There’s a lot that’s shitty about our healthcare system. Even if you have a pretty good idea of what treatment will help you, it takes a lot of time and money to go through the proper channels to get it. So there will always be a market for anything that you can simply order online and start taking, doctors be damned. That’s the appeal of berberine, the supplement that’s being touted as “nature’s Ozempic.”
Why are people looking for a natural version of Ozempic?
Ozempic is, famously, the new injectable drug that helps people lose weight. (Technically Wegovy is the drug that’s approved for weight loss, and Ozempic is a diabetes medication with the same active ingredient in a lower dose. But for whatever reason, Ozempic is the buzzier brand name.)
Health insurance doesn’t cover most weight-loss treatments, so when you see celebs and socialites raving about how they got thin on Ozempic (and speaking approvingly about how it reinforces disordered-sounding attitudes toward food like only having one to three bites of a meal, yikes), you can be pretty sure they’re paying out of pocket. They’re either getting a doctor to prescribe them Wegovy or off-label Ozempic, or they’re getting an illegal mix of research-grade semaglutide compounded by a sketchy pharmacy. Ozempic costs around $1,200 for each month’s injection, and Wegovy is about $1,600. (The compounded stuff is cheaper, but still in the hundreds of dollars.)
Whatever the source, it’s expensive. And if you’re considering taking the medication yourself, you may be worried about the side effects that are unpleasant enough that about 10% of people who start taking semaglutide end up quitting. So if you scroll past a TikTok video telling you you can get the same weight-loss effects from a plant-derived supplement, that’s going to sound pretty good.
Berberine is not “nature’s Ozempic”
Berberine and semaglutide (the active ingredient in Ozempic) can both decrease the levels of glucose in your blood. This makes both of them potentially useful in treating diabetes. But the similarities stop there.
Semaglutide mimics a gut hormone called GLP-1. Besides lowering blood sugar, it makes your stomach empty more slowly, allowing you to feel full for longer, and also acts on the brain to affect appetite (and possibly cravings in general). Semaglutide isn’t a game-changing weight-loss drug because it lowers your blood glucose—other drugs already do that—but because it helps people to eat less without being hungry.
Berberine works differently. Some of the TikTokers will tell you that berberine isn’t really nature’s Ozempic; it’s actually nature’s metformin. While that’s not literally true, it’s a better analogy. Both metformin and berberine act on the AMPK pathway. They both seem to decrease the amount of sugar that your liver makes, and encourage cells of your body to take up more sugar from the bloodstream. As a result, you have lower blood sugar—good news if you are trying to control your diabetes.
A 2018 review compared metformin and berberine, finding a number of similarities in how the two chemicals are known to work, but also some differences. “It is not clear whether metformin and berberine undertake all actions via the same mechanisms,” the authors write, “or some via similar and others different mechanisms.”
In other words—contrary to what some TikTokers are saying—berberine is not a natural version of Ozempic, and it’s not even a natural version of metformin. There is a natural version of metformin, by the way: it’s French lilac, which was reportedly used to treat symptoms of diabetes in Europe in the 17th century. French lilac and its extracts were too toxic to make a good diabetes drug, but in the 1990s scientists figured out that one of its components—metformin—was less toxic than the others, and could be synthesized in the lab.
We don’t even know if berberine works for weight loss
As TikTokers advertise berberine supplements, the nickname “nature’s Ozempic” is doing a lot of the marketing work. But berberine has actually not been shown to cause weight loss in humans. This 2020 review compiles a few studies on berberine’s effect on blood glucose and other biomarkers in humans, but the studies relating directly to weight loss are in mice and rats. The only human study that mentions weight loss did not have a control group.
Scrolling through TikTok, you can find a lot of people saying or implying that berberine causes weight loss, but they never back up that claim. I did find one video in which a woman poses with pills under the headline “Ozempic Dupe/Monjaro [sic] Dupe” while a voiceover says that the “average weight loss is 21 pounds in eight weeks and you do not need a prescription.”
Click the link in bio, though, and the voiceover’s results turn out to be from a study of a supplement containing “modified cellulose and cetylated fatty acids.” Not berberine, and definitely not anything related to Ozempic. Like the ice water diet hack, creators are hashtagging their videos with whatever is trending, to sell whatever supplements they already have an affiliate code for. Sometimes that’s berberine, but they’re hoping you won’t care if it’s not.
Berberine is basically a drug, even if it’s regulated like a supplement
In the U.S., there are two different ways a chemical can be sold to you to affect your health. One is that it can be approved as a drug, which requires extensive testing and FDA approval. Ozempic and Wegovy have been through this process.
The other is to package it up as a “dietary supplement,” carefully word the health claims you put on the label (“glucose support,” not “treats diabetes”), and expect that the FDA will probably not have the time or budget to come after you (as long as you don’t kill too many people). While many supplements probably do nothing, some of them actually do have pharmaceutical effects on your body. Ironically, the lack of oversight on dosage and formulation means that it’s often impossible to tell which is which, even if you’ve done your research on the active ingredients.
Being “natural” does not exempt supplements from doing harm. As Kate Knibbs points out in her excellent Wired piece on the TikTok berberine fad, berberine has enough of an effect on blood sugar that actual health professionals are cautious about it. One dietitian Knibbs spoke with says that she recommends bloodwork for her clients who use berberine, to make sure their blood sugar doesn’t drop too low.
Berberine may also cause or exacerbate jaundice in newborns if you take it when you are pregnant or breastfeeding, and the Memorial Sloan Kettering Cancer Center points out that it may interfere with some types of immunosuppressants and chemotherapy drugs. So if you want to give this supplement a try, you’re best off working together with a doctor to make sure it’s safe for you—the very thing you probably wanted to avoid in the first place.
