Literature Review

Berberine: Mechanisms, Drug Interactions, and Other Things You Should Know

Berberine is a quaternary ammonium salt belonging to the protoberberine subclass of benzylisoquinoline alkaloids, distributed in the roots, rhizomes, and stems of over 500 plant species indigenous to Asia and North America, including the medicinal species Hydrastis canadensis  (goldenseal), Coptis chinensis (Coptis or goldenthread), Berberis aquifolium (Oregon grape), and Berberis vulgaris (barberry) (Kumar et al, 2015; Singh and Sharma, 2018).  Through antiproliferative and anti-adhesive actions, berberine inhibits a wide range of microbial pathogens including Staphylococci, Streptococci, Salmonella, Clostridium, H. pylori, Shigella, Vibrio, and Cryptococci.  Accordingly, berberine-containing plants have an extensive history in Ayurvedic and Chinese medicine, as antibacterial, antifungal and antidiarrheal agents, with medicinal use dating back over 2,500 years (Birdsall et al, 1997; Domandia et al, 2008).  Multifarious actions in the host intestine include remediation of mucosal damage and anti-inflammatory effects, which are thought to contribute to its utility in chronic, non-infectious conditions such as irritable bowel syndrome and inflammatory bowel disease (Chen et al, 2015; Habtermariam, 2016).

In 1998, berberine was reported to ameliorate hyperglycemia in diabetic patients undergoing treatment for diarrhea (Ni et al, 1988).  Lipid-lowering effects were later demonstrated and confirmed in multiple human intervention trials (Kong et al, 2004).  Diabetes, metabolic syndrome and dyslipidemia have since comprised the predominant focus of clinical research, with the totality of evidence supporting insulin sensitizing and cholesterol-reducing efficacy at doses of 500-1500 mg/day as berberine hydrochloride (Zeng et al, 2003; Kong, et al, 2004; Zhang et al, 2008; Zhang et al, 2010; Dong et al, 2012; Wei, et al, 2012; Perez-Rubio et al, 2013; Lan et al, 2015; Yan et al, 2015).

An eclectic repertoire of protein interactions, genomic signatures and gut microbial shifts has emanated from the preclinical literature, collectively suggesting a mechanistic departure from all other dietary ingredients.  While metabolic effectors bear partial redundancy with polyphenols and metformin (e.g. AMPK activation), new findings underscore unique and esoteric targets such as the LDL receptor regulator PCSK9 (proprotein convertase subtilisin/kexin type 9), which contributes to lipid-lowering effects in humans (Lee et al, 2006; Pirillo and Catapano, 2015; Dong et al, 2015).  

In integrative and functional medicine, berberine is gaining recognition as an evidence-based modality for highly prevalent metabolic conditions in the U.S., for which there is a growing demand for alternative and complementary options.  Thus, berberine has the potential for significant consumption as both a single agent and adjunct.  A critical examination of the safety of this compound is warranted for several reasons.  First, it is worth noting that isolated plant alkaloids have seldom appeared on the dietary supplement market.  Moreover, the divergent pharmacological behaviors of berberine may potentially extend to a distinctive and unfamiliar risk profile.  In addition, doses required for metabolic application exceed those for historical antimicrobial uses; further, berberine is now preferred as a pure salt, not as constituent of whole herbs or extracts that have more extensive safety records.  Exposure may be further amplified by the continuous use encouraged by the chronicity of metabolic disorders.  Finally, the potential for berberine to disrupt intestinal microbial ecology with long-term treatment is a tenable point of speculation appearing in Natural Standard, which advises caution “when taking longer than eight weeks due to theoretical changes in bacterial gut flora.”   

Bioavailability & pharmacokinetics in humans

The massive oral doses needed to cause systemic toxicity are underpinned by the reported absolute oral bioavailability of <1%, which is due to limited aqueous solubility, low passive permeation, post-absorptive efflux and pre-systemic biotransformation (Chae et al, 2008; Chen et al., 2011; Liu et al, 2016; Feng et al, 2018).  The absorbed fraction is subject to extensive pre-systemic demethylation, demethylenation, reduction, hydroxylation and subsequent conjugation.  Of these reactions, hepatic CYP2D6 is pivotal, metabolizing the majority of the small fraction reaching the liver (Guo et al, 2011).  In humans given berberine orally at lipid-lowering doses (900-1500 mg/day), peak plasma levels only reach 0.004 to 0.40 mg/ml after one dose, at best (Hua et al, 2007; Li et al, 2008) and 6.1 ± 4.9 ng/ml after 3 months at daily dosing of 1000 mg (Zhang et al, 2008).  Plasma levels and tissue distribution of metabolites, generated by xenobiotic metabolizing enzymes and by intestinal microbiota, may exceed those of the parent compound (Tan et al, 2013; Feng et al, 2018).  However, their contribution to the clinical pharmacology of berberine in humans remains unclear.

Such modest exposure of target tissues to the parent compound offers a viable explanation for why inhibition of certain proteins of toxicological significance in vitro (e.g. cardiac hERG channels, IC50= 1-100 μM; Yu et al, 2017) is not overtly evident in humans taking supplements.  Such interactions would require profound bioavailability enhancement or parenteral administration to become clinically manifest. The low micromolar IC50 range for a variety of protein target inhibitions in vitro is thousands of times greater than plasma berberine levels in orally supplemented humans (Wang et al, 2018), questioning the translational viability of many in vitro investigations performed thus far.   

Drug interactions

Numerous studies have explored potential influences of isolated berberine on phase I drug metabolism (cytochromes p450), but only a small number of these interactions have been validated in vivo.  In human liver microsomes, berberine inhibits CYP2D6 (IC50 =45 μM) and to a lesser extent, CYP2C9 and CYP3A4 (IC50 ~400 μM) (Etheridge et al, 2007).  Partial P-glycoprotein (P-gp) and CYP3A4 blockade are implicated in a well-documented interaction with cyclosporin A (Pan et al, 2002; Wu et al, 2005; Xin et al, 2006; Qiu et al, 2009; Columbo et al, 2014).  The interaction has been demonstrated at doses as low as 300 mg berberine/day in healthy volunteers (Xin et al, 2006). 

In a two-phase randomized-crossover clinical study in healthy male subjects, berberine (300 mg t.i.d., p.o. for two weeks) resulted in plasma elevations of co-administered CYP2D6, CYP2C9 and CYP3A4 substrates.  Berberine increased plasma accumulation of dextromethorphan, losartan and midazolam, probe drugs for CYP2D6, CYP2C9 and CYP3A4, respectively (Guo et al, 2012; Li et al, 2016).  These interactions justify caution when using berberine in conjunction with these agents.  

Of all the p450 enzymes interrogated with regard to berberine thus far, CYP2D6 is most sensitive to inhibition (Etheridge et al, 2007; Guo et al 2012).  Since CYP2D6 is paramount to phase I biotransformation of berberine itself, substrate competition is a probable mechanism of catalytic blockade (Guo et al, 2012).  Given the relatively high potency of this interaction, together with supporting clinical evidence, special mention of CYPD26 in cautionary statements should be considered.  It is should be noted that highly prevalent CYP2D6 “slow metabolizer” genotypes are generally more vulnerable to interactions of this nature.  Since berberine is a CYP2D6 substrate, risk allele carriers may also acquire higher plasma levels than normal- and fast-metabolizers.  

Berberine’s potential for pharmacodynamic interactions with antihypertensive drugs is mentioned ubiquitously in the clinical reference literature.  Natural Medicines Comprehensive Database and Natural Standard also advise caution with glucose-lowering drugs.  Despite the theoretical basis for these interactions, such warnings in product literature are prudent.

Effects on intestinal microbiota

According to Natural Medicines Comprehensive Database, “in vitro research shows that berberine can inhibit the growth of certain probiotic species, including Bifidobacterium longum and Bifidobacterium bifidum citing a study using a preliminary antibiotic paper disk assay (Chae et al, 1999).  These findings were never corroborated, and similar studies of berberine’s effects on these species in vitro is lacking.

In contrast, multiple studies support a selective and beneficial influence on gut bacteria in animals with diet-induced metabolic deregulation, in which berberine enriches beneficial taxa in conjunction with amelioration of systemic metabolic pathology (Xie et al, 2011; Zhang et al, 2012; Zhang et al, 2015; Wang et al, 2017; Sun et al, 2017; Li et al, 2016).  Improvements in metabolic parameters correlated with growth of short-chain fatty acid (SCFA)-producing symbionts, including Allobaculum, Bacteriodes, Blautia, Butyricoccus, and Phascolarctobacterium, with simultaneous increases in Lactobacilli (Xie et al, 2011; Zhang et al, 2012; Zhang et al, 2015; Li et al, 2016).  Restoration of Bifidobacteria, Akkermansia and the ratio of Bacteroidetes/Firmicutes with berberine treatment accompanied reversal of diet-induced metabolic and vascular dysregulation (Cao et al, 2016; Zhu et al, 2018).  In dogs, levels of butyrate, a therapeutically active SCFA, increased by 1.3 fold in plasma after 7 days of oral berberine treatment (Feng et al, 2018). 

Taxonomic shifts in the microbiota are now believed to play a role in berberine-induced reversal of hypercholesterolemia and insulin resistance. Attenuation of intestinal permeability and metabolic endotoxemia may also occur via the microbiota (Han et al, 2011; Xu et al, 2017).  The possibility that the clinical effects of berberine ramify from primary influences at the gut level offers a potential explanation for its remarkable efficacy despite modest systemic exposures.  

The discourse on diabetes drugs and their interface with the microbiome is not new.  Emerging research on metformin, a widely prescribed hypoglycemic drug with antimicrobial properties, underscores modification of the microbiota as a potential mechanism of action (Lee et al, 2014; Wu et al, 2016; Malik et al, 2018).  Metformin’s taxonomic imprints bear several similarities with those of berberine (Zhang et al, 2015).  Like berberine, metformin significantly augments SCFA-producing bacterial genera, along with Akkermansia and Bifidobacteria (Shin et al, 2014; Montandon et al, 2017).  From a safety standpoint, redundant effects of these drugs offers some qualified reassurance that many effects of berberine on gut bacteria have been seen before, and are likely to occur in a large proportion of the population receiving ongoing metformin thearpy.  Naturally, the similarities also evoke skepticism as to whether changes in the microbiota occur as a corollary of systemic metabolic improvements, and would therefore be achievable with any antidiabetic modality.  Lessons learned from metformin may inform future research directions for berberine.   

Although preliminary, the totality of preclinical evidence does not support untoward effects of berberine on the gut bacterial profile.  To date, no controlled investigations have examined berberine’s influences on the taxonomic signatures in humans.  Given the critical contributions of intestinal microecology to general health, clarifying these obscurities in humans will be vital to confirming the long-term safety of berberine.  


Berberine is not well absorbed into the systemic circulation. The intestinal microbiota may comprise a target organ where berberine imparts modifications that improve insulin sensitivity.

Berberine is generally well tolerated.  Adverse effects reported in the clinical literature include mild to moderate nausea, vomiting, abdominal bloating, and constipation.  

Caution is advised for patients taking drugs metabolized by CYP2C9 and CYP3A4, particularly losartan and midazolam. Berberine may increase blood levels of these drugs.   

Berberine may inhibit CYP2D6, so use caution when using berberine in combination with dextromethorphan and other drugs metabolized by this enzyme.


Birdsall TC, Kelly GS. Berberine: Therapeutic potential of an alkaloid found in several medicinal plants. Altern Med Rev. 1997;2:94-103.

Cannillo M, Frea S, Fornengo C, Toso E, Mercurio G, Battista S, Gaita F. Berberine behind the thriller of marked symptomatic bradycardia. World J Cardiol. 2013 Jul 26;5(7):261-4.

Cao Y, Pan Q, Cai W, Shen F, Chen GY, Xu LM, Fan JG. Modulation of Gut Microbiota by Berberine Improves Steatohepatitis in High-Fat Diet-Fed BALB/C Mice. Arch Iran Med. 2016 Mar;19(3):197-203.

Chae, S. H., Jeong, I. H., Choi, D. H., Oh, J. W., and Ahn, Y. J. Growth-inhibiting effects of Coptis japonica root-derived isoquinoline alkaloids on human intestinal bacteria. J Agric.Food Chem. 1999;47(3):934-938

Chae HW, Kim IW, Jin HE, Kim DD, Chung SJ, Shim CK. Effect of ion-pair formation with bile salts on the in vitro cellular transport of berberine. Arch Pharm Res. 2008 Jan;31(1):103-10.

Chan E. Displacement of bilirubin from albumin by berberine. Biol Neonate. 1993;63(4):201-8.

Colombo D, Lunardon L, Bellia G. Cyclosporine and herbal supplement interactions. J Toxicol. 2014;2014:145325.

Derosa G, Maffioli P, Cicero AF. Berberine on metabolic and cardiovascular risk factors: an analysis from preclinical evidences to clinical trials. Exp Opin Biol Ther. 2012, 1113–24.

Domadia PN, Bhunia A, Sivaraman J, Swarup S, Dasgupta D.  Berberine targets assembly of Escherichia coli cell division protein FtsZ. Biochemistry. 2008 Mar 11; 47(10):3225-34.

Dong H, Wang N, Zhao L, Lu F. Berberine in the treatment of type 2 diabetes mellitus: a systemic review and meta-analysis. Evid Based Complement Alternat Med. 2012;2012: 591654.

Dong H, Zhao Y, Zhao L, Lu F.  The effects of berberine on blood lipids: a systemic review and meta-analysis of randomized controlled trials.  Planta Medica. 2013; 6:437-46.

Dong B, Li H, Singh AB, Cao A, Liu J. Inhibition of PCSK9 transcription by berberine involves down-regulation of hepatic HNF1α protein expression through the ubiquitin-proteasome degradation pathway. J Biol Chem. 2015 Feb13;290(7):4047-58.

Etheridge AS, Black SR, Patel PR, So J, Mathews JM. An in vitro evaluation of cytochrome P450 inhibition and P-glycoprotein interaction with goldenseal, Ginkgo biloba, grape seed, milk thistle, and ginseng extracts and their constituents. Planta Med. 2007;73(8):731–741.

Feng R, Zhao ZX, Ma SR, Guo F, Wang Y, Jiang JD. Gut Microbiota-Regulated Pharmacokinetics of Berberine and Active Metabolites in Beagle Dogs After Oral Administration. Front Pharmacol. 2018 Mar 21;9:214.

Guo Y, Li F, Ma X, Cheng X, Zhou H, Klaassen CD. CYP2D plays a major role in berberine metabolism in liver of mice and humans. Xenobiotica. 2011 Nov;41(11):996-1005.  

Habtemariam S. Berberine and inflammatory bowel disease: A concise review. Pharmacol Res. 2016 Nov;113(Pt A):592-599.

Han J, Lin H, Huang W. Modulating gut microbiota as an anti-diabetic mechanism of berberine. Med Sci Monit. 2011 Jul;17(7):RA164-7.

Hua W, Ding L, Chen Y, Gong B, He J, Xu G: Determination of berberine in human plasma by liquid chromatography-electrospray ionization-mass spectrometry. J Pharm Biomed Anal. 2007;44:931-937.

Kheir MM, Wang Y, Hua L, Hu J, Li L, Lei F, Du L. Acute toxicity of berberine  and its correlation with the blood concentration in mice. Food Chem Toxicol. 2010 Apr;48(4):1105-10.

Kong W, Wei J, Abidi P, Lin M, Inaba S, Li C, Wang Y, Wang Z, Si S, Pan H, Wang S, Wu J, Wang Y, Li Z, Liu J JJ. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med. 2004;12: 1344–51.

Kumar A, Ekavali, Chopra K, Mukherjee M, Pottabathini R, Dhull DK. Current knowledge and pharmacological profile of berberine: An update. Eur J Pharmacol. 2015 Aug 15;761:288-97.

Lee H., Ko G. Effect of Metformin on Metabolic Improvement and Gut Microbiota. Appl Environ Microbiol. 2014;80:5935–5943. 

Lee YS, Kim WS, Kim KH, Yoon MJ, Cho HJ, et al. Berberine, a natural plant product, activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant states. Diabetes. 2006;55(8): 2256–2264.

Li H, Liu L, Xie L, Gan D, Jiang X. Effects of berberine on the pharmacokinetics of losartan and its metabolite EXP3174 in rats and its mechanism. Pharm Biol. 2016 Dec;54(12):2886-2894.

Li Y, You XF, Jiang JD (2008) Progress in pharmacokinetic researches of berberine. Zhong Guo Xin Yao Zha Zhi. 2008;17:733–8.

Linn YC, Lu J, Lim LC, Sun H, Sun J, Zhou Y, Ng HS. Berberine-induced haemolysis revisited: safety of Rhizoma coptidis and Cortex phellodendri in chronic haematological diseases. Phytother Res. 2012 May;26(5):682-6.

Liu CS, Zheng YR, Zhang YF, Long XY. Research progress on berberine with a special focus on its oral bioavailability. Fitoterapia. 2016 Mar;109:274-82.

Mahmoudi M, Zamani Taghizadeh Rabe S, Balali-Mood M, Karimi G, Memar B, Rahnama M, Tabasi N, Khazaee M, Riahi-Zanjani B. Immunotoxicity induced in mice by subacute exposure to berberine. J Immunotoxicol. 2016;13(2):255-62.

Malik F, Mehdi SF, Ali H, Patel P, Basharat A, Kumar A, Ashok F, Stein J, Brima W, Malhotra P, Roth J. Is metformin poised for a second career as an antimicrobial? Diabetes Metab Res Rev. 2018 May;34(4):e2975.

Marazzi G, Cacciotti L, Pelliccia F, Iaia L, Volterrani M, Caminiti G, Sposato B, Massaro R, Grieco F, Rosano G. Long-term effects of nutraceuticals (berberine, red yeast rice, policosanol) in elderly hypercholesterolemic patients. Adv Ther. 2011 Dec;28(12):1105-13.

Montandon SA, Jornayvaz FR.  Effects of Antidiabetic Drugs on Gut Microbiota Composition. Genes (Basel). 2017 Oct; 8(10): 250.

Ni YX. Therapeutic effect of berberine on 60 patients with type II diabetes mellitus and experimental research. Zhong Xi Yi Jie He Za Zhi. 1988 Dec; 8(12):711-3, 707.

Pérez-Rubio KG, González-Ortiz M, Martínez-Abundis E, Robles-Cervantes JA, Espinel-Bermúdez MC. Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion. Metab Syndr Relat Disord. 2013; Oct;11(5):366-9.

Pan G, Wang G, Liu X, Fawcett JP, Xie Y. The involvement of P-glycoprotein in berberine absorption.  Pharmacol Toxicol. 2002;91(4), 193-7.

Pirillo A, Catapano AL. Berberine, a plant alkaloid with lipid- and glucose-lowering properties: From in vitro evidence to clinical studies. Atherosclerosis. 2015 Dec;243(2):449-61.

Qiu W, Jiang XH, Liu CX, Ju Y, Jin JX. Effect of berberine on the pharmacokinetics of substrates of CYP3A and P-gp. Phytother Res. 2009 Nov;23(11):1553-8.  

Rad SZK, Rameshrad M, Hosseinzadeh H. Toxicology effects of Berberis vulgaris (barberry) and its active constituent, berberine: a review. Iran J Basic Med Sci.2017 May;20(5):516-529.

Shin N.R., Lee J.C., Lee H.Y., Kim M.S., Whon T.W., Lee M.S., Bae J.W. An increase in the Akkermansia spp. population induced by metformin treatment improves glucose homeostasis in diet-induced obese mice. Gut. 2014;63:727–735. 

Singh N, Sharma B. Toxicological Effects of Berberine and Sanguinarine. Front Mol Biosci. 2018 Mar 19;5:21.  

Sun R, Yang N, Kong B, Cao B, Feng D, Yu X, Ge C, Huang J, Shen J, Wang P, Feng S, Fei F, Guo J, He J, Aa N, Chen Q, Pan Y, Schumacher JD, Yang CS, Guo GL,  Aa J, Wang G. Orally Administered Berberine Modulates Hepatic Lipid Metabolism by Altering Microbial Bile Acid Metabolism and the Intestinal FXR Signaling Pathway. Mol Pharmacol. 2017 Feb;91(2):110-122.

Tan XS, Ma JY, Feng R, Ma C, Chen WJ, Sun YP, Fu J, Huang M, He CY, Shou JW, He WY, Wang Y, Jiang JD. Tissue distribution of berberine and its metabolites after oral administration in rats. PLoS One. 2013 Oct 31;8(10):e77969.

Wang Y, Zidichouski JA. Update on the Benefits and Mechanisms of Action of the Bioactive Vegetal Alkaloid Berberine on Lipid Metabolism and Homeostasis. Cholesterol. 2018 Jul 2;2018:7173920.

Wang Y, Shou JW, Li XY, Zhao ZX, Fu J, He CY, Feng R, Ma C, Wen BY, Guo F, Yang XY, Han YX, Wang LL, Tong Q, You XF, Lin Y, Kong WJ, Si SY, Jiang JD. Berberine-induced bioactive metabolites of the gut microbiota improve energy metabolism. Metabolism. 2017 May;70:72-84.

Wei W, Zhao H, Wang A, Sui M, Liang K, Deng H, Ma Y, Zhang Y, Zhang H, Guan Y. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. Eur J Endocrinol. 2012 Jan;166(1):99-105.

Wu X, Li Q, Xin H, Yu A, Zhong M. Effects of berberine on the blood concentration of cyclosporin A in renal transplanted recipients: clinical and pharmacokinetic study. Eur J Clin Pharmacol. 2005;61(8);567–72.

Wu T, Horowitz M, Rayner CK. New insights into the anti-diabetic actions of metformin: from the liver to the gut. Expert Rev Gastroenterol Hepatol.2017 Feb;11(2):157-166.

Xin H-W, Wu X-C, Li Q,  Yu A-R, Zhong M-Y, Liu, Y-Y. The effects of berberine on the pharmacokinetics of ciclosporin A in healthy volunteers. Methods Findings Exp Clinical Pharmacol. 2006;28(1), 25-9.

Xin H-W, Tang X, Ouyang M, Zhong JX, Li WL.  Effects of berberine on pharmacokinetics of midazolam and rhodamine 123 in rats in vivo. Springerplus. 2016;5:380.  

Xie W, Gu D, Li J, Cui K, Zhang Y: Effects and action mechanisms of berberine and rhizoma coptidis on gut microbes and obesity in high-fat diet-fed c57bl/6j mice. PloS One.  2011;6:e24520.

Xin, H.-W., Wu, X.-C., Li, Q., Yu, A.-R., Zhong, M.-Y. The effects of berberine on the pharmacokinetics of cyclosporin A in healthy volunteers.  Methods Find Exp Clin Pharmacol 2006, 28(1): 25.

Xu JH, Liu XZ, Pan W, Zou DJ. Berberine protects against diet-induced obesity  through regulating metabolic endotoxemia and gut hormone levels. Mol Med Rep. 2017 May;15(5):2765-2787.

Yan HM, Xia MF, Wang Y, Chang XX, Yao XZ, Rao SX, Zeng MS, Tu YF, Feng R, Jia WP, Liu J, Deng W, Jiang JD, Gao X. Efficacy of Berberine in Patients with Non-Alcoholic Fatty Liver Disease. PLoS One. 2015 Aug 7;10(8):e0134172.

Zeng XH, Zeng XJ, Li YY. Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2003 Jul 15; 92(2):173-6.

Zhang Y, Li X, Zou D, Liu W, Yang J, Zhu N, Huo L, Wang M, Hong J, Wu P, Ren G, Ning G. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab. 2008 Jul;93(7):2559-65.

Zhang H, Wei J, Xue R, Wu JD, Zhao W, Wang ZZ, Wang SK, Zhou ZX, Song DQ, Wang YM, Pan HN, Kong WJ, Jiang JD. Berberine lowers blood glucose in type 2 diabetes  mellitus patients through increasing insulin receptor expression. Metabolism. 2010 Feb;59(2):285-92.

Zhang X, Zhao Y, Zhang M, Pang X, Xu J, Kang C, Li M, Zhang C, Zhang Z, Zhang  Y, Li X, Ning G, Zhao L. Structural changes of gut microbiota during berberine-mediated prevention of obesity and insulin resistance in high-fat diet-fed rats. PLoS One. 2012;7(8):e42529.

Zhang X, Zhao Y, Xu J, Xue Z, Zhang M, Pang X, Zhang X, Zhao L. Modulation of  gut microbiota by berberine and metformin during the treatment of high-fat diet-induced obesity in rats. Sci Rep. 2015 Sep 23;5:14405.

Zhu X, Bian H, Gao X. The Potential Mechanisms of Berberine in the Treatment of Nonalcoholic Fatty Liver Disease. Molecules. 2016 Oct 14;21(10).  

Zhu L, Zhang D, Zhu H, Zhu J, Weng S, Dong L, Liu T, Hu Y, Shen X. Berberine treatment increases Akkermansia in the gut and improves high-fat diet-induced atherosclerosis in Apoe(-/-) mice. Atherosclerosis. 2018 Jan;268:117-126.

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