May 29, 2023

Berberine & Metformin were both exciting molecules to extend healthspan. However, there are key differences between these molecules, and new human research has been published on their effects

While reviewing berberine and metformin for health span benefits i realized that this is a bit like deciding between traditional medicine and western medicine let me explain both berberine and metformin they’ve got a traditional origin the discovery of metformin dates back to the 17th century where the french lilac was used as a herbal remedy to relieve the

Intense urination caused by diabetes berberine on the other hand has been used in chinese medicine from around 3000 bc and in the 1960s that’s where drug companies got a hold of the french lilac and manufactured metformin and they did this to isolate the key ingredient that was causing the benefits from the french lilac and made sure that that ingredient could be

Absorbed by the body berberine on the other hand is still in its natural form but because of that it’s got poor absorption into the body and even the small amount of berberine that can be absorbed most of it is broken down by the liver that’s the first big difference between berberine and metformin one can be absorbed really well but the other one can’t when it

Comes to how these molecules work both of them activate an enzyme called ampk but berberine it also activates something different which we’ll talk about later ampk is an energy sensing enzyme that signals to the cells that they need to absorb sugar they need to absorb glucose it also reduces the amount of glucose that the liver creates there’s substantial evidence

Suggesting that problems with ampk leads to metabolic syndrome or type 2 diabetes and when tested in the lab berberine potently activates ampk the same with metformin so let’s unpack this in my type 2 diabetic patients that i see in the clinic the first thing that i recommend to them is a low sugar diet and regular exercise but sometimes that’s not enough and the

First medication that i prescribe is metformin and this is because i want to activate ampk when i’m treating my patients i want to know that the medication that i’m prescribing to them they can absorb it and it will have an effect on the cells but the same can’t be said for berberine like we’ve gone through the body struggles to absorb berberine so it only weakly

Activates ampk plus i want to make sure that anything i’m prescribing has got manufacturing oversight so for example in 2020 the fda found that metformin it may contain an impurity that causes cancer so the batches of metformin that may have been affected were recalled and the problem was fixed so when deciding to activate ampk i want to do it properly and i do

That by using metformin but that leads us on to the second question is activating ampk a good thing for non-diabetic patients i recently did a video on metformin explaining some new research that has come to light on non-diabetic patients overall it seems that activating ampk by using medications or supplements for non-diabetic people that’s crucial doesn’t appear

To be a good idea so let’s go through the research initially there was exciting data coming out suggesting that using metformin may extend health span so for example in 2014 it was found that type 2 diabetic patients who were treated with metformin seems to have a 15 better survival rate compared to people without diabetes but the important thing to know about this

Data is that it’s looking in the rear view mirror it’s an observational trial and when the interventions testing program trialled metformin in three separate labs there was no lifespan extension and that brings us onto the latest trial of activating ampk in non-diabetic patients towards the end of last year a paper was published that followed over 3 000 adults at

High risk for developing type 2 diabetes and they were followed up for 21 years it was a randomized controlled trial comparing metformin to placebo and overall although metformin prevented diabetes it did not reduce all cause death rates cancer or heart disease so for non-diabetic people trying to activate ampk by using supplements or medications probably won’t

Give us any benefits however it may cause problems in 2019 a paper was published that showed that metformin it reduced the benefits of exercise so after 12 weeks of training metformin it blunted the improvement in vo2 max by around 50 and after looking at all of this data it doesn’t look like metformin or berberine should be used to activate ampk for non-diabetic

Patients but let’s move on to the second pathway that berberine influences which is completely separate to metformin berberine appears to block an enzyme called pcsk9 and this has important effects for our cholesterol by blocking pcsk9 we encourage the cells to absorb ldl cholesterol therefore there’s less ldl cholesterol in our bloodstream causing problems so

Let’s have a look at the human data for berberine and cholesterol we’ve got a 2018 systematic review which combined 16 different trials with a total of over 2 000 people unfortunately these trials had high clinical heterogeneity all this means is that the results from the trials were very different so if we would be seeing a positive effect from berberine most of

The trials should be showing that benefit however some of these trials were showing a benefit and others weren’t so this is what we mean by high heterogeneity the clinical trials are producing different results so it can be quite difficult to interpret them and when trials are showing different results it’s often because the methods for those trials are low so yes

When the data is combined berberine does appear to improve cholesterol however these findings need to be interpreted with caution again because of the high clinical heterogeneity and high risk of bias in the included trials but for me this brings us back to the debate between traditional and western medicine we do have medications now that patiently block pcsk9

So if the reason for taking berberine is to improve cholesterol why not do that by a great diet regular exercise and then using medications that block or activate certain pathways we know that those medications can be absorbed and we know the effect that they’re going to have on the body personally i’m deeply grateful for the insights that traditional medicine

Has provided it’s given us clues that needed further research and now that we understand how some of those traditional medicines work we can make medications to potentially activate specific pathways overall for me i don’t take either berberine or metformin there doesn’t seem to be a strong reason to try and activate ampk for non-diabetic patients and if i want

To improve my cholesterol i would do that through diet and exercise and for some of my patients who need extra help with their cholesterol i use either statins or pcsk9 inhibitors but please let me know in the comments section what you thought of this video and what you think about the differences between traditional and western medicine and a massive thank you

To all of you who have donated to my rapamycin clinical trial we’ve still got a long way to go and i will be producing a video with an update on how it’s going with the clinical trial design and ethics approval and thank you to all of the patrons who support the channel so until next time thanks very much

Transcribed from video
Berberine vs Metformin | Crucial Differences 2022 By Dr Brad Stanfield