at a glance
Berberine and PCOS: Is this a promising supplement?
Table of Contents
Berberine and PCOS a newer “natural” remedy on the scene.
Natural Treatment for Insulin Resistance
People have been using plants and herbs to treat common illnesses and diseases for thousands of years. Nowadays these plant-based compounds are sometimes called “Nutraceuticals” or more commonly “supplements”.
What is a nutraceutical?
Let’s break it down. “Nutra-” means natural or plant-based, and “-ceutical” means possessing pharmaceutical-like powers. You can think of them as the super hero’s of the supplement world: unassuming yet powerful.
People with PCOS are very familiar with pharmaceuticals. In fact, most of us are offered multiple prescriptions at medical appointments to treat PCOS. Most commonly metformin and birth control.
This blog isn’t about those. We want to highlight a nutraceutical that has the potential to help insulin resistance and hormone regulation – in fact, it can do so in ways that are similar to metformin.
What is Insulin Resistance?
Tucked under the liver is a little organ called your pancreas. It’s a small but mighty part of our body that single-handedly pumps out insulin.
Once insulin enters the bloodstream it helps the body manage blood sugar levels. We can think about insulin like the amazon-delivery-worker who rings your doorbell alerting that your last online shopping binge is on the doorstep.
The alert, “aka” the message, signals that your package is waiting outside, take it in, and open it up. When insulin is released from the pancreas it alerts every cell in your body, via a “doorbell” known as an insulin receptor, that glucose is hanging out in your bloodstream waiting to be taken into your cells and used.
PCOS can make it hard for our cells to “hear” the doorbell. Just like when the neighborhood dingdong ditcher rings our doorbell over and over and we tune out the sound; our bodies can become deaf to insulin.
When our cells ignore insulin it is known as insulin resistance. Insulin resistance makes it more difficult for cells to take in glucose causing higher levels of glucose in the blood. This has unfortunate consequences:
weight gain (all that extra glucose has to go somewhere),
reduced ovulation (oocytes express insulin receptors too) (1)
What is Berberine?
Barberry, Oregon grape, and goldenseal are all plants that contain a compound called “berberine”. It’s a newer supplement on the scene for the PCOS population. Yet it has been used for thousands of years (mostly in Chinese medicine) to treat fertility and diabetes.
In short, berberine is an insulin sensitizer.
How Can Berberine Be Used As A Natural Treatment for Insulin Resistance
What do nutraceuticals have to do with insulin resistance?
In modern culture we turn to doctors for support for our medical problems like polycystic ovary syndrome. However, most doctors are only taught to treat disease with medication and surgery. They receive very little training in the realm of nutriceuticals, botanicals and supplements.
Often medications like metformin are prescribed to help patients manage insulin resistance. Sometimes these medications have uncomfortable side effects. This is where Berberine comes in. Berberine typically doesn’t include the same uncomfortable gastrointestinal side effects of metformin.
Berberine Improves Insulin Sensitivity
Berberine makes your body more sensitive to insulin’s messages(that’s why we call it an insulin sensitizer) which helps keep our blood glucose in check. It helps your cells offer more receptors (aka doorbells) for insulin to utilize.
A greater number of insulin receptors increases the volume of the doorbells alerting your cells that it’s time to pull in glucose from the bloodstream.(3) This is great because it keeps our bodies from storing fat in places it shouldn’t, like our liver.
Improving insulin and glucose levels has the potential to improve many different areas of PCOS health.
Berberine Can Lower Risk of Fatty Liver Disease
When fat starts building up in the liver, it’s referred to as Non-alcoholic fatty liver disease–but for now we will just call it fatty liver. Fatty liver is an important topic for those of us learning to manage PCOS because many of us have an increased risk of developing fatty liver.
Fatty liver can be a rather silent condition at first and doctors often look for it in your annual appointment when they order AST and ALT – which are just liver enzymes.
If elevated, that is a sign you may have Fatty Liver disease. Other than diet and lifestyle changes, scientists have found that berberine may help our body combat both insulin resistance and fatty liver disease.(7)
Berberine Helps Your Body Activate Metabolic Pathways
Berberine is helpful for these conditions because it kick-starts a metabolic pathway called AMPK. AMPK ramps up when the body thinks it’s starving or fasting. It tells our cells to be more sensitive to insulin which makes them gobble up glucose at a quicker rate leading to less fat storage in organs like the liver.
When we take berberine we trick our cells into activating AMPK which gives us some of the benefits of fasting (like increased insulin sensitivity) without actually starving ourselves, or fasting.
Berberine Improves PCOS Hormone Imbalances
Berberine Lowers Testosterone Levels
Studies have shown that the administration of berberine can improve testosterone levels. Testosterone is responsible for a number of frustrating PCOS symptoms. It can also increase insulin resistance and result in poor-quality oocytes.
Improving testosterone levels is something that will not only provide relief from frustrating PCOS symptoms, but it also has promise for improving ovulation and fertility.
Berberine Can Improve Fertility With PCOS
Berberine is not a supplement recommended in pregnancy. Often this makes women with polycystic ovary syndrome avoid it in the pre-conception period.
This is not something to be afraid of while trying to conceive. In fact, evidence shows it is a promising treatment to improve fertility. (8)
How Berberine Can Improve Fertility
Berberine improves insulin sensitivity which has a downstream effect of lowering testosterone production in the ovary. This can improve ovulation rates, egg quality, and progesterone production.
Berberine has also been shown to increase sex hormone binding globulin. Sex hormone binding globulin grabs hold of testosterone and essentially turns it off.
Berberine has multiple avenues of lowering androgens and improving cycle regularity. It can lower the production of testosterone and “turn off” the testosterone that has already been created.
Berberine and IVF Treatment
One study considering the benefits of metformin or berberine prior to IVF looked at 150 PCOS patients. Taking berberine or metformin for 3 months prior to IVF showed lower total testosterone, fasting glucose, fasting insulin, and increases in sex hormone binding globulin.
Berberine and metformin resulted in increased pregnancy rates and reduced incidence of ovarian hyperstimulation when compared with a placebo group.
Berberine had a higher rate of live birth rates than metformin. It also had better decreases in BMI, lipids, and total FSH.
The study also noted lower GI side effects when compared to the metformin group.
Berberine Promotes Sex Hormone Binding Globulin(SHBG)
We saw above how berberine can support the liver and improve fatty liver disease. This is done in part because of it’s impact on insulin sensitivity.
Yet the liver has many more functions when it comes to hormones. It is responsible for breaking down estrogen and getting it out of the body. It converts most of your inactive thyroid hormone T4 into the active form T3.
The liver also makes the protein SHBG. The main purpose of SHBG is to turn off sex hormones. Supporting the liver, means we see all of these benefits: estrogen detox, thyroid hormone function, and SHBG levels increasing meaning that testosterone will be less potent in your body.
Are you convinced this is a supplement worth trying yet?
Acne, PCOS, and Berberine
Acne in PCOS often has a hormonal source – usually androgenic(testosterone or DHEA-S)in nature. We have already established how berberine can lower testosterone, but it can improve acne via another pathway as well.
Berberine has powerful antimicrobial properties, which make it great for acne clearance. Sometimes acne is fueled by hormones but can also be exacerbated by bacterial infections.
Our gut and our skin are reflections of one another. If our skin is angry in any way, we always should “pop the hood” in a sense – and see what’s going on inside the engine.
Berberine and the Gut
When we think about our guts we often think dysfunction should be treated with acid-lowering medications or laxatives. No matter which end of your gastrointestinal tract you may be suffering symptoms, berberine has a history of treating it.
Struggle with gas? Feel bloated all the time? Have diarrhea or constipation? Berberine can help with some of these symptoms and is certainly worth a try if you experience any of these AND you have PCOS.
Berberine increases the gut microbial communities’ production of short-chain fatty acids. This is an important fuel for the gut.
Berberine Has Anti-Microbial Properties
Berberine has the ability to kill off certain gut microbes. Because of this, I have heard many practitioners in the functional medicine world discuss the need to limit use of berberine.
The rationale for this suggestion is that we don’t know what long-term administration of berberine will do to gut microbiota.
When you look at the research with a critical lens, I don’t see the need to be so concerned. Evidence shows that berberine can kill opportunistic (or bad) bacteria and promotes the proliferation of good bacteria.
Is There A Downside to Berberine and Gut Health?
Berberine has powerful antimicrobial properties. Can this mean it can kill off too many of the good bacteria populating our gut if we take it for too long? Science isn’t sure yet. (5)
It also makes sense to me that this benefit or drawback may be highly individual as our microbiomes are so individual – perhaps even more so than your fingerprint itself.
You can choose to be more conservative with this supplement. In times when we aren’t sure of long-term benefits or risks we choose to cycle people off of berberine every few months and replace it with another similar supplement like inositol, turmeric, or NAC.
Some people report stomach discomfort while taking berberine. To avoid this side effect start with a low dose and move up while also monitoring how you feel. I have found in practice a dose of up to 1000 mg is very effective at lowering insulin levels.
Berberine Is More Accessible than Metformin
Metformin is a prescription medicine. While many doctors are more than willing to prescribe it, the medication doesn’t always get covered by insurance. It also requires a medical appointment to obtain metformin.
Berberine is an over-the-counter supplement(OTC) that can be taken without a prescription. Berberine is a potent insulin sensitizer, perhaps one of the most potent that is available OTC.
Berberine is nicknamed the “poor man’s metformin”. It’s more accessible. It is often less expensive than the prescription for metformin.
Berberine has been used in metabolic syndrome patients for a long time and those with polycystic ovary syndrome tend to struggle with metabolic syndrome in greater quantities.
Berberine and Weight loss for PCOS
As we see insulin resistance improve it is often combined with the benefit of weight loss. As insulin levels go down, so does the signal to store fat. This is very positive for the PCOS population who often struggle to see the benefits of their weight loss efforts.
No doubt you have heard of Ozempic and other GLP-1 receptor agonists lately. They were originally designed to help diabetics lower blood sugar levels and Hemoglobin A1C levels. In fact, we recently released an article on Ozempic for PCOS.
Berberine has similar abilities to up-regulate the activity of GLP-1 receptors. When this happens blood sugar levels decrease and appetite levels can go down as well.
Berberine and Cholesterol
Berberine improves lipid dysregulation and can improve high cholesterol levels. Berberine has been shown to lower total cholesterol and lower the risk of developing cardiovascular disease.
Berberine also has the potential to improve lipid metabolism by promoting liver health. The beneficial metabolic effects can not but over stated.
What is an effective dose of Berberine for PCOS?
Much of the research looks at a dose between 1,000 mg and 2,000 mg. The 2,000 mg dose is often considered for a prediabetic or diabetic population.
In my years of treating women with PCOS I typically have used a dose of 1,000 mg daily broken up in divided doses. This tends to help insulin resistance and hormones levels regulate without any unnecessary or overly expensive supplementation.
Where Can I Buy Berberine?
PCOS Formularies has a product called metabolic berberine. Taking 1 cap at each meal daily will harness the power of berberine and alpha lipoic acid(ALA).
Berberine and ALA both improve insulin resistance however, the addition of ALA increased the anti-oxidant power of this supplement. It has been thoughtfully formulated to improve PCOS symptoms and root causes.
Who May Want to Skip Using Berberine?
Some researchers have found that berberine may impact the immune system and make it function a little less effectively, especially in people with autoimmune conditions like rheumatoid arthritis, cancer, and possibly Hashimoto’s. (6)
If you are taking a blood pressure-lowering medication, it is important to discuss with your doctor before taking berberine as it can also lower blood pressure.
Common Questions About Taking Berberine
Can I take berberine with myoinositol?
Berberine is often combined with inositol, NAC, magnesium, and other blood sugar-regulating supplements. Many of these supplements work in different ways to help improve insulin levels.
Taking a combination can be a powerful way to support your body in lowering blood sugar levels. When I am working one on one with clients I will typically recommend starting supplements one at a time so we can see if there are any negative side effects.
It is also helpful to make sure that you do not have any low blood sugar events by adding multiple supplements to improve insulin sensitivity all at one time.
Can I take berberine in pregnancy?
Berberine is not recommended during pregnancy. It is often used in preconception with PCOS patients to help improve blood sugar and ovulation. Once a pregnancy is confirmed berberine use should be discontinued immediately.
Due to ethical concerns, we have little data on specific herbs and supplements in pregnancy. Myoinositol is a supplement we have some data on and I will typically recommend my PCOS patients stay on during pregnancy.
Does berberine interact with birth control pills?
There is no interaction between birth control pills and berberine according to the Natural Medicine Comprehensive Database, however, there are medications that are used to treat diabetes that are listed. The main concern is not creating an environment where low blood sugar events can take place.
Berberine Quick Facts
All in all berberine is a nutraceutical that you may want to include in the next conversation with your PCOS practitioner. It could be helpful for combating insulin resistance, acne related to hormones or the gut microbiome (yep, your face and your gut are connected), and may even play a beneficial role in regulating ovulation.
Pay attention to how you feel when you start it. Once pregnant or if breastfeeding berberine should be discontinued.
If you want to learn more about nutraceuticals or the safe use of supplements like berberine in PCOS, pregnancy and beyond you are in the exact right place.
We have the answers to your questions here in the PCOS App or in the Find Fertility Course.
Check out our popular berberine product on the PCOS Formularies website.
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The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a physician, dietitian, naturopathic doctor or other primary care provider is recommended for anyone suffering from a health problem.