As the frenzy over Ozempic, Mounjaro, and other incretin-based weight-loss prescriptions continues, a herbal supplement known as berberine has gone viral on TikTok, with devotees calling it nature’s Ozempic.
“I first heard about it from a friend who learned about it on social media,” said Esther Andries, a 34-year-old vegan and wellness entrepreneur who lives in LA. Unlike most berberine devotees posting on TikTok, Andries says she wasn’t motivated by weight loss. “I’m very passionate about my health, so after doing some research, I thought maybe it could help me. I’m a vegan, and I’ve had some issues with bloating, and it definitely helped with that. It also decreased my sugar cravings and gave me more energy.”
With costs for weight-loss drugs like Ozempic and Monjouro—the incretin du jour—hovering around $1,000 a month when not covered by insurance, many are turning to this relatively inexpensive over-the-counter supplement instead. And don’t even get us started on the nationwide shortages of the drug, which are negatively impacting those who desperately need the drugs to combat diseases like diabetes. So how safe is it to take this unregulated, bioactive substance? And does berberine—which has been used for centuries in Far Eastern medicine—really offer the kind of mind-blowing weight-loss benefits as incretins?
Ozempic is part of a class of medications known as GLP-1 receptor agonists, primarily used for treating type 2 diabetes. “These medications function by increasing insulin production, slowing digestion, and reducing appetite,” says Rocio Salas-Whalen, a New York–based, board-certified endocrinologist. “While berberine has shown potential in managing blood-sugar levels and improving lipid profiles, it is important to acknowledge that individual responses can vary. It should not be considered a substitute for prescribed medications, especially for individuals with diabetes or other chronic conditions.”
Studies about berberine are quite encouraging: Recent findings highlight its ability to help maintain a healthy weight, reduce insulin resistance, and help with type 2 diabetes, as well as act as an antidepressant (which, in return, can lead to a more active lifestyle). When it comes to Andries noticing she was less boated, there are studies to back that up too. But—like most supplements or medications—it’s not for everybody. Berberine can negatively interact with a handful of drugs, which is why it’s always important to speak to your doctor before starting anything new…especially something you heard about on a social media platform.
Looking for more answers, we sat down with Dr. Salas-Whalen for a deeper dive into this popular herbal supplement.
Vogue: The hashtag for berberine has over 67 million views on TikTok. If this supplement has been around for centuries in the Far East, what is driving its sudden surge in popularity in the States?
Dr. Salas-Whalen: I think it is being driven by the increasing awareness of drugs like Ozempic and also the shortages we’re seeing with these incretin medications. They are also very expensive—especially for those whose insurance won’t cover the expense—so many people are looking for alternatives to help them lose weight.
There have been so many OTC pills and supplements marketed for weight loss over the years. How is berberine different?
There is a fair amount of research supporting its positive effect on health in the medical literature. The herb has been used for centuries in traditional medicine, so most of the important studies have been published in Chinese medical journals. Research shows it can have some effect on weight loss, not to mention glucose regulation, fatty liver, and high cholesterol.
How exactly does it work?
In addition to its anti-inflammatory and antioxidant effects, berberine activates brown adipose tissue. We have white and brown fat cells or adipose tissue. White fat is what stores fat, and brown fat is a kind of good, healthy fat that promotes thermogenesis (heat production). This increases your metabolic rate, improves insulin sensitivity, and helps regulate insulin production. In addition to activating the brown fat, it also converts white fat into brown fat. This is why it helps with metabolic diseases.
That sounds positive. So what is the downside to people taking berberine?
There’s no regulation with any kind of OTC supplement. If you take too much, you may have side effects like gastric upset. There’s also a question of quality. It’s always good to find a reliable source [like Whole Foods pharmacy] and to consult your health care provider. Do the research. On Amazon, look for products with more reviews that have been around the longest. Of course, with any supplement, it’s a hit or miss. Some people will respond better, and others may have side effects.
What are the main side effects?
The most common side effects are diarrhea, constipation, gas, and stomach upset. It’s also dangerous for pregnant women or those who are nursing. It can cross the placenta and also enter breast milk, causing liver problems for the fetus. It can also negatively interact with many drugs, including antihypertensive medications, sedatives (Ambien), and diabetes medications (like metformin), so this is definitely something people need to discuss with their doctor.
You mention berberine can be dangerous for a baby’s developing liver. Does berberine cause liver toxicity in normal adults?
No, it actually helps with fatty liver because it increases thermogenesis (heat production), which decreases fat cells.
Is it an appetite suppressant?
No, it doesn’t affect appetite. As I mentioned before, it increases thermogenesis, which boosts how much fat you’re burning. But it does help with insulin so it may decrease sugar cravings.
If berberine increases insulin, can it cause hypoglycemia?
Yes, that’s why it’s been used to treat diabetes. When you increase insulin secretion in the pancreas, it can potentially cause hypoglycemia (low blood sugar). That’s one of the reasons we need to do more research; many of the studies didn’t look at the side effects.
What are some symptoms of hypoglycemia?
If it’s really low, you could pass out. But before that happens, you might feel shaky, clammy, and hungry. I don’t think it would cause a seizure, but if somebody is already taking a glucose-lowering medication, this could throw that into overdrive. It can also interfere with other herbal supplements (like glutathione) that help lower blood pressure or others (like glutamine) that regulate blood sugar. Also, if you are taking any herbs or supplements that slow down blood clotting, this could increase the risk of bleeding. Again, this is why it’s very important to consult your doctor before starting any kind of supplement.
How does berberine affect gut health? Does it interfere with probiotics?
Berberine is not an antibiotic, but it has some antibacterial effects. So if somebody’s taking probiotics and taking a high dose of berberine, then the supplement could kill a lot of the bacteria in their probiotics.
What is a safe dose of berberine, and how often should you take it?
I recommend people take 500 mg three times a day for up to two years. You run into problems when you start overdosing. People think that because it’s an herbal supplement, they can take as much as they want and the more they take, the better. Again, this is why being supervised by a physician is very important. With all the research that’s been published, we still don’t really know enough about the supplements’ side effects and what happens if you take too much.
So, what’s the bottom line: Is it nature’s Ozempic or just another weight-loss snake-oil pill?
I have a patient who lost 160 pounds with incretins. You are never going to lose that amount of weight with berberine. But for patients who need just a little bit more control managing their sugar cravings, there’s promising evidence that it could potentially help.
That said, comparing berberine to a specific medication like Ozempic oversimplifies the complex mechanisms at play. Prescription medications undergo rigorous testing and are approved based on evidence-backed safety and efficacy. Natural supplements like berberine may offer benefits, but they should be considered as part of a holistic approach to health and should never replace prescribed treatments without proper medical guidance.
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