Medicine

Berberine

This post originally appeared on Medical News Bulletin.

What You Need To Know

  • Berberine is a herbal remedy.
  • Some claim berberine can be used in weight loss.
  • Berberine can act on the liver, act as an antidiuretic, interfere with blood sugar regulation and has an antibiotic effect.
  • We do not know how it works or what else it does in the body.
  • Sale of berberine is unregulated- you cannot be sure what is in each pill and how much if any berberine they contain.
  • Pregnant and breast-feeding women must not use berberine-it may be dangerous for infants and unborn babies.
  • People with diabetes should avoid berberine unless advised by a medical doctor. 
  • Berberine interacts with several prescription medications. 
  • Berberine can cause severe diarrhoea, bloating and abdominal pain.

What is Berberine? 

Claims that herbal remedy, berberine, is a weight loss miracle drug are making the rounds on social media. Proponents of berberine claim in TikTok videos and Instagram posts that it can aid weight loss. Some herbalists say that it can regulate blood sugar, cure diarrhea, has an antidiuretic effect and that it is a potent antibiotic.1

Does It Work?

There is little evidence to support weight-loss claims, and subsequent research has not yet validated blood sugar claims.2,3 A pattern of poor study design renders the mild health benefits touted by some researchers, as arguable.

Companies selling herbal supplements frequently fund and perform the studies, this could suggest a conflict of interest in how they then present their findings. As a result, evidence berberine’s efficacy varies wildly between reports with some suggesting marginal benefits, and others claiming it to be on par with insulin. We should, therefore, treat health claims about berberine with a grain of salt until researchers can supply more robust supporting evidence.

We do not yet know how Berberine works, at which doses it is safe or which additional physiological processes it can influence.

Where does it come from?

Isolated from the European Barberry’s flower, this yellow powder can affect key bodily functions. Historically, Asian cultures have used berberine as a crude antibiotic, antidiuretic and anti-diabetic agent.4

More recently, several 1990s Chinese studies showed berberine could lower blood glucose. However, the tests into blood sugar regulation did not consistently account for diabetes severity, dosing and lacked clear control groups.2 The research periods tend to be short, meaning doctors were unable to assess long-term effects. 

Why Am I Hearing About It Now?

Interest in the herb surged in the summer of 2023, on the wave of endorsements by health TikTok influencers. Despite weak evidence, multiple people have taken up the use of berberine as a weight-loss supplement against the advice of medical professionals. Peter Lin, a director at the Canadian Heart Research Association, explains in a CBC interview about Berberine:


“That’s why a lot of doctors, if you talk to them, they’ll say, ‘You know, it might have some effect, but we don’t know exactly what it does inside your body. And if it’s touching all of these systems, we need to make sure that it’s not causing harm,’

Will Berberine Make Me Lose Weight Fast?

In short, no. Technically speaking berberine can decrease body fat and blood glucose to a limited extent. Systematic reviews of the studies show that it can decrease BMI by a value of about 0.25. Most dietary clinicians point out that this is not a clinically relevant weight change. 3 In contrast, Ozempic achieves BMI changes of 3.19 in a similar time frame.3

Comparing Ozempic and berberine’s efficacy may well be a fool’s errand. Despite being called “nature’s Ozempic” they work in completely different ways. In fact, so far scientists have not identified how berberine purportedly affects weight change. In comparison, Ozempic mimics the GLP-1 hormone, which is lowered in diabetic patients. GLP-1 promotes a feeling of fullness, reducing food intake.

While a month’s supply of Ozempic costs $936 U.S./month and berberine at $60/month, you get the results for which you pay. Of course, using either of these medicines without a doctor’s approval could cost patients their health.

Is Berberine Safe?

As with any drug, berberine can be a medicine or a poison. Unfortunately because researchers have not yet fully characterized its effects on the body, it is impossible for an individual to know whether berberine will be a curse or a cure. Berberine can be lethal if consumed by infants.1

 Unlike drugs approved for use as medicines, government agencies do not regulate nutritional supplements.5 This means the manufacturers and sellers do not need to conform to quality or safety standards. The pills may contain several “filler ingredients” that provide no medicinal value. Without knowing the actual quantity of berberine in each pill, you will not know what dose you are receiving from one bottle to the next.6

More troubling than the lack of active ingredient, several incidences of “spiked” shipments of traditional Chinese medicine containing warfarin and anti-inflammatory agents have occurred. Contaminants can also include heavy metals, sulphur and pesticides.7 There have also been cases where entirely different herbs have been sold under false names. None of these potential contaminants are listed on the label. 

When You Should NOT Use Berberine

There are a number of situations where you should not take berberine.

Pregnant and breast-feeding women should never use berberine.8 Berberine can cause jaundice and kernicterus in babies.8 Berberine lowers the ability of the liver to remove bilirubin (a waste product our body usually passes out in feces). In infants, that can’t process bilirubin, it can build up in the brain causing brain damage an in some cases death.

Diabetics are encouraged to discuss taking berberine with their doctor before use. Improper doses of berberine can result in dangerously low blood-glucose levels.9 Do not take berberine with antidiabetic medications without consulting with your doctor. 

Doctors recommend avoiding berberine if using any of the following:9

  • Cyclosporin
  • Dextromethorphan
  • Losartan
  • Midazolam
  • Pentobarbital
  • Tacrolimus
  • CYP450 altering-drugs 
  • Blood-pressure medication
  • anticoagulants
  • sedatives

In general, if you are on any medications or have a medical condition consult with your doctor before using supplements.

The Most Common Side Effect of Berberine…Diarrhea

Berberine has a strange relationship with diarrhea in that it can be both a cure and a cause.10 Traditionally, berberine has been used as a remedy for the runs. As a short-term treatment for loose bowels berberine is effective. In the last decade, researchers have confirmed that it does indeed decrease bowel movement rates and abdominal pain.10 However, with long-term use berberine will cause digestive issues. This is due to berberine’s ability to act as an antibiotic. Multiple studies have shown that berberine exposure can disrupt the delicate balance of the gut microbiome.11 Consequently, bloating, gas and diarrhea are common side effects of berberine. If any of these issues occur, patients should discontinue use immediately.

While berberine is generally safe, any supplement or drug can be dangerous if used incorrectly. Consult with your doctor before engaging in berberine use.

References
1. In the News: Berberine. U.S. Department of Health and Human Services: National Center for Complementary and Integrative Health. Updated June 2023. Accessed August 2023. https://www.nccih.nih.gov/health/in-the-news-berberine

2. Zamani, M., Zarei, M., Nikbaf-Shandiz, M., Hosseini, S., Shiraseb, F., & Asbaghi, O. The effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis. Front Nutr. 2022;9. https://doi.org/10.3389/fnut.2022.1013055 

3. Zhang, R., Hou, Q., Li, B., Deng, L., Yang, Y., Li, T., Yao, X., Yang, L., Lin, X., Liao, Y., Wang, L., Liu, Y., Tan, J., Wan, Z., & Shuai, P. Efficacy and safety of subcutaneous semaglutide in overweight or obese adults: A subgroup meta-analysis of randomized controlled trials. SSRN Electronic Journal. 2023. Accessed August 2023. https://doi.org/10.2139/ssrn.4249801 

4. Song, D., Hao, J., & Fan, D. (2020). Biological properties and clinical applications of Berberine. Front Med, 14(5), 564–582. https://doi.org/10.1007/s11684-019-0724-6 

5. Traditional chinese medicine: What you need to know. National Center for Complementary and Integrative Health. Updated April 2019. Accessed August 2023. https://www.nccih.nih.gov/health/traditional-chinese-medicine-what-you-need-to-know

6.Funk, R. S., Singh, R. K., Winefield, R. D., Kandel, S. E., Ruisinger, J. F., Moriarty, P. M., & Backes, J. M. Variability in potency among commercial preparations of berberine. J Diet Suppl. 2017; 15(3), 343–351. https://doi.org/10.1080/193902121.2017.1347227 

7.Kim, H., Hughes, P. J., & Hawes, E. M. Adverse events associated with metal contamination of traditional Chinese medicines in Korea: A clinical review. Yonsei Med J. 2014;55(5), 1177. https://doi.org/10.3349/ymj.2014.55.5.1177 

8. Linn, Y., Lu, J., Lim, L., Sun, H., Sun, J., Zhou, Y., & Ng, H. Berberine-induced haemolysis revisited: Safety of RHIZOMA Coptidis and cortex phellodendri in chronic haematological diseases. Phytother Res. 2011; 26(5), 682–686. https://doi.org/10.1002/ptr.3617 

9.U.S. National Library of Medicine. Berberine: Medlineplus supplements. MedlinePlus. Updated September 16, 2021. Accessed August 2023 https://medlineplus.gov/druginfo/natural/1126.html

10. Chen, C., Lu, M., Pan, Q., Fichna, J., Zheng, L., Wang, K., Yu, Z., Li, Y., Li, K., Song, A., Liu, Z., Song, Z., & Kreis, M. Berberine improves intestinal motility and visceral pain in the mouse models mimicking diarrhea-predominant irritable bowel syndrome (IBS-D) symptoms in an opioid-receptor dependent manner. PLOS ONE.2015; 10(12). https://doi.org/10.1371/journal.pone.0145556

11.Yue, S.-J., Liu, J., Wang, W.-X., Wang, A.-T., Yang, X.-Y., Guan, H.-S., Wang, C.-Y., & Yan, D. Berberine treatment-emergent mild diarrhea associated with gut microbiota dysbiosis. Biomedicine. 2019; 116, 109002. https://doi.org/10.1016/j.biopha.2019.109002 
 

This post originally appeared on Medical News Bulletin.

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