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Barberry

Scientific Name(s): Berberis aristata Sims., Berberis vulgaris L., Mahonia aquifolium (Pursh) Nutt.
Common Name(s): Barberry, Berberis, Holly barberry, Jaundice berry, Oregon barberry, Oregon grape, Oregon grapeholly, Pepperidge bush, Sour-spine, Sowberry, Trailing mahonia, Woodsour

Medically reviewed by Drugs.com. Last updated on Feb 9, 2024.

Clinical Overview

Use

Clinical applications may include use in treating diabetes and dyslipidemia, although clinical trials are limited and are often of poor quality. Other activity includes antimicrobial, antioxidant, and anti-inflammatory effects. No clinical trials exist to support uses related to effects on the cardiovascular and central nervous systems or treating cancer.

Dosing

Daily doses of 2 g of the berries and 1.5 to 3 g daily of dry bark have been used; however, there are limited clinical studies to substantiate barberry's varied uses.

Contraindications

Caution is warranted in the presence of cardiac arrhythmia. Use in children has not been validated.

Pregnancy/Lactation

Avoid use. There are documented adverse effects, including uterine stimulant effects.

Interactions

Case reports are lacking; however, barberry exhibits anti-cytochrome P450 3A4 (CYP3A4) activity similar to that of grapefruit. Caution is warranted with coadministration of potentially toxic medicines such as cyclosporine.

Adverse Reactions

GI symptoms (eg, nausea, vomiting, diarrhea), dizziness, and fainting have been reported. Effects on the cardiovascular system (eg, hypotension, decreased heart rate) and decreased respiration may occur with high dosages. The German Commission E reports that lower doses of berberine are well tolerated. Hypersensitivity has been documented.

Toxicology

Symptoms of poisoning are characterized by lethargy, stupor and daze, vomiting and diarrhea, and nephritis. A median lethal dose (LD50) for berberine was noted as 27.5 mg/kg in humans. Berberine showed mutagenicity in yeast cells and Ames test, while a phototoxic reaction between berberine alkaloid and ultraviolet A (UVA) light has been described.

Scientific Family

Botany

Some 500 species of barberry are recognized, and plants within the genus Berberis and Mahonia have similar chemical composition. Barberry grows wild throughout Europe but has been naturalized to many regions of the eastern US. M. aquifolium is an evergreen shrub native to the northwestern US and Canada. Barberry grows to more than 3 m with branched, spiny, holly-like leaves and is widely planted as an ornamental. Its yellow flowers bloom from May to June and develop into red to blue/black oblong berries.1, 2, 3, 4

History

Barberry has a long history of use, dating back to the Middle Ages in Europe. Salishan tribe native elders of the Pacific Northwest used M. aquifolium to treat acne, and Native Americans utilized Mahonia berries to treat scurvy. The species B. aristata has been used in traditional Chinese and Nepalese medicine and in the Ayurvedic medical system for many years. The sundried fruits are eaten for antipyretic and diuretic effects in Turkey. A decoction of the plant has been used to treat GI ailments and coughs. The alkaloid berberine was included as an astringent in eye drops, but its use has become rare. The edible fruits have been used to prepare jams, jellies, and juices. The use of the plant in traditional medicine has been limited by the bitter taste of the bark and root. However, multiple medicinal uses for barberry have been listed and include treatments in cancer, cholera, and hypertension.2, 3, 5

Chemistry

Plant parts include the stem, root, fruit, flowers, and leaves. Alkaloids, tannins, phenolic compounds, sterols, and triterpenes have all been described. The isoquinoline alkaloids are of primary interest and include berberine, berbamine, and oxycanthine, among numerous others. Variation in content exists among the different species. Methods for identification and quantification have been established and berberine fingerprinting has been described.2, 4, 6, 7, 8

Uses and Pharmacology

Anti-inflammatory

Animal data

Alkaloids isolated from M. aquifolium exhibited anti-inflammatory and antiproliferative activity.(2, 3)

Clinical data

Limited clinical studies have evaluated the efficacy of topical M. aquifolium in psoriasis. Efficacy was greater than with placebo but not as effective as with standard therapy; exacerbations have been described. Further studies are required. (9) Pooled data from a 2019 meta-analysis of 5 randomized controlled trials (N=317) showed that a berberine dose ranging from 300 to 1,500 mg/day given for 1 month to 2 years significantly reduced plasma C-reactive protein levels, with no heterogeneity among trials. Patients included those with acute coronary syndrome, hypertension, type 2 diabetes, obesity and ischemic stroke. No significant effect was found in results for baseline CRP or trial duration in subgroup analyses.(59)

Antimicrobial effects

Because of the association of Helicobacter pylori with gastritis, peptic ulcer, and gastric cancer, in vitro experimentation was conducted in H. pylori-infected gastric epithelial cells with 24 medicinal plants indigenous to Pakistan to evaluate their effect on secretion of interleukin (IL)-8 and generation of reactive oxygen species (ROS) in order to assess anti-inflammatory and cytoprotective effects. Although no significant direct cytotoxic effects on the gastric cells or bactericidal effects on H. pylori were found, root extract of barberry was observed to have mild and moderate inhibitory activity on IL-8 at 50 and 100 mcg/mL, respectively, and the most significant suppression on ROS generation in H. pylori-infected gastric cells of extracts tested.(9)

Animal data

Antimicrobial effects have been described for Berberis spp. and berberine.(2, 10, 11) In mice, a topical 20% root bark extract application was effective against cutaneous leishmaniasis,(12) while chickens with severe diarrhea fed B. vulgaris root bark extract fared better through anticoccidal activity.(13)

Clinical data

Older, limited clinical studies evaluated berberine for treating diarrhea caused by Eschericia coli and cholera, and against microbes such as giardia and trichomonas.(14, 15)

Cancer

Animal data

Induction of apoptosis and cell cycle arrest, interference with tumor signalling, and tumor inhibition have been shown in vitro by B. vulgaris and B. aristata extracts, and berberine and berbamine constituents.(7, 10, 16, 17)

Clinical data

Research reveals no clinical data regarding the use of barberry for cancer. Berberine alone has been evaluated as an adjunct to prevent adverse effects of radiation.(18)

Cardiovascular effects

Animal data

Experiments have shown berberine to exhibit effects on the cardiovascular system, although the mechanisms remain poorly understood. Positive inotropic and negative chronotropic effects, as well as vasodilatory, antiarrhythmic, and hypotensive effects, have been described.(7, 19, 20)

Clinical data

Research reveals little clinical data regarding the use of Berberis or Mahonia spp. for cardiovascular conditions. Caution is warranted in the presence of cardiac arrhythmia. Results from 2 low-quality controlled trials (one translated from Chinese to English via Google translate) reported significant within-group improvements in diastolic and/or systolic blood pressure with administration of berberine to adults with primary hypertension. Between-group comparisons were not reported. Dosage was 300 and 500 mg administered 3 times daily for 8 weeks and 3 months in patients with concomitant gout and newly diagnosed type 2 diabetes, respectively.(61)

CNS/Dementia

Animal data

Anti-acetylcholinesterase activity has occurred for berberine and extracts of B. vulgaris in animal studies and in vitro experiments.(10, 21, 22, 23, 24) In mice, neuroprotective effects have been demonstrated whereby berberine inhibited apoptosis in hippocampal tissue and prevented dopaminergic neuronal damage on histology. Improvements in short-term memory and enhanced motor balance and coordination were observed in a mouse model of Parkinson disease.(24) An anticonvulsant effect was demonstrated in mice.(21)

Clinical data

Research reveals no clinical data regarding the use of Berberis or Mahonia spp. for CNS-related conditions.

Diabetes

Animal data

Studies in rodents both normotensive and with induced diabetes have consistently demonstrated improved glycemic control with administration of berberine and Berberis extracts. Inhibition of alpha-glucosidase activity has been demonstrated; however, the precise mechanism of action remains unclear.(10, 25, 26, 27, 28)

Clinical data

Berberine exerted a hypoglycemic action in a small trial of patients with type 2 diabetes.(29) In women with metabolic-associated polycystic ovary syndrome, berberine taken over 3 months decreased fasting blood glucose levels.(30) Findings from a larger, multicenter clinical trial evaluating this effect have not been concluded.(31) Small clinical trials examining the effect of consumption of the fruit in type 2 diabetes showed improvements in the lipid profile and glycemic control.(28, 32) Data from trials in which Berberis extracts were used in combination with other plant extracts cannot be attributed to a single plant.(33, 34, 35)

A systematic review and meta-analysis exploring the use of barberry on glycemic indices identified 7 eligible placebo-controlled, randomized controlled trials (N=452) published up to 2020. All studies were conducted in Iran in overweight and obese adults, predominantly in those diagnosed with type 2 diabetes but also in those with non-alcoholic fatty liver disease, metabolic syndrome, and benign breast disease. Daily dosages ranged from 1 mg to 5 g given for 6 to 12 weeks. Most studies were of good quality. Barberry was not found to produce a significant effect on fasting blood sugar overall (6 studies, N=392; significant heterogeneity) or in any of the subgroup analyses related to patient age, treatment duration, or dose. Similarly, no significant effects for barberry supplementation were found for HbA1c or insulin resistance (3 studies for each). In contrast, a significant effect was seen with barberry for reducing insulin levels (P=0.04); although, heterogeneity was significant.(Safari 2020)

Dyslipidemia

Animal data

Studies in rodents have shown positive effects of berberine on the lipid profile.(10, 36)

Clinical data

Berberine alone improved the lipid profile in dyslipidemia in several clinical trials among participants with differing conditions, including familial hypercholesterolemia, obesity, and diabetes.(37, 38, 39) Barberry taken over 6 weeks improved the lipid profile and influenced C-reactive protein in a randomized clinical study in 106 patients with metabolic syndrome; effect on blood pressure or other cardiovascular outcomes was not reported.(40) Small clinical trials have been conducted examining the effect of barberry consumption in type 2 diabetes and demonstrated improvements in the lipid profile and glycemic control.(28, 32) In 124 euglycemic, dyslipidemic patients intolerant to high doses of statins, administration of half the statin dose plus twice daily dosing of a B. aristata 588 mg/S. marianum 105 mg combination product significantly reduced fasting plasma glucose, insulin, insulin index and stabilized lipid levels compared to baseline and placebo in a 6-month double-blind, randomized, placebo-controlled trial. Lipid levels increased significantly during the study period in the placebo group. The intervention (a patented nutraceutical in Italy containing B. aristata extract standardized to 85% berberine plus S. marianum extract titrated to more than 60% flavanolignans) was well tolerated.(53)

A systematic review and meta-analysis identified 5 randomized controlled trials (N=339; sample size ranged from 42 to 106) that investigated the impact of barberry on lipids. All trials were conducted in Iran in overweight or obese participants with a mean age of 39 to 56 years who had metabolic syndrome, type 2 diabetes, or non-alcoholic fatty liver disease. Barberry fruit, fruit juice, and fruit extract capsules were administered for 6 to 12 weeks and compared to controls (ie, placebo, apple cider vinegar, regular diet). All trials were good quality. Results from pooled data revealed that barberry significantly reduced total cholesterol (mean difference [MD] −23.58 mg/dL; P≤0.001), low-denity lipoprotein ([LDL]; MD −13.75 mg/dL; P≤0.001), and triglycerides (MD −29.16 mg/dL; P≤0.001) with low, no, and moderate heterogeneity, respectively. Body mass index of 30 and an intervention duration of less than 12 weeks were common subgroups that experienced higher reductions in total and LDL cholesterol. No significant effect was observed on high-density lipoprotein.(58)

The 2017 joint position statement of the Italian Society of Diabetology (ISD) and the Italian Society for the Study of Arteriosclerosis (ISSA) on nutraceuticals for the treatment of hypercholesterolemia state that data strongly support the cholesterol-lowering effects of berberine in Asian populations particularly in patients with mild-to-moderate hypercholesterolemia and low-to-moderate cardiovascular risk; patients with mild hypercholesterolemia and metabolic syndrome; patients with multi-statin intolerance; or as an adjunct to drug therapy in patients with suboptimal LDL with drug therapy alone. However, because data are predominantly from Asian populations, use cannot necessarily be extrapolated to other ethnic groups (Level I, Strength A – specific to Asian populations).(57)

Other uses

Limited studies in rodents and when using homeopathic doses suggest B. vulgaris extracts possess activity against calcium oxalate deposition.(41, 42) B. aristata improved benign prostatic hyperplasia in rats possibly by inhibition of androgen and anti-inflammatory effects.(22, 43) A small clinical trial reported positive effects for B. vulgaris fruit extract in treating acne. The study was conducted for only 4 weeks, with results from a longer trial required.(44) The American Academy of Dermatology/American Academy of Dermatology Association guidelines of care for the management of acne vulgaris (2016) states that oral barberry has been reported to have value in the treatment of acne (limited; moderate).(55)

Antioxidant effects have been documented.(45, 46) Effects on the GI tract have been described in rodent studies. Protection against inflammatory-related damage and motility effects have been reported, suggesting therapeutic uses for inflammatory bowel conditions.(47, 48)

Further effects for berberine alone have been described in studies using Goldenseal (see Goldenseal monograph).

Dosing

Barberry berries and root bark have been used as a source of berberine. Daily doses of 2 g of the berries and 1.5 to 3 g daily of dry bark have been used3; however, there are limited clinical studies to substantiate barberry's varied uses.2, 49 Berberine and related alkaloids are poorly absorbed when taken orally; in vitro and animal studies must be interpreted with care. Use in children has not been validated.

turmeric, Ginkgo Biloba, creatine

Pregnancy / Lactation

Avoid use. There are documented adverse effects, including uterine stimulant effects.3, 49, 50

Interactions

Case reports are lacking; however, in animals, Berberis exhibits anti-CYP3A4 activity similar to that of grapefruit. Caution is warranted with coadministration of medications with significant CYP3A4 metabolism.19, 51 Berberine may also induce P-glycoprotein.56

Adverse Reactions

GI symptoms (eg, nausea, vomiting, diarrhea), dizziness, and fainting have been reported. Effects on the cardiovascular system (eg, hypotension, decreased heart rate) and decreased respiration may occur with high dosages.2, 3 Hypersensitivity has been documented.9 The German Commission E reports that doses of berberine 500 mg are well tolerated.49

Toxicology

Symptoms of poisoning are characterized by lethargy, stupor and daze, vomiting and diarrhea, and nephritis.49 An LD50 for berberine was noted as 27.5 mg/kg in humans.8

Berberine showed mutagenicity in yeast cells and Ames test.3 A phototoxic reaction between berberine alkaloids and UVA light has been described.52

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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