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.