Berberine is a botanical extract that has been extensively researched for its potential to support many functions throughout the body including lipid and blood sugar metabolism. It may also play a supportive role in cardiovascular function, gut and immune health, and the inflammatory response. Evidence also indicates that berberine interacts with the gastrointestinal (GI) microbiome and may support certain aspects of gut microbial health. 

A recently published review by Yang and colleagues explored berberine’s potential to modify and support the gut microbiome through several different pathways. Berberine may promote the synthesis of short-chain fatty acids (SCFAs) produced by bacteria in the gut microbiome. Laboratory studies indicate that SCFAs such as butyrate may help support lipid and blood sugar metabolism. They may help modulate the secretion of glucagon-like peptide-1 (GLP-1), insulin, and glucagon. 

Animal studies have reported increases in the SCFA-producing bacteria Roseburia and Faecalibacterium in the presence of berberine. Additional animal studies have also observed increases in Lactobacillus, Akkermansia, and Bifidobacterium and decreases in Firmicutes populations. Akkermansia muciniphila plays a critical role in maintaining epithelial tight junctions and gut barrier integrity. 

Clinical studies suggest that berberine may influence the gut microbiome. A study involving berberine supplementation in individuals with certain psychiatric illnesses found increases in Bacteroides and decreases in Firmicutes after supplementation with 100 to 300 mg three times daily for 12 weeks. Other clinical studies involving individuals with metabolic diseases have reported changes in SCFA-producing bacteria and other bacteria that may be related to cholesterol and blood sugar metabolism including Blautia and Alistipes.

Evidence suggests that berberine may also exhibit synergistic qualities with certain probiotics. A randomized double-blind controlled clinical trial involved over 400 individuals with type 2 diabetes mellitus. Participants were randomized to one of three arms: berberine, berberine plus a probiotic, or placebo. This 12-week study observed greater improvements in certain parameters related to blood sugar metabolism in the berberine-only group and the berberine plus probiotic group. Increases in bile acid production and beneficial alterations in gut microbial composition were also observed. 

Exposure to berberine has been associated with the alteration of certain populations of intestinal bacteria such as Clostridium cluster XIVa and IV. This may in turn modulate the activation of the intestinal farnesoid X receptor, which is a nuclear receptor that is involved in the metabolism of glucose, lipids, and bile acids. A four-week animal study involving berberine administration in certain liver disease models reported increases in the abundance of bacteria known to activate the intestinal farnesoid X receptor. 

Yang and colleagues also reported that berberine was shown to influence the gut microbiome in relation to many other disease models. While more clinical research is needed, evidence suggests that berberine may play an important role in microbial health and the optimal function of many body systems. Through its potential ability to modulate gut microbial populations, berberine may help promote gut mucosal integrity, help regulate immune homeostasis, support lipid metabolism, and help promote healthy blood sugar balance. 

Berberine is an alkaloid compound found in several botanicals including goldenseal, Oregon grape, and barberry, and has been used in Chinese medicine and other Asian traditions for over a thousand years. It may support overall metabolic and GI health and may play a beneficial role in GI microbiome modulation.

By Dr. C. Ambrose, ND, MAT