A centuries-old Chinese and Indian herbal medicine ingredient could beat Big Pharma at its own game when it comes to managing pre-diabetes

A new placebo-controlled trial found that taking a berberine supplement significantly improved markers of pre-diabetes like blood sugar and insulin levels compared to placebo over 2 months. The study suggests berberine could be an effective natural alternative to metformin for those with pre-diabetes.¹

In a recent double-blind, placebo-controlled trial, Italian researchers examined whether taking a specialized berberine supplement could improve markers of pre-diabetes, also known as impaired fasting glucose (IFG).² Berberine is a compound found in several plants used in Chinese and Indian traditional medicine, including barberry, goldenseal, and Oregon grape.³ Previous research suggests it may have anti-inflammatory, antioxidant, and glucose- and lipid-lowering effects.⁴

However, berberine tends to have very poor oral bioavailability on its own.⁵ To overcome this, the researchers used a patented delivery technology called Berberine PhytosomeTM, which combines berberine with phospholipids to enhance absorption.⁶

The study included 49 overweight adults aged 59 years on average with IFG.⁷ IFG is defined as a fasting blood glucose level between 100-125 mg/dL and signifies pre-diabetes.⁸ The participants were randomly assigned to take either 550 mg of Berberine Phytosome twice a day (188 mg berberine content per dose) or a visually identical placebo pill twice a day with meals for 2 months.⁹

Compared to placebo, taking Berberine Phytosome resulted in significant decreases in:¹⁰

• Fasting blood sugar levels: 0.24 mmol/L average greater reduction  
• Insulin levels: 1.78 μIU/mL average greater reduction
• Total cholesterol: 0.25 mmol/L average greater reduction
• Triglycerides: 0.14 mmol/L average greater reduction
• Visceral abdominal fat volume by CT scan: 91.5 grams average greater reduction
• Total body fat mass by DXA scan: 945 grams average greater reduction

No serious side effects were reported.¹¹ This is particularly noteworthy compared to metformin, the most commonly prescribed medication for managing prediabetes and type 2 diabetes. Metformin is associated with risks like vitamin B12 deficiency, lactic acidosis, diarrhea, nausea/vomiting, and kidney injury.¹²

Overall, this rigorous clinical trial demonstrates taking a highly bioavailable berberine supplement can safely improve several markers of pre-diabetes compared to placebo over 2 months. The researchers concluded berberine could be a natural alternative to standard pharmaceutical options like metformin for those at high risk of developing diabetes.¹³  

In addition to the current study, berberine has shown promise for improving markers of high blood sugar in other clinical trials.

In one 2013 placebo-controlled trial in 116 patients with type 2 diabetes, taking 1500 mg per day of berberine for 3 months lowered hemoglobin A1c levels (a marker for average blood sugar over 2-3 months) by an average of 0.7% more than placebo.¹⁴

Another trial compared taking 500 mg of berberine with the diabetes medication metformin in 68 patients with metabolic syndrome and high blood sugar. After 3 months, berberine lowered fasting blood sugar by 31 mg/dL, on par with a 38 mg/dL reduction for metformin.¹⁵

Overall, accumulating evidence from randomized trials suggests berberine supplementation can lead to clinically significant declines in short- and long-term blood sugar markers, though more research is still needed.

For more information on strategies for prediabetes consult our database on the subject here.

For more information on the researched therapeutic applications of berberine, consult our database on the subject here.

References

1. Rondanelli, M., Gasparri, C. et al. Berberine phospholipid exerts a positive effect on the glycemic profile of overweight subjects with impaired fasting blood glucose (IFG): a randomized double-blind placebo-controlled clinical trial. European Review for Medical and Pharmacological Sciences, 2023;27(1): pp. 6718-6727. https://www.europeanreview.org/article/29065.

2. Rondanelli et al., pp. 6719-6720. 

3. Rondanelli et al., p. 6719.

4. Rondanelli et al., pp. 6718-6719.

5. Kumar, A., Chopra, K. et al. Current knowledge and pharmacological profile of berberine: An update. European Journal of Pharmacology, 2015;(761): pp. 288-297. https://doi.org/10.1016/j.ejphar.2015.05.068

6. Rondanelli et al., p. 6720.

7. Rondanelli et al., p. 6720, Table 1. 

8. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes--2022. Diabetes Care 2022 Jan 1;45(Supplement 1):S17-38. https://doi.org/10.2337/dc22-S002

9. Rondanelli et al., p. 6720.

10. Rondanelli et al., pp. 6723-6724, Tables 3-4.

11. Rondanelli et al., p. 6724. 

12. Qaseem A, Barry MJ, Humphrey LL, Forciea MA. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline update from the American College of Physicians. Ann Intern Med. 2017;166(4):279-290. doi:10.7326/M16-1860. https://www.acpjournals.org/doi/10.7326/M16-1860

13. Rondanelli et al., p. 6725.

14. Zhang, Y., Li, X. et al. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. Journal of Clinical Endocrinology and Metabolism. 2008 Jul;93(7):2559-65. doi: 10.1210/jc.2007-2404. https://pubmed.ncbi.nlm.nih.gov/18397984/

15. Pérez-Rubio, KG., González-Ortiz, M. et al. Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion. Metabolic Syndrome and Related Disorders. 2013 Oct 1;11(5):366-9. doi: 10.1089/met.2013.0009. https://pubmed.ncbi.nlm.nih.gov/23808999/