Resolving Metabolic Dysfunction: the Power of Berberine

At SAFM, we’ve been teaching about the power of berberine for over 15 years now (evident in the throwback video above!).  Yet a surprising number of practitioners don’t use it in their clinical toolbox. Or we’ve left powerful tools on the sideline in deference to novel options (e.g., GLP-1 agonists).

Insulin resistance, the common root cause of Type 2 Diabetes, is truly epidemic in our society. Whether we realize it yet or not, most of us have a practice loaded with patients or clients with brewing metabolic dysfunction. The good news is that, with thorough functional medicine-informed care, Type 2 diabetes is often reversible! Long-term healing requires a client to change their diet and lifestyle – usually substantially. 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 kidneys, blood vessels, liver, nerves, and more.

As a scientist at heart, I am inherently skeptical of claims of seemingly “magical” effects of any supplement.  Some are true, but many are overblown (just as we see with pharmaceutical remedies, marketing claims can be exaggerated and predatory). However, berberine is an herbal solution that holds up quite well to scrutiny. Like another herbal powerhouse curcumin, berberine is a plant phytonutrient, specifically an alkaloid that’s long been used as a natural antibiotic, and commonly found in Oregon grape root, barberry, and goldenseal (what you see in the picture).

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 long-standing mainstay of hyperglycmia, metformin (and even better than the drug, with no notable side effects). 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 blood sugar and insulin equally as well as metformin. 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 do 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 via several mechanisms. 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. Importantly, a major mode of action is 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 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, choose a product with a standardized berberine extract (as opposed to a whole-herb product like goldenseal).
(On a side note, if your client is indeed taking metformin, make sure they take a daily Vitamin B12 supplement with a meal, ideally a lozenge (e.g. 1000mcg methylcobalamin for most) to ensure absorption. A significant, documented side effect of metformin is Vitamin B12 depletion, making neuropathy an even larger risk than it already is for diabetics.)

Don’t forget, however, that berberine is a Potent antimicrobial herb. Ongoing use can dramatically shift microbial balance in the gut. For this reason, don’t count on 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.  Or used in cycles off/on of this type of duration is needed for longer. In sensitive individuals, it may be best tolerated if taken in cycles of ~3 weeks off/on 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. We’ve seen many cases over the years of clients eventually able to stop both supplemental insulin and, eventually, metformin too. While life-saving as a short-term therapy, long-term insulin use can make Type 2 diabetics even less healthy and at greater risk of metabolic syndrome. Surplus insulin promotes more inflammation in the body, imbalances hormones, and increases body fat storage, especially visceral fat in the abdominal area (again, a source of inflammation and estrogen).

Educate and inspire your clients and patients to know that they can indeed address Type 2 diabetes at its roots – IF they are willing to change their lives. With your help and their commitment to change, they can find true healing.