Berberine-induced hypoglycaemia and electrocardiogram interpretation in athletes

Area of Science:

• Cardiology
• Endocrinology
• Herbal Medicine Research

Background:

• Athletes may use herbal supplements for performance enhancement.
• Berberine is known to lower blood glucose, but typically in diabetic patients.
• Unexplained syncope requires thorough investigation, including supplement use.

Purpose of the Study:

• To report a novel case of berberine and exercise-induced hypoglycemia.
• To emphasize the importance of supplement history in diagnosing hypoglycemia.
• To highlight normal ECG variants in athletes to prevent misdiagnosis.

Main Methods:

• Case report of an athletic male presenting with syncope.
• Biochemical analysis revealing severe hypoglycemia.
• Electrocardiogram (ECG) interpretation.
• Detailed medical and supplement history acquisition.
• Literature review on berberine and hypoglycemia.

Main Results:

• The patient experienced symptomatic hypoglycemia (0.9 mmol/L) and syncope.
• ECG showed sinus bradycardia, incomplete right bundle branch block, and first-degree heart block.
• Berberine supplement use was identified as a likely cause.
• Hypoglycemia due to berberine was previously unreported in non-diabetic individuals.

Conclusions:

• Berberine, combined with exercise, can induce significant hypoglycemia even in healthy individuals.
• Thorough review of supplements and over-the-counter medications is crucial for diagnosing unexplained hypoglycemia.
• Awareness of normal ECG variants in athletes is essential to avoid unnecessary cardiac investigations.