Ozempic and other similar weight loss drugs have recently garnered widespread attention, but these drugs are not always easy to obtain or are cost-prohibitive. As a result, some people are turning to natural alternatives. Touted on social media as “nature’s Ozempic,” berberine has become a supplement of interest due to its purported effectiveness for weight loss.
But what exactly is berberine?
What Is Berberine?
Berberine is a naturally occurring compound that’s found in several types of plants, including:
— European barberry.
— Chinese goldthread.
— Indian barberry.
— Oregon grape.
— Tree turmeric.
Similar to turmeric, berberine has a bright yellow color and is considered an alkaloid, which is another name for nitrogen-containing compounds that have pharmaceutical properties when used in the body, explains Tracy Adkins, a board-certified women’s health care nurse practitioner based in Eleva, Wisconsin.
The opiates codeine and morphine are in the same family of alkaloids as berberine, but berberine itself is not an opiate.
Although only recently in the news, berberine has been around for a long time. Berberine is more commonly used in Chinese, East Asian and Ayurvedic medicine. But berberine is available in the U.S., as well, sold over the counter as an oral supplement.
Berberine has been studied for several potential health benefits, including:
— Diabetes management and lowering blood sugar. A 2021 meta-analysis of 46 clinical trials published in Oxidative Medicine and Cellular Longevity studied berberine alone and berberine along with standard therapies for diabetes. The researchers found that both approaches helped to significantly lower hemoglobin A1C as well as cholesterol and body mass index.
— Lowering cholesterol. A 2020 meta-analysis in the Journal of Medicinal Food that included 19 studies focused on the effectiveness of berberine alone or with other formulations to lower cholesterol. Among participants taking berberine, researchers found a reduction in both total cholesterol and LDL cholesterol (sometimes called “bad” cholesterol) and a smaller reduction in triglycerides, a type of fat found in the blood.
— Lowering blood pressure. Berberine may reduce blood pressure when used in combination with blood pressure medication, says registered dietitian Veronica Rouse, owner of The Heart Dietitian in Ottawa, Ontario. A 2015 review in the Journal of Ethnopharmacology found that using berberine lowered blood pressure more effectively on its own or combined with blood pressure-lowering medications or lifestyle changes versus placebo or lifestyle changes alone. However, a 2021 study in Complementary Therapies in Clinical Practice found that evidence regarding berberine’s ability to lower blood pressure was low quality and inconclusive.
— Improving gut microbiome health. Berberine helps to balance the gut microbiome by regulating bacteria and promoting cellular detoxification, says Dr. Mahmud Kara, founder and CEO of the natural remedies company KaraMD, based in Cleveland.
Berberine is available as a capsule, tablet, powder or liquid extract.
Most formulations of berberine are sold in 1,000 milligrams to 1,200 milligrams per two capsules. Most manufacturers of the supplement recommend taking berberine once a day before meals or with a meal. As with any new supplement, it’s best to speak with your health care provider before beginning to take the supplement. These professionals can help answer any questions you may have about dosing.
Is Berberine Nature’s Ozempic?
Ozempic is one of the brand names for semaglutide, a glucagon-like peptide-1 (GLP-1) agonist that was originally designed to help those with Type 2 diabetes control their blood sugar, along with following a healthy diet and physical activity.
Recently, there’s been great interest among some people without diabetes in using Ozempic for weight loss. Another brand name for semaglutide is Wegovy, which is geared toward those with obesity. A 2021 study in the New England Journal of Medicine found that the use of semaglutide for 68 weeks led to an average of 15% decrease in body weight.
Ozempic and Wegovy can be expensive and sometimes hard to find, leading some people to look for alternatives. Yet berberine isn’t a magic alternative to Ozempic, experts say.
“Calling berberine ‘nature’s Ozempic’ is inaccurate and misleading. The two compounds work differently,” says Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California.
First, semaglutide targets the GLP-1 hormone, which plays a key role in regulating appetite. By mimicking the hormone, it suppresses hunger and sends signals from the brain to the body to feel full, helping people lose weight.
“Ozempic is a diabetes drug that suppresses appetite. It aids in weight loss by delaying stomach emptying, which results in staying full longer and feeling full faster,” explains Dr. Rekha Kumar, chief medical officer with the medically-assisted weight loss program Found and a practicing endocrinologist in New York City.
By contrast, berberine activates an enzyme in the body called AMP-activated protein kinase that helps to regulate blood sugar. It signals to the liver to lower the production of sugar it’s producing and helps the body to be more sensitive to insulin, which is important if you have Type 2 diabetes.
“Berberine increases the uptake of glucose (blood sugar) by the muscles and increases insulin sensitivity, so it’s not directly affecting hunger, satiety or gut function,” Ali says.
Berberine actually works more similarly to metformin, another diabetes drug, as it can make you respond better to your own insulin, Kumar explains.
A 2021 meta-analysis of 18 studies published in Frontiers in Pharmacology found that berberine helped improve obesity, as well as cholesterol and the body’s ability to process insulin. The meta-analysis found that the treatment period and dosage of berberine affected results and that there were many differences among the patient populations, including sex, age and lifestyle.
“It’s not a ‘one-supplement fits all’ for this,” Kumar says.
It’s possible that other benefits from berberine, such as lowering blood sugar and cholesterol, could aid weight loss if used along with a healthy diet and regular physical activity, says Amy Kimberlain, a Miami-based registered dietitian and spokesperson for the Academy of Nutrition and Dietetics.
“Berberine supplementation regarding weight loss needs to be studied more heavily, especially in humans,” says Rhyan Geiger, a registered dietitian and owner of Phoenix Vegan Dietitian in Phoenix.
Should You Try Berberine for Weight Loss?
Always check with a health care provider before using a supplement or medication to help with weight loss. It’s important to focus on a plan that works for your individual health needs.
Kumar says she would be open to a patient using berberine for weight loss if they had mild diabetes or obesity and used it along with prescription medications and lifestyle changes such as a healthy diet and physical activity. She’s less concerned about any side effects from berberine as she is about “the emotional impacts of yet another trend that leaves people thinking there is an easy, natural, quick-fix solution to treat obesity,” she says.
Effective Weight Loss Strategies
There are a few things you can do to help lose weight beyond relying on a quick fix:
— Don’t focus on the number on the scale. Instead, Kimberlain says to focus on numbers related to blood pressure, blood sugar and cholesterol, all of which help to measure your health.
— Set small goals to get started with healthier choices. For example, Kimberlain says to aim to add a vegetable to your lunch three days over a week. After that week, reflect on whether you were able to reach that goal. If you didn’t, analyze what barriers you encountered. Consider similar small but attainable goals to focus on healthier eating.
— Aim to lower the amount of added sugar and saturated fat that you eat daily. Geiger generally recommends no more than 10% of calories coming from added sugar and 5% to 6% of calories from saturated fats. Both of these guidelines match the American Heart Association’s recommendations for added sugar and saturated fat.
— Find regular physical activity that you can do most days of the week. Kimberlain calls physical activity “joyful movement,” and any type of movement or activity that gets your heart rate up and that you enjoy counts. Federal guidelines recommend 150 minutes of moderate heart-pumping activity a week, which can break down to 30 minutes, five times a week.
— Ask a health care provider or a weight loss program for help if you’re struggling to lose weight.
Berberine Side Effects and Who Should Avoid It
Berberine is tolerated well throughout the body, according to studies. Like any supplement or medication, there are always some people who experience side effects. For berberine, those side effects can include:
— Abdominal pain.
— Low blood sugar if used in high doses.
— Nausea or vomiting.
Although berberine appears safe in studies, more long-term safety research is needed, Powers says. Berberine, like many other supplements unregulated and evaluated by the FDA, lacks large clinical trials to evaluate long-term safety. You should avoid berberine if you’re:
— Using the oral chemotherapy drug bosutinib. Berberine may increase concentrations of this drug in the body, MSKCC reports.
— Using the immunosuppressive drugs tacrolimus or cyclosporine. Berberine may increase levels of these drugs in your blood or lead to kidney toxicity.
— Using medications for diabetes. If you have diabetes, you want to be cautious because both the prescription drugs you use as well as berberine could affect your blood sugar level.
As with any type of medication or supplement, it’s important to speak with your health care provider before using berberine. You’ll want to make sure it doesn’t have a negative interaction with other medications you use. It’s especially important to discuss berberine use with your health care provider if you use:
— Blood thinners.
— Blood pressure medications.
— Cholesterol medications.
— Diabetes medications.
— Sleep aids.
That’s because you want to avoid a potentially negative interaction, Kara says.
Other Precautions With Berberine
If you plan to try using berberine, here are a few other precautions to keep in mind:
Shop around for a transparent company. Comparison shopping for the best berberine supplement or any type of supplement isn’t just about price. It’s about finding a company that makes safe, reputable products, Kara says. He recommends asking a few questions as you choose a supplement company:
— Does the product clearly display a supplement facts panel with ingredients, dosage information and ingredient quantities?
— Are the claims about the product, either online or in the packaging, detailed and/or supported by research? Conversely, are they vague?
— Does the company include customer feedback, both positive and negative, or do they only show you the 5-star reviews?
— What’s the company’s return policy?
If faced with a choice, use the product that’s made by a company more transparent about what it offers, Kara advises.
Look for a supplement that’s been third-party tested. Supplements are not approved by the FDA like medications are. This means that supplements may contain other ingredients beyond what they purport to have. For this reason, many supplement companies will seek out third-party testing for purity and potency, Powers says. He recommends looking for an NSF® seal from the National Sanitation Foundation, a third-party, independent organization that visits manufacturing facilities and ensures that the product contains only what it claims to. Other third-party testers include U.S. Pharmacopeia and ConsumerLab.com.
Finally, keep in mind that a supplement doesn’t replace a medication. Rouse cautions that using too much of any supplement could cause unintended side effects. It’s yet another reason to confirm with a health care provider beforehand that it’s OK to use berberine.
If you already use berberine and you have an appointment with a health care provider, make sure to let them know that you are using it along with any other over-the-counter medications or supplements.
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Update 07/17/23: This story was previously published at an earlier date and has been updated with new information.