Another study published in the journal Diabetes Care compared the effects of berberine and metformin on weight loss in individuals with type 2 diabetes. Not only does metformin lower blood glucose levels, but it can also reduce any complications that diabetes patients experience on a daily basis. It has been shown to have similar effects on blood glucose levels and insulin sensitivity as metformin, but with fewer side effects. In addition, berberine displays an inhibitory effect on proliferation and differentiation of preadipocytes. Berberine exerts its long-term body weight losing effect through enhancing AMPK-mediated ATGL expression, which increases the basal lipolysis state of triglycerides in adipocytes . This anti-obese activity is consistent with the finding that berberine significantly decreased sizes and number of lipid droplets in 3T3-L1 adipocytes . Mice treated with berberine were found to contain shrunk adipocytes . If those are not providing benefit, I find berberine to work well with Metformin as well. “I have seen berberine work exceptionally well alone, and I often begin first with berberine capsules and nutritional therapy. And these effects are being seen in real life scenarios. You can even take it alongside medications you already take, as the studies above showed. Glycolysis is the pathway that assists with utilizing and storing glucose in the body. There have been numerous clinical trials investigating the effects of metformin on weight loss, while the research on berberine is still relatively limited. In addition to its effects on blood sugar control, metformin has also been shown to have some beneficial effects on weight loss. Research suggests that berberine may help regulate blood sugar levels, improve insulin sensitivity, and reduce inflammation – all factors that can contribute to weight gain. They both offer modest weight loss benefits and help improve insulin sensitivity, which leads to lower blood sugar levels. This nuanced understanding of berberine vs metformin side effects is essential in optimizing patient care and outcomes. The elderly and those with pre-existing conditions need to follow their healthcare provider’s guidance closely due to potential interactions and side effects exacerbated by comorbidities. Rare side effects might include hypoglycemia when taken in high doses, though this is more prevalent in patients concurrently using other glucose-lowering agents. In conclusion, both Berberine and Metformin display significant potential for promoting longevity through their effects on metabolic processes and cellular health. Metformin, commonly used as a first-line treatment for type 2 diabetes, has also shown potential in promoting longevity. My top secrets to boost energy, rev up metabolism, and lose weight and keep it off- naturally! As an RD, author, & speaker, I show you how to make time for health, even when you have no time for yourself. In addition, each of these options can impart other health benefits. I do not condone blindly taking berberine for all of these reasons, plus the possibility that you may be taking something that can interact with this supplement. However, there is not a standard recommendation in terms of dosage and scheduling when it comes to berberine. In recent years, Berberine has been gaining recognizable momentum within the medical field for treating type 2 diabetes. Metformin is a commonly prescribed commercial pharmaceutical for individuals at risk for or who have developed type 2 diabetes. We are a health and wellness site, with work written by Registered Dietitians or Medical Professionals, please review our editorial process here. There is no one-size-fits-all solution to maximizing your health and utilizing a comprehensive approach with your medical healthcare team. It’s important to highlight that berberine, being a supplement, is not under regulatory scrutiny. Reporting bias was explored through funnel plot analysis when the number of included trials exceeded ten. The exclusion criteria were non-randominzed controlled trials and quasi-randomized controlled trials; abstracts or comments from conference papers; animal studies and obvious duplicate studies. The secondary outcomes consisted of homeostasis model assessment of insulin resistance (HOMA-IR) and adverse effects. The primary outcomes consisted of fasting plasma glucose levels (FPG), 2-hour postprandial plasma glucose (2hPG), glycosylated hemoglobin levels A1c (HbA1c). This research used the Cochrane systematic evaluation method and evaluated the efficacy and safety of berberine and metformin in treating T2DM in RCTs. Berberine and Metformin both are great aids to help your overall health, but which one is best for you? Metformin reduces A1C ~1% vs placebo and improves hard outcomes; berberine lowers A1C ~0.6–0.7% in meta-analyses but with smaller, heterogeneous trials. Use berberine when metformin is contraindicated or intolerable, preferably short-term with clinician oversight and third-party–tested products. Consider berberine if you can't take metformin and want a modest, supplement-based metabolic aid from a vetted brand, with attention to interactions and pregnancy avoidance. Therefore, the activation of LKB1/AMPK pathway by metformin offers a meaningful strategy for tumour treatment. A plethora of in vitro studies have demonstrated that metformin inhibit tumour cell growth via various mechanisms 24, 60. The T2DM patients with cancers such as lung cancer, pancreatic cancer and breast cancer showed better prognosis when metformin was used as a hypoglycemic drug 62–64. The first seminal report is the retrospective investigation on the incidence of tumour in T2DM patients receiving metformin, which shows 30% reduction of overall tumour onsets . The effects of metformin on tumour have emerged as a hot topic during the last decade or so 24, 59, 60. They carry the potential to unlock AMPK, considered a highly conserved pathway that switches on catabolic pathways generating ATP.For example, a study published in the journal “Evidence-Based Complementary and Alternative Medicine” found that Berberine significantly reduced body weight and improved lipid profiles in obese patients.For HbA1c, the highest level of efficacy was observed with an intervention duration of no more than eight weeks and less than twelve weeks, especially for those patients with T2DM that have had this condition for 5–10 years.The findings are encouraging but less consistent than metformin.Metformin and berberine are both powerful tools for improving insulin sensitivity and managing blood sugar.Research illustrates that Berberine’s ability to enhance insulin sensitivity parallels that of Metformin.For those primarily focused on diabetes management, metformin may offer more immediate and reliable blood glucose control.While early research shows it may lower blood sugar similarly to metformin, the scientific evidence is still developing. Can You Have Hypoglycemia Without Diabetes? (Low Blood Sugar) In humans, a single oral dose of 500 mg berberine administration generates 0.07±0.01 nM in plasma, while the Cm is 4.0±2.0 nM after chronic administration of 15 mg/kg for three months . The maximum concentration (Cm) of berberine in plasma is 12 nM after the oral administration of 100 mg/kg in rats . In keeping with this, the concentrations required for AMPK activation in vitro are at mM levels. One explanation is that metformin is a cation and transport to mitochondria slowly, but accumulates there to high concentrations (100~500 fold, i.e. 1~5 mM), which is sufficient for AMPK activation . In rodent animals, usually 5 times injection dose (150 mg/kg, i.p.) or 10 times oral dose (250~300 mg/kg) of humans will achieve 5~10 μM which generate similar effects . Third, literature qualities were uneven, although the included trials were RCTs. Subgroup analyses were also conducted to clarify how berberine is used. The results showed that the different interventions in the control groups seemed to be a potential impact factor of heterogeneity. In addition, berberine stabilizes LDL receptor mRNA to increase the clearance rate of plasma LDL . Metformin works by reducing the amount of glucose produced by your liver. Metformin is an oral prescription medication commonly used to treat type 2 diabetes. It also helps our liver, muscles, and fat respond better to insulin, making everything work more smoothly. Commonly reported effects include improved glucose levels, weight loss, reduced inflammation, and improved lipid profiles. In one study, berberine was found to be effective in terms of lowering blood glucose levels. In terms of its effectiveness, berberine appears to be comparable to metformin at lowering blood glucose levels. This activation helps to increase glucose uptake in cells, improve insulin sensitivity, and reduce blood sugar levels. At this stage, it can be converted to energy in the form of fat and glucose. Consequently, this drops glucose production in the liver. It also keeps lipid levels within bounds, per some research. Although the process is less clear, these effects could result from a reduction in appetite or alter the way our bodies store and use fat. Research suggests that it reduces glucose-induced cell death in mice and enhances autophagy. A Mediterranean-style diet—rich in plants, fish, and olive oil—works synergistically, lowering A1c by an extra 0.3 % in studies. In the U.S. berberine is over-the-counter, but professional guidance is still recommended for dosing and monitoring. Not usually, but when combined with insulin or sulfonylureas, mild hypoglycemia has been reported. Taper only after discussing recent labs, weight changes, and lifestyle stability with your clinician. Most trials see measurable change at 12 weeks when taken at 500 mg three times daily with meals. Categorical variables used the odds ratio (OR) and continuous variables used the mean differences (MD) as analysis statistics. The quality of the included trials was assessed using the Cochrane risk bias tools (Review Mamager 5.4 provided by the Cochrane Collaboration) . They extracted data concerning details of the sample size, interventions, duration of treatment, age and outcomes by using a standard Microsoft Excel (Microsoft Corporation, office 2016) file. Two reviewers independently assessed trials for inclusion in the review. In the future, the association of each factor with the effect of berberine for the treatment of T2DM patients should be quantified by metaregression analysis. The latest study was published in 2019, which first performed subgroup analyses to examine the source of heterogeneity and identify the potential factors which likely determine the effects of berberine. Six trials were considered for the analysis of the efficacy of berberine on IL-6 levels. The choice between metformin and berberine for weight loss ultimately depends on individual circumstances, medical history, and preferences. While both metformin and berberine have shown potential benefits, it's essential to consider their potential safety profiles and side effects. How to take them: Dosage and timing For most people needing reliable glucose lowering and long-term outcome data, choose metformin. Neither berberine nor metformin should be used without clinician guidance. Patients often come to the pharmacy or clinic with recurring questions about metformin and berberine. “Berberine is a plant-based supplement some people use to support blood sugar and cholesterol. Furthermore, the lipid lowering effect of berberine is comparable to those conventional lipid drugs but with low toxicity. Another drug, berberine, extracted from berberis vulgaris L. Since the discovery that it activates AMP-activated protein kinase (AMPK) and reduces risk of cancer, metformin has drawn great attentions. Avoid proprietary blends that obscure the actual berberine dose. Always review your full medication list with a clinician or pharmacist before starting berberine. It does this by starting a chain reaction with something called insulin-like growth factor-1 (IGF-1). Which means, it has been done in a lab isolating the study sample outside of the living organism. More research does need to be conducted since many of the studies were done on animals or in vitro. Our work also showed the plasma lipid profiles of diabetic patients were improved by berberine intake.Metformin and berberine are both used to manage type 2 diabetes and insulin resistance, but they have some distinct differences that you should be aware of.Metformin reduces A1C ~1% vs placebo and improves hard outcomes; berberine lowers A1C ~0.6–0.7% in meta-analyses but with smaller, heterogeneous trials.Although the effect size for Fins in BBR monotherapy was reversed after trimming and filling, overall, the results of our meta-analysis are considered reliable.In the U.S. berberine is over-the-counter, but professional guidance is still recommended for dosing and monitoring.A random effects model was applied if there was any heterogeneity observed. A total of 15 studies (Li and Liu, 2007; Yin et al., 2011; Zhou and Huang, 2012; Yao, 2015; Yu, 2015; Zhu et al., 2015; Meng, 2016; Sun, 2017; Wu, 2017; Huang et al., 2018; Yao et al., 2018; Chen Z. et al., 2021; Wang et al., 2022; Yu, 2022; Yang B. et al., 2023) reported data on TG. Sensitivity analysis indicated that the results were relatively robust (Figure 8H). We hypothesized that the heterogeneity may be related to the dosage of the combined medications, and further high-quality studies are needed for validation. A total of 14 studies (Li and Liu, 2007; Yin et al., 2011; Zhou and Huang, 2012; Yao, 2015; Yu, 2015; Zhu et al., 2015; Meng, 2016; Sun, 2017; Huang et al., 2018; Yang et al., 2020; Chen Z. et al., 2021; Wang et al., 2022; Yu, 2022; Yang B. et al., 2023) reported data on TC. Additionally, there is a lack of long-term studies on berberine and its potential side effects. Overall, berberine appears to be a potent supplement for those looking to regulate their blood sugar and cholesterol levels. It is used to control blood sugar levels, thus improving the quality of life for those with diabetes. So, if you want to learn more about how metformin and berberine can help you control your blood sugar, keep reading. Two trials 24, 25 were aimed at evaluating the effectiveness and safety of Rhizoma Coptidis in the treatment of T2DM, and two 26, 27 were for root dry extracts including berberine. Of these, 38 were related to berberine in the treatment of T2DM, and four 20–23 were for prediabetes. Subgroup analysis was planned to explore the source of heterogeneity according to the differences of treatment methods among trials. Alkaloids from Huanglian have been widely used for the treatment of diabetes and hyperglycemia with inconspicuous toxicities and side effects . Moreover, patients with T2DM are more likely to be overweight or obese, which indicates insulin resistance and dyslipidemia along with hyperglycemia 5, 6. Cardiovascular advantages may further elevate berberine’s status as a metabolic aid. Researchers have observed measurable improvements in glycemic control among individuals taking berberine supplements regularly. Berberine’s wide-ranging effects have prompted comparisons to pharmaceutical drugs, although it’s important to remember its classification differs significantly. Interest in natural alternatives to conventional medications continues to rise, especially among those managing type 2 diabetes. Get a week of healthy meal ideas that take 20 minutes or less, right to your inbox. Berberine could be a part of your overall PCOS treatment plan, depending on a doctor’s evaluation and recommendation. This insulin resistance contributes to hormonal imbalances, irregular periods, and other symptoms that many women struggle with.” According to Eapen, MD, “PCOS is now recognized primarily as a metabolic condition, with insulin resistance being a key driver in 60-70% of cases. These early findings suggest that the two may work in similar ways to improve insulin sensitivity. A review of 14 studies found berberine to be equally effective at lowering blood sugar as commercial type 2 diabetes medications, including Metformin, Avandia, and Glucotrol. However, more evidence is emerging on berberine’s therapeutic effects on blood sugar, insulin sensitivity, and cardiovascular biomarkers. There was a study conducted where researchers tested how metformin affects the feeling of fullness and weight loss in women with diabetes and obesity. Metformin helps control blood sugar levels in individuals with type 2 diabetes by addressing several aspects of glucose metabolism. In one study, it found that berberine was just as effective as metformin in the reduction of their HBA1C in patients living with type 2 diabetes. However, metformin has been studied more extensively and is available only with a prescription, while berberine is available as a dietary supplement.Why science matters in weight and brain healthIn 2019, approximately 4.2 million adults had an estimated cause of death related to diabetes and its complications.And of course, the most interesting benefit to you as a person with type 2 diabetes or prediabetes, is berberines’ ability to help improve blood glucose control.Berberine is marketed in capsules or tablets, usually as berberine hydrochloride.Singh et al. (2020) found in in vitro experiments that when BBR is co-incubated with SU, it may interfere with the metabolism of SU, potentially weakening its hypoglycemic effect to some extent.Monitoring is recommended to track any potential side effects or interactions with other medications.First, the limitations of study methodology may vary across research conducted in different years; earlier studies may have less rigorous designs, potentially introducing greater bias in results, whereas study designs may have improved over time. Berberine vs Metformin for Diabetes Management Both berberine and metformin have their origin in natural elements that have been prescribed in glucose regulating treatment. This can lead to weight loss in individuals with diabetes, as excess glucose is converted into fat. It is crucial to discuss the potential risks and benefits with a healthcare professional before starting any weight loss regimen involving these medications. Gastrointestinal issues are the most common side effects of both drugs, but metformin carries a higher risk of lactic acidosis, while berberine can lower blood pressure. Like metformin, berberine works by improving insulin sensitivity and reducing glucose production in the liver. Berberine’s broader therapeutic scope, impacting lipid metabolism and potentially having antioxidative effects, might offer added benefits such as improved cardiovascular health. In conclusion, both Berberine and Metformin offer viable options for weight loss, working through distinct yet complementary pathways to enhance metabolic health. Similarly, research in the “Diabetes, Obesity and Metabolism” journal highlighted that Metformin administration led to moderate weight loss in individuals with insulin resistance. For example, a study published in the journal “Evidence-Based Complementary and Alternative Medicine” found that Berberine significantly reduced body weight and improved lipid profiles in obese patients. We encourage readers to share their experiences and insights on berberine vs metformin to foster a deeper understanding and support others in making informed choices. Consultation with healthcare providers is essential before making any changes or beginning new treatments. Importantly, personal preferences, potential side effects, and lifestyle integration should also influence the decision. Patients should consult their healthcare providers to determine the most appropriate dosage for their condition and monitor any side effects. Both treatments appear to offer promising life extension benefits through their effects on cellular metabolism. When combined, closer glucose monitoring is needed to avoid unexpected hypoglycemia, and medication interactions should be rechecked. • Check fasting glucose within 2–6 weeks and HbA1c around 8–12 weeks. • Document baseline fasting glucose, HbA1c, liver enzymes, and renal function if indicated. Some clinicians and patients also look to specific formulations such as Motus when considering supplement options; see Motus for product details Motus. Below are common, real-world examples where berberine can be a reasonable part of shared decision-making. You can find berberine as a supplement in the form of a capsule, tablet, or powder. On the other hand, metformin may help slow aging, lower the risk of cancer, and lower the risk of cognitive decline. These side effects may go away after you adjust to the supplement/medication and fine-tune your dosage schedule. This means you should be extra cautious about the source of your berberine supplement, and seek out high quality, third-party tested brands to ensure purity. Just like any supplement, berberine is not heavily regulated. Metformin dosage For an overview comparing metformin and berberine pharmacology and clinical findings see this review Metformin and berberine review 2017. Many berberine trials are small and run for a few weeks to several months. Remarkably, when data are pooled, the magnitude of HbA1c reduction with berberine often approaches reductions we commonly observe with metformin in clinical practice. In addition, this treatment did not increase the risk of serious adverse events when the routine dosage ranged from 0.6 g to 1.5 g. This indicates that berberine as an additional therapy shows synergistic benefits with hypoglycemic agents. In T2DM, obesity and dyslipidemia bring about low-grade inflammation and factor like IL-6 and TNF-α levels were found to be strikingly increased. This is consistent with the current meta-analysis specific to T2DM, which showed a remarkable lowering of TC, TG, and LDL, along with moderate upregulation of HDL. The efficacy of berberine on dyslipidemia has been widely researched. To determine the potential advantages of berberine for diabetic care, we conducted this systematic review and meta-analysis to examine the efficacy and safety of berberine in the treatment of patients with type 2 DM. Find the best berberine supplement for improved metabolic function, gastrointestinal health, and blood sugar management! Both metformin and berberine can help to improve one’s very own life with the help of controlling their weight and to stay at a healthy BMI. Berberine, which lowers blood sugar and cholesterol, has become a popular supplement in recent years. In contrast, berberine may cause gastrointestinal side effects such as nausea, abdominal pain, and diarrhea. In terms of safety, metformin is generally considered to be a well-tolerated medication with few side effects. Metformin reduces liver glucose release and hyperglycemia faster than berberine. It also makes the body more sensitive to insulin, which lowers the risk of long-term problems. Metformin is taken orally and works to reduce the amount of glucose that is released from the liver. Metformin is a commonly prescribed medication for type 2 diabetes and prediabetes. I am a registered dietitian and certified as a diabetes care and education specialist (formally known as a certified diabetes educator). If you are living with diabetes, you may be wondering if you can take protein bars as a snack…. It is possible that berberine might accumulate inside cells, similarly to metformin, to achieve the in vivo effects. In light of the anti-tumour activities mentioned above, simultaneous treatment of inflammation and cancer by berberine or metformin may yield a better prognosis and point to a new research area . In terms of possible role in inhibiting EMT and metastasis of cancer, berberine and metformin seem to have similar effects 81–83. 1. Search Strategy and Study Selection And it also regulates activities such as lipid and glucose production.” Dr. Morstein explains that berberine influences the AMPK pathway (adenosine monophosphase-activated protein kinase). Now that you have those concepts in mind, let’s move on to how berberine works… Your liver plays a critical role in insulin resistance, along with energy metabolism as well. Another important thing to recognize is it’s not just the pancreas and insulin involved here. She combines her comprehensive knowledge with a dedication to patient-centered care, embodying a commitment to enhancing healthcare standards in her field. A Northwestern University alumna, she pursued her medical degree at the University of Vermont, fostering a deep understanding of women's health and reproductive medicine. She is an experienced healthcare executive and the President of Global Insight Advisory Network. Chandana Balasubramanian is a science writer who loves to translate complex science into clear insights on metabolism, weight management, nutrition, and much more. Fay Nutrition has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. In addition to the improvement in blood sugar levels, Berberine has anti-inflammatory and immune-supporting properties that do not appear to be present in Metformin. Clinical studies demonstrate Berberine may support healthy body function, however, more research is required to confirm the long-term safety and side effects of Berberine. Due to Berberine’s favorable effects against insulin resistance, it is popularly used among individuals with type 2 diabetes. This corresponds to its effects of improving insulin resistance and the regulation of glycemic and lipid metabolisms. Regarding safety, our work demonstrated that berberine had no toxic effects on Scr and BUN. Our meta-analysis illustrated that berberine significantly downregulates CRP, IL-6, and TNF-α. A meta-analysis proved that berberine supplementation ameliorates the state of chronic inflammation by lowering the serum level of CRP . Whether used alone or combined with other therapies, meta-analyses 16, 72 suggested that berberine improve obesity and hyperlipidemia by reducing TG, TC, and LDL and increasing HDL in the setting of several metabolic disorders along with improving glucose metabolism. That question sits at the intersection of curiosity, caution, and real-world choices for people with prediabetes or type 2 diabetes.AMPK functions specifically to help to regulate metabolism and energy levels within your body.Based on the current scientific evidence there are more randomized controlled trials that support metformin in its uses for diabetes management.Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression.To identify potential publication bias among the included studies, funnel plots as well as Egger’s test were employed (Egger et al., 1997).Berberine’s safety profile is less established due to supplement variability and lack of large-scale trials.Similarly, research in the “Diabetes, Obesity and Metabolism” journal highlighted that Metformin administration led to moderate weight loss in individuals with insulin resistance.No severe adverse effects were reported in all trials. Some studies suggest that berberine may aid in weight loss by improving insulin sensitivity and metabolism. Participants taking berberine saw similar reductions in fasting blood glucose levels and hemoglobin A1c (HbA1c) as those taking metformin. But berberine, a natural compound found in plants like barberry, goldenseal, and Oregon grape, is gaining attention for its potential to control blood sugar levels. Metformin also makes insulin work better, which is important for people with diabetes who want to control their blood sugar levels. It can cause side effects such as gastrointestinal upset, and it should be used with caution in individuals with kidney or liver disease. It should be used in conjunction with a healthy diet and regular exercise for optimal results. Metformin works by improving insulin sensitivity, allowing the body to use insulin more effectively. However, a recent report demonstrates that berberine blocks complex I, leading to increases in glucose consumption and lactate release, which is independent of AMPK . Thus, Madiraju et al have demonstrated that metformin inhibits mitochondrial glycerol-3-phosphate dehydrogenase, leading to changes in mitochondrial and cytoplasmic redox states and glucose synthesis . Second, in vitro studies revealed that the concentration of metformin required for activation of AMPK is greater than that for acute inhibition of gluconeogenesis in hepatocytes . Berberine improves insulin sensitivity by upregulating autophagic levels in macrophage and inhibiting ATM phenotypic switch to decrease CD11c+ population 94, 95. The optimal dose, optimal duration of berberine and metformin, even interactions between them requires further study.Similar findings were reported in a clinical study of Zhang et al .In conclusion, both metformin and berberine can be effective options for individuals looking to lose weight.Both metformin and berberine have been studied extensively, and while they have similar mechanisms of action, there are some key differences between the two.Treatment protocols often include Metformin, a medication traditionally used for diabetes management, and, more recently, Berberine, a natural compound with similar therapeutic properties.This corresponds to its effects of improving insulin resistance and the regulation of glycemic and lipid metabolisms.Berberine is often taken as a general supplement for metabolic health, while metformin is strictly used for medical treatment.Its effects are considered to be beneficial for overall health but it also has some specific uses and benefits.When you hear about "reversing diabetes," this actually means achieving remission—where blood sugar levels return to normal ranges without medication. Its effects are considered to be beneficial for overall health but it also has some specific uses and benefits. While there are several options out there, two stand out – metformin and berberine. High blood sugar is becoming more common, so many people are looking for medications and supplements to help control it. Although its absorption level is limited, continuous clinical studies are being performed to further investigate Berberine’s full potential to be used as an herbal alternative to diabetic drug therapy. Typically, Berberine is administered as an oral supplement and performs equivalently to commercial diabetes medications, such as Metformin, concerning hypoglycemic effects on type 2 diabetes. To identify potential publication bias among the included studies, funnel plots as well as Egger’s test were employed (Egger et al., 1997). Additionally, we utilized the ROB to appraise the potential biases within the studies (Higgins et al., 2011). Additionally, current systematic reviews have predominantly focused on BBR’s effectiveness in modulating blood glucose (Xie et al., 2022; Lan et al., 2015; Dong et al., 2012; Liang et al., 2019). In contrast, BBR not only significantly ameliorates glycemic control but also intervenes in the pathological state of T2DM through multiple molecular mechanisms, including improving insulin resistance, regulating gut microbiota, and exerting anti-inflammatory and antioxidant effects (Kong et al., 2009; He et al., 2022; Utami et al., 2023). Current evidence suggests that BBR alone or in combination has significant potential for treating type 2 diabetes mellitus (T2DM). Intravenous infusion of berberine in 12 patients with heart failure refractory to digitalis and diuretics led to an acute decrease in peripheral resistance and increase in cardiac index. The documentation of the beneficial effects of berberine on CVD dates back to the 1980s . Studies have shown that metformin significantly reduces free fatty acid, triglyceride and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels in body, which account for decreases in the risk of CVD . A landmark study published in the journal Metabolism compared 500mg of Berberine (3x daily) against Metformin.It's important to discuss your medical history, including any existing conditions or medications you're taking, with your doctor to determine if metformin is appropriate for you.In rats, berberine has been shown to improve renal function in nephropathy.Berberine and metformin are known to be used widely of late in terms of their biohacking potential.Insulin is the hormone produced by your pancreas that is needed to help glucose (sugar) move out of your bloodstream and into the cells (such as muscle and liver cells).On the other hand, metformin operates through several well-established mechanisms, with its primary action being the reduction of hepatic glucose production. We conducted qualitative and quantitative analyses of adjusted data using Revman v5.3 (Cochrane Collaboration, Oxford, United Kingdom) and Stata/SE v15.1 (StataCorp, College Station, TX, United States) for meta-analysis. When details were insufficient to judge the conduct of the study, the risk was typically deemed unclear. Random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, completeness of outcome data, selective reporting, and other potential sources of bias were all assessed via the tool. Defects in insulin action at first can be compensated by increased insulin secretion, resulting in hyperinsulinemia, so as to maintain blood glucose homeostasis. The guanides are rich in French lilac and essential compounds in lowering blood glucose, which led to development of three biguanides, metformin, phenformn, and buformin (Figure 1). To assess the efficacy and safety of berberine in the treatment of type 2 diabetes mellitus (T2DM). Metformin is an FDA-approved prescription drug, widely accepted as a first-line treatment for Type 2 diabetes. While personal experiences can vary, these anecdotal reports add to the growing interest in berberine as a complementary approach to diabetes management. That means berberine could be just as effective in managing type 2 diabetes. According to several studies, including one published in the journal Metabolism, berberine might just do that. Berberine enhances insulin sensitivity through stimulation of insulin-like growth factor-1 (IGF-1). Berberine and metformin exhibit similarities and differences in their mechanisms of action. Both compounds have the similar ability to activate AMPK and regulate glucose and lipid homeostasis. Berberine’s alkaloid composition positions it as a promising agent for metabolic diseases, lipid metabolism, and brain health. Metformin remains the gold standard for glycemic control, with proven HbA1c and fasting glucose reductions in large, long-term studies. In contrast, metformin’s efficacy is supported by decades of global, multicenter studies with hard outcome data (cardiovascular, renal, mortality). Its glucose-lowering effect is consistent and durable, which is why it remains the first-line drug in type 2 diabetes guidelines. By activating this enzyme, berberine triggers multiple pathways in the body that help to regulate blood sugar. This enzyme is found within cells throughout your body and helps regulate metabolism and impacts your blood sugar levels. In studies where metformin was taken alongside berberine, the results people achieved were often better. “People with high glucose levels have decreased immune system functioning, so boosting immune protection by way of altering gut bacteria is another benefit of berberine. As already indicated above, the influence of berberine doesn’t stop at better blood glucose control. If you type “berberine vs metformin” into a search bar, you’ll find headlines, small trials, and passionate anecdotes. Metformin is weight-neutral to modest loss; berberine may modestly reduce weight/lipids, but effects are smaller than approved anti-obesity drugs. Metformin is often called “more than a glucose drug” because its effects extend to weight, cardiovascular outcomes, and other metabolic markers. Traditionally used in Chinese and Ayurvedic medicine, berberine has attracted modern scientific attention for its potential metabolic effects. For both patients and healthcare providers, the challenge lies not only in managing diagnosed diabetes but also in preventing disease progression. In addition, berberine lowers blood cholesterol levels through inhibiting intestinal absorption, cholesterol uptake and secretion in enterocyte . The results revealed a lower blood level of LDL-c in T2DM patients treated with metformin, compared to other groups. In a 7-year follow-up study, Xu et al assessed the effects of metformin on metabolite profiles and LDL cholesterol (LDL-c) . In 1998, the UKPDS demonstrated that monotherapy of metformin was correlated to decreased risk of CVD in overweight T2DM patients . Metformin has been used as a glucose lowering drug for several centuries and is now a first-line drug for type 2 diabetes mellitus (T2DM). Choose products with transparent labeling, standardized berberine content, and third-party testing or certificates of analysis when available. That means it can change blood levels of statins, anticoagulants, immunosuppressants, and other medicines. Human pharmacokinetic studies show berberine can affect cytochrome P450 enzymes and P-glycoprotein, which are involved in the metabolism and transport of many drugs. Many human clinical trials show meaningful effects on glycemia and lipids at doses of 900 to 1,500 mg/d. Lion’s Mane Mushroom: Brain-Boosting Benefits and Research Among the 17 trials, 15 specifically reported the number of gastrointestinal AEs, which included 732 volunteers in the trial group and 730 in the control group. (b) Homeostasis model assessment-insulin resistance (HOMA-IR). However, compared with Western medicine, there was no significant difference observed in the HbA1c level, the FPG level, or the 2hPG level when berberine was applied alone (Figures 3–5). Forty trials, 45 trials, and 36 trials provided the data of HbA1c, FPG, and 2hPG, respectively. The effect of metformin on body weight and NAFLD has been assessed in a number of studies with inconclusive results. In a three months trial, 36 patients with T2DM were randomly assigned with berberine or metformin. Yin et al compared the effects of berberine and metformin . It's important to note that berberine may interact with other medications by affecting how the liver metabolizes them. When it comes to berberine, the typical dosage is 500 mg taken two to three times daily. Always talk to your healthcare provider before making changes to your medication regimen. Scores ranged from 0 to 7 points, with 4–7 indicating high-quality studies and 1–3 indicating low-quality studies. Expanding upon the original Jadad scale, this modified version evaluates random sequence generation, allocation concealment, blinding, and withdrawals and loss to follow-ups, providing a comprehensive assessment of study design and execution quality. Following the removal of duplicate entries, the preliminary screening entailed evaluating titles and abstracts was conducted to filter out studies that did not align with the predefined criteria. Included studies should report at least one primary outcome and may include one or more secondary outcome measures. Due to the lack of high quality clinical trials, the efficacy of berberine alone or combined with metformin at treating T2DM remains to be validated. The evidence from our meta-analysis suggests that berberine combined with metformin has a significant hypoglycemic effect and safety for T2DM. Studies sample should be large with a long term follow-up to assess long term effects and safety of berberine and metformin. Furthermore, these patients may need a longer time to exhibit treatment effects, and the timing of measurements during this period could influence efficacy assessment, contributing to overall heterogeneity.These features effectively address the limitations of existing treatment options and demonstrate promise as a new first-line therapeutic agent.Berberine and metformin share many features in actions despite different structure and both could be excellent drugs in treating T2DM.One study found that berberine was as effective as metformin in reducing fasting blood glucose levels and HbA1c levels in patients with type 2 diabetes.Sensitivity analysis indicated that the results were relatively robust (Figure 8I).Metformin is a drug that works by reducing the amount of glucose produced by the liver and improving insulin sensitivity.Although the process is less clear, these effects could result from a reduction in appetite or alter the way our bodies store and use fat.Therefore, it is important to use both berberine and metformin under the supervision of a physician. Despite the seemingly casual start, I’m well aware of the underlying reason for their visit – they want to explore ways to lower their blood sugar without relying solely on medication. Consulting with a healthcare provider is very important to make sure you are choosing the right option, monitoring your health and any side effects. Berberine, in the other hand, is a well known natural supplement derived from plants that has show promise in regulate blood sugar. Emerging studies suggest that Metformin may play a role in bone health, as it has been linked to improve bone's density and lower risk of fractures in some individuals. Over time, this leads to chronically high insulin and blood sugar levels, which can progress to prediabetes and type 2 diabetes. Several scientific studies and clinical trials have investigated the merits of berberine vs metformin for diabetes management. The management of Type 2 Diabetes necessitates the careful selection of effective treatments to maintain optimal blood glucose levels, HbA1c, and insulin sensitivity. In essence, understanding the mechanisms of action helps in discerning the appropriate context for each agent’s use, be it berberine vs metformin for PCOS, diabetes, weight loss, or life extension. However, studies have shown that berberine may be more effective in reducing body weight and improving insulin sensitivity compared to metformin. Recently, there have been claims that berberine has the ability to lower blood sugar, along with promoting heart, kidney, liver, and overall immune health. In a 12 week study in obese adults, 500 mg of berberine 3 times per day produced a modest weight loss of 5 pounds (2.2 kg). “If the AMPK is once again activated, as it can be with the addition of berberine, those pathways can be corrected and therefore, initiate weight loss, energy burning and reduced glucose and lipids.” Berberine + metformin vs metformin – 5 trials have demonstrated combination therapy improves fasting blood glucose and A1c more than using metformin alone. Marin-Neto JA, Maciel BC, Secches AL, Gallo Junior L. Cardiovascular effects of berberine in patients with severe congestive heart failure. Effects of metformin on metabolite profiles and LDL cholesterol in patients with type 2 diabetes. Chronic effects of berberine on blood, liver glucolipid metabolism and liver PPARs expression in diabetic hyperlipidemic rats. Effectiveness of metformin on weight loss in non-diabetic individuals with obesity. According to the inclusion criteria, 124 records were excluded because they were not RCTs, animal studies, not set control group reasonable, reviews or comments. The clinical and methodological heterogeneity of the included studies was evaluated with Χ2 test and I2 test. 95% confidence interval (95% CI) was used as effective size for the combined analysis. You have been experiencing any number of symptoms related to your diabetes, and now you notice that your hair… Side effects and benefits – Pros and Cons (myayan.com) Talk with your medical care provider or diabetes care and education specialist if you are interested in learning more. However, people have taken berberine-rich plants for years, with no reported symptoms. Metformin is a drug that works by reducing the amount of glucose produced by the liver and improving insulin sensitivity. Evidence that metformin exerts its anti-diabetic effects through inhibition of complex 1 of the mitochondrial respiratory chain. Ye L, Liang S, Guo C, Yu X, Zhao J, Zhang H, Shang W. Inhibition of M1 macrophage activation in adipose tissue by berberine improves insulin resistance. Application of berberine on treating type 2 diabetes mellitus. A total of 12 studies (Zhang et al., 2000; Gao et al., 2002; Li et al., 2008; Yin et al., 2008; Zhang et al., 2010; Xiang et al., 2011; Zhang et al., 2011; Wang et al., 2012; Xing, 2017; Rashidi et al., 2018; Zhang et al., 2020; Chen et al., 2023) reported data on TG. This study had a relatively narrow confidence interval and small standard deviation, which may have significantly influenced overall heterogeneity. A subgroup analysis was conducted based on intervention duration (Figure 5F), but heterogeneity within subgroups was not completely reduced. A total of 7 studies (Gao et al., 2002; Li et al., 2008; Yin et al., 2008; Wang et al., 2012; Xing, 2017; Rashidi et al., 2018; Zhang et al., 2020) reported data on HDL-C. We hypothesized that the high heterogeneity may be related to the disease course of patients’ T2DM, and further research is needed for validation. Often referred to as “nature’s Ozempic,” berberine is a natural supplement that’s been compared to metformin for its blood sugar-lowering effects. When it comes to managing diabetes, both berberine and metformin have gained attention for their ability to lower blood sugar. Berberine may increase the effects of drugs that lower blood glucose levels, such as insulin and sulfonylureas. Di Pierro F, Villanova N, Agostini F, Marzocchi R, Soverini V, Marchesini G. Pilot study on the additive effects of berberine and oral type 2 diabetes agents for patients with suboptimal glycemic control. Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression. And of course, the most interesting benefit to you as a person with type 2 diabetes or prediabetes, is berberines’ ability to help improve blood glucose control. Here you’ll discover how the ancient remedy berberine not only rivals pharmaceuticals such as Metformin in controlling blood sugar but also enhances insulin sensitivity, manages cholesterol, reduces inflammation, and more. Metformin and berberine are both powerful tools for improving insulin sensitivity and managing blood sugar. Combining Berberine and Metformin may, in some cases, cause digestive issues like bloating, gas or diarrhea, so its important to monitor your digestive health. You can take Berberine and Metformin together, but its important to do it under the supervision of a healthcare professional to make sure its safe for you. If you're thinking about switching from Metformin to Berberine, its key that you talk to your doctor about how the change might impact in your overall health. It has anti-inflammatory and antioxidant properties which can potentially protect the brain from oxidative stress and inflammation, both of which are linked to cognitive decline. Up to date, berberine has been used as a non-prescription drug in clinics for diarrhea, dysentery, stomatitis and hepatitis . Its constituents were then extracted, among which berberine was the most active alkaloid . Moreover, it has been expanded to treatment of other diseases such as obesity and tumour. Phenformin and buformin were abandoned in 1970s for intolerable side effects such as high frequency of lactic acidosis and increased mortality. Among them metformin was found to be the most useful drug because of its low toxicity. Ultimately, the goal is not to declare a universal “winner,” but to equip readers with balanced, guideline-informed knowledge to discuss options with their healthcare providers. Independent testing (e.g., USP Verified, NSF Certified) may help identify reliable supplements, but not all berberine products are subject to such scrutiny. Metformin has been the first-line pharmacologic therapy for type 2 diabetes for decades. Left unaddressed, prediabetes often progresses to type 2 diabetes, increasing the risk of heart disease, stroke, kidney disease, neuropathy, and vision loss. According to the CDC National Diabetes Statistics Report, more than 38 million Americans live with diabetes, and nearly 97 million have prediabetes. Lupi R, Del Guerra S, Fierabracci V, Marselli L, Novelli M, Patane G, Boggi U, Mosca F, Piro S, Del Prato S, Marchetti P. Lipotoxicity in human pancreatic islets and the protective effect of metformin. Yang X, Xu Z, Zhang C, Cai Z, Zhang J. Metformin, beyond an insulin sensitizer, targeting heart and pancreatic beta cells. Effectiveness of berberine in bacillary dysentery Article in Chinese. Hopefully, more clinical investigation on the use of berberine will be conducted in the near future. Metformin and berberine shares many aspects in actions and mechanisms despite different structure. The patient’s blood glucose levels improved, including her postprandial blood glucose levels. She tolerated berberine treatment with minimal side effects, with some mild abdominal pain. I learned from Dr. Turner that Berberine can be used in conjunction with other diabetes treatments, including Metformin and insulin. In conclusion, it is clear that both metformin and berberine have potential benefits when it comes to managing elevated blood sugar levels. However, studies have shown that taking berberine and metformin together can lower blood sugar levels more than taking either one on its own. By improving the body’s response to insulin and reducing the overall amount of glucose in the bloodstream, metformin helps regulate blood sugar levels. Several studies have directly compared the weight loss effects of metformin and berberine, providing valuable insights into their relative efficacy. Research suggests that berberine supplementation can lead to reductions in body weight, waist circumference, and markers of metabolic health, such as fasting blood sugar and cholesterol levels. Numerous studies have investigated the weight loss potential of metformin and berberine, yielding promising results. By activating AMPK, berberine can contribute to improved blood sugar control, reduced inflammation, and potentially, weight loss. However, berberine is considered to be well-tolerated by most people and these side effects are rare. In addition to the risk of hypoglycemia, there can also be some digestive side effects from taking berberine, including gas, bloating, constipation, abdominal cramping and pain, and diarrhea. Another impact of berberine is that it can help you to lose weight. Even further, berberine has been shown to slow down carbohydrate digestion in the gut, slowing down sugar absorption into the bloodstream. Both metformin and berberine exert their effects through complex mechanisms that involve influencing key metabolic pathways. It has been widely used for decades, with its efficacy in controlling blood sugar levels well-established. It's crucial to consult your healthcare provider to evaluate any potential interactions, especially if you're taking medications like blood thinners or blood pressure drugs. Thirteen studies (fifteen trials) with 1173 participants were included. Third, All the trials were conducted among Chinese participants in the mainland of China and they did not describle the study plan or publish a study protocol in advance; therefore, attrition bias and selective reporting bias might exist. The incidence of adverse events did not differ between berberine and metformin group. Berberine achieves this through multiple mechanisms, including the activation of AMP-activated protein kinase (AMPK), a central metabolic regulator that enhances insulin sensitivity. Furthermore, both Berberine and Metformin have been shown to enhance insulin sensitivity, a critical factor in managing Type 2 Diabetes. Berberine, a bioactive compound extracted from various plants, and Metformin, a well-established pharmaceutical drug, have both garnered attention for their efficacy in diabetes management. This biochemical perspective underscores their roles in modern therapeutics and guides medical professionals and patients in making informed decisions. These actions collectively contribute to better glycemic control in individuals with diabetes. Thus, it is essential to explore more effective and safe strategies for the prevention and treatment of DM. Though 10% of the global health expenditure is currently spent on DM, this disease remains in the top 4 causes of noncommunicable disease deaths . In 2019, approximately 4.2 million adults had an estimated cause of death related to diabetes and its complications. Diabetes mellitus (DM) is a chronic, noncommunicable disease that has become a worldwide threat to public health. Rhizoma Coptidis is an herb that has been frequently used in many traditional formulas for the treatment of diabetic mellitus (DM) over thousands of years. Therefore, it seems likely that berberine works by decreasing insulin resistance.In terms of possible role in inhibiting EMT and metastasis of cancer, berberine and metformin seem to have similar effects 81–83.Few studies directly compare the efficacy of metformin and berberine in treating T2DM and MetS.Did you know a natural supplement might rival the leading diabetes medication?Metformin is also known to cause a decrease in vitamin B12 levels, which can lead to anemia, fatigue, and other issues.A subgroup analysis based on patients’ baseline average 2hPBG levels did not completely reduce the heterogeneity within the subgroups (Figure 3D).In terms of effectiveness, both medications have been shown to aid in weight loss.Being healthy is a top priority for everybody because it allows you to continue to live a long and happy life.Metformin is a commonly prescribed medication for the treatment of type 2 diabetes.Emerging studies suggest that Metformin may play a role in bone health, as it has been linked to improve bone's density and lower risk of fractures in some individuals. Role of AMP-activated protein kinase in mechanism of metformin action. Imbalance between neutrophil elastase and its inhibitor alpha1-antitrypsin in obesity alters insulin sensitivity, inflammation, and energy expenditure. Zhou H, Mineshita S. The effect of berberine chloride on experimental colitis in rats in vivo and in vitro. Wang J, Yang S, Cai X, Dong J, Chen Z, Wang R, Zhang S, Cao H, Lu D, Jin T, Nie Y, Hao J, Fan D. Berberine inhibits EGFR signaling and enhances the antitumor effects of EGFR inhibitors in gastric cancer. Su K, Hu P, Wang X, Kuang C, Xiang Q, Yang F, Xiang J, Zhu S, Wei L, Zhang J. Tumor suppressor berberine binds VASP to inhibit cell migration in basal-like breast cancer. Studies suggest that berberine can be taken long-term, but more research is needed on its safety with prolonged use. It’s important to divide the doses to avoid gastrointestinal side effects. The typical dose for berberine is 500 mg, taken two to three times a day with meals to optimize absorption. Another study in men and women with metabolic syndrome, given 300 mg of berberine 3 times per day for 3 months, showed an improvement in Body Mass Index (BMI), along with a reduction in belly fat. In terms of weight, berberine helps prevent fat deposits by influencing cellular regulators of fat accumulation, and by downgrading inflammation – a known driver of obesity. “Oftentimes my diabetic patients are already taking prescription medications for their diabetes,” says Dr. Esposito. Suppressing mTOR mimics the effects of fasting (Caloric Restriction), which triggers Autophagy—the cellular cleanup process. Beyond glucose, both compounds are used as anti-aging compounds. A landmark study published in the journal Metabolism compared 500mg of Berberine (3x daily) against Metformin. Glycemic metabolisms were the main factors studied, including glycosylated hemoglobin (HbA1c), fasting plasm glucose (FPG), and 2-hour postprandial blood glucose (2hPG). You can use this index to help identify which foods can cause wild swings in your blood sugar This approach is all about eating foods that don’t spike your blood sugar quickly Plus, healthcare providers know the right dosage to prescribe and understand its side effects. The amphipathic property of berberine interferes with cholesterol micellarization in the intestinal lumen, thus decreasing absorption. With regard to the mechanism, it has been reported that berberine modulates LDLR at a post-translational level 56, 57. Therefore, metformin can reduce the risk of coronary heart diseases complicated with T2DM. Our work also showed the plasma lipid profiles of diabetic patients were improved by berberine intake. Low and medium doses of (1–2 g) berberine showed the same effects on reducing HbA1c and 2hPG. The efficacy of berberine seemed to decrease with an increased treatment course. A comparative analysis of Berberine vs Metformin for PCOS reveals nuanced differences in their impact on symptoms such as menstrual irregularities, insulin resistance, and hyperandrogenism. Personal preferences and tolerance to side effects will likely influence individuals’ choices when selecting either substance for weight management. Nonetheless, it is essential to consider potential side effects when choosing between Berberine and Metformin. Likewise, Metformin users have observed steady weight reduction and better overall metabolic health. Berberine, a compound derived from various plants, has gained attention due to its potential to improve metabolic health. No serious adverse events were reported during the treatment period in any of the studies, indicating that BBR is relatively safe. The study by Du (2016) noted that the incidence of adverse events with BBR was significantly lower than that with metformin. Sensitivity analysis identified a significant deviation in the study by Zhou and Huang (2012). We hypothesized that the high heterogeneity may be related to the pancreatic function level of patients, and further high-quality studies are needed for validation. Sensitivity analysis indicated a deviation in the study by Zhou et al., 2012 (Zhou and Huang, 2012). Both reduce hepatic glucose output, improve insulin sensitivity, and influence the gut microbiome. Unlike metformin, it is not FDA-approved for diabetes but marketed as a dietary supplement for metabolic support. It is considered the foundation of pharmacologic type 2 diabetes care due to its unique ability to reduce hepatic glucose output without causing hypoglycemia. Globally, the International Diabetes Federation projects that diabetes cases will rise to 643 million by 2030, straining health systems and impacting quality of life for millions. Diabetes and prediabetes are among the most pressing public health concerns of our time. Berberine’s safety profile is less established due to supplement variability and lack of large-scale trials. Metformin is one of the few medications with high-quality evidence for diabetes prevention. The findings are encouraging but less consistent than metformin. Berberine has been investigated in multiple small-to-moderate-sized clinical trials, often in China, with several systematic reviews pooling results. Metformin has been studied in tens of thousands of patients across decades.