Is Berberine Nature’s Weight Loss Drug?

According to the Centers for Disease Control and Prevention, obesity affects more than 40 percent of U.S. adults. More than half report that willpower alone is insufficient to lose weight and keep it off. A new class of drugs, the GLP-1 agonists, including Ozempic, Wegovy, and Mounjaro have soared in popularity ever since their introduction.

Originally formulated to treat type 2 diabetes, the FDA approved Wegovy for chronic weight management in 2021. They work by mimicking hormones that target the areas in your brain that control appetite and food intake. In addition, they slow digestion and make you feel full. The main side effects reported are gastrointestinal reactions and reactions at the injection site.

They are a novel breakthrough for those who suffer from weight-related conditions, including diabetes, high blood pressure, and heart disease. However, as with any new drug that promises to be a panacea, some individuals choose to take these medications to “lose a few pounds,” like one of my patients who wanted to look good for her 30^th high school reunion.

Aside from contributing to the scarcity of these medications for those who need them, it has led to countless profitable pop-up clinics and online sites where these medications can be purchased without significant medical oversight. As a psychiatrist, my main concern is how these “miracle” drugs affect your brain and what types of mental health issues can ensue. A previous weight loss drug, Zimulti, was withdrawn from the European market due to reports of increased suicidal thoughts and behaviors among users. In the U.S., Qnexa (Vivus) contains two active ingredients, phentermine, and topiramate, which, despite demonstrating more than 9 percent body weight loss, was rejected by the FDA partly because of concerns regarding the potential risk of increased suicidal ideation.

Alarming side effects
The FDA has received reports of suicidal ideation from Wegovy users. However, the reports have not been verified, and the research has been limited and contradictory. Nevertheless, reports of suicidal thinking have been associated with other weight-loss medications. Sanofi's Acomplia, which never won U.S. approval, was withdrawn in Europe in 2008 after being linked to suicidal thoughts. The weight-loss drug Contrave carries a black box warning about suicidal thinking, and another obesity medicine, Qsymia, carries a warning telling patients to stop taking it if they experience suicidal thoughts.

Given that even the slightest risk for suicidal ideation should be monitored and mitigated at all costs, nature has provided us with a possible safe weight loss alternative. Berberine is found in various plants, including goldenseal, barberry, and Oregon grape. Plants containing berberine have a long history of use in both Ayurvedic and Chinese medicine. In modern times, plants containing berberine have been used for infections, skin diseases, and digestive disorders. Berberine is currently being studied due to its positive effects on diabetes and heart disease. Recently, it has become popular as a potential weight loss aid.

After ingesting berberine as a pill or powder, it enters your bloodstream and travels to your cells, binding to different molecules. But instead of producing a single change, berberine interacts with multiple targets, affecting more than one disease at a time.

In a review article published in Biomedicine and Pharmacotherapy, researchers documented berberine's positive effects in lowering fasting blood sugar in hundreds of patients. In addition, they found that berberine could lower basal metabolic indices in a small group of experimental subjects over three months. In a different realm, they reviewed studies that showed berberine supplements decreased cardiovascular risk in over 100 menopausal women by lowering their total plasma cholesterol, and in patients who suffer from high blood pressure, the addition of berberine to their daily dose of hypertensive medication led to more significant lowering of their blood pressure numbers than taking their antihypertensives alone.

The compound appears to decrease insulin resistance in cells, which can lead to obesity and the onset of type 2 diabetes. Another mechanism for its effectiveness is the modulation of your gut’s secretion of the hormone related to regulating food intake and energy balance. However, controlled scientific studies that look solely at berberine for weight loss are limited due to their small sample size. In one such study of individuals with fatty liver disease, participants who took a daily dose of berberine for three months lost significant weight.

Berberine improves how your cells respond to insulin and affects how your blood sugar is used. One of its actions is to enhance the movement of blood glucose into your cells, so once they are “satisfied,” you feel fewer hunger signals. One additional benefit of berberine is its positive effect on your gut environment. It may balance the good and bad bacteria by suppressing harmful ones and allowing the growth of beneficial ones.

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If you add berberine to your daily diet regimen:

• The FDA does not regulate it. Try to source a higher-quality product to avoid side effects from additives in some less expensive forms.
• Berberine does interact with some drugs because it can inhibit the clearance of these drugs from the liver, causing an elevated blood level. Check with your healthcare provider before starting this if you take prescription medication.
• Berberine's half-life is only a few hours. That means your blood level will decrease to about 50 percent within a few hours. To maintain a more constant level, many providers recommend multiple daily dosing—two or three times per day at a total of 1500mg.
• Side effects: All medications have potential side effects. The most common ones reported for berberine are gastrointestinal, like constipation, nausea, and diarrhea. However, these are the same side effects reported with the new generation of weight loss drugs. The difference is that berberine has not been shown to contribute to mental health issues.