How can berberine help you? What the research says

Berberine, an active ingredient in several plants, shows good effects in managing high blood sugar and excess body weight, plus lower risk of colorectal cancer.

How can berberine help you? What the research says

We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).

To see more details, click the plus sign to the right of any section.

Our assessments of evidence for each medical benefit fall into one of these categories:

Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)

Learn more about how we research and rate therapies and practices in How We Rate Therapies ›

Improving treatment outcomes

Is berberine linked to improved survival? Is it linked to less cancer growth or metastasis? Does it enhance the anticancer action of other treatments or therapies?

The only published evidence we have found regarding berberine’s use in improving treatment outcomes is preclinical—involving cells, tissues, or lab animals. Preclinical evidence is a first step toward finding whether a therapy has anticancer activity. Without any evidence of effects in living humans, we do not recommend concluding that berberine might have anticancer effects for you. The preclinical evidence is promising, but we consider it still only a weak indication of possible effects in people with cancer. Preclinical evidence is a bit like taking a poll several months before an election. Most of us would not be comfortable saying that the election results will be identical to the poll, and sometimes the election results are not at all what the poll predicted.

We list preclinical evidence separately from clinical evidence to highlight that it should not be regarded with the same strength as clinical evidence. We summarize preclinical evidence in Are you a health professional? ›

Optimizing your body terrain

Does berberine promote an environment within your body that is less supportive of cancer development, growth, or spread? We present the evidence.

See Optimizing Your Body Terrain ›

Find medical professionals who specialize in managing body terrain factors: Finding Integrative Oncologists and Other Practitioners ›

We also recommend that you share with your doctor the information here about how berberine might affect these terrain factors if you have any imbalances.

Body weight

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of lower measures of body weight among people treated with berberine (not specific to cancer)

Moderately lower measures of obesity (body weight, body mass index, and waist circumference) among people treated with berberine (not specific to cancer) compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 12 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹Asbaghi O, Ghanbari N et al. The effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes: a systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition ESPEN. 2020;38:43-49.
Lower body mass index and waist circumference, but no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on body weight, among people treated with berberine (not specific to cancer) compared to controls in a meta-analysis of 10 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial²Xiong P, Niu L et al. The effect of berberine supplementation on obesity indices: a dose- response meta-analysis and systematic review of randomized controlled trials. Complementary Therapies in Clinical Practice. 2020;39:101113.
Lower waist-hip ratio but no evidence of an effect on body weight, body mass index, or waist circumference among people treated with berberine (not specific to cancer) compared to controls in a meta-analysis of 12 RCTs³Amini MR, Sheikhhossein F et al. Effects of berberine and barberry on anthropometric measures: a systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine. 2020;49:102337.
Larger reductions in body mass index, but no evidence of an effect on waist-hip ratio, among people with polycystic ovary syndrome treated with both berberine and metformin compared to metformin alone in a meta-analysis of 2 RCTs⁴Zhao H, Xing C, Zhang J, He B. Comparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS: a network meta-analysis. Reproductive Health. 2021;18(1):171.
Comparable benefits on body mass index among people with polycystic ovary syndrome with insulin resistance treated with either berberine or metformin in a meta-analysis of 3 RCTs⁵Li MF, Zhou XM, Li XL. The effect of berberine on polycystic ovary syndrome patients with insulin resistance (PCOS-IR): a meta-analysis and systematic review. Evidence-based Complementary and Alternative Medicine. 2018 Nov 14;2018:2532935.
Smaller waist circumference among obese women with infrequent menses and polycystic ovary syndrome treated with 500 mg berberine twice a day for 6 months compared to controls in a mid-sized RCT⁶Orio F, Muscogiuri G et al. Berberine improves reproductive features in obese Caucasian women with polycystic ovary syndrome independently of changes of insulin sensitivity. E-SPEN Journal. 2013 Oct;8(5):e200-e204.
Less weight gain at 9 weeks and 12 weeks and better body mass index at 12 weeks among people with schizophrenia spectrum disorders who had developed metabolic syndrome and were treated with 600 mg berberine per day for 12 weeks compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a mid-sized RCT⁷Chan M, Qin Z et al. Adjunctive berberine reduces antipsychotic-associated weight gain and metabolic syndrome in patients with schizophrenia: a randomized controlled trial [published correction appears in Psychiatry and Clinical Neurosciences. 2022 Oct;76(10):536]. Psychiatry and Clinical Neurosciences. 2022;76(3):77-85.
Better body weight while participating in a lifestyle intervention among people with non-alcoholic fatty liver disease treated with 0.5g berberine 3 times a day for 16 weeks compared to the lifestyle intervention alone in a mid-sized RCT⁸Yan HM, Xia MF et al. Efficacy of berberine in patients with non-alcoholic fatty liver disease. PLoS One. 2015;10(8):e0134172.e.
Lower body mass index among people with mild metabolic disorders induced by a psychiatric drug and treated with berberine for 12 weeks compared to placebo in a mid-sized RCT⁹Pu Z, Sun Y et al. Effects of berberine on gut microbiota in patients with mild metabolic disorders induced by olanzapine. American Journal of Chinese Medicine. 2021;49(8):1949-1963.
More loss of body weight and reduced body mass index among people with schizophrenia on stable dose of a single antipsychotic for at least one month treated with 900 mg berberine per day for 8 weeks compared to placebo in a small RCT¹⁰Qiu Y, Li M et al. Berberine treatment for weight gain in patients with schizophrenia by regulating leptin rather than adiponectin. Asian Journal of Psychiatry. 2022;67:102896.
No evidence of an effect on body mass index or waist-hip ratio among Chinese men with hyperlipidemia treated with 500 mg berberine orally, twice a day for 12 weeks compared to placebo in a small RCT¹¹Zhao JV, Yeung WF et al. Effect of berberine on cardiovascular disease risk factors: a mechanistic randomized controlled trial. Nutrients. 2021;13(8):2550.
Decreases in waist circumference among people with metabolic syndrome treated with 500 mg berberine hydrochloride 3 times a day before meals for 3 months compared to placebo in a small RCT¹²Pérez-Rubio KG, González-Ortiz M, Martínez-Abundis E, Robles-Cervantes JA, Espinel-Bermúdez MC. Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion. Metabolic Syndrome and Related Disorders. 2013;11(5):366-369.
Lower body mass index, visceral adipose tissue, and fat mass among normal-overweight women with polycystic ovary syndrome with normal menses treated with 110 mg bioavailable berberine phospholipid formulation for 60 days compared to baseline in a small uncontrolled studya study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design¹³Rondanelli M, Riva A et al. Berberine phospholipid is an effective insulin sensitizer and improves metabolic and hormonal disorders in women with polycystic ovary syndrome: a one-group pretest-post-test explanatory study. Nutrients. 2021;13(10):3665.

High blood sugar and insulin resistance

Good evidence of lower markers of blood sugar among people with type 2 diabetes treated with berberine, comparable to oral diabetes medicine

Good evidence of lower markers of blood sugar and insulin resistance among people with metabolic disorders besides type 2 diabetes treated with berberine

Hormone imbalance

Changes in hormone levels seen in the studies here may not be beneficial in every situation. Your oncology team needs to determine whether any changes would be favorable for your condition.

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of changes in leptina hormone that helps regulate energy balance by inhibiting hunger levels correlating with weight loss among people with schizophrenia treated with berberine

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of better sex hormone balance among people with polycystic ovary syndrome treated with berberine

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of higher testosterone among men with hyperlipidemia treated with berberine

Appetite hormones: preliminary evidence of changes in leptina hormone that helps regulate energy balance by inhibiting hunger levels correlating with weight loss among people with schizophrenia treated with berberine

Changes in leptin levels correlating with weight loss among people with schizophrenia on stable dose of a single antipsychotic for at least one month treated with 900 mg berberine per day for 8 weeks compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects³¹Qiu Y, Li M et al. Berberine treatment for weight gain in patients with schizophrenia by regulating leptin rather than adiponectin. Asian Journal of Psychiatry. 2022;67:102896.

Sex hormones

Modest evidence of better sex hormone balance among people with polycystic ovary syndrome treated with berberine

Weak evidence of higher testosterone among men with hyperlipidemia treated with berberine

Lower total testosterone among people with polycystic ovary syndrome treated with both berberine and metformin compared to metformin alone in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 2 RCTs³²Zhao H, Xing C, Zhang J, He B. Comparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS: a network meta-analysis. Reproductive Health. 2021;18(1):171.
Comparable effects on follicle-stimulating hormone and luteinizing hormone among people with polycystic ovary syndrome with insulin resistance treated with either berberine or metformin in a meta-analysis of 3 RCTs³³Li MF, Zhou XM, Li XL. The effect of berberine on polycystic ovary syndrome patients with insulin resistance (PCOS-IR): a meta-analysis and systematic review. Evidence-based Complementary and Alternative Medicine. 2018 Nov 14;2018:2532935.
Greater reductions in total testosterone and free androgen index, decreases in total follicle-stimulating hormone requirement, lower incidence of severe ovarian hyperstimulation syndrome, and increases in sex hormone binding globulin and live birth rate during in vitro fertilization treatment among infertile women with polycystic ovary syndrome treated with berberine for 3 months before ovarian stimulation compared to placebo in a mid-sized RCT³⁴An Y, Sun Z et al. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clinical Endocrinology (Oxford). 2014;80(3):425-431.
More favorable levels of total testosterone, free androgen index, androstenedione, sex hormone binding globulin, and progesterone, and better menses frequency among obese women with infrequent menses and polycystic ovary syndrome treated with 500 mg berberine twice a day for 6 months compared to controls in a mid-sized RCT³⁵Orio F, Muscogiuri G et al. Berberine improves reproductive features in obese Caucasian women with polycystic ovary syndrome independently of changes of insulin sensitivity. E-SPEN Journal. 2013 Oct;8(5):e200-e204.
Lower testosterone and higher sex hormone-binding globulin among normal-overweight women with polycystic ovary syndrome with normal menses treated with 110 mg bioavailable berberine phospholipid formulation for 60 days compared to baseline in a small uncontrolled studya study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design³⁶Rondanelli M, Riva A et al. Berberine phospholipid is an effective insulin sensitizer and improves metabolic and hormonal disorders in women with polycystic ovary syndrome: a one-group pretest-post-test explanatory study. Nutrients. 2021;13(10):3665.
Lower sex hormone binding globulin and better menstrual pattern and ovulation among normal weight Chinese women with polycystic ovary syndrome treated with 0.4 g berberine 3 times a day for 4 months compared to baseline in a small uncontrolled study³⁷Li L, Li C et al. A single arm pilot study of effects of berberine on the menstrual pattern, ovulation rate, hormonal and metabolic profiles in anovulatory Chinese women with polycystic ovary syndrome. PLoS One. 2015;10(12):e0144072.

Immune function

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on white blood cell counts among people with severe COVID-19 treated with berberine

Inflammation

Good evidence of lower markers of inflammation among people with a variety of health conditions other than cancer or after surgery

Your microbiome

Preliminary evidence of better composition of intestinal flora, especially fewer Firmicutes species, among people with metabolic disorders treated with berberine; a higher Firmicutes to Bacteroidetes ratio is associated with dysbiosismicrobial imbalance or maladaptation on or inside the body and obesity

Preliminary evidence of better markers of intestinal flora among people with Parkinson’s disease treated with berberine

Berberine combined with other therapies

Modest evidence of lower glucose levels among people treated with NComb, a mixture of red yeast rice, berberine, policosanol, astaxanthin, coenzyme Q10, and folic acid

Preliminary evidence of lower levels of insulin and insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy among adults with impaired fasting glucose treated with Lagerstroemia speciosa, Berberis aristata, Curcuma longa, alpha-lipoic acid, chromium picolinate, and folic acid

Preliminary evidence of more weight loss and better glycemic control among people with fatty liver disease and diabetes treated with HTD1801 (berberine ursodeoxycholate)

Preliminary evidence of better body mass index, waist circumference, waist to hip ratio, percent of abdominal fat, fasting blood glucose and insulin, and insulin resistance (HOMA-IR) among overweight or obese people with type 2 diabetes treated with berberine and silymarin

Weak evidence of lower body mass index after 3 months among women with estroprogestin-induced hypercholesterolemia treated with berberine and monacolins

Preliminary evidence of lower measures of blood sugar, insulin, and insulin resistance among people with high cholesterol treated with policosanol, red yeast rice containing monacolin K, berberine, and in one case other nutriceuticals

Preliminary evidence of lower fasting insulin and insulin resistance among overweight people with hyperlipidemia treated with berberine, chlorogenic acid, and tocotrienols

NComb: red yeast rice, berberine, policosanol, astaxanthin, coenzyme Q10, and folic acid: modest evidence of lower glucose levels among people treated with NComb

Lower glucose levels among people treated with red yeast rice, berberine, policosanol, astaxanthin, coenzyme Q10, and folic acid (NComb) compared to controls, with a higher effect seen among people with higher baseline glucose levels and longer duration of supplementation in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁵¹Pirro M, Mannarino MR et al. The effects of a nutraceutical combination on plasma lipids and glucose: a systematic review and meta-analysis of randomized controlled trials. Pharmacological Research. 2016 Aug;110:76-88.

Lagerstroemia speciosa, Berberis aristata, turmeric, alpha-lipoic acid, chromium picolinate, and folic acid: preliminary evidence of lower levels of insulin and insulin resistance among adults with impaired fasting glucose treated with Lagerstroemia speciosa, Berberis aristata, Curcuma longa, alpha-lipoic acid, chromium picolinate, and folic acid

Lower levels of insulin and insulin resistance (HOMA-IR) among adults with impaired fasting glucose treated with Lagerstroemia speciosa, Berberis aristata, turmeric, alpha-lipoic acid, chromium picolinate, and folic acid in a small RCT⁵²Cicero AFG, Fogacci F et al. Nutraceutical effects on glucose and lipid metabolism in patients with impaired fasting glucose: a pilot, double-blind, placebo-controlled, randomized clinical trial on a combined product. High Blood Pressure & Cardiovascular Prevention. 2017 Sep;24(3):283-288.

Berberine ursodeoxycholate, an ionic salt of berberine and ursodeoxycholic acid: preliminary evidence of more weight loss and better glycemic control among people with fatty liver disease and diabetes treated with HTD1801 (berberine ursodeoxycholate)

More weight loss and better glycemic control among people with fatty liver disease and diabetes treated with 500 mg or 1000 mg HTD1801 (berberine ursodeoxycholate) twice a day for 18 weeks compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a small RCT⁵³Harrison SA, Gunn N et al. A phase 2, proof of concept, randomised controlled trial of berberine ursodeoxycholate in patients with presumed non-alcoholic steatohepatitis and type 2 diabetes. Nature Communications. 2021;12(1):5503.

Berberine and silymarin: preliminary evidence of better body mass index, waist circumference, waist to hip ratio, percent of abdominal fat, fasting blood glucose and insulin, and insulin resistance (HOMA-IR) among overweight or obese people with type 2 diabetes treated with berberine and silymarin

Better body mass index, waist circumference, waist to hip ratio, percent of abdominal fat, fasting blood glucose and insulin, and insulin resistance (HOMA-IR) among overweight or obese people with type 2 diabetes treated with 500 mg berberine and 105 mg silymarin twice a day for 52 weeks compared to placebo in a mid-sized RCT⁵⁴Guarino G, Strollo F et al. Bioimpedance analysis, metabolic effects and safety of the association Berberis aristata/Bilybum marianum: a 52-week double-blind, placebo-controlled study in obese patients with type 2 diabetes. Journal of Biological Regulators and Homeostatic Agents. 2017;31(2):495-502.

Berberine and monacolins: weak evidence of lower body mass index, fasting plasma glucose, insulin resistance, and inflammation after 3 months among women with estroprogestin-induced hypercholesterolemia treated with berberine and monacolins

Lower body mass index, fasting plasma glucose, insulin resistance (HOMA-IR), and inflammation (hsCRP) after 3 months among women with estroprogestin-induced hypercholesterolemia treated with 500 mg berberine and 3 mg monacolins compared to baseline in a small controlled studya study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial⁵⁵Cicero AF, Reggi A et al. Berberine and monacolin effects on the cardiovascular risk profile of women with oestroprogestin-induced hypercholesterolemia. High Blood Pressure & Cardiovascular Prevention. 2014;21(3):221-226.

Policosanol, red yeast rice containing monacolin K, berberine, and in one study also astaxantine, folic acid, and coenzyme Q10: preliminary evidence of lower measures of blood sugar, insulin, and insulin resistance among people with high cholesterol treated with policosanol, red yeast rice containing monacolin K, berberine, and in one case other nutriceuticals

Lower glycated hemoglobin, fasting glucose, insulin plasma levels, and insulin resistance (HOMA-IR) among people with high cholesterol not on statins treated with 10 mg policosanol, 200 mg red yeast rice containing 3 mg monacolin K, 500 mg berberine, 0.5 mg astaxantine, 200 mcg folic acid and 2 mg coenzyme Q10 compared to 531.25 mg berberine (), 220 mg red yeast rice powder containing 3.3 mg monacolin K) and 200 mg leaf extract of Morus alba for 4 weeks in a small RCT⁵⁶Trimarco V, Izzo R et al. Effects of a new combination of nutraceuticals with Morus alba on lipid profile, insulin sensitivity and endotelial function in dyslipidemic subjects. A cross-over, randomized, double-blind trial. High Blood Pressure & Cardiovascular Prevention. 2015;22(2):149-154.
Better insulin sensitivity (HOMA-IR) among people with high cholesterol and insulin resistance treated with 500 mg berberine, 200 mg red yeast rice, and 10 mg policosanol daily for 6 weeks and a subsequent extension of 4 weeks compared to placebo in a small RCT⁵⁷Affuso F, Ruvolo A, Micillo F, Saccà L, Fazio S. Effects of a nutraceutical combination (berberine, red yeast rice and policosanols) on lipid levels and endothelial function randomized, double-blind, placebo-controlled study. Nutrition, Metabolism and Cardiovascular Diseases. 2010;20(9):656-661.

Berberine, chlorogenic acid, and tocotrienols: preliminary evidence of lower fasting insulin and insulin resistance among overweight people with hyperlipidemia treated with berberine, chlorogenic acid, and tocotrienols

Lower fasting insulin and insulin resistance (HOMA-IR) among overweight people with hyperlipidemia treated with berberine, chlorogenic acid, and tocotrienols for 8 weeks compared to placebo in a small RCT⁵⁸Cicero AF, Rosticci M et al. Short-term effects of a combined nutraceutical of insulin-sensitivity, lipid level and indexes of liver steatosis: a double-blind, randomized, cross-over clinical trial. Nutrition Journal. 2015;14:30.

Managing side effects and promoting wellness

Is berberine linked to fewer or less severe side effects or symptoms? Is it linked to less toxicity from cancer treatment? Does it support your quality of life or promote general well-being? We present the evidence.

Breathlessness and other lung symptoms

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower incidence of radiation-induced lung injury among people with non-small cell lung cancer treated with berberine during radiotherapy

Gastrointestinal symptoms

Preliminary evidence of lower incidence and severity of radiation-induced acute intestinal symptoms during abdominal or pelvic radiotherapy among people with seminoma, lymphomas, or cervical cancer treated with oral berberine

Symptoms not specific to cancer

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of better cardiovascular symptoms among people with cardiovascular conditions treated with berberine

Modest evidence of more physical conditions favorable for cognitive performance among people with dementia associated with diabetes treated with berberine

Preliminary evidence of less diarrhea from conditions other than cancer among people treated with berberine

Cardiovascular symptoms: modest evidence of better cardiovascular symptoms among people with cardiovascular conditions treated with berberine

Lower risk of atrial fibrillation after isolated coronary artery bypass grafting among people treated with 0.4 g oral berberine 3 times a day compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁶¹Zhang J, Wang Y et al. Preventive effect of berberine on postoperative atrial fibrillation. Circulation: Arrhythmia & Electrophysiology. 2022;15(10):e011160.
Better markers of cardiovascular function and better quality of life among people with chronic congestive heart failure treated with 1.2 to 2.0 g berberine per day compared to placebo in a mid-sized RCT⁶²Zeng XH, Zeng XJ, Li YY. Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. American Journal of Cardiology. 2003;92(2):173-176.

Cognitive difficulties: modest evidence of more physical conditions favorable for cognitive performance among people with dementia associated with diabetes treated with berberine

More conditions favorable for cognitive performance (cholinergic neurotransmission, cerebral blood flow, β-amyloid peptide clearance, and less inflammation and hyperphosphorylation of tau) among people with dementia associated with diabetes treated with berberine compared to controls in a systematic review of 22 clinical studies⁶³Shinjyo N, Parkinson J, Bell J, Katsuno T, Bligh A. Berberine for prevention of dementia associated with diabetes and its comorbidities: a systematic review. Journal of Integrative Medicine. 2020;18(2):125-151.

Gastrointestinal symptoms: preliminary evidence of less diarrhea among people with conditions other than cancer causing diarrhea treated with berberine

Less frequent diarrhea, abdominal pain, and urgent need for defecation, plus better irritable bowel syndrome (IBS) symptom scores, depression scores, and anxiety scores among people with IBS treated with 400 mg berberine hydrochloride, delivered twice a day for 8 weeks compared to placebo in a mid-sized RCT⁶⁴Chen C, Tao C et al. A randomized clinical trial of berberine hydrochloride in patients with diarrhea-predominant irritable bowel syndrome. Phytotherapy Research. 2015;29(11):1822-1827.
Smaller stool volumes during 3 consecutive 8-hour periods after treatment and more resolution of diarrhea at 24 hours among people with acute diarrhea due to enterotoxigenic Escherichia coli, but not due to cholera, treated with a single oral dose of 400 mg or 1200 mg berberine sulfate compared to controls in a mid-sized RCT⁶⁵Rabbani GH, Butler T, Knight J, Sanyal SC, Alam K. Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. Journal of Infectious Diseases. 1987;155(5):979-984.
50-70% fewer diarrheal events after 30 days, improving to 70 and 80% after 90 days among people affected by functional diarrhea or diarrhea-type irritable bowel syndrome (IBS-D) treated with a berberine-based nutraceutical, administered every day, every 12 hours, for 90 days compared to baseline in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study⁶⁶Di Pierro F, Bertuccioli A, Giuberti R, Saponara M, Ivaldi L. Role of a berberine-based nutritional supplement in reducing diarrhea in subjects with functional gastrointestinal disorders. Minerva Gastroenterologica e Dietologica. 2020;66(1):29-34.

Berberine combined with other therapies

Preliminary evidence of lower blood pressure among people with cardiovascular conditions treated with policosanol, red yeast rice extract, berberine, folic acid, and coenzyme Q10, and even stronger effects when the herb known as “cat’s whiskers” (Orthosiphon stamineus) was added

Preliminary evidence of shorter hospital stays after endoscopic sinus surgery among people with chronic rhinosinusitis treated with a biodegradable gel containing hyaluronic acid and berberine hydrochloride

Preliminary evidence of a better marker of bone health among postmenopausal women with metabolic syndrome treated with rho iso-alpha acids, berberine sulfate trihydrate, vitamin D₃, and vitamin K₁

Policosanol, red yeast rice extract, berberine, folic acid, and coenzyme Q10: preliminary evidence of lower blood pressure among people with cardiovascular conditions treated with policosanol, red yeast rice extract, berberine, folic acid and coenzyme Q10, and even stronger effects when the herb known as “cat’s whiskers” (Orthosiphon stamineus) was added

Lower systolic and diastolic blood pressure among people with metabolic syndrome treated with policosanol, red yeast rice extract, berberine, folic acid, and coenzyme Q10 compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁶⁷Rozza F, de Simone G, Izzo R, De Luca N, Trimarco B. Nutraceuticals for treatment of high blood pressure values in patients with metabolic syndrome. High Blood Pressure & Cardiovascular Prevention. 2009 Dec;16(4):177-82.
Lower mean 24-hour systolic and diastolic blood pressure among people with grade 1 essential hypertension and low cardiovascular risk treated with policosanol, red yeast rice extract, berberine, folic acid and coenzyme Q10, plus Orthosiphon stamineus compared to the same nutraceutical combination without Orthosiphon stamineus in a small RCT⁶⁸Trimarco V, Cimmino CS et al. Nutraceuticals for blood pressure control in patients with high-normal or grade 1 hypertension. High Blood Pressure & Cardiovascular Prevention. 2012 Sep 1;19(3):117-22.

Hyaluronic acid and berberine hydrochloride: preliminary evidence of shorter hospital stays after endoscopic sinus surgery among people with chronic rhinosinusitis treated with a biodegradable gel containing hyaluronic acid and berberine hydrochloride

Shorter hospital stays after endoscopic sinus surgery among people with chronic rhinosinusitis treated with a biodegradable gel containing hyaluronic acid and berberine hydrochloride in both middle metal spacers at the end surgery compared to merocel in a small RCT⁶⁹Long NP, Thuan ND et al. Efficiency of a biodegradable gel containing hyaluronic acid and berberine hydrochloride in endoscopic sinus surgery (ESS): a prospective comparative study. American Journal of Otolaryngology. 2022;43(3):103397.

Rho iso-alpha acids, berberine sulfate trihydrate, vitamin D₃, and vitamin K₁: preliminary evidence of a better marker of bone health among postmenopausal women with metabolic syndrome treated with rho iso-alpha acids, berberine sulfate trihydrate, vitamin D₃, and vitamin K₁

A better marker of bone health (osteocalcin) during an intervention of a modified Mediterranean-style, low-glycemic-load diet and aerobic exercise among postmenopausal women with metabolic syndrome treated with 200 mg hop rho iso-alpha acids, 100 mg berberine sulfate trihydrate, 500 IU vitamin D₃, and 500 μg vitamin K₁ twice a day for 14 weeks compared to placebo in 2 small RCTs⁷⁰Lamb JJ, Holick MF et al. Nutritional supplementation of hop rho iso-alpha acids, berberine, vitamin D₃, and vitamin K₁ produces a favorable bone biomarker profile supporting healthy bone metabolism in postmenopausal women with metabolic syndrome. Nutrition Research. 2011;31(5):347-355; Holick MF, Lamb JJ et al. Hop rho iso-alpha acids, berberine, vitamin D3 and vitamin K1 favorably impact biomarkers of bone turnover in postmenopausal women in a 14-week trial. Journal of Bone and Mineral Metabolism. 2010;28(3):342-350.

Reducing cancer risk

Is berberine linked to lower risks of developing cancer or of recurrence? We present the evidence.

Colorectal cancer

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of moderately lower risk of recurrence of colorectal adenoma among people treated with berberine

Berberine combined with other therapies

Berberine with other treatments for H. pylori infections: modest evidence of comparable effects in eradicating Helicobacter pylori infections—a risk factor for stomach cancer—among people treated with berberine as part of a combination therapy compared to bismuth-containing combination therapies

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Author

Nancy Hepp, MS

Lead Researcher

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Reviewer

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant

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Last update: December 7, 2023

Last full literature review: February 2023

We are grateful for research assistance from Adriana Rocio Gutierrez Galvis.

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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