Beneficial actions more complex than previously thought
IBS is a common disorder that reduces patients’ quality of life. It is a chronic condition characterized by abdominal pain or discomfort associated with disordered defecation but the absence of identifiable structural or biochemical abnormalities. Alteration in neurohumoral mechanisms and psychological factors, bacterial overgrowth, genetic factors, gut motility, visceral hypersensitivity, and immune system factors are theorized to underlie IBS, but a clear understanding of etiology still eludes us. At this point IBS treatment is dictated by the patient’s most bothersome symptoms.
In this 14-week single-center, double-blind, placebo-controlled clinical trial, both the berberine and the placebo (Vitamin C) groups reported a reduction in symptoms during the 8 weeks they took medication, though the placebo group reported less benefit. At week 8, diarrhea frequency was significantly lower in the berberine group than the placebo group (P=0.032).
The berberine group, but not the placebo group, reported less urgency and frequency in defecation starting in week 4 and persisting through week 8 (P<0.01).
Both groups reported less abdominal pain during the 8 weeks of treatment. In the berberine group significant reductions in pain frequency were seen starting in week 3 of the study and continuing through week 8. The pain frequency scores for week 8 represented a 64.6% (1.54 ± 0.26 vs 4.35 ± 0.58) reduction compared with initial scores. In the placebo group the final score represented a 29.4% (2.88 ± 0.37 vs 4.08 ± 0.23) reduction. The pain reduction was significantly greater in the berberine group than in the placebo group on week 6 (P<0.01) and week 8 (P<0.01).
Berberine significantly decreased overall IBS symptom score, anxiety score, and depression score (P<0.01). Berberine treatment was also associated with an increased QOL score (P<0.05). No significant changes were seen on these scores in the placebo group (P>0.05).
The overall IBS symptoms score, anxiety score, and depression score were significantly lower in the berberine group compared to the placebo (P<0.05). Berberine may be an effective way to manage symptoms of IBS-D.
This clinical trial reveals 2 things. First, and most importantly, that berberine is effective in the treatment of IBS when the predominant symptom is diarrhea. The second is that many patients may also experience some benefit from simply taking a placebo.
The berberine used in this study was isolated from Chinese goldthread rhizome (Coptis chinensis). In North America, commercial sources are generally extracted from Oregon grape (Mahonia aquifolium).
There are some cautions and contraindications with Berberine. It is best prescribed by a medical herbalist as part of an individualized treatment program.
Chen C, Tao C, Liu Z, et al. A randomized clinical trial of berberine hydrochloride in patients with diarrhea-predominant irritable bowel syndrome. Phytother Res. 2015;29(11):1822-1817.