Berberine, a plant-derived alkaloid used in traditional medicine, has become increasingly popular as a dietary supplement for metabolic health. Whilst generally well-tolerated, some users report experiencing anxiety or nervousness when taking berberine. This article examines whether berberine can cause anxiety, explores potential mechanisms behind these symptoms, and provides practical guidance on managing anxiety-related effects. Understanding the relationship between berberine and mood changes is important for anyone considering or currently using this supplement, particularly as it is not regulated as a medicine in the UK and lacks comprehensive safety data.

What Is Berberine and How Does It Work?

Berberine is a naturally occurring alkaloid compound extracted from various plants, including Berberis species (barberry), goldenseal, and Chinese goldthread. Traditionally used in Chinese and Ayurvedic medicine for centuries, berberine has gained attention in recent years as a dietary supplement, particularly for metabolic health support.

The compound appears to work through multiple mechanisms at the cellular level. Research suggests its primary effect involves activation of AMP-activated protein kinase (AMPK), described as a metabolic master switch that regulates energy balance within cells. This activation may influence glucose metabolism, lipid profiles, and insulin sensitivity. Some studies indicate berberine might also modulate gut microbiota composition and influence various signalling pathways, though much of this evidence comes from laboratory and early clinical research.

In the UK, berberine is sold as a food supplement regulated by the Food Standards Agency and Trading Standards, not as a licensed medicine. This means it has not undergone the rigorous safety and efficacy testing required for pharmaceutical products. People typically take berberine for blood sugar management, cholesterol reduction, or weight management, though NICE guidelines do not recommend berberine as a treatment for these conditions, instead favouring evidence-based interventions.

In research settings, dosing typically ranges from 900–1500 mg daily, usually divided into two or three doses taken with meals to improve absorption and reduce gastrointestinal side effects. The supplement is available in capsule or tablet form from health food shops and online retailers. Product quality and dose consistency can vary considerably between manufacturers.

Berberine should be avoided during pregnancy, when breastfeeding, and in children due to limited safety data. It can interact with various medications, particularly those metabolised through CYP3A4, CYP2D6, CYP2C9 enzymes and P-glycoprotein, including some statins, blood thinners, and immunosuppressants.

Why Some People Experience Anxiety When Taking Berberine

Whilst anxiety is not listed among the most common adverse effects of berberine, some users report experiencing increased anxiety, nervousness, or mood changes when taking this supplement. Several hypotheses might explain these experiences, though it's important to note that no definitive causal relationship has been established.

Blood sugar fluctuations represent one plausible explanation. Berberine's glucose-lowering effects, whilst beneficial for those with insulin resistance, might occasionally contribute to hypoglycaemia (low blood sugar) in susceptible individuals. This risk is higher when berberine is combined with diabetes medications like insulin or sulphonylureas, or when taken without adequate food. Hypoglycaemia triggers the release of stress hormones such as adrenaline and cortisol, which can manifest as anxiety, trembling, sweating, and palpitations—symptoms that closely mimic an anxiety attack.

Gastrointestinal disturbance is among the frequently reported side effects of berberine. Studies report variable rates of digestive symptoms, with some users experiencing cramping, diarrhoea, bloating, and nausea. These physical discomforts may contribute to feelings of unease or anxiety in some individuals. The gut-brain axis—the bidirectional communication network between the gastrointestinal tract and central nervous system—means that digestive upset can influence mood and anxiety levels.

Some laboratory research suggests berberine might influence neurotransmitter systems including serotonin and dopamine pathways, though the clinical relevance of these findings in humans remains speculative. Individual variations in metabolism, existing mental health conditions, concurrent medications, and dosage levels may all influence whether someone experiences anxiety-related symptoms.

It is important to emphasise that there is no established causal link between berberine and anxiety in regulatory guidance or major clinical databases. However, individual experiences vary considerably, and what one person tolerates well may cause unwanted effects in another.

Managing Anxiety Symptoms While Using Berberine

If you are experiencing anxiety symptoms whilst taking berberine but wish to continue using the supplement, several practical strategies may help minimise these effects whilst maintaining safety.

Dosage adjustment should be your first consideration. Rather than starting at the full recommended dose, begin with a lower amount—perhaps 500 mg once daily—and gradually increase over several weeks if tolerated. This cautious approach allows your body to adapt to the supplement and may reduce the likelihood of adverse effects. Always take berberine with meals, as this improves tolerability and helps stabilise blood sugar levels.

If you take diabetes medications, consult your GP or pharmacist before starting berberine, as the combination could increase hypoglycaemia risk. Monitor your blood glucose if you have diabetes, prediabetes, or suspect hypoglycaemia may be contributing to anxiety symptoms. If readings fall below 4.0 mmol/L and you experience symptoms, follow NHS guidance for treating low blood sugar (consuming a fast-acting carbohydrate like fruit juice or glucose tablets), then discuss with your healthcare provider as your medication may need adjustment.

Maintain consistent eating patterns with regular, balanced meals containing adequate protein, healthy fats, and complex carbohydrates. Skipping meals whilst taking berberine may increase the risk of hypoglycaemia-related anxiety. Staying well-hydrated and limiting caffeine intake can also help, as caffeine may exacerbate both anxiety symptoms and some of berberine's gastrointestinal effects.

Stress management techniques including deep breathing exercises, progressive muscle relaxation, regular physical activity, and adequate sleep can support overall anxiety management. Keep a symptom diary noting when anxiety occurs in relation to berberine doses, meals, and other activities—this may reveal patterns that help you and your healthcare provider identify triggers.

If gastrointestinal symptoms appear to be contributing to your anxiety, taking berberine with food, ensuring adequate fibre intake, and staying hydrated may provide relief. Some individuals find that splitting the daily dose into smaller, more frequent amounts reduces digestive upset.

Remember that berberine should be avoided during pregnancy, when breastfeeding, and in children due to limited safety data.

When to Stop Taking Berberine and Seek Medical Advice

Whilst berberine is generally well-tolerated by many users, certain situations warrant discontinuation of the supplement and prompt medical consultation. Recognising these warning signs is essential for your safety.

Stop taking berberine immediately and contact your GP or NHS 111 if you experience:

• Severe or persistent anxiety that significantly impairs your daily functioning, sleep, or quality of life

• Symptoms of hypoglycaemia including confusion, severe shakiness, rapid heartbeat, sweating, or difficulty concentrating—particularly if blood glucose readings fall below 4.0 mmol/L

• Chest pain, severe palpitations, or breathing difficulties, as these require urgent assessment to rule out cardiac causes

• Severe gastrointestinal symptoms such as persistent diarrhoea, severe abdominal pain, or signs of dehydration

• Jaundice (yellowing of skin or eyes), dark urine, or pale stools, which may indicate liver problems

• New or worsening depression, panic attacks, or suicidal thoughts

Seek emergency care (call 999) if you experience signs of a severe allergic reaction, including facial swelling, difficulty breathing, or widespread rash.

Before starting berberine, inform your GP if you have existing anxiety disorders, depression, diabetes, liver disease, or cardiovascular conditions. Berberine can interact with numerous medications including:

• Diabetes medications (insulin, sulphonylureas, metformin)

• Blood thinners (warfarin, direct oral anticoagulants)

• Some statins (particularly simvastatin, lovastatin)

• Immunosuppressants (ciclosporin, tacrolimus)

• Certain antibiotics (macrolides, fluoroquinolones)

These interactions occur because berberine can inhibit enzymes (CYP3A4, CYP2D6, CYP2C9) and transport proteins (P-glycoprotein) involved in drug metabolism.

If you are scheduled for surgery, stop taking berberine at least two weeks before the procedure and inform your surgical and anaesthetic team about your supplement use.

Remember that dietary supplements are not substitutes for prescribed medications. NICE guidelines recommend evidence-based pharmaceutical interventions for conditions like type 2 diabetes and hyperlipidaemia. If you are considering berberine as an alternative or addition to conventional treatment, discuss this decision with your healthcare provider rather than making changes independently.

If you suspect berberine has caused an adverse reaction, you can report this through the MHRA Yellow Card scheme, which helps monitor the safety of supplements and medicines.

Frequently Asked Questions