No one has mentioned the research on Metformin and osteoarthritis. Here’s a summary of one study but if you search you’ll find more.
The results of our study demonstrated significant beneficial effects of metformin on the general conditions of OA patients. Metformin also caused a significant reduction in knee swelling. On the other hand, placebo treatment did not produce beneficial effects on the condition of OA patients.
The results of another clinical trial in OA patients confirm the beneficial effects of metformin such as changes in western Ontario and McMaster universities osteoarthritis index (WOMAC) score and visual analog scale (VAS) knee pain with a maximum dose of 2 g/day for 24 months.
From: https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03025-7
2
Wow I see a lot of people spouting off here. I wonder how many have read lifespan by David Sinclair, or life force by Tony Robbins or other books that do deep dives into why we age and why we don't have to. I just ordered metformin I'm on the borderline between pre-diabetic and type 2 diabetes I'm also very active physically. I'm disappointed in the results of this study, but it seems meager and limited in many ways for instance it was performed on people who up until the study have been sedentary that's not the category I fall into I'm a long distance runner and have used it to help control my diabetic tendencies but Sinclair and other world-renowned physicians and scientists swear by metformin and believe most of us should be taking it however if it does prevent mitochondria from breathing I'm sure they will amend their prescriptions. Look forward to hearing more from people who really know what they are talking about
5
@Don Sinclair and Robbins are nothing but click bait. People have made them rich, when what they were telling us about exercising and eating right was told to us since childhood.
This study is dead on accurate from my personal experience. I was diagnosed with type 2 diabetes in September of 2010. I was an active individual, who exercised, ate the right foods. No hx of diabetes in my family whatsoever. I was shocked to say the least.
I told my PC physician that's impossible. I continued to exercise with going to the gym,running, 6 flights of stairs and bike etc. My muscles began to atrophy over the years on MF. MF damages the body over time. It is hard on the organs and such. Especially the kidneys. People on metformin develop kidney issues which leads to other issues. Educate yourself before you make statements like yours.
There is nothing wrong with trying to improve our health. Trying to live longer will just lead to what we know now. Living longer leads to dementia, parkinsons, cancer and a host of other issues. This study was on to something. I am a living example of it.
If people want to have better health, and possibly improve their longevity. Then eat right and exercise. Here in the USA, our government has done nothing to improve our health. They know that eating fast food, fried foods, sugary drinks and high sodium foods is bad. Yet they do nothing.
In South America. They have started an attempt to decrease sodium in food products. Look it up. Cheers m8.
3
I have been using DermalMD Anti Aging Serum for a little over 2 weeks and already my skin feels and looks much more hydrated younger and healthier. I haven't noticed wrinkles changing yet but they look better definitely.
Fantastic study.
The term in and of itself, just shows the lunacy of all of this. Anti-aging? There's no way to stop that train. What's next...anti-death supplements?
3
I don't think metformin is FDA approved for "aging" as suggested by this article. Science writing is difficult as you need to adapt medical jargon to a wider audience, but this article is pure garbage. The study was done on 53 people and the primary outcome was change in insulin sensitivity. The only impression this article leaves for the average reader is that metformin is potentially bad, which can be dangerous for those that truly need it.
6
@Eric S - "I don't think metformin is FDA approved for 'aging' as suggested by this article." Nowhere does the article mention the FDA.
3
@Eric S was the primary outcome insulin sensitivity? It seems the measurement of mitochondrial activity was the primary outcome, or at least the takeaway of the article was that. Otherwise why go though muscle biopsies?
Funny that insulin sensitivity didn't change much, but metformin was never known to be a potent hypoglycemic agent in the first place.
1
@Eric S You are so right sir.
1
How curious. I'm prescribed metformin, but I dose berberine and dulaglutide. Metformin is regarded as a fairly crude means of controlling Type 2. The magic (as in, “Any sufficiently advanced technology is indistinguishable from magic”) is in the dulaglutide which mechanism of action is understood and established. Metformin, while studied extensively, still hasn't had its exact mechanism of action established. All three are helpful. It does take a competent endocrinologist to determine how best or whether to administer the medications - not anecdotes emerging in a letters column.
3
@GWPDA Dulaglitude increases insulin secretion by pancreatic Beta cells. Pushing your Beta cells harder and pumping more insulin through your body (which accelerates inflammation and down regulates autophagy and apoptosis) is the exact opposite of longevity.
2
It continues to seem strange to me that people will try all sorts of things dubbed "anti-aging", even if they have unpleasant side effects. There's no fountain of youth and no way to avoid aging. No matter how many treatments or however much plastic surgery one might have, none of it stops the march of time.
We all age and we all die. No pill can guarantee that we'll live to see the rest of today, let alone tomorrow or the day after. I'm at peace with this reality, if only because it's better than not coping with this hard fact of life.
3
Our bodies are the product of a million years of evolution, so tinkering with the various biochemical processes with a reductionist scientific approach is bound to be fraught with risks and maybe earlier death. Better to follow the Greeks living on Samos or the Japanese, who live long healthy lives, and they light, lean and drink wine, from grapes or rice. Here in the US we eat massive meals and buy soft drinks, all heavy on sugar and factory processed chemicals.
6
Sounds like anti-aging snake oil with someone getting rich and someone getting duped.
Humanity has most likely reached its maximum life expectancy already. For that matter, life expectancy has recently shrunk due to covid and other factors.
Keep the pills for diabetes and accept the fact that we all age.
"everybody wants to go to heaven but nobody wants to die"
5
@John Virgone metformin has been a generic and pretty dirt cheap for a few decades. That being said, I was thinking the same thing....find a new use, repackage or add some other active ingredient and re-patent for the multibillion dollar weight loss industry....the article didn't say who funded the study (unless I missed it).
2
Hopefully the next phase will involve measuring the length of telomeres.
8
Dang! We all get old, pass away and make room for those coming along. At 77 I am nearing the end of my cycle, I take are of my health, but will not prolong at the expense of the next generations. The search/hype to do so is not sustainable, any more than the search for more stuff, personal transportation etc. bit homes, fine lawns, constant travel , and other gratifications which come at the expense of planetary well being. Induced longevity is just another facit of humanity killing off the future out of self indulgent greed.
13
i suggest looking at weight training instead of cardio
4
As this article and the comments show, Metformin is a wonder drug but we really don’t know how it works.
How you respond to that fact pretty much says what kind of person you are.
Personally I’m pretty tired of spending billions to explore Mars and trillions on foreign wars while only a tiny percentage of wealthy people can make it through the artificially constrained supply chain of doctors and scientists.
Science is not brilliance: it is diligence and method, teachable to anyone with time. Let’s teach the ENTIRE next generation how to apply science to health and the environment. All earthly beings will likely be better off, and probably a lot more cooperative.
17
@Friend Was I agree 100%, a lot of our problems are self-inflicted. Bezos spent billions to go to orbit and who really paid for his trip? His workers, that earn low salaries. Same for other areas, med school should be for everyone who wants to go and pass a reasonable exam. Being a GP is not rocket science.
4
@Friend Was Actually, you have it wrong- metformin is NOT a "wonder drug". Its practically speaking, obsolete.
We are entering a new era in the progress of precision medicine- and all those old single-molecule "wonder drugs" are just like all those 1970s American cars. Pure junk.
People taking metformin based on animal models? What do their think human clinical trials are for? To prove or disprove an effect seen in the lab in actual human subjects.
Science has cured cancer in mice dozens of times. Has created longer living mice as well. Not much of this has translated to human effects because, well, mice and humans are very different beasts.
There is a lot of bad science out there.
5
This write hs made a career of writing articles based on one study. In this one she limits the reader to "Worms and rodents given metformin typically outlive their unmedicated labmates."
But there are human studies as well, in which diabetics who are well controlled by metformin and healthy life-style, have good longevity.
The role of metformin with regard to athleticism is controversial and studied by multiple scientists. Depending on study design, some scientists have found that metformin does not degrade strength or athletic performance.
A well-informed article would have examined the findings of (for example) David A Sinclair in his book "LifeSpan" or "Age Later" by Nir Barzilai. Both are at the cutting edge of longevity science and discuss metformin in depth, not like this inept & myopic truncation of the actual science.
8
As a physician and researcher, I would caution readers to be skeptical of any results of a single small study, of this or any subject. Studies need to be reproduced by other laboratories, methods and subjects scrutinized for any potential bias, etc. Otherwise they really aren’t considered valid. For example, if you follow the link to the study this one references, you will find scores of studies on metformin and exercise, both in humans and non-human subjects, with varying results. It would be helpful if articles in the press would state this clearly, rather than imply that readers should make life decisions based on these studies, which they should not. Science is very important in modern life, and I would hope that the press would take seriously the need to educate the public on how to interpret results that the press reports, especially in our current circumstances.
23
@Dan Urbach Well said, and I agree strongly
Research results in biology are famous for their variability or even irreproducibility. People need to keep that in mind when reading stories like this one.
4
@ridgeguy No, I think you guys are totally off base. If anyone just performed the canonical exercise advice in the relevant exercise physiology textbooks, they would be solidly in the zone today, and that material hasn't changed for decades.
Smart people are taking in this information and using it- I really don't understand this appeal to a precautionary principle. Nothing has changed- except for perhaps the legions of people who were popping Metformin and are now inclined to believe they were fooled.
No prescriptions are necessary, people. Just sweat and time spent. Try it before going to Dr. Feelgood who sees 1000s of patients and will write a scrip for anything to get you out of his office so they can move on to the next drug-seeking slob.
3
@Dan Urbach You don't need all that, Doc. You just need common sense and some humility, and some impetus to do actual aerobic work instead of sit around waiting for a magic bullet that will never arrive.
2
Metformin is a great drug for people with type II diabetes. That does not mean it is a great drug for everyone, whether or not it promotes longevity. No drug comes without a downside.
So many people are looking for the "magic pill". They don't want to hear that the key interventions for health are what we have always known: stay active-physically and mentally, eat moderately, and pay attention to your emotional health. It helps if your parents had a long and healthy life as well.
15
I've been taking Metformin for Type II Diabetes for over 15 years. The medicine, in combination with an hour's worth of exercise six days a week and counting carbs has enabled me to keep my A1c in-check and either at-or-below the diabetic threshold consistently without the use of insulin.
I sometimes wonder whether the reason Metformin is associated with longer lifespans is because the people who take it are, more often than not, the diabetics who avoid having to take insulin. In other words, if you're on Metformin and not insulin, you're more likely to be doing other things to control your diabetes (like diet and exercise), which, by definition, is more likely to keep you in decent shape. And if you have a reasonably good diet and exercise regularly, you're also doing more than the average American...so again, you're just more likely to live a little longer. In other words, while Metformin clearly works for diabetics, I wonder if it's also not simply a cause of better health, but also a marker of better health and well-controlled diabetes (which requires better than average lifestyle habits)?
18
Metformin appears to be quite the anti-aging drug. Diabetics who take Metformin do better than non-diabetics. So it appears that diabetics who take Metformin can have their cake and eat it too! Just think about that for a minute.
Can people with type 2 diabetes live longer than those without? A comparison of mortality in people initiated with metformin or sulphonylurea monotherapy and matched, non-diabetic controls https://pubmed.ncbi.nlm.nih.gov/25041462/
Metformin reduces all-cause mortality and diseases of ageing independent of its effect on diabetes control: A systematic review and meta-analysis
https://pubmed.ncbi.nlm.nih.gov/28802803/
If I had room I could prove that Metformin included with other known approaches is MOST DEFINITELY an anti-aging drug.
That being said, the Metformin group gained the same strength in this study without having to tear up muscle tissue. It literally reduces the wear and tear during normal aging. So ignore this nonsense. Even the authors of this study say that the data is being misrepresented in the media for headlines, as in this article. The subjects gained the same strength without the hypertrophy. So move along now. Nothing to see here.
12
1. Diabetics on metformin live longer because their diabetes is better controlled. Their life expectancy remains around ten years less than that of somebody in the same general shape without diabetes.
2. Grabbing the first two things that pop up in a googlr search is not research.
2. Especially when you don’t read the stuff and just stick it to some gibberish about exercise.
4
Metformin lowers B12 substantially. Low B12 causing elevated homocystine and high homocystine contributes to atrophy of the brain, dementia.......
Is it worth it? SERRAPEPTASE is natural and great for inflammation. My C reactive protein, test checking for inflammation in the body, was superior. At age 68.
4
@Shioban
Your comment seems to run against the findings of the study in questions. Seems like a ad for a supplement.
10
I was taking Metformin to lose weight along with walking 5 miles every day. Of course at first the walk was difficult but I figured that it would get easier and that eventually Id be able to jog it. It never got any easier causing me to quit. I did lose weight and then discontinued the Metformin. I would like to try walking again to see if it gets any easier now.
7
If Metformin was taken by millions of people for decades, then we must have a huge cohort of people that appear younger compared to non-Metformin takers.
So why not study those on Metformin for 10y plus, and try to figure out if they actually aged less, or if the results were minimal?
18
@Emre because the people on metformin also have diabetes so you are comparing non-diabetics to diabetics
2
@Emre
You are correct a larger study is needed. However as far as a huge cohort of people that appear younger according to this limited study, it would be the people NOT taking Metformin who would appear younger while the people taking Metformin would have aged. So definitely more research is needed.
@Emre it has been studies. People who take metformin live significantly longer, even if they have diabetes.
5
I have been taking metformin for over 10 years. Anyone who is taking metformin must also take a good B-12 supplement or the benefits are not as good. I can also say it cured a disease I had/have. I can prove it. I was diagnosed with Lattice corneal dystrophy when I was 20. By the time I turned 35 I had several corneal grafts to replace my corneas. You see lattice dystrophy cause amyloid growths in your cornea. These growths eventually restrict your vision. When I was 35 I was diagnosed with type 2 diabetes and was prescribed metformin. Since that time I no longer have the amyloid growths. My cornea specialists have never seen anything like it. I am on Metformin to this day at 60.
8
@Dana
You can't draw conclusions from the experience of one person.
To claim metformin cured you is not possible to prove or disprove. Your cornea specialists have never seen anything like and may never see anything like it again.
10
@Pablo correct. Correlation doesn't equal causation.
5
@Dana
Your comment caused me to reflect on a similar experience. I was diagnosed with Type II Diabetes in 2015. At the time, I needed both short and long distance vision correction; over the past five years my eyes have actually improved with each visit to the eye doctor. I no longer need my distance glasses and rarely use my reading glasses. I know this is just anecdotal but interesting none the less.
5
I'm curious as to the racial breakdown of the people tested...and if the results showed any differences in that regard.
If you’re looking for an anti-aging product, look no further. Dermalmd one will stop the aging process and maybe even buy your skin a few years.
Mitochondria are the primary source of reactive chemical species that damage cellular contents such as DNA. It is not surprising that metformin is associated with longevity in animal studies since it suppresses the formation of new mitochondria. A reduction in mitochondrially-produced reactive species would result in less damage and slower aging.
12
I was prescribed Metformin for pre-diabetes but my body could not handle it. Severe stomach cramps that were debilitating. I got off of it and decided to completely change my diet instead, going to more plant based alternatives, and quit all alcohol. 6 months later my blood sugar levels are fantastic, I’ve lost 37 pounds and I feel amazing. And I’m 65 years old. Diet is the key. With proper food choices you do not need Metformin.
18
@Alice
For anti-aging, I lowered the dose drastically and all side effects resolved.
The dose is 125 mgs. a.m. and p.m.
IMO, this does not affect my aerobic or weight lifting capacity.
The dose that caused side effects was 400 mgs. a.m. or p.m.
So far no side effects.
5
@Alice
For anti-aging, I lowered the dose drastically and all side effects resolved.
The dose is 125 mgs. a.m. and p.m.
IMO, this does not affect my aerobic or weight lifting capacity.
The dose that caused side effects was 400 mgs.in the a.m. and p.m.
I do not have health issues and was only taking it for the proclaimed anti-aging benefit.
So far no side effects.
@Alice
For anti-aging, I lowered the dose drastically and all side effects resolved.
The dose is 125 mgs. a.m. and p.m.
IMO, this does not affect my aerobic or weight lifting capacity.
The dose that caused side effects was 400 mgs.in the a.m. and p.m.
I do not have health issues and was only taking it for the proclaimed anti-aging benefit.
So far no side effects at the lowered dose. Also, when taking the metformin, I am not as hungry for sweet foods as I am, when not taking it.
1
I was prescribed Metformin for diabetes and suffered debilitating side effects including acid reflux and headaches. Before I took Metformin I never had acid reflux or headaches. I now rely solely on diet and exercise to control diabetes.
7
This is kind of obvious that there's going to be some unintended effect there when one understands that the metabolic pathways that the drug aims to influence are similar to (only some of, certainly not all) the major hormonal benefits of intense exercise... but ya know, why work hard for anything when you can take a pill that that almost mimics a bare minority of the beneficial effects, right? Sigh.
3
I think this article is premature.. because as the researchers themselves admit... more research is needed.
The core issue with early research findings, and publishing them in new sources like the NYT is that it almost always triggers some patients to want to stop taking a medication on the basis of limited outcomes.
The reality is.. this is interesting information, but inadequate to make any findings one way or the other. In fact.. most medical research is generally inconclusive because of different parameters of the study.. which is why so many medical studies contradict each other.
What is needed here.. and will not happen.. is a large body controlled long term study... as in 5000+ patients followed in a peer reviewed process over a period of 5, 10, 20 years.. before making any conclusions.
16
@Chuck
Very true Chuck. Just as people like to announce health claims for their favorite supplement or medication. The same people reject the results of long term controlled studies.
4
Slow aging? Such a First World meme.
How and why would anyone/group think 1 drug, which has very narrow effects on the body, could truly slow the aging process? Which involves a multiplicity of factors and interactions, both internal and external - over the course of time.
Every Rx drug, even the OTC types - have an effect on things not related to what they were developed for, and in most cases those are negative effects.
Of course this drug would negatively effect some other function in the human body. Duh! Name a drug that doesn't have negative side effects? And all those side effects in turn, will effect the body's health and its longevity.
Plus, never factored into the longevity "prescriptions", after their inadequate diagnosis procedures - is the real and true effects of ones life prior to that moment. What are the real effects on the body of all the many internal, and maybe more importantly - external effects..?
Take good old stress. Childhood stresses we're discovering have huge impacts on health, that are immediate and not.
We have no real clue what the long term effects of growing up poor, and undernourished does. Or wealthier, overfed, and in many cases under-nourished. The poor face daily stresses that the wealthier do not.Then on the flip-side of that coin, the wealthier face different stresses too.
How do we measure any of those? How do we control for them?
Plus, only the truly wealthy can afford Longevity Therapy, so that group is deeply flawed.
5
@Boregard
I agree with you on this.
A large majority of the world population simply wants to be able to age to a reasonable life span with a reasonable degree of comfort.
Only in 1st world nations where people are obsessed with the latest diet or exercise or supplement/drug findings is this topic presented here an actual thing.
7
@Boregard
Very intelligent comment.
Not mentioned in this article but something my doctor told me: metformin helps reduce appetite, and thus can help reduce weight. Because of this, I take my morning metformin before I eat breakfast.
12
@Joseph Hanania
Great addition to the discussion.
My father in law (he is 86) was just taken off of Metaformin for the time being by his MD.. because he has lost too much weight and needs to gain some to be in a healthy range. A combination of a common anti-depressant (known for promoting appetite as a side effect) prescribed and the removal of Metaformin has worked wonders for his appetite.
My father in law has type 2 Diabetes and has for many years, but his MD evaluated that he had sufficient blood sugar control with his lifestyle that it would be low risk to take him off Metaformin for now. At 86.. insuring proper appetite and weight management is a higher risk for my father in law then his current blood sugar levels. Of course his blood sugar will be more closely monitored as well to insure it stays stable, though somewhat elevated.
2
@Joseph Hanania As a female, early 60s-- I ran to get on the metformin craze as a cancer prevention. It was originally made from french lilacs and thus I think of it, perhaps naively, as a beautiful antioxidant. I happen to tolerate it very well, with a 2,000 mg daily dose. I do cross-fit and therefore strength as well as aerobic exercise 3-4 times/week. My BMI (a ridiculous measurement as far as I can tell) is around 30 and I am decidedly not obese. I am writing to admit that this article speaks exactly to people like me. My stamina and endurance during exercise has not progressed as I would have expected. I was prescribed metformin at my request when I saw that I was in the pre-diabetic range, and now it's accepted protocol forMDs for pre-diabetes. Personally I i take it for all the effects I read in studies, as much as for pre-diabetes. I'm certain it's helped me not get full-blown diabetes plus it helped me lose about 20 lbs and maintain my weight-- even with occasional slices of bread, pizza, a beer here and there. I also enjoy refined sugar in my diet about 2-3 times a week in the form of a cookie or icecream. After coming across this article 2 days ago I cut my 2,000/day mgs of metformin in half and I will be curious to see if my stamina at the gym improves.
11
@SamJ 2,000 strikes me as an unnecessarily high dose. I'm 77, female, not diabetic and on 500 /day with positive outcomes.
Do not take a drug to prolong life. Instead, eat sensibly, exercise sensibly, do not become overweight.
13
@shirley : If it works, why not?
2
It should be noted that metformin does deplete the body of B12 ...D3 and magnesium...........serum folic acid levels CoQ 10. But especially D3 which is essential for proper mitochondrial function.....follow up blood tests for depletion of above stated are essential
11
@Neil Details of your sources, please?
4
@Neil
Yes, Neil it does drastically reduce the levels of B12 in the body. This lack can cause anemia and fatigue.
Also the active form of b12 known as methylcobalamin should be used as some people lack the ability to convert cobalamin to the active methylcobalimin form.
5
A possible explanation for these results is as follows. Sirt3 is an exercise induced mitochondrial enzyme that stimulates increased mitochondria. In this report below, metformin decreases Sirt3 in liver cells. Patients who need metformin should continue to take it, but healthy patients should waist for more information. There are natural compounds that induce sirt3 (honokiol), but clinical studies have yet to be performed
PLoS One. 2012;7(11):e49863. doi: 10.1371/journal.pone.0049863. Epub 2012 Nov 16.
Metformin reduces hepatic expression of SIRT3, the mitochondrial deacetylase controlling energy metabolism.
Buler M1, Aatsinki SM, Izzi V, Hakkola J.
Author information
Abstract
7
Metformin was a horrible drug for me, kept me nauseated and vomiting nearly daily for 4 years before I said no more. I use insulin instead now, much better.
3
@AgentG
Taking the recommended dose of Metformin is the reason I have lost half of my kidney function. I stopped taking Metformin a long time ago but there is no way to get my kidney function back. I take Januvia a brand name drug that is a lifesaver for me. Now on Medicare, I qualify for Extra Help for my drugs and pay only $8.50 for a 90 day supply of Januvia. I am also a Health Insurance Agent who sells Medicare supplement, drug plans and advantage plans. I am saddened to see many newly diagnosed Type II diabetes patients taking metformin prescribed by their primary care physician.. See an endocrinologist to find the best drug options for your overall health.
14
My dad did not react well to Metformin either. Did a number on his stomach. He’s on Januvia (sp?) now. He’s much better.
2
@Linda Sounds like you have a stake in Januvia, and I will guarantee you few people will pay that much - or maybe only for the first 90 days.
3
Great piece! You may want to look into the new study on mitochondrial boosting compound, Urolithin A (UA), which was just published in the rigorously peer reviewed journal Nature Metabolism. https://www.nature.com/articles/s42255-019-0073-4
2
@Urolithin Well, not sure if we have to take urolithin (most easily available as pomegranate juice) if we exercise: "The present study reveals that UA induces a molecular signature response, in both the plasma and skeletal muscle of humans, resembling that observed as a consequence of a regular exercise regimen."
10
@Urolithin A
I’m not sure what you can learn by studying 24 patients taking a medication for four weeks.
19
I’m a type one diabetic dependent on insulin.
Would metformin do me any good?
1
@God Fearing
I am a Type 1 taking insulin (only long-acting insulin, no short acting, with low carb meals) and 500 mg slow-release metformin at night. The metformin seems to reduce my insulin need during the night. The combination works a treat, very good glucose control.
4
@sissifus
Thank you.
I will suggest it to my doctor.
2
I just read the full research article that this is based on, and found a couple of, in my opinion, major caveats. The biggest one is the really high dose of metformin used - 2,000 mg/day for most subjects, 1,500 mg/day for five subjects with lower body weight. These are rather high doses used in people who do not (!) have Type 2 diabetes. Yes, they were considered at potential risk, but none of them was a diabetic. And, I believe that this high dosing is a problem. In many situations, the doses of a drug used for prophylaxis are significantly lower than those used for the actual condition, and for good reasons. Metformin at 2,000 mg/day is actually pretty close to the usual maximum daily dose used in actual type 2 diabetes - 2,500 (2,550) mg/day. So, what this study shows is that giving high doses of metformin to non-diabetic patients might adversely affect some cellular effects of their exercising. I am not surprised. It does not tell us what happens at lower doses of metformin, which is what might be more sensible if the intended benefit is not the treatment of type 2 diabetes.
53
@Pete in Downtown
I agree!! Now, let's test those who do have Type II and take Metformin. Keep them on their usual dose. We may see a different result.
12
@Pete in Downtown
Absolutely wonderful point!
No one that practices Healthy Aging Medicine uses high doses of Metformin for healthy aging that I know of....
We are NOT trying to use "disease" doses to treat health....rather low doses to stay healthy....
14
The lesson--don't take a drug you don't need. If you have DM2 or if you have pre DM worsening and on the brink of frank Type 2 DM Metformin does help. Don't take Metformin to prolong life. Exercise to prolong life and stave off disease and continue to exercise on top of taking meds if you do have diabetes or high cholesterol or high BP. If your sugar is perfectly normal and you take Metformin the drug is diverted from its primary use to secondary unintended effects like exercise hobbling.
13
@Usha Srinivasan
You really sholdn't comment on things you know little about.
8
I would like to see a similar study done on the effects of taking statins while going to the gym. In my case, I ended up with rhabdomyolysis.
12
@Laughingdog
This is a known and uncommon side effect of statins.. and is why your MD needs to monitor you on statins and why they are prescription drugs.
I doubt that exercise triggered this.. but I guess it is possible. Were you doing extreme exercise routines? I ask because that in and of itself could aggravate an other wise normal response to statins. rhabdomyolysis is also a known side effect to over stressed muscles in some people. I ask because I am on a statin and do a 30 minute cardio workout 6 days a week, and have suffered no signs of any side effects from the statin.
2
As the cell respires with exercise it creates lots of antioxidants and other signals that travel to the cells nucleus and triggers of genes that are designed to repair, replace and increase the mitochondria. A study showed that doses of antioxidants given to exercisers blocked the antioxidants but decrease mitochondria changes, Why? the blocked antioxidants did not reach the nucleus and no repairs etc, done. It maybe metformin does the same.
3
Can’t believe this study was even published! A small group, 54, and ONLY 45 days?! Hardly enough to matter!
A medical crisis led to the removal of a third of my pancreas, I now have Type 2 Diabetes and take larges doses of Metformin three times daily. PLEASE someone do better research than this!
13
@Mari
Both the article and the original research study go to pains to state that this is not a definitive study. Rather, it shows an unexpected effect of metformin that has not been seen in humans before. You are absolutely correct in assuming that this should have no impact on your own situation, but it's an interesting study, and I think it's fair enough that the NYT would publish this. Lots of otherwise healthy people are taking metformin because of certain effects of the drug, so it's useful for them to know that these may not be the only effects.
6
@Mari
This was about normal people not people with Type 2 DM.
2
@Mari
When the effect size is large (as in this case) you can be statistically confident in your conclusions (that there is an effect) with fewer observations. This is necessary to get it published and be hypothesis forming and inspire additional work to confirm or refute the hypothesis. This is how science works- we are woefully underfurnished in our understanding of the process.
2
Metformin is known to decrease vitamin B12 serum levels. This study should have included a third group taking both Metformin and B12 supplementation. By the way, in terms of mitochondrial health, HIIT is much more efficient than straight aerobic exercise.
12
@SA
Good point about the B12, but I disagree that the researchers should have included a third group at this point. These studies are expensive, so it's far more effective to ask a single question in this kind of 'signal seeking' study, and then go on to broaden the question if there is a result. Hopefully this will spur follow-on studies and hopefully the Times will report on those too, even if the results are not exciting...
1
@SA. Metformin also reduces uptake of folate, which is why it's a good idea to get a bit (but not huge amounts) extra folate over the RDA if taking metformin.
7
The article (and, apparently, the study described) left out a key question, and that omission may have serious negative health consequences for many: Is the described blunting effect of metformin on the benefits of exercise also true for people with Type 2 diabetes? The standard treatment of type 2 diabetes is a combination of medication (first line: metformin), a low glycemic, healthy diet, and exercise. This article suggests that the exercise component is devalued by taking metformin, which may well lead many type 2 diabetics to either not take metformin or skimp (skip) on exercise, either of which would be quite deleterious to their health. NYTimes, please follow up on this, check with experts, and add clarification as available. Thanks!
32
@Pete in Downtown. And yes, I saw the "don't stop taking your metformin" by one of the researchers, but that just doesn't answer the question. "Don't stop taking your meds" hasn't stopped many from doing just that after they read some negative news about it, never mind what the risk/benefit of stopping actually is.
10
@Pete in Downtown
Exactly my question. Hope to see some responses from the medical community.
2
Just 53 subjects IN TOTAL. Hardly definitive. Ensuing studies will likely produce different findings, followed by meta-analyses averaging them all out. Research will go on -- as it should. The problem is media distortion, suggesting more certainty than we have.
7
Statins have also been shown to block fitness gains from exercise, and gps are still handing them out like candy, without cautions.
In the end, though, to some extent I think it comes down to pragmatism. A lot of people who have dyslipidemia, diabetes, or pre-diabetes could reverse their problems and just age more healthily in general with exercise and a healthier diet. But what fraction of them are actually going to do that? At a certain point, after someone swears up and down they'll make healthy changes and then doesn't for the nth time, it might be better to accept that it's probably not going to happen.
11
@Polly
Not so simple unfortuantely. I am a competitive athlete (rower) who is also on statins. I tried tailing off the statins while keeping my 5X/wk, 60'/day at moderate to high intensity training. Lipids went right back to where they were before I started on the statins.
And always exercise! One lesson of this study (and many others with much larger sample sizes) is that excercise has many beneficial effects that act through several pathways in the body - extremely unlikely that they will be replicated by a single drug/supplement or even a combination.
Measure. Consult. Think. Act.
10
@Savvy - follow your directive:
Measure. Consult. Think. Act.
Like 14Fourteen said, statins correlate well to heart disease. Look it up.
2
@Savvy
Why did your doc put you on statins? If you are healthy, have not had a heart event, but are just doing it to achieve some arbitrary LDL level, for Pete's sake, stop taking them. Go read the research--many more people develop diabetes when taking statins than are spared heart or stroke events. In my case, statin-induced myalgia has robbed me of the pleasure of walking with my wife.
3
Death comes for us all.
Want a cure for Alzheimers?
Forget about it.
11
@RM
Very cute.
2
Actually, doctors are not "very cognizant of drug-drug interactions", as the doctor here claims. Very few studies have been done on polypharmacy, let alone studies on post-market consumer side effects of prescription medications. While BigPharma say they will do these, they seldom follow through. It really is Buyer Beware. As for the FDA's record on prescription drug safety policing, it's abysmal, thanks to corporate campaign cash to our politicians - which make sure to keep the agency weak in this regard.
22
Three things you don't want to see being made: sausage, taxes and FDA decisions on drugs.
The clinical trials are generally inadequate, narrow, sometimes scientifically unsound, and awash in money from Big Pharma, which has captured the FDA through a revolving door between the two. Sound evidence on drug interactions is meager.
17
@Dan K..."The clinical trials are generally inadequate, narrow, sometimes scientifically unsound,"....Have you ever been involved in an FDA clinical trial? What are your qualifications?
17
Well, if metformin will lengthen my life, I might be able to put up with fewer mitochondria. They probably make it so I can jump higher when my wife tells me to, but that’s not my priority actually.
12
@roseberry. Yes, the question is why do I exercise? If it's for an Ironman competition, having a lot of highly active mitochondria in my muscles is key. If it's for better health even at older age, not so much. As far as I can tell, the study didn't address the second scenario.
5
@Pete in Downtown Can't say I agree with that assessment. Mitochondrial respiration is essential to all. Impare it or let it decrease with age without interventions and you get ill and die sooner. Nothing to do with athleticism.
1
I have been a lifetime hiker, and have had Type 2 diabetes for more than 20 years, but I never tried to quantify the benefit I receive from simple walking until just recently. The results astounded me: a 1.4 mile walk reduced my blood-sugar by 100 points. That is enough to make it imperative that a blood test be taken prior to exercising, as well as after & that a source of glucose be ready to hand.
I spoke to my endocrinologist about this, and she mentioned that some people do not respond as such. Now, I wonder what their medications are. BTW, I'm 63 yo.
10
@David Thomason
The glucose lowering ability of exercise of any form can have a prolonged effect of up to 36 hours in some people. The bottom line though for most T2 diabetics and prediabetics is weight reduction by any means.
8
@J L, MD
can you elaborate on "by any means"? How do you advise your patients to lose weight and keep it off?
1
With a lot of patience, regular visits, inquiring as to the specifics of diet and exercise early in each visit, and by setting an example with your own behavior. A doctor will not be very successful getting someone to stop smoking if they smoke themselves. Likewise a doctor will not be very successful in getting patients to exercise if they’re not exercising themselves, or to lose weight if they are fat themselves, or to eat a low-fat diet if they are doing so, or just stop or moderate drinking if they are drinkers. It is very effective when a patient asks me what I eat and I can honestly say I have not eaten meat in over 25 years.
14
It's worth pointing out here that there's more than one definition of "exercise" and "fitness." Both the study and this article focus on "aerobic exercise" and seem to suggest that there's no other worthwhile type of "fitness." I'd argue that fitness also includes strength training. Studies of exercisers have found that increases in mitochondrial capability and function are much less significant, if not absent, for weightlifters than for aerobic exercisers (running, biking, swimming, etc.)
Thus, I suspect that even if this study is true you can increase your fitness (i.e. strength fitness) regardless of Metformin's effect on mitochondria. (FYI, I'd never take a drug like this unless forced to. I'm an exerciser, doing both strength and cardio.)
I raise this because the study subjects are in their early 60s and have an average BMI of 30 making them technically obese. What they ought to be worrying about first and foremost is retaining enough bodily strength in their 70s-90s to be able to walk, get up out of chairs, etc. It would also be advisable to increase their cardio fitness. Even if this med prevents them from serious improvements in cardio fitness, they can still do a good job with some of strength training. (The best option would be controlling diet, losing weight, and exercising without meds at all.)
14
@Paul B
"What they ought to be worrying about first and foremost is retaining enough bodily strength in their 70s-90s to be able to walk, get up out of chairs, etc."
So true. My mother rarely exercised and at 89, she lost the ability to stand up from a sitting position and eventually a stint in rehab, she would up immobile in a nursing home and died several months later at 90.
6
@Vic This is so true. My parents didn't stay active after their kids were grown. They have become more and more sedentary and have always been obese. I tried. I gifted them with light weights, resistance bands, and "how-to" DVDs. All were quietly donated to The Salvation Army. Now, at only 80 and 81 years of age, NEITHER parent can stand up anymore. Both are in a nursing home, are lifted from bed into their wheelchairs and back again by a Hoyer lift machine, and are battling depression because of their situation. Mom has dementia (possibly another fallout from lack of exercise) and is on the highest possible dose of two separate antidepressant medications. Both are very lonely, as they are the youngest residents of the nursing home and most other people around them cannot even talk.
Please, everyone, if you don't already exercise, please do it on behalf of yourselves and those who love you who will have to watch you suffer and who will therefore suffer along with you.
5
Another week, another Science Times article based on a very limited study.
"The study followed only a small group of people for a relatively short period of time and examined a mere fraction of the voluminous bodily impacts of exercise and metformin."
Then don't publish an article about it!! The role of proper science journalism in this situation is to inform the public about important changes in common scientific knowledge, the sort of changes that lead to epistemological confidence because of meta-analyses or very broad studies, especially multiple studies that each the same conclusion. Singular studies with limited subjects are suitable for science journals and limited audiences of fellow scientists who have the proper training and understanding to place a small data point in a constellation of other data points.
I'm honestly a bit depressed when my hometown paper does this sort of shoddy work. I'm sure there's a study out there with n=14 that can help me with this condition.
17
@Locho
These types of stories can be useful if viewed in the proper perspective. The reader should come away thinking that there may be something relevant in this study but further study is needed and the scientific community is a long way off from any additional conclusions about Metformin.
14
Well said: You may be interested in this research:
https://www.lifeextension.com/Magazine/2017/CE/Metformin-Slashes-Cancer-Risks/Page-01
1
@Dan M
yes, of course they're useful to the scientific community, not the general public.
1
Is Metformin profitable? That's the only test.
2
@Sang Ze no it's essentially free. It all comes down to the balance of oxidants vs antioxidants
3
@Sang Ze
No, it is an inexpensive generic
6
@Sang Ze. From the perspective of big pharma, metformin, a cheap generic, is annoyingly effective and cheap. Still the go-to first line medication for Type 2 diabetes.
6
Metformin is a drug that raises serious hazard of lactic acidosis. Since only a small percentage of people diagnosed with "prediabetes" ever progress to diabetes, it is difficult to comprehend why anyone would take this drug on an elective basis, particularly for cosmetic reasons.
7
@Sequel
Lactic acidosis only occurs with metformen in moderate to advanced renal failure. As long as the doctor is monitoring renal function studies, lactic acidosis poses no risk to patients with normal or mildly abnormal renal function
21
@Sequel
its not difficult to comprehend. Lactic Acidosis is a rare side effect.
6
@Sequel I'm a physician in practice for over 25 years. I have never seen a case of lactic acidosis from Metformin. We watch the labs for kidney function too closely to allow that to happen.
1
Is there anything in this universe that in giving with one hand does not also take with the other?
12
@Slipping Glimpser....Worked in drug research for a major pharma for 30 years. Among my colleagues there was a saying - any drug that has real biological activity will necessarily have side effects. The side effects may not be serious, the side effects may not appear in everyone, they may dissipate with time; but they will have side effects.
17
The medical industrial complex can find a way to prescribe any drug for any reason under any circumstances. The NYT recently reported on one example that is representative of common practice.
https://www.nytimes.com/2019/04/17/us/doctor-arrested-prescription-drugs.html
"Doctors Accused of Trading Opioid Prescriptions for Sex and Cash"
1
@Dan M
Dan, this is not common practice
8
@Dan M. This (metformin) is the wrong drug for making the big bucks. It's generic, easy to make, and very cheap.
12
OK, purely anecdotal indications here, but my personal experience taking metformin (for Type II diabetes), exercising, and limiting carbohydrates was: weight loss, increased fitness and strength, and vastly improved blood sugar.
When I had to temporarily drop the metformin (long story), I gained weight and found it much more difficult to limit carbohydrates, then also lost fitness and strength.
Back on metformin now, and struggling to get back to where I was.
24
@Kath This has been my experience, also. I am Type 2 diabetes, but within acceptable guidelines for BMI.
9
The result should not have been surprising. Other drugs with anti-inflammatory properties, such as ibuprofen, have also been shown to blunt the beneficial effects of exercise. The beneficial effects of exercise result from the body's adaptation to the stress/inflamation from exercise. If you reduce the stress/inflamation from exercise as a result of taking an anti-inflammatory when you exercise, you are go to get less of an adaption effect from exercising.
28
@Becks True. Antioxidants do the same.
@Becks
yes!
Also, seems not to be common knowledge that metformin also reduces testosterone. This really helps women with pcos but men and some women…not such a desirable side effect.
Men should have testosterone levels monitored and be given testosterone cream to compensate.
Also, just losing weight, no matter the cause, reduces total muscle…
Add these to the more commonly know side effect of reducing b12, which can be supplemented and maybe there is some of the explanation.
1
My wife and I recently became interested in Nicotinamide Riboside for anti-aging and ordered the supplement. Shortly after that we learned of studies showing a relationship with the substance and cancer cell growth. Possibly raising the risk of several types of cancer. Naturally, we discontinued taking the supplement.
6
@Ric Max What studies show this link?
2
We badly need substitutes for metformin. It is dispensed willy-nilly, and that is always bad. Glipizide and Januvia seem much more helpful. Each person's metabolism is a little different and must be diagnosed fully and correctly. Chromium and cinnamon are other means. Doctors must make more use of non-prescription items. To have even less benefit from exercise is deadly for those who can only do a little to begin with, such as those with Chronic Fatigue Syndrome.
Meanwhile. the plastic surgery industry uses fat freezing for the rich to get rid of their love handles, when it should be being used medically, to remove the lower-abdominal fat that seems to cause so much trouble. How is this permitted? How is possible that hmos will not cover such an effective treatment?
And don't forget the gastric distress caused by metformin. Part of the war on obesity continues to seem to be a lack of respect and disregard for the patients as individuals, particularly as the "science" behind it is based on not seeing them as individuals, such as when the evil Body Mass Index is utilized.
8
@Grittenhouse
Glipizide commonly causes hypoglycemia which can result in increased eating and weight gain. It can be particularly dangerous in the elderly who can go into profound life threatening hypoglycemia. Metformen does not cause hypoglycemia. Many people tolerate and do very well on metformen, although some cannot take it due to diarrhea, not gastric distress.
15
@Grittenhouse
Glipizide commonly causes hypoglycemia which can result in increased eating and weight gain. It can be particularly dangerous in the elderly who can go into profound life threatening hypoglycemia. Metformen does not cause hypoglycemia. Many people tolerate and do very well on metformen, although some cannot take it due to diarrhea, not gastric distress.
I do. To see that metformen is prescribed “Wiley Nilly”
3
@Grittenhouse The amount of cinnamon you would have to take to see any biological response beyond a placebo effect is beyond normal human consumption.
6
Simple but important question; What dosage of metformin? The study abstract doesn’t say, and neither did this coverage of the study.
12
I agree with Percy 100%. There is nothing to be learned from this study. The study design is seriously flawed due to no numbers, short duration, and the fact that it’s endpoint is a primarily a lab test, not disease status. I also agree that people should not be taking metformen for anti-aging.
Response to why don’t doctors prescribe weight loss and exercise instead of medications for diabetes: There is no question that weight loss and exercise can control the vast majority of diabetics. The problem is convincing them to do so. High carbohydrate diets and lack of exercise are learned at a very young age, and after many years of such unhealthy lifestyles, it is hard to get people to change.
Many of my patients are bewildered when I go over their food diary at multiple visits, pointing out specific changes they could make. “That’s not food....drink water instead of soda?...cut back on my 6-pack of beer?....Eat fish instead of meat?...Soy products and vegetables?...no donuts?....Cut out potatoes?....etc, etc.”
30
I have treated tens of thousands of diabetics over 45 years, and the first effort I always make with a new diabetic, and keep reinforcing at each visit as long as I see them, is weight loss and exercise. Those who take heed usually do well and often do not need or can get off medication. Unfortunately the majority just want a pill and don’t want to hear about anything else. Using meds to lower the A1C is better than leaving people at 13%.
Re: metformen and neuropathy: Just because someone developed neuropathy while taking metformen does that mean cause-and-effect. Although your chances of developing neuropathy, vascular disease, kidney disease, retinopathy, etc., with poorly controlled diabetes is greater than with well-controlled diabetes, there is no absolute correlation for every patient. I certainly have seen people with each of these diabetic complications with low A-1 C‘s, but if you play poker you are better off betting on three aces then a pair of deuces
38
@J L, MD
Seems like a good starting point to me. This raises a red flag and now more studies can be conducted. Far from "nothing to be gained." Quite the opposite.
6
@J L, MD Patients taking Metformin also need to have their B12 levels monitored. No one told me that the Metformin would inhibit B12 uptake until after I developed symptoms of neuropathy after 17 years of Metformin use. Adding a simple OTC pill back when I started taking Metformin could have prevented my symptoms. Now I know and the neuropathy has been partly reversed.
23
Although there have been no controlled human experiments with " Nicotinamide Riboside (a unique form of Vitamin B3) that raises Nicotinamide Adenine Dinucleotide( NAD+) levels which are linked to a slower aging process," there is some anecdotal evidence of its efficacy, again through mitochondrial revival. The substance is currently available as a commercial supplement. I have no financial interest in it.
7
You shouldn't be reporting on this study. The study group was too small, the study length too short, the lack of confirming studies too great. The abstract makes this clear, concluding:
"The influence of metformin on AET-induced improvements in physiological function was highly variable and associated with the effect of metformin on the mitochondria. These data suggest that prior to prescribing metformin to slow aging, additional studies are needed to understand the mechanisms that elicit positive and negative responses to metformin with and without exercise."
Metformin without exercise should increase insulin sensitivity and improve glucose metabolism, also causing muscle cells to preferentially take up glucose over fat cells. That the study found that metformin plus exercise attenuated this response is very unexpected. As the abstract's conclusion makes clear, more study is needed.
That being said, no one should be taking metformin as an anti-aging pill. No studies support this. More studies are needed to establish whether there is any real association between taking metformin and slowing the aging process.
Someone mentioned that a possible connection between metformin and neuropathy should be studied, and I support this.
16
@Percy00 There is a long-term study underway trying to assess the utility of metformin as an anti-aging drug. The study has been approved by the FDA. There have been other studies as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709209/
4
@Walter
Not sure what you mean by the FDA approving studies. They are not in the business of approving or unapproving studies. They allow or disallow medications to be sold to the public.
6
@J L, MD
As a drug development clinical researcher with over 30 years of experience with the FDA and clinical trials, it is technically correct to say that the FDA has allowed the conduct [approved] of a specific drug study. The fact that the FDA allows a study to be performed just means that the study has sufficient scientific validity and safety. Additional approvals needed to start a study are obtained from an ethics committee and from the study patients (written informed consent).
1
The Steno-2 study compared a protocol of lifestyle combined with metformin, atorvastatin, ACE inhibitors, and aspirin with usual care in patients with type 2 diabetes and small amounts of protein in the urine. Twenty-one year follow-up shows an 8 year delay in developing complications and an 8 year prolongation of life at lower annual expense in humans. Metformin inhibits the mechanistic target of rapamycin (mTOR) directly. The other medications mentioned inhibit it indirectly. These are all antioxidants that work. Excess mTOR activation is involved in aging, cardiovascular disease, and cancer. Exercise and caloric restriction also inhibit mTOR. That is a common denominator of interventions that improve health and slow aging.
I take metformin for prediabetes. I am 72 years old. With regular resistance exercise. I have increased my ability to do 20 arm curls from 45 pounds to 80 pounds. Evidence in humans trumps small animal studies and opinion.
22
I was prescribed metformin in 1998 for Type 2 and took it until 2016. During this time I developed serious neuropathy and some loss of short term memory. I also exercised regularly, was a successful competitive Masters swimmer. I stopped taking metformin after losing 35 pounds over three years by becoming a vegetarian. I think research should be done on the effect of metformin on dementia, short term memory and neuropathy.
42
@Dren Geer
Metformin interferes with B12 uptake. You need to take a supplement so that you get enough even with the reduction in uptake. And, I think, a B12 deficiency can indeed cause neuropathy. However, diabetes is also a cause of neuropathy.
2
@Jennie To be more precise, diabetes is the MAJOR cause of peripheral neuropathy in the United States.
This is another fiasco with people using small bits of evidence to sell drugs (or other things) to the public with the hope of slowing ageing--as if that is always a good idea. Long life does not consistently coincide with a good or healthy life.
We predict effects based on testing we have at the time, not necessarily because the testing measures anything definitive. In ten or twenty years there may be many more hypothetical pathways to model and the results could be even more conflicting--or not.
These sorts of speculative behaviors are hardly new. When a prominent scientist endorses an approach, that approach may be given credence just because of someone's reputation, not because the idea has been adequately investigated.
We have plenty of examples of similar nonsense, for instance with much of the nutraceutical industry. Look at what has occurred with the over-hype of vitamin C by Nobel winner Linus Pauling--we are still fighting about overzealous assumptions and inconclusive bits of information.
One lesson: anything that can be oversold as "healthcare" will be. And it will be years untangling all the unproven assertions. Maybe this should be no surprise, given the slow and incremental process of scientific discovery. Healthy skepticism is still a valuable commodity.
21
Why take it? There are numerous examples in which changes in diet and exercise correct adult-onset diabetes. Why is the medical community so intent on testing and prescribing, instead of diagnosing and treating?
35
@SchnauzerMom It could have a little something to do with the fact that probably around 80% of their patients don't want to do what it takes to get healthy and prefer taking a pill. I think I would get tired of trying to help people who don't want to do the work and would probably just give them the pills. I'm not saying this is the right thing to do but I can understand what's happening. I myself am taking metformin but I have also changed a lot of bad eating and exercise habits and will probably get off the med soon. I'm feeling so much better, more active and have managed to lose some weight in the process. It's all about major lifestyle changes that so many people don't want to bother with.
8
@Vicky I did all the recommended lifestyle changes and my A1c fell only slightly. I resisted taking metformin because I didn't want to add to my personal pharmacy. Long talk with my doc on the long term effects of not controlling A1c better finally convinced me to accept it. I would like to get off the med but it seems like the conventional wisdom about lifestyle changes doesn't apply to everyone. I did the work and did not get the results. Am continuing to do the work. Tired of people making blanket statements about people like me being non-compliant and lazy.
66
@Linda I appreciate your comments. I also take Metformin, but I have lost 55 pounds, I am on a healthy diet, and exercise regularly. Still, my A1c only dips slightly. Therefore, I may need to stay on Metformin. Like you, I am not one of the "lazy" ones who prefer a pill. To the contrary, I would prefer to be taken off Metformin and know that I've done everything right to get off it. That is not possible at this point and may never be.
25
If you're interested in anti-aging measures, then check out The Longevity Diet, by Dr Valter Longo, director of the Longevity Institute at USC. (I have no financial or other ties to this author, and I believe I learned about it from a commenter here at the NYT recently.)
If you don't want to get the book, go to createcures.org and watch the videos. He has also done a Ted talk. Also search for his name at Amazon Prime, where there's a free video.
Or go to Pubmed and type in Longo, V. (He's published a lot of studies over 3 decades.)
I've just completed a do it yourself version of his five-day Fasting Mimicking Diet, (FMD). FMD is not a fast; it's a low calorie, short-term diet that persuades your body that you are fasting, thereby causing epigenetic changes and autophagy.)
I'm impressed so far. Have lost a couple of pounds and haven't been hungry until this 5th and last day of the diet, and then only mildly so.
Longo's book has also persuaded me that low carb, high protein diets may be less healthy that I thought.
Note that the reason anti-aging people take Metformin is that it is thought to mimic a fast--and thereby increase longevity. I find it much pleasanter to avoid nausea and to eat more veggies, nuts and fish, per Longo's advice.
21
Protein is bad.
Carbs are bad.
Fat is bad.
Just avoid all those and you’ll be fine!
6
@Kara Ben Nemsi
I know, I know, Kara. If I could eat nothing but good bread and butter for the rest of my life, I'd be perfectly happy--but not likely long and healthily-lived.
An update on the FMD: I'm on Day 6, so eating normally again. I've lost 3.2 lbs over 5 days. The same danged pounds I've been trying to lose for 4 months on a very low carb (under 60 grams/day), hi protein, moderate fat diet! Feel great, energetic, only had my stomach growl in the morning on Day 5.
I'm sure a pound or so of that is water, so I wouldn't be surprised if end result is 2 pounds of loss.
One more reason to consider this: M.D. Anderson Hospital is funding the use of the FMD for cancer patients. It appears (so far in early research) to amplify (not replace) the effects of chemotherapy. Hopefully improves survival. Longo is worth following for the next few years.
6
David Sinclair takes metformin for anti-aging; he says the nausea side effect helps him with his caloric restriction. Doesn't sound like something I want to try.
Glucosamine is worth looking into; it's cheap, OTC, and side effects are rare (sometimes increases LDL, sometimes increases intraocular pressure in people with glacuoma). Google 'Ristow glucosamine metformin' for more. Don't take more than the recommended dose.
3
It is valuable to learn new information about a drug with possible anti-aging effects. The evidence for new benefits and risks of numerous Rx drugs and OTC supplements will only become apparent as well-controlled studies, conducted by medical institutions and academic centers accumulate. New uses for Rx drugs will become part of the product insert when companies are convinced of efficacy, safety and more profits.
2
I like this reader comment: “The message is simple metformin is a drug with serious consequences. Don’t take it unless you really need it.”
I agree with it. As does my brother. About 15 years ago, he was overweight and out of shape, when he was diagnosed with T2 diabetes (as well as several other conditions, including high BP, high cholesterol). He changed his diet to plant based eating (no animal products, minimal to no processed foods) and started exercising, and eventually lost 70 pounds and went off all his meds, including metformin.
In my mind, lifestyle is powerful, for good and for bad. Changes to a healthier one should be the first step for lifestyle diseases or conditions (T2 diabetes, cardiovascular disease, high BP, high cholesterol, obesity, etc), with drugs a very last resort. Patients should be referred to nutritionists and exercise coaches or other fitness experts. Get help with stopping smoking and drinking alcohol.
94
@Dr. J, varies w each person. I too lost 70 pounds after being diagnosed with type 2 diabetes, enough to not require I self administer Insulin, a big fear/phobia. I still need Metforim; increase dosage after 10 years, now 78.
Never smoked but exposed to a year of agent orange Viet Nam 66-67. Try to get a doctor to ask about/recognize that!
36
@Dr. J
There is a push on in Europe to get seniors to take no more than - and hopefully less than - three prescription drugs. None would be best, as they all are "poisons" to the body. All have consequences, many of which BigPharma doesn't want us to know, and even some which are hidden from the physicians. As for drug interactions, almost no one knows - no studies are done.
5
@Ellen
Come on Ellen; describing pharmacological medications as “poisons” is completely inappropriate.
(And expand your reading list too).
7
53 people in the study??? This study does not have enough statistical power to validate any conclusion. This needs to be followed up with a bigger pool size and longer follow up (Obviously I realize that this is more costly, difficult to administrate and will not be funded by pharma because of self interest).
54
@Admiral0V: 53 people still tells you *something* - and in this case, the "something" is important enough that it deserves to be studied with a much larger cohort, as I'm sure it will be.
42
@L
Err, who do you think will fund a larger study? Metformin makers have an enormous $ incentive to ignore this. There's not nearly enough government funding for general questions affecting public health--and no private interests are interested.
12
@Admiral0V
To achieve "statistical significance" (a threshold for publication), the findings in a small study need to be real dramatic, whether you like the size or not.
Actually, in a big study, the differences between test and control groups can be of no practical magnitude and yet professional journal editors (and some reporters) will be impressed.
9
Sounds like the same rabbit hole as statins and exercise. The message is simple metformin is a drug with serious consequences. Don’t take it unless you really need it.
Will they do a follow up study to see if mitochondrial production and insulin sensitivity ever return to normal levels after participants quit taking the drug? Or are these study participants worse off for the rest of their lives?
44
@SW You bring up statins and exercise, and of course you are exactly correct. In 2013, Gretchen Reynolds herself wrote a column years ago about this, citing in particular the work of Dr. John P. Thyfault.
Statins are the most prescribed drugs in the world, and they do indeed cut the benefit of exercise in an incredibly alarming fashion. ""The unmedicated volunteers improved their aerobic fitness significantly after three months of exercise, by more than 10 percent on average. But the volunteers taking (this drug) gained barely 1 percent on average in their fitness, and some possessed less aerobic capacity at the end of the study than at its start.
"...they found notable differences in the levels of an enzyme related to the health of mitochondria, the tiny energy-producing parts of a cell. Mitochondria generally increase in number and potency when someone exercises. But in the volunteers taking (this drug), enzyme levels related to mitochondrial health fell by about 4.5 percent over the course of the experiment. The same levels increased by 13 percent in the group not taking the drug."
These are huge and profound changes. Regarding your last question about recovery, it's certain that some people suffer for the rest of their lives. (Also, some die of rhabdomyolysis.) Our country has no system for reporting adverse effects, so we don't know how common or how severe. But I know four people locally (two MD's) who've had their lives permanently wrecked: StatinStories.com
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@SW: As far as I can tell, ANY drug that messes with a major biological function (statins, bone-density drugs, etc.) is going to have some serious side-effects that may be worse for the patient than the original problem.
The issue with diabetes is how quickly one can suffer severe long-term damage by NOT treating it - which leads to a very difficult choice.
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@L Yes, serious side effects. (Actually, adverse effects is a better term.) And our country has no sensible system for reporting adverse effects.
Doctors aren't required to report side effects (adverse effects) and they don't. We're supposed to call the F.D.A. ourselves--something most of us don't even know. The F.D.A. is fully aware that the present way of self-reporting doesn't work. Just call them and ask. (I believe that it's an 800#)
To cap it off, 80% of the drugs we take are generic, but thanks to a couple of Supreme Court decisions, you can't count on the warning labels to tell you anything:
Example: In 2011, Pliva v. Mensing found that generic drug makers could not be held liable for failing to warn about a drug’s dangers on their safety label.
Example: In 2013, the Supreme Court ruled that generic drug manufacturers could not be sued by patients who claim that drugs they took were defectively designed.
Yes, that's what it says: defective drug? can't sue; no warning on the label for known problems? can't sue.
Why do I know all this? StatinStories.com will tell you.
So your point about being convinced of the benefit of any medication prescribed to you is a very good one...because you have no way to know or to learn about the downsides.
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There is a lot of enthusiasm for studying metformin as well as rapamycin, and the general aging issue. It's ok to be enthusiastic about it. Not everyone wants a magic pill, I would guess. There's a lot to learn about our current ill health by studying aging. No one really believes in a fountain of youth.
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This is like the other article a few years ago that pointed out that if you exercise regularly and you are on statins, your aerobic endurance will suffer in comparison with not being on statins.
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There is no pharmaceutical free lunch. Anything you ingest may have both benefits and risks. I respect the research and also have been impressed by metformin’s positive effects for patients with diabetes and other selected metabolic disorders but we are a long way from prescribing this for healthy adults.
Many people want the magic pill or potion for aging. Unfortunately the best evidence so far supports what many of our mothers taught us about being healthy: exercise regularly, maintain a reasonable weight, eat your fruits and veggies, play with your friends, do something meaningful with your life. Most of our centenarians would say they followed a lot of this regime...and also that they were a bit lucky.
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@GeriMD I wonder if Berberine, that purports to have metformin like effects, also has similar muscle mitochondria deleterious effects?
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@GeriMD "There is no pharmaceutical free lunch." Ah, would that this were true!
Yes, I do understand that you mean this in a different sense: all medications hold a certain amount of risk.
But the risk is vastly increased because of the better-known meaning of "pharmaceutical free lunch"--the meaning that undoubtedly popped first into most readers' minds: the massive amount of money that pharmaceutical companies pour into everything from lunches to "free" drug samples to advertisements in the medical journals that doctors read, to lobbying, to payment to F.D.A. advisors, to you-name-it.
Had I known, for example, that the cardiological practice that so strongly "encouraged" me to take a statin drug had received over $300,000 from the drugs' manufacturer, I would undoubtedly have pushed back much harder against taking it.
Metformin, like statins, must be a "blockbuster" since it's currently the most-prescribed medication globally for people with Type 2 diabetes--so we may confidently assume that there are tons of industry-funded studies showing how great it is. (And as we also know, industry-funded studies are 5 times more likely to find results in favor of the medication.)
So it's good to see this new report asking questions about downsides.
P.S. Such a small world: statins are associated with an almost 50 percent higher risk of developing Type 2 diabetes, even after adjusting for other factors.
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@GeriMD: "There is no pharmaceutical free lunch." Well said! I thank you for providing a very coherent & clear statement on this issue.
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