Berberine For Metabolic Health

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Is Berberine Nature’s Ozempic/Wegovy?

Berberine is a compound found in many plants. Of which, some of them are variations of the barberry, hence the name.

It’s been popular this past couple of years, mostly for weight loss. In and of itself, something being good for weight loss doesn’t mean it’s good for the health (just ask diarrhoea, or cancer).

Happily, berberine’s mechanisms of action appear to be good for metabolic health, including:

  • Reduced fasting blood sugar levels
  • Improved insulin sensitivity
  • Reduced LDL and triglycerides
  • Increased HDL levels

So, what does the science say?

It’s (mostly!) not nature’s Wegovy/Ozempic

It’s had that title in a number of sensationalist headlines (and a current TikTok trend, apparently), but while both berberine and the popular weight-loss drugs Wegovy/Ozempic act in part on insulin metabolism, they mostly do so by completely different mechanisms.

Wegovy and Ozempic are GLP-1 agonists, which mean they augment the action of glucagon-like-peptide 1, which increases insulin release, decreases glucagon release, and promotes a more lasting feeling of fullness.

Berberine works mostly by other means, not all of which are understood. But, we know that it activates AMP-activated protein kinase, and on the flipside, inhibits proprotein convertase subtilisin/kexin type 9.

In less arcane words: it boosts some enzymes and inhibits others.

Each of these boosts/inhibitions has a positive effect on metabolic health.

However, it does also have a slight GLP-1 agonist effect too! Bacteria in the gut can decompose and metabolize berberine into dihydroberberine, thus preventing the absorption of disaccharides in the intestinal tract, and increasing GLP-1 levels.

See: Effects of Berberine on the Gastrointestinal Microbiota

Does it work for weight loss?

Yes, simply put. And if we’re going to put it head-to-head with Wegovy/Ozempic, it works about half as well. Which sounds like a criticism, but for a substance that’s a lot safer (and cheaper, and easier—if we like capsules over injections) and has fewer side effects.

❝But more interestingly, the treatment significantly reduced blood lipid levels (23% decrease of triglyceride and 12.2% decrease of cholesterol levels) in human subjects.

However, there was interestingly, an increase in calcitriol levels seen in all human subjects following berberine treatment (mean 59.5% increase)

Collectively, this study demonstrates that berberine is a potent lipid-lowering compound with a moderate weight loss effect, and may have a possible potential role in osteoporosis treatment/prevention.❞

(click through to read in full)

Is it safe?

It appears to be, with one special caveat: remember that paper about the effects of berberine on the gastrointestinal microbiota? It also has some antimicrobial effects, so you could do harm there if not careful. It’s recommended to give it a break every couple of months, to be sure of allowing your gut microbiota to not get too depleted.

Also, as with anything you might take that’s new, always consult your doctor/pharmacist in case of contraindications based on medications you are taking.

Where can I get it?

As ever, we don’t sell it, but you can check out the berberine of one of our sponsors if you like, or else find one of your choosing online; here’s an example product on Amazon, for your convenience.

Enjoy!

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  • Want to sleep longer? Adding mini-bursts of exercise to your evening routine can help – new study

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    Exercising before bed has long been discouraged as the body doesn’t have time to wind down before the lights go out.

    But new research has found breaking up a quiet, sedentary evening of watching television with short bursts of resistance exercise can lead to longer periods of sleep.

    Adults spend almost one third of the 24-hour day sleeping. But the quality and length of sleep can affect long-term health. Sleeping too little or waking often in the night is associated with an increased risk of heart disease and diabetes.

    Physical activity during the day can help improve sleep. However, current recommendations discourage intense exercise before going to bed as it can increase a person’s heart rate and core temperature, which can ultimately disrupt sleep.

    Nighttime habits

    For many, the longest period of uninterrupted sitting happens at home in the evening. People also usually consume their largest meal during this time (or snack throughout the evening).

    Insulin (the hormone that helps to remove sugar from the blood stream) tends to be at a lower level in the evening than in the morning.

    Together these factors promote elevated blood sugar levels, which over the long term can be bad for a person’s health.

    Our previous research found interrupting evening sitting every 30 minutes with three minutes of resistance exercise reduces the amount of sugar in the bloodstream after eating a meal.

    But because sleep guidelines currently discourage exercising in the hours before going to sleep, we wanted to know if frequently performing these short bursts of light activity in the evening would affect sleep.

    Activity breaks for better sleep

    In our latest research, we asked 30 adults to complete two sessions based in a laboratory.

    During one session the adults sat continuously for a four-hour period while watching streaming services. During the other session, they interrupted sitting by performing three minutes of body-weight resistance exercises (squats, calf raises and hip extensions) every 30 minutes.

    After these sessions, participants went home to their normal life routines. Their sleep that evening was measured using a wrist monitor.

    Our research found the quality of sleep (measured by how many times they woke in the night and the length of these awakenings) was the same after the two sessions. But the night after the participants did the exercise “activity breaks” they slept for almost 30 minutes longer.

    Identifying the biological reasons for the extended sleep in our study requires further research.

    But regardless of the reason, if activity breaks can extend sleep duration, then getting up and moving at regular intervals in the evening is likely to have clear health benefits.

    Time to revisit guidelines

    These results add to earlier work suggesting current sleep guidelines, which discourage evening exercise before bed, may need to be reviewed.

    As the activity breaks were performed in a highly controlled laboratory environment, future research should explore how activity breaks performed in real life affect peoples sleep.

    We selected simple, body-weight exercises to use in this study as they don’t require people to interrupt the show they may be watching, and don’t require a large space or equipment.

    If people wanted to incorporate activity breaks in their own evening routines, they could probably get the same benefit from other types of exercise. For example, marching on the spot, walking up and down stairs, or even dancing in the living room.

    The key is to frequently interrupt evening sitting time, with a little bit of whole-body movement at regular intervals.

    In the long run, performing activity breaks may improve health by improving sleep and post-meal blood sugar levels. The most important thing is to get up frequently and move the body, in a way the works best for a person’s individual household.

    Jennifer Gale, PhD candidate, Department of Human Nutrition, University of Otago and Meredith Peddie, Senior Lecturer, Department of Human Nutrition, University of Otago

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Managing Major Chronic Diseases – by Alexis Dupree

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    Our author, Alexis Dupree, is herself in her 70s, and writing with more than three decades of experience of surviving multiple chronic diseases (in her case, Multiple Sclerosis, and then a dozen comorbidities that came with such).

    She is not a doctor or a scientist, but for more than 30 years she’s been actively working to accumulate knowledge not just on her own conditions, but on the whole medical system, and what it means to be a “forever patient” without giving up hope.

    She talks lived-experience “life management” strategies for living with chronic disease, and she talks—again from lived experience—about navigating the complexities of medical care; not on a legalistic “State regulations say…” level, because that kind of thing changes by the minute, but on a human level.

    Perhaps most practically: how to advocate strongly for yourself while still treating medical professionals with the respect and frankly compassion that they deserve while doing their best in turn.

    But also: how to change your attitude to that of a survivor, and yet also redefine your dreams. How to make a new game plan of life—while working to make life easier for yourself. How to deal, psychologically, with the likelihood that not only will you probably not get better, but also, you will probably get worse, while still never, ever, giving up.

    After all, many things are easily treatable today that mere decades ago were death sentences, and science is progressing all the time. We just have to stay alive, and in as good a condition as we reasonably can, to benefit from those advances!

    Bottom line: if you have a chronic disease, or if a loved one does, then this is an immensely valuable book to read.

    Click here to check out Managing Major Chronic Diseases, and make life easier!

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  • The Lupus Encyclopedia – by Dr. Donald Thomas

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    First, a note on the authorship: while this is broadly by Donald E. Thomas Jr. MD FACP FACR, there were more contributors, namely:

    Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD

    The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition last year) information.

    And if you have lupus, you’ll be aware there are a lot of doctors who don’t know a tremendous amount about it, hence the value of this “…for patients and healthcare providers” tome.

    It is what it claims to be: a very comprehensive guide. It’s not light reading, and it is 848 pages of information-dense text and diagrams. If you want to know something, anything, about lupus, then if science knows it, then chances are it is in this book, or this book will at least point you directly to a paper you can read about your specific query.

    The style is, nevertheless, about as readable for the layperson as possible, which is quite an achievement for a book with this amount of dense scientific information. For that, the author thanks his husband, for being the non-doctor beta-reader to screen it for readability—quite a service, with all those doctors writing!

    Bottom line: if you or someone you love has lupus, this book should absolutely be in your collection.

    Click here to check out The Lupus Encyclopedia, and have everything at your fingertips!

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  • What does it mean to be transgender?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Transgender media coverage has surged in recent years for a wide range of reasons. While there are more transgender television characters than ever before, hundreds of bills are targeting transgender people’s access to medical care, sports teams, gender-specific public spaces, and other institutions.

    Despite the increase in conversation about the transgender community, public confusion around transgender identity remains.

    Read on to learn more about what it means to be transgender and understand challenges transgender people may face.

    What does it mean to be transgender?

    Transgender—or “trans”—is an umbrella term for people whose gender identity or gender expression does not conform to their sex assigned at birth. People can discover they are trans at any age.

    Gender identity refers to a person’s inner sense of being a woman, a man, neither, both, or something else entirely. Trans people who don’t feel like women or men might describe themselves as nonbinary, agender, genderqueer, or two-spirit, among other terms.

    Gender expression describes the way a person communicates their gender through their appearance—such as their clothing or hairstyle—and behavior.

    A person whose gender expression doesn’t conform to the expectations of their assigned sex may not identify as trans. The only way to know for sure if someone is trans is if they tell you.

    Cisgender—or “cis”—describes people whose gender identities match the sex they were assigned at birth.

    How long have transgender people existed?

    Being trans isn’t new. Although the word “transgender” only dates back to the 1960s, people whose identities defy traditional gender expectations have existed across cultures throughout recorded history.

    How many people are transgender?

    A 2022 Williams Institute study estimates that 1.6 million people over the age of 13 identify as transgender in the United States.

    Is being transgender a mental health condition?

    No. Conveying and communicating about your gender in a way that feels authentic to you is a normal and necessary part of self-expression.

    Social and legal stigma, bullying, discrimination, harassment, negative media messages, and barriers to gender-affirming medical care can cause psychological distress for trans people. This is especially true for trans people of color, who face significantly higher rates of violence, poverty, housing instability, and incarceration—but trans identity itself is not a mental health condition.

    What is gender dysphoria?

    Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity, or their internal sense of gender. A 2021 study of trans adults pursuing gender-affirming medical care found that most participants started experiencing gender dysphoria by the time they were 7.

    When trans people don’t receive the support they need to manage gender dysphoria, they may experience depression, anxiety, social isolation, suicidal ideation, substance use disorder, eating disorders, and self-injury.

    How do trans people manage gender dysphoria?

    Every trans person’s experience with gender dysphoria is unique. Some trans people may alleviate dysphoria by wearing gender-affirming clothing or by asking others to refer to them by a new name and use pronouns that accurately reflect their gender identity. The 2022 U.S. Trans Survey found that nearly all trans participants who lived as a different gender than the sex they were assigned at birth reported that they were more satisfied with their lives.

    Some trans people may also manage dysphoria by pursuing medical transition, which may involve taking hormones and getting gender-affirming surgery.

    Access to gender-affirming medical care has been shown to reduce the risk of depression and suicide among trans youth and adults.

    To learn more about the trans community, visit resources from the National Center for Transgender Equality, the Trevor Project, PFLAG, and Planned Parenthood.

    If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • Alzheimer’s: The Bad News And The Good

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Devi’s Spectrum of Hope

    This is Dr. Gayatri Devi. She’s a neurologist, board-certified in neurology, pain medicine, psychiatry, brain injury medicine, and behavioral neurology.

    She’s also a Clinical Professor of Neurology, and Director of Long Island Alzheimer’s Disease Center, Fellow of the American Academy of Neurology, and we could continue all day with her qualifications, awards and achievements but then we’d run out of space. Suffice it to say, she knows her stuff.

    Especially when it comes to the optimal treatment of stroke, cognitive loss, and pain.

    In her own words:

    ❝Helping folks live their best lives—by diagnosing and managing complex neurologic disorders—that’s my job. Few things are more fulfilling! For nearly thirty years, my focus has been on brain health, concussions, Alzheimer’s and other dementias, menopause related memory loss, and pain.❞

    ~ Dr. Gayatri Devi

    Alzheimer’s is more common than you might think

    According to Dr. Devi,

    ❝97% of patients with mild Alzheimer’s disease don’t even get diagnosed in their internist offices, and half of patients with moderate Alzheimer’s don’t get diagnosed.

    What that means is that the percentage of people that we think about when we think about Alzheimer’s—the people in the nursing home—that’s a very, very small fraction of the entirety of the people who have the condition❞

    ~ Dr. Gaytatri Devi

    As for what she would consider the real figures, she puts it nearer 1 in 10 adults aged 65 and older.

    Source: Neurologist dispels myths about Alzheimer’s disease

    Her most critical advice? Reallocate your worry.

    A lot of people understandably worry about a genetic predisposition to Alzheimer’s, especially if an older relative died that way.

    See also: Alzheimer’s, Genes, & You

    However, Dr. Devi points out that under 5% of Alzheimer’s cases are from genetics, and the majority of Alzheimer’s cases can be prevented be lifestyle interventions.

    See also: Reduce Your Alzheimer’s Risk

    Lastly, she wants us to skip the stigma

    Outside of her clinical practice and academic work, this is one of the biggest things she works on, reducing the stigma attached to Alzheimer’s both publicly and professionally:

    Alzheimer’s Disease in Physicians: Assessing Professional Competence and Tempering Stigma

    Want more from Dr. Devi?

    You might enjoy this interview:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    And here’s her book:

    The Spectrum of Hope: An Optimistic and New Approach to Alzheimer’s Disease and Other Dementias – by Dr. Gayatri Devi

    Enjoy!

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  • Mammography AI Can Cost Patients Extra. Is It Worth It?

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    As I checked in at a Manhattan radiology clinic for my annual mammogram in November, the front desk staffer reviewing my paperwork asked an unexpected question: Would I like to spend $40 for an artificial intelligence analysis of my mammogram? It’s not covered by insurance, she added.

    I had no idea how to evaluate that offer. Feeling upsold, I said no. But it got me thinking: Is this something I should add to my regular screening routine? Is my regular mammogram not accurate enough? If this AI analysis is so great, why doesn’t insurance cover it?

    I’m not the only person posing such questions. The mother of a colleague had a similar experience when she went for a mammogram recently at a suburban Baltimore clinic. She was given a pink pamphlet that said: “You Deserve More. More Accuracy. More Confidence. More power with artificial intelligence behind your mammogram.” The price tag was the same: $40. She also declined.

    In recent years, AI software that helps radiologists detect problems or diagnose cancer using mammography has been moving into clinical use. The software can store and evaluate large datasets of images and identify patterns and abnormalities that human radiologists might miss. It typically highlights potential problem areas in an image and assesses any likely malignancies. This extra review has enormous potential to improve the detection of suspicious breast masses and lead to earlier diagnoses of breast cancer.

    While studies showing better detection rates are extremely encouraging, some radiologists say, more research and evaluation are needed before drawing conclusions about the value of the routine use of these tools in regular clinical practice.

    “I see the promise and I hope it will help us,” said Etta Pisano, a radiologist who is chief research officer at the American College of Radiology, a professional group for radiologists. However, “it really is ambiguous at this point whether it will benefit an individual woman,” she said. “We do need more information.”

    The radiology clinics that my colleague’s mother and I visited are both part of RadNet, a company with a network of more than 350 imaging centers around the country. RadNet introduced its AI product for mammography in New York and New Jersey last February and has since rolled it out in several other states, according to Gregory Sorensen, the company’s chief science officer.

    Sorensen pointed to research the company conducted with 18 radiologists, some of whom were specialists in breast mammography and some of whom were generalists who spent less than 75% of their time reading mammograms. The doctors were asked to find the cancers in 240 images, with and without AI. Every doctor’s performance improved using AI, Sorensen said.

    Among all radiologists, “not every doctor is equally good,” Sorensen said. With RadNet’s AI tool, “it’s as if all patients get the benefit of our very top performer.”

    But is the tech analysis worth the extra cost to patients? There’s no easy answer.

    “Some people are always going to be more anxious about their mammograms, and using AI may give them more reassurance,” said Laura Heacock, a breast imaging specialist at NYU Langone Health’s Perlmutter Cancer Center in New York. The health system has developed AI models and is testing the technology with mammograms but doesn’t yet offer it to patients, she said.

    Still, Heacock said, women shouldn’t worry that they need to get an additional AI analysis if it’s offered.

    “At the end of the day, you still have an expert breast imager interpreting your mammogram, and that is the standard of care,” she said.

    About 1 in 8 women will be diagnosed with breast cancer during their lifetime, and regular screening mammograms are recommended to help identify cancerous tumors early. But mammograms are hardly foolproof: They miss about 20% of breast cancers, according to the National Cancer Institute.

    The FDA has authorized roughly two dozen AI products to help detect and diagnose cancer from mammograms. However, there are currently no billing codes radiologists can use to charge health plans for the use of AI to interpret mammograms. Typically, the federal Centers for Medicare & Medicaid Services would introduce new billing codes and private health plans would follow their lead for payment. But that hasn’t happened in this field yet and it’s unclear when or if it will.

    CMS didn’t respond to requests for comment.

    Thirty-five percent of women who visit a RadNet facility for mammograms pay for the additional AI review, Sorensen said.

    Radiology practices don’t handle payment for AI mammography all in the same way.

    The practices affiliated with Boston-based Massachusetts General Hospital don’t charge patients for the AI analysis, said Constance Lehman, a professor of radiology at Harvard Medical School who is co-director of the Breast Imaging Research Center at Mass General.

    Asking patients to pay “isn’t a model that will support equity,” Lehman said, since only patients who can afford the extra charge will get the enhanced analysis. She said she believes many radiologists would never agree to post a sign listing a charge for AI analysis because it would be off-putting to low-income patients.

    Sorensen said RadNet’s goal is to stop charging patients once health plans realize the value of the screening and start paying for it.

    Some large trials are underway in the United States, though much of the published research on AI and mammography to date has been done in Europe. There, the standard practice is for two radiologists to read a mammogram, whereas in the States only one radiologist typically evaluates a screening test.

    Interim results from the highly regarded MASAI randomized controlled trial of 80,000 women in Sweden found that cancer detection rates were 20% higher in women whose mammograms were read by a radiologist using AI compared with women whose mammograms were read by two radiologists without any AI intervention, which is the standard of care there.

    “The MASAI trial was great, but will that generalize to the U.S.? We can’t say,” Lehman said.

    In addition, there is a need for “more diverse training and testing sets for AI algorithm development and refinement” across different races and ethnicities, said Christoph Lee, director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington School of Medicine. 

    The long shadow of an earlier and largely unsuccessful type of computer-assisted mammography hangs over the adoption of newer AI tools. In the late 1980s and early 1990s, “computer-assisted detection” software promised to improve breast cancer detection. Then the studies started coming in, and the results were often far from encouraging. Using CAD at best provided no benefit, and at worst reduced the accuracy of radiologists’ interpretations, resulting in higher rates of recalls and biopsies.

    “CAD was not that sophisticated,” said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society. Artificial intelligence tools today are a whole different ballgame, he said. “You can train the algorithm to pick up things, or it learns on its own.”

    Smith said he found it “troubling” that radiologists would charge for the AI analysis.

    “There are too many women who can’t afford any out-of-pocket cost” for a mammogram, Smith said. “If we’re not going to increase the number of radiologists we use for mammograms, then these new AI tools are going to be very useful, and I don’t think we can defend charging women extra for them.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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