Is Berberine Nature’s GLP-1?

The World Health Organization estimates that 40.3% of US adults are obese, resulting in a significant societal burden. Defined as a body mass index (BMI) of 30 kg/m² or greater, obesity is an epidemic affecting both men and women 20 years and older. While rates have shown a slight decline since 2017, when prevalence peaked at approximately 42.7%, this shift may be driven in part by the approval and growing use of incretin-based therapies targeting glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide.^1,2

In recent years, incretin-based therapies—such as semaglutide and tirzepatide—have received FDA approval for several indications, including type 2 diabetes and weight management, potentially impacting the overall obesity trends in the US.³ These therapies promote weight loss by delaying gastric emptying and enhancing satiety.⁴ Concurrently, many individuals continue to turn to prescription medications and dietary supplements in their efforts to reduce weight and manage fat accumulation.¹

One supplement gaining popularity for weight management is berberine, a plant-derived alkaloid and medicinal herb used for centuries.⁵ Berberine has been studied for its potential effects on glucose regulation, cardiovascular health, and weight management.⁶ It is thought to influence multiple metabolic pathways, including lipid metabolism, glucose regulation, and energy production. Proposed mechanisms include reducing cholesterol, lipoprotein, and triglyceride levels by modulating gene expression and limiting intestinal absorption of cholesterol by inhibiting reuptake in Caco-2 cells. In terms of glucose metabolism, berberine may suppress hepatic gluconeogenesis by targeting phosphoenolpyruvate carboxykinase and glucose-6-phosphatase, resulting in lower blood glucose levels. Additionally, it has been indicated to enhance mitochondrial efficiency, potentially improving energy conversion and contributing to weight regulation.

These proposed mechanisms indicate that berberine may support weight management by impacting lipid metabolism, glucose homeostasis, and cellular energy use; however, most evidence is preclinical or based on small, heterogeneous studies. Most clinical trials have included fewer than 100 participants and were of short duration (typically 8–12 weeks), often targeting glycemic or lipid outcomes rather than weight loss as a primary end point. A 2020 systematic review of 35 studies concluded that while berberine shows promise in metabolic regulation, robust clinical data demonstrating meaningful weight loss outcomes are lacking, highlighting the need for further high-quality clinical trials to establish its role in weight management.⁶

The rapid rise in the use of incretin-based therapies such as GLP-1 receptor agonists has also fueled public interest in alternative, nonprescription options. Popularized on platforms such as TikTok and Instagram, berberine has been referred to as “nature’s Ozempic.” Despite the popularity it has gained from this claim, it is misleading and not supported by scientific evidence.^6,7 Unlike GLP-1 receptor agonists, there is little evidence that berberine directly increases satiety; some mechanistic parallels have been drawn with metformin, though clinical equivalence is unproven.⁷

Available data suggest that berberine produces only modest weight reductions of approximately 2 to 4 kg (about 4.4–8.8 lb); however, results vary, and many trials show little to no effect compared with the approximately 10% weight loss observed with incretin-based therapies.⁸ Studies examining berberine’s effects have often focused on its impact on diabetes, cholesterol reduction, and insulin resistance.⁶ A standardized dosing regimen for weight loss has not been established, but doses ranging from 900 to 1500 mg per day, divided into 2 or 3 doses due to berberine’s short half-life, have been used in studies.⁸ Results were also dependent on concurrent lifestyle modifications.⁸ A 2022 review found that berberine reduced BMI and body weight when taken for at least 2 months, with 1000 mg per day identified as an effective dose.⁹ Individuals who take berberine may experience gastrointestinal adverse effects (AEs) such as nausea, abdominal pain, constipation, diarrhea, and bloating.¹⁰ Berberine is available over the counter, but it is not regulated by the FDA.¹¹ As with other dietary supplements, the potency, purity, and consistency of berberine products can vary widely, potentially impacting both safety and efficacy.

Pharmacists are in a key position to guide patients considering supplement use. In addition to counseling on proper administration and potential AEs of berberine, pharmacists should educate patients about potential drug-supplement interactions. Berberine can interact with prescription medications, particularly those that are metabolized by the liver, specifically medications that target CYP2D6, CYP2C9, and CYP3A4.¹² It is imperative to screen for these interactions and stress the importance of patients also consulting their primary care provider before using berberine to ensure safety and avoid potential changes in drug efficacy.

Pharmacists should also emphasize that berberine is not a standalone therapy and should be combined with lifestyle interventions, such as a balanced diet and 150 to 300 minutes of moderate-intensity exercise per week.¹³ Furthermore, pharmacists can counsel patients about the variability in supplement quality. Unlike prescription medications, supplements are not subject to the same safety and efficacy regulations. Products with a US Pharmacopeia verification mark have been independently tested to confirm they contain the ingredients listed on the label and meet quality standards.¹⁴ Not all supplements carry this mark, so patients should be advised to look for it when choosing products.¹⁴

Overall, current evidence suggests that berberine may contribute to modest, short-term weight loss and may positively affect cholesterol, glucose, and weight when used alongside other weight management strategies; however, data remain limited, and berberine is not FDA-approved. Its mechanisms differ from incretin-based therapies, and its efficacy is considerably lower. Pharmacists should be aware of berberine’s availability, recent popularity, associated claims, and evidence base to support informed discussions with patients and help determine whether it may be an appropriate option.

REFERENCES

1. United States. World Obesity Federation. Accessed October 22, 2025. https://data.worldobesity.org/country/united-states-227/#data_prevalence

2. Rader B, Hazan R, Brownstein JS. Changes in adult obesity trends in the US. JAMA Health Forum. 2024;5(12):e243685. doi:10.1001/jamahealthforum.2024.3685

3. Kommu S, Whitfield P. Semaglutide. In: StatPearls [Internet]. StatPearls Publishing; 2024. Updated February 11, 2024. Accessed October 22, 2025. https://www.ncbi.nlm.nih.gov/books/NBK603723/

4. Ard J, Fitch A, Fruh S, Herman L. Weight loss and maintenance related to the mechanism of action of glucagon-like peptide 1 receptor agonists. Adv Ther. 2021;38(6):2821-2839. doi:10.1007/s12325-021-01710-0

5. Pizzorno J. Thinking about berberine. Integr Med (Encinitas). 2023;22(5):6-8.

6. Ilyas Z, Perna S, Al-Thawadi S, et al. The effect of berberine on weight loss in order to prevent obesity: a systematic review. Biomed Pharmacother. 2020;127:110137. doi:10.1016/j.biopha.2020.110137

7. Weiss H. Why the supplement berberine is not ‘nature’s ozempic.’ Time. June 8, 2023. Accessed October 22, 2025. https://time.com/6285790/berberine-natures-ozempic-does-it-work/

8. Balasubramanian C. Berberine for diabetes: benefits, risks, and more. Fay. July 2, 2025. Accessed October 22, 2025. https://www.faynutrition.com/post/berberine-for-diabetes-benefits-risks

9. Berberine and weight loss: what you need to know. NIH. Updated November 2023. Accessed October 22, 2025. https://www.nccih.nih.gov/health/berberine-and-weight-loss-what-you-need-to-know

10. Berberine: what it is, benefits and side effects. Cleveland Clinic. June 10, 2025. Accessed October 22, 2025. https://health.clevelandclinic.org/berberine

11. Warning letter: Fresh Nutrition Inc. FDA. Updated June 22, 2021. Accessed October 22, 2025. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/fresh-nutrition-inc-612984-05272021

12. Zieniuk B, Pawełkowicz M. Berberine as a bioactive alkaloid: multi-omics perspectives on its role in obesity management. Metabolites. 2025;15(7):467. doi:10.3390/metabo15070467

13. Stone T, DiPietro L, Stachenfeld NS. Exercise treatment of obesity. In: Feingold KR, Ahmed SF, Anawalt B, et al, eds. Endotext. MDText.com, Inc.; 2000. Accessed October 22, 2025. https://www.ncbi.nlm.nih.gov/books/NBK278961/

14. Why USP verified matters. USP. Accessed October 22, 2025. https://www.quality-supplements.org/why-usp-verified-matter