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Savannah Crosby had been gaining weight despite tracking her calories and hitting the gym. Looking for answers, the 34-year-old Texas resident fell down an internet rabbit hole that led her to berberine: a yellow, bitter-tasting chemical found in plants that some claim helps weight loss.

“After seeing how cheap berberine was, I figured I didn’t have anything to lose,” said Crosby, who has been chronicling her <a href="https://www.tiktok.com/@beingsavv/video/7245390133208517934?_r=1&_t=8dIVlNLadb9&social_sharing=v3" target=_blank>weight-loss journey</a> on TikTok. More than two months later, Crosby said she has lost eight pounds.

Others on social media are making similar claims, and some have even dubbed the supplement “nature’s Ozempic,” a misleading comparison to the Type 2 diabetes drug that has gained popularity as a weight-loss treatment.

The catchy comparison has taken off. On TikTok, the hashtag <a href="https://www.tiktok.com/tag/berberine" target=_blank>#berberine</a> has 73 million views and counting

“The term ‘nature’s Ozempic’ is pure marketing, and implies that the berberine chemical is similar in any shape, form, or mechanism to Ozempic, and it’s not,” said F. Perry Wilson, a Yale School of Medicine physician and epidemiologist who studies the supplement industry.

“Supplements really are the wild west,” Wilson said. “Just because a supplement says it’s natural and has a price that doesn’t break the bank, doesn’t mean it works or that it’s safe.”

Here’s everything to know about the berberine’s risks, side effects, and the research studying whether it actually works.

Berberine is a chemical found in several plants, such as European barberry, goldenseal, goldthread and tree turmeric, that has been extracted and sold as a supplement in powder or pill form.

You can find berberine supplements at your health store, as well as major retailers. Bottles with 60 capsules, about a month’s supply, can range anywhere from $12 to $50.

Berberine has been used in traditional Chinese medicine to treat <a href="https://journals.sagepub.com/doi/10.1177/1756284820961299" target=_blank>bacterial diarrhea</a> due to its antimicrobial properties. Some research suggests the supplement can <a href="https://www.spandidos-publications.com/10.3892/etm.2019.7295" target=_blank>lower blood sugar and decrease insulin resistance</a> in people with Type 2 diabetes. Studies have also suggested that berberine can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871262/" target=_blank>lower cholesterol</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S1744388120311622?via%3Dihub" target=_blank>reduce blood pressure</a>.

Still, much of the research on berberine is limited, of low quality and ultimately inconclusive, said Carol Haggans, a registered dietitian and consultant for the NIH’s Office of Dietary Supplements. Many studies include small sample sizes and short study periods or have analyzed berberine <a href="https://journals.sagepub.com/doi/10.1177/2156587216687695" target=_blank>in combination with other dietary supplements</a>.

“Although berberine has been studied for a variety of different things, I wouldn’t say it’s been proven for the treatment of anything,” Haggans said.

Although <a href="https://www.sciencedirect.com/science/article/abs/pii/S0367326X0900255X" target=_blank>a study of obese mice</a> found that berberine reduced weight and food intake, clinical trials in people haven’t shown meaningful weight loss.

A recent systematic review and meta-analysis of 12 randomized controlled trials found that berberine helped people, on average, <a href="https://www.sciencedirect.com/science/article/abs/pii/S2405457720300802" target=_blank>lose about four and a half pounds</a> and less than half an inch from their waist — results that Wilson said are “not exactly impressive.” Trials included in the review used different doses of berberine for about one to three months. The analysis has also been met with skepticism because the studies included are of low quality, and the team of researchers behind it have been<a href="https://retractionwatch.com/2020/11/10/journals-flag-concerns-in-three-dozen-papers-by-nutrition-researchers/" target=_blank> flagged over data concerns</a>.

Berberine isn’t strong enough to facilitate weight loss on its own, said <a href="https://drkananind.com/" target=_blank>Nikka Kanani</a>, a Costa Mesa, Calif., practitioner licensed in naturopathic medicine. Proper diet and exercise are always most important in any weight loss journey, no matter if herbal supplements are involved.

Weight loss that occurs while taking berberine is really a “happy byproduct” of its effect on other factors, Kanani added. Lowering blood sugar, for example, will decrease the amount of glucose that is stored as body fat.

“Berberine is not to be thought of as a weight loss herb. It’s never been used that way and it’s never going to be because that’s not its mechanism of action,” said <a href="https://dramyrothenberg.com/" target=_blank>Amy Rothenberg</a>, a Northampton, Mass., practitioner licensed in naturopathic medicine. “Can it be a component related to improving insulin sensitivity? Absolutely. But is your diet more important? 100 percent.”

Berberine’s long-term effects on weight loss are also unclear, Wilson said. “Weight loss, no matter how you’re achieving it, is notoriously hard to maintain. Are you supposed to take berberine, or even Ozempic, forever to keep the weight off? We just don’t know.”

The mechanisms behind berberine and Ozempic could not be more different, experts said.

Ozempic, one of the brand names for <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss" target="_blank">semaglutide</a>, reduces appetite and makes people feel full by mimicking the GLP-1 hormone that the gastrointestinal tract releases in response to eating. It also helps the body produce more insulin, which reduces blood sugar. Berberine increases the uptake of glucose by muscle fibers and improves insulin sensitivity by <a href="https://www.sciencedirect.com/science/article/abs/pii/S0041008X16303957" target="_blank">activating AMP-activated protein kinase</a> (AMPK).

If anything, Wilson says, “berberine is ‘nature’s metformin,” which is a drug used to treat Type 2 diabetes that works <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214027/#:~:text=Metformin%20works%20by%20helping%20to,the%20intestines%20or%20stomach%20absorb." target=_blank>via the same AMPK pathway</a>.

What are the side effects of taking berberine supplements?

Berberine most commonly causes GI upset, including diarrhea, constipation and gas. If these symptoms persist for more than two weeks, you should stop taking berberine. In more serious cases, the supplement can cause nausea and vomiting if doses are too high, Rothenberg said, as well as neurologic symptoms such as tingling of the hands and feet, although these are rare.

The potential for sensitivity or an allergic reaction to berberine, or any supplement or medication, is also possible, Rothenberg warned.

People who are pregnant or breastfeeding should not take berberine because it can cross the placenta and breastmilk, respectively, and potentially harm newborn infants.

The supplement may <a href="https://medlineplus.gov/druginfo/natural/1126.html" target=_blank>slow the removal of a chemical called bilirubin</a> (a byproduct of the breakdown of old red blood cells) from the liver, causing a rare type of brain damage called <a href="https://pubmed.ncbi.nlm.nih.gov/8513024/" target=_blank>kernicterus</a>. Infants born with high levels of bilirubin (jaundice) face greater risks if exposed to berberine.

People taking certain medications should also be wary of berberine. The supplement can affect how the liver breaks down some drugs, which could enhance their effects. Taking berberine alongside diabetes medications, for example, might lower blood sugar too much. The same idea applies to mixing berberine with anticoagulants and medications for hypertension.

“There could be more potential interactions with other medications, but there’s just not enough data,” Kanani said. “When something blows up like this, we're almost playing catch up.”

Are berberine supplements regulated by the FDA?

Companies that sell supplements don’t have to prove that their products are safe or effective before going on the market. The <a href="https://www.fda.gov/food/dietary-supplements" target=_blank>Food and Drug Administration only steps in</a> to review a product if safety concerns arise.

The lack of regulation also means that supplements could contain “other fillers and compositional ingredients,” such as stimulants, that could interact poorly with other drugs, said <a href="https://hnrca.tufts.edu/people/faculty/jennifer-lee-phd" target=_blank>Jennifer Lee</a>, a scientist studying gut health and function at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University.

When it comes to vitamins and supplements, you will want to check if they are verified by the US Pharmacopeia (USP), Wilson said, which conducts independent lab testing on certain products to ensure the quality of their ingredients.

None of the experts we spoke to were aware of berberine supplements with USP certification.

“There have been many waves of new therapeutics and supplements for weight loss that seem all the rage, but time tells all truths in a sense,” Lee said. “Social media doesn’t offer the full picture, and there’s still no one hit wonder that can safely and effectively help people lose weight.

Do you have a question about healthy eating? Email <a href="mailto:EatingLab@washpost.com">EatingLab@washpost.com</a> and we may answer your question in a future column.

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Why berberine, a trendy diet supplement, isn't 'nature's Ozempic.'

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Why a trendy weight-loss supplement is not ‘nature’s Ozempic’

Berberine is a chemical found in several plants that has been extracted and sold as a supplement in powder or pill form