April 22, 2025

Berberine: Benefits, Risks & Best Uses

Berberine, or "Nature's Metformin," has gained fame because of the many uses it has claimed. The claims include weight loss, lowering blood sugar, lowering cholesterol and even preventing cancer. But how much of these claims are based on science and how much is marketing?

The purpose of this article will be to eliminate the hype surrounding berberine. In this article, we will discuss the research surrounding berberine's effects on cholesterol, blood sugar, and metabolic health. Also, we will examine if and how berberine can be used as part of a comprehensive treatment plan for patients.

What is Berberine?

Berberine is a bioactive compound found in various plants and has been used in traditional Chinese medicine for years to treat infections including diarrhea. Berberine has also gained a lot of attention lately for its use in treating metabolic syndrome, type 2 diabetes and lowering cholesterol.

Will Berberine Stop Cancer?

Berberine has been studied in vitro and has shown to have anti-cancer effects. It has been shown to kill cancer cells in petri dishes from breast, colon, lung, prostate and liver cancers. Berberine has also been shown to enhance some types of cancer therapy. Despite the results of the studies done in vitro, the majority of them have not been translated into effective treatments for humans. As such, there is not enough clinical evidence to support the use of berberine as a cancer-fighting supplement.

Lowering Cholesterol.

Berberine has been shown to lower LDL (bad) cholesterol. It does so by a few different ways:

Berberine reduces the amount of dietary cholesterol absorbed in the intestine.
Berberine increases the number of LDL receptors in the liver. The more LDL receptors in the liver, the better able the liver is to remove LDL from the blood stream.
Berberine decreases PCSK9. PCSK9 is a protein that breaks down LDL receptors.

A 2018 meta analysis of 16 clinical studies showed that berberine resulted in a slight decrease in total and LDL cholesterol and a slight increase in HDL (good) cholesterol. A 2024 update of the same study showed that berberine had the same effect on total and LDL cholesterol as well as a slight increase in HDL cholesterol. Researchers felt that the quality of the studies was inconsistent and that the effects of berberine were relatively minor.

Berberine and Blood Sugar Control.

Berberine activates an enzyme called AMPK. AMPK is often referred to as a metabolic master switch. This enzyme helps to regulate blood sugar and energy balance. AMPK works similarly to the prescription medication metformin.

A 2021 meta-analysis of 46 studies demonstrated that berberine decreased hemoglobin A1C (a measure of long-term blood sugar control) by about .38%. Berberine also reduced fasting glucose levels and postprandial (after eating) glucose levels. In some instances, berberine appeared to be as effective as metformin.

There was one small study that demonstrated berberine was slightly superior to metformin. However, this study only involved 36 subjects and lasted only 3 months. On the other hand, metformin has been extensively studied for decades. Because of this, clinical guidelines continue to recommend metformin, rather than berberine, as a treatment for type 2 diabetes.

Berberine and Weight Loss.

Some of the social media influencers have said that berberine is "nature's Ozempic." While both berberine and Ozempic (GLP-1) drugs appear to have some beneficial effects on weight loss, the two drugs work differently and have different amounts of effect.

A 2020 meta-analysis of berberine studies demonstrated that berberine resulted in an average weight loss of approximately 2 kilograms. A more recent systematic review demonstrated that the results were closer to a 1-kilogram weight loss.

On the other hand, GLP-1 drugs like semaglutide resulted in an average weight loss of around 15 kilograms in clinical trials lasting up to 68 weeks. Therefore, while berberine may provide a small amount of weight loss, it is clearly not as effective as GLP-1 medications.

Berberine and Longevity/Anti-Aging.

As mentioned above, because berberine activates AMPK, similar to metformin, some people have suggested that berberine may also aid in slowing aging. However, studies on metformin have not consistently demonstrated a benefit for longevity in healthy individuals.

In fact, metformin did not demonstrate a benefit in preventing cardiovascular disease nor did it demonstrate an extension of lifespan in studies of healthy individuals. In some studies, metformin even demonstrated negative effects of reducing the benefits of exercise and decreasing testosterone.

At present, we have little data on berberine and its side effects. However, in animal studies, berberine appears to reduce the rate of muscle protein synthesis and may impair muscle growth. These findings are a major reason I do not recommend using berberine in general health supplements, especially for healthy individuals.

When to Use Berberine.

While lifestyle modifications such as diet, exercise and sleep are always the foundation of maintaining good metabolic health, when medications are necessary, we need to use medications that are safe and effective.

Here is how to think about the use of berberine:

Metformin is still the first line of treatment for elevated blood sugars. GLP-1 medications are commonly prescribed for weight loss greater than expected or for advanced diabetes.
Statins are commonly prescribed for elevated cholesterol. Statins are started at the lowest dose possible (e.g., rosuvastatin or pravastatin). If a patient cannot tolerate statins, they may require additional medications (e.g., ezetimibe or PCSK9 inhibitors).

At times, berberine may be used as a secondary choice when the primary treatment options have failed. Specifically, berberine may be used when a patient cannot take statins due to side effects or cannot afford or obtain PCSK9 inhibitors. Then, berberine may be considered as a cost-effective alternative.

Research Sources

Filed in: Supplements

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