For those looking to lose weight but are hesitant to seek out prescription drugs like Ozempic, Wegovy, or Mounjaro, hearing that there’s a “natural” alternative may be alluring. Ozempic, used to treat type-2 Diabetes, also called Wegovy when prescribed specifically to help manage weight loss, and Mounjaro have become social media fodder as people share their success in dropping pounds while using the drugs. The newest curiosity in the world of weight loss is berberine, as extract from plants such as goldenseal, barberry and various poppies.
Berberine is considered a dietary supplement by the U.S. Food and Drug Administration and is consequently regulated as a food, not a drug. As we’ve shared in previous posts, supplements can be dangerous. A paper written by a team from the California Department of Public Health found that dietary supplement use has been associated with 23,000 emergency department visits and 2,000 hospitalizations in the United States each year. Serious adverse events reported with the use of dietary supplements include stroke, acute liver injury, kidney failure, pulmonary embolisms, and death.
“That’s the problem with berberine and all of these herbal substances — they’re typically not rigorously studied in the type of large, randomized clinical trials that we put actual drugs through. So, you have to be very careful,” said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. “As for it being nature’s Ozempic, there’s no evidence to suggest that is true,” added Apovian.
Sources share that berberine is a part of some of the roughly 500 different species of plants that belong in the genius Berberis. They have been used for centuries in Ayurveda and traditional Chinese medicine to fight inflammation and heal wounds, cure constipation and hemorrhoids, and battle infections of the ear, eye, mouth and digestive tract.
Dating back to 650 BC, information regarding the barberry plant can be found in the library of Assyrian emperor Ashurbanipal, where information written on clay tablets stated it was used as a blood-purifying agent. Dr. Joshua Levitt, a naturopathic doctor in Hamden, Connecticut shares, “It [was] used in its whole plant extract form — leaves, roots, bark all made into a tincture powder”. Since then, scientists were able to extract berberine as the active ingredient in these plants (about 100 years ago) and began to study the compound for metabolic issues such as cholesterol, diabetes and obesity. Levitt shares that “When it comes to glycemic control and for regulation of cholesterol and other lipids and antimicrobial uses, there’s some cool stuff to be done with herbs and nutrients.”
Berberine may enhance the body’s natural production of GLP-1, or glucagon-like peptide 1, a gastrointestinal hormone that’s used in Ozempic and other new weight loss drugs. That’s how the compound “fits into this discussion. However, in terms of its weight loss benefits, they are modest at best,” Levitt says.
What are Ozempic and Mounjaro, and do they work?
Berberine is gaining intrigue as it is being posed as a “natural” way to achieve weight loss results comparable to those from taking Ozempic or Mounjaro. To better understand the intrigue, let’s backtrack a bit. Medicines like Ozemic (also called Wegovy when prescribed specifically for weight loss) and Mounjaro were developed to help manage diabetes, but it has been discovered that people without diabetes can lose weight when using the drugs. Studies surrounding the weight loss in people who take the medicines are impressive.
- Diabetics that used Ozempic lost 6-7% of their body weight while those that used Mounjaro lost roughly 15% of their body weight.
- Non-diabetics using Ozempic lost roughly 15% of their body weight. While those that used Mounjaro lost up to 25% weight of their body weight.
Clearly impressive. But let’s look at what that really meant.
The study was conducted over the course of 18 months. Participants received counseling sessions to help them follow a healthy diet and maintain a 500-calorie deficit. With that approach, participants would typically lose about a pound a week from the calorie deficit alone. They also adhered to 150 minutes of physical activity each week, which would help their efforts. Still, despite these lifestyle changes that certainly boosted results, researchers share that it doesn’t explain the magnitude of weight loss experienced by the participants.
Risks and side effects
Do not take Ozempic/Wygovy or Mounjaro if any of the following apply to you:
- Type 1 diabetes
- Under 18 years of age
- Pregnant or breastfeeding
- Diabetic retinopathy
- Problems with the pancreas or kidneys
- Family history of medullary thyroid carcinoma (MTC)
- Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), an endocrine system condition
Some side effects include:
- Pancreatitis (inflammation of the pancreas)
- Vision changes
- Hypoglycemia (low blood sugar)
- Kidney problems
- Allergic reactions
- Gallbladder problems
- Thyroid tumors or cancer
All this information begs the question- if you adhered to the following guidelines, as study participants did:
- Ate healthy foods
- Kept a 500 calorie deficit
- Exercised for at least 150 minutes weekly
Would the weight loss results be much different, without all the risks of taking the medicines?
Don’t forget that it is well-reported that people who stop using the medications almost always gain the weight back. That means that if you go this route, you will need to continue using the medication in perpetuity. And it isn’t cheap. In fact, most insurance companies won’t cover it unless you meet certain criteria, based on BMI (>30) and whether you also have other weight related comorbid conditions (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia).
These new drugs may be valuable adjunct tools when used properly and supervised carefully by a reputable healthcare provider. Personally, I have yet to see any impressive losses of weight as touted by the manufactures in my patient population.
How does berberine compare to Ozempic/Wegovy?
The actual weight loss results from using berberine compared to Ozempic or Wegovy are minimal. That doesn’t mean that the herb has no impact at all on the body’s metabolic systems, however. A pooled meta-analysis of a number of small clinical studies on berberine’s impact on cardiovascular risk factors, including obesity, found a very small, but statistically significant weight loss benefit.
“But statistical significance does not mean clinically meaningful,” said Dr. Justin Ryder, a pediatric obesity researcher and associate professor of surgery and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago.
“What do I mean by that? On average across the studies, the pooled response was about a 0.25 reduction in body mass index or BMI compared to placebo,” he said. “For Ozempic and Wegovy, the decrease in BMI compared to placebo was 4.61 BMI units, or 18 times more effective than berberine, Ryder added. “So, does berberine have an effect? The data would suggest yes. Is the effect meaningful? Probably not.”
Side effects and concerns of berberine
The FDA does not regulate herbal supplements in the same way as it does prescription medicines. This opens the door for several issues. Supplements have been found to be tainted with ingredients unknown to consumers. Herbal supplements, including berberine, can also cause serious side effects when mixed with other medications.
One example includes the medication metformin, which is often prescribed for people with diabetes and polycystic ovary syndrome and, more recently, for weight loss. “Metformin lowers blood sugar, and berberine lowers blood sugar,” Levitt said. “And if you take two items that lower blood sugar at the same time, you could have a problem like excessive hypoglycemia, when blood sugar crashes.”
Berberine can be dangerous if taken with cyclosporine, an immunosuppressive drug used to treat organ rejection post-transplant, as it might heighten that drug’s effects and possible side effects. Another known interaction is with sedative drugs, as berberine can cause additional sleepiness and slowed breathing, according to the National Library of Medicine.
Berberine can be dangerous during pregnancy and deadly to infants. If you are breastfeeding, do not use berberine as it can cross the blood barrier and can cause or worsen jaundice in newborn infants and could lead to a life-threatening problem called kernicterus (brain damage as a result of high levels of bilirubin).
In addition, berberine is “directly antimicrobial,” which was its most common use in historical herbal medicine, Levitt said: “Antimicrobial effects can irritate the GI tract so unless a person has an overgrowth of bad bugs it can cause digestive distress.” Read here to learn more about the importance of gut health and how an unbalanced gut can negatively impact weight loss efforts.
Proceed with caution when it comes to naturopathic medicine
While some may give naturopathic medicine the cold shoulder, under careful supervision of naturopathic physician, it can address a variety of concerns. The University of Minnesota states “Naturopathic medicine is a science-based tradition that promotes wellness by identifying the unique aspects of each patient and then employing non-toxic natural therapies to restore his or her physiological, psychological, and structural balance.”
Many people approach their wellness from a holistic perspective and partner with a conventional physician as well as a naturopathic provider. You must be cautious though, as the range of education and experience required to practice naturopathic medicine varies greatly. One source shares the differences:
- Naturopathic physicians: These are also called naturopathic doctors (ND) or doctors of naturopathic medicine (NMD). They usually attend an accredited four-year, graduate-level school. There they study basic sciences similar to those studied in conventional medical school. They also study nutrition, psychology, cardiology, biochemistry, immunology, and complementary therapies such as herbal medicine and homeopathy. The American Association of Naturopathic Physicians (AANP) state, “[Naturopathic physicians] cooperate with all other branches of medical science, referring patients to other practitioners for diagnosis or treatment when appropriate.”
- Traditional naturopaths: These practitioners don’t attend an accredited naturopathic medical school or receive a license. Their education varies widely.
- Healthcare providers: Some medical doctors, dentists, doctors of osteopathy, chiropractors, and nurses have training in naturopathic medicine. Many are either NDs or they studied naturopathy.
While we encourage making well-informed decisions about your health, don’t solely rely on information found on the internet, social media, or that is shared by anybody that isn’t a trained professional. Inform your medical provider of any and all naturopathic approaches (including herbal supplements!) you are considering as there can be serious contraindications with medications or treatments. There is no quick fix. Weight loss is a long-term process that requires a multi-pronged approach. Speak to your provider about how to best approach weight loss for your individual health.