Is Berberine the natural medicine for weight loss?

According to the Centers for Disease Control and Prevention, more than 40 percent of adults in the United States are obese. More than half say that willpower alone is not enough to lose weight and keep it off. A new class of drugs called GLP-1 agonists, including Ozempic, Wegovy and Mounjaro, have become increasingly popular since their introduction.

Wegovy was originally developed to treat type 2 diabetes and was approved by the FDA in 2021 to treat chronic weight loss. It works by mimicking hormones that target the areas in your brain that control appetite and food intake. In addition, it slows digestion and makes you feel full. The main side effects reported are gastrointestinal reactions and injection site reactions.

They represent a breakthrough for people suffering from weight-related diseases such as diabetes, high blood pressure and heart disease. However, as with any new drug that promises a cure-all, some people choose to take these drugs to “lose a few pounds,” like one of my patients who wanted to look good in her 30s.^th class reunion.

Aside from making these drugs scarce for those who need them, it has also led to countless lucrative pop-up clinics and online sites where these drugs can be purchased without significant medical oversight. As a psychiatrist, I am particularly concerned about how these “miracle drugs” affect your brain and the types of mental health problems that can result. A previous weight-loss drug, Zimulti, was pulled from the European market because of reports of increased suicidal thoughts and behavior among users. In the U.S., Qnexa (Vivus) contains two active ingredients, phentermine and topiramate, which, although it produced over 9 percent weight loss, was rejected by the FDA in part because of concerns about the potential risk of increased suicidal thoughts.

Alarming side effects
The FDA has received reports of suicidal thoughts from Wegovy users. However, these reports have not been verified and research has been limited and conflicting. Nevertheless, reports of suicidal thoughts have been linked to other weight loss drugs. Sanofi's Acomplia, which was never approved in the U.S., was taken off the market in Europe in 2008 after being linked to suicidal thoughts. The weight loss drug Contrave carries a black label warning about suicidal thoughts, and another obesity drug, Qsymia, carries a warning telling patients to stop taking it if they have suicidal thoughts.

Since even the slightest risk of suicidal thoughts should be monitored and curbed at all costs, nature has provided us with a possible safe alternative for weight loss. Berberine is found in various plants, including goldenseal, barberry, and mahonia. Plants containing berberine have long been used in both Ayurvedic and Chinese medicine. In modern times, plants containing berberine are used for infections, skin diseases, and digestive disorders. Berberine is currently being studied for its positive effects on diabetes and heart disease. Recently, it has become popular as a potential weight loss agent.

After taking berberine as a pill or powder, it enters the bloodstream and travels to cells, where it binds to various molecules. However, instead of causing a single change, berberine interacts with multiple targets, affecting multiple diseases at once.

In a review article published in Biomedicine and PharmacotherapyIn another study, researchers documented the beneficial effects of berberine in lowering fasting blood sugar in hundreds of patients. In addition, they found that berberine was able to reduce basal metabolic rate in a small group of subjects over three months. In another area, they reviewed studies that showed that berberine supplements reduced cardiovascular risk in over 100 menopausal women by lowering their total plasma cholesterol, and in patients suffering from hypertension, supplementing their daily dose of antihypertensive medication with berberine resulted in a more significant reduction in their blood pressure levels than taking their antihypertensive medication alone.

The compound appears to reduce insulin resistance in cells, which can lead to obesity and the onset of type 2 diabetes. Another mechanism for its effectiveness is the modulation of the secretion of the hormone in the gut, which is related to the regulation of food intake and energy balance. However, controlled scientific studies that look exclusively at berberine for weight loss are limited due to their small sample size. In one such study on people with fatty liver disease, participants who took a daily dose of berberine for three months lost a significant amount of weight.

Berberine improves your cells' response to insulin and affects how your blood sugar is used. One of its effects is to improve the transport of blood sugar into your cells, so you feel less hungry once you're “full.” Another benefit of berberine is its positive effect on your gut flora. It can restore balance between good and bad bacteria by suppressing harmful bacteria and allowing beneficial bacteria to grow.

When you add berberine to your daily diet:

• The FDA does not regulate this. Try to get a higher quality product to avoid side effects from additives in some less expensive forms.
• Berberine interacts with some medications because it can inhibit the excretion of these drugs from the liver, resulting in increased blood levels. If you are taking prescription medications, talk to your doctor before taking it.
• The half-life of berberine is only a few hours, meaning your blood levels will drop to about 50 percent within a few hours. To maintain a more consistent level, many providers recommend multiple daily doses—two or three times a day for a total of 1500 mg.
• Side effects: All medications have potential side effects. The most common side effects seen with berberine are gastrointestinal discomfort such as constipation, nausea, and diarrhea. However, these are the same side effects seen with the new generation of weight loss medications. The difference is that berberine has not been shown to contribute to psychological problems.