Astaxanthin plus berberine: a nutraceutical strategy for replicating the benefits of a metformin/fibrate regimen in metabolic syndrome

摘要

The phytochemical berberine, a constituentof certain herbs used in traditional Chinesemedicine, has long been in use in Chinaas a well-documented therapy for type 2diabetes.1 2 Mechanistic studies demonstratesthat, like metformin, it activates AMP-activatedkinase (AMPK); this is thought to bethe chief basis of its utility in diabetes.3–5 Thetypical therapeutic regimen is 500 mg two orthree times per day, or 850 mg two times perday. The most common side effect is constipation,which tends to remit during continuingtreatment.6 Unlike metformin, however,berberine upregulates the hepatic expressionof LDL receptors, through a mechanism thatis complementary to that of statins or redyeast rice (RYR); whereas statins increase transcriptionof the gene coding for LDL receptors,berberine increases the half-life of LDLreceptor mRNA.7 Hence, the combination ofberberine plus RYR—a natural low-potencysource of monacolin K (lovastatin) and othermonacolins that has moderate hypocholesterolaemicactivity in a standardised dose thatis well tolerated in most patients who don’ttolerate pharmaceutical statins8–10—has beenrecommended as a nutraceutical alternativeto pharmaceuticals in the management ofhypercholesterolaemia.