Berberine for Type 2 Diabetes

Introduction

Berberine is a chemical found in several plants including goldenseal (Hydrastic canadensis), Oregon grape (Berberis aquifolium), Barberry (Berberis vulgaris), Chinese goldthread (Coptis chinensis), phellodendron, and tree turmeric.^1,2 Berberine has been used in traditional Chinese medicine to treat infections, reduce inflammation, stimulate bile secretion.^2,3 Currently, berberine is used as an herbal supplement for high cholesterol, hypertension, diabetes, polycystic ovary syndrome (PCOS), and canker sores.¹

What is Type 2 Diabetes?

Type 2 diabetes is a disease in which the blood glucose is too high. The hormone insulin helps regulate the blood glucose in the body.⁴ In type 2 diabetes, the body does not produce enough insulin or does not use insulin well.⁴ Some factors that may increase the risk of developing type 2 diabetes are family history, obesity, physical inactivity, and blood pressure. Symptoms of type 2 diabetes include increased thirst and urination, increased hunger, feeling tired, numbness or tingling in the feet or hands.⁴ Type 2 diabetes can be managed by maintaining healthy weight, managing blood glucose, blood pressure, and cholesterol, being physically active, and quitting smoking if you smoke.⁴ Type 2 diabetes can be treated with many diabetes medications, including metformin and insulin.⁴

How does berberine help lower blood glucose?

Berberine is shown to activate an enzyme inside the cells called adenosine monophosphate-activated protein kinase (AMPK).² AMPK regulates how energy is produced and used in the body.² It also controls various biological activities that normalize lipid, glucose, and energy imbalances.² When AMPK-regulated pathways are turned off, metabolic syndromes such as hyperglycemia and lipid abnormalities start to develop.²

Many studies have been conducted to evaluate the efficacy of berberine in lowering blood glucose. A 2008 randomized controlled trial was done to determine the efficacy and safety of berberine in the treatment of type 2 diabetes.⁵ The participants were randomly assigned to berberine 500 mg three times daily for 3 months or metformin 500 mg three times daily for 3 months. Significant decreases in A1c and blood glucose were observed in the berberine group.

Another study published in 2008 investigated the use of berberine in the treatment of type 2 diabetes and dyslipidemia.⁶ The participants were given either berberine 1 g daily for 3 months or placebo daily for 3 months. Compared to placebo, berberine demonstrated significant reductions in blood glucose (20%), A1c (12%), triglyceride (36%), and total cholesterol (18%).

A 2015 meta-analysis reviewed 27 randomized controlled trials on the effect and safety of berberine in the treatment of type 2 diabetes.⁷ The participants received berberine or either placebo or intensive lifestyle intervention or oral diabetes medications (metformin, glipizide, glimepiride, and rosiglitazone). The meta-analysis concluded that berberine with lifestyle intervention produced significant reduction in the blood glucose and A1c, compared to lifestyle intervention alone or placebo. A significant reduction in the blood glucose and A1c was also observed in patients receiving berberine and oral diabetes medications, compared to oral diabetes medications alone. Berberine was as efficacious as oral diabetes medication metformin in lowering blood glucose and A1c.

Lastly, a 2019 systematic literature review and meta-analysis looked at 28 studies on effects of berberine on blood glucose in patients with type 2 diabetes.⁸ The participants received berberine or either lifestyle modifications or placebo or oral diabetes medications (insulin, metformin, glipizide, rosiglitazone, glyburide, and acarbose). The meta-analysis concluded that berberine treatment was associated with a better reduction in blood glucose and A1c than control groups. The blood glucose lowering effect became unremarkable with berberine use of more than 90 days, berberine dose of greater than 2 g daily, and patients age 60 or older.

How do you take berberine?

Berberine herbal supplement is made from the barks, leaves, roots, and stems of the plants.² The supplement is available as capsules and powder.² Berberine is not approved as a drug by the Food and Drug Administration (FDA). It can be difficult to determine how much berberine to take as there are no official recommended dosages. It is recommended to start with a low dosage and increase slowly until the desired effect is reached. And, before using berberine, have a discussion with your healthcare provider to make sure it is safe and appropriate to use.

Safety of berberine

Berberine is safe and generally well-tolerated. Common side effects are diarrhea, constipation, gas, upset stomach, and headache.¹ The safety of berberine during pregnancy and lactation has not been established yet. Kernicterus (a type of brain damage) has been reported in newborn infants who were exposed to berberine.¹ Berberine may reduce the rate in which the liver removes bilirubin, leading to jaundice in newborns.¹

Berberine is not known to have serious interactions with any medications. It may lower blood sugar, so taking it with diabetes medications may increase the risk of hypoglycemia.¹ Berberine also may lower blood pressure. Concurrent use of berberine and hypertension medications may lower the blood pressure too much.¹ Berberine interacts with anticoagulants and antiplatelets, resulting in increased risk of bleeding and bruising.¹

Conclusion

Berberine is used as an herbal supplement for type 2 diabetes. Berberine works by activating the enzyme AMPK which regulates the various metabolic processes in the body. Study findings demonstrated that berberine lowered blood glucose and may be as efficacious as oral diabetes medications. If you are planning to use berberine for type 2 diabetes, please consult your healthcare provider to make sure it is safe and appropriate for you.

References:

“Berberine.” MedlinePlus. https://medlineplus.gov/druginfo/natural/1126.html. Aug. 26, 2020. Accessed Oct. 29, 2020.
“Clinical Applications for Berberine.” Natural Medicine Journal. https://www.naturalmedicinejournal.com/journal/2012-12/clinical-applications-berberine. Dec. 2012. Accessed Oct. 29, 2020.
“Berberine – A Powerful Supplement with Many Benefits.” Healthline. https://www.healthline.com/nutrition/berberine-powerful-supplement. Jan. 14, 2017. Accessed Oct. 29, 2020.
“Type 2 Diabetes.” National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes. May 2017. Accessed Oct. 29, 2020.
Yin, Jun et al. “Efficacy of berberine in patients with type 2 diabetes mellitus.” Metabolism: clinical and experimental vol. 57,5 (2008): 712-7. doi:10.1016/j.metabol.2008.01.013
Zhang, Yifei et al. “Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine.” The Journal of clinical endocrinology and metabolism vol. 93,7 (2008): 2559-65. doi:10.1210/jc.2007-2404
Lan, Jiarong et al. “Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension.” Journal of ethnopharmacology vol. 161 (2015): 69-81. doi:10.1016/j.jep.2014.09.049
Liang, Yaping et al. “Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis.” Endocrine journal vol. 66,1 (2019): 51-63. doi:10.1507/endocrj.EJ18-0109