Berberine and Goldenseal Supplements Review
Choose the Best Berberine
& Goldenseal Supplements. CL Tests Reveal Problems With 25% of Berberine
and 67% of Goldenseal Supplements.
Medically reviewed and
edited by Tod Cooperman, M.D. 
Last Updated
: 07/31/2021 | Initially Posted:
12/10/2017
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Table of Contents
Summary
·
What is berberine? Berberine is a yellow-colored compound
found in goldenseal root. As a supplement, it is typically sold in the form of
berberine HCl (which is 90% berberine) in capsules or tablets containing
hundreds of milligrams. Goldenseal root powder or extract supplements generally
provide less than 30 mg of berberine per serving (See What It Is and ConsumerTips™).
Use the Results table to compare the amounts of
berberine we found in supplements.
·
What do berberine and goldenseal do? Berberine appears
to be effective in reducing blood sugar levels in people with type 2 diabetes
or metabolic syndrome, and improvements in cholesterol levels and even body
composition have been noted, although higher quality studies are needed to
confirm these effects. Preliminary evidence suggests that berberine may be of
benefit with certain arrhythmias and congestive heart failure. There is
insufficient evidence to support the use of goldenseal root powder or extract
in treating or preventing any condition (See What It Does).
·
How much berberine should I take? Berberine is
typically taken as 500 mg of its hydrochloride or sulfate forms two to three
times daily. There is no established dose for goldenseal (See Dosage).
·
Best choice for berberine supplements? Be careful!
Three-quarters of the goldenseal supplements selected for testing in this
Review failed to pass testing — one contained no detectable
berberine! Berberine supplements fared better, but one contained only 78% of
the amount it listed and it was not properly labeled (See What CL Found). Among products that were
Approved, see our Top Picks to
find those that provide berberine at much lower cost than others.
·
Safety and side effects of berberine and goldenseal: Berberine can
increase bilirubin levels and should not be taken by women who are pregnant or
nursing or by young children. It may affect blood sugar levels and blood
pressure. It can interfere with the activity of many drugs. Because it contains
berberine, goldenseal carries the same cautions. For more details, see Concerns and Cautions.
What It Is:
Berberine
Berberine is a bright yellow alkaloid compound found
in plants such as barberry, Oregon grape and goldenseal. Although it exists in
the "free form" in plants, berberine in supplements is typically
chemically stabilized as either berberine hydrochloride or berberine sulfate.
Goldenseal
Goldenseal root naturally contains a small amount of
berberine (25 mg or more per 1,000 mg of root powder), which gives the root
(and the base of its stem) its golden yellow hue (although not as yellow as
berberine extract).
What It Does:
Berberine
Berberine has traditionally been
used as an antibiotic, and there is some evidence it might have benefit for
eliminating H. pylori infection (a common cause of peptic
ulcers). Some research has shown that taking berberine with triple therapy
for H. pylori (i.e., clarithromycin, amoxicillin, and
esomeprazole) can modestly increase eradication rate while reducing side
effects such as nausea and diarrhea compared to triple therapy alone (Jiang, Evid Based Complement Alternat Med 2018).
Other research has shown that the combination of berberine along with triple
therapy eradicates H. pylori about as effectively as triple
therapy plus bismuth (Zhang, Medicine 2017). Doses used in clinical
studies have typically provided about 900 mg to 1,500 mg of berberine per day.
Berberine is currently promoted for a range of other uses, mostly focusing on
metabolic diseases.
Several studies suggest that berberine may lower blood sugar and
cholesterol, particularly in people with type 2 diabetes. In a
study of 116 men and women with type 2 diabetes and elevated levels of
cholesterol and/or triglycerides, those who took 500 mg of berberine
(apparently as berberine sulfate) twice daily for 3 months had significantly
greater improvements in fasting glucose, glucose levels after eating, and HbA1c
levels (a measure of glucose levels over a period of time) than those who took
a placebo. They also had greater improvements in levels of total cholesterol,
"bad" LDL cholesterol, and triglycerides. (Zhang, J Clin Endocrinol Metab
2008). A small, 3-month study in men and women newly diagnosed with
type 2 diabetes found that 500 mg of berberine HCl taken before meals 2 to 3
times daily was as effective as 500 mg of the diabetes drug metformin (also
taken 2-3 times daily before meals) for lowering fasting glucose and glucose
levels after eating, as well as HbA1c. In this study, berberine was also found
to significantly reduce total and LDL cholesterol and triglyceride levels (Yin, Metabolism 2008).
A small study found that men and women with metabolic syndrome who
took 500 mg of berberine hydrochloride 3 times daily with meals had significant
decreases in blood sugar and insulin levels, as well as body mass index (BMI),
and in women, waist circumference -- while those who took a placebo had no
significant changes. Triglyceride levels and systolic blood pressure also
decreased significantly among those who took berberine; cholesterol levels were
not measured (Perez-Rubio, Metab
Syndr Relat Discord 2013).
In a review of 14 clinical studies, researchers concluded that berberine
appears to be beneficial for reducing blood sugar, although larger,
high-quality studies are needed to confirm this (Dong, Evid Based Complement Alternat Med 2012).The
most common side effects reported in the studies were gastrointestinal
symptoms, such as diarrhea, constipation, gas and abdominal pain, but no
serious adverse reactions were reported.
A combination of berberine (500 mg) and red yeast rice (providing
3 mg of lovastatin), taken once daily, was found to further reduce LDL and
total cholesterol levels in a 47-year-old woman with statin intolerance
and familial hypercholesterolemia who was already being treated with
the non-statin cholesterol-lowering medications evolocumab
and ezetimibe. The prescription medications lowered her LDL and total
cholesterol levels from 363 mg/dL and 445 mg/dL, respectively, to 115 mg/dL and
185 mg/dL, and adding the berberine and red yeast rice further lowered her
levels to 68 mg/dL and 143 mg/dL, respectively (Parra-Virto, Clin Investig Arterioscler 2018).
Other uses
Preliminary research suggests that berberine can help reduce premature
ventricular contractions in people with ventricular tachyarrhythmia and
strengthen heart contractions in people with congestive heart failure (Xia, Chronic Dis Transl Med 2015).
A 2-year, controlled trial in China of over 800 people aged 18-75 with a
history of removal of colorectal adenomas found that 300 mg of
berberine (as berberine HCL) taken twice daily modestly reduced the risk of
developing additional precancerous polyps to 36% in the berberine group versus
47% in the placebo group. Even after adjusting for a greater proportion of the
placebo group having advanced colorectal adenoma at baseline (a strong risk
factor for recurrent adenoma), the risk reduction with berberine was still
statistically significant (Chen, Lancet Gastroenterol Hepatol, 2020).
Goldenseal
There is insufficient evidence to support goldenseal's use in the prevention or
treatment of any disease.
Due to the ability of berberine to inhibit or kill microorganisms in laboratory
experiments, goldenseal root has been suggested as topical or oral antibiotic.
However, the efficacy of these applications has not been demonstrated.
There is only weak evidence that goldenseal may be helpful lowering cholesterol
and improving blood sugar control, as well as helping with arrhythmias,
congestive heart failure, high blood pressure, dyspepsia, and irritable bowel
syndrome (Mandal, Pharmacol
Res 2020).
Goldenseal is sometimes combined with Echinacea and taken as an immune booster
or antibiotic for the prevention and treatment of colds, but there is no
credible evidence to support goldenseal's use in these applications.
Although a myth has been perpetuated that goldenseal can block a positive drug
screen, there is no evidence to support this.
Quality Concerns and
Tests Performed:
Neither
the Food and Drug Administration (FDA) nor any other federal or state agency
routinely tests supplements for quality prior to sale. A study conducted in
2016 of 15 berberine supplements sold in the U.S. found that, on average,
products contained just 75% of the amount of berberine listed on their labels—
with some products containing as little as 33% and others containing 100% of
their listed amount of berberine. Nine berberine products contained less than
90% of their claimed amount of berberine (Pura Organics, Lean Nutraceuticals,
Double Wood, VitaCost, Pure Science, Only Natural, LongLifeNutri, Swanson and Biotics Research Corp). Six
products contained between 90% and 100% of their claimed amounts of berberine
-- an acceptable range (Vital Nutrients, Thorne Research, Integrative
Therapeutics, Nutritional Concepts, Natural Factors and Healthy Directions). No
product contained more than the listed amount (Funk, J Diet Suppl 2017). A concern with the
above study is its use of an analytical method based on extremely small sample
sizes (5 milligrams), which can introduce error.
In August, 2020 (three years after publication of this Review), an organic
goldenseal root powder supplement was recalled for potential microbial
contamination. In general with herbal products, the
possibility for contamination is greater with root powders than with extracts.
In order to help consumers identify products of better quality, ConsumerLab.com
tested products containing berberine and goldenseal sold in the U.S. and
Canada. For products designated as berberine only, the claimed form of
berberine was determined. For products containing goldenseal extract or root
powder, the amounts of berberine and hydrastine were reported. To decrease the
potential for error that existed in the study mentioned above, CL used the USP
method which requires larger sample sizes (120 milligrams). All supplements
sold as tablets were tested to see how long tablets take to break apart in a
heated liquid solution; if they can't break apart fast enough, less ingredient
may be available for absorption by the body. Products containing whole herbs
and/or 250 mg or more of minerals per daily serving were also tested for
contamination with lead, cadmium and arsenic. See How Products Were Evaluated for
more details.
What CL Found and Top
Picks:
Among the 10 products selected by CL for testing, one of four
(25%) berberine supplements and four of six (67%) of goldenseal supplements failed
testing. The reasons for these failures are noted below, as are our Top
Picks among products that passed testing and label review and were
"Approved" (which includes three products tested through ConsumerLab.com's voluntary Quality Certification Program).
More details are found in the Results table further below.
Berberine
Problem: Only Natural Berberine 1,000. While all
other berberine supplements in this review contained their listed amounts of
berberine and correctly listed the chemical form as Berberine HCl, Only
Natural did not: Its label claims that a serving of 2 capsules
provides "Berberine (HCl 97%) 1000 mg," but only 778 mg of berberine
were found. If the intention was to provide 1,000 mg of berberine HCl (which is
about 90% berberine), it still would have fallen short of its claim and the
label should have read "Berberine HCl." It is unclear to what
"97%" on the label is meant to refer. The name "Only
Natural" also seems misleading as berberine HCl is a chemically
modified form of berberine and is not natural. This brand was
among those found to contain less than 90% of their listed amounts of berberine
in the Funk study noted above.
Top Pick: Amazing Formulas
Berberine. This Approved product provided berberine at the lowest cost —
just 17 cents per capsule containing 500 mg of berberine HCl. The next least
expensive Approved product was Dr. Whitaker Berberine at 26
cents per 500 mg capsule, and the cost to obtain the same amount of berberine
among other products ranged from 54 cents to 97 cents.
Goldenseal
Problems: Three of the goldenseal extracts contained lower
amounts of berberine plus hydrastine than expected based on United States
Pharmacopeial (USP) standards: Bluebonnet Goldenseal Root Extract (only
70% of the expected amount), PipingRock.com Goldenseal Root 500 mg (only
54%), and Spring Valley [Walmart] Goldenseal Extract (only
50%).
The worst product was Organika
Goldenseal. No berberine or hydrastine could be detected in its capsules.
Interestingly, the color of the powder in the capsules also lacked the yellow
hue of berberine (see image below) and, when tasted, lacked the characteristic
bitter taste of goldenseal. Shockingly, the label of this product containing
fake goldenseal powder lists a valid Canadian Natural Product Number
registration number (NPN 80004263), which,
according to the Canadian government, indicates that it has been "assessed
by Health Canada and found to be safe, effective and of high quality under
their recommended conditions of use." Furthermore, the Organika label includes a GMP Practices Quality
Assurance Certified logo and an ISO9001 Certified Company logo.
Real vs. Fake Goldenseal Root Powders
(Eclectic Institute - left, Organika -
right)
Real goldenseal root should have a yellow hue from berberine, like the product
on the left. No berberine could be detected in the product on the right. [Be
aware that berberine itself, such as found in root extracts, is
yellow.]
Top Picks: Among Approved
goldenseal extracts: GNC Herbal Plus Goldenseal Root
Extract 200 mg (48 cents per 200 mg capsule found to provide about 30
mg of berberine); and among Approved goldenseal powders Eclectic
Institute Goldenseal Root (19 cents per 400 mg veg cap found to
provide about 26 mg of berberine). Between these two, for an equal dose of
berberine Eclectic Institute is about half the price but you
need to take twice as many capsules.
Test Results by Product:
Listed
below are results for 13 products containing berberine, goldenseal extract, or
goldenseal root powder. Products are shown alphabetically within each category.
ConsumerLab.com selected 10 of these products. Three other products (indicated
with a CL flask) were tested at the request of their manufacturers or
distributors through CL's voluntary Quality
Certification Program, and are included for having passed testing.
Also shown below for each product is the claimed amount of berberine and, for
goldenseal products, hydrastine, the serving size recommended on the label, and
ingredient and cost comparisons. Products listed as "Approved" met
their ingredient label claims and ConsumerLab.com's
quality criteria (see Passing Score). The full
list of ingredients is available for each product by clicking on the word
"Ingredients" in the first column.
|
RESULTS OF CONSUMERLAB.COM TESTING OF GOLDENSEAL/BERBERINE
SUPPLEMENTS |
|||||
|
Product Name, Serving
Size and Suggested Daily Serving on Label |
Claimed Amount and
Form of Berberine or Goldenseal Per Labeled Daily Serving |
--TEST RESULTS-- |
Cost For Daily
Suggested Serving On Label |
||
|
OVERALL RESULTS: |
Contained Labeled
Amounts of Berberine and Hydrastine |
Did Not Exceed
Contamination Limit for Lead, Cadmium and Arsenic2 |
|||
|
[Cost Per 500 mg of
Berberine HCL or Sulfate] |
|||||
|
|
500 mg |
APPROVED |
|
NA |
$0.17 |
|
|
1,500 mg |
APPROVED |
|
NA |
$0.78 |
|
|
1,500 mg |
APPROVED4 |
|
|
$1.67 |
|
|
400 mg to 1,200 mg |
APPROVED |
|
|
$0.77-$2.32 |
|
|
1,000 mg |
NOT APPROVED |
Found: |
NA |
$0.80 |
|
|
1,000 mg to 2,000 mg |
APPROVED |
|
NA |
$1.09-$2.17 |
|
[Cost per 50 mg of
Berberine + Hydrastine] |
|||||
|
|
250 mg |
NOT |
Found: |
NA |
$0.33 |
|
|
200 mg to 400 mg |
APPROVED |
|
NA |
$0.48-$0.96 |
|
|
1,270 mg to 3,125 mg |
APPROVED |
|
NA |
$0.54-$1.34 |
|
|
250 mg |
NOT |
Found: |
NA |
$0.19 |
|
|
100 mg |
NOT |
Found: |
NA |
$0.12 |
|
[Cost per 50 mg of
Berberine + Hydrastine] |
|||||
|
|
400 mg to 1,200 mg |
APPROVED |
|
|
$0.19-$0.57 |
|
|
1,500 mg |
NOT |
Found: |
|
$0.95 |
|
|
|||||
|
Unless otherwise noted, information about the products
listed above is based on the samples purchased by ConsumerLab.com (CL) for
this Product Review. Manufacturers may change ingredients and label
information at any time, so be sure to check labels carefully when evaluating
the products you use or buy. If a product's
ingredients differ from what is listed above, it may not necessarily be of
the same quality as what was tested. |
|||||
|
Copyright ConsumerLab.com, LLC, 2017. All rights reserved.
Not to be reproduced, excerpted, or cited in any fashion without the express
written permission of ConsumerLab.com LLC. |
|||||
ConsumerTips™:
Berberine
Berberine is typically sold as berberine HCl
(referring to the hydrochloride form) or berberine sulfate and the
"Supplement Facts" panel on labels should list the amounts of the
specified form. Expect berberine to be yellow in color and, if tasted, bitter.
Although the amounts shown are not specifically berberine (90.4% of berberine
HCl is berberine, and 87.5% of berberine sulfate is berberine), most clinical
studies also tend to state the dose used in terms of these same chemical forms,
most of which is berberine.
Dose — Most published clinical studies with berberine cite the dose of
berberine hydrochloride used, although they tend to refer to it as just
berberine. A common dose of berberine HCl is 500 mg taken two to three times
daily.
Formulation — Berberine
has low absorption when taken by mouth. Only about 0.5% of berberine appears to
be absorbed from the small intestines when taken orally, with the remaining
dose either excreted or broken down (metabolized) in the small intestines. For
this reason, some berberine supplements are formulated with additional
ingredients to enhance absorption (Note: None of the products reviewed by
ConsumerLab.com in 2017 contained these enhancers). Research in animals has
shown that combining berberine with 2.5% D-alpha-tocopheryl
polyethylene glycol 1000 succinate (TPGS) doubled berberine absorption compared
to berberine alone (Chen, AAPS PharmSciTech
2011). Similarly, inclusion of berberine in a cyclodextrin complex
has also been shown to increase intestinal absorption of berberine in animals (Zhang, Int J Biol Macromol 2013).
Several studies in humans suggest that combining berberine with silymarin, a
constituent of milk thistle, may improve the effects of berberine possibly by
increasing the absorption of berberine, because silymarin can inhibit
P-glycoprotein, a protein "pump" that otherwise reduces the
absorption of berberine (Fogacci, Phytother Res 2019). However, it is possible
that the benefits of the berberine/silymarin combination are due to an additive
effect rather than increased bioavailability of berberine (Imenshahidi, Phytother Res 2019). While these results suggest
that these, and possibly other, absorption enhancers may increase the levels
and effects of berberine, more research is needed to confirm these results.
How to take — Berberine may cause gastrointestinal symptoms such as nausea,
abdominal bloating and pain, diarrhea or constipation. To help minimize these
effects, take smaller, divided doses with food, or, immediately after
eating.
Goldenseal
Labels should indicate that products are made from the root and/or rhizome of
goldenseal. Goldenseal root and rhizome powders should have a yellow-green hue
(and the taste is bitter). If listed, the powder should provide at least 2.5%
berberine and 2% hydrastine.
Unlike some other herbal extracts that are very concentrated, goldenseal
extracts are generally only about twice as concentrated as goldenseal root and
rhizome powders. This is because concentrating the hydrastine can results in
crystals that would make it difficult to create a uniform dried extract. Labels
should, ideally, indicate that they are standardized to provide at least 10%
berberine plus hydrastine and 5% hydrastine. Since the extract is not highly
concentrated, goldenseal extracts are not an economical way of getting
berberine.
Dose — Although products tend to suggest approximately 500 mg to 1,000 mg of
root powder and 200 mg to 400 mg of extract daily, typically in divided doses,
there is insufficient evidence to determine appropriate dosage.
How to take — Because goldenseal contains berberine, it's possible that it may
also cause gastrointestinal symptoms. If this occurs, take smaller, divided
doses with food, or, immediately after eating.
Concerns and Cautions:
Berberine
Berberine may cause gastrointestinal symptoms
such as nausea, diarrhea, constipation, gas and abdominal pain (Yin, Metabolism 2008; Dong, Evid Based Complement Alternat Med 2012).
Taking smaller, divided doses with food or immediately after eating may help if
you experience these symptoms when taking berberine.
Berberine can increase bilirubin, elevated levels of which can
cause jaundice (yellowing of the skin and eyes). Berberine
should not be taken by women who are pregnant or nursing, as it can
cause elevated levels of bilirubin and bilirubin-induce brain dysfunction in
infants, and potentially, in children (Chan, Biol Neonate 1993).
Berberine should not be taken with medications that lower blood sugar,
including insulin, glimepiride (Amaryl), pioglitazone (Actos), and others, as
this could further lower blood sugar and increase the risk of hypoglycemia.
As berberine may potentially lower blood pressure, it should be
used with caution in people with low blood pressure, or those taking drugs
or supplements that may lower blood
pressure.
Berberine inhibits enzymes in the body that help to
break down certain drugs, which could increase blood levels of these
drugs and increase the risk of adverse effects. For example, berberine
inhibits the activity of the enzyme CYP3A4 and has been shown to increase blood
levels of the immunosuppressant drug cyclosporine (Neoral,
Sandimmune) (Wu, Eur J Clin Pharmacol
2005). Other drugs metabolized by CYP3A4 which could potentially be
affected by berberine include the antibiotic clarithromycin (Biaxin), the
cholesterol-lowering drugs atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor), sildenafil (Viagra) and
triazolam (Halcion). Berberine may also decrease activity of enzymes CYP2C9 and
CYP2D6 (Guo, Eur J Clin Pharmacol
2012) and could potentially increase blood levels of the
cholesterol-lowering drug rosuvastatin (Crestor), the blood-pressure lowering
drug losartan (Cozaar), warfarin (Coumadin), and anti-inflammatory drugs such
as ibuprofen (Advil, Motrin), celecoxib (Celebrex) and diclofenac (Voltaren). Medications metabolized by CYP2D6 include the
beta-blocker drug metoprolol (Lopressor, Toprol XL), ondansetron (Zofran),
paroxetine (Paxil), risperidone (Risperdal), tramadol (Ultram), venlafaxine
(Effexor), midazolam (a benzodiazepine drug for anxiety) risperidone
(Risperdal), tramadol (Ultram), venlafaxine (Effexor) and cough suppressants
codeine and dextromethorphan.
Berberine may cause skin rash in sensitive
individuals. A 54-year-old man developed a severe, burning, red rash in the
groin/trunk and underarm area on both sides of the body (a drug reaction known
as symmetrical drug-related intertriginous and flexural exanthema (SDRIFE))
after taking 1,200 mg of berberine HCL ( Sunergenic)
daily for two months; the rash resolved completely two weeks after he stopped
taking the berberine (Labadie, Int J Dermatol 2018).
Goldenseal
Although there are no reports of severe adverse effects attributable to use of
goldenseal, this herb has not undergone much safety testing. As goldenseal
contains berberine (at a low concentration), the cautions above also apply to
goldenseal. Goldenseal should not be used by pregnant or nursing women or young
children and its safety has not been established for those with severe liver or
kidney disease.
An organic goldenseal root powder supplement from Maison Terre was
recalled in August, 2020 due to potential contamination with microorganisms
including Enterobacter cloacae, Cronobacter
sakazakii, and Cronobacter
dublinensis. The death of an infant was
associated with use of the product.
A laboratory study suggests that topical use of berberine or goldenseal could
cause photosensitivity (a reaction to sun exposure) (Inbaraj, Chem Res Toxicol 2001).
+ 16 sources
Information on this site
is provided for informational purposes only. It is not an endorsement of any
product nor is it meant to substitute for the advice provided by physicians or
other healthcare professionals. The information contained herein should not be
used for diagnosing or treating a health problem or disease. Consumers should
inform their healthcare providers of the dietary supplements they take.
Latest Clinical Research Updates for Berberine Supplements
Improving Berberine Absorption?
7/31/2021
Learn if special
formulations have greater benefit than berberine alone, in the ConsumerTips section of our
Berberine and Goldenseal Supplements Review.
2/04/2020
A large study
investigated the potential for berberine (promoted for blood sugar control) to
prevent precancerous colon polyps. Find out if it worked in the What It Does section
of the Berberine & Goldenseal Supplements Review. Also see our Top Pick for
berberine.
6/05/2018
Supplements that contain
berberine (a compound extracted from goldenseal) can cause a range of side
effects, in addition to drug interactions. It was recently reported that
berberine can cause a rare, but severe, skin reaction. Learn more in the Concerns and Cautions section
of the Berberine and Goldenseal Supplements Review. Also see our Top Pick among products in this category.
Related CL Answers (5)