Berberine...metabolic master switch or something to ditch?
Berberine, a chemical found in several plants, is an isoquinoline derivative alkaloid that has been used as an insulin sensitizer. It is believed to have potential therapeutic use in PCOS (Wei et al., 2012). No doubt Berberine’s popularity is due to its supposed anti-diabetic properties and weight-loss effects despite the fact that the modes by which it has this effect are not certain (Lee et al., 2006).
I recently started taking a Berberine supplement. Numerous articles on webpages and social media recommend Berberine for PCOS. So, no harm in trying I thought, or was there? A few hours after taking the supplement I had severe chest pains. Something I’ve never experienced before. This was not mild pain, it was horrendous pain and I thought I was having a heart attack. I had to rest until the pain passed and got checked by the GP. I immediately stopped the supplement and threw them in the bin.
A few weeks later when reading a magazine I happened to see an article about Berberine. The article mentioned how in France warnings have been issued on supplements that contain Berberine. The French Agency for Food, Environment & Occupational Health & Safety (ANSES) has said that they do not guarantee the safety of the use of berberine based supplements. They go on to add that from a 400mg daily dose, these supplements can have pharmacological effects on the cardiovascular system, nervous system, immune system and metabolism. In other words, it acts like a medication and not just a food substance. It turns out, other countries have similar warnings in place.
A report by the UK Herbal Medicines Advisory Committee (HMAC) for the Herbal Medicines and Practitioners Working Group (HMPWG) concluded that herbal medicinal products, like all other medications, can have pharmacological effects and can give rise to significant adverse effects or interactions with existing medications. They add that toxicity is also a problem with some low grade products containing toxic ingredients due to misidentification and substitution. The report acknowledges the difficulty members of the public can have in identifying competent practitioners who can supply supplements. They also found evidence that practitioners lacking expertise are treating vulnerable groups, and that less responsible practitioners may purchase unlicensed herbs from sources with no reliable quality standards (Safety, regulation and herbal medicines: a review of the evidence A report prepared by the UK Herbal Medicines Advisory Committee (HMAC) for the Herbal Medicines and Practitioners Working Group (HMPWG), 2014).
I was astonished to learn that in general there is little high-quality evidence to support the effectiveness of some nutritional supplements for those with PCOS and evidence of safety is lacking. One recent study has called for high quality trials to examine the adverse effects of such supplements in those with PCOS (Arentz et al., 2017). Moreover, a recent meta-analysis found that the mechanisms of how Berberine works in PCOS insulin resistance is unclear and suggests that more research is required to determine its efficacy and safety (Li et al., 2018)
In contrast, Berberine has been lauded for its anticancer effects. It has been found that berberine analogues could improve Berberine’s anti-tumour effects against gynaecological cancers (Mortazavi et al., 2020). If so, why is this not investigated further and ratified for safety given the fact that gynaecological disorders such as cervical, ovarian and endometrial cancers are the second most prevalent cancer types in women worldwide? And why are we getting such mixed messages?
Clearly there is an unmet need in PCOS treatment that can lead to self-medication. We need much more research and safe and thoroughly tested treatments for PCOS. The point of this article is to highlight the effects of Berberine may vary according to each individual and you should seek medical advice if you are unsure if herbs or supplements containing berberine are suitable for you. I for one will be taking a much more cautious approach to the use of supplements for PCOS. Always speak with your doctor before taking anything.
© PCOS Vitality, 2020
This is not medical advice. Always consult your doctor.
Arentz, S., Smith, C. A., Abbott, J., & Bensoussan, A. (2017). Nutritional supplements and herbal medicines for women with polycystic ovary syndrome; a systematic review and meta-analysis. BMC Complementary and Alternative Medicine, 17(1), 500. https://doi.org/10.1186/s12906-017-2011-x
Lee, Y. S., Kim, W. S., Kim, K. H., Yoon, M. J., Cho, H. J., Shen, Y., Ye, J. M., Lee, C. H., Oh, W. K., Kim, C. T., Hohnen-Behrens, C., Gosby, A., Kraegen, E. W., James, D. E., & Kim, J. B. (2006). Berberine, a natural plant product, activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant states. Diabetes, 55(8), 2256–2264. https://doi.org/10.2337/db06-0006
Li, M. F., Zhou, X. M., & Li, X. L. (2018). The Effect of Berberine on Polycystic Ovary Syndrome Patients with Insulin Resistance (PCOS-IR): A Meta-Analysis and Systematic Review. In Evidence-based Complementary and Alternative Medicine (Vol. 2018). Hindawi Limited. https://doi.org/10.1155/2018/2532935
Mortazavi, H., Nikfar, B., Esmaeili, S. A., Rafieenia, F., Saburi, E., Chaichian, S., Heidari Gorji, M. A., & Momtazi-Borojeni, A. A. (2020). Potential cytotoxic and anti-metastatic effects of berberine on gynaecological cancers with drug-associated resistance. European Journal of Medicinal Chemistry, 187. https://doi.org/10.1016/j.ejmech.2019.111951
Safety, regulation and herbal medicines: a review of the evidence A report prepared by the UK Herbal Medicines Advisory Committee (HMAC) for the Herbal Medicines and Practitioners Working Group (HMPWG). (2014).
Wei, W., Zhao, H., Wang, A., Sui, M., Liang, K., Deng, H., Ma, Y., Zhang, Y., Zhang, H., & Guan, Y. (2012). A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. European Journal of Endocrinology, 166(1), 99–105. https://doi.org/10.1530/EJE-11-0616