What is berberine worth combining with?

In the search for safe and effective ways to prevent and treat insulin resistance and type 2 diabetes, much attention is being paid to natural compounds with hypoglycaemic properties, i.e. those that lower blood glucose levels. Berberine is one of the important natural compounds that support glycaemic control. The possibility of combining it with other plants or nutrients with similar metabolic potential is being increasingly explored.

1. The action of berberine
2. Berberine with herbs
3. Berberine with nutrients

The action of berberine

Berberine is a well-known plant alkaloid, naturally occurring in, among others, common barberry (Berberis vulgaris) and Chinese goldthread (Coptis chinensis), and in dietary supplements most often used in the form of highly soluble salts, such as hydrochloride or sulphate. Its hypoglycaemic effect consists, among other things, in stimulating pancreatic cells to secrete insulin by facilitating the influx of calcium.

This effect occurs mainly at elevated glucose levels, which reduces the risk of hypoglycaemia. Berberine also activates the AMPK enzyme, which influences a number of metabolic processes.

What do studies show?

It has been observed that it can reduce glucose production in the liver, increase its uptake by muscles and improve tissue sensitivity to insulin. Analysis of the results of human experiments suggests that berberine supplementation may contribute to lowering fasting glucose, glycated haemoglobin (HbA1c) and postprandial glycaemia, with these effects depending on the initial glucose level and the severity of metabolic disorders.

The studies analysed did not find a significant increase in the risk of hypoglycaemia or serious adverse effects, but it should be noted that most of the data come from short-term studies or studies conducted in Asia, often with limited methodological quality.

Berberine and substances that "work with" it

Berberine with herbs

The effects of berberine may be supported by other plants with hypoglycaemic properties, such as gurmar (Gymnema sylvestre), which can reduce glucose absorption from the intestines, block sweet taste receptors and support the regeneration of pancreatic β cells. Research analyses suggest that it may lower blood sugar levels and improve the lipid profile at the same time.

Cinnamon, popular among people with diabetes, may increase insulin sensitivity, support glucose uptake and delay gastric emptying, but its effectiveness depends on the form and dose, initial health status and disease progression. Fenugreek (Trigonella foenum-graecum), thanks to its fibre and saponins, can slow down the absorption of carbohydrates and improve insulin sensitivity, which in human studies at higher doses has been associated with improved blood glucose parameters.

In addition, extracts from white mulberry leaves (Morus alba) contain α-glucosidase inhibitors, which may lower postprandial glycaemia, although their effect on long-term blood sugar control requires further research.

Berberine with nutrients

Certain nutrients may support the action of berberine in regulating glucose levels, although the effects of supplementation have not been conclusively proven. Chromium, a micronutrient that supports insulin action, has been shown in human studies to have a slight effect on lowering HbA1c, without significant changes in fasting blood glucose. Magnesium, which is involved in insulin signalling, appears to be more effective. In human studies, supplementation was associated with lower fasting glucose levels and improved insulin resistance in both people with diabetes and those at risk.

Vitamin B6 may have a protective effect due to its antioxidant properties and involvement in glucose metabolism, and its deficiency is associated with a higher risk of diabetes and its complications. Folic acid (vitamin B9) may indirectly support glucose metabolism by regulating homocysteine levels associated with metabolic disorders. Furthermore, levels of vitamin B12, which is essential for the proper functioning of the nervous system and energy metabolism, may be reduced when using certain antidiabetic drugs, such as metformin, which resembles berberine in its action.

Sources:

• Nuffer W, Tall Bull S, Bakhach H, Nuffer M. Sweetly Improving Sugars? Reviewing Cinnamon's Effects on Blood Glucose. J Med Food. 2023;26(1):68-73. doi:10.1089/jmf.2022.0073
• Morales Ramos JG, Esteves Pairazamán AT, Mocarro Willis MES, Collantes Santisteban S, Caldas Herrera E. Medicinal properties of Morus alba for the control of type 2 diabetes mellitus: a systematic review. F1000Res. 2021;10:1022. Published 2021 Oct 8. doi:10.12688/f1000research.55573.1
• Xie W, Su F, Wang G, et al. Glucose-lowering effect of berberine on type 2 diabetes: A systematic review and meta-analysis. Front Pharmacol. 2022;13:1015045. Published 2022 Nov 16. doi:10.3389/fphar.2022.1015045
• Devangan S, Varghese B, Johny E, Gurram S, Adela R. The effect of Gymnema sylvestre supplementation on glycemic control in type 2 diabetes patients: A systematic review and meta-analysis. Phytother Res. 2021;35(12):6802-6812. doi:10.1002/ptr.7265
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• Zhao F, Pan D, Wang N, et al. Effect of Chromium Supplementation on Blood Glucose and Lipid Levels in Patients with Type 2 Diabetes Mellitus: a Systematic Review and Meta-analysis. Biol Trace Elem Res. 2022;200(2):516-525. doi:10.1007/s12011-021-02693-3
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