Berberine and Metformin: A Comprehensive Guide

After delving into the research on berberine for diabetes, it really is quite amazing to see it’s potential to help control blood sugar levels as effectively as metformin and other medications. 

Here you’ll discover how the ancient remedy berberine not only rivals pharmaceuticals such as Metformin in controlling blood sugar but also enhances insulin sensitivity, manages cholesterol, reduces inflammation, and more.

LISTEN TO THE PODCAST

PODCAST CHAPTERS

3:19 What is Berberine?

3:59 Berberine’s Cellular Impact For Diabetes Health

7:09 Berberine and Metformin for Blood Sugar and A1c Compared

10:02 Berberine vs Metformin or Glipizide

11:52 Berberine For Insulin Resistance

13:44 Berberine For Inflammation

14:34 Q&A

14:38 > Does berberine work as well as metformin?

14:56 > Can you take berberine instead of metformin?

15:17 > Can you take berberine and metformin together?

15:51 Berberine For Weight Loss, Cholesterol & Diabetes Complications

18:09 Side Effects of Berberine

20:05 Berberine Dosage For Diabetes

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Berberine and Metformin Explained

To confirm the research-based benefits of berberine in clinical practice, we spoke to two physicians about berberine, Dr. Ralph Esposito, Naturopathic Physician and Licensed Acupuncturist, and Dr. Mona Morstein, Naturopathic Physician and Author.

Right out of the gate, Dr. Esposito shares that he prescribes berberine to his patients on a regular basis. So too does Dr. Morstein.

Of course, no supplement routine is going to perform miracles without adherence to a great nutrition program.

But when nutritional changes and berberine are combined, “I find these two combinations work exceptionally well and most of my patients are eventually able to get off most of their medications for diabetes,” says Dr. Esposito.

And as already suggested above, berberine has even been shown to outperform several medications.

What is Berberine?

Berberine is a compound originally extracted from the Chinese herb – coptis chinensis (Huanglian). But according to Dr. Morstein, it can be found in many different botanicals: Barberry, Oregon Grape, Goldenseal, Chinese goldthread, California poppy, and others.

Even though berberine may be new to you, it has been around for a long time – being used in folk medicine, along with traditional Chinese, Indian and Middle-Eastern medicine for over 400 years.

So, not surprisingly, this yellow-colored, alkaloid compound is now being studied by avid scientists for its numerous health benefits, which include:

• lowering blood glucose
• improving metabolism
• assisting with weight loss
• boosting heart health

And of course, the most interesting benefit to you as a person with type 2 diabetes or prediabetes, is berberines’ ability to help improve blood glucose control.

Berberine for Better Blood Glucose Control

Quite amazingly, berberine has been shown to help control blood sugar levels as effectively as metformin – one of the most widely-prescribed diabetes drugs worldwide.

Researchers compared the glucose-lowering effects of berberine and metformin in newly diagnosed adults with type 2 diabetes, over the course of 13 weeks.

The randomized groups were given either 500 mg of berberine per day, 3 times per day, or 500 mg metformin, 3 times per day after meals. If people experienced any gastrointestinal side effects from the berberine, their dosage was reduced to 300 mg, 3 times per day.

The results at the conclusion of the study showed that the glucose-lowering effect of berberine was highly similar to that of metformin. And in fact, outperforming it for A1c reduction!

Metformin

• A1c reduced by 1.43%
• Postprandial (after meal) blood glucose levels reduced by 138.1 mg/dL (7.67 mmol/l)
• Fasting blood glucose reduced by 50.4 mg/dL (2.8 mmol/l)

Berberine

• A1c reduced by 1.99%
• Postprandial (after meal) blood glucose levels reduced by 158 mg/dL (8.78 mmol/l)
• Fasting blood glucose reduced by 68 mg/dL (3.78 mmol/l)

“This study of berberine against metformin at equal doses was very impressive, with berberine lowering A1C by 2%, which is higher than any conventional oral hypoglycemics have been shown to lower A1C in the same time,” says Dr. Morstein.

The same study also set a secondary study with combination therapy, adding 500 mg of berberine alongside metformin for an additional 5 weeks. Fasting blood glucose showed a dramatic reduction and A1c reduced by 0.8%.

Results from a review of clinical trials also demonstrate that berberine stands up against diabetic medications:

Berberine vs metformin – 500 mg per day, 3 times per day berberine vs 0.75 g metformin – no difference in fasting blood glucose and A1c – meaning they performed the same.

Berberine vs rosiglitazone – Two clinical trials demonstrated that berberine performs better than the medication rosiglitazone for lowering fasting blood glucose, with no difference between the two for A1c reductions.

Berberine vs glipizide – no significant difference in the fasting blood glucose outcomes for groups.

What about when berberine is taken in conjunction with other medications? Well, let’s take a closer look…

Berberine + metformin vs metformin – 5 trials have demonstrated combination therapy improves fasting blood glucose and A1c more than using metformin alone.

Berberine + glipizide vs glipizide – one trial has shown that combo therapy may be more beneficial for lowering postprandial blood glucose.

How Does Berberine Work?

To help get your head around how berberine works, let’s do a quick recap of insulin and insulin resistance.

Insulin is the hormone produced by your pancreas that is needed to help glucose (sugar) move out of your bloodstream and into the cells (such as muscle and liver cells). On the outside of cells lies ‘insulin receptors’ and under normal circumstances, insulin acts as the key to unlock the cells so that clearing of the bloodstream can occur.

There’s just one problem: when you have type 2 diabetes and prediabetes, chances are you have insulin resistance. This means insulin does not unlock the door. Your cells don’t respond.

Another important thing to recognize is it’s not just the pancreas and insulin involved here. Your liver plays a critical role in insulin resistance, along with energy metabolism as well.

Now that you have those concepts in mind, let’s move on to how berberine works…

Dr. Morstein explains that berberine influences the AMPK pathway (adenosine monophosphase-activated protein kinase). “The AMPK is a cellular enzyme that is a regulator for how energy is produced and used in body cells,” she explains. “It induces numerous events in the cells involved in helping the body maintain its energy needs. If a cell is low in energy the AMPK signals the production of more energy. And it also regulates activities such as lipid and glucose production.”  

“When insulin resistance is occurring the AMPK regulated pathways are shut off, triggering the development of hyperglycemia, increased cholesterol and triglycerides, and of course, diabetes,” Dr. Morstein continues. “If the AMPK is once again activated, as it can be with the addition of berberine, those pathways can be corrected and therefore, initiate weight loss, energy burning and reduced glucose and lipids.”

“In Western botanical medicine, berberine is considered an “alterative,” that is, an herb that helps support the functioning and health of the liver, and the production and secretion of bile. The liver is a key organ for insulin resistance, and most obese patients have fatty liver. Therefore, supporting liver health and functioning is an added bonus to using berberine,” adds Dr. Morstein.

Indeed, research on liver cells shows that berberine increases the expression of insulin receptors by as much as 40%, making them more sensitive to insulin so they can unlock those cell doors.

Similarly, berberine also improves insulin sensitivity in muscle cells, increasing the activity of glucose transporters, and therefore improving overall glucose metabolism.

Additionally, berberine alters glucose metabolism by stimulating glycolysis – a pathway of nutrient metabolism that can become disrupted in diabetes and prediabetes. Glycolysis is the pathway that assists with utilizing and storing glucose in the body.

Another function of berberine is it suppresses gluconeogenesis, the production of glucose in the liver. If you have high morning blood sugar levels, this is often the result of gluconeogenesis – your liver producing glucose, along with your body’s lack of ability to hormonally counteract/control these effects. 

Other potential mechanisms of berberine include:

• Influencing intricate cellular transcription factors
• Improving pancreatic function and stimulating insulin secretion
• Increasing glucose uptake and decreasing glucose absorption
• Reducing inflammation

In any case, the results of studies clearly show that berberine could be a beneficial inclusion to your diabetes or prediabetes treatment plan, either in solo or as a combo therapy alongside the medications you already take.

Yes, that’s right. You can even take it alongside medications you already take, as the studies above showed. And these effects are being seen in real life scenarios.

“Oftentimes my diabetic patients are already taking prescription medications for their diabetes,” says Dr. Esposito. “I have seen berberine work exceptionally well alone, and I often begin first with berberine capsules and nutritional therapy. If those are not providing benefit, I find berberine to work well with Metformin as well. Generally berberine is safe and effective with other diabetic drugs,” he said.

Of course, it’s always recommended to work with your doctor if you’re considering taking any supplements, especially if you currently take medications.

Please pin, tweet or share; then keep reading about it’s other benefits below.

Berberine May Assist With Weight Loss

As already indicated above, the influence of berberine doesn’t stop at better blood glucose control.

In terms of weight, berberine helps prevent fat deposits by influencing cellular regulators of fat accumulation, and by downgrading inflammation – a known driver of obesity.

In a 12 week study in obese adults, 500 mg of berberine 3 times per day produced a modest weight loss of 5 pounds (2.2 kg).

Another study in men and women with metabolic syndrome, given 300 mg of berberine 3 times per day for 3 months, showed an improvement in Body Mass Index (BMI), along with a reduction in belly fat.

Berberine May Lower Cholesterol

In terms of cholesterol improvements, researchers suggest berberine helps stabilize the low-density lipoprotein receptor (LDLR) messenger RNA – yes, very scientific but important because these mechanisms assist the body to regulate cholesterol more efficiently.

One study in rats found that combining berberine with the cholesterol lowering drug known as simvastatin (a statin) improved the cholesterol-lowering effect of the drug and produced a 31.8% reduction in LDL cholesterol, which was more effective than either of the therapies used alone, producing an average 28% reduction.

The researchers then went on to test these effects in hypercholesterolemic patients and also found a positive result – the combo therapy produced a 31.8% reduction in LDL cholesterol.

A review of several clinical trials confirms that taking berberine alone was more effective than taking lipid lowering drugs. And not surprisingly, taking lipid lowering drugs + berberine was more effective than taking lipid lowering drugs on their own.

Berberine for Diabetic Complications

The development of many of the associated diabetic complications is due to endothelial  dysfunction, or in other words, damage to the lining of the blood vessels in your body.

This includes complications such as cardiovascular disease, neuropathy, and nephropathy.

Berberine has been shown to improve endothelial function, which subsequently reduces risk of damage and may even restore function on various levels.

In terms of heart disease, lowering cholesterol and blood glucose protects you. And we already know berberine can help with that. But additionally, researchers suggest berberine directly protects the cardiovascular system by directly modulating sympathetic heart activity – this basically means there is some influence on the bodies sympathetic nervous system.

And in rats, this effect has been shown to reduce the impact of heart attacks.

In rats, berberine has been shown to improve renal function in nephropathy. And nerve conductivity in neuropathy.

One of Dr. Esposito’s areas of specialization in clinical practice is helping men overcome erectile dysfunction in diabetes – yes urological issues are a complication of diabetes.

He suggests that his patients see great improvements when taking berberine accompanied by lifestyle changes, saying they usually come off any medications they are taking for the condition.

Does Berberine Help With Diabetes

The following benefits have been found to support berberine supplementation in type 2 diabetes and prediabetes:

• Lowers blood glucose
• Lowers A1c
• Lowers insulin resistance and improves insulin sensitivity
• Lower cholesterol
• Aids weight loss and reduces weight gain
• Reduces risk of damage from diabetic complications

Additionally, “berberine is also a good antimicrobial agent, both for pathogens in the gastrointestinal tract, and for upper respiratory infections,” advises Dr. Morstein. “It may also increase beneficial bacteria in the intestinal tract, which has systemic benefits.”

“People with high glucose levels have decreased immune system functioning, so boosting immune protection by way of altering gut bacteria is another benefit of berberine. Berberine is an anti-inflammatory agent as well. It can lower inflammatory molecules that promote insulin resistance, steatohepatitis, and depression,” adds Dr. Morstein.

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Berberine Side Effects

Possible side effects include gastrointestinal problems such as constipation, stomach cramps, nausea and diarrhea.

It is best to take berberine with a meal to reduce the likelihood of gastric upsets.

Berberine can also interact with a certain class of antibiotics called macrolide antibiotics.

Berberine should not be used by pregnant or breastfeeding women.

Berberine Dosage

Most studies suggest a dosage recommendation of 3 separate doses of 500 mg of berberine daily, taken in capsule form. Or if you experience stomach upset, a reduced amount of 300 mg 3 times per day.

Both Dr. Morstein and Esposito confirm that this is the dosage used in clinical practice to produce effective results with their patients.

When you regain good control, you should be able to come off supplements, just as you do with medications. However, both doctors also agree that taking berberine long term is safe and preventative if necessary.

And remember, supplements are there to provide assistance but are best used in conjunction with diet and lifestyle changes.

Best Berberine Supplement

One of the best brands we’ve seen is the Berberine HCL.

Compared to other brands Berberine HCL is made completely natural and does not contain any synthetic product.

Berberine HCL from Berberis Aristata Root for Support Immunity and Intestinal Health, Vegetable Capsules 120 Servings 4 Month Supply.

Berberine vs Metformin Q&A

Does berberine work as well as metformin?

The evidence clearly shows berberine works as well if not better than Metformin. When berberine has been compared to Metformin in randomized controlled trials, the groups taking berberine had better improvements in A1c, fasting blood sugar, postprandial blood sugar and insulin resistance. 

Can you take berberine instead of metformin?

Absolutely yes you can! If you don’t want to take medication, berberine is a fantastic alternative. If you’re currently taking metformin but want to stop with prescription meds, speak to your doctor about trialing berberine instead. 

Can you take berberine and metformin together?

Yes you can. In studies where metformin was taken alongside berberine, the results people achieved were often better. The combination therapy of berberine and metformin together achieves better improvements in A1c, fasting blood sugar, postprandial blood sugar and insulin resistance.

Can you wean off metformin and introduce berberine?

Yes, and this could be an important conversation to have with your doctor if they are hesitant about reducing or stopping your medication. You could speak to your doctor about introducing 500mg at a time, while reducing metformin by 500mg at a time. Keep a log of your numbers so you can both assess the impact of the changed treatment. 

Metformin and berberine side effects?

The most common side effects of both are gastric side effects like constipation, stomach cramps, nausea and diarrhea. These are more common with metformin but can also happen with berberine too. Berberine is a bitter compound, which is why you need to take berberine with food.

What is the berberine dosage for diabetes?

The recommended berberine dosage is 500 mg daily 3 times per day, taken with food to minimize any gastric side effects. Or if you experience stomach upset, take a reduced amount of 300 mg 3 times per day.

What is the best berberine supplement?

The brand we recommend is Berberine HCL is made completely natural and does not contain any synthetic product.

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