The Nutrition Facts website had a recent entry about metformin, a widely-used drug for type 2 diabetes, which I will summarize in this blog.

Metformin continues to be the most used first line drug for patients with type 2 diabetes. It is very inexpensive, effective and has few side effects.

In recent years metformin is being used to prevent diabetes in some pre-diabetic patients.

Some years ago it was noted that people who took metformin lived longer than those who did not. This is compared to those who don’t even have diabetes as well as other diabetics. The TAME (Targeting Aging with Metformin) was designed by a good research institute and approved by the FDA in 2015. This study was projected to cost $75M but has not yet found funding. Metformin is available in generic form and so inexpensive that there is no profit in the drug: ergo — no funding for TAME.

David Sinclair is an Australian professor at Harvard who does research on aging and has written a popular book on the subject. He is a strong advocate of lifestyle modification and drug intervention to increase aging. He is a partner in for profit companies developing drugs to prevent aging. He states that he himself and his relatives take metformin but does not tell others to do so since it is not proven and he is not allowed to do so. I feel that this is really a recommendation that others take metformin but he wants to avoid liability. The evidence for metformin is questionable and there are potential problems with the drug, especially for some groups of people. (Please look at Nutrition Facts website for more details.) Sinclair states in his book that intermittent fasting, calorie restriction and lifestyle changes are the proven, safe ways to lead a longer, healthy life but he is trying to make money by designing drugs to do the same thing. The evolution in recent decades is for skilled scientists to concentrate on creating wealth for themselves rather than using their talents to advance scientific knowledge for the common good. Big business has always had their own labs; now they have control of many labs at university and independent research facilities through research grants and promises of profit sharing. Medical and research training is now dominated by institutions and professors who are paid and controlled by big Pharma.

Sinclair’s and others’ work has resulted in many in Silicon Valley and elsewhere taking metformin which I would not even consider doing myself. Evidence of effectiveness is incomplete and all drugs have potential side effects.

Metformin has also been shown to prevent the development of diabetes in some pre-diabetic patients, but only in those under 60 who have very high blood sugar and are obese.

The Diabetes Prevention Study is a large, long term look at what to do stop America’s diabetes epidemic. One study divided people with high risk of diabetes into 3 treatment groups:

Placebo pill

Metformin

Lifestyle modification advice including low fat diet and moderate exercise

Most in the last group followed little or none of the lifestyle modifications suggested, but this group still did twice as well as those given metformin. Of the small number who followed most of the lifestyle modifications none developed diabetes.

Again and again, lifestyle modification is much superior to any drug to prevent and treat chronic disease. Prospective long term studies looking at longevity are not feasible, but it’s almost assuredly true that it is the best approach to healthy aging and longevity.

Dysbiosis is defined as an unhealthy balance of gut bacteria. Because of bowel wall permeability to harmful bowel contents, dysbiosis leads to chronic systemic inflammation which in turn causes heart attacks, strokes, cancer, arthritis, collagen vascular disease and increased susceptibility to infections such as pneumonia. Older people with dysbiosis have much higher rates of all these conditions compared to people the same age who have a healthy gut microbiome.

Dysbiosis is caused by insufficient fiber intake; excess protein; excess salt; alcohol; artificial sweeteners and some other food additives; antibiotics; non-steroidal anti-inflammatory drugs (NSAID’s) like aspirin, ibuprofen, naproxen. Reviews of antibiotic prescriptions by experts indicate that 75% are not indicated. An even bigger source of antibiotics in people is the food they eat. Virtually all animal products tested, including fish, have harmful levels of antibiotics in just one portion.

Recently in America we have had a philosophical/political war about diversity. Some conservatives complain that it is overdone, beaten to death by woke liberals. Some liberals reply that many conservatives are bigots, cloaking their bigotry with claims that we have emphasized diversity too much and taken the rights of those who are not part of certain minority groups.

Greger discusses a different type of diversity that I think all might agree on.

Experiments have shown that eating a wide variety of different whole plant foods decreases radiation exposure damage, lowers systemic inflammation, and improves cognition. The beautiful thing is that this is independent of quantity; small amounts of many whole plant foods will do the trick.

This was taken to an extreme in a study in which a variety of cancer patients were secretly given a tiny amount of pomegranate, broccoli, turmeric and green tea in capsule form; another group was given placebo capsules with only filler. Quantities of food: 1/100 of a pomegranate; less than a small broccoli floret; 1/8 tsp of turmeric; 1/6 of a bag of green tea. Cancer progression was measurably slowed in those who ate the microdoses of the four healthy foods compared to those who only were given a placebo.

It’s been well documented that a whole food, plant based diets slow disease progression, reduce recurrences, and increase longevity across a spectrum of cancer patients. This diet is particularly effective in breast and prostate cancer as I have discussed in prior blogs. The remarkable thing about these new studies is demonstrating that diversity of foods is paramount and that quantities can be minuscule. EVEN THOSE WHO HATE FRUITS AND VEGGIES CAN BE HELPED. I’ve met many people who avoid whole plant foods but cannot imagine anyone who can’t eat the tiniest amounts of lots of different vegetables, fruits, herbs, spices, legumes, nuts and seeds. This seems a no brainer even for those who don’t have cancer or another chronic disease.

Many people face important end of life decisions for family and themselves. Options are often confusing, but some information is clear cut.

Hospice is a good option for many, but sometimes resisted as not making use of the best that medical science can offer. This is false. A good hospice organization will only accept those who will almost certainly die in the next six months or year, no matter what medical intervention is used.

Multiple studies confirm that quality of life is much better with hospice. Hospice is not relinquishing the last few months of life. Those who choose hospice on average live a month longer than those who do not.

Other dying options including physician assisted suicide, where allowed, are also discussed by Greger.

The one he seems to favor is legal everywhere: VSED, voluntarily stopping eating and drinking. Death in 80-90% of people occurs within a week; almost everyone dies by 14 days. Surprisingly this is not an unpleasant death since the body adapts in multiple ways. ‘Primitive’ societies often used this technique- probably because it is practical and achieves an important goal the best way.

Later in this long book Greger at least partially retracts a prior recommendation. A recent massive review suggests that vitamin D supplements, like other vitamin supplements except B-12, may not aid health or longevity except for those who are deficient. Many centenarians have very low serum levels of vitamin D and are in good health. Looking at the entire current literature only those with low vitamin D levels seem to benefit from supplements.

The range of ‘normal’ vitamin D levels is probably large, with some people doing very well with levels below the established normal range. Some of these people show little or no rise in D levels after supplementation.

Herbal supplements have become a multi-billion dollar business with no regulation by the FDA or any other government body. A study done in New York State analyzed herbal supplements bought at GNC, Walmart, Walgreens and a few other retail outlets. 80% had none of the herbs claimed on the labels! Usually all they had was some neutral filler. This massive fraud is being carried out by some of our largest retailers with few repercussions.

Greger also repeats that amla, dried, powdered Indian gooseberries, have well studied health benefits, as I discussed years ago in a blog. Amla has been a favorite Ayurvedic medicine for centuries and really does work better than many heavily used western prescription drugs at very low cost and with little chance of harm.

Amla lowers blood sugar in diabetics, lowers cholesterol and triglycerides, lowers levels of systemic inflammation, all to a significant amount. It is also frequently effective treating heartburn and indigestion. Anyone with one or more of these problems should consider amla. Those with diabetes always have to monitor blood sugar to avoid hypoglycemia which can be very dangerous. Physicians treating diabetics with dietary change often run into this problem unless pharmaceutical diabetes treatments are decreased or stopped.

Creatine is a substance made of three different amino acids which is made in the body. It is helpful in brain and muscle function. Extraneous creatinine is found in meat, fish and supplements. Supplements appear very safe and provide a much higher level than any other source. Optimal dosage is 3-5 grams a day.

Creatine supplements are by far the most effective way of boosting muscle mass and strength but only if associated with regular (2-3 times a week) progressive resistance training. Creatine’s mechanism is through increased time to muscle failure when resistance training is very strenuous and done until exhaustion of the muscle group. Otherwise creatine has no benefit in increasing muscle mass or strength.

Unsweetened cocoa powder (not Dutch processed) and coffee, perhaps due to caffeine effects, are also shown to be effective ways to improve strength and muscle mass but creatine is the most effective (again, only if taken while doing a strenuous program of resistance training.)

Muscle strength is critical in older adults for longevity and health. Since virtually every American gets enough total protein in her diet the critical factor in building and maintaining muscle mass is resistance training of some sort. Nothing else matters much.

Different protein sources have been extensively evaluated with multiple criteria to determine how effective they are for building and maintaining muscle mass. There are some surprising results.

There is a huge business selling whey powders for body building. Using multiple criteria, whey and all other animal protein sources were inferior to natural soy products like edamame, tofu, tempeh and soy milk for building and maintaining muscle mass. This evaluation does not even take into consideration that animal proteins cause increased systemic inflammation and renal damage.

Anther food that is very effective in building and maintaining muscle mass is unsweetened cocoa powder. This does not apply to Dutch processed cocoa powder which has been dealkalized to remove bitterness. The bitter polyphenols removed are the source of cocoa’s health and muscle building properties.

In spite of the huge number of studies looking at muscle building benefits of specific foods, the bottom line is that virtually everyone is eating enough protein for muscle building except for serious body builders. Those people should be eating soy products and unsweetened cocoa.

There have been exhaustive studies evaluating the benefits of routine screening mammography. Note this is routine screening, not a woman with a lump or another reason to suspect breast cancer.

Greger has summarized the results:

One woman in 1000 will have her life saved by screening mammography.

Total death rate is the same in screened and unscreened, presumably since unnecessary treatment for non-fatal breast cancer or benign breast disease has led to the death of one in a thousand women.

Screening for breast cancer is a huge business with many powerful interests profiting. Screening guidelines are controlled by these special interest groups. A non-profit consortium of international experts has recommended against routine screening with either mammography or self examination.

Your American physician is told by the federal government to recommend screening with mammography.

An important consideration is peace of mind. If a woman is anxious and feels reassured if she has screening mammography, then she should probably do it.