The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
in the end i was like why am i gonna do some tests on somebody to see if they over express pcsk9 before I give them bourbon I'll just give them berberine make no other change and see if there's not a significant enough difference in their LDL I don't care
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the other thing about berberine and this is that this is when i still do use it in clinical practice is it is also a weak inhibitor of the enzyme pcsk9 which any listener this podcast is gonna be very well up to speed on what pcsk9 is the word on the street is it probably only works in a subset of people who over express pcsk9 so if you so pcsk9 is a is a protein that degrades LDL receptors so if you overexpress this enzyme you're gonna really degrade LDL receptors you're gonna have a higher LDL particle number and probably a higher LDL cholesterol if you take that subset of patients they seem to respond quite nicely to berberine
and every once in a while you just you look like a rock star you get this patient who's LDL is really high and you check your boxes like they don't have their triglycerides aren't that high they're phytosterols are not that high they're Standells are not that high they're does mas trawls not that high hey they clearly have defective LDL clearance maybe they overexpress pcsk9 which would be one of a thousand reasons you could have like literally there are two thousand genetic mutations that can lead to an inability to clear LDL receptor goes this is like one of them but this one amounts to about 5% of them and so in that patient you hit them with berberine and all of a sudden like everything's fixed
and so in that patient you hit them with berberine and all of a sudden like everything's fixed
the other thing about berberine and this is that this is when I still do use it in clinical practice is it is also a weak inhibitor of the enzyme pcsk9 which any listener this podcast is gonna be very well up to speed on what pcsk9 is
I'll just give them berberine make no other change and see if there's not a significant enough difference in their LDL I don't care