Berberine—a compound extracted from a variety of plants, including barberry, goldenseal, and tree turmeric—has been used for centuries in traditional Ayurvedic and Chinese medicine, mostly to treat gastrointestinal issues. But now it’s become a popular supplement that’s being touted as “nature’s Ozempic,” primarily as a natural way to lose weight but also to regulate blood sugar. Promotors from around the world peddle it big time on TikTok and other social media platforms. Its appeal: No prescription needed, ready availability, and low cost, compared to Ozempic (semaglutide) and other similarly used drugs that face continuing shortages. Is it time to forgo a doctor’s prescription and head to the health-food store instead? In short, not yet.
Weighing the claims
According to a 2020 review and meta-analysis of a dozen randomized controlled studies on berberine and obesity parameters, the supplement had a modest effect on body weight (average weight loss of 4.5 pounds); it also reduced waist circumference and body mass index (BMI). But it’s difficult to compare these studies, mostly from China, because they varied in dose and formulation, duration, and participant characteristics (such as their ages and health status). Most studies had a small number of people and were short term—just several months.
In another review and meta-analysis, of 28 studies, berberine appeared to do a better job of lowering blood sugar compared with lifestyle modifications alone or a placebo. Combining prescription hypoglycemic drugs (those that lower blood sugar) with berberine was more effective at lowering blood sugar than taking the drugs alone. But as the authors point out, most of the studies in the analysis were of low to moderate quality, included only Chinese patients (so findings may not apply to other populations), and ranged in duration, among other study limitations.
It’s not clear what mechanisms may account for any weight loss or blood sugar effects, but some researchers think berberine may activate an enzyme (AMP-activated protein kinase, or AMPK) involved in glycemic control, fat metabolism, and energy expenditure, similar to how the diabetes drug Metformin works. Other hypotheses are that berberine may affect the microbiome in the gut, resulting in a greater predominance of bacteria that could improve body weight and blood sugar.
Based on some lab and animal studies, researchers have also suggested that berberine—similar to how semaglutide works—may mimic a hormone in the body (GLP-1 or glucagon-like peptide-1) that increases secretion of insulin and has other physiological effects that result in reduced blood sugar, appetite, and food intake. However, research on semaglutide has shown much greater weight loss—of more than 30 pounds in one study (though over a longer period, along with lifestyle changes)—compared to the weight loss associated with berberine. Same goes for the greater effect of semaglutide on blood sugar compared to berberine.
Beyond weight and sugar control
A 2022 systematic review of some four dozen studies reported a variety of benefits of berberine if it’s taken for many months, including improvements in blood lipids and blood pressure. And a 2023 “umbrella” review from China, which combined the results of almost a dozen meta-analysis papers, concluded that berberine “is beneficial to human health,” similarly showing some promise for lowering blood lipids, blood pressure—and more.
There’s also interest in berberine as an anti-cancer agent. Lab and animal studies suggest it may help promote cancer cell suicide, arrest cell division that’s needed for cancer cells to proliferate, and downregulate the inflammation that enhances cancer cell development, among other potential mechanisms.
Before jumping on the berberine bandwagon
Although the research may look somewhat promising for berberine—MedlinePlus (a service of the National Library of Medicine) considers it “possibly effective” for diabetes, blood lipids, and blood pressure, for example—keep in mind, again, that the limited studies, mostly from China, have generally been small in size and have had methodological variations that make it difficult to come to any firm conclusions of benefits for the supplement at this time. And, in contrast to semaglutide and other obesity/diabetes medications, berberine supplements have not been deemed safe or effective by the FDA. That is, they are not regulated in the same way as prescription drugs, and there is no guarantee that the supplement bottle even contains the ingredients the label says it has.
In fact, over the years, testing of berberine supplements, including by the independent private supplement-testing company ConsumerLab.com, has often found less berberine than promised in bottles—with some containing less than one-third the listed amount, and no supplements containing more (which suggests that the shortchanging is not by accident). As reported in December 2023, when the supplement maker NOW Foods tested lesser-known brands sold online, they found that 32 of 33 products had less berberine than stated on the label. More than half had less than 40 percent of the claimed amount; six products had no detectable berberine at all.
Then there are the potential side effects. Gastrointestinal symptoms seem to be most common, with reports of stomach upset, nausea, diarrhea, and constipation, as well as skin rashes. Moreover, the long-term effects of taking berberine are not clear.
Berberine could also adversely affect the action of some drugs, including cyclosporine (an immunosuppressant). It may interact with blood thinners and some cholesterol-reducing drugs (like rosuvastatin). Because berberine may affect blood sugar and blood pressure, you shouldn’t take it if you are on medications for diabetes or hypertension. There’s also concern that when used during pregnancy or breastfeeding, it can seriously harm the fetus or newborn.
BOTTOM LINE: Given the number of uncertainties associated with berberine at this time, including that individual products are not regulated in the same way as prescription drugs, we don’t recommend using “nature’s Ozempic” for weight loss or any other reason. In particular, pregnant or breastfeeding people should not take it. If you are overweight or obese and diet, exercise, and other lifestyle changes haven’t been effective enough (even with the help of professionals like a registered dietitian/nutritionist and personal trainer), you should discuss other options with your doctor, who may recommend semaglutide or another prescription medication. If you’ve been told you have high blood sugar (prediabetes or diabetes), your doctor should also prescribe what’s appropriate for you. No one with diabetes or other blood sugar problems should ever take any dietary supplements to help control their condition without their doctor’s okay.
