Star supplement of online pharmacies, often presented as a natural “fat burner”,
berberine has just been scrutinized in a large clinical study. Published in 2026 in JAMA Network Openshe compared this plant compound to a
placebo in obese adults with non-alcoholic fatty liver, without diabetes. The results go against the image of a miracle product.
In this at-risk population, researchers focused on the liver fat and the
visceral fat belly, two forms of fat linked to inflammation and cardiovascular disease. More than 40% of the world’s population has excess body fat, which explains the interest in simple solutions in capsules. What exactly does this rigorous trial conducted in China show?
Liver fat, belly fat: does berberine keep its promises?
Steatotic liver disease associated with metabolic dysfunction (MASLDnew term for NAFLD or or non-alcoholic fatty liver disease) corresponds to a deposit of fat in the liver, common in people with
obesity abdominal. THE visceral adipose tissue around the organs is strongly linked to diabetes and heart risk. GLP-1 receptor agonists reduce these fats, but their price, digestive effects and weight regain upon stopping can limit their use.
Berberine, particularly from
Berberis vulgarisacts on the utilization of glucose and fatty acids and has already shown an improvement in lipid profile and insulin sensitivity in smaller studies, often in diabetic patients. Many sites have therefore relayed the idea that it could “defat” the liver and refine the stomach. What this test specifically sought to verify.
Berberine vs placebo? Draw on fat
The study included 337 obese adults with MASLD, without diabetes, from 11 Chinese hospitals. Mean age was 41.8 years, 65.6% were male, mean body mass index 31.8 (obesity stage 1). Participants were randomly given 1 g per day of berberine oral (169 people) or a
placebo identical (168 people) for 6 months, with high adherence around 90%. Scans measured visceral adipose tissue and liver fat at baseline and 6 months.
At the end of follow-up, the surface area of visceral fat had slightly decreased in both groups: approximately −2.0% with placebo versus −0.6% with berberine, with no significant difference. Same observation for the liver fat : −1.1% with placebo versus +0.1% with berberine. Analyzes by subgroups (age, sex, prediabetes, liver function) show no advantage of the supplement. “Based on our results, berberine should not be recommended specifically to reduce liver fat or visceral fat in non-diabetic patients with MASLD and obesity,” concluded Professor Haibo Zhang, from the Chinese Academy of Medical Sciences and Beijing Union Medical College.
A modest effect for certain patients only
Tolerance remained good, with serious adverse effects in 3.6% of people on berberine compared to 1.2% on placebo, and similar non-serious effects (10.1% compared to 7.7%). Secondary analyzes attribute to berberine, on the other hand, modest reductions in LDL-cholesterol (−7.72 mg/dL), apolipoprotein B (−3.42 mg/dL), and ultrasensitive C-reactive protein. In the most inflammatory participants (with high levels of hs-CRP), these effects were more pronounced and a decrease in BMI, waist circumference and body weight was even noted.
“These results suggest a heterogeneous response to berberine treatment and position hs-CRP as a potential biomarker to predict which patients with obesity and MASLD are most likely to benefit from berberine treatment.”write the authors.
What Researchers Recommend for Liver and Belly Fat
For fatty liver and belly fat, the team reminds that the priorities remain sustainable weight loss and physical activity. “Instead, clinicians should focus on treatments that include sustained lifestyle interventions and evidence-based weight loss strategies.“added Professor Zhang, who also mentions GLP-1 receptor agonists and others”pharmacological therapies with proven effects on adiposity and hepatic fat” when clinically justified.
The authors finally emphasize that other studies will be useful to know if more severely affected patients, or with more marked inflammation, benefit more from berberine.
Finally, let us recall that in 2019, ANSES recommended “Pregnant and breastfeeding women, diabetics and people with liver or heart problems to refrain from consuming food supplements containing berberine, due to the adverse effects they may encounter. In the absence of specific data, this recommendation also applies to children and adolescents“.