffering from both diabetes and hepatitis.
Other Beneficial Effects
Diabetes does not typically exist in isolation. Many patients with diabetes may also have cardiovascular problems, high blood pressure, or high cholesterol.
As has been noted in the above trials, berberine seems to have regular success at improving cholesterol status. Several other clinical trials have been conducted supporting berberine’s role as a lipid-lowering agent. Affuso’s group found, when combined with 200mg of red yeast rice, 500mg of berberine led to significant reductions in total cholesterol, LDL, and triglycerides after a six-week trial.7 Kong’s group found berberine added to the medication simvastatin achieved greater lipid-lowering effects than simvastatin alone (reaching a total of 31.8% reduction in serum LDL).8
Vascular health also seems to be improved by berberine. The afore-mentioned study by Affuso et. al. also found notable benefits from berberine on the ability of the blood vessels to dilate with increases in blood flow (called “flow-mediated vasodilation”).7 Another group tracked the effects of 1200 grams of berberine on 14 healthy subjects over one month, and also found improvements in flow-mediated vasodilation.9
Concerns and Side Effects
Nearly all treatments whether pharmaceutical or herbal have potential side effects. The most commonly found adverse effects of berberine seem to be gastrointestinal in nature, and these tend to be transient and responsive to dose reductions.
The potential for drug-drug interactions is of greater concern because berberine shares the same metabolic enzymes in the liver with numerous medications. Depending on the exact medication, this interaction can lead to increased or decreased levels of the medications. In some circumstances, this can lead to dose reductions in medications, or of berberine. However, it can also increase medication side effects. Please discuss all of your medications and supplements with your physician and/or pharmacist, and find a qualified source for health information related to herbal medicines (e.g., naturopathic physicians, integrative medical doctors or nurse practitioners, or licensed herbalists).
Although additional clinical trials are needed on berberine in the United States, the available clinical trials support berberine for blood sugar and cholesterol-lowering, combining it with other medications may lead to a dangerous lowering of blood sugar. In addition, the effect of berberine on the breakdown of other medications is an additional reason to be conservative. Finally, be sure you’re purchasing from a trusted source that can answer questions regarding the source of the berberine and has quality-certified manufacturing processes. Contaminated supplements, or supplements that don’t contain what they claim to, are more expensive in their health consequences than paying a few dollars more for a supplement from a trusted source.
Rather than treating this compound as a simple over-the-counter remedy to be safely added to any diabetes regimen, you should discuss with your naturopathic physician or other licensed healthcare provider whether berberine may be a helpful therapy in managing your diabetes.
And, as always, the best ways to get your blood sugar under control don’t come in a bottle they involve the tried-and-true approach of a sensible diet and regular exercise.
Ryan Bradley, ND, MPH and Bill Walter, ND April, 2012
Kong WJ, Zhang H, Song DQ, et al. Berberine reduces insulin resistance through protein kinase C-dependent up-regulation of insulin receptor expression. Metabolism. Jan 2009;58(1):109-119.
Zhang H, Wei J, Xue R, et al. Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression. Metabolism. Feb 2010;59(2):285-292.
Liu L, Yu YL, Yang JS, et al. Berberine suppresses intestinal disaccharidases with beneficial metabolic effects in diabetic states, evidences from in vivo and in vitro study. Naunyn Schmiedebergs Arch Pharmacol. Apr 2010;381(4):371-381.
Han J, Lin H, Huang W. Modulating gut microbiota as an anti-diabetic mechanism of berberine. Med Sci Monit. Jul 2011;17(7):RA164-167.
Zhang Y, Li X, Zou D, et al. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab. Jul 2008;93(7):2559-2565.
Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. May 2008;57(5):712-717.
Affuso F, Ruvolo A, Micillo F, Sacca L, Fazio S. Effects of a nutraceutical combination (berberine, red yeast rice and policosanols) on lipid levels and endothelial function randomized, double-blind, placebo-controlled study. Nutr Metab Cardiovasc Dis. Nov 2010;20(9):656-661.
Kong WJ, Wei J, Zuo ZY, et al. Combination of simvastatin with berberine improves the lipid-lowering efficacy. Metabolism. Aug 2008;57(8):1029-1037.
Wang JM, Yang Z, Xu MG, et al. Berberine-induced decline in circulating CD31+/CD42- microparticles is associated with improvement of endothelial function in humans. Eur J Pharmacol. Jul 1 2009;614(1-3):77-83.
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Can Berberine Help Prevent or Treat Type 2 Diabetes?
When it comes to type 2 diabetes, it seems every day there’s a new “magic” pill being touted for weight loss and lower A1C. But one such pill — the supplement berberine — may have some real science to support its use in type 2 diabetes management.
Berberine is a compound that’s naturally found in plants like European barberry, goldenseal, and goldthread, according to MedlinePlus. And it’s nothing new — a study published in December 2014 in Biochemistry and Cell Biology notes berberine has been used in Chinese, Indian, and Middle Eastern folk medicine for at least four centuries.
In more recent years, the supplement has gained a foothold in the United States as an over-the-counter supplement. “It might be hitting the mainstream now, but the herb itself has been used for thousands of years,” says Robin Foroutan, RDN, a registered dietitian nutritionist specializing in integrative medicine, functional medicine, and holistic healing modalities with the Morrison Center in New York City. “It’s almost as though our research is catching up with something that ancient healers knew about for a long, long time.”
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Proposed Health Benefits of Berberine
Research has shown berberine may help with high cholesterol, high blood pressure, polycystic ovary syndrome (PCOS), and skin issues like burns and canker sores, according to MedlinePlus. It’s also been shown to help people with type 2 diabetes because it appears to help regulate blood sugar, according to MedlinePlus. Researchers have found this effect, but aren’t exactly sure why it has these anti-diabetic properties, per the aforementioned study in Biochemistry and Cell Biology.
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Research About Whether Berberine Can Treat Type 2 Diabetes
Much of the research that’s been done on berberine has explored the effect it has on people with type 2 diabetes. Below are some of the studies and their findings.
May Lower Blood Sugar
The Biochemistry and Cell Biology study notes that not only does berberine have antioxidant and anti-inflammatory properties, but it may also help reduce insulin resistance, which is the hallmark of type 2 diabetes. The researchers note that it appears taking berberine on its own or as an add-on therapy to other diabetes treatments may be beneficial. The researchers concluded that berberine may be a good treatment option to try before insulin therapy (under a doctor’s supervision, of course) and may offer better results than metformin, which is generally the first-line treatment for type 2 diabetes.
Could Reduce A1C
About a decade ago, a study published in Metabolism found that berberine not only lowered blood glucose levels, but it also lowered levels of hemoglobin A1C, triglycerides, and insulin in people with type 2 diabetes. A1C is a two- to three-month average of blood sugar levels and a test used to diagnose diabetes, according to the American Diabetes Association.
Has the Potential to Improve Fasting and Postprandial Glucose
Berberine may reduce fasting and postprandial, or post-meal, glucose levels by more than 30 percent, according to a one study. These are other markers for blood glucose control.
A Bonus Benefit: Affordability
A study published in February 2015 in the Journal of Ethnopharmacology notes that berberine is usually inexpensive, which could make it an attractive option for diabetes patients in low-income areas.
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Science-Backed Benefits of Berberine for Preventing Type 2 Diabetes
“Nobody just wakes up one day with diabetes — it’s a slow process,” Foroutan says. “People can start to take action when their hemoglobin levels are starting to approach the prediabetes range.” According to the Mayo Clinic, hemoglobin is a protein in your red blood cells that transports oxygen, and A1C measures how much of your hemoglobin is covered in sugar (glycated hemoglobin).
A study on rats found berberine may help protect against diabetes because it can increase insulin expression, regenerate B cells (which lose function as diabetes progresses), provides antioxidant properties, and decreases lipid peroxidation, which is a marker for oxidative stress. Oxidative stress is linked to cell damage and various chronic health conditions, notes past research. This study on berberine was also done on rats, and this protective factor hasn’t been studied well among humans.
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Side Effects and Interactions of Berberine and Diabetes Meds
Lynn Grieger, RDN, CDE, a certified diabetes educator based in Prescott, Arizona, says one of her concerns about berberine is the fact that it’s a supplement, and the supplement industry is not well regulated. “If you buy a supplement, you’re never exactly sure what’s in it, so you have to be cautious about that,” she says.
The typical dose of berberine is 500 milligrams (mg) two to three times a day, Foroutan says, and there are some side effects to be aware of. The Biochemistry and Cell Biology study notes it’s generally well tolerated, but some people have experienced nausea, vomiting, diarrhea, or constipation. Headaches, skin irritation, and bradycardia (the clinical term for a slow heart rate) may also occur when it’s taken at a high dose. A past study found that 34.5 percent of patients experienced gastrointestinal side effects. Foroutan says digestive issues should go away within a few days or a week, and that you may be able to start by taking the 500 mg dose once a day and then increase the amount once your body gets used to it. (Because everyone’s different, be sure to ask your healthcare team which dosage is right for you.)
Also, even though berberine is credited with lowering blood sugar, it can create problems for people who are controlling their blood sugar with insulin or another medication by dropping blood sugar too low, according to MedlinePlus. “Berberine does seem to lower blood sugar levels in some people, so there’s a risk that, say, they’re taking metformin and then they add the berberine supplement to it and their blood sugar could drop lower than they think,” Grieger says.
Finally, berberine may interact with certain medications. Physicians typically ask what medications you’re taking, but Grieger says people often list just their prescription medications and fail to mention supplements. “People have the feeling that if it’s an herb or a supplement that it’s inherently safe,” she says. But that’s not always the case, so Grieger recommends talking with both your physician and your pharmacist before taking any type of supplement, including berberine.
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Known Medications That Interact With Berberine
Research has shown berberine may interact with:
Warfarin, a blood-thinning medication sold under the brand names Coumadin and Jantoven, according to a study published in December 2015 in Chronic Diseases and Translational Medicine.
Diabetes medications, because it may drop blood sugar too low. Speak with a doctor first to see if your dosage of diabetes medication needs to be changed. And be sure to monitor your blood sugar closely.
Cyclosporine, which is a type of drug prescribed to patients who’ve received an organ transplant. (The brand name is Restasis.) Berberine may delay the breakdown of cyclosporine in the body, according to MedlinePlus.
You should also proceed with caution if you take medications changed by the liver, sedatives, and medications that slow blood clotting, according to MedlinePlus.
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Groups That Shouldn’t Take Berberine Because of Health Risks
Though berberine is generally safe for adults to take short term, there are a few groups of people who should not take it, according to MedlinePlus.
Pregnant and breastfeeding women Berberine may harm the fetus if the mother takes it while pregnant, and a type of brain damage called kernicterus could occur if an infant is exposed to berberine through breast milk.
Newborns Babies are subject to the brain-damage risk mentioned above. Berberine may also delay the liver’s process of eliminating bilirubin, which is a chemical that’s made by breaking down red blood cells. This can also cause brain problems.
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One Last Thing About Using Berberine to Manage Type 2 Diabetes
Berberine is a supplement that emerging research has shown can be effective in treating type 2 diabetes because of its blood-sugar-lowering properties. It’s generally well tolerated and affordable, and it can be effective for some people, but it’s not without side effects and risks. Be sure to speak with a doctor and pharmacist before taking it.