Berberine

Last Updated: August 7, 2023

Berberine is a plant alkaloid with a long history of use in Ayurvedic and traditional Chinese medicine for the management of various health conditions. Its seemingly potent ability to reduce blood sugar rivals that of some anti-diabetic drugs.

Berberine is most often used for

What is berberine?

Berberine is an alkaloid found in the barks, leaves, twigs, rhizomes, roots, and/or stems of various plants, such as barberry, Oregon grape, and tree turmeric. Traditionally, berberine has been used as an antimicrobial, antiprotozoal, and antidiarrheal agent in Ayurvedic medicine and traditional Chinese medicine.[1][2][3] Most research in humans has examined berberine’s effects on markers of glycemic control, blood lipids, markers of liver function, and anthropometric parameters in people with metabolic disorders.

What are berberine’s main benefits?

Evidence from clinical trials conducted in people with type 2 diabetes (T2D) suggests that berberine’s glucose-lowering effect may be on par with some anti-diabetic drugs or standards of care.[4][5] In people with metabolic disorders, limited research suggests that berberine may improve blood lipids and liver enzymes, and reduce body weight and fat mass.[6] However, most of the available trials examining the effects of berberine on the aforementioned outcomes are of poor methodological quality.[7] The best-quality clinical evidence on berberine’s effects to date are related to improvements in hormonal health in polycystic ovarian syndrome (PCOS) and to immune system response. Even these studies, however, warrant interpretation with a degree of caution due to the imprecision and inconsistency of their results.[7] In those with PCOS, the evidence suggests that berberine may improve hormonal outcomes.[4] In those with a variety of metabolic conditions (T2D, dyslipidemia, cardiovascular disease), berberine may be able to lower C-reactive protein (CRP), a biomarker of inflammation.[8] Finally, in those with a history of colorectal cancer, it was found that berberine could potentially reduce the recurrence rates of colorectal polyps.[9]

What are berberine’s main drawbacks?

Although berberine appears to be generally safe, more long-term safety research is needed. Supplementation with berberine (especially in doses above 300 mg/day) has been reported to cause gastrointestinal side effects in some people, including diarrhea, constipation, flatulence, and stomach pain.[10] Due to its ability to reduce blood sugar, berberine may increase the risk for hypoglycemia in high doses. Additionally, berberine inhibits several enzymes involved in drug metabolism, so there’s a risk of serious drug interactions when taken alongside other medications or supplements.[11]

How does berberine work?

Berberine seems to produce most of its benefits through acting on high-level controllers of energy homeostasis, including the enzymes adenosine monophosphate-activated protein kinase (AMPK), protein kinase c (PKC), and sirtuin 1 (SIRT 1), all of which regulate biological processes related to metabolism, immunity, and inflammation.[12]

What else is Berberine known as?
Berberine should not be confused with:
  • Piperine (Black Pepper extract)
  • Berberol (Brand name)
  • Berberrubine (Metabolite)
Dosage information

The standard dose of berberine is 900-2,000mg a day, divided into three to four doses.

Berberine should be taken with a meal, or shortly after, to take advantage of the blood glucose and lipid spike associated with eating.

Too much berberine at once can result in stomach upset, cramping, and diarrhea.

Examine Database: Berberine
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References
  1. ^Ai X, Yu P, Peng L, Luo L, Liu J, Li S, Lai X, Luan F, Meng XBerberine: A Review of its Pharmacokinetics Properties and Therapeutic Potentials in Diverse Vascular Diseases.Front Pharmacol.(2021)
  2. ^Hu Q, Peng Z, Li L, Zou X, Xu L, Gong J, Yi PThe Efficacy of Berberine-Containing Quadruple Therapy on Helicobacter Pylori Eradication in China: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Front Pharmacol.(2019)
  3. ^Gao Y, Wang F, Song Y, Liu HThe status of and trends in the pharmacology of berberine: a bibliometric review 1985-2018.Chin Med.(2020)
  4. ^Xie L, Zhang D, Ma H, He H, Xia Q, Shen W, Chang H, Deng Y, Wu Q, Cong J, Wang CC, Wu XThe Effect of Berberine on Reproduction and Metabolism in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Control Trials.Evid Based Complement Alternat Med.(2019)
  5. ^Jing Guo, Hongdong Chen, Xueqin Zhang, Wenjiao Lou, Pingna Zhang, Yuheng Qiu, Chao Zhang, Yaoxian Wang, Wei Jing LiuThe Effect of Berberine on Metabolic Profiles in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsOxid Med Cell Longev.(2021 Dec 15)
  6. ^Ye Y, Liu X, Wu N, Han Y, Wang J, Yu Y, Chen QEfficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Front Pharmacol.(2021)
  7. ^Li Z, Wang Y, Xu Q, Ma J, Li X, Yan J, Tian Y, Wen Y, Chen TBerberine and health outcomes: An umbrella review.Phytother Res.(2023-May)
  8. ^Omid Asbaghi, Niloofar Ghanbari, Mahdi Shekari, Željko Reiner, Elaheh Amirani, Jamal Hallajzadeh, Liaosadat Mirsafaei, Zatollah AsemiThe effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes: A systematic review and meta-analysis of randomized controlled trialsClin Nutr ESPEN.(2020 Aug)
  9. ^Fang S, Guo S, Du S, Cao Z, Yang Y, Su X, Wei WEfficacy and safety of berberine in preventing recurrence of colorectal adenomas: A systematic review and meta-analysis.J Ethnopharmacol.(2022-Jan-10)
  10. ^Xu X, Yi H, Wu J, Kuang T, Zhang J, Li Q, Du H, Xu T, Jiang G, Fan GTherapeutic effect of berberine on metabolic diseases: Both pharmacological data and clinical evidence.Biomed Pharmacother.(2021-Jan)
  11. ^Hermann R, von Richter OClinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions.Planta Med.(2012-Sep)
  12. ^Ma X, Egawa T, Kimura H, Karaike K, Masuda S, Iwanaka N, Hayashi TBerberine-induced activation of 5'-adenosine monophosphate-activated protein kinase and glucose transport in rat skeletal muscles.Metabolism.(2010-Nov)
  13. ^Song D, Hao J, Fan DBiological properties and clinical applications of berberine.Front Med.(2020-Oct)
  14. ^Jeon SMRegulation and function of AMPK in physiology and diseases.Exp Mol Med.(2016-Jul-15)
  15. ^Allyson F O'Donnell, Martin C SchmidtAMPK-Mediated Regulation of Alpha-Arrestins and Protein TraffickingInt J Mol Sci.(2019 Jan 25)
  16. ^Kong WJ, Zhang H, Song DQ, Xue R, Zhao W, Wei J, Wang YM, Shan N, Zhou ZX, Yang P, You XF, Li ZR, Si SY, Zhao LX, Pan HN, Jiang JDBerberine reduces insulin resistance through protein kinase C-dependent up-regulation of insulin receptor expression.Metabolism.(2009-Jan)
  17. ^Gomes AP, Duarte FV, Nunes P, Hubbard BP, Teodoro JS, Varela AT, Jones JG, Sinclair DA, Palmeira CM, Rolo APBerberine protects against high fat diet-induced dysfunction in muscle mitochondria by inducing SIRT1-dependent mitochondrial biogenesis.Biochim Biophys Acta.(2012-Feb)
  18. ^Yun S Lee, Woo S Kim, Kang H Kim, Myung J Yoon, Hye J Cho, Yun Shen, Ji-Ming Ye, Chul H Lee, Won K Oh, Chul T Kim, Cordula Hohnen-Behrens, Alison Gosby, Edward W Kraegen, David E James, Jae B KimBerberine, a natural plant product, activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant statesDiabetes.(2006 Aug)
  19. ^Kong W, Wei J, Abidi P, Lin M, Inaba S, Li C, Wang Y, Wang Z, Si S, Pan H, Wang S, Wu J, Wang Y, Li Z, Liu J, Jiang JDBerberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins.Nat Med.(2004-Dec)
  20. ^Wang Y, Yi X, Ghanam K, Zhang S, Zhao T, Zhu XBerberine decreases cholesterol levels in rats through multiple mechanisms, including inhibition of cholesterol absorption.Metabolism.(2014-Sep)
  21. ^Yang L, Zhu W, Zhang X, Zhou X, Wu W, Shen TEfficacy and safety of berberine for several cardiovascular diseases: A systematic review and meta-analysis of randomized controlled trials.Phytomedicine.(2023-Apr)
  22. ^Blais JE, Huang X, Zhao JVOverall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.Drugs.(2023-Apr)
  23. ^Lan J, Zhao Y, Dong F, Yan Z, Zheng W, Fan J, Sun GMeta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertensionJ Ethnopharmacol.(2015 Feb 23)
  24. ^Suadoni MT, Atherton IBerberine for the treatment of hypertension: A systematic review.Complement Ther Clin Pract.(2021-Feb)
  25. ^Mohammad Reza Amini, Fatemeh Sheikhhossein, Sina Naghshi, Farhang Djafari, Mohammadreza Askari, Hossein Shahinfar, Maryam Safabakhsh, Alireza Jafari, Sakineh Shab-BidarEffects of berberine and barberry on anthropometric measures: A systematic review and meta-analysis of randomized controlled trialsComplement Ther Med.(2020 Mar)
  26. ^Zamani M, Zarei M, Nikbaf-Shandiz M, Hosseini S, Shiraseb F, Asbaghi OThe effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis.Front Nutr.(2022)
  27. ^Han Zhao, Chuan Xing, Jiaqi Zhang, Bing HeComparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS: a network meta-analysisReprod Health.(2021 Aug 18)
  28. ^Ciebiera M, Ali M, Prince L, Jackson-Bey T, Atabiekov I, Zgliczyński S, Al-Hendy AThe Evolving Role of Natural Compounds in the Medical Treatment of Uterine Fibroids.J Clin Med.(2020-May-14)
  29. ^Xue W, Xue F, Jia T, Hao AResearch and experimental verification of the molecular mechanism of berberine in improving premature ovarian failure based on network pharmacology.Bioengineered.(2022-Apr)
  30. ^Liu P, Duan JA, Hua YQ, Tang YP, Yao X, Su SLEffects of xiang-fu-si-wu decoction and its main components for dysmenorrhea on uterus contraction.J Ethnopharmacol.(2011-Jan-27)
  31. ^Lu Y, Zhang X, He J, Dai Z, Shi P, Lu Y, Chang FThe effects of berberine on inflammatory markers in Chinese patients with metabolic syndrome and related disorders: a meta‑analysis of randomized controlled trials.Inflammopharmacology.(2022-Jun)
  32. ^Mohammad Beba, Kurosh Djafarian, Sakineh Shab-BidarEffect of Berberine on C-reactive protein: A systematic review and meta-analysis of randomized controlled trialsComplement Ther Med.(2019 Oct)
  33. ^Warowicka A, Nawrot R, Goździcka-Józefiak AAntiviral activity of berberine.Arch Virol.(2020-Sep)
  34. ^Wu S, Yang K, Hong Y, Gong Y, Ni J, Yang N, Ding WA New Perspective on the Antimicrobial Mechanism of Berberine Hydrochloride Against Revealed by Untargeted Metabolomic Studies.Front Microbiol.(2022)
Examine Database References
  1. High-density lipoprotein (HDL) - Derosa G, D'Angelo A, Bonaventura A, Bianchi L, Romano D, Maffioli PEffects of berberine on lipid profile in subjects with low cardiovascular riskExpert Opin Biol Ther.(2013 Apr)
  2. High-density lipoprotein (HDL) - Zamani M, Zarei M, Nikbaf-Shandiz M, Hosseini S, Shiraseb F, Asbaghi OThe effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis.Front Nutr.(2022)
  3. HbA1c - Dong H, Wang N, Zhao L, Lu FBerberine in the treatment of type 2 diabetes mellitus: a systemic review and meta-analysisEvid Based Complement Alternat Med.(2012)
  4. HbA1c - Zhang Y, Li X, Zou D, Liu W, Yang J, Zhu N, Huo L, Wang M, Hong J, Wu P, Ren G, Ning GTreatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberineJ Clin Endocrinol Metab.(2008 Jul)
  5. HbA1c - Xie W, Su F, Wang G, Peng Z, Xu Y, Zhang Y, Xu N, Hou K, Hu Z, Chen Y, Chen RGlucose-lowering effect of berberine on type 2 diabetes: A systematic review and meta-analysis.Front Pharmacol.(2022)
  6. Total cholesterol - Blais JE, Huang X, Zhao JVOverall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.Drugs.(2023-Apr)
  7. Total cholesterol - Osadnik T, Goławski M, Lewandowski P, Morze J, Osadnik K, Pawlas N, Lejawa M, Jakubiak GK, Mazur A, Schwingschackl L, Gąsior M, Banach MA network meta-analysis on the comparative effect of nutraceuticals on lipid profile in adults.Pharmacol Res.(2022-Sep)
  8. Glycemic Control - Yan HM, Xia MF, Wang Y, Chang XX, Yao XZ, Rao SX, Zeng MS, Tu YF, Feng R, Jia WP, Liu J, Deng W, Jiang JD, Gao XEfficacy of Berberine in Patients with Non-Alcoholic Fatty Liver DiseasePLoS One.(2015 Aug 7)
  9. Glycemic Control - Pérez-Rubio KG, González-Ortiz M, Martínez-Abundis E, Robles-Cervantes JA, Espinel-Bermúdez MCEffect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretionMetab Syndr Relat Disord.(2013 Oct)
  10. Exercise Capacity (with Heart Conditions) - Zeng XH, Zeng XJ, Li YYEfficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathyAm J Cardiol.(2003 Jul 15)
  11. Canker Sores Symptoms - Jiang XW, Zhang Y, Zhu YL, Zhang H, Lu K, Li FF, Peng HYEffects of berberine gelatin on recurrent aphthous stomatitis: a randomized, placebo-controlled, double-blind trial in a Chinese cohortOral Surg Oral Med Oral Pathol Oral Radiol.(2012 Dec 12)
  12. Total cholesterol - Yang L, Zhu W, Zhang X, Zhou X, Wu W, Shen TEfficacy and safety of berberine for several cardiovascular diseases: A systematic review and meta-analysis of randomized controlled trials.Phytomedicine.(2023-Apr)
  13. High-density lipoprotein (HDL) - Jing Guo, Hongdong Chen, Xueqin Zhang, Wenjiao Lou, Pingna Zhang, Yuheng Qiu, Chao Zhang, Yaoxian Wang, Wei Jing LiuThe Effect of Berberine on Metabolic Profiles in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsOxid Med Cell Longev.(2021 Dec 15)
  14. Insulin Resistance - Ye Y, Liu X, Wu N, Han Y, Wang J, Yu Y, Chen QEfficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Front Pharmacol.(2021)
  15. Fasting Glucose - Xie L, Zhang D, Ma H, He H, Xia Q, Shen W, Chang H, Deng Y, Wu Q, Cong J, Wang CC, Wu XThe Effect of Berberine on Reproduction and Metabolism in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Control Trials.Evid Based Complement Alternat Med.(2019)
  16. Colorectal adenoma (polyps) - Fang S, Guo S, Du S, Cao Z, Yang Y, Su X, Wei WEfficacy and safety of berberine in preventing recurrence of colorectal adenomas: A systematic review and meta-analysis.J Ethnopharmacol.(2022-Jan-10)
  17. Body Mass Index (BMI) - Mohammad Reza Amini, Fatemeh Sheikhhossein, Sina Naghshi, Farhang Djafari, Mohammadreza Askari, Hossein Shahinfar, Maryam Safabakhsh, Alireza Jafari, Sakineh Shab-BidarEffects of berberine and barberry on anthropometric measures: A systematic review and meta-analysis of randomized controlled trialsComplement Ther Med.(2020 Mar)