Caution urged over use of berberine

If you’ve been on TikTok recently you might have seen a supplement labelled ‘nature’s Ozempic’, with claims it can aid weight loss. So does it, Hannah Martin asks.

Asupplement called berberine is being touted as ‘‘nature’s Ozempic’’ online, with social media users claiming it can help weight loss like the popular anti-diabetic drug.

Globally, Google searches for ‘‘berberine’’ soared in May, and on TikTok, the hashtag #berberine has garnered more than 66.2 million views – with a weight loss-focused tag amassing 3.1m views.

But what is it, and what do we know about its use?

Berberine is a bioactive compound found in certain plants, and has a long history in traditional Chinese and Ayurvedic medicine, and Native American healing.

In the US, where many of the TikToks originate, berberine has not been approved by the FDA (Food and Drug Administration) for any prescription use, as it is considered a food (or dietary) product.

This means it doesn’t receive the same scrutiny medications do.

Peter Shepherd, a professor in the University of Auckland’s department of molecular medicine and pathology, said berberine is chemically similar to a drug often used to treat diabetes, called metformin.

Metformin had been shown to result in a small weight loss, he said, but was ‘‘way less’’ effective

than Ozempic.

Ozempic, or semaglutide, is used for type 2 diabetes – to help people manage their blood glucose – and for weight management.

Last year, Ozempic starting trending online leading to a global shortage, including in New Zealand.

It works by replacing (or mimicking) a hormone we make in our gut, called GLP-1, which controls our appetite and how much we eat, Shepherd said.

Shepherd said the ‘‘current evidence would suggest berberine would work along the same line’’.

A meta-analysis of 49 studies published in Frontiers in Nutrition last year found berberine may provide metabolic benefits in people, mainly for the heart, although there may be small benefits for weight loss, NBC reported.

But, ‘‘it’s certainly not the new [Ozempic], or nature’s Ozempic’’, Shepherd said.

Forbes reported that, when pooled, the results of the metaanalysis indicated an average weight loss of 0.84kg (about 1.85lbs) – compared to the average weight loss of 3.6kg in an Ozempic clinical trial, published in The Lancet Diabetes and Endocrinology.

Shepherd said while it seems berberine has the potential to have a small effect, further formal trials are ‘‘really needed’’.

Existing clinical data were not conclusive as most published studies are small and of varying quality, according to an article in The Conversation.

Studies have also only been conducted in people who are overweight or obese, so it’s unclear what the impact is in others; nor is there any data on what happens when people stop taking berberine, they say.

According to Healthline, berberine generally appears to be well-tolerated, but in some situations, it can cause digestive side effects such as diarrhoea, constipation, flatulence and stomach pain.

If you’re taking any medication, it’s important to talk to a healthcare provider before taking berberine due to the risk of interactions.

Berberine may interact with medications that lower blood sugar, increasing the risk of hypoglycemia, and may also interact with medicines processed by the liver, Healthline says.

It is not recommended for people who are pregnant as it is thought to cross the placenta, which may harm the foetus. It is also not appropriate if breastfeeding, pharmacologists wrote in The Conversation.

Shepherd cautioned people to ‘‘be sensible, and don’t expect a huge effect’’.

More is also not better, he said: people need to be careful about dosing and overdosing, and do so with health advice.

In New Zealand, products intended for weight reduction/ control are medicines under the Medicines Act (1981), and cannot be advertised or supplied unless first approved as medicines (with a few limited exemptions) by the Minister of Health or their delegate, a Ministry of Health spokesperson said.

Products available containing berberine have not been approved as medicines for this purpose, so Medsafe could not provide ‘‘any information about the safety, efficacy or quality of the products’’.

As of Tuesday, Medsafe did not have a record of any adverse reactions from the use of berberine for weight loss.

In 2021, Cabinet decided to regulate natural health products under the Therapeutic Products Bill (which has not yet gone to its second reading), as, while these are ‘‘generally lower-risk products than medicines’’, they are ‘‘not risk-free’’.

A ministry spokesperson said medications to aid with weight management should only be considered after other approaches, such as appropriate dietary changes, physical activity, and behaviour change have been tried.

‘‘It is important to consult the healthcare team at your general practice before starting any weight management medications as they may have side effects, and interfere with other medications and/or other underlying medical or physical conditions,’’ they said.

‘‘Be sensible, and don’t expect a huge effect.’’ Peter Shepherd University of Auckland professor