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Blood-Sugar-Busting Berberine: a Diabetes Solution


Insulin resistance, the common root cause of Type 2 Diabetes, is truly epidemic in our society.  Whether we realize it yet or not, I believe every one of us has a practice loaded with patients or clients with suboptimal blood sugar control and related metabolic issues.   The good news is that Type 2 diabetes is absolutely reversible!  Long-term healing requires a client to change their diet and lifestyle – usually substantially.  And, as you know, some of them just aren’t ready emotionally for that change.  It takes time.  But in the interim, these clients absolutely need help alleviating the toxic oxidative effects of  elevated sugar on their organs, glands, and other tissues.  (We’re featuring this popular post again because it’s about a particularly powerful tool.)

As a scientist at heart, I am inherently skeptical of claims of seemingly “magical” effects of herbal remedies.  Some are absolutely true, but many are overblown (just as we see with pharmaceutical remedies,  marketing claims can be predatory and irresponsible).   I want to introduce you, however, to an herbal solution that holds up quite well to scrutiny:  berberine.  Like another herbal powerhouse curcumin, berberine is a plant phytonutrient, specifically an alkaloid.  It’s been used for eons as a natural antibiotic. I’ve used it successfully in my practice to help people who choose natural treatment (as opposed to prescription antibiotics) for all sorts of unwelcome microbial infections…bacteria,  yeast, parasites.  Berberine is extracted from a number of medicinal herbs, most commonly Oregon grape root, barberry, and goldenseal (what you see in the picture).

But that’s only the beginning of berberine’s power, and this is not “news”. A  couple of ground-breaking clinical studies way back in 2008 found that berberine regulates blood sugar in Type 2 diabetes just as well as the blockbuster drug metformin (and even better than the drug, with no notable side effects). No, I am not exaggerating.  In peer-reviewed studies in the medical journals Metabolism and the Journal of Clinical Endocrinology, berberine was found to lower both fasting and post-prandial (after a meal) blood sugar and insulin equally as well as metformin. And beyond blood sugar, berberine also reduced those participants’ triglycerides by an average 35% and their LDL cholesterol by an average 21% and their blood pressure by 7/5 mm Hg (three things metformin doesn’t and doesn’t claim to do).  These further effects are critical benefits  for our patients and clients with not just advanced insulin resistance but full-blown metabolic syndrome.  (There were some concerns expressed about the experimental methodology in some earlier berberine studies, but there is a clear pattern of superiority in these follow-on studies, including the gold standard experimental design in the Journal of Clinical Endocrinology feature.)

Berberine works in this disease process for a variety of reasons.  It activates a primal metabolism-regulating enzyme in the body called AMPK. When we are producing less ATP (energy) in our cells, the body secretes AMPK to ensure our survival in times of crisis. This is the same enzyme that gets triggered with severe calorie restriction (which has been shown to prolong life in animals, but is practically sustainable by very few). AMPK stimulates our cells to take in more blood sugar, thus improving insulin sensitivity. But it also slows our liver’s own production of extra blood sugar (a key issue for most Type 2 diabetics). By supporting our liver, berberine also slows the release of free fatty acids into the blood (which is what creates triglycerides) and boosts natural fat-burning in the mitochondria (the little energy factories in all our cells that turn fuel into energy).  Its mode of action is also via modulating the microbiome (and thus its downstream effect on short chain fatty acid production and bile acid metabolism), all of which we know have an impact on insulin regulation and signaling (yet another excellent example of how disease begins in the gut).  You may learn more about berberine’s mechanisms of action here. and  And more about the comparative features, risks, and benefits of metformin vs. berberine here.

For the typical adult, berberine is effective for blood-sugar management taken 400-500mg at once, twice or thrice a day, ideally about 30 minutes prior to each meal. To ensure your client gets an effective dose each time, I suggest choosing a product with a standardized berberine extract (as opposed to a whole-herb product like goldenseal). I recommend Thorne’s Berberine-500 or (if your client is struggling with GI issues as well, like gas and bloating)  try the multi-herbal formula Metagenics CandiBactin-BR.
(On a side note, if your client is indeed taking metformin, make sure they take a daily Vitamin B12 supplement with a meal (e.g. 1000mcg methylcobalamin for most, to ensure cellular absorption).  A significant, documented side effect of metformin is Vitamin B12 depletion, making neuropathy an even larger risk than it already is for diabetics.  I have seen this in several clients.)

Don’t forget, however, that berberine is a Potent antimicrobial herb.  Ongoing use can dramatically shift microbial balance in the gut.  For this reason, I do not, recommend berberine for ongoing “management” of elevated blood sugar but rather as a supportive remedy while you are working with them to reverse the root causes, typically for 2-3 months.  It may be best tolerated if taken in cycles of ~3 weeks with a couple of weeks off in between to allow the microbiome to recover.  While short-term modulation of microbiome diversity may help improve insulin signaling, ongoing suppression may promote other GI or immune system imbalance.

If your client is an insulin-dependent diabetic (i.e. taking insulin shots), be sure to encourage them to monitor their blood sugar regularly as they start to use berberine or any new therapy (and do so in consult with the original prescribing practitioner – if that’s not you).  Encourage them to start with just one dose/day and increase slowly to ensure they can stay in control.  You may be surprised at just how quickly insulin sensitivity improves!  They often need to cut back on their insulin dramatically to avoid dangerous blood sugar troughs.  Almost all of my clients eventually end up able to stop both supplemental insulin – and eventually metformin too.  While life-saving as a short-term, triage therapy, long-term insulin use makes Type 2 diabetics even less healthy.  Surplus insulin promotes more inflammation in the body, imbalances hormones, and increases body fat storage, especially in the abdominal area (again, a source of inflammation and estrogen).

Perhaps like you, I still find it amazing that this type of solution (and its clinical study results) doesn’t typically make media headlines. And this one is from 2008 – over a decade ago.  Of course, I understand you cannot patent an herb.  And so no single corporation stands to corner the market on berberine.  But this is (still!) BIG news for the millions of people struggling with diabetes.  Actually, it’s not the only natural remedy I’ve seen successfully stabilize and then help to reverse Type II diabetes, but it is definitely the most potent one.

Educate and inspire your clients and patients to believe that they are neither doomed or destined to live their entire lives with Type 2 diabetes if they are willing to change their lives.  With your help and their commitment to change, they can find true healing.  Type 2 Diabetes is absolutely reversible!  Our deep dive clinical course teaches healthcare practitioners exactly how to do that clinically.


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76 Questions for “Blood-Sugar-Busting Berberine: a Diabetes Solution”

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  1. 20
    Manny Kandola says:

    Also you mentioned in your previous comments to cut down grains and carbs. Then what should we eat. Any recommendations will be helpful. Thanks

    • 20.1
      SAFM says:

      An excellent diet for reversing insulin resistance includes a rich mix of vegetables, nuts/seeds, fruit, proteins, and healthy fats (e.g. extra virgin olive oil, coconut oil). You do not need to consume grains in order to have a balanced, nutrient-rich diet. Enjoy!

  2. 19
    Manny Kandola says:

    I was diagnosed for higher sugar in 2014. I am 38 years old. I was prescribed metformin 1000 mg 2 times a day. I took it for 3 months and then quit. I started taking homeopathic medicine but my sugar level are still up. I check my in the morning and it was 248. I am thinking about taking berberine. Do you think will it help. Thanks

    • 19.1
      SAFM says:

      Please see our responses to related questions already posted. Alas, we are not able to give tailored, individual guidance via this forum.

  3. 18
    Kat says:

    I have been taking Berberine for almost 2 1/2 months (3x400mg daily), my carbs are primarily from fruits and vegetables, with a very limited amount of rice or quinoa. I average about no more than 100g carb daily. However, I still am hovering in the 110-112 fast blood glucose in the morning. The lowest I dropped was 90. I was expecting to see lower numbers after a few months taking Berberine. From a non medical opinion, more from a nutritional or experience, what may be keeping my fasting number still high. It is registering the same with or without the Berberine. Does it take this long to show signs of working?
    At this point I don’t know the questions I need to ask since this is rather new and alarming me not to see any changes. The frustrating part is that when I made an appointment with all the local Endos, they have a 6-8 month waiting list. And the local functionalist has even longer. That almost 1/2 year that my body goes untreated or given a plan for healing.

    • 18.1
      SAFM says:

      Good for you for owning your wellness and exploring options! I don’t think you should be using your fasting glucose as the best marker of progress. Your morning glucose is highly affected by many other factors, especially the stress hormone cortisol which rises to its diurnal peak first thing in the morning. Your specific level of cortisol is going to vary dramatically based on things like how well (and how long) you slept, the time of your menstrual cycle, your level of stress or emotional upheaval, exercise habits, and any other inflammatory dynamics happening in the body. You would be much better off having your regular PCP check your HbA1c. While he or she is at it, ask them to also check your RBC magnesium (not serum, but RBC). You will want to boost it into the upper third of the reference range (assuming you have no active kidney issues). Suboptimal magnesium can be a confounding factor in insulin resistance as well. Also, make sure you are using a high-quality berberine product (vs. the least expensive one you might find); herbal extract efficacy can be significantly reduced via over-processing. I highly recommend Thorne’s Berberine-500. Lastly, it may also be true that 100g of carbs daily for you is simply too much given your lifestyle, level of exercise, and unique metabolism and body composition. If your triglycerides are above 100 mg/dl (and you are not taking drugs to lower lipids), it’s likely a sign that you could benefit from further reducing carbohydrates a bit. Alas, I cannot provide any customized guidance via this type of format, but I hope these general points are helpful. Be well!

  4. 17
    cece says:

    I’ve had diabetes since 2007 I’m taking metformin 2 in am & 2 in pm also taking 90 insulin in am & 70 insulin in pm I’ve purchased pure Berberine should I take 1gram in am &1gram in pm before meals also continue my regular meds please help I want to stop using Metforman & Insulin?

    • 17.1
      SAFM says:

      Alas, this format does not allow us to give individualized guidance. In general, I will share that I have worked with a number of clients who used berberine in addition to metformin and insulin to counter insulin resistance and eventually remove the need for either medication. However, this absolutely must be monitored closely. In most people, the berberine is very effective, and doses of insulin need to be reduced dynamically as well to avoid low blood sugar episodes – which can be quite dangerous if they happen unexpectedly. Generally, our clients work first of all to not require supplemental insulin. Then they can work on not requiring the metformin. You will also want to be sure that there is no contraindication to using berberine with any other medications you are using. Please realized that dietary change is a critical part of any success in countering and eventually reversing insulin resistance. No amount of supplements removes the need to dramatically change what you eat. Among other changes, we recommend removing all added sweeteners (natural or artificial), all fruit juice, and all grains (all types, all forms – that is things made out of flour but also “whole grains”) for at least four months. 100%. I also highly encourage you to have your physician check your RBC magnesium to ensure your level is in the upper third of the reference range. Type 2 diabetes promotes low magnesium, and suboptimal magnesium worsens insulin resistance.

  5. 16
    Addie Esc says:

    I just discovered your website and also just discovered Berberine and am quite excited about both. I am on Metformin 1000 twice a day and my A1C number is 8.2. I have just started on Trulicity just this last Friday but I have had a strong reaction to it. Nausea. I am sure that i will probably not be able to continue using it but i am so determined to get my numbers down. I think that I would put up with nausea for a little while if it would help me meet my goals of BG and A1C at healthy levels.
    My fasting numbers have been for the most part in 140-160 range. But after reading about Berberine I have decided to start this supplement as soon as I order and receive it. Can I take the Berberine while i am doing the Trulicity? I am discussing this find with my health provider so that she will know what I am doing.
    Thank you so much for your website and all the information you provide.

    • 16.1
      SAFM says:

      Good for you, Addie! Alas, we cannot give responsible, individual guidance in this format. I encourage you to speak with your physician about any possible contraindications between berberine and your other medications. As I have already shared, the most important thing is to actively and frequently assess and monitor blood sugar impacts and lower other diabetes medications as warranted once you start the berberine. For this purpose, berberine can be VERY effective, and without vigilant control and adjustment, blood sugar can drop dangerously low unexpectedly. Again, your physician can help you with this, and I am glad you are consulting her and working as a team. Thanks for joining us here – I wish you the very best!

  6. 15
    Ambercita says:

    I have pcos and my endo said that I have a slight level of insulin resistance. It was still in the normal ramge but on the higher side. She mentioned taking metformin for preventative reasons. I tried it out for 3 months but felt horrible on it. I eat low glycemic and low carb and exercise 6 days a week for about an hour each (insanity program) and I have been able to lose weight. Is it dangerous for me to try berberine if my insulin resistance is slight and I do not have to monitor my blood sugar or anything like that? The fact that it helps with gut bacteria and things like that sounds appealing! I just dont know if it will lower my blood sugar too low or have any dangerous effect.

    • 15.1
      SAFM says:

      Of course, we cannot give personalized guidance here, Ambercita, but I am happy to offer some general comments. Optimal fasting insulin is actually quite low in the reference range and optimal fasting glucose is in the lower half of the reference range. Too high insulin level promotes PCOS in women, so working on your insulin resistance sounds like a very prudent idea! Berberine is normoglycemic. That is, it will counter insulin resistance and normalize blood sugar control but will not drive it unnaturally low.

      • Ambercita says:

        I do take inositol in the morning and at night to help with my insulin resistance and I feel that it is working. I also take NAC, b complex and other “normal” vitamins such as a multi, d3, and fish oil. Can I take berberine while taking these? And if it doesn’t have a negative reaction to these when should I take the berberine, inositol and vitamins? Berberine 30 min before breakfast and inositol and vitamins with meal? Also, how will I know when I am no longer insulin resistant is the labs can look normal even with insulin resistance? Should I stay on berberine even after the insulin is fixed for preventative/ gut reasons? I know you can’t offer specific medical advice. I would just like your opinion. I am currently looking for a natural doctor in my area and I would like to present your opinion during my appointment. Thanks!

        • SAFM says:

          Good for you! Inositol is also a powerful remedy for insulin resistance; just make sure you take enough to have a clinical effects. Most effective clinical research was using at least ~2400mg/day in divided doses. Yes, berberine 30 min. before meals. Others can be taken with the meal. With the earlier stages of insulin resistance (with normal – or even optimal -blood sugar), you are seeking for your fasting insulin to become optimal over time (~5 mIU/L). In the early stages, this is the best marker for progress. I do not recommend staying on berberine long-term, as it has antimicrobial properties that may interfere with gut balance. Just use is as long as you need it, and commit to a diet that helps you keep it there. Remember that magnesium is critical in this arena too. You might consider asking your MD to check your “RBC magnesium” level (not serum) to ensure it’s in the upper third of the reference range. Be well!

  7. 14
    Kat says:

    Interesting article. What has been your experience with a Berberine supplement that also includes Alpha Lipoic Acid – supporting liver health, cardiovascular health, and optimal insulin and blood sugar levels. The capsule has 400 mg Berberine, 100 mg ALA.
    I live in the Charleston SC area, do you have any recs on a functional medicine Dr, I have been fighting with many doctors on my treatment, many not willing to lookout side textbook TSH levels and diagnose and treat by symptoms. Another abnormality that I have found in looking back on my blood work since 2009, is an Elevated Glucose Serum. In 2009 it was 110 (65-99), 2011 it was 110, 2014 it was 117, in March 2015 it went to 122, in Dec 2015 it dropped to 115 but still high. In April 2016 my A1c was at 6.2 (4.8-5.6). My fasting level is holding at 112, no budge. I carry weight in my middle, I have Hashimoto and struggle to move the scale. I eat Low carbs(110-120g) , concentrating on lean protein- good fat. I haven’t been diagnosed but I think I have insulin resistance or metabolic resistance, but it not being treated. Any other supplement suggestions?

    • 14.1
      SAFM says:

      Hi Kat – I recommend you go to and click to “search for a practitioner” in your area. You definitely want to work with a physician who resonates with you and who will work with you synergistically on doing a deeper dive into your challenges. With Hashimoto’s you definitely want a practitioner who is going to monitor actual thyroid hormones closely (e.g. Free T3, Free T4) to ensure effective treatment and who will also help you to get to the root cause of the autoimmune dynamic at play. Of course, this format does not allow us to provide any responsible, individualized guidance. In general, I will say that the labwork values you share would typically be fully diagnostic of prediabetes, and strong insulin resistance would be a given. Alpha lipoic acid (ALA) is also an excellent supplement for increasing insulin sensitivity; however, typically much higher doses are needed for this purpose (e.g. 300mg/dose). Don’t start berberine and alpha lipoic acid at the same time. Give your body time to adjust to one for a week or so before you add something else; then you can better see how your unique body responds. Be well!

  8. 13
    Penny says:

    Is it okay to open a berberine capsule and mix with water or applesauce? I have a hard time swallowing capsules.

    • 13.1
      SAFM says:

      I definitely wouldn’t do that. Berberine can be quite staining to teeth, and the taste will be highly unpalatable. Try swallowing a pill by taking it with a liquid that has some fat in it (e.g. room temp chicken broth or almond milk). Put the liquid in your mouth first. Then the pill. Lean your head down until your chin nearly rests on your chest and – in that position – swallow. This works with the physics at play and eases pill swallowing greatly. It’s worked for many of my clients who had struggles.

      • Penny says:

        Thanks! That worked very well.. I’m hoping that the berberine will help with my PCOS. I have had a horrible time staying on the metformin (GI issues) and so far after a couple of doses of the berberine, I’ve had no stomach issues.. I’m very hopeful.

  9. 12
    Michelle says:

    I have PCOS with insulin resistance, Metabolic syndrome. Have had it since puberty. I’m 42 now. Trying to get pregnant in my 20’s I was successful with the protein modified fast. Lost 50lbs and got pregnant without infertility doc. After having my daughter I was back up to 200lbs and the diet didn’t work. Got in with my endocrinologist and my fasting insulin was abnormally high. He started me on Januvia and I was already on metformin. Been on both ever since, plus zocor for cholesterol and blood pressure medicine. The weight came off with just diet and exercise. I then had another child 3 yrs ago and gained all the weight back. Went back on my meds after delivery and no weight loss. Joined a boxing club and the intense workout got me back down but still not at a good BMI. I have been reading about berberine and wondering if it would finally help me lose weight by correcting what my insulin resistance is doing to my body, storing more fat than normal. But do I continue both januvia and metformin. I have never needed to check my blood glucose because my hgba1c has always been normal with my pancreas working overtime to secrete enough insulin to keep my blood glucose normal. I also want to buy the genuine berberine. There are so many companies making it. Your advice is appreciated. I’m so tired of fighting to lose weight. I eat perfect for weeks and can’t lose a pound and one bad meal and I gain 5lbs. So frustrated. My labs are all normal, TSH, hgba1c, lipid panel etc. Thank you

    • 12.1
      SAFM says:

      I appreciate so much your journey and frustrations, Michelle. And you certainly don’t want to remain on the Januvia any longer than necessary, as it’s doing nothing ta all to calm or directly address the true root cause of metabolic syndrome. Alas, this kind of general, online Q&A is not effective or appropriate for trying to give customized guidance. However, a health coach could definitely help you to sort through all of your lab data and what is happening very specifically with your body and then give you tailored guidance. Some of your “normal” lab values are likely big clues about what is imbalanced. Keep in mind that “normal” just means you are within the 95% statistical norm of the population; norm does not mean healthy, much less optimal. You also need some support coordinating the effects of multiple other hormones that are going to be increasingly “in the way” of your goals as you age. Progesterone, estrogen, testosterone, cortisol, thyroid hormones (specific ones – not TSH)…these all dramatically affect each other. So it’s not just a matter of their overt levels but rather the balances between them. Indeed, weight loss is ALL about hormone balance and inflammation! I would be happy to recommend a practitioner to you if you would like some help.

  10. 11
    Anna says:

    I’ve been using for a week now. What i can tell is that it is best to take AFTER a meal. I had a week of diarrhea by taking it before. When I take it AFTER it works wonderfully for me. I actually feel in better mood too. Lot more pep to my step. I’m taking it with my Metformin but hope to wean off it. It has dropped my sugar by 25pts immediately.

    • 11.1
      SAFM says:

      Good for you, Anna! Berberine is also a fairly potent anti-microbial agent that can help to balance out imbalances of bacterial populations in the intestines. It is especially effective for this purpose when it is taken on an empty stomach. I suspect that you might have been clearing up an imbalance – as a secondary, positive benefit. Thanks for sharing your lovely success.

  11. 10
    martha says:

    Is it ok to take a berberine 500 while I’m in insulin 40 u” /night

    • 10.1
      SAFM says:

      Alas, Martha, this is something you will need to discuss with your doctor, as your full overall medical condition needs to be considered. This venue does not allow me to give any customized guidance at all. For my own clients, I generally recommend modifying the diet first – to allow you to require less insulin – before starting berberine – and to ensure the combination allows you to be at optimal blood sugar. If you want to reverse your T2 diabetes, there is absolutely no getting around the need to *dramatically* change your diet and get rid of refined carbohydrates (e.g. things made out of flour), added sugars, and fruit juice. Modify the diet first, so that you require less insulin (vs. eating more carbs to simply “accommodate” your insulin, as some physicians might erroneously recommend). Then it will be safer for you to add the berberine. The most important thing during this whole type of transition journey is to carefully monitor your body for blood sugar *lows* and back away from the insulin steadily to avoid creating dangerous episodes. Some of my clients realize they need to allow themselves to run a little high as an extra precaution during the transition. Some people are surprised at just how quickly they need to reduce/remove the insulin after going on the berberine (again, to avoid going dangerously low).

  12. 9
    Hollie says:

    Is this recommended and safe for teenagers? My 14y/o daughter is not yet diabetic but has severe insulin resistance (1st & 2nd hour of insulin test were 300+…should have been under 25) and hyperinsulinemia. She struggles with her weight. Endo wanted to put her on Metformin, but we are not comfortable starting that and are looking for natural alternatives. Would love your opinion on this! Thank you.

    • 9.1
      SAFM says:

      Of course, I cannot give you or your daughter any specific medical guidance. What I can do is give you my opinion and encourage you to seek guidance from a functional or integrative pediatrician. As is true of the vast majority of natural remedies, especially herbals one, there is little to no testing on children or teens. If it were my daughter who had this type of labwork and struggles, and she were otherwise healthy with seemingly normal detoxification processes and normal liver enzymes, then I would definitely have her use berberine – 500mg three times daily. I would also check her RBC magnesium and boost with mag glycinate to get into upper third of reference range. And I would ensure optimal levels of nutrients that support insulin sensitivity. A product I often recommend for this is Designs for Health “Metabolic Synergy” and also Metagenics “Insinase”, both as directed. But more importantly, your daughter’s diet has got to drastically change. I totally understand that it’s a challenge for a teenager; I also totally understand that it’s a complete necessity. Alas, no supplement or med is going to overcome the impact of an inflammatory, high-glycemic diet over time. If there are any sweetened beverages (e.g. soda, flavored waters, gatorade, fruit juice, iced teas, Vitamin Water, etc.), these really need to be cut out 100% (not just reduced). As well as removing highly refined carbohydrate foods (e.g. potato chips, fries, crackers, breads, cookies) – again, as close to 100% as possible. With this level of insulin resistance, I don’t believe that mild or even moderate change is going to help her body to reverse the insulin resistance. My heart goes out to you because I see in my practice all too often the highly debilitated, morbidly obese twenty-two-year-old who now is exhausted and has a higher risk of cardiovascular disease – that can result a few years later from a teenager who has these types of clear, red flag warnings early on. Your daughter deserves better! And of course, I know you know that and want that too. I don’t mean to be harsh, and I am probably telling you things you already know. I am just so passionate about addressing dis-ease in the body aggressively and early, especially in a child whose hormone fluctuations over the next few years are likely only to make things more challenging, not less. I hope that’s helpful!

      • Hollie says:

        Thank you for the info. She has always been active and great at making healthy food choices, nothing to drink but water, very rare pre-packaged foods. We felt like we were doing everything right… which is partly why this has been such a frustrating journey. We have been eating Paleo for several years without much success though (just realized though that some of the “paleo-approved” foods are way higher in carbs than she should be eating. Even just by adding small amounts of honey or maple syrup, and using tapioca starch to our baked goods apparently was a huge no-no for her. After much research on how insulin works in our bodies, we recently switched to eating a Ketogenic diet for the past 2 months. I’m sure it is helping to lower her insulin set-point, but still have not seen much for weight loss, which is why I was curious about Berberine…I feel like she is on a really good path now, but that her body needs a little boost of help from some sort of a supplement. I appreciate your response and suggestions. I will be ordering Berberine and will also check into the Designs for Health “Metabolic Synergy” and Metagenics “Insinase”. I respect your opinions so much, and I truly appreciate your thoughts about this. Thank you!

        • SAFM says:

          You are so very welcome! In light of this additional information, I would make sure that you get a complete thyroid panel for her, not just TSH but also Free T4 and Free T3 and ensure both are in the upper half of the reference range. Beyond this, if you still are looking for answers, I would look at two other areas: hormone imbalance, esp. as driven by xenoestrogens, and gut microbial balance, which we know plays a huge role in metabolism set point. In additional to insulin and thyroid hormone, overall hormone imbalance also includes sex hormones, and if she has already achieved menarche, then estrogen dominance can also be involved in body fat increase. Unfortunately this is driven by the huge exposure to xenoestrogens that young people in particular experience, especially in pesticides/herbicides/fungicides in non-organic foods, most popular brands of personal hygiene products, and food packaging (esp. BPA, as from nearly all canned beverages). A comprehensive stool test (e.g. Genova’s GI Effects) would be able to fully assess her gut microbial population (note this is much more comprehensive than the typical stool test given by a gastoenterologist, specifically looking for pathogens). I wish you all the very best!

          • Hollie says:

            Excellent info. We have worked with a functional medicine doctor in the past…years ago…it sounds like it’s time to go back and see him again now that she’s older and all the crazy hormones have come into play. Thank you.

  13. 8
    Kendra says:


    Thank you for this wonderful article. I have recently been diagnosed with hypothyroidism and metabolic syndrome, along with MTHFR gene. I have been taking metformin and synthroid for a few months. I’m not loving the side effects of the met. It would be wonderful to move towards a more natural routine, but I’m not sure where to begin or how to wean off of my current meds. I also take an active b vitamin. Do you have any suggestions on how to move forawrd? Thank you so much for your time!

    • 8.1
      SAFM says:

      You are very welcome! Alas, I cannot give direct medical advice, especially about a medication. I will share that most of my own clients have been able to add berberine to their existing metformin and simply monitor their blood sugar more often. Once it starts to dip too low, they begin to wean off the metformin (vs. simply eating more carbs to “fix it”), usually by 1/3 reductions. As they continue to modify their diet to a low-glycemic one, take magnesium, and user the berberine, they are able to drop their metformin lower and lower. The B-complex is a good idea, not only given the possible effects of your MTHFR SNP but also because metformin often depletes Vitamin B12 and renders levels suboptimal. You might consider having that checked to make sure you are using enough B12 (to get serum B12 up to at least 650) in particular as long as you continue to use the drugs. The simplest labwork to monitor the cellular effects of folate in combination with B12 are


      (want about 5-7 umol/L) and


      (want about 85-90 fL). Best of luck to you! I am delighted you are so empowered about your health.

  14. 7
    Lauren says:

    Please help. My blood sugar is around 69-81 regularly. However, I have PCOS and am insulin resistant. I have hit a weightloss plateau and have been stuck fo like 5 months. I’ve lowered my calories, upped my exercise, changed my macros and eat more protein. I’m still stuck at 260 and when I get slightly below 260 it bounces back the next day. I’m so frustrated and want to try berberine but don’t know if it is right for me? Please help!

    • 7.1
      SAFM says:

      My heart goes out to you with your frustration! Indeed, it’s quite common for those with moderate insulin resistance to have seemingly optimal or even low fasting blood sugar. That’s because the body’s first response to insulin resistance is to increase insulin output from the pancreas. This means your fasting insulin becomes higher. It’s a phase of the insulin resistance progression where people are more prone to hypoglycemic episodes as well. And the higher circulating insulin can promote PCOS. Assuming you aren’t taking any diabetes type medications, then there are no general reasons why you shouldn’t try berberine. I would also have your thyroid function check thoroughly, not just TSH but a full panel including Free T4 and Free T3, both of which need to be in the upper half of the reference range for optimal metabolism. You may have to be a little “pushy” with your physician to have this more thorough assessment done, but I recommend insisting it. You deserve comprehensive assessment and care! Given your weight and rebound experience, I also recommend two other key choices: (1) eliminate all grains from the diet entirely – all forms, all types and (2) begin taking a detoxification-oriented multivitamin e.g. Metagenics Advaclear. When you lose weight, you typically free up circulating toxins which can promote inflammation and cause some rebound (and perhaps inflammatory symptoms too). Working with a certified health coach could also help you to identify more dynamics specific to your unique body, so I encourage you to seek that out if you need more help. Having a true, understanding partner support you throughout the journey can make all the difference!

  15. 6
    CJ says:

    I tried taking Dr. Whitaker’s Berberine several years ago but saw no difference in my BSL’s. Today I am on a ketogenic diet and would like to get off metformin (1000mg x 2day). Do you think it’s worth a try again? My doctor is testing me for LADA. Is Thorne your first choice of brand?

    Thank you for your time.


    • 6.1
      SAFM says:

      Indeed, I do think it is likely worth a trial, especially with your choice of a ketogenic diet now. Yes, I do often recommend Thorne’s Berberine-500 specifically. Keep in mind that as an autoimmune diagnosis, LADA requires a very different approach in terms of calming the immune system (the true cause of the dysfunction vs. just insulin resistance itself). I have seen several clients in my practice who actually had a combination of LADA and insulin resistance, requiring a focus on both priorities. I will also mention here the importance of ensuring the metformin is not making your levels of B12 suboptimal and also the importance of ensuring optimal levels of magnesium (which is reduced via insulin resistance and, in doing so, exacerbates insulin resistance). You might appreciate and . As an aside, keep in mind also the importance of keeping protein consumption moderate on a ketogenic diet and truly emphasizing fats as the primary source of calories (given protein also triggers insulin secretion, and recovery from Type 2 diabetes – or its role in LADA – requires healing in the pancreas).

  16. 5

    I was diagnosed with Type 2 Diabetes in June 2015. After a short trial with Metformin (I have one kidney and it was not enough to filter the additional lactic acid in my body — thus, I developed lactic acidosis and spent a few days in the hospital).

    I came across Berberine after researching Chinese Medicine and Diabetes. After reading Clinical Trials (the same ones mentioned in this article), I decided to give it a try with my doctor’s permission.

    With diet change and Berberine, my a1c adventure:

    June 2015: 8.1%
    September 2015: 6.3%
    December 2015: 5.6%

    I am very happy with Berberine, it works extremely well without any horrible side effects. Please be careful with lows though, as I experience them more often than highs. However, I’m new to all this.

    • 5.1
      SAFM says:

      Wow, Dominik! What an inspiration you are to so many. And a wonderful testament to what is possible with a commitment to lifestyle change. I am delighted you have had such a positive experience with berberine, and I appreciate your sharing it here. Congratulations – onward and upward with your wellness! I also appreciate your comment about being aware of the risk of blood sugar lows. At times, berberine (and other agents that improve insulin resistance) can work so well that blood sugar drops unexpectedly low (especially a risk while clients/patients continue to use diabetes drugs or insulin therapy). Checking blood sugar regularly and, if necessary, erring on the side of keeping blood sugar a little high during the titration downward off of the medication is important.

  17. 4
    Charissa says:

    Great article! I have a client who is underweight and hypoglycemic. Would you use the same approach described above?

    • 4.1
      SAFM says:

      Thanks! In principle, yes, assuming your client’s hypoglycemic episodes are definitely being caused by some level of insulin resistance. I would encourage her to seek some confirmation of this by looking specifically at her fasting insulin level. Optimal levels are likely around 5 mIU/L. Levels much higher than that can cause blood sugar to be overly lowered; rock-bottom levels may be an indication of pancreatic deficiency (as is seen in full-fledged type 2 diabetes). Both of these could cause hypoglycemia, and it’s important to know the difference. I focus on confirming this as well because hypoglycemic episodes could also be caused by other hormone imbalances, especially low cortisol. I have seen the combination of hypoglycemia and underweight in several of my clients with gastrointestinal disease where malabsorption is contributing to inappropriate weight loss, and the adrenal output has been depleted due to sustained, elevated response (often due to an imbalance of – and/or presence of pathogenic – micrboes in the gut). Just make sure you client is eating frequent small meals that also involved healthy fats (especially medium chain fatty acids such as those found in coconut oil) in order to promote sustainable energy while addressing the insulin resistance. Fats in the meal will slow (and thus sustain) the absorption of sugars for energy production, and MCFAs specifically readily taken up in the mitochondria for energy production too, regardless of blood sugar levels.

  18. 3
    Nazneen says:

    Hi, can berberine (500 mg x 3x/day) be taken along with metformin?
    Currently on a dose of 1000 mg 2x/day (breakfast and lunch) for PCOS and insulin resistance.
    And the dosage of the berberine?
    thanks 🙂

    • 3.1
      SAFM says:

      Yes, it can. And 400-500mg, 3x/day (ideally ~30 min. before a meal) is appropriate. But use the combination of both at once only if the metformin on its own is not fully bringing blood sugar down to mid-normal levels. Otherwise, the combination may be too much without reducing the metformin. I often recommend this combination/transition with my clients who have decided that they wish to find natural alternatives to the medication. However, it’s important to make sure you advise them to check their blood sugar regularly. Especially if you are also simultaneously helping them with a lower-glycemic diet to begin to reverse insulin resistance. Berberine can be extremely effective for some people and may bring down blood sugar dramatically, and unexpected low blood sugar dips can be dangerous. Other people are more resistant to the effects and will need higher doses of berberine, likely paired with other “Reversing Diabetes” supplements e.g. chromium, biotin, or alpha lipoic acid to achieve the full effect.

  19. 2
    Felicia. A says:

    My mom bought me berberine for my diabetes
    but it says to take 3 a day before
    each meal. The capsules are 1000mg each so
    so i am afraid the dose is too high. Every dr.
    I researched on the internet says to take 3
    500mg a day. Should i take such a high

    • 2.1
      SAFM says:

      Great question! And I agree with your research. Until you know how berberine affects you, I would be cautious about using too much. I usually recommend to my diabetic clients (especially ones who are on diabetes medication) that they start with one 500mg cap prior to their largest meal of the day for the first three days. This helps to identify if the berberine (even at 500mg) in combination with their drugs is lowering blood sugar too much. Assuming all goes well, then increasing to 500mg three times daily is appropriate given current research. For


      effect, you will want to take it about 30 min. prior to your meal. Thanks for reaching out.

  20. 1
    Debby says:

    My husband (64) is on Metformin (500mg 2x a day) and would really like to get off of it and try something natural. We do take a lot of other vitamins and supplements. I’m kind of a nut about that…He is slim and runs and lifts weights, so his weight is not the issue. He also takes Lipator. I have been seeing and searching out articles on berberine. I have on order Berberine from my favorite vit./supplement co. Swanson Vitamins. My question to you is, can he stop the Metformin and start taking the Berberine? Or should he take it with the Metformin and wean off the Metformin after a few days? I don’t know what other information you might need to answer this, or what other advise you can add…anything would be appreciated.

    • 1.1
      SAFM says:

      Congratulations on your journey to final natural alternatives! I love nuts. 😉 I always recommend starting berberine while still using metformin and then weaning off the metformin based on how the unique body responds. Obviously it’s critical that the diet be changing at the same time to minimize refined carbohydrates and overt sugars. In my clients, I recommend 100% flour-free diet (any type) and limiting grains to just ~1/2 cup day (truly whole – still intact – grains only). No fruit juice and no added sugars/sweeteners (moderate use of stevia is okay). Some clients begin to notice a dramatic reduction in blood sugar right away, while others take a few weeks. Of course, you’ll want him to pay close attention to his blood sugar and monitor carefully for any signs of lows (e.g. dizziness, brain fog). He really needs to be taking at least 100mg ubiquinol form of CoQ10 twice a day at a minimum to counter the effects of the statin. Given the B12-depleting effects of metformin, I also assume your husband is using a high-quality B-complex!?! Swanson’s Activated B-Complex (be sure to get the “high potency” variety) is an excellent choice. Good fortune to you both!

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