Off-label use of Ozempic is booming for weight loss now that popular culture is sadly worshipping at the altar of skinny again. But with dwindling supplies, berberine has shot to fame as a sought-after herbal alternative. Testament to that fact: the hashtag #berberine already has 84 million views on TikTok and this yellow, bitter-tasting chemical found in plants is now being touted as 'Nature's Ozempic'.
But let's take a step back for a moment. Before Ozempic was dropped into conversations about weight loss and appetite suppression with dizzying frequency, it was a drug prescribed for diabetes. Likewise, berberine has been around for centuries in the Far East as a remedy for bloating and poor metabolism, as well as regulating blood sugar.
The experts break down how it works, what it treats, side effects, and more.
“I started using berberine because I was noticing an unshakeable slump mid afternoon," says Emily Maddick, GLAMOUR UK's entertainment director and assistant editor. "I was reaching for Pret chocolate almonds every day without fail and couldn't seem to be motivated to do anything. But after a few days of popping two tablets a day after my breakfast, I just didn't need that 4pm sweet fix and my energy levels had noticeably improved."
Now the focus has shifted away from berberine's health benefits to before and after pictures on TikTok; jeans several sizes larger hanging off toned stomachs and invitations to follow a content creator's weight loss journey. Some might even argue that diet culture is hijacking the idea of good metabolism – which can impact our overall health – and distorting it as a quick fix for shedding pounds.
So what is the truth behind berberine? Does it really work in the same way as Ozempic? And health-wise, what should we actually be using it for to reap its benefits? Keep scrolling as we demystify this buzzy health supplement.
What is berberine?
“Berberine is one of the active phytonutrients found in a variety of medicinal plants," says Rhian Stephenson, a nutritional therapist and founder of ARTAH, whose Metabolic Fix supplement, which Emily has been taking, contains berberine alongside the mineral chromium for healthy metabolism. These botanicals include barberry, goldenseal, Oregon grape, and tree turmeric.
"Berberine is known to have multiple therapeutic benefits because if has anti-fungal, antibacterial, antioxidant, antiviral and anti-inflammatory properties as well as regulating blood glucose," she adds.
What is berberine normally used for?
Plants laced with berberine have been used in traditional medicine since 3000 B.C., mainly to treat diarrhoea and other stomach-related issues. But according to Rhian, this botanical extract also has over 20 years of modern clinical research to support its benefits for our metabolism.
Berberine has been dubbed a ‘blood sugar hero’. “Specifically, it regulates glucose and insulin," Rhian notes. This is important because the role of insulin in the body is to lower your blood sugar by storing glucose in the cells. If you have insulin sensitivity, then your cells don’t have enough glucose. This sets off a domino effect: you feel hungry all the time so you eat more and your body stores the excess glucose as fat.
Because of these actions, berberine is used for conditions such as Polycystic Ovary Syndrome (PCOS), says Rhian, where there is often an issue with high blood sugar levels. And if low energy, digestive issues and a sluggish metabolism sound familiar, you may also see an improvement after taking berberine supplements.
Whether used in pill or powder form, berberine is widely used to support immunity, too. “Berberine is known to have antimicrobial effects so it has been used therapeutically to treat conditions such as canker sores and thrush," says Lola Ross, a nutritionist and co-founder of the mood and hormone health app Moody Month.
I take semaglutide for my pre-diabetes, which is nearly impossible to treat without medical intervention. And I wish Ozempic critics—the most outspoken of whom happen to be naturally thin celebrities who have never had it or been obese—would understand.
How does berberine differ from Ozempic?
Berberine has been proven to lower blood sugar, improve insulin sensitivity, combat cravings and reduce the formation of fat cells, but it differs from Ozempic in many ways. "Weight loss is just one of the many potential outcomes of using berberine - it shouldn't be the only focus as it has potential health benefits that far exceed this," Rhian says.
- Unlike Ozempic, berberine is not a licensed drug for type II diabetes.
Regulating blood sugar decreases the amount of glucose that is stored as body fat. “This has led to comparisons between Ozempic and berberine,” says Lola. “Poorly controlled blood glucose can result in weight gain or obesity, which is often a symptom of type II diabetes.
“Ozempic, a brand name for the drug Semaglutide, is an injection licensed for adults with type II diabetes,” she continues. "In multinational clinical trials that included adult patients with type II diabetes, it was shown that Ozempic is clinically effective for weight loss within 3-6 months of use.
"While berberine has been shown to lower blood glucose, the evidence around potential weight loss is much smaller and more research is needed. It certainly should not replace a prescribed diabetes medicine by a doctor.”
- Berberine won’t lead to the same rapid weight loss as Ozempic in non-diabetics.
It's true that berberine "slows carbohydrate absorption in the gut and inhibits adipogenesis (the formation of fat cells)," says Rhian. Berberine also helps with insulin so it may decrease sugar cravings.
"But ultimately berberine is not going to have the same effect on suppressing appetite or delaying gastric emptying [when the stomach takes longer to empty so you feel fuller for longer], and thus won't cause the rapid weight loss you'll see with Ozempic," she adds.
In fact, a review of 12 randomised controlled trials found that berberine only helped people lose on average four and a half pounds (that's less than half an inch from their waist).
- Berberine and Ozempic doen't work in the same way on the body.
Ozempic mimics a naturally occurring hormone known as GLP-1 that releases insulin and reduces appetite after eating food. As levels of this hormone rise, it sends a message to your brain, telling it that you're full. Ozempic also slows digestion and increases the time it takes for food to pass through the body.
On the other hand, berberine activates an enzyme known as AMPK that plays a key role in regulating metabolism and controlling how our bodies use energy at a cellular level. “AMPK is involved in managing blood sugar levels, insulin signalling, food intake and body weight," adds Rhian.
- Berberine may help to reduce harmful bacteria in the gut
Berberine causes different chemical reactions within our bodies' cells. For this reason, “it can be an effective way to naturally support some of the chronic issues we're facing today, like inflammation and weakened immunity,” Rhian says.
These benefits also extend to a balanced gut microbiome as “berberine has been shown to inhibit the growth of certain harmful bacteria, and promote the growth of beneficial bacteria like Akkermansia spp,” she adds.
One woman vomited blood after using an unlicensed weight loss injection.
Does berberine have negative side effects?
As with any supplement or medication, there is always the potential for sensitivity or an allergic reaction. That said, “berberine is generally considered a safe and well-tolerated botanical medicine by the German Commission E, which is one of the most widely accepted committees on botanical safety,” Rhian says.
Physically, you run into problems when you start overdosing. Some TikTokers are advocating a dosage of 5 grams of berberine per day, which is irresponsible and unsafe. “At higher doses, individuals may experience side effects, which include diarrhoea, abdominal pain, dizziness and flatulence; however, side effects are uncommon at normal doses,” Rhian notes.
There are also psychological considerations when the popular narrative around a health supplement changes. When its sole benefit is suddenly pegged off of weight loss, it can be triggering for those who are suffering with an eating disorder or have done so in the past, says Dr. Galyna Selezneva, who is both an aesthetic doctor, a trained psychiatrist and a member of The Royal College of Psychiatrists. It can also set you on a dangerous dieting cycle in much the same way as those ‘natural’ diet teas in the '00s.
“When talking about weight loss there is always the risk of missing the point of healthy eating patterns and a healthy lifestyle," says Dr Galyna. "Healthy doesn’t mean skinny. Incorporating a variety of nutrient-dense foods, engaging in regular physical activity and adopting healthy habits are what can contribute to long-term wellbeing.”
Who shouldn't take berberine?
“Those who are pregnant or breastfeeding, and also children should avoid berberine,” says Lola. Because berberine changes how quickly the liver breaks down certain medicines, “there is also the risk of a negative interaction between berberine and certain antidepressants, anticoagulants, diabetes and heart medications.”
Rhian concurs, adding, “Because berberine can impact insulin sensitivity and blood sugar levels, insulin dependent diabetics or anyone on medications that lower blood sugar also need to be cautious and only use berberine if supervised by their primary physician.”
For more from Fiona Embleton, GLAMOUR's Acting Associate Beauty Director, follow her on @fiembleton.
A doctor breaks it down…
