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.
Safety and precautions
Interactions with cancer treatments
Preclinical (cell line) studies have found that low-dose berberine reduces gastric cancer cell response to paclitaxel (Taxol), fluorouracil (5-FU), and camptothecin.1Bao J, Huang B et al. Hormetic effect of berberine attenuates the anticancer activity of chemotherapeutic agents. PLoS One. 2015 Sep 30;10(9):e0139298; Lin HL, Liu TY, Wu CW, Chi CW. Berberine modulates expression of MDR1 gene product and the responses of digestive track cancer cells to Paclitaxel. British Journal of Cancer. 1999 Oct;81(3):416-22. Also see studies finding an increased response to these drugs in Are you a health professional? ›
With a lack of evidence of berberine’s influence on the effectiveness of these chemotherapy drugs in humans or clarity regarding the effects of berberine at various doses and with different types of cancer, we recommend that you be sure your oncologist knows if you are taking berberine while using any of these chemotherapy drugs and follow their recommendations.
Side effects or adverse events
Few serious adverse events have been seen in studies using berberine.2Fang S, Guo S et al. Efficacy and safety of berberine in preventing recurrence of colorectal adenomas: a systematic review and meta-analysis. Journal of Ethnopharmacology. 2022;282:114617; Qiu 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; Zhao JV, Yeung WF et al. Effect of berberine on cardiovascular disease risk factors: a mechanistic randomized controlled trial. Nutrients. 2021;13(8):2550; Mirzaee F, Razmjouei P et al. The effect and safety of berberine on polycystic ovary syndrome: a systematic review. Journal of Obstetrics and Gynaecology. 2021;41(5):684-689; Meng S, Wang LS et al. Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention. Clinical and Experimental Pharmacology and Physiology. 2012 May;39(5):406-11; Chan 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; Chen 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; Rabbani 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; Cicero AF, Tartagni E et al. Combined nutraceutical approach to postmenopausal syndrome and vascular remodeling biomarkers. Journal of Alternative and Complementary Medicine. 2013;19(6):582-587; Zhang J, Han C et al. A randomized, multicenter and noninferiority study of amoxicillin plus berberine vs tetracycline plus furazolidone in quadruple therapy for Helicobacter pylori rescue treatment. Journal of Digestive Diseases. 2020;21(5):256-263; An 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; Chen XX, Chen YX et al. Efficacy and safety of triple therapy containing berberine hydrochloride, amoxicillin, and rabeprazole in the eradication of Helicobacter pylori. Journal of Digestive Diseases. 2022;23(10):568-576. The most common side effects are gastrointestinal, including nausea, abdominal distension, constipation, or diarrhea.3Di 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; Zhang Y, Gu Y et al. Gut microbiome-related effects of berberine and probiotics on type 2 diabetes (the PREMOTE study). Nature Communications. 2020;11(1):5015; Harrison 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; Dong H, Wang N, Zhao L, Lu F. Berberine in the treatment of type 2 diabetes mellitus: a systemic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2012;2012:591654; Yan HM, Xia MF et al. Efficacy of berberine in patients with non-alcoholic fatty liver disease. PLoS One. 2015;10(8):e0134172.e. One case of a rash was reported.4Zhang BY, Chen M et al. Berberine reduces circulating inflammatory mediators in patients with severe COVID-19. British Journal of Surgery. 2021;108(1):e9-e11.
Effects on hormone levels
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) shows a possible link between berberine use and higher testosterone among men with high blood lipids. The researchers note that “higher testosterone may be associated with more unfavorable cardiac function.”
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward higher testosterone among Chinese men with blood lipids (hyperlipidemia) treated with 500 mg oral berberine twice a 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 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 effects5Zhao JV, Yeung WF et al. Effect of berberine on cardiovascular disease risk factors: a mechanistic randomized controlled trial. Nutrients. 2021;13(8):2550.
Effects on the gut microbiome
Preliminary evidence shows less gene diversity (richness) in gut microbiota among people newly diagnosed with hyperglycemia treated with berberine. The researchers point out that treatment with probiotics may reduce this effect.
- Lower gene richness (fewer Firmicutes and Roseburia and more Blautia including Ruminococcus gnavus and Ruminococcus torques) in gut microbiota among people newly diagnosed with hyperglycemia treated with berberine, whether with Bifidobacterium or alone, for 16 weeks compared to placebo in a mid-sized RCT6Ming J, Yu X et al. Effectiveness and safety of Bifidobacterium and berberine in human hyperglycemia and their regulatory effect on the gut microbiota: a multi-center, double-blind, randomized, parallel-controlled study. Genome Medicine. 2021;13(1):125.
Interactions with other therapies
A case studya descriptive and exploratory analysis of a person, group, or event regarding changes observed over time; because changes due to treatment are not compared to similar changes over time without treatment, a case study is considered a weak study design described a man who presented to an emergency department with a 3-day history of jaundice and vomiting and high concentrations of rivaroxaban—a drug to treat blood clots in the veins— which may have been due to an interaction with his recent use of berberine.7Bonnichsen M, Stoklosa T, Bowen D, Majumdar A. Safety first, a harmful interaction between rivaroxaban and berberine. Internal Medicine Journal. 2022;52(5):887-888.
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