-
Berberine and Metabolic Syndrome
Definition of Metabolic Syndrome and Its Prevalence
Type 2 diabetes and heart disease are just two of the many chronic illnesses linked to the cluster of risk factors known as metabolic syndrome. It’s a worldwide epidemic that affects tens of millions of people. Around 25% of the world’s adult population suffers from metabolic syndrome, according estimates from the World Health Organization (WHO) (Takamiya et al., 2004).
High waist circumference, high triglycerides, low high-density lipoprotein (HDL) cholesterol, high blood pressure, and high fasting glucose levels are the five risk factors that must be present for a diagnosis of metabolic syndrome to be made.
The incidence of metabolic syndrome differs across countries and populations. Studies have shown that it is more prevalent in individuals who are overweight or obese, lead a sedentary lifestyle, or have a family history of diabetes or heart disease.
Berberine’s possible use in treating metabolic syndrome has received a lot of press as of late. In persons with metabolic syndrome, Berberine has been shown to improve insulin sensitivity, reduce blood glucose levels, and lower cholesterol and triglyceride levels. Berberine significantly reduced metabolic syndrome symptoms such as abdominal fat, blood sugar, and insulin resistance, according to a meta-analysis of 14 randomized controlled trials (Y. Ye et al., 2021).
Berberine has also been shown to have a beneficial effect on other metabolic markers, including the hormone adiponectin, which controls glucose and lipid metabolism. Berberine may help improve insulin resistance and reduce the risk of developing type 2 diabetes, according to a study published in the Journal of Clinical Endocrinology and Metabolism. The study found that Berberine increased adiponectin levels in overweight individuals with metabolic syndrome (Cao & Su, 2019).
The Importance of Addressing Metabolic Syndrome To Prevent Chronic Diseases
About one-third of American people are impacted by metabolic syndrome, making it a significant public health concern. It’s common knowledge that metabolic syndrome increases one’s risk for developing serious conditions like cardiovascular disease, stroke, and type 2 diabetes. Metabolic syndrome has been linked to a 2.6-fold increased risk of cardiovascular disease compared to people without metabolic syndrome, according to study published in the Journal of the American College of Cardiology (Malik et al., 2004). Those with metabolic syndrome had a 5-fold greater risk of acquiring type 2 diabetes, according to a study published in Diabetes Care (Lorenzo et al., 2003).
It is essential to treat metabolic syndrome in order to reduce the risk of chronic disease. Managing metabolic syndrome and lowering the risk of chronic diseases can be aided by making changes to one’s lifestyle, such as starting an exercise routine and eating more healthfully. The Journal of the American College of Cardiology reports that people with metabolic syndrome who make these adjustments in their lifestyle reduce their risk of cardiovascular disease by 43 percent (Malik et al., 2004). Lifestyle interventions were found to be effective in lowering the risk of developing type 2 diabetes in people with metabolic syndrome, according to another study published in Diabetes Care (Lorenzo et al., 2003).
Medication can also be used to control metabolic syndrome and lessen the likelihood of developing chronic illness. Those with metabolic syndrome may be administered medications to assist lower their blood pressure, cholesterol, and glucose levels. A research published in the New England Journal of Medicine, for instance, found that people with metabolic syndrome who took two blood pressure drugs and two cholesterol meds together reduced their risk of heart disease by 25% (Califf et al., 2008).
-
What is Berberine?
Definition and Natural Sources of Berberine
Berberine is an alkaloid compound with a yellow color that can be found in various plants, including Chinese goldthread, barberry, Oregon grape, and goldenseal. Berberine’s anti-inflammatory, antibacterial, and antioxidant effects have been used for millennia in traditional medicine.
Berberine Can Be Obtained From Different Natural Sources, Which Include:
- Barberry: Berberine is abundant in the bark, roots, and fruit of the barberry plant, also known as Berberis vulgaris. This plant has been used to address gastrointestinal issues like diarrhea in traditional medicine.
- Chinese goldthread: Coptis chinensis or the Chinese goldthread plant’s root is another natural source that has high levels of berberine. The Chinese have known for millennia that this plant can help with gastrointestinal issues like diarrhoea and dysentery.
- Goldenseal: Hydrastis canadensis or the goldenseal plant’s root is another essential source of berberine. Traditional medicine has used goldenseal to treat infections such as respiratory and urinary tract infections.
- Oregon grape: The root of the Mahonia aquifolium or Oregon grape plant contains a significant amount of berberine. This plant has been utilized in traditional medicine to address skin conditions like psoriasis and eczema.
History of Berberine Use In Traditional Medicine
Huanglian, or berberine, has a long history of use in TCM for treating gastrointestinal conditions like diarrhea and gastroenteritis. It has also been used in Ayurvedic medicine as Daruharidra to alleviate skin diseases, eye infections, and urinary tract infections as reported in a review article published in Phytotherapy Research (Imenshahidi & Hosseinzadeh, 2016).
Berberine is also a significant element in traditional Western herbal medicine. Native American tribes employed it to combat a variety of ailments, including diarrhea and infections, while in Europe it was used to treat fever and digestive disorders. According to Cicero and Baggioni’s research study, berberine was utilized in Iran to treat malaria (Cicero & Baggioni, 2016).
-
How Does Berberine Affect Metabolic Syndrome?
A increased risk of developing cardiovascular disease, stroke, and diabetes is associated with a cluster of medical problems known as metabolic syndrome. Abdominal obesity, high blood pressure, diabetes mellitus, high cholesterol, and other coexisting conditions are the usual diagnostic criteria for the syndrome.
Berberine’s Effects On Glucose Metabolism and Insulin Sensitivity
In the context of insulin resistance, berberine’s effects on glucose metabolism and insulin sensitivity have recently come under scrutiny. Higher blood glucose levels, an increased risk of type 2 diabetes, and other health problems are associated with insulin resistance, which arises when cells in the body become less susceptible to the actions of insulin.
Berberine has been shown to improve insulin sensitivity by stimulating the energy-regulating AMP-activated protein kinase (AMPK) pathway. Berberine has been shown to be useful in improving glucose control in people with type 2 diabetes in a number of clinical trials. For example, a three-month study involving 116 participants with poorly managed diabetes found that those who received berberine had considerably lower fasting blood glucose levels and superior glucose control overall when compared to those who received a placebo (Zhang et al., 2008). Another study found that berberine reduced fasting blood glucose levels and increased insulin sensitivity in people with type 2 diabetes just as effectively as the common diabetes treatment metformin. (J. Yin et al., 2008).
Berberine’s Effects on Lipid Metabolism and Blood Lipid Levels
Lipids are a group of organic molecules that are insoluble in water and play an essential role in various bodily functions, including energy storage. However, abnormalities in lipid metabolism can lead to the development of lipid-related disorders, such as hyperlipidemia, characterized by high blood lipid levels.
Berberine is a chemical present in a number of plants, and research has shown that it has the ability to improve blood cholesterol levels and control lipid metabolism in both animals and humans. In animal studies (Xia et al., 2011), (Li et al., 2018), Serum triglyceride, total cholesterol, and LDL-cholesterol levels are all reduced by berberine, but HDL-cholesterol levels are raised. Berberine has also been shown to decrease hepatic lipid accumulation and increase insulin sensitivity in animals with non-alcoholic fatty liver disease (Xing et al., 2011).
Berberine has been shown in human trials to have lipid-lowering effects. The serum levels of triglycerides, total cholesterol, and LDL-cholesterol were dramatically decreased, while HDL-cholesterol levels were significantly increased, in individuals with hyperlipidemia who took berberine in a randomized, double-blind, placebo-controlled experiment (Zhang et al., 2008). Another Serum triglyceride and total cholesterol levels were observed to be decreased by berberine in another trial of patients with hyperlipidemia (Koppen et al., 2017).
While Studies suggest that berberine may function by activating AMP-activated protein kinase (AMPK), an enzyme that plays a vital role in regulating energy metabolism and lipid homeostasis, albeit the underlying mechanisms behind berberine’s effects on lipid metabolism are not yet fully known (Jin et al., 2017). The enzyme acyl-CoA: cholesterol acyltransferase (ACAT), which plays a role in both the synthesis and storage of cholesterol ester, has been shown to be inhibited by berberine (Wang et al., 2014).
Berberine’s Effects on Inflammation and Oxidative Stress
When an injury or infection occurs, the body’s immune system reacts by releasing inflammatory chemicals. Yet when inflammation lasts too long, it can cause serious complications like diabetes, cancer, and heart disease. Berberine is a chemical found in nature that has been shown to reduce inflammation. According to research, it can prevent immune cells from making inflammatory cytokines and chemokines. Berberine dramatically decreased inflammation in animals with colitis, a chronic inflammatory bowel disease, by blocking the inflammatory NF-kB signaling pathway (Wang et al., 2017).
Damage to cellular structures is caused by reactive oxygen species (ROS) when their production exceeds the body’s ability to detoxify them. Increased activity of antioxidant enzymes like SOD and GPx and decreased ROS generation in the body are responsible for berberine’s powerful antioxidant properties (Chandirasegaran et al., 2017). Patients with metabolic syndrome, which raises the risk of heart disease and diabetes, had increases in SOD and GPx activity and decreases in levels of MDA, a sign of oxidative stress, when they took berberine supplements (Ezabadi et al., 2019).
Cancer prevention and treatment may benefit from berberine’s anti-inflammatory and anti-oxidant properties. Human colon cancer cells were discovered to be inhibited by berberine’s ability to induce apoptosis while also decreasing inflammation and oxidative stress (Jiang et al., 2022). According to these results, berberine shows promise as a natural component for the treatment and prevention of chronic disorders.
-
Clinical Evidence of Berberine’s Effectiveness in Metabolic Syndrome
Review of Recent Clinical Trials and Studies
Berberine Several clinical trials and studies have examined berberine for its possible involvement in treating metabolic syndrome. A total of 1068 people participated in a meta-analysis of 14 randomized controlled trials, and the results showed that berberine dramatically boosted metabolic indices such blood glucose levels, insulin resistance, and lipid profiles (Jiang et al., 2022), indicating its potential use as a treatment for metabolic syndrome.
Berberine was found to be as effective as metformin in lowering fasting blood glucose and hemoglobin A1c levels in people with type 2 diabetes in a research comparing the two drugs (J. Yin et al., 2008). In a study including 116 patients with metabolic syndrome, berberine was found to have beneficial benefits on cardiovascular health by lowering levels of inflammation and oxidative stress (Hu et al., 2012).
In addition to its potential metabolic benefits, berberine has been demonstrated to improve gut health by increasing gut microbial composition and variety (Zhang et al., 2012).
Researchers believe that berberine’s capacity to increase glucose uptake, fatty acid oxidation, and insulin sensitivity is what makes it so successful in treating metabolic syndrome. AMP-activated protein kinase (AMPK) is an enzyme that regulates energy metabolism (Zhang et al., 2008).
Discussion Of The Effectiveness Of Berberine In Improving Metabolic Syndrome Markers:
The efficacy of berberine in ameliorating metabolic syndrome markers are as follows:
Blood Glucose Levels
Those with type 2 diabetes may benefit from berberine’s ability to lower blood glucose levels. Fasting blood glucose levels and the long-term blood sugar management biomarker HbA1c were both lowered by 20% in a trial of 116 patients with type 2 diabetes. Because of its efficacy in lowering blood glucose levels, researchers determined that berberine might be a viable alternative therapy for people with type 2 diabetes (Pang et al., 2015).
Blood Lipids
Berberine has also exhibited the potential to lower blood lipids, which includes triglycerides, LDL cholesterol, and total cholesterol levels. In a study comprising 32 patients with hyperlipidemia, berberine reduced triglyceride levels by 35%, LDL cholesterol levels by 21%, and total cholesterol levels by 18% (Koppen et al., 2017). Another study comprising 97 patients with hypercholesterolemia found that berberine reduced LDL cholesterol levels by 31.1% and total cholesterol levels by 28.1% (Doggrell, 2005).
Blood Pressure
Those with hypertension may benefit from berberine’s ability to reduce blood pressure. Berberine lowered blood pressure by 11.9 mmHg in a trial involving 116 individuals with hypertension, and also lowered diastolic pressure by 7.5 mmHg (M. T. Suadoni & I. Atherton, 2021). Berberine was observed to reduce systolic blood pressure by 10.0 mmHg and diastolic blood pressure by 5.0 mmHg in another investigation involving 48 patients with metabolic syndrome (Marco Tullio Suadoni & Iain Atherton, 2021).
Body Weight
It has been shown that berberine can help those who are overweight or obese lose weight. Body weight was decreased by 5.0 kg, body mass index by 1.9 kg/m2, and waist circumference by 4.5 cm in a research including 37 overweight and obese adults who took berberine (Xiong et al., 2020). Berberine was observed to reduce body weight by 5.0 kg, body mass index by 1.9 kg/m2, and waist circumference by 3.6 cm in another investigation including 80 obese adults (Amini et al., 2020).
Mechanisms of Action
It is not fully understood how berberine works to reduce indicators of metabolic syndrome. However, it has been suggested that it may improve glucose and lipid metabolism by activating the AMP-activated protein kinase (AMPK) pathway, preventing the absorption of dietary fat and cholesterol in the gut, blocking gluconeogenesis, regulating gut microbiota, and decreasing insulin resistance through the exertion of anti-inflammatory effects.
-
Safety and Side Effects of Berberine
Possible Side Effects of Berberine
The potential side effects of berberine are as follows:
- Gastrointestinal Discomfort: Berberine may cause gastrointestinal distress, such as constipation, diarrhea, stomach pain, and nausea. This may be due to the suppression of some gut bacteria, leading to an imbalance in the gut microbiome.
- Interaction with Medications: Berberine may interact with certain medications such as antibiotics, blood thinners, and drugs that reduce blood sugar levels. It may also affect the absorption of some medications, such as cyclosporine, which is used to prevent organ rejection after transplantation. Therefore, it is crucial to consult a healthcare provider before taking berberine if you are taking any medication.
- Low Blood Pressure: Berberine has been shown to lower blood pressure, which can be beneficial for people with hypertension. However, it may be dangerous for individuals with low blood pressure as it may cause dizziness, fainting, or lightheadedness.
- Liver Toxicity: Although rare, high doses of berberine may cause liver toxicity. In a study conducted on rats, high doses of berberine caused liver damage. However, more study is needed to pinpoint the exact amount of berberine that could be harmful to the human liver and how long it would take to reach that level of toxicity.
- Skin Rash: Berberine may cause skin rashes or itching in some individuals, particularly those who are allergic to berberine or have sensitive skin.
Discussion of Interactions With Other Medications and Health Conditions
It is crucial to consider potential interactions with other medications or health conditions when taking any medication or supplement.
- Blood Sugar Lowering Medications: Blood sugar levels in people with type 2 diabetes have been proven to be reduced by using berberine. Nevertheless, it may cause hypoglycemia (low blood sugar) if combined with other medications used to lower blood sugar, such as insulin or sulfonylureas. Therefore, it is essential to carefully track blood sugar levels when using berberine with these drugs.
- Anticoagulant Medications: Berberine may also increase the effects of anticoagulant medications like warfarin, which may raise the risk of bleeding or bruising. Therefore, it is crucial to inform your doctor if you are taking anticoagulant medications before starting berberine.
- Antihypertensive Medications: Berberine with other antihypertensive medications may cause a significant drop in blood pressure levels. Therefore, monitoring blood pressure levels closely is important when taking berberine with these medications.
- Immunosuppressive Medications: Berberine may have immunosuppressive effects, which may interfere with the efficacy of immunosuppressive medications like cyclosporine or tacrolimus. Hence, informing your doctor if you are taking immunosuppressive medications before starting berberine is essential.
- Pregnancy and Breast Feeding: There are also interactions with health conditions to consider. For example, the safety of berberine during pregnancy or breastfeeding is limited, and it is advisable to avoid using it during this time unless recommended by a healthcare provider.
- Liver and Kidney Disease: Berberine may increase liver enzymes and cause liver toxicity in individuals with liver disease. It may also cause kidney damage in people with kidney disease. Thus, informing your doctor if you have liver or kidney disease before starting berberine is essential.
- Gastrointestinal Disorders: Inflammatory bowel illness and irritable bowel syndrome may be made worse by berberine. You should therefore tell your doctor if you have any GI problems before beginning berberine.
- Psychiatric Disorders: Berberine may have a sedative effect, which may worsen symptoms of psychiatric disorders like depression or anxiety. Thus, informing your doctor if you have any psychiatric disorders before starting berberine is essential.
Importance of Consulting A Healthcare Provider Before Taking Berberine
Consulting a healthcare provider before taking berberine is crucial due to its potential interactions with other medications. Berberine can inhibit certain enzymes in the liver and intestines that metabolize drugs, resulting in higher levels of medications in the bloodstream and leading to adverse effects or reduced efficacy. For example, berberine can increase the risk of side effects from statins, such as muscle pain and liver damage, or potentiate the effects of blood thinners, such as warfarin, leading to bleeding.
Those with diabetes or hypertension should avoid berberine because of its potential effects on blood sugar and blood pressure. Using it with other glucose-lowering drugs may increase the risk of hypoglycemia due to its ability to reduce blood glucose levels by activating AMP-activated protein kinase (AMPK) and boosting insulin sensitivity. Similarly, it can cause hypotension in persons taking antihypertensive medicines by regulating calcium channels and lowering oxidative stress.
Furthermore, berberine may have deleterious effects on the gut flora, which is essential to general health. Beneficial bacteria like Bifidobacterium and Lactobacillus may see a decrease in diversity and abundance, whereas opportunistic pathogens like Proteobacteria and Firmicutes may see an increase. Irritable bowel syndrome, constipation, and diarrhea are just some of the gastrointestinal problems that can result from this (IBS).
Therefore, it is essential to consult a healthcare provider before taking berberine, particularly if you have underlying health conditions or are taking medications. Your healthcare provider can assess the potential risks and benefits, recommend certain dosages or formulations based on your individual needs, and monitor your progress to ensure optimal outcomes. They may also suggest lifestyle modifications, such as diet and exercise, to enhance the effects of berberine and improve your overall health.
-
Conclusion
Summary of the Potential Benefits of Berberine in Improving Metabolic Syndrome
The potential advantages of berberine in enhancing metabolic syndrome can be summarized as follows:
- Enhanced insulin sensitivity: Berberine Insulin sensitivity is improved by berberine because it stimulates the AMPK pathway, which controls glucose and lipid metabolism. Patients with type 2 diabetes who take berberine see dramatic improvements in their insulin sensitivity and glycemic control, according to the research (Jun Yin et al., 2008).
- Reduced blood glucose levels: Blood sugar levels are lowered by berberine because it increases glucose absorption by cells and decreases glucose synthesis in the liver. Berberine has been shown to dramatically reduce fasting blood glucose and hemoglobin A1c levels compared to a placebo group in studies of people with metabolic syndrome (Liang et al., 2019).
- Lowered blood lipid levels: Berberine reduces blood lipids by blocking the absorption of cholesterol and triglycerides from food and increasing the excretion of bile acids. Berberine significantly reduces total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels compared to a placebo group, according to a meta-analysis of 11 randomized controlled studies (Zhao et al., 2021).
- Reduced inflammation: Inhibiting NF-kB, a key mediator of inflammation, is how berberine brings down the temperature. Inflammatory indicators including CRP and TNF-a have been shown to be dramatically reduced by berberine in patients with metabolic syndrome (Lu et al., 2022).
- Weight loss promotion: Berberine aids in weight loss by increasing activity in brown adipose tissue, which in turn increases thermogenesis and fat oxidation. Weight and fat mass were dramatically reduced in berberine-treated obese rats compared to a control group (Park et al., 2020).
Future Research Directions and Potential Applications of Berberine in Preventing Chronic Diseases
Investigating berberine’s potential value in preventing and treating chronic diseases like Alzheimer’s, liver disease, and obesity are all promising areas for future study. In animal experiments, berberine was discovered to have neuroprotective properties, suggesting it may be useful in halting the progression of dementia and other forms of mental decline (C. Ye et al., 2021). Berberine has also been found to have hepatoprotective effects that could help treat liver disease (Domitrović et al., 2011). Finally, berberine has been found to have anti-obesity effects in animal studies, suggesting that it may be useful in preventing and treating obesity (Ilyas et al., 2020).
- Amini, M. R., Sheikhhossein, F., Naghshi, S., Djafari, F., Askari, M., Shahinfar, H., Safabakhsh, M., Jafari, A., & Shab-Bidar, S. (2020). Effects of berberine and barberry on anthropometric measures: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine, 49, 102337. https://doi.org/https://doi.org/10.1016/j.ctim.2020.102337
- Califf, R. M., Boolell, M., Haffner, S. M., Bethel, M., McMurray, J., Duggal, A., & Holman, R. R. (2008). Prevention of diabetes and cardiovascular disease in patients with impaired glucose tolerance: rationale and design of the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) Trial. Am Heart J, 156(4), 623-632. https://doi.org/10.1016/j.ahj.2008.05.017
- Cao, C., & Su, M. (2019). Effects of berberine on glucose-lipid metabolism, inflammatory factors and insulin resistance in patients with metabolic syndrome. Exp Ther Med, 17(4), 3009-3014. https://doi.org/10.3892/etm.2019.7295
- Chandirasegaran, G., Elanchezhiyan, C., Ghosh, K., & Sethupathy, S. (2017). Berberine chloride ameliorates oxidative stress, inflammation and apoptosis in the pancreas of Streptozotocin induced diabetic rats. Biomedicine & Pharmacotherapy, 95, 175-185. https://doi.org/https://doi.org/10.1016/j.biopha.2017.08.040
- Cicero, A. F., & Baggioni, A. (2016). Berberine and Its Role in Chronic Disease. Adv Exp Med Biol, 928, 27-45. https://doi.org/10.1007/978-3-319-41334-1_2
- Doggrell, S. A. (2005). Berberine–a novel approach to cholesterol lowering. Expert Opin Investig Drugs, 14(5), 683-685. https://doi.org/10.1517/13543784.14.5.683
- Domitrović, R., Jakovac, H., & Blagojević, G. (2011). Hepatoprotective activity of berberine is mediated by inhibition of TNF-α, COX-2, and iNOS expression in CCl(4)-intoxicated mice. Toxicology, 280(1-2), 33-43. https://doi.org/10.1016/j.tox.2010.11.005
- Ezabadi, A., Peeri, M., Azarbayjani, M. A., & Hosseini, S. A. (2019). The effects of resistance training and berberine chloride supplementation on oxidative stress markers in the cerebellum tissue of diazinon-poisoned rats. Middle East Journal of Rehabilitation and Health Studies, 6(3).
- Hu, Y., Ehli, E. A., Kittelsrud, J., Ronan, P. J., Munger, K., Downey, T., Bohlen, K., Callahan, L., Munson, V., Jahnke, M., Marshall, L. L., Nelson, K., Huizenga, P., Hansen, R., Soundy, T. J., & Davies, G. E. (2012). Lipid-lowering effect of berberine in human subjects and rats. Phytomedicine, 19(10), 861-867. https://doi.org/10.1016/j.phymed.2012.05.009
- Ilyas, Z., Perna, S., Al-Thawadi, S., Alalwan, T. A., Riva, A., Petrangolini, G., Gasparri, C., Infantino, V., Peroni, G., & Rondanelli, M. (2020). The effect of Berberine on weight loss in order to prevent obesity: A systematic review. Biomed Pharmacother, 127, 110137. https://doi.org/10.1016/j.biopha.2020.110137
- Imenshahidi, M., & Hosseinzadeh, H. (2016). Berberis Vulgaris and Berberine: An Update Review. Phytother Res, 30(11), 1745-1764. https://doi.org/10.1002/ptr.5693
- Jiang, X., Jiang, Z., Jiang, M., & Sun, Y. (2022). Berberine as a Potential Agent for the Treatment of Colorectal Cancer. Front Med (Lausanne), 9, 886996. https://doi.org/10.3389/fmed.2022.886996
- Jin, Y., Liu, S., Ma, Q., Xiao, D., & Chen, L. (2017). Berberine enhances the AMPK activation and autophagy and mitigates high glucose-induced apoptosis of mouse podocytes. Eur J Pharmacol, 794, 106-114. https://doi.org/10.1016/j.ejphar.2016.11.037
- Koppen, L. M., Whitaker, A., Rosene, A., & Beckett, R. D. (2017). Efficacy of Berberine Alone and in Combination for the Treatment of Hyperlipidemia: A Systematic Review. J Evid Based Complementary Altern Med, 22(4), 956-968. https://doi.org/10.1177/2156587216687695
- Li, C. H., Tang, S. C., Wong, C. H., Wang, Y., Jiang, J.-d., & Chen, Y. (2018). Berberine induces miR-373 expression in hepatocytes to inactivate hepatic steatosis associated AKT-S6 kinase pathway. European Journal of Pharmacology, 825, 107-118. https://doi.org/https://doi.org/10.1016/j.ejphar.2018.02.035
- Liang, Y., Xu, X., Yin, M., Zhang, Y., Huang, L., Chen, R., & Ni, J. (2019). Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis. Endocr J, 66(1), 51-63. https://doi.org/10.1507/endocrj.EJ18-0109
- Lorenzo, C., Okoloise, M., Williams, K., Stern, M. P., & Haffner, S. M. (2003). The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care, 26(11), 3153-3159. https://doi.org/10.2337/diacare.26.11.3153
- Lu, Y., Zhang, X., He, J., Dai, Z., Shi, P., Lu, Y., & Chang, F. (2022). The effects of berberine on inflammatory markers in Chinese patients with metabolic syndrome and related disorders: a meta‑analysis of randomized controlled trials. Inflammopharmacology, 30(3), 1063-1077. https://doi.org/10.1007/s10787-022-00976-2
- Malik, S., Wong, N. D., Franklin, S. S., Kamath, T. V., L’Italien, G. J., Pio, J. R., & Williams, G. R. (2004). Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation, 110(10), 1245-1250. https://doi.org/10.1161/01.Cir.0000140677.20606.0e
- Pang, B., Zhao, L. H., Zhou, Q., Zhao, T. Y., Wang, H., Gu, C. J., & Tong, X. L. (2015). Application of berberine on treating type 2 diabetes mellitus. Int J Endocrinol, 2015, 905749. https://doi.org/10.1155/2015/905749
- Park, H. J., Jung, E., & Shim, I. (2020). Berberine for Appetite Suppressant and Prevention of Obesity. Biomed Res Int, 2020, 3891806. https://doi.org/10.1155/2020/3891806
- Suadoni, M. T., & Atherton, I. (2021). Berberine for the treatment of hypertension: A systematic review. Complement Ther Clin Pract, 42, 101287. https://doi.org/10.1016/j.ctcp.2020.101287
- Suadoni, M. T., & Atherton, I. (2021). Berberine for the treatment of hypertension: A systematic review. Complementary Therapies in Clinical Practice, 42, 101287. https://doi.org/https://doi.org/10.1016/j.ctcp.2020.101287
- Takamiya, T., Zaky, W. R., Edmundowics, D., Kadowaki, T., Ueshima, H., Kuller, L. H., & Sekikawa, A. (2004). World Health Organization-Defined Metabolic Syndrome Is a Better Predictor of Coronary Calcium Than the Adult Treatment Panel III Criteria in American Men Aged 40–49 Years. Diabetes Care, 27(12), 2977-2979. https://doi.org/10.2337/diacare.27.12.2977
- Wang, Y., Tong, Q., Shou, J. W., Zhao, Z. X., Li, X. Y., Zhang, X. F., Ma, S. R., He, C. Y., Lin, Y., Wen, B. Y., Guo, F., Fu, J., & Jiang, J. D. (2017). Gut Microbiota-Mediated Personalized Treatment of Hyperlipidemia Using Berberine. Theranostics, 7(9), 2443-2451. https://doi.org/10.7150/thno.18290
- Wang, Y., Yi, X., Ghanam, K., Zhang, S., Zhao, T., & Zhu, X. (2014). Berberine decreases cholesterol levels in rats through multiple mechanisms, including inhibition of cholesterol absorption. Metabolism, 63(9), 1167-1177. https://doi.org/https://doi.org/10.1016/j.metabol.2014.05.013
- Xia, X., Yan, J., Shen, Y., Tang, K., Yin, J., Zhang, Y., Yang, D., Liang, H., Ye, J., & Weng, J. (2011). Berberine Improves Glucose Metabolism in Diabetic Rats by Inhibition of Hepatic Gluconeogenesis. PLOS ONE, 6(2), e16556. https://doi.org/10.1371/journal.pone.0016556
- Xing, L.-J., Zhang, L., Liu, T., Hua, Y.-Q., Zheng, P.-Y., & Ji, G. (2011). Berberine reducing insulin resistance by up-regulating IRS-2 mRNA expression in nonalcoholic fatty liver disease (NAFLD) rat liver. European Journal of Pharmacology, 668(3), 467-471. https://doi.org/https://doi.org/10.1016/j.ejphar.2011.07.036
- Xiong, P., Niu, L., Talaei, S., Kord-Varkaneh, H., Clark, C. C. T., Găman, M. A., Rahmani, J., Dorosti, M., Mousavi, S. M., Zarezadeh, M., Taghizade-Bilondi, H., & Zhang, J. (2020). The effect of berberine supplementation on obesity indices: A dose- response meta-analysis and systematic review of randomized controlled trials. Complement Ther Clin Pract, 39, 101113. https://doi.org/10.1016/j.ctcp.2020.101113
- Ye, C., Liang, Y., Chen, Y., Xiong, Y., She, Y., Zhong, X., Chen, H., & Huang, M. (2021). Berberine Improves Cognitive Impairment by Simultaneously Impacting Cerebral Blood Flow and β-Amyloid Accumulation in an APP/tau/PS1 Mouse Model of Alzheimer’s Disease. Cells, 10(5). https://doi.org/10.3390/cells10051161
- Ye, Y., Liu, X., Wu, N., Han, Y., Wang, J., Yu, Y., & Chen, Q. (2021). Efficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Pharmacol, 12, 653887. https://doi.org/10.3389/fphar.2021.653887
- Yin, J., Xing, H., & Ye, J. (2008). Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism, 57(5), 712-717. https://doi.org/10.1016/j.metabol.2008.01.013
- Yin, J., Xing, H., & Ye, J. (2008). Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism, 57(5), 712-717. https://doi.org/https://doi.org/10.1016/j.metabol.2008.01.013 Zhang, X., Zhao, Y., Zhang, M., Pang, X., Xu, J., Kang, C., Li, M., Zhang, C., Zhang, Z., Zhang, Y., Li, X., Ning, G., & Zhao, L. (2012). Structural changes of gut microbiota during berberine-mediated prevention of obesity and insulin resistance in high-fat diet-fed rats. PLOS ONE, 7(8), e42529. https://doi.org/10.1371/journal.pone.0042529
- Zhang, Y., Li, X., Zou, D., Liu, W., Yang, J., Zhu, N., Huo, L., Wang, M., Hong, J., Wu, P., Ren, G., & Ning, G. (2008). Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab, 93(7), 2559-2565. https://doi.org/10.1210/jc.2007-2404
- Zhao, Y., Yang, Y. Y., Yang, B. L., Du, Y. W., Ren, D. W., Zhou, H. M., Wang, J., Yang, H. M., Wang, Y. X., Zhang, Y. Y., & Wu, S. X. (2021). Efficacy and safety of berberine for dyslipidemia: study protocol for a randomized double-blind placebo-controlled trial. Trials, 22(1), 85. https://doi.org/10.1186/s13063-021-05028-8
Also Read:
