EDITOR’S SUMMARY: Berberine, derived from a handful of plant sources, shows high efficacy across multiple studies in its ability to decrease blood sugar levels. Whether you show signs of metabolic syndrome (3 out of 5 symptoms: high blood sugar, excess belly fat, high blood pressure, low HDL, high triglycerides), are prediabetic, or diagnosed with type 2 diabetes, integrating this nutritional supplement into your health plan could be worth looking into.
Written by Megan Silcott
Edited by Nicki Steinberger, Ph.D.
The phone rings. It’s the doctor’s office. Your stomach drops. This is a real life experience for many people when it comes to receiving results from diagnostic procedures. You cross your fingers hoping for a favorable outcome, but can’t help to let the worst case scenario slip into your mind. “Type 2 diabetes,” the practitioner announces. And while considered a life-altering condition, in an attempt to comfort you, she says you’ll be alright. Hundreds of thoughts rush through you at lightning speed, while the medical plan laid out for you gets drowned out.
Maybe you’d like a second opinion, and a new HbA1c (hemoglobin A1C) blood test. Perhaps you just ate too much sugar that day/week/month, and your diagnosis is a mistake. And if it’s not an error, if the diabetes is real, are there other options for treatment than ads seen on T.V., or handed out in pamphlets at the doctor’s office? In the case for most diabetics, metformin is the first-line drug therapy, and will be prescribed to help you manage your blood sugar. It’s given for a host of other ailments as well, including pain management, cancer prevention, and cardiovascular disease. As reported in 2022, more than 20 million people in the U.S. received prescriptions for metformin. It’s widely available and affordable at just $0.07 per day. Metformin (brand name: Glucophage) is so common in fact, a simple internet search will bring up approximately 68 million results in half a second.
While this article is not intended to be a thorough investigation on metformin, it’s important to provide some background, and point out the warning signs of the most popular pharmaceutical treatment for type 2 diabetes. And though metformin might be right for you (always a personal decision), there are short-term and long-term side effects to be aware of. Please consult with a trusted integrative practitioner to collaborate on making this decision.
For many people, the number one complaint and displeasure of taking metformin is stomach pain. Here is a list of the most common side effects:
- “Abdominal or stomach discomfort
- cough or hoarseness
- decreased appetite
- diarrhea
- fast or shallow breathing
- fever or chills
- general feeling of discomfort
- lower back or side pain
- muscle pain or cramping
- painful or difficult urination
- sleepiness”
Less common effects include, but are not limited to, anxiety, blurred vision, headaches, seizures, slurred speech, tightness in the chest, and fatigue. Long-term effects include B12 deficiency, as metformin disrupts absorption. This can lead to concerning levels of fatigue, neuropathy, and anemia. Lactic acidosis is metformin’s most severe side effect. Though not a common occurrence it should be taken seriously. You are at most risk if your kidneys or liver are compromised. Taken from “Side Effects of Metformin: What You Should Know”:
“Although it is rare, metformin’s most serious side effect is lactic acidosis. Metformin has a boxed warning — also called a black box warning — about this risk. A boxed warning is the most severe warning the FDA issues.
Lactic acidosis is a rare but serious problem resulting from a buildup of metformin in your body, which causes a pH imbalance. It’s a medical emergency that must be treated immediately in the hospital.”
In 2021, there was a recall of extended-release metformin. This was due to the discovery of unacceptable levels of a probable carcinogen, Nitrosodimethylamine (NDMA). The FDA posted the recall as a “public service.” You might ask yourself: Are there “safe” levels of NDMA? Is this substance regularly found in metformin? Do I want to consume this drug long-term? And note: Treatment using metformin for diabetes is usually for life.
Berberine Has a Strong Track Record
Berberine is found in several different plants and has been used for centuries in Chinese medicine, Ayurvedic practices, and Native American healing. Plant species containing berberine include goldenseal (Hydrastis canadensis), Oregon grape (Berberis aquifolium), bayberry (Berveris vulgaris), coptis (Coptis chinensis), Amur cork tree (Phellodendron amurense), and tree turmeric (Berberis aristata). One definition of berberine from ScienceDirect, “A bird’s eye view on a therapeutically ‘wonder molecule’: Berberine”:
“Berberine is a quaternary ammonium salt and naturally occurring benzylisoquinoline alkaloid, present in numerous medicinal herbs’ roots and stem bark as an active constituent, especially in the genus Berberis. It contains many pharmacological properties such as antioxidant, antiviral, antidiabetic, antidepressant, antidiarrheal, antibacterial and many more.”
Berberine is known for its positive effects on glucose (sugar) management and blood pressure, and in fact does much more. It has been used to improve cellular processes that today are known to aid in treating and preventing cancer, diabetes, cardiovascular, and neurodegenerative diseases. The Natural Medicines Comprehensive Database identifies berberine as effective for high levels of cholesterol, and the hormonal disorder that causes enlarged ovaries with cysts—polycystic ovary syndrome (PCOS).
Even the National Cancer Institute acknowledges that berberine may inhibit cancer cell proliferation, and modulate lipid and glucose metabolism. Berberine doesn’t require a prescription, and is readily available. On the high end, berberine supplements cost approximately $1.20/day, while providing 1,000 mg of berberine HCl (from Indian Barberry extract). On the lower end of the cost spectrum, you can find 1,200 mg berberine HCl for $.56/day (from Phellodendron Bark extract).
Of all the ailments berberine affects positively, it is most widely studied for diabetic management. Here’s why: Much of berberine’s health benefits for type 2 diabetes may be the result of modulating the gut microbiota, specifically increasing the level of Akkermansia muciniphila, which forms a healthy probiotic gut barrier. That process is “inversely associated with diabetes, obesity metabolic syndrome, and low-grade chronic inflammation.”
With gut health and microbiome knowledge making mainstream news, and going viral on social media, more and more people have been treating their illnesses by going to the root cause—the health of their gut—and some are now doing so by including berberine. Several animal studies have proven berberine to be effective in increasing good gut bacteria, and gut wall strength. From “Berberine treatment increases Akkermansia in the gut and improves high-fat diet-induced atherosclerosis in Apoe-/- mice”:
“Results: Berberine treatment significantly reduced atherosclerosis in HFD [high-fat diet]-fed mice. Akkermansia spp. abundance was markedly increased in HFD-fed mice treated with berberine. Moreover, berberine decreased HFD-induced metabolic endotoxemia and lowered arterial and intestinal expression of proinflammatory cytokines and chemokines.”
From ScienceDirect, on investigating the growth of Akkermansia, “Berberine, a potential prebiotic to indirectly promote Akkermansia growth through stimulating gut mucin secretion”:
“Our results reveal that BBR [berberine] is a promising prebiotic for Akkermansia, and it promotes Akkermansia growth via stimulating mucin secretion in colon.”
In addition to berrberine’s positive influence on insulin sensitivity and gut health, it can help clean up your bloodstream. Berberine has been found to decrease the levels of trimethylamine (TMA) and Trimethylamine-N-oxide (TMAO). These two components decrease atherosclerosis (a common type of arteriosclerosis), which is the thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of your artery. It turns out, this relatively low-cost plant can improve your cardiovascular health. From High Intensity Health, “Berberine Shrinks Arterial Plaque, New Study Finds”:
“Scientists recently found berberine can decrease arterial plaque in the carotid artery by some 3.2% after 16 weeks of use. They write, ‘“…21 patients with atherosclerosis exhibited the average decrease of plaque score by 3.2% after oral BBR (500 mg, twice daily) for 4 months (*P < 0.05, n = 21).”’
Most over the counter berberine supplements are derived from berberine hydrochloride (HCL), as compared to berberine sulfate. Both are deemed effective, while the sulfate aids more in detoxification at the cellular level. Organic berberine sources are encouraged to decrease synthetic chemical exposure. One example of organic berberine, certified by Oregon Tilth, is in the Oregon grape form of the supplement offered by Oregon’s Wild Harvest. They offer certified organic goldenseal as well.
Being aware of the diverse sources of berberine may increase your access by allowing you to purchase your product locally, or substitute for another brand if your preferred company is out of stock or sold in limited quantities. While there’s currently no established dosage for berberine, most studies dispensed the equivalent of 1,000-1,500 milligrams per day. Many supplements contain 500 milligrams per capsule, and labeling guidelines suggest taking two to three capsules per day. It is recommended that you consult with your holistic healthcare specialist to determine the right dosage for you.
A Few Key Points When Using Berberine
If you plan to use berberine in addition to taking metformin, be sure to monitor your blood sugar closely. Timing of the combination seems to be critical, as berberine can increase metformin’s efficiency. In this case, with your doctor’s support, you may choose to reduce your current dosage of metformin, and create a treatment plan you’re comfortable with. In contrast, a 2020 in vitro-in vivo extrapolation study found berberine derived from goldenseal lowered the absorption of metformin, having unfavorable effects on glucose control. This particular combination needs further investigation.
Berberine is recommended to be taken with food, and if combined with metformin, both products should be consumed together. The idea is not to cause overproduction of metformin. You’ve heard the saying, “Too much of a good thing …” and in this case, berberine may increase the effects and side effects of metformin. This doesn’t appear to do so when they are taken together.
Consuming high-quality supplements is a must if you are to use them at all. There is simply no good reason to swallow synthetic fillers and additives that are inflammatory, adding to your risk of unwanted symptoms and illness. Always read the “other ingredients,” and among additional substances, stay away from dyes, added sugars, including maltodextrin, natural flavors, vegetable stearate, magnesium stearate, industrial seed oils, including sunflower oil, dextrose, silicon dioxide, and titanium dioxide.
As the connections between gut, brain, and heart health are being further explored and understood, working to improve one area such as cardiovascular disease or diabetes, may lead to decreases in neurodegenerative disease down the road. Who knew a phone call from your practitioner giving you a diabetic diagnosis could be a positive factor for preventing Alzheimer’s disease in your future? Keep exploring holistic health options, and stay curious about natural medicine. Dr. Julian Whitaker has been an expert on treating diabetes for many years. In “Gut Health and Diabetes: The Important Connection,” this is what he said about using berberine with his patients:
“I want to mention berberine as well. When I first started using this botanical extract for my patients with diabetes 10 years ago—with incredibly positive results for lowering blood sugar—we knew that it activated an enzyme called AMPK that helps regulate glucose and fatty acid metabolism.
Since then, research on berberine has grown by leaps and bounds, and we now know that it also exerts its beneficial effects via the gut microbiome. This goes a long way towards explaining the wide breadth of berberine’s therapeutic uses, which include reducing cholesterol and triglycerides, lowering blood pressure, improving fatty liver disease, treating intestinal disorders, and facilitating weight loss.”
As with all nutritional supplements (and pharmaceuticals), alone they don’t prevent, cure, or reverse disease. By themselves, they cannot transport the root of your imbalance to some far off, unknown place; never to be seen again. At best, with no other help, they may mitigate unwanted symptoms and restore balance for a time being. Berberine and other supplements are meant to be integrated into a meaningful lifestyle; one where you value and implement nutrient-dense, anti-inflammatory, minimally-processed food, daily physical activity, sound sleep, stress-reduction practices, self-supporting thoughts, spiritual connection, and loving, compassionate relationships.
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Published on June 20, 2024.
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