It was over two years ago when you first read here about the powerful plant extract called berberine. Long used as an effective natural antibiotic there has since been a virtual explosion of new scientific research on this botanical extract.
Berberine has emerged as an incredibly effective natural treatment for controlling blood sugar and lipids. In fact, research found that it performs just as well as metformin, the #1 patent medication for type-2 diabetes. In case after case it has lived up to its research reputation in clinical observations at Tahoma Clinic. In fact, it turns out that in most of the cases where type-2 diabetes didn’t respond to berberine the patients were misdiagnosed before they came to us. Careful testing of their insulin responses to sugar revealed that they were actually type-1 diabetics.
Since 2008, there’s been a virtual avalanche of scientific research on berberine. But you may be surprised to find out that the research hasn’t only focused on type-2 diabetes and prediabetes or metabolic syndrome. Studies have revealed that the extract’s abilities reach far beyond blood sugar control.
In fact, research has found that berberine could play an important role in fighting cancer, guarding against Alzheimer’s, lowering cholesterol and triglycerides in non-diabetics, speeding recovery from strokes, and stimulating nerve cells and injured nerves. But before we cover the details on those findings let’s ‘re-cap’ some berberine basics.
Berberine is known scientifically as an ‘isoquinoline alkaloid’. It has been used by our ancestors for centuries. (That’s right, even without double-blind studies and ‘approval’ by the medical authorities.) Berberine occurs naturally in the stem, bark, and roots, of a variety of plants, including goldenseal (Hydrastis canadensis), Oregon grape (Berberis aquifolium), barberry (Berberis vulgaris), goldenthread (Coptis chinensis) and tree turmeric (Berberis aristata).1
Help in the fight against bacterial blindness
Western medicine has generally ignored berberine. But the little attention the mainstream has given to the botanical has focused on its ability to treat infections, particularly gastrointestinal conditions. Berberine is an anti-fungal and anti-inflammatory and has been used in the treatment of bacterial and parasitic causes of diarrhoea.
In ‘underdeveloped’ countries, berberine is known as an effective treatment for trachoma, the #1 cause of infectious blindness and visual impairment worldwide, caused by the Chlamydia trachomatis. It’s estimated that 40 million people are infected by this bacteria, and 8 million of them are visually impaired or blind.
Dramatic results seen with type-2 diabetes in mere months
Berberine isn’t well absorbed by our intestinal tracts because it isn’t very soluble in water. This has led researchers to look for alternative ways of delivering it if it’s needed in non-intestinal areas of the body.2 Its poor absorbability is due, at least in part, to a molecule called a ‘P-glycoprotein’.3 Since milk thistle is a natural inhibitor of P-glycoprotein, researchers at the National University of Singapore felt pairing it with berberine may improve the oral absorption of the extract.4 They put their theory to the test with some diabetes research.
The 26 research volunteers in this study were already taking a variety of patent medicines, which included metformin, sulfonylureas, oral glitazones and injected insulin. Despite all these treatments, their type-2 diabetes was still poorly controlled.
These volunteers took a combination product, ‘Berberol®’, which contained 500mg of berberine from Berberis aristata and 105mg of milk thistle (for the technically inclined, Silybum marianum containing 60% flavolignans) per capsule. They were asked to take two capsules at night on an empty stomach, for 90 days. Twenty-two of the original group completed the three months.
Those volunteers who had successfully completed the 90 days were rewarded for their efforts. They saw significant reductions in key markers related to glucose control: HbA1c, fasting insulin, triglycerides, total cholesterol and LDL cholesterol, and a measurement of insulin resistance (HOMA-IR). The researchers reported that ‘Berberol®’ in these amounts was safe and well tolerated.5
Resisting insulin resistance
Berberine has clearly shown great promise against type-2 diabetes. This success led many… including me… to assume that berberine could improve, or even reverse, the signs and symptoms of ‘metabolic syndrome’, the ‘precursor state’ for type-2 diabetes. But in science, assumptions are just that – assumptions – until they’re proven.
However, further research has now proven this hypothesis correct. Berberine does in fact help improve metabolic syndrome. In one double blind, placebo-controlled study, 64 individuals with metabolic syndrome ate a nearly identical diet (it was adjusted only according to each person’s ideal weight). Each of the volunteers also took either a combination of berberine (500mg), policosanol (10mg), and red yeast rice (3mg, a very small dose) or a placebo after dinner each day for 18 weeks.
At the end of the study, those taking the berberine and other botanicals had significant improvements in measurements of insulin resistance when compared to those who took the placebo. In addition, the botanical users had better fasting and ‘two-hours-after-eating’ blood sugar and insulin levels. Their systolic blood pressure, total cholesterol, and LDL cholesterol were all significantly improved as well.6
Other researchers also concluded that berberine can effectively treat metabolic syndrome and insulin resistance, and help prevent them from proceeding inevitably to type-2 diabetes.7,8,9
Revealing the PCOS connection
Women with polycystic ovarian syndrome (PCOS) suffer from an unusually high incidence of insulin resistance. In addition, approximately 75% of women with PCOS have significantly higher levels of testosterone and other androgens than other women. Berberine may be able to help here as well. Research in China revealed that berberine can help relieve some of the troubling symptoms of this condition.
Eighty-nine women with PCOS who were already taking an anti-androgenic patent medicine took one of three additional treatments for three months.10 Thirty-one took berberine, 30 took the patent medicine metformin, and 28 took a placebo.
When compared with the metformin group, the berberine group had a significant decrease in waist circumference, waist-to-hip ratio, total cholesterol, triglycerides and LDL cholesterol. In addition, the berberine users saw a significant increase in their HDL cholesterol and sex hormone binding globulin (SHGB) levels.
When compared with placebo, berberine again came out on top. The berberine users had even more significant improvement for all these parameters, plus a significant improvement in fasting blood sugar and insulin, insulin resistance measurement, and ‘area under the curve’ of insulin.
Berberine and your bones
Diabetic osteopathy is a complication of diabetes. In normal bone, there’s a balance between new bone building done by bone cells called ‘osteoblasts’ and older bone destruction done by bone cells called ‘osteoclasts’.
In addition, there’s a balance between two parathyroid gland hormones, called ‘calcitonin’ which promotes bone building, and ‘parathyroid hormone’ which promotes bone degradation. But, in contrast, in diabetic osteopathy the activity of bone-building osteoblasts is inhibited, and the activity of bone-degrading parathyroid hormone is increased.
Research has shown that berberine can decrease the bone destruction done by osteoclasts, and inhibit the promotion of bone degradation by parathyroid hormone.11
Of course, it also helps by lowering the insulin resistance and blood sugar levels that stimulate these problems in the first place.
Berberine may be one of your brain’s best friends
Researchers are exploring berberine’s potential for the treatment of neurodegenerative disorders as well as its potential protective effects against depression, schizophrenia and anxiety.12 Although there are no controlled studies completed yet, the fact that berberine is a known inhibitor of the brain enzyme ‘cholinesterase’ makes it a breakthrough in Alzheimer’s disease treatment.13 This is the same enzyme deliberately targeted by patent medicines ‘approved’ by the medical authorities for Alzheimer’s disease treatment.
Even though studies of berberine’s effect on human Alzheimer’s aren’t yet reported, one animal study has already found that berberine suppresses brain cells’ inflammatory response to beta amyloid, a major factor in Alzheimer’s dementia.14 A second animal study – done with mice genetically engineered to develop human-style Alzheimer’s disease – found that berberine reduced both the damage caused by beta amyloid, and the amount of cognitive impairment.15 These animal studies were building on earlier research that had already shown berberine significantly reduces beta-amyloid production in cultured human brain cells.16
Other animal studies have found that berberine may also help repair peripheral nerve damage. Animals with sciatic nerve damage were given berberine by injection; within a month, there was a noticeable regrowth of the damaged sciatic nerve.17 In the same publication, the researchers reported that berberine stimulated increased growth of ‘dendrites’, the very thin extensions branching out from the main body of a nerve cell which transmit ‘information’ in and out.
As berberine research continues, we’re finding out that it really is one of the most versatile plant substances for supporting human health. It not only kills many micro-organisms, research has also found that it could significantly improve type-2 diabetes, and may even help to prevent it, too. Berberine has shown promise in fighting Alzheimer’s disease, and, most recently, its anticancer actions have been the subject of considerable research.18
However, all these novel uses are really only new to ‘Western’ science. Chinese medicine has long used a herbal remedy known as ‘huanglian’. Huanglian, derived from Coptidis rhizoma, is primarily made up of berberine. The remedy is used for the treatment of many diseases, including cancer.19
Could berberine help stop the spread of cancer?
Although powerful on its own, research has found that berberine can give some medications a boost. For example, it’s been shown to increase the sensitivity ‘in vitro’ (that is in cell cultures, not living animals or humans) of two cancer cell types… A549 and HeLa… to doxorubicin, an anti-cancer patent medicine.20 And it has been studied for its ability to inhibit breast cancer cell metastasis.21
Berberine has been found to have its own cytotoxic effect on cancer cells. It was shown to have the ability to kill cancer cells in a specific breast cancer cell line known as MCF-7. Researchers speculate that the herb may be able to serve as a naturally occurring treatment for breast cancer therapy.22
But berberine doesn’t stop with breast cancer. It turns out that melanoma, or skin cancer, may be susceptible to berberine treatment as well. One group of researchers found that the botanical inhibited cancer on the cellular level, keeping two types of melanoma cells from metastasizing or spreading around the body. This is particularly important since this is typically how melanoma kills.23
Berberine’s cancer-fighting prowess doesn’t even end there. It reportedly has beneficial effects against oral cancer, and helps stop the development and spread of tumours of the colon.24,25 And the herb has been shown to inhibit prostate cancer cell growth in mice.26 (See page 7 for more details on berberine’s prostate cancer fighting prowess.)
Keep your cholesterol under control
Berberine isn’t only a friend to diabetic cholesterol control, it can lower cholesterol in non-diabetics, too. One study tracked 32 people with high cholesterol who took berberine for three months. By the end of the study, total cholesterol levels were reduced 29%, triglycerides were reduced by 35%, and LDL-cholesterol was reduced by 25%. The same group of researchers28 (as well as another group29) demonstrated that berberine lowers cholesterol in a different way than ‘statin’ patent medicines.
Another group of researchers investigated the possibility of using berberine as a treatment for obesity and elevated cholesterol and triglycerides. Ten individuals participated in the 12 week pilot study, taking 500mg of berberine three times daily. Seven of 10 completed the study; of these, four experienced an average weight loss of 5 pounds and the other three did not lose or gain weight. However, there was an average 12.2% decrease in total cholesterol and an average 23% decrease in triglycerides.
In addition, the researchers observed an increase of calcitriol (a bone-building parathyroid hormone) levels in all 10 volunteers during the study, suggesting berberine may also aid in the prevention of osteoporosis. These same authors also conducted a rat study that found a significant decline in total cholesterol and triglycerides at the end of a 12 week berberine protocol.30
Improved heart function in just 8 weeks
Berberine improves heart function in chronic congestive heart failure. 156 individuals with congestive heart failure were taking conventionally prescribed therapy of ACE inhibitors, digoxin, nitrates and diuretics. Seventy-nine of the group also took 1,200 to 2,000mg of berberine daily, while 77 took a placebo.
When symptoms and heart function were compared at eight weeks and two years later, the patients who took berberine showed significantly better heart function, better exercise capacity, and significantly less fatigue than the placebo group. There were 13 deaths in the placebo group, but only seven in the berberine group.31
Berberine has also been found to be useful in the treatment of congestive heart disease and for arrhythmias.32 And the herb has been shown to significantly lower homocysteine (a cardiovascular risk factor) in experimental animals, while at the same time lowering lipids.33
In a study of stroke caused by blocking an artery to the brain in experimental animals, administration of berberine within 24 hours significantly improved recovery time, and reduced the overall area of dead brain cells.34
The natural antibiotic
You read earlier that berberine was first used as a natural antibiotic and it still has much to offer in this area. The list of micro-organisms berberine works against is a long one, including Staphylococcus, Streptococcus, Chlamydia, Diphtheria, Salmonella, Vibrio cholerae, Diplococcus pneumoniae, Pseudomonas, Gonorrhea, Candida (technically a fungus) and others.
Berberine also works against parasites, including Giardia lamblia, Trichomonas vaginalis, Entamoeba histolytica and Leishmania donovani. In one study, comparing the effects of berberine to the patent medicine metronidazole (Flagyl®), just half a dose of berberine was nearly as effective against parasites as metronidzole at full dose.35
Berberine’s therapeutic effects go beyond just killing germs. The botanical can help fight the sometimes fatal diarrhoea caused by a few of them. That’s right, death from intense diarrhoea! Less than two centuries ago in America, and even recently in ‘third world countries’, the majority of the population of small towns and villages could be wiped out by the intense diarrhoea caused by the nasty parasite Vibrio cholerae. Vibrio cholerae secretes a toxin which causes tremendous water loss from the internal intestinal walls.
In cases of cholera and other diarrhoea-causing bacteria, berberine’s poor absorbability is actually an advantage, since the majority of it stays within the inner walls of the intestines directly killing the germs lurking there.36 In a separate diarrhoea-combating action berberine reduces the intestinal release of water and electrolytes caused by the cholera toxin.37 The botanical then adds a third layer of protection against diarrhoea by reducing abnormal gut permeability.38
Showing promise against MRSA
In the 21st century one of the ‘most-feared’ bacterial infections is methicillin-resistant Staphylococcus aureus, also known as MRSA or ‘flesh eating bacteria’. It’s possible that berberine may help against this deadly micro-organism, too. Research has shown that berberine alone inhibited some strains of MRSA. Combining the botanical with particularly nasty antibiotics, azithromycin or levofloxacin, inhibited 90% of all MRSA strains tested.39
Berberine’s germ-killing ability could also be the answer to four seemingly unrelated problems: low platelet counts (for the technically inclined, idiopathic thrombocytopenic purpura, or ITP), gastric hypochlorhydria (low stomach acid), peptic ulcers, and some cases of ischaemic (lack of blood flow) stroke.
How can this be? The answer may lie in berberine’s ability to kill the germ Helicobacter pylori.
Helicobacter pylori are associated with ITP, and while the exact way the bacteria lead to the condition is unknown, it’s believed that they trigger autoimmunity. Researchers have reported that, in test tubes, a very low concentration of berberine (12 micrograms per millilitre) inhibits the growth of Helicobacter.40
Canadian researchers completed a systematic review of the existing literature on the effects of Helicobacter pylori eradication therapy on people diagnosed with ITP. The studies compared the platelet response of those infected with H. pylori to people not infected. (It’s a bit of a mystery why Helicobacter eradication therapy would even be tried in individuals who didn’t have Helicobacter, but perhaps it’s because it’s the only treatment ever found to be effective in ITP).
Eleven studies were included in the review. In those, a total of 200 individuals were diagnosed with ITP and 282 patients received Helicobacter pylori eradication therapy. Two hundred and five were Helicobacter pylori-positive and 77 were Helicobacter pylori-negative. Over 52% of the Helicobacter-positive individuals had a significantly improved platelet count, while only 8.8% of the Helicobacter-negative saw a significant improvement in platelet count.
Putting these two studies together, it appears that berberine treatment – rather than harsh conventional ‘triple antibiotic’ treatment – should be tried first in Helicobacter-positive individuals with ITP.
The digestion connection
It may seem strange at first glance that berberine could treat both peptic ulcers and low stomach acid. That’s because of the mistaken impression that these two conditions are opposites. It’s true that for nearly the entire 20th century Western medical dogma said that peptic ulcers were caused by too much stomach acid, despite the finding by Japanese researchers in 1919 that spiral bacteria (Helicobacter are spiral-shaped) caused gastric ulcers, as well as the discovery of Helicobacter in human stomachs by an American researcher in 1939.
After that, a number of physicians cured peptic ulcers with antibiotics, including penicillin. (A Greek physician was actually fined for curing ulcers with antibiotics!) In the 1980s Australian researcher Barry Marshall famously gave himself a peptic ulcer by swallowing – you guessed it – a big dose of Helicobacter pylori. He and fellow researcher Robin Warren also cured peptic ulcer patients with antibiotics.
But as ‘Wikipedia’ politely writes: ‘an extensive effort was required to convince the medical community of the relevance of their work.’ (It appears that some things never change…) Marshall and Warren were finally awarded the Nobel Prize in Medicine and Physiology in 2005 for this discovery.
So, as the majority of peptic ulcers are caused by Helicobacter pylori, and berberine inhibits Helicobacter, the connection is clear. Now, for low stomach acid…
In 2000, Japanese researchers reported on the results of acid secretion tests done on 280 individuals. They concluded: ‘In the population studied, advancing age had no influence on gastric acid secretion in Helicobacter pylori-negative subjects. Gastric acid secretion decreases with age in Helicobacter pylori-positive subjects because of the increasing prevalence of FAG [fundal gastric atrophy] with age.’41 (The ‘fundus’ of the stomach is – a bit loosely – the upper part.)
In other words, the presence or absence of H. pylori corresponded to the presence or absence of low stomach acid. So it’s a reasonable conclusion that the Helicobacter caused the hypochlorhydria as time went by (‘with age’), and not that advancing age causes Helicobacter infection. And it’s also reasonable to conclude that, if caught before the damage is too great, berberine might reverse hypochlorhydria, maybe even returning things all the way back to normal!
Lastly, there’s the type of stroke that’s caused by lack of blood flow, called ‘ischaemic stroke’. A Japanese research team reported that in a group of 62 first-time stroke sufferers, chronic Helicobacter pylori infection was significantly associated with a higher risk of stroke due to small artery occlusion (for the technically inclined, p <0.001).42 Since berberine inhibits Helicobacter… well, you see where I’m going here.
Ooops, that wasn’t ‘lastly’, because I mustn’t leave off the research connecting some cases of coronary atherosclerosis with Helicobacter pylori. Because we’re running out of space, and still have one important question to answer, I’ll just reproduce part of the title of one of the many research articles proving the association: ‘The detection of H. pylori specific DNA in human coronary atherosclerotic plaque.’43 Yup, H. pylori are implicated in the hardening of arteries too. And of course, as we learned earlier, the best form of berberine for bacteria found outside of the gut would be the better absorbed berberine with milk thistle combination.
Berberine’s effect on ‘friendly’ bacteria
With all the anti-bacterial and anti-parasite effects associated with berberine, there’s been (until recently) one unanswered question. Does berberine act like ‘regular’ antibiotics in your body… killing off all the ‘friendly’ bacteria in your gut along with the ‘bad guy’ types? In other words, if you’re taking the botanical for a long period of time do you also need to be taking probiotics to counteract the ‘number’ it’s doing on your gut? The answer from a preliminary research study appears to be ‘no’.
This study was done on rats, so even though it’s very likely the same results would be seen in humans, it’s not for certain. It demonstrated two separate but (as the researchers wrote) likely interrelated effects. First, berberine prevented diet-caused insulin resistance and obesity. Secondly, using very sophisticated genomic testing, the researchers found beneficial changes in the rats’ gut bacteria. Even though there was less ‘diversity’ of gut bacteria after berberine administration, the over 200 bacterial species which disappeared were thought to be ‘antigenic’ and ‘pro-inflammatory’, while the remaining bacteria produced significantly more ‘short-chain fatty acids’, which have anti-inflammatory effects. So, in other words, it appears that berberine mostly targeted the bad guys leaving the good guys alone.
The researchers concluded that the changes in gut bacteria may be at least partly responsible for the effects in preventing obesity and insulin resistance.44
No, this isn’t a definitive answer to whether berberine will ultimately be found to be in the same category as oregano and garlic, which discourage ‘unfriendly’ bacteria while promoting the growth of good ones. So it can’t hurt to use probiotics. But – in my opinion – when this research is done in humans it will come to the same conclusion: Berberine targets the bad germs while leaving our ‘friendly’ bacteria alone.
In fact, as research continues to pour in, I think it will not only be confirmed that berberine is good for us in all the ways both proven and hinted at in this article, but in many other ways that have yet to be discovered as well.
Wishing you the best of health,
Dr. Jonathan V. Wright
Nutrition & Healing
Volume 7, Issue 2 – February 2013
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.