Qualy #52 - Insights about berberine
This Qualys episode discusses berberine, a plant extract, highlighting its two main properties: weak AMPK activation to decrease hepatic glucose output and weak PCSK9 inhibition to improve LDL clearance, with the latter being its primary clinical use for the speaker.
Deep Dive Analysis
5 Topic Outline
Introduction to Berberine's Properties
Berberine as a Weak AMPK Activator
Berberine as a Weak PCSK9 Inhibitor
Clinical Approach to Using Berberine for High LDL
Distinction Between Berberine and Metformin
2 Key Concepts
AMPK Activation
AMPK is an enzyme that, when activated, signals the liver to decrease its glucose output. Berberine is a weak activator of AMPK, similar to metformin, which reduces the amount of glucose the liver sends into the body.
PCSK9 Inhibition
PCSK9 is a protein that degrades LDL receptors, leading to higher LDL particle numbers and cholesterol. Berberine acts as a weak inhibitor of the PCSK9 enzyme, which can potentially increase LDL receptors and lower LDL, particularly in individuals who overexpress PCSK9.
4 Questions Answered
Berberine is a plant-derived extract that acts as a weak AMPK activator, which decreases hepatic glucose output, and a weak inhibitor of the PCSK9 enzyme, which can help reduce LDL.
Berberine weakly inhibits PCSK9, an enzyme that degrades LDL receptors. By inhibiting PCSK9, berberine can help increase the number of LDL receptors, potentially leading to lower LDL particle numbers and cholesterol, especially in individuals who overexpress PCSK9.
Berberine is a weak AMPK activator, similar to metformin, but Peter Attia prefers metformin for its potency and regulation. However, berberine also uniquely acts as a weak PCSK9 inhibitor, a property metformin does not possess.
Since there isn't a reliable test to measure PCSK9 overexpression, a practical clinical approach is to administer berberine without making other changes and then observe if there is a significant reduction in the patient's LDL levels.
1 Actionable Insights
1. Trial Berberine for High LDL
If you have high LDL, particularly when other markers like triglycerides, phytosterols, stanols, and desmostrol are not elevated, discuss with your healthcare professional the possibility of trying berberine. The speaker suggests a protocol of administering berberine and then observing LDL changes, especially since a test for PCSK9 overexpression is not readily available.
3 Key Quotes
Berberine is a plant derived extract that has two properties one of which it gets a lot of attention for one of which it might not be as well known.
Peter Attia
Berberine... is a poor man's version of metformin.
Peter Attia
I'll just give them berberine make no other change and see if there's not a significant enough difference in their ldl I don't care and every once in a while you just you look like a rock star.
Peter Attia
1 Protocols
Assessing Berberine Efficacy for High LDL
Peter Attia- Give the patient berberine.
- Make no other changes to the patient's regimen.
- Observe if there is a significant difference in the patient's LDL levels.