As the demand for Ozempic — the injectable diabetes medication that has become coveted for inducing weight loss — continues to intensify, people across TikTok are posting about alternatives. Some gush about other diabetes drugs, like Mounjaro; some tout so-called “generic” Ozempic from compounding pharmacies. And some are trumpeting what they claim is a cheaper option, readily available in pharmacies and online: “nature’s Ozempic,” better known as berberine.
Berberine is a chemical compound extracted from plants like goldenseal and barberry and often sold as a supplement, typically in capsules filled with yellow-tinged powder. The compound has been used in Asia for at least 2000 years, and physicians have long employed it to treat diarrhea and other gastrointestinal complaints. More recently, researchers have looked to berberine as a potential aid in treating conditions like hypertension and insulin resistance.
Berberine is vastly different from semaglutide, the active ingredient in Ozempic, though. Experts say that while berberine has proven metabolic effects on the body, whether it can actually induce weight loss remains murky. Some limited studies have indicated berberine could play a role in weight loss, which is possibly where the Ozempic comparisons stem from, but there isn’t high-quality data from large clinical trials.
“Generally, it’s a really good compound that has some good evidence behind it,” said Dr. Melinda Ring, an integrative medicine specialist at Northwestern Medicine. But, she said, the online hype around berberine’s weight loss effects is grossly overstated. “Don’t think that you’re going to take this and the pounds are just going to drop off,” she said.
What berberine can — and can’t — do for your health
A growing body of research over the last 20 years — some in petri dishes, some in mice, and a few small, but encouraging, trials in humans — suggests that berberine can potentially help lower cholesterol and regulate blood sugar. Researchers have examined whether the compound can be particularly helpful for patients with diabetes, particularly when used alongside other treatments.
Berberine also has antimicrobial properties, meaning it may help clear out detrimental bacteria in the gut and help improve the overall composition of your microbiome, said Dr. Yufang Lin, an integrative medicine specialist at the Cleveland Clinic. Those antimicrobial perks may play a role in how berberine could alleviate gastrointestinal complaints.
But when it comes to weight loss, the studies involving berberine have been patchy and preliminary.
There have been very few trials assessing weight loss in humans, said D. Craig Hopp, a deputy division director at the National Center for Complementary and Integrative Health, and none have been robust. “There’s a whiff of plausibility there,” he said, adding that animal models that have indicated the supplement could lead to weight loss — but there’s a big gap between evidence and marketing, he said.
“It’s an interesting thought, but I don’t think clinically, it’s been panning out,” added Dr. Lin.
The risks of taking berberine
Most people taking berberine will tolerate it well, Dr. Ring said, but it does come with some documented side effects. People ingesting the supplement, even at standard doses, may feel nauseated and vomit; their blood pressure may rise and their hands and feet might tingle, said Dr. Pieter Cohen, an associate professor at Harvard Medical School who studies supplements. Berberine also could contribute to uterine contractions in people who are pregnant, Dr. Lin said.
But while the supplement itself isn’t necessarily dangerous, Dr. Cohen said, he worries more about the possibility that supplement manufacturers could add another ingredient, like a stimulant— and that additive could cause harm.
Weight loss supplements are among the most likely supplements to be adulterated and potentially contaminated with banned substances, Dr. Cohen said. Data from the Centers for Disease Control and Prevention shows that herbal products marketed for weight loss are the type of supplements that most frequently send people to the emergency room, with patients often reporting adverse effects like palpitations or chest pain.
“If the manufacturer is trying to cram something into that pill, legal or illegal, that would lead to noticeable weight loss, that’s when you’re going to be taking a risk,” he said.
Particularly troubling is how berberine might interact with other medications. Berberine acts as a “perpetrator,” Dr. Hopp said, meaning that when you take certain drugs alongside berberine, you effectively get a higher concentration of the drugs in your blood. For instance, mixing berberine and Metformin, a medication used to treat type 2 diabetes, can be particularly dangerous, Dr. Hopp said, because the Metformin could act more potently, and the combination could potentially cause hypoglycemia.
And, as with any supplement, the Food and Drug Administration does not assess the safety, quality or effectiveness of berberine, which means you can’t be confident that a bottle of capsules actually contains what’s stated on the label.
“If patients are just thinking, ‘Oh, let me just add this because this is a natural substance and it has benefit,’ you can actually get into trouble without realizing it,” Dr. Lin said.
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