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Monday, July 22, 2024

TikTok’s Berberine Fad Is About More Than ‘Nature’s Ozempic’

The claims are enticing. “Helps decrease belly fat.” “Improves ovulation.” “Prevents recurring UTIs.” “Reduces inflammation levels.” “Lowers cholesterol.” “Improves depression.”

These splashy promises don’t appear on the side of a bottle, a billboard, or a TV commercial. Instead, they come from social media posts from regular people gushing about their new favorite dietary supplement: a chemical called berberine. They’ve nicknamed the product “nature’s Ozempic,” a play on the popular type 2 diabetes drug that became a phenomenon when it was discovered to cause weight loss. One prominent berberine booster on TikTok calls it “natures ozempyyy” and swears that it has reduced his food cravings. The popularity of these videos has translated into a major surge in sales this summer. Thorne, a supplement company selling the product, told WIRED that its berberine sales have increased more than 165 percent in the second quarter of 2023 so far, compared to sales in the same time period last year.

Berberine isn’t new. It’s been an ingredient in traditional Chinese and Ayurvedic medicine for centuries, and can be found in a variety of plants, including barberry, a shrub with tart berries, and goldenseal, a perennial herb with a thick, knotty root. But as the Ozempic craze took off, berberine’s devotees began talking it up as a kind of kinder, gentler alternative to prescription medications. Now, Western wellness types, who take it a la carte in pill form, evangelize for it enthusiastically. “I can’t think of another example where something has gone viral to this extent,” says Craig Hopp, a deputy division director at the National Center for Complementary and Integrative Health, the National Institutes of Health office tasked with researching alternative medicines.

Amid all this hoopla, one specific claim about berberine got my attention. I saw it over and over: “Lowers blood sugar.” It was as if the algorithms knew precisely what would push me over the edge to actually purchase the stuff. I developed gestational diabetes a few years ago; to keep my blood sugar in check, I followed a carb-restricted diet and went through my pregnancy staring longingly at bagels and pricking my finger three times a day. It sucked. Now, with an increased chance of developing type 2 diabetes, I’ll do just about anything to avoid it. After a few consecutive nights getting served these giddy pro-berberine videos, I ordered two different kinds of berberine capsules online. What was the harm? It was natural, after all.

They arrived on my doorstep the next day. One bottle contained 200-milligram capsules of berberine, while the second contained pills with berberine and cinnamon, divided into 2,000-milligram capsules. The first option touted “GI support” and “immune support.” The second highlighted its gluten-free, “non-GMO” formulation.

Shaking the pills out onto my palm, it was impossible to tell which was which—they were both translucent, oblong, and filled with a yellow powder that resembles turmeric. Yet despite their identical appearances, they were very different dosages. I had no idea which one to take.

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Instead of swallowing either pill, I called Cassandra Quave, a doctor and research scientist who studies medicinal plants, to ask whether berberine was even wise to take at all.

Her response? “It’s crazy to me that these things are available.”

When people criticize alternative medicine, it’s often for being new-fangled snake oil. But some alternative medicines sold as supplements are worth scrutinizing not because they’re ineffective but because they’re so potent. A supplement like berberine can be as beneficial as a pharmaceutical, but also as strong as one. Yet, culturally, people often view supplements as benign additions to their diets, rather than remedies that can be both effective and intense.

Quave is wary of the easy availability of single-ingredient supplements like berberine, which are sold in powerful compound form with few warnings about potential side effects, and without the same regulatory scrutiny as over-the-counter or prescription medications. She finds the fad for casually taking berberine to lose weight troubling for several reasons. “Berberine is a natural antibiotic, so it interferes with the growth of different bacteria in the intestines,” she says. “This is not something you’re supposed to take on on a long-term basis, because you are changing the dynamics of your gut microflora.” Plus, berberine is known to interfere with enzymes in the body that break down other drugs, so it can cause dangerous interactions.

Berberine has antibiotic properties, as Quave noted, which is why it is often used to treat bacterial diarrhea on a short-term basis. Studies also suggest that it can indeed reduce insulin resistance. It is a remarkable substance, and it’s easy to understand why people are excited about its benefits. But that does not mean it’s wise to start ingesting this powerful pharmacological compound as casually as a cough drop. And even alternative healthcare practitioners have concerns.

“It does get a little scary to me when we’re talking about extracts of particular herbs, because that gets to be as strong as a pharmaceutical medication,” Jaquelyn Taylor, an herbalist in Chicago, says. “I’d worry about antibiotic resistance with using berberine.” Taylor does not instruct her clients to take berberine to lower blood sugar or for weight loss. When she does incorporate herbs containing berberine into a recipe, she pairs them with other herbs that will help temper its effects, following traditional methods.

Lisa Makeeva, an Ontario-based dietician who often treats digestive disorders, has recommended berberine to some of her patients for years. Makeeva has even made TikTok videos about berberine’s effects—but she has reservations about how the supplement has turned into a fad diet product. “I think any supplement you’re introducing should be monitored by a health care practitioner,” she says; when her clients start on it, Makeeva orders blood work to watch how and if it impacts their blood sugar. She does not recommend it for shedding body mass. Despite TikTok claims about berberine’s weight-loss benefits, its functionality as a dieting aid hasn’t actually been proven in peer-reviewed studies.

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“We don’t really have much data to show that taking berberine will lead to weight loss,” she says.

Although they are sometimes embraced as alternatives to modern medicine, botanical ingredients are an undeniably vital component of mainstream pharmacology. Aspirin comes from willow bark; metformin, the diabetes medicine to which berberine is often compared, is derived from a plant known as French lilac. If a plant-derived substance is classified by the US Food and Drug Administration as a pharmaceutical drug, it must undergo rigorous testing before it’s approved.

But if a plant-derived substance is classified as a supplement, rigor goes out the window. There’s no mandatory development and approval process for supplements. In 1994, the Dietary Supplement Health and Education Act (DSHEA) changed how the FDA could regulate supplements, undermining its power within a rapidly-growing market. While the FDA evaluates medications for safety and efficacy before they go to market, the agency only has the power to ban a supplement after it has been sold and there is evidence it is harmful. (To understand more about this dynamic, read this investigation WIRED published in 2020 into why the memory supplement Prevagen stayed on the market despite questions about its safety.)

Despite several high-profile public health disasters related to supplements, including the herbal stimulant ephedra causing a wave of heart attacks and other adverse effects, regulatory control over the supplement industry remains startlingly lax—even as the market has exploded in popularity. According to Patricia Deuster, acting executive director at the Uniformed Services University’s Consortium for Health and Military Performance and chair of the Department of Defense’s Dietary Supplement Subcommittee, there were only around 3,000 dietary supplements on the market when DSHEA became law. Today, there are between 80,000 and 150,000. Some of these supplements are demonstrably safe and beneficial, like Vitamin D. But many of them are not.

This explosion in popularity has not led to a commensurate spike in rigorous research. “The biggest problem with dietary supplements is that there really isn't much funding to do randomized controlled trials,” Deuster says. “It's usually funded by the supplement company if it's done at all, so that the opportunity for good evidence is almost nonexistent.”

This laissez-faire regulatory atmosphere has led to a wide variety of products that simply don’t do what they say they’re going to do—or much of anything at all. It has also led to cases like berberine, where the danger isn’t that the supplement will be ineffective so much as it is that people taking it aren’t made aware of how powerful it can be in ways they weren’t expecting. They may think they’re taking a gentle, all-natural weight-loss remedy with lots of traditional uses; instead, what they are taking is a powerful antimicrobial that may interfere with other medications, isolated and sold in a pill form that resembles traditional preparations only as much as a caffeine pill resembles a guarana leaf.

Although it hasn’t been subject to the same trials that a pharmaceutical goes through during its approval process, and although berberine is not regulated like a medication, it can still function like one. The body doesn’t know or care, after all, how a substance is classified. “There's no difference between a pharmaceutical drug and the sort of compounds like berberine that are sold in supplements. They're exactly the same,” says Pieter Cohen, an associate professor of medicine at Harvard Medical School who studies supplements. “The law creates these artificial categories.”

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Some supplement companies do make efforts to at least offer some educational materials for their customers. For example, when I asked Thorne whether it is putting out any messaging about how powerful berberine is, and how it may not be suitable for long-term use, a spokesperson told me that the company had run a Q&A with an in-house doctor via Instagram Stories. (It is now available to rewatch if you sit through an earlier Q&A about an unrelated supplement in the Highlights tab.) The most easy-to-find information about berberine on the company’s Instagram account is a Reel promoting the ingredient as “a supplement you don’t want to miss.” In addition to GI support, the promotion hails berberine for its “weight-management” properties. There’s nothing about side effects or about its suitability for long-term use, nor is there anything to that effect on the bottle itself—just a warning not to use while pregnant. (If you navigate to Thorne’s website, the company does offer a warning not to use while pregnant there, too, in addition to a warning about potential allergies and drug interactions.)

Some supplements have origins that are startlingly medical; melatonin, for example, is widely viewed as a mild sleep aid. While it is generally safe, melatonin is a potent hormone, originally extracted from a cow’s pineal gland, and it can have a number of adverse effects and drug interactions, ranging from nausea to increased blood pressure. When its bovine origins raised concerns that it could become contaminated with mad cow disease, manufacturers largely shifted over to deriving the hormone synthetically. In his illuminating 2006 book Natural Causes: Death, Lies, and Politics in America’s Vitamin and Herbal Supplement Industry, journalist Dan Hurley points out how odd it is that this kind of product is widely considered something less serious than medication. “One has to wonder how a synthetic brain hormone ever wound up being sold as a ‘dietary supplement’ in the first place,” Hurley writes.

The way metformin and berberine are treated makes this false dichotomy obvious. In addition to getting called “nature’s Ozempic,” berberine is also frequently discussed as “nature’s metformin.” But metformin is already nature’s metformin. The primary difference, then, isn’t that metformin is unnatural while berberine is natural, or that one works and one doesn’t. It is that metformin has been evaluated within a far more stringent system, and obtaining it requires a prescription, whereas berberine is subject to far less scrutiny and is available to order online with no medical oversight or third-party quality control checking the purity of the ingredients.

“Herbal supplements can be especially dodgy when it comes to issues with contamination,” says Nicholas Milazzo, the lead researcher at nutrition and supplement database Examine.com. The industry has an alarming track record regarding unlisted and sometimes hazardous ingredients turning up in supplements.

Although many people turn to supplements out of a desire to avoid Big Pharma, the quality control problems within the industry mean that they may end up inadvertently consuming prescription medications anyways. An analysis of 800 over-the-counter dietary supplements sold between 2007 and 2016 found more than one pharmaceutical ingredient in 20 percent of the products, ranging from antidepressants to anabolic steroids—and the FDA doesn't have the authority to recall these kinds of tainted supplements.

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This spring, for example, Illinois-based supplement company NOW discovered that counterfeiters were selling fake versions of its products on Amazon; the counterfeit supplements contained a pharmaceutical drug called sildenafil. If that name isn’t familiar to you, it’s likely because sildenafil is the generic name for a very popular brand-name drug: Viagra.

Berberine isn’t a new supplement, but it is an intensely timely one. It’s a fad because people are enthralled by Ozempic and eager to find a “natural” alternative. Without the breakthrough in semaglutide drugs, it might’ve remained just another obscure herb somebody’s acupuncturist recommended. “Because it’s riding that anti-pharma wave, it doesn’t surprise me that berberine has taken off,” says Derek Beres, a writer and podcaster who covers the intersection of wellness culture and conspiratorial thinking. Berberine’s boosters gave it an unbeatable marketing hook by positioning it in opposition to Ozempic, the pharmaceutical industry’s most recent blockbuster drug.

Above all, it’s a fad because of how desiccated trust in public health is. Alternative medicine has been popular for decades, but in recent years, it has moved from the fringes into an increasingly mainstream and politically extreme position. Wellness communities are drifting politically rightward and define themselves in opposition to the medical establishment.

Berberine’s rise did not happen in a vacuum. Its popularity is emblematic of a rising worldview, one championed by Democratic presidential primary contender Robert F. Kennedy Jr., which rejects evidence-based medicine in favor of contrarian pseudoscience. It’s no coincidence that some major players pushing berberine include figures like Joseph Mercola, an osteopath whose immensely popular alternative-health websites push anti-vaccine conspiracy theories.

Supplements are the self-help aisle—pulling yourself up by your bootstraps, living your best life—made manifest in pills and powders. Why wait for some old fogey in a white coat to fix your body, when you could simply purchase elixirs yourself? While medications are prescribed by an elite medical authority figure, supplements are peddled by entrepreneurs beholden only to the market.

And social platforms, especially TikTok, are making it easier than ever for anyone to take on the role of supplement peddlers. The industry had already used multilevel marketing schemes to rope regular people into shilling herbs for decades—Herbalife, which launched in 1980, remains one of the largest MLMs in the world—but influencer culture has accelerated this blurring of lines between customer and seller.

“I started seeing it blow up on Instagram and TikTok, being compared to ‘nature’s Ozempic,’” says Shelby Worth, a bubbly, earnest nursing assistant based in Prince Edward Island, Canada. “That’s when I decided to give it a try.”

Worth is not a stereotypical wellness influencer. She doesn’t do fancy matching workout sets or use a ring light. She mostly posts tossed-off videos of herself wearing sweatshirts in her kitchen, often goofing around with her fiancé. But she’s interested in leading a healthy lifestyle and was curious enough about berberine to order her own. When Worth posted her own series of videos detailing her experience with the remedy, she racked up millions of views. She even nabbed a sponsorship deal from a supplement company after her initial video on berberine went viral on TikTok; it’s her first brand partnership. Afterward, she was approached by two companies about trying Ozempic and posting about the experience; she declined, eager to continue her focus on alternatives to prescriptions.

Worth’s quick jump from new customer to active seller demonstrates how quickly regular people can get pulled into the sprawling supplements industry. Even though I ended up throwing my berberine out, in the course of reporting this story, new videos hawking the product continued to appear in my feeds daily.

“Order berberine,” Worth’s TikTok bio now reads, linking potential customers out to her affiliates. 

Updated 7-31-23, 11:10 am EDT: This story was updated to correct Thorne's berberine sales figures.

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