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Berberine Lowered ApoB and Lp(a) in Women, and by More Than in Men

Writer: Joyce Knieff, NMD, LAc
Joyce Knieff, NMD, LAc
Oct 29
5 min read

Berberine usually comes up in my office after someone gets a cholesterol result they do not like. A new analysis from the University of Hong Kong adds a detail I have not seen tested this directly before: whether women and men respond to berberine in the same way or differently.


Close-up of red barberries and leaves on a branch in autumn
Image by monika1607 via Pixabay

Two trials, one in women and one in men


The research team ran a randomized, placebo-controlled trial in 100 women aged 20 to 65, who took berberine or a placebo for 12 weeks [1]. To compare the sexes, they used stored blood samples from an earlier, completed trial in 84 men who had taken the same berberine regimen. The main outcome was apolipoprotein B (apoB). In case the term is new to you, apoB is a protein found on each particle that carries LDL-type cholesterol, so measuring it gives a count of those particles.


In the women, berberine lowered apoB, total cholesterol, LDL cholesterol, triglycerides, and lipoprotein(a) compared with placebo. Lipoprotein(a), or Lp(a), is a cholesterol particle whose level is largely inherited. The researchers reported the results in standard deviation units, which do not convert neatly into lab values. A standard deviation is a measure of how spread out the values in a group are, so these units describe the size of a change against that spread. The reduction in apoB was 1.18 standard deviations, and the Lp(a) reduction was 0.71, both with confidence intervals well clear of zero. A confidence interval is the range of values where the true effect might be. The men showed similar trends, and the drop was larger in women for apoB, total cholesterol, LDL, and Lp(a).


Berberine also changed testosterone, lowering it in women and raising it in men. Nobody knows yet what that means clinically.


The comparison between the sexes relies on two separate trials carried out at different times, so it is less solid than a single trial that enrolled both. The women's trial took place in Hong Kong over 12 weeks, and the outcomes were blood markers, not heart attacks or strokes.


What other berberine trials have found


Berberine has been tested in many trials. A 2025 meta-analysis of placebo-controlled trials found that berberine lowered triglycerides by about 0.37 mmol/L (roughly 33 mg/dL), LDL cholesterol by about 0.50 mmol/L (roughly 19 mg/dL), and total cholesterol by about 0.45 mmol/L (roughly 17 mg/dL), along with fasting blood sugar and waist size [2]. It did not significantly change HDL cholesterol or blood pressure, and side effects were no more common than with placebo.


Berberine does lower cholesterol in trials [2], though it is not the strongest option in its class. A 2022 network analysis of 131 trials compared ten cholesterol-lowering nutraceuticals head to head, and red yeast rice and bergamot ranked highest for LDL reduction; berberine was among the nutraceuticals that lowered LDL more than placebo [3]. A 2023 umbrella review of 11 meta-analyses found effects on blood sugar, insulin resistance, and blood lipids, and reported that the most common side effects were digestive, mainly constipation and diarrhea [4]. Its authors also noted that the quality of the pooled research needs to improve.


An earlier review found a similar testosterone result. In a 2019 review of trials in women with polycystic ovary syndrome (PCOS), berberine lowered total testosterone compared with placebo [5].


Berberine is a botanical with drug-like interactions


Berberine is a good example of something I take seriously as a naturopathic doctor: "natural" and "gentle" are different words. In one crossover study, two weeks of berberine in healthy men changed how the body cleared several test medications, raising exposure to one of them by about 40% [6]. A crossover study tests the same people both with and without the treatment. The authors concluded that drug interactions should be considered whenever berberine is used. A 2026 review of berberine-family plants came to a similar conclusion, listing pregnancy, liver and kidney function, and interactions with drug-processing enzymes as key factors in its safety [7].


In my practice, a lipid result is the start of a wider look: thyroid function, blood sugar, diet, family history, and, given this new study, sex and hormone status. The testosterone findings are one more reason I want to understand someone's hormone levels before I add berberine to a plan.


Berberine and your next lipid panel


If your apoB, LDL, or Lp(a) came back higher than you hoped, these are the points I would want to talk through with you:


  1. Your medication list comes first. Berberine changed how the body processed test drugs within two weeks [6], so anyone taking prescription medications needs a provider or pharmacist review before starting it.

  2. Pregnancy is a safety concern. It is one of the conditions linked to berberine toxicity in the 2026 review [7], so berberine is not something to start on your own while pregnant.

  3. Digestive side effects are the most common ones. In the umbrella review, constipation and diarrhea were the most frequently reported [4].

  4. Blood markers are an interim result. The trials here measured lab values rather than heart attacks or strokes, so any berberine use goes together with the care your provider recommends for your overall cardiovascular risk and never replaces it.


References


  1. Zhao JV, Chen B, Chan YH, et al. Sex-specific lipid, apolipoprotein B, and lipoprotein(a) responses to berberine based on 2 randomized placebo-controlled trials. JACC Asia. 2026. PMID: 42470424. doi:10.1016/j.jacasi.2026.06.011. Original digest link: https://pubmed.ncbi.nlm.nih.gov/42470424/

  2. Liu D, Zhao H, Zhang Y, Hu J, Xu H. Efficacy and safety of berberine on the components of metabolic syndrome: a systematic review and meta-analysis of randomized placebo-controlled trials. Front Pharmacol. 2025;16:1572197. PMID: 40740996. doi:10.3389/fphar.2025.1572197

  3. Osadnik T, Goławski M, Lewandowski P, et al. A network meta-analysis on the comparative effect of nutraceuticals on lipid profile in adults. Pharmacol Res. 2022;183:106402. PMID: 35988871. doi:10.1016/j.phrs.2022.106402 (Yggdrasil abstract library record)

  4. Li Z, Wang Y, Xu Q, et al. Berberine and health outcomes: an umbrella review. Phytother Res. 2023;37(5):2051-2066. PMID: 36999891. doi:10.1002/ptr.7806 (Yggdrasil abstract library record)

  5. Xie L, Zhang D, Ma H, et al. The effect of berberine on reproduction and metabolism in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized control trials. Evid Based Complement Alternat Med. 2019;2019:7918631. PMID: 31915452. doi:10.1155/2019/7918631

  6. Guo Y, Chen Y, Tan ZR, Klaassen CD, Zhou HH. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol. 2012;68(2):213-217. PMID: 21870106. doi:10.1007/s00228-011-1108-2 (Yggdrasil abstract library record)

  7. Ma J, Lan X, Luo X, et al. Balancing efficacy and risk: a toxicological review and safety transformation of Berberis plants and their alkaloids. Phytomedicine. 2026;162:158782. PMID: 42731298. doi:10.1016/j.phymed.2026.158782


This article is for education only and is not medical advice. Berberine interacts with many medications, so please talk with your own healthcare provider or pharmacist before starting it.



If this resonates with what you're experiencing and you'd like to explore a naturopathic approach, book a consultation with our clinic.




 
 
 

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