Social media played a key role in popularizing the semaglutide-based drug Ozempic® as an off-label weight loss drug, which eventually caused shortages. This unavailability – as well as the high cost of these commercial drugs – led patients to seek alternatives like compounded semaglutide, despite its risks. Now, social media influencers have turned their attention to berberine, a naturally-derived supplement that they’ve dubbed “Nature’s Ozempic®.” However, as is often the case with “all-natural” supplements, greater scrutiny reveals that berberine may not be as effective as social media influencers claim it is – and it’s definitely not without potential for risks.
Why are patients using berberine?
Even after Ozempic® was made available again, some patients experienced numerous side effects, including the dreaded “Ozempic® face.” Due to the gamut of side effects (gastrointestinal upset, constipation, etc.) and because Ozempic® is incredibly expensive and typically not covered by insurance when used off-label, patients sought cheaper alternatives. One such alternative is berberine, which can be obtained at a fraction of the cost and without a prescription. Social media followers and the general public have been led to believe that all-natural weight loss supplements like berberine are safer alternatives to drugs that have been approved by the Food and Drug Administration (FDA) and often view them as equivalent to food.1
There is limited research that shows that berberine acts similarly to Ozempic®.
As a supplement, the efficacy of berberine hasn’t been verified by the FDA’s rigorous clinical trial process, as approved drugs like Ozempic® have. In the absence of FDA approval, we have to rely on clinical experience and fundamental clinical research, most of which has yet to provide compelling evidence. Some research has suggested that berberine may not even be effective at the doses at which patients are ingesting it due to its poor oral bioavailability. In several studies, the concentrations of berberine that have been demonstrated effective in in vitro studies are typically thousands of times greater than the doses most patients are ingesting.2–4
The effects of berberine may be more similar to those of metformin than semaglutide although berberine’s mechanism of action is somewhat unclear. Some evidence has shown that it may help reduce blood sugar and lipid levels, and combining berberine with metformin might permit a lower dosage of each individual drug, which may help reduce the side effects of each alone. However, the evidence for this is not extensive, and most has been performed in murine models or in vitro.
Of course, there are safety risks as well.
Berberine is a naturally-occurring compound found in several plants, which may give patients the impression that it and other supplements are inherently safer than FDA-approved drugs.5 However, these two groups of compounds are not mutually exclusive, and many FDA-approved drugs that have been derived from plants still have the potential to cause adverse events. Because patients often take supplements without physician supervision and because the FDA cannot strictly regulate them, supplements potentially carry more health risks than other medical interventions.
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Many patients take berberine without physician supervision.
Because supplements can be purchased over-the-counter (OTC) without a prescription, patients often take them without consulting their physician. Moreover, they are unlikely to inform their physicians that they’re taking them, even when asked,6 which creates the risk of drug-supplement interactions. Patients may also take megadoses due to the perception that “more is better,” but such high doses will likely increase the risk of adverse events such as diarrhea.7
Supplement regulations are incredibly lax.
In addition to the frequent lack of supervision from a licensed prescriber, supplements are a highly unregulated space and receive no oversight from the FDA except for post-market surveillance. Safety issues are typically only found after many severe adverse events are reported or after the FDA has found a violation during a facility inspection. This is a widespread problem, and many supplements often don’t contain exactly what’s on the label.8 FDA inspections have found supplements that contained potentially dangerous unapproved dietary ingredients in their formulations, either due to adulteration or inadequate purification and separation processes.
The FDA inspections needed to identify these violations aren’t being performed often enough to catch everything, underscoring the importance of sourcing supplements from reputable pharmacies. Patients should take supplements under the guidance of a licensed prescriber, who should in turn source them from a licensed pharmacy like VLS Pharmacy and New Drug Loft.
Why should patients choose VLS Pharmacy and New Drug Loft?
When used correctly and sourced from a trusted pharmacy, supplements can provide benefits to patients. VLS Pharmacy and New Drug Loft offers alternatives to semaglutide and berberine for weight loss. As we’ve mentioned before, the best approach to weight loss is likely a multifaceted approach that may include a combination of medication and long-term lifestyle changes performed under the supervision of a physician.
Because of the importance of sourcing medications and supplements from a reliable source, all of our formulations are compounded using high-quality USP-grade active pharmaceutical ingredients (API) sourced directly from PCCA, the leader of superior-quality APIs. As a 503A pharmacy specializing in sterile and non-sterile compounding, we will support you and your patients’ weight loss journey by creating safe, individualized, and effective pharmaceutical therapies.
For men and women at any age, feeling healthy, conﬁdent, and comfortable is of the utmost importance. Your patients’ needs will change with each life stage and will require an adaptive and personalized treatment plan. By working with a compounding pharmacy like VLS Pharmacy and New Drug Loft, you are expanding the possibilities for successful and sustainable care.
Please comment below with any thoughts or questions. Reach out to our team to learn about best practices and to partner with our experts about our other nutritional IV therapies for your patients. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.
Want to learn even more? VLS Pharmacy, in partnership with Pharmacy Compounding Centers of America, presents an exclusive recording of the Dermatology Conference: Inspiration & Innovation to guide seasoned providers as well as those looking to get started.
- Chiba T, Tanemura N. Differences in the Perception of Dietary Supplements between Dietary Supplement/Medicine Users and Non-Users. Nutrients. 2022;14(19):4114. doi:10.3390/nu14194114
- Liu CS, Zheng YR, Zhang YF, Long XY. Research progress on berberine with a special focus on its oral bioavailability. Fitoterapia. 2016;109:274-282. doi:10.1016/j.fitote.2016.02.001
- Wang H, Zhu C, Ying Y, Luo L, Huang D, Luo Z. Metformin and berberine, two versatile drugs in treatment of common metabolic diseases. Oncotarget. 2017;9(11):10135-10146. doi:10.18632/oncotarget.20807
- Hua W, Ding L, Chen Y, Gong B, He J, Xu G. Determination of berberine in human plasma by liquid chromatography-electrospray ionization-mass spectrometry. J Pharm Biomed Anal. 2007;44(4):931-937. doi:10.1016/j.jpba.2007.03.022
- Shahrokh LE, Lukaszuk JM, Prawitz AD. Elderly herbal supplement users less satisfied with medical care than nonusers. J Am Diet Assoc. 2005;105(7):1138-1140. doi:10.1016/j.jada.2005.04.002
- Gardiner P, Sadikova E, Filippelli AC, White LF, Jack BW. Medical reconciliation of dietary supplements: Don’t ask, don’t tell. Patient Education and Counseling. 2015;98(4):512-517. doi:10.1016/j.pec.2014.12.010
- Yue SJ, Liu J, Wang WX, et al. Berberine treatment-emergent mild diarrhea associated with gut microbiota dysbiosis. Biomedicine & Pharmacotherapy. 2019;116:109002. doi:10.1016/j.biopha.2019.109002
- 8. Starr RR. Too Little, Too Late: Ineffective Regulation of Dietary Supplements in the United States. Am J Public Health. 2015;105(3):478-485. doi:10.2105/AJPH.2014.302348
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