Can Berberine Trump Metformin for Diabetes Management?

In my initial sessions with new patients, my priority is to establish a comfortable and safe environment. We don’t immediately dive into discussions about “nutrition” or “medical” topics. Instead, the conversation might start with them sharing personal interests, like their favorite guitar or a necklace crafted by their six-year-old niece. Despite the seemingly casual start, I’m well aware of the underlying reason for their visit – they want to explore ways to lower their blood sugar without relying solely on medication.

As the conversation unfolds, usually within the first five minutes, we delve into why managing their diabetes is crucial to them. What I often hear is their desire for the freedom to choose a path that involves giving their best effort to bring down their A1C and potentially reduce medication, which often includes the commonly prescribed metformin. This opens a window for them to inquire about supplements or alternatives to medication alone, with berberine and cinnamon frequently coming up as options worth exploring.

My goal has always been to craft a strategy that aligns with the patient’s comfort while also delving into evidence-based alternatives. The goal is for them to experience sustained energy levels through well-managed blood sugar and personalized lifestyle changes.

What if there are effective options beyond prescribed medications? In this article, we’ll explore how berberine and metformin can play a dual role in lowering blood sugar.

What is Berberine?

Berberine is a compound found in several plants, including goldenseal, barberry, and Chinese goldthread. Like metformin, berberine is known for its potential benefits in managing blood sugar levels.

There have been some new findings that it helps with weight loss, improvements in insulin sensitivity and potentially reduce the development of new fat cells.

More research does need to be conducted since many of the studies were done on animals or in vitro. Which means, it has been done in a lab isolating the study sample outside of the living organism.

How Does Berberine Work on Blood Sugar?

Berberine helps our body handle sugar better. It does this by starting a chain reaction with something called insulin-like growth factor-1 (IGF-1). This makes our body produce more insulin, which is good for us. It also helps our liver, muscles, and fat respond better to insulin, making everything work more smoothly.

In one study, it found that berberine was just as effective as metformin in the reduction of their HBA1C in patients living with type 2 diabetes.

What is Hemoglobin A1c and Why is it Important in Diabetes

Your HbA1c, or hemoglobin A1c, is a blood test that measures the average blood sugar levels over the past 2-3 months. It provides a longer-term view of how well blood sugar has been controlled and is commonly used in the management of diabetes. The test measures the percentage of hemoglobin (a protein in red blood cells) that has glucose (sugar) attached to it.

Higher levels of HbA1c indicate poorer blood sugar control, while lower levels suggest better control. It is a crucial tool for healthcare professionals to assess and monitor the effectiveness of diabetes treatment plans and make adjustments as needed.

Therefore, when utilizing metformin or berberine you want to track your A1C through blood work to measure the three-month average. Then daily, you want to check your blood sugar at least two times a day. One time upon fasting and another time 1-2 hours after the first bite of the meal. According to the American Diabetes Association you want to aim for the following metrics if you’re living with type 2 diabetes:

What is Metformin?

Metformin is an oral prescription medication commonly used to treat type 2 diabetes. It belongs to a class of drugs known as biguanides. Metformin helps control blood sugar levels in individuals with type 2 diabetes by addressing several aspects of glucose metabolism. It works by:

• Reducing glucose production in the liver
• Enhancing insulin sensitivity in tissues like your muscles
• Then, decreases the absorption of glucose from the digestive tract

By improving the body’s response to insulin and reducing the overall amount of glucose in the bloodstream, metformin helps regulate blood sugar levels. 

In addition to its use for diabetes management, metformin is sometimes prescribed for certain medical conditions such as polycystic ovary syndrome (PCOS) and may have potential benefits beyond glycemic control, such as cardiovascular protection. 

How Does Metformin Work on Blood Sugar?

Metformin works by reducing the amount of glucose produced by your liver. It signals to the liver, “We’re good on glucose, no need to release more into the bloodstream.” This helps keep your blood sugar levels stable.

Metformin doesn’t stop there; it’s also like insulin’s helper. It makes cells more responsive to insulin’s instructions, creating a smooth process for using glucose and avoiding sudden spikes or drops.

In the intricate dance of cellular energy usage, Metformin ensures efficiency. It fine-tunes the use of glucose, directing it where it’s needed without causing chaos in the bloodstream.

Interestingly, besides its main job, Metformin sometimes has a side effect: weight loss. The details aren’t entirely clear, but think of it as a positive extra benefit.

Other Benefits to Taking Metformin

In addition to blood sugar control, there have been several other benefits to taking Metformin.

Weight Management

Earlier on in this article, it was mentioned how Metformin was effective in weight loss. There was a study conducted where researchers tested how metformin affects the feeling of fullness and weight loss in women with diabetes and obesity. They gave different amounts of metformin or a fake pill (called a placebo) to 12 women for three days, followed by a meal test.

The women who took metformin, especially the higher dose, ate fewer calories and felt less hungry. In another part of the study with 48 women, those who took metformin lost more weight over 24 weeks compared to those who took a fake pill. So, the study suggests that metformin can help reduce appetite and improve your natural hunger regulation.

Cardiovascular Benefits

Using data from the NHANES database (2017-2020), this study aimed to investigate the relationship between how metformin helped cardiovascular health in patients with diabetes. The results found that those who used metformin experienced improved cardiovascular protection.

Metformin helps your body in two main ways. First, it prevents certain cells (monocytes) from turning into types that could be bad for your heart. Second, it stops signals that might make your blood vessels too active.

These actions work together to keep your blood vessels healthy. If your blood vessels become “sticky” from having high blood sugar for a long time, metformin steps in and manages your blood sugar levels, making sure they stay safe.

Anti-Inflammatory Effects

Metformin is thought to activate a key cellular regulator called AMP-activated protein kinase (AMPK), which is believed to be responsible for its anti-inflammatory effects. AMPK main job is to keep an eye on the energy levels in your cells, making sure everything is in balance.

When AMPK is active, it does things like stop processes that could cause inflammation, reduce stress inside your cells, and even influence your immune system to respond better to challenges.

Berberine Benefits for Diabetes

Researchers have been investigating how berberine may lower blood sugar levels, and they’ve suggested various ways it might work. Note that researchers are still conducting ongoing research, and while some mechanisms are well understood, others still require further investigation.

Improving Insulin Sensitivity

Research demonstrates that berberine improves insulin sensitivity, making the body respond more effectively to insulin. Insulin, a crucial hormone in regulating blood sugar levels, facilitates the absorption of glucose (sugar).

Increase Sugar Usage to Reduce Blood Sugar

Berberine may increase the uptake of glucose by cells, especially muscle cells, promoting the utilization of glucose for energy. This action helps to reduce elevated blood glucose levels.

It is believed to activate an enzyme that helps bring sugar into the cell. What enzymes do they help to speed up the reactions that take place in the breakdown of food?

Prevent Glucose Release by the Liver

It may suppress the production of glucose in the liver. The liver is involved in gluconeogenesis, a process where it breaks down the storage forms of glucose in the liver and utilizes it. What berberine does is stops this process when it’s not necessary to keep blood sugar levels in a favorable range.

Reduce Inflammation

Chronic inflammation is associated with insulin resistance and impaired glucose metabolism. Berberine has anti-inflammatory properties, which may contribute to its positive effects on insulin sensitivity and blood sugar regulation.

Side Effects of Taking Berberine or Metformin

Metformin: Typical side effects of Metformin include digestive issues like nausea and diarrhea, impacting the consumption of calories. Prolonged usage may pose a potential risk of vitamin B12 deficiency, and in rare cases, lactic acidosis can occur. Please note that Metformin is FDA-approved as an anti-diabetic medication

Berberine: The common side effects of Berberine include general gastrointestinal discomfort. With high doses potentially causing liver toxicity. It’s important to highlight that berberine, being a supplement, is not under regulatory scrutiny. The absence of regulation implies that the safety and effectiveness of berberine supplements may not undergo systematic monitoring or validation over an extended period, and there is a scarcity of data concerning its long-term safety profile. It’s also not encouraged for use in infants or those who are pregnant.

What a Dietitian Thinks About Berberine

Clinically, I’ve seen patients take berberine combined with metformin as a combination therapy and their blood sugars have improved. It’s highly advised to consult with your doctor before you do so.

Based on the current scientific evidence there are more randomized controlled trials that support metformin in its uses for diabetes management. However, more evidence is emerging on berberine’s therapeutic effects on blood sugar, insulin sensitivity, and cardiovascular biomarkers.

There is no one-size-fits-all solution to maximizing your health and utilizing a comprehensive approach with your medical healthcare team. Work with a registered dietitian to help you create lifestyle changes that support blood sugar management. This will help you create forever change building on habits to bring with you throughout your life! If you’re looking to work with a dietitian click on the button below!

Disclaimer: This article is not intended to provide medical advice, diagnosis, opinion, treatment or services. This article and the links contained in it provide general information for educational purposes only. The information provided in this article is not a substitute for medical care, and should not be used in place of the advice of your physician or registered dietitian.

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