HOMA-IR subgroup analysis showed a notable difference in heterogeneity through different treatment periods, treatment doses, and study designs, revealing that more data are needed to enrich credibility. The oral bioavailability of berberine is low (<5%) because of both poor solubility and the presence of P-glycoprotein in the human intestines, which expels the alkaloid from . Approximately half of the participants were female, and the average age was 82 years. Screening was performed by passing 1,660 papers through title and abstract review; precluding duplicate papers, non-clinical trial papers, and irrelevant papers; selecting 56 papers for full-text review; and ultimately excluding articles with non-data, drug combination treatment, different life intervention strategy, non-blank, or placebo controlled. Nutraceutical approach to moderate cardiometabolic risk: results of a randomized, double-blind and crossover study with Armolipid Plus, Nutraceutical pill containing berberine versus ezetimibe on plasma lipid pattern in hypercholesterolemic subjects and its additive effect in patients with familial hypercholesterolemia on stable cholesterol-lowering treatment. The difference between 3-month TC values in the 2 groups was statistically significant (P < .001). Without pellucidity of these components, clinical reproducibility, potential for bias, and presence of confounding variables are of concern. Additionally, most trials had very small sample sizes. (2018). Given the difference in trial design and measurement unit, the data adopted the standard mean difference (SMD) to eliminate the difference (Riley et al., 2011). After standardization, the FPG concentration of the trial group decreased by 0.65 (95%CI: 0.28, 1.03) compared with the control group. When EZE was added to NC monotherapy, the changes in TC, LDL, and TG after 3 months of dual treatment were only 9.7%, 13.6%, and 4.5%, respectively; tests for statistical significance were not performed. Compared with previous studies, we discuss the therapeutic effect of berberine alone in the treatment of metabolic disorders for the first time. (2018). Berberine can be used to treat many diseases, such as cancer and digestive, metabolic, cardiovascular, and neurological diseases. Aryaeian N., Sedehi S. K., Khorshidi M., Zarezadeh M., Hosseini A., Shahram F. (2020). This excludes a large number of patients who would normally benefit from lipid-lowering medication (ie, diabetics, individuals with elevated ASCVD risk, and individuals with coronary artery disease). Ultimately, 11 articles from PubMed were selected for inclusion: one additional article was found through the examination of study references and included in the review. Studies that were identified through title and abstract review during the literature search, reasons for exclusion, and the ultimate number of studies included in the review. Berberine activates AMPK to reduce fat production and body fat ratio, improves insulin sensitivity, and promotes glucose transport. The chart illustrates that berberine can reduce the LDL level of the patients (Figure 5). Berberine may even help fight cancer, improve symptoms of ulcerative colitis and irritable bowel syndrome, and more. Authors analyzed multiple efficacy and safety endpoints, including TC, LDL, HDL, and TG.22, Baseline characteristics were similar between groups, and the authors reported no statistically significant differences; however, baseline TC and TG levels varied somewhat between the MBP-NC and placebo groups (TC: 238.4 and 248.1 mg/dL, respectively; TG: 132.1 and 119.0 mg/dL, respectively). the contents by NLM or the National Institutes of Health. Treatment period is the main factor causing heterogeneity. The HDL and TG treatment differences between groups were 1.91 mg/dL (95% CI 1.50 to 5.32 mg/dL, P = .268) and 6.40 mg/dL (95% CI 36.26 to 23.47 mg/dL, P = .671), respectively.21, A limitation of the study was the effect size used to determine the sample size. Figure 8 illustrates the efficacy of berberine treatment on FPG. The Use of Berberine for Women with Polycystic Ovary Syndrome Undergoing IVF Treatment. Wang J.-M., Yang Z., Xu M.-G., Chen L., Wang Y., Su C., et al. A literature search for randomized, controlled trials of berberine that assessed at least 2 lipid values as endpoints resulted in identification of 12 articles that met criteria. The confidence intervals for the endpoints were all very wide, which decreases the likelihood that the results could be accurately reproduced.21, Gonnelli et al22 assessed the efficacy and safety of a combination nutraceutical containing berberine in 60 patients with low-to-moderate risk hypercholesterolemia. These exclusions decrease the validity of trial results and decrease the applicability of the results to the general population. The I Bethesda, MD 20894, Web Policies Percent reductions in TC and LDL from baseline were decreased slightly at 24 weeks compared with the initial 4- and 12-week reductions (TC at 4 weeks: 30.3% 33.9%, 12 weeks: 26.7% 33.1%, 24 weeks: 24.6% 32.1%; LDL: 29.4% 35.3%, 25.6% 31.5%, and 23.7% 32.6%, respectively). Figure 7 illustrates the efficacy of berberine treatment on HOMA-IR. government site. Usefulness of nutraceuticals (Armolipid Plus) versus ezetimibe and combination in statin-intolerant patients with dyslipidemia with coronary heart disease, Journal of Evidence-based Complementary & Alternative Medicine, http://www.creativecommons.org/licenses/by-nc/3.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, http://www.consort-statement.org/extensions?ContentWidgetId=557, Average baseline and study end values SD (mg/dL), T: 163 22 to 140 23 C: 166 20 to 140 23, T: 226 15 to 179 20 C: 220 18 to 195 15, 3 months postrandomization average values SD (mg/dL), 3 months after treatment restart, post-washout average values SD (mg/dL), Absolute change from baseline SD (mg/dL), T: 172 16 to 119 21 C: 173 10 to 175 25, T: 252 23 to 201 26 C: 253 19 to 175 25, Least square means change between groups (95% CI) (mg/dL), Placebo followed by pravastatin 10 mg daily, T: 151 23 to 119 25 C: 150 29 to 144 33, T: 239 30 to 208 27 C: 239 38 to 243 34, Intervention 12 weeks, 1 year follow-up, Average baseline and values after 12 weeks SD (mg/dL), T: 149 16 to 109 8 C: 150 8 to 126 11, T: 218 15 to 177 12 C: 219 14 to 194 16, Average values after 12 months SD (mg/dL), Description of how patients were allocated to interventions, Statement of reasoning behind trial with reference to specific herbal product being tested, Setting and location where data were collected, Explanation of how the dose was determined, Content of all herbal products per dosage unit form, Clearly defined primary and secondary outcomes, Description of statistical methods used for analysis, Dates of period of recruitment and follow-up, Baseline demographic and clinical characteristics of each group, including concomitant medications, Number of subjects in each group included in the analysis, Summary of results for each group with precision, Report of any other analyses performed distinguishing prespecified from exploratory, All important adverse events or side effects in each group, Interpretation of results taking study hypotheses into account as well as sources of potential bias or imprecision. Patients were randomized to receive a food supplement (10 mg policosanol, 200 mg red yeast extract, 2 mg folic acid, 2 mg coenzyme Q10) plus berberine 500 mg once daily, collectively referred to as COMB, or berberine 500 mg alone (BERB) once daily. It may help lower cholesterol, lower blood sugar, and reduce inflammation.Very few studies have been done in the United States to show how berberine effects cholesterol and blood sugar. The majority of evaluated articles consistently suggest that berberine has a beneficial effect on low-density lipoprotein (reductions ranging from approximately 20 to 50 mg/dL) and triglycerides (reductions ranging from approximately 25 to 55 mg/dL). Patients were excluded from the trial if they were pregnant, or if they had diabetes mellitus, a history of cardiovascular disease, or TG >350 mg/dL. Suraweera C., de Silva V., Hanwella R. (2016). When the lipid profile values in the berberine group were compared with the placebo group, all differences were found to be statistically significant (P < .05). The primary endpoint of the study was the reduction in LDL in the Armolipid Plus arm from baseline. National Library of Medicine The percent change in TC was 13.5% 0.7% versus 0.2% 0.5% with placebo (P < .001), the percent change in HDL cholesterol was +4.7% 1.5% versus 1.2% 1.0% with placebo (P < .001), and the percent change in TG was 18.9% 2.5% versus 1.3% 1.2% with placebo (P < .001). found that weight loss and anti-inflammatory effects related to berberine intake may play an indirect role in improving the clinical symptoms of metabolic disorders (Asbaghi et al., 2020). In TC subgroup analysis, overall differences were found in the therapeutic effects of different treatment periods (p = 0.01), whereas no difference was found in the therapeutic effects of different treatment doses (p = 0.60) and study designs (p = 0.06). At the end of 3 months, the LDL levels were 140 23 and 157 20 mg/dL, respectively, in the berberine and placebo groups (P < .05). Significant decreases in LDL were also evident in both time periods (191 9 mg/dL, 16.4% after randomization, P < .05 compared with placebo; 14310 mg/dL, 17.9% 2 months after reintroduction, P < .05 compared with the washout period). The set effect size and standard deviation were 16 28 mg/dL, which was high variability considering the observed effect. Berberine is a bitter-tasting and yellow-colored chemical. The study also did not describe sample size calculations, methods used for randomization, who was blinded, or confidence intervals for their results, limiting applicability and reproducibility. The findings of the present meta-analysis demonstrated that berberine alone can reduce TG, TC, LDL, HDL, FPG, and HOMA-IR levels in patients with metabolic disorders, and this effect was observed in healthy participants. Patients underwent a 6-month run-in period in which they were advised to follow a specific diet and exercise regimen. One patient did report a headache for 1 day during the run-in phase, and 2 patients reported transient flatulence for 2 days.17, Patients included in this study were at low cardiovascular risk, which significantly limits the study applicability to populations who would typically receive a cholesterol-lowering drug (ie, diabetics, patients with cardiovascular disease). The investigators reported that no deaths were observed during the 12-month follow-up period. Patients were then randomized to receive placebo or berberine 500 mg twice daily for 3 months. Berberine also inhibited the cholesterol ingestion activity of macrophages and promoted reverse cholesterol transport by upregulating the expression of LOX-1 and decreasing SR-BI expression. The effect refers to some unusual swelling in the neurons of patients who take statins, leading to the occurrence of memory and cognitive impairment. We used a combination of medical subject headings (Mesh) terminology and keywords to search four databases, namely, PubMed, Cochrane, GeenMedical, and China National Knowledge Infrastructure (CNKI), for the original studies about berberine treatment of type 2 diabetes, hyperlipidemia, and other metabolic disorders for randomized controlled trials (RCTs) without any limitations of time (19272021) or language. Clinical Study of Berberine Intervention in Patients with Impaired Fasting Blood Glucose (Chinese), Clinical Study of Berberine Intervention in Delaying the Development of Diabetes in Pre-diabetic Population (Chinese). This study does not exclude the possibility that life intervention can improve monitoring indicators. The first analysis assessed the impact of dual NC/EZE treatment on lipid values among 26 of the original study patients who had less than a 30% reduction in LDL with monotherapy. Nonetheless, its side effects can cause high blood glucose; thus, it cannot be used alone for hyperlipidemia with diabetes (Sukhija et al., 2009), and a common clinical side effect is memory and cognitive impairment. 8600 Rockville Pike 1University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA, 2University Health System, San Antonio, TX, USA, 4Manchester University College of Pharmacy, Natural and Health Sciences, Fort Wayne, IN, USA. Patients were excluded from the trial if they had a history of cardiovascular disease or coronary risk equivalents, secondary hyperlipidemia caused by diabetes, renal, liver, or thyroid diseases, alcohol consumption >40 g/d, ASCVD risk >20%, muscular diseases, or abnormally elevated creatinine phosphokinase. Ethical Approval: It was determined that this project was exempt from institutional review board review. Patients in the intervention and placebo groups had average ages of 49 and 52 years, respectively, and average BMIs of 25 and 28 kg/m2. A single-blind clinical investigation, Effects of a nutraceutical combination (berberine, red yeast rice and policosanols) on lipid levels and endothelial function randomized, double-blind, placebo-controlled study. The site is secure. 15 -26 Moderate-intensity statin medications have been proven to lower LDL cholesterol by 30 to 50% and high-intensity statins lower LDL even further, upward of 50%. We grouped all data of TG, TC, LDL, HDL, HOMA-IR, and FPG according to the abovementioned three procedures and then analyzed the data in each subgroup to obtain the following table (Supplementary Table S1). Npoje s vysokm obsahom antioxidantov, ako s vitamny C a E, preukzatene zlepuj erektiln funkciu tm, e brnia pokodeniu buniek, produkujcich oxid dusnat," hovor Pearlmanov. It might help strengthen the heartbeat, which could benefit people with certain heart conditions. This breaks down into a steep $1.27 per serving, even though you are getting 1,000mg per dose. The set effect size and standard deviation were 39 46 mg/dL; variability was quite high considering the observed effect. When Armolipid Plus was compared with placebo for the primary endpoint, Armolipid Plus was significantly more effective in lowering LDL (119 25 mg/dL at 8 weeks vs 144 33 mg/dL, P < .0001). The berberine group and placebo group baseline LDL values were 163 22 and 166 20 mg/dL, respectively. 5) Some articles do not indicate whether the research object is newly diagnosed or has been sick in the past. Berberine alone and in combination with other dietary supplements provides an average LDL percentage lowering capability of 20% to 30%. FOIA 75%). No difference was observed in terms of percent change in HDL (0.64% 7.2% vs 1.24% 6.9% in the NC and ezetimibe groups, respectively) or percent change in TG (19.5% 16.1% vs 14.9% 11.5% in the NC and EZE groups, respectively). Careers, Unable to load your collection due to an error. government site. (3) Blinding of participants and personnel (performance bias): the literature states that a double-blind study design is considered low risk. Derosa G, DAngelo A, Bonaventura A, et al. No patient discontinued study treatment or reported adverse effects.26, One caveat to this study is although baseline characteristics were similar between the NC and EZE groups at baseline, the average baseline LDL in both groups was below the prespecified inclusion criteria value of >160 mg/dL (mean LDL values were 149 16 and 150 8 mg/dL in the NC and EZE groups, respectively). The Metabolic Syndrome and Alzheimer Disease. As if these berberine benefits weren't enough, the compound also "minimizes the absorption of carbs and fat from the food we eat," according to berberine fan Stephanie Redmond, PharmD., co . (2011). The majority of patients had a low 10-year cardiovascular risk (78.4% and 82.4% of patients in the intervention and placebo groups, respectively). 2013. As a library, NLM provides access to scientific literature. The differences in data extraction were resolved through consultation between the two investigators. Overview Berberine is a chemical found in some plants like European barberry, goldenseal, goldthread, Oregon grape, phellodendron, and tree turmeric. Forest plot illustrates the differences in changes in fasting plasma glucose in adults with metabolic disease who did or did not receive berberine in 13 trials (n = 1,052). Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Some patients may have had an LDL as low as 133 mg/dL. / Getty Images. In comparison, our top budget pick, Puritan's Pride, is only $0.20 per 500mg serving, which equates to $0.40 per 1,000mg. Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. It is unknown if patients were allowed to take other cholesterol-lowering agents, since these were not specifically identified as exclusion criteria or addressed in the baseline characteristics. Random-effect model analysis was performed: TG (SMD: 0.94; 95%CI: 0.49,1.38; p = 0.00), TC (SMD: 1.06; 95%CI: 0.64, 1.48; p = 0.00), LDL (SMD: 1.77; 95%CI: 1.11,2.44; p = 0.00), HDL (SMD: 1.59; 95%CI: 2.32, 0.85; p = 0.00), HOMA-IR (SMD: 1.25; 95%CI: 0.25,2.24; p = 0.01), and FPG (SMD: 0.65; 95%CI: 0.28,1.03; p = 0.00). However, the analysis of patients on a stable regimen of statin EZE should have been conducted as a separate study, as it included a completely different subset of patients. sharing sensitive information, make sure youre on a federal P value indicates within-group difference (ie, from baseline). Another 417 additional records were included through other sources to fully incorporate all data (Figure 1). 8600 Rockville Pike As a library, NLM provides access to scientific literature. (2009). 2 The mean difference (blue squares), 95% CI (horizontal lines through blue squares), and pooled-effect sizes (green diamonds) were presented using random-effect Hedges models. The I For the second half of the tour, QOTSA will join forces with likeminded spirits Viagra Boys and with former Savages leader Jehnny Beth. In TG subgroup analysis, overall differences were found in the therapeutic effects of different treatment periods (p = 0.02), whereas no difference was found in the therapeutic effects of different treatment doses (p = 0.08) and study designs (p = 0.20). No effect sizes or confidence intervals were reported; these values would have strengthened the interpretability of their results.23, A randomized, double-blind, crossover study compared Armolipid Plus (200 mg red yeast rice, 500 mg berberine, 10 mg policosanol, 0.2 mg folic acid, 2 mg coenzyme Q10, and 0.5 mg astaxanthin) to placebo in 30 patients for 8 weeks.24 This initial treatment period was followed by a 4-week washout period, and then treatment with pravastatin 10 mg/d in all patients for an additional 8 weeks. GLUT4, AMP Kinase, but Not the Insulin Receptor, Are Required for Hepatoportal Glucose Sensor-Stimulated Muscle Glucose Utilization, A Clinical Study of Multi-Factor Intervention to Improve Insulin Resistance in Type 2 Diabetes (Chinese). Meta-analysis and migration analysis of the effect of berberine on homeostasis model assessment of insulin resistance. After 3 months of therapy, 14 patients (28%) in the NC group and 0 patients in the EZE group achieved the primary outcome (P < .0001 for differences between groups). Extending the berberine treatment period (>3months) will significantly increase the therapeutic effect. The difference in administration frequency and lack of blinding increases the risk of bias. Due to its effectiveness . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. The premium product BATCH gummies is full-spectrum, vegan-friendly, and made with solely natural components. Human clinical trials that were published in English were reviewed for inclusion. Masters Degree. Berberine, a Natural Plant Product, Activates AMP-Activated Protein Kinase with Beneficial Metabolic Effects in Diabetic and Insulin-Resistant States. Our meta-analysis results correspond to the theory that berberine activates AMPK to regulate metabolism. 0 5 ). A. Eight trials specified a double-blind study design. Our study still has the following limitations: 1) random errors may be found in the inclusion of the sample; 2) differences are observed in the characteristics of RCT samples, such as gender and age differences; 3) metabolic disorders are often combined with several diseases. Marazzi G, Pelliccia F, Campolongo G, et al. Another 417 trials were included through other sources to increase confidence in results. Study results were not pooled in a meta-analysis due to high anticipated heterogeneity among studies from differences in patients, intervention, control, duration, and blinding. Neag M. A., Mocan A., Echeverria J., Pop R. M., Bocsan C. I., Crisan G., et al. For some people, side effects of prednisone, as well as the inflammation that brings PMR, might be alleviated by berberine, an OTC plant-based drug. Inclusion in an NLM database does not imply endorsement of, or agreement with, The Cochrane Collaborations Tool for Assessing Risk of Bias in Randomised Trials, Clinical Observation on 60 Cases of Hyperlipemia Treated by Berberine (Chinese), Interventioal Effect of Berberine Liposome on Impaired Glucose Tolerance Accompanied with Hyperlipemia. (2019). value was 96%, and the p-value was 0.00. However, due to the limited effectiveness and potential adverse effects of current treatments, the long-term prognosis of CVD patients is still discouraging. In the placebo group, change in LDL from baseline to 8 weeks was not significant (150 29 mg/dL at baseline and 144 33 mg/dL at 8 weeks, P = .617). Simvastatin-induced Cognitive Dysfunction: Two Case Reports. The mean difference (blue squares), 95% CI (horizontal lines through blue squares), and pooled-effect sizes (green diamonds) were presented using random-effect Hedges models. This feature improves the shortcomings of the combination of statins and metformin and shows potential as a new first-line treatment drug. At the 1-year visit, 58 patients (73%) in the EZE-nutraceutical combination therapy group had achieved LDL <100 mg/dL. The screening and extraction of trial data were independently and simultaneously performed by Yu Ye and Xiufen Liu. FOIA sharing sensitive information, make sure youre on a federal p < 0.05 is considered statistically significant, and a forest graph was used to analyze the effect size. Below, check out the tour dates, as well as a weird tour . Efficacy of Berberine in Patients with Non-Alcoholic Fatty Liver Disease. In evaluating the therapeutic effect of berberine on metabolic disorders, we selected four commonly and clinically used blood lipid tests as indicators to measure the effect of berberine in lowering blood lipids. At the end of the washout period, patients were restarted on the same medication, placebo, or berberine, for an additional 3 months. Berberine was found to increase cholesterol secretion from the liver into bile (Guo et al. (2014). Berberine is clinically safe and well-tolerated by the human body. Methods and results: Using meta-analysis of Cochrane Handbook for Systematic Reviews of Interventions as guidelines, we searched PubMed, GeenMedical, Cochrane library, and china national knowledge infrastructure (CNKI) for trials reporting clinical treatment data of berberine. TC is a risk factor for patients with hyperlipidemia, and atherosclerosis dominated by elevated TC is a key factor affecting the treatment effect. 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