The recent popularity of Ozempic has led to concerns about the supply of the injectable drug for patients who actually need it for its intended purpose.
Ozempic is approved in Canada for treatment of Type 2 diabetes, as is Rybelsus, a similar drug which comes in a tablet. But it’s increasingly being used off-label for weight loss by otherwise healthy people here and especially in the United States.
With supplies sometimes running short, some influencers on TikTok and other social media are now touting a so-called “miracle” herbal supplement, berberine, as another shortcut to weight loss — even fashioning it “nature’s Ozempic.”
“Everybody said, ‘Weight loss in a needle? That’s fantastic!'” said Dr. Peter Lin, director of primary care initiatives at the Canadian Heart Research Centre and a family physician, of the Ozempic craze.
“Then, if you’re trying to catch on to that wave, you’ll say, ‘Here’s a natural version of the thing that you can’t get right now.'”
But with most things that sound too good to be true, this claim is, too, say doctors — and could even pose some risks.
Here’s what you need to know about berberine.
What is it?
Berberine is a chemical found in different kinds of plants including European barberry, goldenseal, goldthread, Oregon grape, phellodendron and tree turmeric. It’s yellowish and has a bitter taste.
It’s been used for thousands of years in traditional Chinese and Ayurvedic medicine, commonly to treat stomach bugs, diarrhea or other gastrointestinal issues.
What it does, doesn’t and might do
Other studies have shown it has “some efficacy in decreasing blood sugars, correcting your cholesterol levels… a number of the things that people living with obesity tend to have,” said Dr. Sean Wharton, internal medicine physician and assistant professor at University of Toronto and McMaster University in Hamilton.
But Wharton, who has done work for the company that produces Ozempic, says many of the studies suggesting some weight-loss benefits were short term, not randomized and not done against a placebo.
In other words, not scientifically rigorous.
“When we do studies, we really try to eliminate confounding factors in bias. But when it’s a small study and it’s not a well-done study, then there’s always bias,” he said.
For the average healthy person who may want to lose 10, 15, or 20 pounds and keep it off, Wharton says, the science on berberine just isn’t there.
“Does berberine have some health benefits? Sure it does, through probably very natural processes.
“But is it a natural Ozempic? My thoughts would be no,” he said, though more research along those lines would be “interesting.”
How does berberine differ from Ozempic?
Ozempic mimics a hormone, GLP-1, which tells the brain that food is coming in and to stop eating.
“The rest of the body knows what to do once you give the signal that food is coming,” Lin said.
“It turns out, in patients with diabetes, that signaling system isn’t working well. That GLP-1 is not coming out at the right amount, or the right timing. And so what we do instead is we give you an injection of it.”
But berberine works nothing like Ozempic, Lin says.
“It is not a messaging system.”
It’s not entirely clear how berberine does work, but it appears that the only reason it’s being touted as a natural alternative to Ozempic is because of the hint that it might contribute to some weight loss in some people. But doctors say large-scale, solid data to back up the claim is lacking.
“We all have anecdotes of things that worked for us,” said Wharton. “That doesn’t mean that they are proven effective for the entire world.”
Are there potential harms?
Natural substances are not regulated by Health Canada the way manufactured drugs are, but berberine does fall under this country’s regulations for natural health products, or NHPs.
In an email to CBC News, Health Canada said it “recommends that consumers use only authorized NHPs according to the approved terms of market authorization shown on its label.”
“In the herbal world, we don’t do as many studies and the approval process isn’t quite there. So therefore we don’t know exactly what all the side effects are,” said Lin.
He says while berberine is one of the more studied herbals, there is still a lack of information when it comes to its benefits versus risks — which is why medical doctors do not prescribe it.
“Until we know that ratio, then how do I know I’m not doing harm to you?”
He says herbals are traditionally used in small amounts — extracted from plants, maybe used as a tea — so when people experience side effects like some nausea or diarrhea, that’s only from ingesting it on a small scale.
His concern is that if people think taking more berberine will help them to lose more weight, or if the supplement is modified so that the body absorbs more of it, the negative side effects could also increase.
“That’s why a lot of doctors, if you talk to them, they’ll say, ‘You know, it might have some effect, but we don’t know exactly what it does inside your body. And if it’s touching all of these systems, we need to make sure that it’s not causing harm,'” he said.
And because it is unregulated, says Wharton, it carries other uncertainties.
“Are you getting actual berberine? What dose of it are you getting? What concentration are you getting? And does it matter?” he said.
“It would matter if there was some serious adverse effects connected to it, if there was drug interactions, if there was things that were causing a real problem. Then Health Canada would have to regulate it as it would be a toxin. At this stage, it’s just a natural food.”