If you know about metformin, a drug that is the “main first-line oral drug of choice” for type 2 diabetes patients of all ages[i], you may be wondering, “Why is Dr. Sperling writing about something that has nothing to do with prostate cancer?” In fact, metformin DOES apply to PCa, though at this time it would be considered an off-label use. Check out my blog on that topic.
But wait, there’s more. Metformin is safe, effective, and cheap. What’s amazing are its benefits beyond diabetes, including protection against cardiovascular disease, breast cancer, prostate cancer – even dementia. The more we learn about metformin, the more exciting it sounds! Nir Barzilai MD, the director of the Institute for Aging Research at the Albert Einstein College of Medicine, says, “New research is suggesting that metformin may hold promise in treating or preventing a whole host of conditions in patients with and without type 2 diabetes.”[ii]
An anti-aging drug?
One area of interest is the relationship between metformin and aging, where it appears to protect against the effects of growing old. The initial evidence was gathered from diabetics on metformin, compared with insulin or other drug therapy. In a recent article, Campbell et al. (2017) searched through published studies and identified 53 papers that contained clinical observations and statistics[iii]. They found that diabetics taking metformin were unusual compared to non-diabetics, or diabetics on other drug therapies. What was unique? Those taking metformin had “significantly lower all-cause mortality” as well as lower cancer rates and fewer cardiovascular problems, suggesting that metformin extended healthy lifespans.
This is good news. People now live longer, on average, than at any other time in history—resulting in a huge elderly population. “Worldwide, 901 million people are over the age of 60 today. That number is projected to reach 1.4 billion by 2030 and nearly 2.1 billion by 2050.”[iv] We are living longer, but we aren’t necessarily aging better. Heart disease, osteoarthritis, respiratory disease, cancer, etc. lead to chronic impairments that rob the elderly of dignity and quality of life. This creates a cost burden for specialized care and housing for geriatric patients.
Therefore, a drug that would lessen the effects of aging, allowing people to extend their lifespan while enjoying good physical health and productive mobility, would ease that burden.
What about aging minds?
However, it’s not just bodies that age. Mental function often suffers as we grow older. Dementia (aging-related confusion, memory loss) and its more dreaded form, Alzheimer’s disease, will cripple an aging person even when his or her physical functioning is vigorous. Here is another area in which metformin is promising.
Campbell and his team conducted another review of published literature, this time focused on metformin in connection with mental deterioration.[v] As with the above study, they found that diabetics on metformin had significantly less cognitive impairment and dementia than those on other therapies. They reasoned that the action of metformin in reducing insulin blood levels helped avoid the formation of damaging plaques in the brain, and in other ways helped reduce brain inflammation and oxidative stress. Beyond this, they observed that the effects of metformin mimic those of restricting caloric intake, as in studies demonstrating that limiting calories results in lab animals living longer in good health. Thus, they hypothesized that the positive effects of metformin on the aging brain might occur whether or not diabetes is present. This theory is supported by a 2014 study out of Singapore showing that metformin use over a long period (6 years) was associated with the least risk for cognitive impairment.[vi]
As rosy as all this sounds, we need to restrain our enthusiasm since there is also reason for caution. Metformin’s mechanisms are not fully understood nor does it affect all users equally. Scientists can’t explain this: “A quarter of the patient population does extremely well. Half the population does rather well, and a quarter of the patient population doesn’t do well at all.”[vii]
Nonetheless, international studies (laboratory, animal, human) are ongoing, and the future looks bright for metformin as a means to preserve quality of health and lifestyle for an aging population.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Chaudhury A, Duvoor C, Dendi V, Kraleti S et al. Clinical Review of Antidiabetic Drugs: Implications for Type 2 Diabetes Mellitus Management. Front Endocrinol (Lausanne). 2017; 8: 6.
[iii] Campbell JM, Bellman SM, Stephenson MD, Lisy K. Metformin reduces all-cause mortality and diseases of ageing independent of its effect on diabetes control: A systematic review and meta-analysis. Ageing Res Rev. 2017 Nov;40:31-44.
[v]Campbell JM, Stephenson MD, de Courten B, Chapman I et al. Metformin use associated with reduced risk of dementia in patients with diabetes: a systematic review and meta-analysis. J Alzheimers Dis. 2018;65(4):1225-1236.
[vi] Ng TP, Feng L, Yap KB, Lee TS et al. Long-term metformin usage and cognitive function among older adults with diabetes. J Alzheimers Dis. 2014;41(1):61-8.