Berberine and Diabetes Care

Berberine and Diabetes Care

Berberine and its Role in Diabetes Care

In the last five years, Berberine has come to the forefront of the treatment for chronic diseases such as diabetes. Berberine is an herbal nutraceutical noted for its multisystem effects, primarily in lipid and glucose reduction.

What is Berberine?
Berberine is a chemical extract from herbs containing a complex of vitamins, antioxidants, and other synergistic chemicals that form a compound called Berberine, a bitter crystalline yellow alkaloid.  It is a compound obtained from the parts of various plants (such as barberry) and used in medicine specifically for its antimicrobial, hypoglycemic, and hypolipidemic properties.

Berberine has its roots in Chinese and Ayurvedic medicine. It can be isolated from various traditional herbs such as goldenseal, tree Tumeric (not spice Tumeric), barber, Oregon grape, Phellodendron, and golden thread herbs. The compound is found in all parts of the with the roots containing the highest concentration of the alkaloid.

How does Berberine act to control blood sugar?
The downfall of studying potential mechanisms for Berberine is that many of the studies have been conducted in animal models or, at best, in human' cellular tissues. Actual clinical trials are sparse and need to be performed on a widespread basis. What we know are the following:

Berberine stimulates AMPK, or 5' adenosine monophosphate-activated protein kinase, is a crucial energy-regulating enzyme in the human system. The key roles of this enzyme are:

• Activation or stimulation of oxidation in the liver of fat.
•  Ketogenesis.
•  Stimulation of skeletal muscle fatty acid oxidation.
•  Glucose uptake.
• Inhibition of cholesterol synthesis.
•  Lipogenesis.
• Triglyceride synthesis.
• Inhibition of adipocyte lipogenesis (fat generation).
•  Activation of adipocyte lipolysis (fat breakdown).
• Modulation of insulin secretion by pancreatic beta-cells.

Very few things activate AMPK , but we know that exercise, low-calorie diets, and resveratrol all stimulate AMPK. When AMPK is activated, blood sugar is better controlled.

Berberine reduces insulin resistance
Insulin resistance is a primary finding in diabetes type II. Exercise, calorie restriction, low glycemic load diets all reduce insulin resistance. We are finding that Berberine, through multiple metabolic pathways, reduces insulin resistance through multiple mechanisms.

Insulin resistance is reduced by upregulating insulin receptors, so there are more receptors for insulin to bind to.This is a unique way around the resistance of the existing receptors – make new ones. Berberine stimulates this process. Although AMPK mediates this process, it deserves mentioning on its own.

Clinical Role of Berberine.

• Lowers  blood glucose.
• Lowers serum insulin.
• Enhances movement of glucose across cell membranes.
• Stimulates the breakdown of glycogen into glucose.
• Stimulates the enzyme AMPK.
• Reduces insulin resistance.

Dosage:
500 mg of Berberine t.i.d.
(three times daily)

A study published in 2010 replicated the increase in humans' insulin receptors, concluding that a 500 mg. berberine supplement taken twice per day lowered serum insulin in the patient group by 28% and fasting glucose by 26%, similar to the drug intervention group receiving Metformin and rosiglitazone.

Berberine reduces insulin resistance by inhibiting the uptake of free fatty acids as well. Berberine also stimulates the insulin-signaling cascade, or the way insulin talks to the cells.

Action on Glut1
​Glut1 is a transport protein that carries glucose across cell membranes without the requirement of insulin. Recent data has shown that Berberine facilitates the glucose transport mechanism of Glut1, which is another potential explanation for Berberine’s positive blood-glucose-lowering role in diabetes.  A study published in 2011 demonstrated for the first time that Berberine acutely activates the transport activity of GLUT1 in mouse fibroblast cells.

Action on branched-chain amino acids
Obesity and insulin resistance have been associated with a high circulating blood level of the branched-chain amino acids (BCAAs), leucine, valine, and isoleucine.  A recent 2019 study in mice demonstrated that Berberine reduces these amino acids, thus reducing insulin resistance. Of course, whether this study can be extrapolated to humans remains to be seen in well-designed clinical trials.

Stimulation of glycolysis
Glycolysis is the breakdown of glucose for energy. Berberine is known to stimulate this function.

What does the research say about type 2 diabetes and berberine treatment?
Berberine has become well known as a nutraceutical similar in effectiveness to Metformin or Glucophage without the serious gastrointestinal side-effects Metformin is so well known for. Through identified mechanisms such as stimulating AMPK, and glycolysis, as well as other identified actions, Berberine may very well be a suitable adjunctive therapy for prediabetes or diabetes in conjunction with diet and exercise. Studies back in 2008 showed significant drops in HbA1C and fasting glucose in hyperglycemic patients given 500 mg berberine three times per day compared to traditional Metformin treatment. Fasting plasma insulin and insulin resistance were reduced by 28.1 and 44.7%, respectively, in this study.

A 2019 review revealed more extensive studies of Berberine relative to its hypoglycemic effects and positive relationship in diabetes management. Used in a traditional dosage of 500 mg two to three times a day, Berberine can be a successful adjunctive treatment to medical nutrition therapy in the management of diabetes.

Safety Profile of Berberine Treatment for Diabetes
Berberine has been used safely for thousands of years. However, recent studies have shown interaction with drug detoxifying enzymes and thus a potential for drug-drug interactions. As with any nutraceutical treatment, always check with your health care provider before adding a nutraceutical to your care plan regimen.

ConclusionThe use of Berberine in the control of blood sugar is well supported by the literature and historically in treatment regimens. It has proven to be a safe alternative to Metformin and may be preferable, or certainly, an alternative given the side-effects associated with this medication.