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Berberine is getting much attention on social media for its potential as a weight management aid, but what is berberine, and what are its health benefits?
Berberine is an alkaloid compound found in many plants, most notably in goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), and goldthread (Coptis chinensis).
Over 5,000 scientific studies have been performed with berberine, including over 150 human clinical trials. The results from this immense scientific research are why berberine has emerged as a popular dietary supplement over the past decade.
Research has shown that berberine can do a lot of good for health. Many of the health benefits of berberine supplementation result from its ability to improve digestive health by enhancing the gut microbiome's composition.
Since the intestinal microbiome plays an integral role in not only digestive health but also virtually every system in the body, many of the positive effects observed in clinical trials with berberine supplementation, such as helping to maintain proper blood sugar control, blood pressure, and body weight are the result of the beneficial changes that berberine facilitates in the microbiome.
The most well-researched beneficial effect of berberine on digestive health is its usefulness in helping resolve diarrhea caused by an imbalance in the intestinal microbiome. Berberine accomplishes this effect by exerting an antimicrobial effect against unwanted organisms while exerting little or no antimicrobial action against health-promoting bacterial species such as Lactobacilli andBifidobacter species. It also exerts beneficial effects on an essential bacteria for the health of the intestinal lining, Akkermansia muciniphila.
Many double-blind, placebo-controlled studies have confirmed berberine's benefits for digestive health. However, it is not appropriate to self-medicate with berberine in cases of intestinal infection. It is important to be properly monitored by your physician when dealing with any intestinal infection.
Berberine has also been shown to have benefits in irritable bowel syndrome (IBS), and several preliminary studies suggest that it may also be effective in small intestinal overgrowth (SIBO). In a 2015 double-blind study, 196 patients with IBS that included frequent bowel movements and diarrhea were randomized to receive either berberine (200 mg) or a placebo (vitamin C 200 mg) twice a day for eight weeks. The berberine group, but not the vitamin C group, reported significant improvement in diarrhea and less urgency and frequency in bowel movements. The berberine group also experienced a 64.6% reduction in abdominal pain and 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.
Several studies suggest berberine may be effective in SIBO. In addition to the benefits noted above in IBS, berberine inhibits bacterial and yeast overgrowth in the small intestine, and in animal models, berberine also improves intestinal motility. This action on motility is another key goal in patients with SIBO (and IBS).
As described above, in addition to exerting action against disease-causing organisms, berberine appears to promote the growth of health-promoting bacteria. The existing data on berberine is quite convincing that its health benefits in weight management, insulin resistance, and inflammation may largely result from modulating the gut microbiome.
One of the significant changes seen with berberine supplementation on the gut microbiome is the increased quantity of the beneficial bacteria Akkermansia muciniphila. This bacterium plays a critical role in gut health because it works closely with intestinal cells to create the mucin layer that protects the intestinal lining from damage. Berberine increases the manufacture and secretion of mucin, and the term "muciniphila" literally translates to mucin loving. Akkermansia muciniphila loves mucin and uses it as nourishment. The combination of improved mucin secretion and healthy levels of Akkermansia muciniphila means a healthy intestinal barrier.
A thinning or absent mucin layer is associated with increased intestinal permeability (leaky gut) and inflammation. Akkermansia muciniphila colonization in the gut is inversely associated with obesity, diabetes, metabolic syndrome, and low-grade chronic inflammation. In other words, when the levels and activity of Aklermansia muciniphila are low, these disorders take root. These disorders are associated with altered gut barrier function due to reduced mucin protection. This leads to the absorption of many gut-derived toxins that trigger a cascade of different systems that promote chronic inflammation and insulin resistance.
Berberine helps reverse this leaky-gut situation by promoting mucin production and the growth of Akkermansia muciniphila. This, in turn, leads to an improved intestinal barrier, reduced circulating levels of gut-derived toxins, and a significant reduction in inflammation.
Berberine also increases the levels of other health-promoting bacteria, such as Bifidobacterium. This species also promotes intestinal health, reduces absorption of gut-derived toxins, and reduces gut and systemic inflammation.
Berberine has been extensively studied in over 50 double-blind clinical trials for supporting normal blood sugar, cholesterol, and blood pressure levels, as well as supporting liver health. These double-blind clinical trials in humans attest to their efficacy and safety in promoting these health benefits.
In regards to supporting blood sugar control, results showed quite convincingly that berberine (500 mg two to three times daily) along with lifestyle intervention supports fasting blood sugar, after-meal blood sugar, and glycosylated hemoglobin (HbA1c) levels more than lifestyle intervention alone or a placebo. Newer forms of berberine are also showing clinical benefits. For example, berberine bound to phosphatidylcholine (i.e., Berbevis or Berberine Phytosome®) at a dosage of 550 mg per day has shown considerable benefits in overweight individuals with insulin resistance and women with polycystic ovarian syndrome, a condition characterized by insulin resistance and hormonal disturbances. Improvements were noted in insulin sensitivity, blood lipids, visceral fat reduction, and overall body fat loss.
In addition to supporting normal total cholesterol levels, berberine has also been shown to support normal LDL cholesterol and triglyceride levels. It has also been shown to lower another blood lipid, apolipoprotein B, which is linked as an important indicator of vascular health by 15%.
Berberine produces these metabolic effects through various mechanisms. In addition to its effects on the microbiome, berberine has been shown to increase glucagon-like peptide-1 (GLP-1), a hormone secreted in the small intestine and colon by cells known as L-cells. GLP-1 enhances the action of insulin, leading to improved blood sugar control and the promotion of satiety.
Berberine also activates AMP-activated protein kinase (AMPk) – an enzyme involved in activating mitochondria and regulating the body's energy levels. By targeting this pathway, berberine induces the uptake of glucose into cells, where it is converted into energy. Activating AMPk is also key to berberine's function in regulating blood lipids, such as LDL cholesterol, total cholesterol, and triglycerides. This enzyme acts as a master switch, regulating energy production and storage as well as lipid metabolism. It helps burn fatty acids within cells, stabilize the receptors for LDL cholesterol, and inhibit the formation of lipids by the liver.
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 as well as appetite control and weight management.
Berberine exerts several mechanisms that indicate it may support weight management. In addition to increasing GLP-1 secretion and thereby improving insulin sensitivity and promoting feelings of satiety, berberine also improves the gut microbiome, specifically Akkermansia muciniphila, enhancing AMPk levels and supporting liver function. All of these mechanisms point to possible benefits in weight management. At least a dozen double-blind, placebo-controlled clinical trials have looked at the weight management-promoting effects of berberine in humans dealing with the metabolic syndrome characterized by abdominal obesity, insulin resistance, and elevated blood lipids.
In addition to a reduction in body mass index, there were also improvements in insulin sensitivity, visceral fat mass, fat-regulating hormones, waist circumference, and markers of inflammation in these studies. 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 from 31.5 to 27.4.25. In another study, 500 mg of berberine three times per day caused an average of 5 pounds of weight management over 12 weeks.
Berberine is generally well-tolerated at recommended dosage levels (500 mg two to three times daily before meals).
Side effects are generally mild and may include 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 may enhance the effects of oral hypoglycemic drugs through its multitude of effects that improve insulin sensitivity. People on oral hypoglycemic drugs or insulin should monitor blood glucose levels if taking berberine. The prescribing physician may need to adjust the drug or insulin dosage.
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By Dr. Michael Murray, N.D. 
