Metformin: Pill Popping or Gym Hopping!

Should non-diabetics take Metformin for their  healthier longevity?

Tara:  Hello! Dr. E! Can you hear and see me? My internet connection hasn’t been very cooperative lately.

Dr. E: Hello Tara! I see and hear you clearly! Our Zoom connection is fine!

Tara:  Today is finally the day! I can’t wait to hear your verdict on Metformin! 

Dr. E:  What else do you remember about what I had to talk about today?

Tara: Oh, my goodness…it has been ringing in my ears all day long … “pill popping or gym hopping”!

Dr. E:  Bravo! You remember that punch line so well! I’m so happy to see you are following my longevity stories. I just hope to see more young doctors become so enthusiastic about their own longevity! Reduction of pain and suffering, promotion of a happy and productive life, and facilitation of disability free longevity is the major goals of medicine. If it’s up to me to define the ultimate purpose of medicine, I would say: promoting healthy longevity…period! Can you think of any higher purpose for medicine than what I just said? 

Tara: I don’t believe there’s any!

Dr. E: Before we go off much on and more tangents, I must confess that it took me a little longer than what I originally expected to make up my mind on the matter of Metformin! Honestly, I underestimated the wealth of recent knowledge that I had to master before making up my mind on it! 

“Taking Metformin supplements or not” has been one of my recent longevity-related dilemmas. Knowing myself, all along deep in my heart I have known that I want the best for my own longevity…and whatever I decide on will affect my way of life hereafter. So, I had to choose wisely, as rewards only come to those who make wise choices and faithfully follow them! Let me be clear and let me say it aloud: my goal is to excel at my own longevity! But when I say excellence in longevity, it just doesn’t mean getting healthily to a farther finish line! It means to get there as a better person who has truly excelled at his or her own humanity!  But how can I truly excel at my own humanity, if I do not wish upon others who tag along with me that which I truly wish for myself? Do you see the burden of moral pressure on me? I have to make such a wise choice, that firstly it convinces me to follow it full-heartedly for long, and secondly, I get morally content to share it with those who tag along with me through the passage for the conquest of longevity!

Again, what did you say has been ringing in your ears about Metformin?

Tara: Oh…you’re asking ME! I could never forget… “the pill popping or gym hopping!”

Dr. E:  Bravo! To add a little onto it for you, the crux of my dilemma was this: should I take Metformin to boost my longevity and bust my weight and blood sugar levels or is there a better way to get all these rewards without the pills? I have also been wondering if I should consider an alternate synergistic plan that can most frugally blend the two for me!

Let’s Begin!

Dr. E:  How about beginning with what we know quite well about Metformin! By this I mean starting with the classics that anyone who is into the medical literature should know about Metformin! Well, I guess the following chart would allow us to get a quick feel for what it is all about:

Dr. E: What is your topmost concern about Metformin?

Tara:  I would really like to know how it jumped from being the top choice treatment for type 2 diabetes, to becoming the elixir of longevity.

Dr. E: Actually, there are more assigned roles for it than just diabetes! It is prescribed for treating obesity, polycystic ovary syndrome, cognitive decline, high cholesterol, high blood pressure, heart failure, kidney disease, rheumatoid- and osteo-arthritis, cataracts, COVID, influenza, cancer, and much more!

Tara:  After looking at such an extensive list of so many dreadful things that Metformin can bust, I’m curious why you’ve considered hopping-in-gyms as a reasonable alternative!

Dr. E: Well, what’s intriguing in all this is that some geroscientists passionately believe that Metformin does what exercise, fasting and exposure to ambient extremes can do for our bodies and for our longevities. To make the matter even a little more complicated, some other scientists passionately believe that the two, if added together, will have antagonistic effects, or may nullify some of the positive aspects of each other. Moreover, I personally believe that metformin fixes diabetes, and the entire long list that I just enumerated for you are simply consequences of diabetes!

Which one would you rather do, and which one do you think is better for you eventually?

Tara:  Honestly…I am opting for Metformin! All I have to do is to pop it in with soda! But I’m also wondering what will happen if, every now and then, I add a little workout into the mix? 

I’m curious if my modest workouts, like walking my dog, and leisurely biking, hiking, and swimming will qualify me for living healthier for longer? Also, I am wondering if it matters to start my regimen now that I’m in my early thirties, or I should wait for later when the reality of my own longevity hits me harder.

Dr. E: There is no solid prospective data on those who have started Metformin at your age and kept at taking it through their senior years! Even if there’s one or a few on it, I just don’t know about them! We knew about Metformin for so long, but the longevity-related subcellular associations of it are new. So, I guess we must be patient and wait for more solid data to appear on this!

Tara:  I wish they had complementary effects for our healthy longevity!

Dr. E: Me too! Actually, some middle-aged geroscientists, who can’t exercise the way that they ideally should, have used their expertise to mix and match the two outlooks to produce- and advocate their own personal best recipe. The only drawback that I see in this is that most of those that I know about are middle-aged molecular geroscientists who know well about the intricacies of their field but have not had much experience with their own longevity. They have yet a long way to go to highlight themselves as the spiritual leaders in the field of longevity. I wish I could have been able to see them about twenty to thirty years into their futures! Wouldn’t you love it if you could peek into the future?

Tara:  I’ve always wished I could!

Metformin and the Knights of the Medieval Kingdoms

Dr. E: Before I get deeper into this matter let me tell you a relevant story!

During the late 1990’s I had a research assistant who was a member of the Society for Creative Anachronism (SCA). Through him I learned that members of the society would dress in pre-17th century clothing, and would participating in competitive battles, recreational artisanship, royal court events, medieval dancing, and more. You may click on this link and get a feel for what they’re all about: https://www.sca.org/

As it turned out, at the time, my research assistant was promoted to a knight in his kingdom, and he was required to wear armor, participate in sword, and shield battles at their future gatherings. He told me that for quite a while he has been researching to find authentic armor belonging to medieval knights, and he hasn’t had much luck on finding any that could fit him. When I asked him if he could order a customized version of the armor, he replied that well-preserved armors of past warriors were more popular among the SCA knights! To make the story short, he said that none of the authentic armors could fit him even though he was a medium-built person. I vividly recall the ring of his voice when he said something of this effect to me: “…apparently, mighty medieval knights must have had muscular physiques and sizes of the 21st century teenage boys”!

Are we overweight people?

Dr. E: Why did I remember that story? Before answering this question, let me begin by saying I know a thing or two about health and medicine! I feel that so far, give and take, I might have not done that badly for my own longevity. Some even say that I’ve done a wonderful job given my age! I tell you this though; they just don’t know what I know about me! They only see the impression of me! They can’t peek into me! Am I genuinely happy with what I’ve so far made for myself? Absolutely not! Am I ever going to give up on thriving to impress myself? Never! 

I have said it so many times and I will say it again…if you’re true to your own core, you should know deep inside that the only person that you cannot fool is YOU, and if you don’t believe in this, you’re a fool!  

Tara: Amen!

Dr. E: Let me say it loud and clear again before moving on: I want to excel at my own longevity with workable lifestyle habits, and without popping unnecessary pills!

Tara: May I ask if you mind taking natural supplements such as turmeric, vitamins, and minerals?

Dr. E: Actually, I don’t mind them much, as they’ve been around for so long, and I’ve always been enthusiastic about using them.

My Confessions …

Tara: I’ve heard that you’ve been relentlessly performing your daily workout rituals for two or more hours daily, for almost all days of the year, and for as far back as your first college year! Is this true?

Dr. E: It is! I guess you must have heard this from me! I wonder what would have happened to me had I not done all that! Regardless, I know deep in my heart that I haven’t done enough, and I should’ve done much better! I understand that life is too short, especially if we truly try and never stop trying to excel at our own longevities!

Let me make another confession! For the past several years I have been at war on several fronts for keeping my weight, my blood pressure, glucose and cholesterol, and osteoarthritis of a few of my joints at bay. 

Tara:  I couldn’t have believed it until I heard it from you! May I ask, how have you been managing them all?

Dr. E: Those who have come to know me may like to say that I might have not done that badly for myself for my own age…but, honestly, I cannot fool myself! I have to do much better than what I’ve done so far for myself! Why? Because I believe that the detriments to my health that many blame on aging are all actually self-inflicted. I’m quite sure of one thing; in order to excel at my own longevity, I have to bust these culprits one after another or negotiate a mutually workable relationship with those that I can’t get rid of! 

If you ask me, how am I doing so far in all those battlegrounds? I can tell you: I guess not that badly! These culprits: blood sugar and pressure, and other rascals who have breached my body don’t know what’s about to happen to them! Between you and me, I will knock them down one after the other! They don’t know yet that they’ve started messing with the wrong guy! Just follow me as I love to break the news of their defeats, myself! 

Tara: Come on…Dr. E! You’re already doing so well!

Dr. E: That’s what I have been hearing from some others too, which, honestly and truly, isn’t true! Have you heard about the famous proverb of the Dutch philosopher Desiderius Erasmus? He said, “in the country of the blind, the one-eyed man is king“! They are comparing me with wrong people! 

For as long as I’ve known myself, and especially after starting my college years, I have been a little on the heavier weight’s side compared to my cohorts. Not because I have been fat and flabby, but because I was heavily into sports and always used to have some muscle on my bones. Despite this, when I compare myself, waist-wise, weight-wise, and size-wise with how I used to look during my early thirties, I couldn’t shake the thought of being-overweight off me! 

Tara: I guess this was what you meant when you once said, “Obesity is in the Eye of the Beholder”!

Dr. E: That’s correct! Actually, it would not be a bad idea if you peek at it once more as it is highly relevant to my verdict on Metformin: https://conquestoflongevity.com/obesity-is-in-the-eye-of-the-beholder/

Tara: I will…definitely!

Dr. E: For almost forty years, starting with my early thirty’s, I have been going through annual cycles of weight gain and loss that some scholars describe as the “yo-yo” effect! Interestingly, throughout all those ups and downs, despite being overweight, I’ve always scored relatively better compared to most of my cohorts. However, my conscious awareness of being a one-eyed king, and my non-stop self-criticisms have been the curse that I haven’t shaken off since my thirties!

Tara: Now, I can’t wait to re-read your blog. Please allow me to save the link of it, https://conquestoflongevity.com/obesity-is-in-the-eye-of-the-beholder/, on my to-do bucket list. 

Pill Popping or Gym Hopping!

Dr. E: I must confess that the vast amount of literature on Metformin’s weight reduction and longevity benefits has made it extremely tempting for me. Deep in my heart I couldn’t shake off the desire of adding Metformin to the list of my dietary health supplements! For someone like me who has always been enthusiastic about daily workouts, the added benefits of Metformin would have been a dream-come-true for my conquest of longevity. However, after I came across some literature pointing to lack of synergism and even presence of antagonistic reactions between Metformin and exercise, fasting, and longevity, I have started having my doubts on this matter.

Did you read a blog entitled “Get Hold of Thyself” that I wrote back in December of 2019?

Tara: I can’t recall if I have or not!

Dr. E: You may read it at this link: https://conquestoflongevity.com/get-hold-of-thyself/

Tara: I will definitely do it! 

Dr. E: That blog casts some light on why we may have the temptation to take in Metformin pills instead of working out, spending energy, or fasting. What I’m about to say may shock you…are you ready for it?

Tara: You already have my attention! 

Dr. E: We are hard-wired to be possessive! Eating is the utmost primal way of expressing our possessiveness! It is as if the more we own in the world around us the more satisfaction we get! Whatever I love I tend to grab with my mouth! This includes eating, drinking, kissing, taking pills and supplements, and even popping Metformin. There are those that I tend to hold by grabbing with my arms…such as hugging those whom I love. And there are those that I like to make mine by our entitlement laws or conventions, such as my physical properties. Don’t call me or anyone else for the same reason “obese or overweight”…as these terms belittle us all… call us wealthy fat and flab rig owners! Don’t call us pre-diabetics or diabetics, call us sugar tycoons instead!

I don’t want to drag you any more on this ground, just read that blog, you will get a feel for it all! It somehow explains why we innately desire to get more food into our bodies or pop Metformin pills instead of giving a bit of our bodily fat assets and energy resources away! 

What was the title of that blog again? 

Tara: Get Hold of Thyself!

Dr. E: Lovely! To sum it up…we love to make Metformin ours! Don’t you get ashamed of being jealous of those who pop their Metformin pills? Aren’t you troubled by comments such as:  “Oh, my goodness, the rich people get it all…the best food and the best pills…it’s not fair! Do you see how they make those pills theirs? They  pop them all up! If it’s good for them it must be for everyone else!”

Which of the two do you think soars higher, a lighter or heavier hot air balloon? 

Tara: This one is a no brainer…the lighter one!

Dr. E: Likewise, never forget this: to ascend to the highest altitudes of our own longevities we should get rid of our extra body weight! 

Tara: I guess I’m getting a feel for where we are heading now!

Dr. E: I want to do all that is in my power to excel at my own longevity! I want to excel at the art of training myself to endure reasonable extremes of heat, cold, anoxia, fasting, or alike that I passionately believe are conducive to healthier longevity.

But what can be done for the diabetics!

Dr. E: Please do not misunderstand me; for diabetics, obese individuals, and those with sedentary lifestyles, Metformin is so far and by far the best of all remedies for knocking down their sugar levels and weight. As a result, Metformin minimizes a wide spectrum of nasty diabetes-related consequences such as high blood lipids, clogged arteries, and coronary heart disease, and others on in these patients! More importantly Metformin adds to the longevity of type 2 diabetics because they have already set themselves up for shorter lifespans. Why is this so? Because diabetes is one of the most common detriments to longevity in our era! Type 2 diabetics first sweeten their bodies, and then they turn all those sweets into body fat and flab! These patients have earned their diabetes with their own lifestyle! Do they have to be blamed for their illnesses or is it the curse of our modern lives that makes us all prone to diabetes? The answer to this is beyond the scope of what I intend to get to today. All I can say is that hopping gyms at moderate levels of up to 2 hours or so per week and performing daily activities such as walking in the grocery stores while our Apple phones count our daily strides is not a good definition of meaningful anti-aging physical activity. Therefore, diabetics who perform the latter types of physical activities, can gain many benefits from Metformin.

To excel at our own longevity by modifying our lifestyles presumes that we appreciate the fact that deep in our bones we are not well-equipped to cope with abundance and over-indulgence. We must first begin our conquest of longevity by embracing this reality! Have you read the blog that I wrote about the prehistoric persons within us?

Tara: I think I did, but I couldn’t relate it to Metformin at the time that I read it!  

Dr. E: I suggest that you peek at it again in light of what we’ve discussed so far. Here is the link for it, in case: https://conquestoflongevity.com/the-key-to-healthy-longevity-is-to-appreciate-that-deep-inside-we-are-still-prehistoric-people/

Tara: Thank you, I will definitely read it!

Dr. E: What intrigues me is how we are brainwashed to take diabetes for granted in our older adulthood! When I turn on the TV I see dozens of diabetes-related ads interrupting my favorite shows. Those who feed us this information already know that we, the people, by nature love to eat, and we love the easy-way-out method of pushing pills into our guts. They know we’re not wired to give away much, even a few drops of blood daily to gauge our sugar levels! So, they have saved us repetitive finger pokes and drops of blood by introducing continuous glucose monitoring (CGM) devices that save us pain and few less drops of our blood to give away! Those who are sold to the ads are the people who may need their Metformin pills, whether for the sake of their diabetes or longevity, or because the ad that they saw was so convincing! Some people even think of Metformin as a miracle elixir and desire to cache some for themselves! 

The Curious Case of Benjamin Button!

Tara: But what do you plan to do for your own longevity? I know that if you believe in it, you will also wish it for others who are in your circle.

Dr. E: All I can say is that I am not yet ready to take Metformin. Firstly, I want to try all within my power to see if I can reset my weight-clock back to my early thirties! You may want to say that this seems like mission impossible! I tend to agree! Why? Because doing so requires disentangling the effects of lifelong problems that I have acquired by living in the world that we have helped to make for ourselves! But no matter how I throw the dice, I refuse to accept my current metabolic profile! I don’t like it when I’m told that my profile is about the average or even better than most of my cohorts. I even refuse to accept our current average health norms! We’ve been on the wrong track for so long, and it’s about time for us to reexamine our way of life. I want to do my best to turn back the clock of my body! Am I going to be able to do it? Without trying, the answer is definitely, “NO”! But all I can tell you is that I have already started giving it my best! Will I rule out Metformin as an add-on supplement for boosting my healthier longevity? For now, all I can say is that I will keep an eye on it! Who knows, a little down the road I may come across experts who think along the same lines as I do, and we may come-up with some workable resolutions to excel at our own longevity! Where do I expect to run into them? Of course, on the passage for the conquest of longevity! 

Worrisome Complication of Metformin

Tara: I have been curious about the side effects of Metformin…are there any worrisome ones? 

Dr. E: I always tell my students that a good doctor must firstly rule out the worst of all health issues for their patients! The most worrisome but uncommon side effect of Metformin for type 2 diabetics who have been taking it for a long time is lactic acidosis! The gravity of lactic acidosis may have a multifactorial nature, and it may result from interactions among diabetes, kidney damage as a result of diabetes, and the mechanism of action of Metformin. I must add that one of the most dreaded consequences of uncontrolled diabetes is end-stage renal failure. For now, all I like to say is that one of the major roles of the kidney is to get rid of acids. Metformin, indirectly and via inhibiting mitochondrial electron transport systems, causes lactic acidosis. In diabetics with end-stage renal failure, this translates to accumulation of lactic acid waste all over the body. If diabetics have any compounding dreaded ailments such as sepsis due to their compromised immune systems, their synergistic effects raise the toxicity of lactic acidosis! A worrisome consequence of the latter is fatal heart dysfunctions and arrhythmias.  

I’m sorry that I have to wrap-up our session for today! For our next meeting, what would you like to know more about Metformin as it relates to the conquest of longevity? And please don’t forget that you can always email your questions by sending an email to contact@conquestoflongevity.com. Just address it to Dr. E!

Tara: I would like to know a little more about the theories that relate Metformin to longevity and what subcellular mechanisms make Metformin similar to exercise, fasting and oxygen deprivation.

Dr. E: Sold!

Tara: Dr. E! Dr. E! One final question! What do you do for yourself in the interim? 

“I will minimally keep up with my intermittent fasting of not eating for 16 hours after 5 PM.”

Dr. E: I thought I said it, but I might have not been clear about it! I will bump up the intensity and duration of my workouts by several notches! I will try to excel at performing a variety of fasting patterns! I will expose my body to more ambient extremes! I will try to shed as much extra pounds off me as I can! Will it be difficult to do? I bet it will be, as the entire world, the way that I have come to know it, will constantly try to seduce me! What else I will do? Of course, I will constantly monitor my metabolic profiles during the process! Will I give up on the Metformin? All I can say is that I will keep it on my radar!

One final thing… take care of yourself until I catch you down the road again! 

Tara: Thank you so much Dr. E! Have a lovely day!

Dr. Eftekar (Dr. E) is the founder and head coach of the Center for Conquest of Longevity and Northwestern Medical Review. A unique attribute of Dr. E is his well-rounded academic background that, in addition to the science of medicine, extends over several other disciplines such as physiology of aging and longevity, philosophy of science and medicine, and integrated kinesiology.

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