What Berberine Research Shows for Cardiovascular Health

Okay, so the next question was submitted by Richard, and Richard asks, have your thoughts on berberine changed now that we know it can actually reduce cholesterol plaque? And I chose this question because it piqued my interest considering we have a topic page on berberine. I believe the topic page went live in maybe 2020. So it's certainly time for an update. And we will be updating it now based on all the deep diving that we did to look into this question. And also, I was interested in myself because, you know, I'm always looking for alternative ways to improve cholesterol, LDL, to improve, you know, plaque formation, disintegration, all of the above. All right. Before we dive in, I do want to mention that berberine can interact with a number of prescription drugs.

So taking berberine along with medications that lower blood pressure might cause blood pressure to go too low. Taking berberine along with medications that slow blood clotting might increase the risk of bruising and bleeding. So if someone decides to supplement with berberine, it is something to discuss with your physician. And certainly if you are taking any prescription drugs, then you absolutely need to talk about it with your physician because of the fact that berberine can interact with A number of drugs. And what I'm going to talk about here obviously is not medical advice.

I'm just going to cover the scientific literature on berberine in terms of things that are updated since the last time I've talked about it in another Q&A episode and also on our topic page, our berberine topic page, which you can find at FoundMyFitness.com/topics and then just scroll to the B and you'll find berberine there. There's a lot of animal studies. I'm not going to dive into the animal studies. We will update the animal studies on the topic page, but there's a lot of animal studies that have shown berberine can significantly decrease plaque area and plaque macrophage content, which is definitely interesting. But I do want to focus on the human studies and the review of clinical data. So there's 44 different randomized controlled trials. So this was— this is a 2023 publication.

This is new. Um, it's a systematic review and meta-analysis of 44 different randomized controlled trials. The trials, basically, the age range of people in the trial were between 18 to 83 years. So really everything from a young adult to an older adult. The dosage range of berberine was about 0.3 grams to 1.8 grams per day. So quite high, although the 0.3 grams would be on the low end. And these clinical trials, there was a variety of ways they were done. In some instances, they were giving berberine in combination with other drugs like statins. And so the dosage range of statins were 10 milligrams to 80 milligrams per day. The treatment duration range was between 7 days to 2 years. Okay.

So when berberine was given alone. This was 8 randomized controlled trials, and there was a sample size of about 804 people. Berberine alone significantly reduced a variety of things compared to routine therapy. So what did it reduce? It reduced what's called the NIH Stroke Scale. So this is a quantitative measure of stroke-related neurological deficit. So berberine was able to reduce the tests that are given to quantify stroke-related neurological deficit. Berberine decreased high-sensitivity C-reactive protein. It decreased interleukin-6, IL-6. This could be a pro-inflammatory cytokine. It is a pro-inflammatory cytokine. It also decreased tumor necrosis factor-alpha. TNF-alpha, which plays a role in inflammation.

These play a role in atherosclerosis as well, both, you know, all 3 of these inflammatory molecules. So it seems as though berberine is reducing inflammation, inflammatory biomarkers, and it reduced the quantitative measure of stroke-related deficit. Now, when berberine— so berberine compared to a routine or routine care or statins, it reduced what's called the intima-media thickness. So this is— it's basically a quantitative index of atherosclerosis, and it's a value that is used to monitor disease progression. progression and also the effects of treatment.

So it's kind of like, it's used a lot in clinical studies because if you can decrease the intima-media thickness, the IMT, then that is a marker that the treatment is beneficial for atherosclerosis, either in preventing or in reducing perhaps atherosclerotic plaque as well. So berberine seemed to also significantly reduce that, the intima-media thickness, which again is really a marker of atherosclerosis, atherosclerotic plaque. Their statins also did the same and also standard treatment did it. So it's interesting that berberine also did it. Now, there was no differences in berberine alone versus either statins alone statins or, you know, the routine of care in improving total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein.

So basically, this is, you know, berberine was still having a positive effect on them, but it wasn't doing it more than statins or the routine care. To me, that's interesting, because if you can still have an effect on— a positive effect on all the things that statins is, then why not try berberine? I mean, that's kind of what I would go to. That's where I naturally go first. Berberine plus statins or versus statins alone? So there was, you know, either giving statins with berberine or not, or just giving statins alone. There were a— it seems as though there were a number of benefits. So berberine combined with statins significantly reduced, again, that stroke score.

So looking at the potential damage from stroke, the NIH stroke score was reduced when adding berberine to statins compared to statins only. There was no significant difference in the inflammatory biomarkers like IL-6 when doing statins versus berberine plus statins. But remember, berberine alone did reduce IL-6. So it just wasn't reducing it when someone was already taking statins. It wasn't reducing it even more than what the statins was already reducing it. So statins are also reducing IL-6. The intima-media thickness level was also decreased significantly in the berberine plus statins group.

So again, it seems as though that berberine could be a promising alternative therapy for atherosclerosis, perhaps ischemic stroke, and coronary heart disease, considering the benefits it has on, you know, anti-hyperlipidemia. So, you know, the triglycerides, cholesterol, the effect it's having on the NIH Stroke Score. its effects on anti-inflammatory, its anti-inflammatory effects, so lowering all those inflammatory cytokines, and its effects on the IMT score. So that was the progression of atherosclerosis. So it's basically able to decrease the progression of it, and without really any serious adverse reactions.

But also, it seems as though berberine could be an adjunctive, potential adjunctive, have an adjunctive role to basically people with statin intolerance because it might improve the efficacy of statins by lowering the dosage and perhaps even reducing the side effects because the statin dosage may be lowered. Obviously, this is early. I mean, more studies are going to need to be done on this before it is adopted, I think, into routine clinical practice. But I do think it is something to bring up to a physician for people that are taking statins. In fact, actually, people that I know, I'm going to send them these studies and then tell them to talk to their physician as well. I also was convinced that I would like to start testing berberine on myself.

So I did already place an order for berberine from Thorne. And I also got some for my mother who has a higher risk for coronary heart disease and she's got higher triglycerides, although the omega-3, she's been able to improve that with omega-3. She's been taking the Lovaza. And also, she's got higher LDL cholesterol, total cholesterol. And so, I'm curious to see how berberine will affect her lipid levels as well. So I went ahead and ordered a few bottles of that for the family. There was some safety evaluation as well in the meta-analysis of these trials. And people— so patients that were receiving berberine alone appeared to have significantly lower risk of liver enzyme abnormalities and myalgia compared to those receiving statins. So that's really interesting.

needs to be investigated further. Again, you know, whether or not people on statins could be combining berberine to lower their statin dose and perhaps lower the negative and adverse side effects is very interesting. Also, there was no GI effects with people taking berberine compared to patients receiving statins. Those receiving berberine plus statins seemed to have a lower risk of abnormal liver enzymes. And the myalgia. So all in all, I think, you know, this is in the big greater context of things, this is still limited evidence. Even though we're looking at 44 different randomized controlled trials, there needs to be more before this is adopted into clinical, routine clinical practice.

But I do think for People like, you know, myself, I'm interested in definitely trying and also experimenting with my mother who has higher cholesterol as well, and she is not on a statin. So, and then, you know, people that are on statins could ask their physician and try it out if they get the okay and see what berberine does and whether or not they could even lower their dose of statin. I think all very interesting. There's some interesting stuff I'm not going to get into. I'm going to update the topic page on berberine potentially lowering the TMAO production in the gut. And a lot of this is animal work. And so again, needs to be taken with a grain of salt. And that's why I'm not really going to get into it. There's one study that was in about 50 people, one clinical study.

It was not a randomized controlled trial, of course. So, it's not— I mean, you're talking one study, not even a randomized controlled trial. So, again, not very high-quality evidence, nothing to really draw any conclusions on. But again, seems to be indicating that berberine may really improve the progression of atherosclerosis in people with atherosclerosis that were not undergoing any drug treatment. And so take a look at the topic page if you want to kind of dive even further into this, because I'm not going to talk about all that stuff. But there's some— there's a lot of interesting updates that we will be making to that topic page. And I am I'm going to be supplementing with berberine, and I'm going to be checking all my lipids and cholesterol.

And I mean, my inflammatory biomarkers are just rock bottom low, so I don't— there won't be any difference there, but I will be curious to see how it affects my LDL. Ed and Twilia are asking if you need to skip berberine on workout days. So, you know, we cover a lot of stuff in the topic page. Yeah. The way I plan on supplementing with berberine is I will take it in the evening. So I do my exercise in early morning. I mean, we're talking before 9:00 AM typically. And most of my supplements I take with dinner. And so, you know, when you're talking many hours after the exercise. Yeah. The biggest, I would say, you know, risk of taking supplements, you know, is within the one, you know, immediately after, you know, to maybe 3 hours after exercise.

And once you start to get 4 or 5 hours after, you know, you've generated the inflammatory response, the oxidative response has been generated without blunting it, that has activated genetic pathways. And so you're not going to be dampening that, you know, if you're taking it several hours after that.