There is growing scientific evidence supporting the use of Berberis species (especially due to their berberine content) in the management of non-alcoholic fatty liver disease (NAFLD). Berberine, an isoquinoline alkaloid found in Berberis vulgaris and related species, has been shown in several animal studies and limited clinical trials to improve lipid metabolism and reduce hepatic fat accumulation. Mechanistically, berberine activates AMP-activated protein kinase (AMPK), which enhances fatty acid oxidation and reduces lipogenesis in the liver. A 2012 randomized controlled trial (RCT) demonstrated that berberine supplementation significantly reduced liver fat content and improved liver enzyme levels in patients with NAFLD compared to a control group. Systematic reviews and meta-analyses also suggest that berberine supplementation leads to improvements in hepatic steatosis, liver enzymes (ALT, AST), and metabolic parameters such as insulin resistance.

However, it should be noted that while the evidence is promising, most clinical studies use isolated berberine rather than crude Berberis extracts, and sample sizes are often small. Further large-scale, high-quality clinical trials are needed to fully establish efficacy and safety. Nevertheless, the current data provide moderate scientific validation for the use of Berberis (primarily via its berberine content) as adjunctive support for fatty liver disease.