Berberine improves markers of cardiovascular health, meta-analysis shows
Highlights
- Meta-analysis of 49 clinical trials
- Berberine provides support for weight management, glucose balance & lipid metabolism
- Optimal dosage: 1 g/day (weight management/lipid metabolism); 1.8 g/day (glucose balance)
- Main side effect is digestive upset due to high dosages needed for efficacy
- Low-dose dihydroberberine may be a more tolerable alternative
Summary
Study Design
This meta-analysis involving 49 randomized, controlled clinical trials examined the ability of berberine supplementation to reduce cardiovascular disease (CVD) risk factors. Weight-related parameters were reported in 43% (21/49) of the studies.
The inclusion criteria were limited to randomized clinical trials (parallel or crossover design) published in the peer-reviewed literature up to July 2022, adult study participants; berberine interventions for at least one week; and data related to berberine's effect on one or more CVD risk factors.
Study Results
Results were reported as weighted mean differences (WMD) between berberine interventions and control groups from baseline.
Compared to placebo, berberine significantly improved numerous CVD risk factors, including blood lipids, glycemic control, weight management, and systolic blood pressure (see Table 1).
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Table 1. Berberine vs. Placebo: Cardiometabolic Parameters with Significant Improvements |
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|
Parameter |
WMD* |
No. of Studies |
|
TG |
−23.70 mg/dl |
38 |
|
TC |
−20.64 mg/dl |
28 |
|
LDL-C |
−9.63 mg/dl |
35 |
|
HDL-C |
1.37 mg/dl |
34 |
|
FBG |
−7.74 mg/dl |
35 |
|
Insulin |
−3.27 mg/dl |
16 |
|
HbA1c |
−0.45% |
21 |
|
HOMA-IR |
−1.04 |
14 |
|
SBP |
−5.46 mmHg |
20 |
|
Weight |
−0.84 kg (−1.85 lbs) |
21 |
|
BMI |
−0.25 kg/m2 |
24 |
|
WC |
−1.77 kg/m2 |
11 |
|
WMD indicates weighted mean difference between berberine and control interventions; TG, triglycerides; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; FBG, fasting blood glucose; HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model assessment-insulin resistance; SBP, systolic blood pressure; BMI, body mass index; WC, waist circumference. P-value for all parameters is P<.001, except BMI (P=.02) and WC (P=.005). |
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By contrast, berberine had no significant effect on diastolic blood pressure, markers of inflammation (C-reactive protein, Interleukin-6) or liver enzymes (ALT, AST).
Berberine was especially effective for individuals with overweight, type 2 diabetes, or non-alcoholic fatty liver disease.
The optimal berberine dosage was reported to be 1 g/day for most blood lipid parameters and weight parameters and 1.8 g/day for glycemic parameters. The most common adverse effect reported was mild-to-moderate digestive upset (e.g., nausea, constipation, and diarrhea).
Clinical Relevance
These findings suggest berberine supplementation is generally safe as a complementary or alternative therapy to help reduce CVD risk and support weight management goals.
Note: A separate pharmacokinetic study in healthy men (Moon et al., 2021) found low-dose dihydroberberine (100 or 200 mg) raises blood berberine levels more effectively than high-dose berberine (500 mg), suggesting dihydroberberine may be a better tolerated and easier-to-use treatment choice. A summary of this study is here.
References
Zamani M, Zarei M, Nikbaf-Shandiz M, Hosseini S, Shiraseb F, Asbaghi O. The effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis. Front Nutr. 2022;9:1013055. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9614282/
Moon JM, Ratliff KM, Hagele AM, Stecker RA, Mumford PW, Kerksick CM. Absorption kinetics of berberine and dihydroberberine and their impact on glycemia: a randomized, controlled, crossover pilot trial. Nutrients. 2021;14(1):124.
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