Qualy #52 - Insights about berberine
Episode Stats
Summary
In this episode, Dr. Kelly discusses berberine, a plant- derived extract that has two properties, one of which is that it is a weak amp kinase activator and a weak inhibitor of the enzyme PCSK9. It's a poor man's version of metformin, which is a potent anti- oxidase inhibitor of LADHD. In fact, if you overexpress this enzyme, you'll have a higher ldl cholesterol and a much lower ldl LDL cholesterol. How does this happen? And what does it have to do with diabetes?
Transcript
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welcome to the qualies a subscriber exclusive podcast qualies is just a shorthand slang for
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a qualification round which is something you do prior to the race just a little bit quicker
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subscribe so without further delay i hope you enjoy today's quali insights about berberine so berberine
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is a plant derived extract that has two properties one of which it gets a lot of attention for one of
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which it might not be as well known the first is that it is a weak amp kinase activator and for those
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of you that have shown an interest in what metformin does that's sort of the the that's probably the
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secret sauce of metformin is its ampk activation so berberine when taken at you know sort of recommended
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otc doses which i i remember the doses anymore i think it's like a it might be actually a comparable
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dose to metformin it might be like either 500 twice a day or a thousand twice a day does have some
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of that weak ampk activation and what that the net effect of that is it decreases hepatic glucose output
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so it's upregulating ampk is telling the liver hey you can make less glucose so send less glucose out
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of the body and so in that sense it's a poor man's version of metformin i don't find that that
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interesting i prefer to just use metformin if we're going to go down that path like let's do it
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pharmacologically with potent drugs that we understand that are consistent from batch to
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batch that have a much higher sort of oversight of regulation that kind of stuff the other thing
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about berberine and this is that this is when i still do use it in clinical practice is it is also
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a weak inhibitor of the enzyme pcsk9 which any listener of this podcast is going to be very well up
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to speed on what pcsk9 is the word on the street is it probably only works in a subset of people who
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overexpress pcsk9 so if you so pcsk9 is a as a is a protein that degrades ldl receptors so if you
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overexpress this enzyme you're going to really degrade ldl receptors you're going to have a higher ldl
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particle number and probably a higher ldl cholesterol if you take that subset of patients they seem to
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respond quite nicely to berberine now the question is how do you know that i don't think there's a
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test anymore to measure that athratec which i think might have got absorbed into vap or something like
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that i think used to have a test but in the end i was like why am i going to do some test on somebody
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to see if they overexpress pcsk9 before i give them berberine i'll just give them berberine make no other
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change and see if there's not a significant enough difference in their ldl i don't care
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and every once in a while you just you look like a rock star you get this patient whose ldl is really
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high and you check your boxes like they don't have their triglycerides aren't that high their
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phytosterols are not that high their stanols are not that high their desmostrol is not that high
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hey they clearly have defective ldl clearance maybe they overexpress pcsk9 which would be one of
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a thousand reasons you could have like literally there are two thousand genetic mutations that can
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lead to an inability to clear ldl receptacles this is like one of them but this one amounts to about
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five percent of them and so in that patient you hit them with berberine and all of a sudden like
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everything's fixed do you see that with metformin at all no no i don't think metformin possesses that
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piece of what berberine has i hope you enjoyed today's quali now sit tight for that legal disclaimer
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