Berberine products have become increasingly popular lately due to their touted ability to support blood sugar and insulin sensitivity, alongside metabolic health and lipid metabolism. Berberine has even been clinically shown to give the gastrointestinal tract a boost by reducing inflammation and microbial overgrowth. However, not all berberine is the same. Berberine products can vary widely in their strength and quality. In this article, I'll explore how you can pick the best one for your situation. 

Berberine in Clinical Practice: Our Experience

Berberine has become one of our favorite metabolic herbs to use in clinical practice. Why, you may ask? Well, I’m not referring to any old berberine product, but Berberine Active from MediHerb.

Most people see “berberine” on a label and assume the products are interchangeable, but in our clinical experience, Berberine Active is in its own category. We have been impressed by what we have seen clinically, particularly in difficult blood sugar cases. Some of our most interesting cases have been patients whose glucose remained poorly controlled despite conventional therapy such as metformin. Since Berberine Active has been on the market, we've seen stunning anecdotal evidence for its effectiveness with real patients in our clinic (more on this below). 

What is Berberine?

Berberine is a naturally occurring plant alkaloid that is present in several medicinal plants (not just from one isolated plant species). Berberine isn't actually the name of one particular herb, but it is an active constituent found within a few certain herbs. Traditional herbal medicine used berberine-containing plants long before isolated berberine supplements became popular.

As a result, selecting a berberine supplement begins with this question: do you want an isolated berberine compound, or do you want berberine delivered as part of a concentrated herbal extract? Let me explain the difference and why it matters.

Berberine Active uses Phellodendron amurense stem bark and is standardized to contain 200mg berberine per tablet. The tablet doesn't simply contain 200mg of an isolated ingredient. It provides a concentrated Phellodendron extract standardized to deliver 200mg berberine.

Berberine hydrochloride is an isolated form of berberine commonly used in supplements and research and the typical research dosages can be relatively high. For example, a recent meta-analysis found that 900–1,500mg/day was among the most common dosage ranges studied. Milligrams alone don't tell the entire story of an herbal product and what I want you to take away from this comparison is that more milligrams doesn't equal a better, stronger product.

As a pharmacist, I spend a lot of time researching products and clinical data as a resource for our clinical practice, and I don't choose an herbal product simply by looking for the biggest number on the Supplement Facts panel. Instead, I look at the source, what part of a plant (or animal for that matter) that it came from, the extraction method, standardization, quality (what company sources and processes/makes it and do they third-party test), and the appropriate dose.

Berberine and Blood Sugar

I want to share some relevant clinical data on how we are testing patients on blood sugar support protocols. What we are seeing with continuous glucose monitoring (CGMs) is fascinating. CGMs have changed the way we can observe metabolic responses. (And if you haven’t tried a CGM and you want to give one a whirl, here’s the link to the Stelo that we use with our patients in office.)

Instead of waiting months for an HbA1c marker to change, with Stelo our patients can watch glucose patterns throughout the day. They can see fasting patterns, post-meal spikes, how long their glucose stays elevated, overnight glucose, and responses to individual foods or activities.

In our practice, some patients wearing CGMs have been able to observe changes in their glucose patterns before, after, and while using Berberine Active. We've had patients watch their response on their CGM, and they are pretty wowed. CGM observations don't always prove that a supplement alone can cause an improvement. Diet, medications, activity, weight change and other interventions may also influence glucose. But we have seen time and time again how potent Berberine Active is and it has been quite remarkable.

You may be wondering, ok I get all of this about berberine, but I have had poorly managed glucose for years. What can you tell me about some of your difficult blood sugar cases Often, we get the patients that “have been everywhere and no one has been able to fix their ____”. This is because patients typically see their allopathic physician for primary health challenges, and if the concern continues, they get referred around before finally throwing their hands in the air and giving up.

It’s easy to say we get a large number of these patients who come in despite already “doing everything.” Many of them are watching carbohydrates, exercising, taking medications and they are still seeing elevated fasting or post-meal glucose. Some of the most dramatic changes we've observed clinically have been in complex cases where their blood sugar has remained difficult to manage, even in cases where they have been taking metformin.

Research has investigated berberine both alone and alongside glucose-lowering medications. We put these patients on Berberine Active along with other lifestyle modifications and a couple of our other go-to products and we see some significant changes. Now, we do ask these patients to wear a CGM and be reassessed by their prescribing clinician to reduce hypoglycemia risk until they get their glucose in a consistent range with medications adjusted.

Other Blood Sugar Support Supplements

To touch on some other products and lifestyle tips that we use alongside Berberine Active for blood sugar support and management, I’ll list some of our favorites. We aren't chasing the glucose number but looking at the broader metabolic picture: blood sugar regulation, meal responses, stress, sleep, activities, and liver health/digestive health.

We use our sugar challenge protocol to reset the patients’ eating habits and evaluate what is most likely causing the spikes. Addressing chronic and acute stress that could be causing glucose spikes is something we often see as a major factor. Some of our most prescribed blood sugar products include Standard Process’s Diaplex and Chromium Complex. However, the goal isn't to throw supplements at a high glucose reading. It's to understand why that patient's glucose regulation is struggling in the first place.

Berberine and Microbiome Health

I can’t talk about berberine without hitting on how berberine research has also explored interactions with the gut microbiome and metabolic health. We have seen certain patients with signs/symptoms associated with gut inflammation improve after roughly six weeks of consistent Berberine Active use. 

Sometimes the reason we reach for Berberine Active has as much to do with the gut as it does with glucose. We are functional medicine practitioners, and we connect gut health, liver function, and metabolic health rather than treating them as completely separate systems. To improve glucose symptoms in our patients, we take the same root cause approach that we take with patients dealing with hormone, weight, or other imbalances. We look at the whole person and so much of the time it points back to the gut.

Berberine Drug Interactions

Who should be careful with berberine? Berberine is biologically active—it isn't “just a supplement." It can interact with medications, so we use extra caution when our patients are already using glucose-lowering drugs because combined effects can potentially lower glucose further. GI symptoms including nausea, diarrhea, constipation and bloating have been reported. Berberine should not be used during pregnancy or breastfeeding and should not be given to infants or children.

Berberine isn't new. The explosion of inexpensive berberine products is. Natural alternatives should be about more than finding the highest milligram count. The question isn't simply, "Should I take berberine?" The better question is: "What form, what dose, what quality, and what does my individual physiology need?"

Berberine Active is a product that I and Dr. Eric both use daily as part of your own metabolic/liver-support routines. Is it right for everyone? No. Does it help a lot of people? Yes. Check with your healthcare provider before taking any product. If you need guidance, we can help.

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