BergaMet has three main modes of action. Firstly, it works to block the rate limiting step in cholesterol production known as the HMG CoA Reductase Enzyme, which is the enzyme that is blocked by statin drugs. BergaMet works at a different site on this enzyme, and therefore does not appear to affect the muscles and the liver in the same way that statin drugs may do. It does, however, have a significant reduction in cholesterol through this first mode of action.
Secondly, BergaMet works directly on the insulin receptor, thus affecting the metabolic syndrome, i.e., the combination of the tendency to diabetes, high blood pressure, specific cholesterol abnormalities and abdominal obesity. All of these factors contribute to cardiovascular disease.
Thirdly, BergaMet blocks cholesterol absorption in the gut similar to the plant sterols found in some types of margarine and avocado. This is the major reason it is important to take BergaMet before meals, i.e. to block the absorption of cholesterol and other fats following the ingestion of a meal. Bergamot will still have an action though not as strong as if it is taken after meals, but certainly if you forget to take it before, you should still take BergaMet later.