Clinical Benefits

Berberine from Indian barberry and milk thistle exert a synergisticeffect.¹ Milk thistle supports healthy liver function and reduces free radicalsformed in the body.² Berberine typically has low oral bioavailability, andits cellular uptake is limited by the P-glycoprotein efflux pump locatedon cell membranes. Milk thistle's flavanolignans act as inhibitors of thispump,³ supporting berberine’s cellular uptake (Figure 1).⁴ In a single-blind,randomised placebo-controlled trial, patients with elevated blood sugargiven the combination of 210 mg per day of milk thistle flavanolignanswith Indian barberry, equating to 1 g per day of berberine, was shown tosynergistically increase berberine's therapeutic effects on glycosylatedhaemoglobin (HbA1c) compared to the same dose of Indian barberry givenalone (p<0.05).⁵ The two ingredients in a randomised double-blind placebocontrolledtrial led to signification reductions in biomarkers: body mass index(BMI), waist circumference and visceral fat compared to placebo after 12months of supplementation (p<0.01).⁶

Poor blood sugar control is associated with low-grade systemic inflammation (meta inflammation) caused by nutrient excess.⁸ Thetwin-cycle hypothesis presents the interconnecting pathways followingovernutrition and inflammation, leading to fat accumulation in the liver andinsulin resistance. The result of higher very low density lipoprotein (VLDL) inthe circulation leads to fat accumulation in the pancreas and subsequently,beta cells (β-cells) dysfunction.⁹ To improve insulin resistance, both pancreaticβ islet cell dysfunction and liver lipid metabolism must be addressed (Figure2).^10,11

Chromium assists carbohydrate metabolism, supports healthy bloodsugar, and is an essential element in glucose homeostasis.¹³ It achievesthis by promoting insulin signalling.¹⁴ A meta-analysis of human clinical trialsshowed combining milk thistle and Indian barberry presented a significantreduction in fasting blood glucose, total cholesterol, triglycerides, low densitylipoproteins, and a significant increase in high density lipoproteins.¹⁵

Metabolic stress, such as lipodysfunction and meta inflammation maypredispose to pancreatic impairment.¹⁶ Metabolic imbalances (e.g. fattyliver, insulin resistance, weight gain and hormonal imbalances) all involveliver function alterations, fatty acid abnormalities and changes in blood sugarcontrol.¹⁷ Berberine aids the breakdown of dietary fat and protects the liver.In an animal study, berberine improves pancreatic β islet cell function undermetabolic stress.¹⁸ In another animal study, berberine has been shown toreduce hypercaloric induced liver lipid infiltration,¹⁹ and was also shown toinhibit pancreatic inflammation and pancreatic β islet cell damage associatedwith insulin resistance.²⁰