Metformin - The Apeiron Life Perspective
- Dev Mishra, MD
- Apr 13, 2022
- 3 min read
Updated: Mar 12, 2024
Our Apeiron Life Scientific Advisory Board members review each perspective post.
Metformin As A Healthspan Enhancer
Perspective By:
Dev Mishra, M.D.
Medical Director, Apeiron Life
Updated February 27, 2024
What Is Metformin?
Metformin belongs to a class of drugs called “biguanides,” commonly used to control blood sugar in people with type 2 diabetes. It has been used in Europe to treat diabetes since the 1950s and was approved in 1995 by the FDA for use in the United States. It is now the most widely prescribed medication for people with diabetes worldwide. Because of its extensive use, a great deal is known about the safety profile of metformin and its dosage levels.
Metformin is an “AMPK activator,” likely its primary mechanism of action. AMPK is “adenosine monophosphate-activated protein kinase,” an enzyme that plays a critical role in metabolism. While its primary role is in energy metabolism, AMPK is now known to play a role in many physiological processes in the human body.
What Are The Claimed Benefits Of Metformin Regarding Healthspan and Longevity?
For decades, clinicians have known that metformin does more than help lower blood sugar in people with diabetes. Hundreds of human clinical studies have been performed showing that diabetics taking metformin compared to those who do not take metformin, the metformin takers consistently have lower rates of death due to cardiovascular disease, and it mimics certain aspects of calorie restriction. It can be a helpful adjunct in weight reduction, lowers the risk of certain cancers such as breast, colon, and prostate, and can reduce the risk of dementia and stroke.
The question then arose: What could the benefits of metformin be in non-diabetics or those seeking to improve health and longevity? Initial research suggested that metformin either directly or indirectly slows aging, prevents certain age-related diseases, and increases lifespan in non-diabetics.
What Does The Science Say?
The data appears to support the anti-aging benefits of metformin in diabetes and pre-diabetes. However, direct evidence that it increases lifespan remains controversial.
We are now starting to see published studies that cast some doubt on the effectiveness of metformin in non-diabetics concerning lifespan and physical performance. One published paper followed 3234 pre-diabetic adults for 21 years and showed no differences in rates of cancer or cardiovascular death for those taking metformin vs. those people pursuing lifestyle modification. This is just one study, but it was well-conducted and should cause us to rethink the role of metformin in the non-diabetic.
There is also some evidence that, from a physical performance standpoint, metformin reduces the effectiveness of aerobic conditioning and strength training programs.
What Is My Perspective?
Metformin is a medication that will require a physician’s prescription for you to obtain. It is inexpensive and widely available as a generic or brand-name medication. Due to its extensive use, we know a great deal about the safety and efficacy of metformin. In its typical dosages, the most frequent side effect is GI discomfort, which occurs in about 5% of people and tends to be transient. A serious side effect called lactic acidosis is rare, and metformin should not be used if you have a history of lactic acidosis or if you have significant kidney disease.
I support metformin in anyone who is a Type 2 diabetic, pre-diabetic, or for those individuals showing wide swings in glucose control on a continuous glucose monitor. The safety profile of metformin is extremely well-known, and the potential benefits are wide-ranging and plausible.
Recent evidence, however, suggests caution when considering metformin in non-diabetics with excellent glucose control. More evidence is needed, prompting me to recommend a wait-and-see approach for the non-diabetic.
Will It Benefit You?
Yes, I recommend metformin as a healthspan optimizing tool for most adults who are Type 2 diabetic, pre-diabetic, or struggling to maintain healthy glucose control. In the non-diabetic, we await additional data before recommending metformin as a healthspan optimizer.
References And Additional Reading:
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