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Traditional Chinese medicine · Western herbalism

BerberineBerberis, Hydrastis, Coptis and Mahonia species (source plants)

An alkaloid from barberry, goldenseal and coptis. One IBS-D trial used 400 mg a day for 8 weeks; it also changes how the body handles several medicines.

Botanical name
Berberis, Hydrastis, Coptis and Mahonia species (source plants)
Part used
root, rhizome and stem bark of the source plants; sold as the isolated alkaloid
Also called
pinyin Huang lian (coptis rhizome, a berberine-rich source) (黄连); Barberry alkaloid, Berberine hydrochloride, Berberine sulfate
Used in
Traditional Chinese medicine, Western herbalism
Taken for
Loose stools and diarrhea, Cramping and pain, Antimicrobial use
Sold as
capsules, tablets, tincture, powder

What berberine is

Berberine is a yellow isoquinoline alkaloid, not a whole herb. It is concentrated in the roots, rhizomes and stem bark of several plants: barberry (Berberis vulgaris), goldenseal (Hydrastis canadensis), coptis or goldthread (Coptis chinensis), and Oregon grape (Mahonia aquifolium).

Supplements usually contain berberine hydrochloride at a standardized amount per capsule, which is different from taking a barberry or goldenseal root powder, where berberine is one alkaloid among several. A pharmacokinetic review puts the bioavailability of berberine at less than 1 percent because of poor solubility and absorption, so most of an oral dose stays in the gut, where it is excreted in feces (11 to 23 percent of the dose in the reviewed work), with a smaller share absorbed and metabolized by the liver.

Berberine has two identities on the page: a plant constituent in traditional medicine, and an isolated compound studied in human trials for diarrhea, irritable bowel syndrome (IBS) and blood sugar. The two bodies of evidence are kept separate below.

What the traditions use it for

Traditional Chinese medicine (about TCM)

TCM texts class coptis rhizome (huang lian), the most widely cited berberine-rich herb, as bitter and cold. In the tradition’s terms it “clears heat and dries dampness,” and the pattern it is listed for is damp-heat in the stomach and intestines, a picture that includes diarrhea, dysentery and nausea with vomiting from what the texts call stomach heat. Practitioner references add that it is not used for cold or deficient patterns and that long use without tonifying herbs is thought to harm the spleen and stomach. It is prescribed inside formulas, not alone. A pharmacology paper on berberine and newborn jaundice describes huanglian as a traditional Chinese herb whose main ingredient is berberine.

Western herbalism

Berberine-bearing plants entered Western herbalism by several routes. NCCIH records that Native Americans used goldenseal, a berberine source, for digestive disorders, wounds, and skin and eye conditions; it is now sold as a supplement for colds, diarrhea, constipation and other complaints. These are statements about how the plants were used, not findings about the isolated alkaloid.

The constituents

Berberine is a quaternary isoquinoline alkaloid. In goldenseal it sits alongside hydrastine and canadine; coptis and barberry carry berberine with related alkaloids such as palmatine. In laboratory and animal work it has antimicrobial activity, and in the 1987 cholera and E. coli trial it acted as an antisecretory agent, reducing stool volume in infected patients. Its metabolites are formed by demethylenation and then glucuronidation, sulfation and methylation. Lab findings on drug-metabolizing enzymes and the P-glycoprotein transporter are covered under interactions.

The human evidence

For IBS with diarrhea (IBS-D), the main randomized trial recruited 196 patients and randomized 132 to berberine hydrochloride 400 mg a day (given twice daily) or placebo for 8 weeks, followed by a 4-week washout. Diarrhea frequency (P = 0.032), abdominal pain frequency (P < 0.01) and urgency (P < 0.01) fell more with berberine than with placebo, and the drug was well tolerated. A meta-analysis of 19 randomized trials with 1,489 participants tested berberine added to other IBS-D treatments, not berberine alone; combinations raised the response rate (odds ratio 4.19), and the authors still called the evidence insufficient because the studies were small.

For diarrhea in general, a systematic review of 38 trials with 3,948 participants (27 of them in children, 22 of those using berberine as an enema) found higher clinical cure rates and shorter diarrhea with berberine than with control groups, with no deaths or serious adverse events. The evidence quality was moderate to low or very low. In a 1987 trial of 165 adults with diarrhea from toxin-producing E. coli or cholera, a single 400 mg dose of berberine sulfate cut stool volume, and 42 percent of the E. coli patients had stopped having diarrhea at 24 hours versus 20 percent of controls. In cholera the effect was slight, and 1,200 mg added to tetracycline did not lower stool output further.

For metabolic outcomes, which are covered here briefly, a trial of 116 people with type 2 diabetes and dyslipidemia gave 1.0 g a day for 3 months: fasting glucose fell from 7.0 to 5.6 mmol/L and HbA1c from 7.5 to 6.6 percent. An umbrella review of 11 meta-analyses found effects on glucose, insulin resistance and lipids and called for higher-quality trials. We did not find trials of berberine on constipation, reflux or bloating as primary outcomes.

StudyDoseWhat it found
Randomized placebo-controlled trial in IBS-D, 196 recruited, 132 randomized PMID 26400188400 mg berberine hydrochloride a day, twice daily, 8 weeksDiarrhea frequency (P = 0.032), pain frequency and urgency (both P < 0.01) reduced more than placebo
Meta-analysis of 38 randomized trials, 3,948 participants (27 trials in children) PMID 33149763Various; 22 of 27 pediatric trials used enemasHigher clinical cure rate and shorter diarrhea than control; no serious adverse events; low-quality evidence
Randomized trials in adults with E. coli or cholera diarrhea, 165 patients PMID 3549923400 mg berberine sulfate onceE. coli: 42% vs 20% free of diarrhea at 24 hours; cholera effect slight
Meta-analysis of 19 randomized trials in IBS-D, 1,489 participants (berberine plus other agents) PMID 42877511Various, in combinationResponse rate odds ratio 4.19; authors call evidence insufficient
Randomized placebo-controlled trial in type 2 diabetes with dyslipidemia, 116 people PMID 183979841.0 g a day, 3 monthsFasting glucose 7.0 to 5.6 mmol/L; HbA1c 7.5% to 6.6%; mild to moderate constipation in 5

Doses, in trials and in practice

The IBS-D trial used 400 mg of berberine hydrochloride a day, given as two doses, for 8 weeks. The 1987 diarrhea trials used a single 400 mg dose of berberine sulfate. The diabetes trial used 1.0 g a day for 3 months. The cyclosporine study in volunteers used 0.3 g twice daily for 10 days. In traditional use the berberine arrives as the whole herb: coptis rhizome in decoctions inside a formula, or barberry and goldenseal as teas, capsules and tinctures, at amounts that depend on the herb and the practitioner, with no standard berberine content.

The amounts above are what trials and pharmacopoeias record, not a dose for you; your medicines and conditions change the answer, and a clinician or pharmacist who knows them is the person to ask.

What is known about safety

Gastrointestinal effects are the common ones. An umbrella review lists constipation and diarrhea as side effects, and the diabetes trial recorded mild to moderate constipation in 5 of the berberine group. In the diarrhea and IBS-D trials no serious adverse events were reported.

Berberine displaced bilirubin from albumin in a laboratory study, about tenfold more strongly than phenylbutazone, and raised unbound bilirubin in adult rats; the authors concluded berberine-rich herbs are best avoided in jaundiced newborns and pregnant women. NCCIH makes the same point about goldenseal, saying the berberine constituent can be harmful to newborns. Safety in pregnancy and breastfeeding has not been established by trials. Supplement content varies by product, and the reviews we read note that evidence for long-term use is limited.

Where it meets prescription medicines

Berberine inhibits the P-glycoprotein transporter in rats and increased the exposure of cyclosporine and digoxin there (digoxin AUC 169 percent of control at 100 mg/kg). In six volunteers given 0.3 g of berberine twice daily for 10 days, cyclosporine at 3 mg/kg had a 19.2 percent higher AUC (P < 0.05), while at 6 mg/kg there was no significant change. Sources also report effects on CYP3A4 and note a glucose-lowering action, so medicines for blood sugar, transplant and heart rhythm are the classes most often flagged.

Medicines the site’s own interaction rules flag with berberine

The quiz applies these rules when someone names a medicine. They come from published interaction references and are a reason to ask a pharmacist, not a diagnosis:

Catalog entries that list berberine

If you want berberine in a product rather than as a loose herb, these are the entries that carry it, with the label amounts and the reviews read.

Emma Relief Daily Digestive Supplement 4 out of 5 from 11,119 ratings from Amazon · $2.00 a day Gundry MD Total Restore 4.1 out of 5 from 9,333 ratings from Amazon · $2.33 a day Thorne Berberine 4.4 out of 5 from 6,514 ratings from Amazon · ~$2.93 a day at the full label dose, about $1.47 at the lowest Omyo GLP-1 Digestive Support 4.8 out of 5 from 2,814 ratings from omyohealth.com · $2.00 a day ActivatedYou Morning Complete 3.9 out of 5 from 1,503 ratings from Trustpilot · $2.08 a day Snap Supplements Gut Health 4.5 out of 5 from 410 ratings from Amazon · $1.20 a day Nuora Gut Ritual 2.2 out of 5 from 39 ratings from Amazon · $1.30 a day

Match it to your own case

The quiz takes about three minutes, asks what you have tried and which medicines you take, and shows the products whose trials and labels fit, with the reasons.

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Herbs that sit beside it

Western Goldenseal Hydrastis canadensis TCM Coptis Coptis chinensis Western Oregano Origanum vulgare Western Olive leaf Olea europaea

The questions that come up

Is berberine a herb?

No. It is a single alkaloid found in several plants, including barberry, goldenseal, coptis and Oregon grape. Supplements usually contain the purified alkaloid, which is a different thing from a root powder of one of those plants.

What did the IBS-D trial find?

In a randomized trial of 132 people with IBS-D, 400 mg of berberine hydrochloride a day for 8 weeks reduced diarrhea frequency, abdominal pain frequency and urgency more than placebo. The later meta-analysis of 19 trials tested berberine combined with other drugs, so it does not show berberine alone.

Is goldenseal the same as berberine?

Goldenseal contains berberine along with hydrastine and canadine. NCCIH notes that very little berberine may be absorbed when goldenseal is taken by mouth, so berberine trial results may not apply to goldenseal itself.

Does berberine interact with medicines?

Lab, animal and small human studies show it can raise levels of cyclosporine, a medicine cleared in part by CYP3A4 and P-glycoprotein. It also lowers blood glucose, which matters for people on diabetes medicines. The advice in the sources is to check with a prescriber or pharmacist first.

Why is it flagged around newborns and pregnancy?

A laboratory study found berberine pushes bilirubin off albumin, the protein that carries it in blood, which is a concern in jaundiced newborns. Trials have not established safety in pregnancy or breastfeeding, and NCCIH advises against goldenseal in both.

Sources