I have been an advocate of metformin for everyone, and enthusiastic about Nir Barzilai’s trial of metformin as an anti-aging drug. Last week, I learned fromBrian Hanley that metformin has a dark side, to wit, a statistical association with higher frequency of Alzheimer’s disease [ref, ref]. There is a biochemical mechanism that makes the epidemiology more compelling. B12 supplementationmay mitigate the risk.
Other studies [ref, ref] have found that diabetes patients have elevated risk of dementia, and that that risk is reduced when they take metformin. So it’s fair to say that there is contradictory evidence, and the direction of the effect may depend on individual variation. Here is a balanced view of both sides.
A reader of this blog, George Goldsmith has written to me that berberine is a good herbal substitute for metformin. Everything we know about berberine looks really good–it is an anti-inflammatory as well as helping preserve insulin sensitivity, acting through the AMPK pathway. But we have much more experience with metformin, both clinically and in the lab.
Metformin increases life span in mice, and to my knowledge, this test has yet to be performed with berberine. Magnesium supplements also can help prevent insulin resistance, and there are other good reasons to take magnesium.
Gynostemma pentaphyllum, sold by LEF under the brand name AMPK Activator, is another herbal alternative to metformin.
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