Life Extension… in a bottle?

If I’ve said it once, I’ve said it a thousand times. Get Serious, page 141: “An analog of metformin will one day be launched as an “anti-aging” drug” due to its potentially life-extending effects. And this is exactly what can be inferred from the data of a recent entry in Diabetes, Obesity and Metabolism. Bannister, et al compared mortality in people initiated with metformin or sulphonylurea monotherapy and matched non-diabetic controls. And guess what? The diabetics on metformin lived longer than their non-diabetic patient matched counterparts. Yes. That was not a typo. And the study was massive and therefore scientifically powerful: 78,241 subjects over a 5 and ½ year period. Specifically, adjusted mean survival time was 15% lower in matched individuals without diabetes relative to diabetics on metformin monotherapy.

What is going on here?!?! Can people with type 2 diabetes live longer than those without by virtue of a drug effect? Diabetics classically succumb to the effects of accelerated aging manifested as premature development of cancer, atherosclerotic heart disease, Alzheimer’s dementia, you name it. So metformin’s actions must be pretty substantial, more-than-negating the untoward metabolic effects of elevated glucose levels and secondarily insulin! How? It is unclear. Remember though that metformin increases one’s insulin sensitivity and by virtue, lowers circulating levels of the inflammatory hormone insulin. Less inflammation, longer life. No questions asked. Secondly, by reducing mTOR pathway throughput (like rapamycin), metformin reduces circulating levels of “growth factors” which accelerate the atherosclerotic process. Testimony to this is the observation that survival was better with metformin even in those people who did not receive cardiac prophylactic medications at baseline. Surprised You shouldn’t be. Clearly metformin served as the cardioprotectant in this large patient cohort.    

The results beg the obvious question: What about those of us who are non-diabetic? (You knew that was coming.) Can metformin exert similar life-extending effects in those of us with normal HbA1c and normal serum insulin levels? There is no “indication” for metformin in the normal population, certainly not as a protective or preventive medication. Most physicians shudder at the thought of such an off-label indication for metformin (I’m speaking from a lot of experience), but this recent data cannot be ignored. These questions need to be asked however. The answer? Not so simple. Pharmaceutical companies have ZERO interest in sponsoring trials for medicines that potentially have a preventive role for the population at large. Why? How many times do I have to say this? There is money in disease, not health. If lesser people were sick, there would be lesser people to whom their medications (many of which are bogus) could be peddled. 

My advice: Discuss these issues with your doctor. Inform him of the recent study data (likely he or she will be unaware of it). Metformin has a fairly benign side effect profile and usually is well-tolerated. In fact, one of the often noted “side effects” is weight loss. You heard me. So explore this option, aggressively. If your doctor is unreceptive to even the idea… well, find another doctor. Someone forward-thinking. One who doesn’t wait until disease sets in before taking action. One who instead assumes a preventive stance with a focus on longevity and health maintenance. One who hesitates not to add metformin to your arsenal. I use it liberally in my patient population and personally have been maxed-out on metformin for years…


Bannister CA, Holden SE, Jenkins-Jones S et al. 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. Diabetes, Obesity and Metabolism 2014; DOI: 10.1111/dom.12354 [Epub ahead of print].