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JAMA Open Network

Anyone on prescription medications should consult their physician before adding berberine supplementation in any form

Lifestyle changes tend to yield only modest results over a prolonged period of time, medications may bring about unwanted side effects or may not be appropriate for everyone, and while bariatric surgery can be effective, it is a more invasive option that may not be suitable for all patients (Ruze et al

A few things that may help: Try eating earlier in the evening (at least 34 hours before sleep) Keep meals lighter, especially at night Avoid lying down right after eating Elevate your head slightly during sleep Stay well hydrated throughout the day From a microbiome perspective, combining Akkermansia with butyrate-producing support (such as Clostridium butyricum) can sometimes improve gut motility and reduce irritation over time

Due to body habitus, neither magnetic resonance imaging (MRI) nor lumbar puncture was possible to obtain