• Posted June 16, 2023

Is Supplement Berberine Really 'Nature's Ozempic'? Experts Weigh Pros & Cons

The herbal supplement berberine has become the latest social-media obsession for weight-loss, with some on TikTok calling it "nature's Ozempic."

Experts don't agree.

"I would say it's a big exaggeration to call it 'nature's Ozempic,'"said Dr. Melinda Ring, executive director of the Osher Center for Integrative Health at Northwestern University, in Chicago.

But berberine has been associated with a variety of health benefits, including modest weight loss, lower cholesterol and improved blood sugar levels, she said.

Ring said she "wouldn't swap one for the other"if someone is already prescribed a medication for any of these conditions.

Berberine also has its drawbacks. It can cause potentially dangerous interactions if used with some other medications, and shouldn't be used by pregnant or breastfeeding women or by children, Ring cautioned.

"But that being said, it is one of my favorite compounds,"she continued. "The safety profile is good and the potential benefits are diverse. So I actually like it for people who have weight concerns. Especially if they have weight concerns and blood sugar issues and insulin resistance and high cholesterol, then I think it could be a good option."

Berberine has been used in traditional Chinese medicine for at least 3,000 years, Ring noted.

"Berberine isn't a plant itself. It's an alkaloid compound that's found in a variety of plants,"she explained.

Plants that contain berberine include European barberry, goldenseal, goldthread, Oregon grape, phellodendron and tree turmeric, according to the U.S. National Center for Complementary and Integrative Health (NCCIH).

"People using those different herbs are getting berberine,"Ring said. "Commonly, what's popular now, it's being used as an extract, a compound in and of itself, just a berberine supplement."

Some studies have associated berberine with modest weight loss, although experts note the evidence is thin.

For example, a meta-analysis of 10 previous studies on berberine found that the supplement reduced body mass index (BMI) by about 0.29 on average and waist circumference by about an inch, according to a 2020 report in Complementary Therapies in Clinical Practice. (BMI is a measure of body fat based on height and weight.)

"That's a very small lowering of BMI,"said Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital in Boston.

Apovian added that the report included a "bunch of poorly done studies, and when you pool a bunch of poorly done studies, you get a poorly done meta-analysis."

Even in specific studies that found a reduction in body weight of 6 pounds or so when using berberine, "with Ozempic we're seeing larger weight loss and larger sustained weight loss if somebody stays on the medication,"Ring said.

But other research has shown that berberine has the potential to help treat other health problems associated with obesity, Ring added.

These studies have shown that berberine can decrease blood sugar and improve insulin resistance, she said.

The compound has also been shown to potentially increase "good"HDL cholesterol while lowering "bad"LDL cholesterol and triglycerides, Ring said. It also could help control blood pressure.

Berberine also might help health and weight by influencing the gut microbiome, Ring said.

"We're aware that certain bacteria are really good at extracting calories and others are not, so it may modulate the gut microbiome,"she said, adding that this effect could improve a person's overall gut health.

Historically, Ayurvedic medicine has used berberine as a remedy for gastrointestinal disorders, as well as for wound healing and treatment of infections, according to the NCCIH.

A July 2020 review in Biomedicine & Pharmacotherapy evaluated all of these effects on weight loss and obesity-related health problems, and concluded that berberine could be helpful.

"Berberine is not only effective for obesity, but also for other systems and consequences of obesity such as diabetes and cancer,"the review concluded.

There are safety concerns related to berberine, experts noted.

Berberine can cause kernicterus, a rare type of brain damage in newborns who have extreme jaundice, according to the U.S. National Institutes of Health (NIH).

The compound also can keep the liver from removing bilirubin, a chemical produced when old red blood cells break down, the NIH said. This can cause brain problems, especially in infants.

For those reasons, pregnant women and breastfeeding mothers should avoid taking berberine, and it shouldn't be given to children, the NIH says.

Berberine can also affect how the liver processes different medications, either increasing or decreasing the effect of specific drugs.

"There are reports in the literature that suggest that if you use berberine, it may alter the absorption or the penetrance of other medications,"Apovian said. "Whenever you use an herbal supplement, really let your doctor know that you're doing this even though the supplements are over-the-counter. Just because it's over-the-counter doesn't mean it's safe."

The NIH specifically cautions against interactions with cyclosporine, losartan and dextromethorphan, a cough suppressant found in Robitussin DM and other cold remedies.

Interactions can also occur with diabetes and blood pressure medications and with anticoagulants, the NIH said.

"Theoretically, if somebody is taking anticoagulants like warfarin to prevent clots and then also took this, they could have a potential increased bleeding risk,"Ring said.

By the same token, a person could wind up with hypoglycemia if berberine lowers blood sugar on top of another prescribed diabetes medication, Ring said.

Apovian said she'd rather people try other weight-loss medications like Ozempic or Alli.

"I never recommend for a patient to try an over-the-counter weight-loss medication unless it's been approved by the [U.S. Food and Drug Administration], and the only one that was ever approved by the FDA is Alli,"Apovian said. "But if a patient sees their primary doctor or an obesity medicine specialist, we are happy to try and get that patient on any of the six medications that we have available for weight management."

Ring agreed that there are many other weight-loss measures that have been proven more effective than berberine.

"We always start with all of the lifestyle things of nutrition, movement, getting sleep, managing stress, avoiding toxins,"she said. "If somebody is doing all of that and we've also ruled out that there's anything else that may be a barrier -- for example, that they have thyroid issues or something -- then at that point, I would say that berberine may be supportive in their journey."

But, Ring added, "I wouldn't say to keep eating quarter-pounders and berberine will just take the pounds off -- that's not going to happen. But is it supportive? Potentially, yes."

More information

The Cleveland Clinic has more about berberine.

SOURCES: Melinda Ring, MD, executive director, Osher Center for Integrative Health, Northwestern University, Chicago; Caroline Apovian, MD, co-director, Center for Weight Management and Wellness, Brigham and Women's Hospital, Boston; Complementary Therapies in Clinical Practice, May 2020; Biomedicine & Pharmacotherapy, July 2020