[HN Gopher] Metformin decelerates aging clock in male monkeys
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       Metformin decelerates aging clock in male monkeys
        
       Author : tortilla
       Score  : 154 points
       Date   : 2024-09-12 16:56 UTC (6 hours ago)
        
 (HTM) web link (www.cell.com)
 (TXT) w3m dump (www.cell.com)
        
       | ninetyninenine wrote:
       | >https://www.frontiersin.org/journals/endocrinology/articles/...
       | 
       | Data is controversial. It's not "not enough" data or anything
       | like that either.
        
         | MarkusQ wrote:
         | 1) Not clear how lit review published in 2021 casts doubt on a
         | study published in 2024
         | 
         | 2) The lit review does not say the data is controversial, only
         | that the claim of life extension is, and then goes on to say
         | "However, via its ability to reduce early mortality associated
         | with various diseases, including diabetes, cardiovascular
         | disease, cognitive decline and cancer, metformin can improve
         | healthspan thereby extending the period of life spent in good
         | health" which is entirely consistent with the monkey study
         | under discussion here
        
         | adrian_b wrote:
         | That article discusses the earlier experiments on nematodes and
         | mice and doubts the applicability to humans of some results.
         | 
         | This new study provides data about positive results in
         | primates, so it removes some of the earlier objections.
         | 
         | Nevertheless, it is not clear yet whether the risks of harmful
         | effects of long-term treatment with high doses of metformin do
         | not outweigh its beneficial effects.
         | 
         | Where I agree with the article linked by you is that metformin
         | is not the actual cause of lifespan extension, but it mimics
         | the effects of some other primary cause, perhaps calorie
         | restriction.
         | 
         | Therefore, the studies on the metformin effects should
         | concentrate on establishing which is the mechanism of its
         | action, even if that is much more difficult than just
         | establishing a correlation between metformin intake and ageing.
         | When the mechanism of metformin action will be understood, it
         | is likely that the same effects will be achievable in safer
         | ways.
        
       | bognition wrote:
       | Interesting, Metformin is mostly commonly used to help treat high
       | sugar levels in diabetics. I'm curious if this is the same
       | mechanism or if its a novel mechanism.
       | 
       | There's data to suggest that too much sugar can cause all kinds
       | of problems to the brain, increasing oxidative stress is one of
       | them.
       | 
       | Maybe the answer we're all looking for is to cut sugar from our
       | diets.
        
         | PaulHoule wrote:
         | The "sugar" in "high blood sugar" is glucose. Your body
         | converts starches (say rice or bread) into glucose quite
         | quickly which elevates your "blood sugar" in the short term. If
         | you are healthy your body can quickly turn glucose into
         | glycogen or fats or utilize it as an energy source but if you
         | have Type I or Type II diabetes that process is impaired.
         | 
         | If you cut back radically on carbohydrate consumption, see
         | 
         | https://en.wikipedia.org/wiki/Ketogenic_diet
         | 
         | you certainly will lower your blood sugar, your body will now
         | use proteins and fat for energy as much as it can and produce
         | both ketone bodies and glucose from those other macronutrients
         | as well as stored fat and muscle tissues.
         | 
         | Table sugar and 'high fructose corn syrup' are roughly
         | equivalent to 50% fructose and 50% glucose so far as your
         | metabolism are concerned. Certainly fruit (rich in fructose and
         | sometimes sugar alcohols) is good for you in moderation but
         | probably not in excess. Your metabolism is certainly capable of
         | converting fructose and some sugar alcohols into glucose. The
         | story of what fructose does to you is much less studied than
         | glucose. Certainly excessive amounts of sucrose and HFCS
         | contribute empty calories that raise your blood sugar.
        
           | catlikesshrimp wrote:
           | You can safely remove the quotes around 'glucose' and replace
           | "high blood sugar" with 'glycemia'
        
       | fnord77 wrote:
       | metformin can also cause gastroparesis, which is a nasty
       | condition I wouldn't wish on anyone.
        
         | toomuchtodo wrote:
         | Something to be aware of is that it can cause genital physical
         | deformities in male offspring.
         | 
         | > Boys were more likely to be born with genital birth defects
         | if their fathers took the commonly prescribed diabetes drug
         | metformin in the three months before conception, according to a
         | new study by Stanford Medicine investigators and their
         | collaborators in Denmark.
         | 
         | https://med.stanford.edu/news/all-news/2022/03/birth-defects...
         | 
         | https://www.acpjournals.org/doi/10.7326/M21-4389
        
           | antisthenes wrote:
           | It's a good idea to go on a "purge" before attempting
           | conception, for both males and females, lasting at least 5-6
           | months
           | 
           | E.g. cut out bad foods, any drugs, exercise regularly.
        
         | caseyy wrote:
         | It does often cause significant gastrointestinal problems. Same
         | as weight loss drugs. A lot of people think these drugs are
         | free lunch but they are not.
        
           | epasveer wrote:
           | My experience with metformin, those gastrointestinal problems
           | occur the first 4 months of taking it.
           | 
           | I had an experience in a Home Depot, had to briskly walk to
           | the bathroom. Like clenching a quater between your cheeks for
           | a 100 yards. Barely made it.
           | 
           | Anyway, the body adjusts. After 3 or 4 months, all is good.
        
             | caseyy wrote:
             | Hmm, that is a very long time to suffer the side effects.
             | The information leaflets often say to discontinue much
             | sooner.
             | 
             | Well, if your doctor was okay with it, then who are
             | internet strangers to judge? If you had the usual non-
             | tolerance GI problems (more frequent than in 1 in 10
             | patients), I can only admire the perseverance. It takes a
             | lot of self-care from keeping close to a toilet to
             | hydration.
        
       | generalizations wrote:
       | https://en.wikipedia.org/wiki/Metformin:
       | 
       | > It works by decreasing glucose production in the liver,
       | increasing the insulin sensitivity of body tissues, and
       | increasing GDF15 secretion, which _reduces appetite and caloric
       | intake._
       | 
       | Emphasis mine. So, looks like the actual aging deceleration is
       | just the cliche, that it's healthy to not be overweight?
        
         | arcticbull wrote:
         | Likely not.
         | 
         | A principal mechanism of action of metformin is AMPK-
         | dependenent inhibition of mTORC1 in the liver. [1] mTORC1
         | inhibition also occurs when fasted and when taking Rapamycin.
         | Rapamycin has been floated many times as a life extension drug.
         | [2]
         | 
         | mTOR is one of the major nutrient sensing pathways in the body,
         | particularly sensitive to amino acids (especially methionine
         | and leucine) but also to energy levels in general via AMPK.
         | Inhibition of mTOR slows down cell division and induces
         | autophagic flux -- further mTOR dysregulation is implicated in
         | about 70% of cancers. It is an incredibly highly conserved
         | pathway in everything from yeast to humans, and [m]TOR
         | inhibition has been shown to dramatically extend life in
         | basically everything that moves. I believe there's a life
         | extension trial in humans under way around Rapamycin but I
         | could be mistaken.
         | 
         | It acts as a very targeted partial starvation mimetic.
         | 
         | [edit] > that it's healthy to not be overweight?
         | 
         | This is separately also true. But what's neat about metformin
         | is that generally diabetics on metformin are less likely to
         | develop cancer than _non-diabetics_. [3] So it stands to reason
         | that non-diabetics taking metformin would have even lower
         | incidence of cancer no?
         | 
         | [edit] I find this stuff very cool, and I personally expect
         | mTOR to be the next golden child after everyone gets on GLP-1s.
         | 
         | [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299044/
         | 
         | [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814615/
         | 
         | [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841986/
        
           | riehwvfbk wrote:
           | Everyone on GLP-1s? Is that a future most people actually
           | want?
           | 
           | I believe that these things work. But I for one don't want
           | more years as a wage slave, particularly when coupled with
           | anhedonia. Sure, I'll extract more value for my corporate
           | overlords, but what's in it for me? For some definition a
           | long life without any pleasure is an optimization, but I'd
           | argue the validity of this definition.
        
             | arcticbull wrote:
             | > Everyone on GLP-1s? Is that a future most people actually
             | want?
             | 
             | I want a future where people aren't dying of cancer,
             | cardiovascular disease, losing limbs and eyes to diabetes,
             | getting strokes and where they're living long and healthy
             | lives. I don't really care so much about the means. GLP-1s
             | are the only proven non-surgical intervention that allows
             | people to lose a clinically significant (>5%) amount of
             | weight and keep it off long-term (>5 years).
        
               | riehwvfbk wrote:
               | So instead of natural selection making it so that people
               | who live longer aren't affected by these issues - you'll
               | have a populace that is dependent on a drug. Perfect
               | recipe for powerful centralized control I suppose.
        
               | mahin wrote:
               | So just like all the life saving drugs being prescribed
               | now?
        
               | daedrdev wrote:
               | We have destroyed natural selection in humans a long time
               | ago when by creating effective healthcare, so don't worry
               | about it.
               | 
               | There are many companies making different versions of
               | this drug, I don't see why you think its some kind of
               | conspiracy intended to control the masses, literally if
               | the benefit is greater than the costs what is your issue
               | with it?
        
             | daedrdev wrote:
             | > Everyone on GLP-1s? Is that a future most people actually
             | want?
             | 
             | If it's a net positive to my life what is the problem?
             | 
             | You have a very dismal view of the world, it is possible to
             | enjoy one's work, or at least tolerate it, or work for
             | yourself in the current economic system. Personally I
             | appreciate the improved standard of living I have thanks to
             | the efficiency of our profit driven system.
        
             | cleandreams wrote:
             | I'm retired and on metformin. I feel great. The wage slave
             | problem is a separate problem for which there is only a
             | political, not medical, solution.
        
               | boringg wrote:
               | What has Met done for you? Curious what noticeable
               | impacts you feel/see.
        
               | singlow wrote:
               | I can't say what MetFORMin did for me on its own since I
               | also changed my diet and lifestyle significantly when I
               | started it. But since starting it I lost 50 pounds, and
               | got my blood sugar from a diabetic range into a normal
               | range, along with many positive side effects such as
               | increased energy, no more sleep apnea, blood pressure in
               | normal range (was over 170/90). Again MET didn't do these
               | things itself, but I do think it helped to achieve the
               | weight loss and blood sugar control that would have been
               | harder without it. I was on a low dose and never had any
               | negative side effects, and am now off of it after 6
               | months and maintaining.
        
               | cleandreams wrote:
               | I describe it as "appetite calming." Not sure how else to
               | put it. I used to have a low grade constant craving for
               | food. I wasn't obese but the weight had crept up. Losing
               | weight was impossible. I had high blood sugar, blood
               | pressure, and cholesterol. (Now on meds for all those
               | things and they are under control.)
               | 
               | Immediately after going on metformin my appetite calmed.
               | Slowly, over the next year, I lost 25 pounds. I did not
               | try to diet. My BMI is now 23.7.
               | 
               | After a few months I started weight training. I changed
               | my diet to lower carbs. I haven't lowered my HbA1c into a
               | totally comfortable level (it is 5.6 and 5.7 and above is
               | prediabetic). But I am better.
               | 
               | But before any of those changes, just the Metformin alone
               | calmed my appetite. I can go hours without thinking about
               | food. I am just less concerned. I feel normal.
               | 
               | Just as a data point, the last time I got Covid, it was
               | quite mild. It's at least possible that the better
               | metabolic health and weight loss had an impact.
        
             | robwwilliams wrote:
             | Absolutely not unless you are fighting serious obesity. In
             | contrast, I can imagine low dose intermittent mTORC1
             | inhibition as generally advantageous over a much wider
             | population of individuals 50 years and older.
        
           | sctb wrote:
           | Do you have a sense of how different mTOR-related
           | interventions stack up? As in, metformin vs rapamycin vs
           | intermittent fasting?
        
             | robwwilliams wrote:
             | Rapamycin and related rapalogs will be far better than
             | metformin at inhibiting mTORC1, and at a low and
             | intermittent dose of 4-6 mg ONCE per week are quite safe.
             | Best paper I know of now is Kaeberlein et al 2023:
             | 
             | https://pubmed.ncbi.nlm.nih.gov/37191826/
        
               | fellowniusmonk wrote:
               | What about stuff like Berberine? Is that all smoke and
               | mirror? It's always hard to tell if the research around
               | "traditional" compounds is actually legit or just other
               | countries engaging in what is effectively marketing.
        
           | robwwilliams wrote:
           | I agree with your enthusiasm for treatments and drugs that
           | inhibit mTORC1 selectively. Low dose rapamycin is our best
           | practical pro-longevity treatment today. I only wish we had a
           | large randomized clinical trial for stronger direct support.
           | 
           | In contrast, the evidence of any direct in vivo action of
           | metformin on mTORC1 is dubious. In vitro studies may be of
           | little relevance in this context.
           | 
           | Even indirect effects of metformin via AMPK activation are
           | controversial.
           | 
           | A careful study by Keys and colleagues of a large Danish
           | cohort of twins (2022)found no reduction in all-cause
           | mortality by metformin treatment.
           | 
           | They point out that the highly influential Bannister et al.
           | study (2014, pushed by a high profile TED presentation) has
           | not been replicated despite a 10-year period in which to do
           | so. Here is the link to the Keys paper that makes me highly
           | skeptical about use of metformin to modulate aging rates.
           | 
           | https://pubmed.ncbi.nlm.nih.gov/36287641/
           | 
           | Could you highlight any strong in vivo studies on metformin
           | targeting mTORC1 selectively or otherwise?
           | 
           | I am not quite sure what to make of this Cell paper yet.
           | 
           | In the NIA Interventions Testing Program (systematic studies
           | of the impact of drugs on longevity) metformin has inly weak
           | effects in males (p ~0.3) and no effect in females:
           | 
           | https://phenome.jax.org/itp/surv/Met/C2012
           | 
           | In contrast adding rapamycin work wonders (in mice).
        
         | onlyrealcuzzo wrote:
         | > Emphasis mine. So, looks like the actual aging deceleration
         | is just the cliche, that it's healthy to not be overweight?
         | 
         | Are typical monkeys obese like typical Americans?
        
           | bee_rider wrote:
           | I wonder how they control for that in lab monkeys. They
           | aren't typical, right? I guess they probably get less
           | exercise than wild monkeys.
        
             | ugh123 wrote:
             | This article describes some of what they do with lab
             | primates for obesity:
             | https://www.nytimes.com/2011/02/20/health/20monkey.html
             | 
             | Essentially: put them in small cages for years, give them a
             | nearly unlimited supply of food, and give them nothing to
             | do. Terrible.
        
         | dukeofdoom wrote:
         | This guy gives a pretty good explanation of (Insulin's effects
         | on the body), from the point of view of adapting it into a
         | lifestyle diet. He also built a pretty amazing DIY cottage in
         | Costa Rica. https://www.youtube.com/watch?v=hDxXprgv3kk&t=2s
         | 
         | This video actually helped to motivate me to get into meal
         | prepping, and significant weight loss.
        
           | bityard wrote:
           | Despite the unnecessarily picturesque location and overt
           | shirtlessness, this was actually an accurate overview of
           | nutritional metabolism for how short it is.
           | 
           | I've been researching this topic (in the context of keto) on
           | my own for the last 10 years or so and can say that nothing
           | he said is wrong. I don't know why all of this isn't common
           | knowledge at this point, other than the signal just gets lost
           | in the noise between dry research papers and fad-pushing
           | articles and products.
        
         | hinkley wrote:
         | It usually gets attributed to oxidative stress, but I think
         | it's also more exposure to toxins and inflammation sources.
         | 
         | Your mercury load is higher if you eat twice as much fish,
         | meanwhile the benefits of eating some fish are proportionally
         | higher than eating a lot of fish. You want small portions of a
         | lot of things, not large portions nor narrow selection.
        
           | arcticbull wrote:
           | From the lens of the mTOR model -- if you just eat a lot of
           | food all the time, mTOR is constantly agonized and your body
           | consistently operates in anabolic mode. Periods of fasting
           | (either explicit through hours/days without eating, or
           | implicit through low calorie diets, or synthetic via
           | metformin or rapamycin) allow your body to enter catabolic
           | mode and tear down aggregated and misfolded proteins. Recent
           | Noble Prize winner Yoshinori Otsumi discovered autophagy does
           | that specifically. [1, 2]
           | 
           | As a SWE/EE I tend to look at things through that lens, and
           | it seems like most processes in the body are AC coupled. DC
           | signals tend to get filtered out and not recognized properly.
           | Lower calorie diets and fasting convert mTOR agonism from a
           | DC signal to an AC signal and it's the periodic alternation
           | of modes that keeps you healthy. Periods where you can tear
           | down the broken and periods where you can rebuild.
           | 
           | Another example, people look at stress hormone cortisol as
           | leading to central adiposity in the context of insulin
           | resistance. This is fundamentally backwards - cortisol is a
           | potent insulin _antagonist_ , it's a catabolic hormone that
           | prevents insulin secretion, disrupts insulin signaling and
           | mobilizes stored fat. The problem is when it's _constantly_
           | elevated (DC signal) it stops working, and the opposite
           | happens.
           | 
           | mTOR inhibition also modulates the immune system and
           | suppresses hyperimmunity. This reduces inflammation (via
           | Hypoxia-indidible factor 1-alpha / HIF1A and several
           | downstream processes). Which explains why metformin reduces
           | inflammation too. Even more interesting is that inhibition of
           | mTOR in the AMPK-mTOR-HIF1A pathway makes vaccines
           | significantly less effective.
           | 
           | [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329718/
           | 
           | [2] https://www.nobelprize.org/prizes/medicine/2016/press-
           | releas...
        
             | hinkley wrote:
             | I walk first thing in the morning before eating. So that's
             | fasting exercise. It's definitely pulled down my pain
             | levels enough that I'm putting off medical intervention for
             | now. I do need to go in anyway because I want to see where
             | my A1Cs are. I was flirting with the lower edge of the
             | danger zone a few years ago.
        
               | datavirtue wrote:
               | 1:1 gummies. THC + CBD, CBG Overlap them, 5mg, wait two
               | hours, 5mg... three or four times
               | 
               | Maybe try 10mg doses but the 5g should do it.
               | 
               | Inflammation bitch slap.
        
             | devmor wrote:
             | How does this reconcile with recent studies that
             | intermittent fasting is severely detrimental to lifespan?
             | (https://newsroom.heart.org/news/8-hour-time-restricted-
             | eatin...)
             | 
             | Is it two antagonistic factors that require us to meet in
             | the middle to find the healthiest balance or is there
             | something else at play?
        
               | arcticbull wrote:
               | I absolutely hate nutritional studies.
               | 
               | My first quibble is: honestly an 8 hour window for eating
               | is pretty large, that's like, late breakfast, lunch and
               | dinner. Is that fasting? It seems like kind of a normal
               | eating schedule.
               | 
               | My first thought when I read something like this is "why
               | would it be severely detrimental" and the first response
               | is "the kind of people who are overweight are the ones
               | who are going to be trying new diets to lose weight, and
               | being overweight in the first place is severely
               | detrimental to lifespan." Controlling for that, there may
               | be something further confounding, for instance.
               | 
               | People skip breakfast all the time, and skipping
               | breakfast leads to a 60% increase cancer risk. Peter
               | Attia has a writeup on this [1]. Turns out, the people
               | who skip breakfast are far less health conscious. People
               | who skipped breakfast were 3X as likely to smoke. As he
               | says, 'health and lifestyle characteristics between
               | groups can either mask or exaggerate the association
               | between frequency of breakfast consumption and
               | mortality.'
               | 
               | I'd be very surprised if a kinda normal ish eating
               | schedule led to a materially worse outcome when properly
               | controlled. But proper control is damn near impossible in
               | nutrition studies.
               | 
               | [1] https://peterattiamd.com/does-skipping-breakfast-
               | increase-th...
        
               | StanislavPetrov wrote:
               | >My first quibble is: honestly an 8 hour window for
               | eating is pretty large, that's like, late breakfast,
               | lunch and dinner. Is that fasting? It seems like kind of
               | a normal eating schedule.
               | 
               | Even worse, they define, "time-restricted eating" as
               | being up to 12 hours!
               | 
               | >Time-restricted eating, a type of intermittent fasting,
               | involves limiting the hours for eating to a specific
               | number of hours each day, which may range from a 4- to
               | 12-hour time window in 24 hours.
        
               | hooverd wrote:
               | Fasting increases nitric oxide levels. Maybe that's bad
               | for people with existing cardiovascular issues? Probably
               | the same people who would try intermittent fasting- it's
               | a relatively bigger population. Of course you have to
               | balance that against complications from being overweight.
        
               | arcticbull wrote:
               | Nitric oxide actually dilates your blood vessels, reduces
               | blood pressure and improves cardiovascular outcomes. [1]
               | Water fasting for a couple of days brings your systolic
               | and diastolic numbers waaaaay down over 10 days.
               | 
               | > The average reduction in blood pressure was 37/13 mm
               | Hg, with the greatest decrease being observed for
               | subjects with the most severe hypertension. [2]
               | 
               | It's probably just a poor job of controlling variables in
               | the study.
               | 
               | [1] https://pubmed.ncbi.nlm.nih.gov/15722114/
               | 
               | [2] https://pubmed.ncbi.nlm.nih.gov/11416824/
        
               | robwwilliams wrote:
               | That study is an abstract and was not peer reviewed. I
               | find this an implausible result. Is there a version that
               | has been peer reviewed yet?
        
       | dewarrn1 wrote:
       | Interesting work. There are also clinical trials, recent and
       | ongoing, looking at the effects of metformin on aging in humans,
       | too, including the TAME trial[0].
       | 
       | [0]: https://www.afar.org/tame-trial
        
         | matthewdgreen wrote:
         | For those who can't access the article, the dosage they used
         | was 20mg/kg per day. The pills I've seen are 500mg, so for me
         | that works out to 3-4 pills per day. I know some people who
         | already take doses like that for high blood sugar with no ill
         | effects, but some also do have ill effects. Also I am not a
         | monkey, so no idea if this would be a great idea to try.
         | 
         | I couldn't find the exact doses TAME is using, but some
         | writeups point out that there's no effect on glucose levels
         | beyond about 1,600mg per day.
        
           | thehappypm wrote:
           | > Also I am not a monkey
           | 
           | [Citation Needed]
        
           | leptons wrote:
           | I've been taking 2000mg of metformin every day for years, no
           | ill effects. I guess I'm one of the lucky ones? Also, I'm a
           | type of monkey more commonly referred to as "human".
        
           | falcolas wrote:
           | 1k pills here, but I can only take one once a day. They're
           | really hard on the stomach, and even when taken with food. A
           | second pill (which my doctor would like to see) just always
           | makes me puke.
        
         | robwwilliams wrote:
         | TAME has not yet been funded by NIA. Stay tuned.
        
         | aanet wrote:
         | Here's more info [1] on the TAM trial, courtesy of Dr Michael
         | Greger.
         | 
         | Apparently, the TAME trial has gotten FDA approval since 2015,
         | but has yet to be launched as a full fledged clinical trial,
         | apparently because _" there is no way in hell to make money on
         | it. So how would we fund a clinical trial? Well, yes, the only
         | way is philanthropic"_ [2]
         | 
         | [1] https://nutritionfacts.org/video/the-tame-trial-targeting-
         | ag... [2] https://youtu.be/_9I0R8I16XQ?feature=shared&t=105
        
       | testfrequency wrote:
       | Not going to lie, I really hate all the recent coverage on
       | Metformin becoming a "miracle pill" - as I've been on Metformin
       | for almost 10 years now without issue.
       | 
       | I really hope my prescription costs and access to Metformin is
       | not ruined by everyone's quest to out live their children
        
         | 7e wrote:
         | Metformin is off patent and is easy to make. You will have no
         | problems.
        
           | fzingle wrote:
           | So is insulin. But at least in the US, it is expensive.
        
             | adrianN wrote:
             | It is my understanding that the expensive insulin is
             | actually more complicated than the insulin that we had a
             | couple of decades ago and that makes it easier to dose
             | correctly so that therapeutic outcomes are improved.
        
             | munk-a wrote:
             | That was due to cartel behavior (and now should be limited
             | by the recent drug capping initiative) - elsewhere in the
             | world insulin is extremely affordable.
             | 
             | Insulin is an interesting case because the insulin you get
             | today is manufactured in a different process than the
             | original batches which has let manufacturers skirt around
             | both generic alternatives and the original patent.
        
             | kurthr wrote:
             | Well, not so much anymore. It's capped at $35/mo if you're
             | on Medicare or ACA and most other sources.
             | 
             | https://investor.lilly.com/news-releases/news-release-
             | detail...
             | 
             | I'd also mention that most of the insulin these days is not
             | extracted from animals as it once was. One can make
             | arguments for/against this, but for safety reasons almost
             | all of it is now made with biopharmaceutical (bacterial
             | recombinant) processes.
        
             | epasveer wrote:
             | I believe it's expensive for the delivery system, not the
             | insulin itself. (Could be wrong).
        
             | klooney wrote:
             | Off patent it's cheap, but the on patent stuff is way
             | better, so it's what everyone wants
        
         | zamadatix wrote:
         | I'm on Metformin and not worried about it given the likely
         | reason you ended up on Metformin 10 years ago is it was already
         | generic and cheap to make, especially compared to many of the
         | alternatives. Where you get screwed is needing a pill that's
         | under heavy patents or still complicated/expensive to make even
         | when it isn't.
        
         | renewiltord wrote:
         | Artificial scarcity of these drugs is an intentional choice.
        
           | __MatrixMan__ wrote:
           | We need more garage chemists so that it can be a less
           | consequential one.
        
             | renewiltord wrote:
             | Compounding pharmacies get around this. My friend runs a
             | very profitable online pharmacy backed by them (which he
             | also owns).
        
         | DeonPenny wrote:
         | More people taking medication lower price not increases it.
        
           | bityard wrote:
           | That is true in a lot of areas. Unfortunately, that's not how
           | the pharma industry works. If a medication is patented, the
           | company who owns it sets the price (or licensing price)
           | according to demand. As an example, there was a scandal or
           | two in the past few years where private equity firms were
           | buying pharma companies and jacking up the price of
           | medications to the point where the users of those medications
           | got to choose between bankruptcy and living.
           | 
           | (Disclaimer 1: I don't know if metformin is patented.)
           | 
           | (Disclaimer 2: This is not an anti-capitlaist rant.
           | Capitalism works fine with adequate governmental regulation.
           | However, practically nothing about the US healthcare system
           | is adequately regulated.)
        
       | birriel wrote:
       | It's so frustrating to get seemingly contradictory results across
       | species with the same treatment. The Interventions Testing
       | Program found no increase in median or maximum lifespan in mice,
       | male or female, treated with metformin (though it did in
       | combination with rapamycin) [0].
       | 
       | I realize "decelarating the aging clock" might be subtly
       | different than increasing lifespan, but it's a reasonable enough
       | comparison, imho. Hopefully we can soon capitalize on
       | improvements in AI to faithfully model human biology in silico,
       | and conduct experiments that way.
       | 
       | [0] https://www.nia.nih.gov/research/dab/interventions-
       | testing-p...
        
         | tines wrote:
         | Mice vs monkeys?
        
           | trhway wrote:
           | yep, mice are burning calories much more actively than larger
           | mammals, and if anything i'd not be surprised for the
           | opposite result - ie. if mice on metformin die earlier from
           | exhaustion and starvation.
        
         | hinkley wrote:
         | Perhaps we should be looking at function levels at 70, 80, 90%
         | of lifespan rather than looking for quantity of life.
         | 
         | Logistically speaking, humans tend to have a lot of disposable
         | income at 60-70% of life expectancy. From the Enlightened Self
         | Interest perspective, extending that zone before functional
         | decline would not only improve society but also be profitable.
        
           | robwwilliams wrote:
           | Yep, optimize healthspan not necessary lifespan. Best to do
           | both and "rectangularize" survival functions (falling off a
           | cliff). Lots of effort on this now.
        
         | robwwilliams wrote:
         | I am pessimistic about purely in silico or even in vitro
         | methodd to tackle a problem as complex as aging rates.
         | Improving mouse models to incorporate a high level of genetic
         | diversity is a better first step. This is what our group of
         | resesrchers is doing now. Results are promising and results are
         | also highly dependent in genetics and sex.
         | 
         | https://pubmed.ncbi.nlm.nih.gov/36173858/
         | 
         | https://pubmed.ncbi.nlm.nih.gov/34666007/
         | 
         | https://pubmed.ncbi.nlm.nih.gov/34552269/
        
       | tocs3 wrote:
       | If I am diagnosed with type II diabetes is it worth choosing
       | metformin over other options (other considerations being the same
       | for the different choices)?
        
         | lambdaba wrote:
         | What are the other options?
        
           | tocs3 wrote:
           | https://diabetes.org/health-wellness/medication/oral-
           | other-i...
        
         | bityard wrote:
         | If you are open to controlling Type II diabetes by changing
         | your diet, look up anything by Dr. Eric Westman.
        
           | UncleSlacky wrote:
           | Also look into the Newcastle Protocol and Prof. Roy Taylor:
           | 
           | https://www.ncl.ac.uk/magres/research/diabetes/reversal/#pub.
           | ..
        
         | shaftway wrote:
         | Metformin is almost always the first medication that you
         | primary physician will prescribe, along with dietary
         | restrictions. There's a reason it's first on almost every
         | single list of diabetes medications. The side-effects are super
         | low and rare, and maximum dosage of it is rather high.
         | 
         | Three months later they check your A1C, and if you aren't
         | responding to Metformin well enough then they'll slap on a
         | second medication from one of the other categories. I think
         | Sulfonylureas combine pretty well with it.
         | 
         | If you're still not responding well your primary will give up
         | and send you to an endocrinologist, who should have enough
         | knowledge of the alternatives to discuss which one is best for
         | you. It's completely fair to say "I'd like to try XYZ because
         | the side effect of <side effect> appeals to me".
        
           | catlikesshrimp wrote:
           | Sulphonyl Ureas are known as secretagoges (They make the
           | pancreas release more insulin) This has many metabolic
           | drawbacks I won't go into.
           | 
           | They reason they are prescribed everytime for DM II by
           | insurance plans is that they are the cheapest drug for
           | diabetes in the world.
           | 
           | They are associated with either no improved mortality or
           | worse mortality.
           | 
           | They naturally don't work in DM I
        
         | mint2 wrote:
         | In addition to following your doctor's directions, It can't
         | hurt to also check your diet is including enough vitamins and
         | minerals - magnesium for example is a common deficiency and
         | effects insulin. Although also make sure you doctor is aware of
         | the supplements !
        
           | datavirtue wrote:
           | House said you should always lie.
        
         | _qua wrote:
         | Guidelines call for metformin first for most people, add ons
         | from there are usually chosen based on the individual patient's
         | comorbidities.
        
       | logifail wrote:
       | (Genuine Q): Why are people - or even just HN readers - really so
       | interested in living longer?
       | 
       | Both my father and my father-in-law have dementia.
       | 
       | My father's dementia is fairly advanced (he doesn't know who I am
       | and hasn't for a while, there are times where he doesn't know who
       | my mother is) although he's still living at home.
       | 
       | My father-in-law's dementia is less advanced although he's much
       | more frail as he was diagnosed with bladder cancer, had it
       | removed, so has ended up with the whole tubes+bags "solution".
       | 
       | My OH and I were discussing this for the Nth time last week.
       | 
       | Apologies for being blunt, but our current perspective is this:
       | try make your life count, and hope for it to end cleanly. Via
       | Dignitas, if necessary.
       | 
       | There is no way I want to see out my final years in the way that
       | my father or my father-in-law are doing now :(
        
         | barrucadu wrote:
         | Obviously the idea is to live longer with good mental and
         | physical health.
         | 
         | There's no point in living longer if your faculties are too
         | degraded to enjoy it, you may as well just be dead.
        
           | Jach wrote:
           | I guess it's not so obvious if GP is the top comment. It
           | seems broader messaging around anti-aging needs to be even
           | better (nothing against the paper). Sometimes I like the
           | jargon of negligible senescence and longevity escape
           | velocity, because I don't think it's possible to know the
           | meaning of those phrases and also think the goal is eking out
           | as much substandard life as possible, so if you can't have a
           | two-way conversation at least you can put in a semantic
           | roadblock that invites a curious reader to look up the
           | meaning and then not have the GP's question.
        
         | ceejayoz wrote:
         | I mean, we want to live longer _and_ not get dementia.
         | 
         | I wanna know what happens. I want to download my brain into a
         | computer and see what humanity does over the next couple
         | million years.
        
           | highwaylights wrote:
           | Even if that were possible, and theoretically we could take
           | the entirety of a person's brain and emulate every synapse
           | into digital storage, along with enough compute to run
           | everything (which is a massive hurdle to overcome), would it
           | really still be _you_?
           | 
           | I kind of think about it a bit like the transporter deck from
           | Star Trek. Are those people really travelling somewhere else
           | or are they getting cloned and then done like Hugh Jackman at
           | the end of The Prestige?
           | 
           | How would anyone even know? A computer simulated you would
           | _seem_ like you to everyone else, but you 'd already be gone.
        
             | incongruity wrote:
             | Worse, still, unless the current me blinks out of
             | existence, "old me" will still be around - unless we can
             | replace neurons in-place with computational analogs, the
             | original me is destined to die, almost no matter what, even
             | if a copy/download is made. From the download's
             | perspective, it continues, but the original, if not ended
             | then and there, still faces a grim end and will know it.
        
               | ceejayoz wrote:
               | If painless (or I don't remember it), I'm 100% fine with
               | a fairly speedy destructive upload process.
        
               | highwaylights wrote:
               | You won't remember it as you'll cease to exist at all is
               | the point.
        
               | ceejayoz wrote:
               | My consciousness gets interrupted on a nightly basis. One
               | more will be fine.
        
             | ceejayoz wrote:
             | > How would anyone even know?
             | 
             | If no one can ever know, I'm not sure I care. Transport me
             | to cool places all you like.
        
             | nikkwong wrote:
             | The correct answer is that there is no "you". Continuity in
             | consciousness is an illusion that can be deconstructed
             | through deep enough meditation, or more accessibly through
             | psychedelics. It certainly feels like there is as "you" at
             | the center, but what you call "you" is sort of a narrative
             | that your brain is stitching together at each moment, and
             | it can be subject to distortion, revision, reinvention.
             | 
             | You are not the same "you" from moment to moment--you are
             | just reassembled by your brain every second in a way that
             | feels conscious. So I would say there is a false dichotomy
             | in the center here. If "you" are already an illusion,
             | digital emulation just manipulates that illusion in
             | different ways. Whether or not "you" survive in a literal
             | sense is not the right question, there was not a fixed
             | "you" to keep or lose in the first place
        
             | cbsks wrote:
             | I'm in the middle of a sci-fi book that explores this. The
             | answer is that you won't be the same person. Your mind will
             | meld with the computer's AI and you will go insane and try
             | to exterminate the human race. I wouldn't risk it.
        
           | logifail wrote:
           | > we want to live longer and not get dementia
           | 
           | ...but why? Dying is natural. Dying is normal. It's what's
           | supposed to happen.
           | 
           | > I wanna know what happens
           | 
           | I've reproduced three times so I've ticked that particular
           | biological box.
           | 
           | My OH is away this week. Our eldest cooked lunch on Tuesday
           | when a meeting I was in ran over by an hour. I stumbled into
           | the kitchen an hour later than planned to find the three of
           | them eating what he'd prepared from what he'd found in the
           | fridge and he'd made enough for me, too. They're pretty well
           | set.
           | 
           | > I want to download my brain into a computer and see what
           | humanity does over the next couple million years
           | 
           | I'm absolutely, completely OK with not doing that :)
           | 
           | I'm confident the next generation will figure it out, just
           | like ours did, and the one before us, and so on...
        
             | lucb1e wrote:
             | It's also natural and normal to die in infancy, but we've
             | solved that and I don't hear many complaints
             | 
             | Edit: looked it up, 49% is the estimated rate for hunter-
             | gatherer societies and 48% until ~200 years ago (depending
             | on the country, may also be ~60% or as "low" as ~40%). In
             | 1950 it was still more than a quarter; only within living
             | memory has it truly become abnormal to die soon after
             | birth. https://ourworldindata.org/child-mortality
             | 
             | This argument of what's "natural" holds so little water to
             | me, I don't understand in what state of belief anyone even
             | brings this up. Is this a religious thing? Why say "it's
             | natural to die and therefore we should always continue to
             | do so"? Arguments of overpopulation, psychological issues
             | (and unknown unknowns), and other real problems, I can
             | certainly understand, but "it's natural"? Please explain
        
             | ceejayoz wrote:
             | > It's what's supposed to happen.
             | 
             | I wear glasses, clothes, and my kids were born three months
             | early. I, and they, were supposed to die.
        
         | tempestn wrote:
         | As others said, obviously the goal is to live longer in good
         | health. As for why, because.. I like living. Why would I not
         | want to do it for longer?
        
         | dangus wrote:
         | People want more healthy years.
        
           | logifail wrote:
           | > People want more healthy years
           | 
           | ...but that doesn't really answer _why_ , does it? To "do
           | more stuff"? To "see more things"? To "earn more money"? To
           | "learn more"? Why?
           | 
           | A friend wasn't enjoying her job a year or two ago and said
           | she felt seriously underpaid for the stuff she was being
           | asked to handle. I asked her if she would feel any happier if
           | they doubled or tripled her salary. After thinking about it
           | she realised the amount of money wouldn't fix the problem,
           | the issue was with the work environment, not the monetary
           | package tagged on to her employment.
           | 
           | Life is finite.
           | 
           | So at least for all of us who don't have some desperately
           | unkind medical issue that specifically shortens it, maybe we
           | need to take a deep breath and learn to deal with that.
           | 
           | "Carpe diem", and all that.
        
             | jjk166 wrote:
             | > To "do more stuff"? To "see more things"? To "earn more
             | money"? To "learn more"? Why?
             | 
             | Yes, to all of it.
             | 
             | Life will still be finite with a longer life, but more is
             | more. If offered the opportunity to have your lifespan
             | shortened for no gain would you take it? Obviously not, and
             | likewise if you have the opportunity to increase your
             | lifespan for no cost, it's exactly the same decision.
        
         | rileymat2 wrote:
         | I am not sure if it would map to dementia, but:
         | 
         | > The results highlighted a significant slowing of aging
         | indicators, notably a roughly 6-year regression in brain aging.
         | 
         | And some people call Alzheimer's type 3 diabetes. So there
         | could be something protective?
        
           | transitionnel wrote:
           | Diabetes causes rupturing of small blood vessels, which has
           | been seen in eyes and feet. It would follow that the same is
           | happening in the brain and an anti-diabetic medicine would
           | directly improve brain longevity in affected individuals.
           | 
           | *I am not a doctor, but also I can correlate data without
           | bias.
        
         | non- wrote:
         | The exciting thing about these findings is not that the
         | monkey's live longer, it's that their brains aged slower.
         | 
         | ---
         | 
         | Highlights:
         | 
         | * Metformin prevents brain atrophy, elevating cognitive
         | function in aged male primates
         | 
         | * Metformin slows the pace of aging across diverse male primate
         | tissues
         | 
         | * Metformin counterparts neuronal aging, delivering
         | geroprotection via Nrf2 in male primates
        
           | iwontberude wrote:
           | * Metformin-associated lactic acidosis has an estimated death
           | rate of up to 50%.
        
         | switchbak wrote:
         | The people in this space talk a lot about not just life span,
         | but health span. I don't know anyone who wants to suffer for a
         | long time, of course we'd want to live well.
         | 
         | I know for myself, I'd love to be around to watch my kids grow
         | up. Even better if I can do that while being old-man jacked and
         | physically capable enough to still enjoy life. I don't think
         | this has to mean that you're putting off enjoying life in the
         | current moment though.
         | 
         | It seems like a funny question to ask who's "interested in
         | living longer"? Taken to an extreme that's a pretty depression
         | question.
        
           | a13n wrote:
           | Survival instinct is deeply hard wired into all animals,
           | including humans. It's natural to want to continue living.
           | 
           | Anti-aging is picking up now because there's a growing belief
           | that significantly extending the healthy human lifespan is
           | within scientific/technological reach.
        
             | logifail wrote:
             | > Survival instinct is deeply hard wired into all animals,
             | including humans.
             | 
             | Survive _and reproduce_...
             | 
             | So if/when one has the reproduction bit out that of the
             | way, the survival bit _as such_ may not seem to be quite as
             | vital.
             | 
             | You know your genes are going to survive, meaning _you don
             | 't personally have to_. Which is the whole point of
             | evolution, right?
        
               | inglor_cz wrote:
               | "Which is the whole point of evolution, right?"
               | 
               | Pretty much the entire point of civilization is _not to
               | be at the mercy of natural forces_ , including evolution.
        
               | logifail wrote:
               | > Pretty much the entire point of civilization is not to
               | be at the mercy of natural forces, including evolution
               | 
               | The parent to my comment did bring up "survival
               | _instinct_ " (!)
        
               | inglor_cz wrote:
               | Sex, hunger, sleep are all instincts, but civilization
               | tries to make their satisfaction nicer, safer, cheaper,
               | more reliable.
        
               | a13n wrote:
               | I don't know that we have evidence that survival instinct
               | goes away after reproduction. It's still valuable to our
               | species to survive after reproduction in order to protect
               | and nurture offspring, for example.
               | 
               | There's no evolutionary reason that survival instinct
               | would turn off after a certain age.
        
               | logifail wrote:
               | > There's no evolutionary reason that survival instinct
               | would turn off after a certain age
               | 
               | Umm, without wishing to get too clinical or morbid, it's
               | clear that once your offspring have reached adulthood
               | there will always come a point beyond which you rely on
               | them more than they rely on you, right?
        
               | stickfigure wrote:
               | Evolution is not a motivational poster or a speech from
               | your therapist. It's just the outcome of a physical and
               | biological process. It just is.
               | 
               | I personally would prefer to survive longer. If you
               | don't, that's your business.
        
               | logifail wrote:
               | > I personally would prefer to survive longer. If you
               | don't, that's your business.
               | 
               | Ideally I'd die in my sleep 75-80 +/- a few years having
               | seen some grandkids. Doing daft stuff now to push that
               | number further out just seems pointless.
               | 
               | The next generations will have enough problems to deal
               | with without having one more cranky 90+ year-old
               | constantly popping pills claiming he can live forever.
        
               | shermantanktop wrote:
               | And voting.
        
           | onemoresoop wrote:
           | I'd trade length of lifespan for quality in a heartbeat.
           | Getting old is not very pleasant. I'm already starting to
           | feel the creaks and decline merely in my mid 40. I'd love to
           | have more time now but do have to work and when/if I will be
           | able to retire I will be too worn out and lacking the desire
           | to do the things I'd do know with that time. I'd be content
           | to live healthily till say 65-70. My mom who is at that age
           | is saying that she used to say the same thing when she was
           | young but she no longer things like that. I guess we all do
           | have some survival instinct kicking in no matter what we
           | rationalize prior.
        
             | r00fus wrote:
             | Why does quality and lifespan have to be a dichotomy? In
             | fact the more I think about it, living a quality lifestyle
             | often leads to longer life (eating healthy, keeping fit,
             | having meaningful friendships).
             | 
             | Both my wife and I have signed the papers to decline
             | extended life in a vegetative state and have confirmed our
             | desires with our kids.
        
         | fnordpiglet wrote:
         | I care more about being healthier longer. And I'd like that to
         | last as long as I can and not a lot longer necessarily. It's
         | because I love life because it's life, and wouldn't mind if it
         | went on for a long time. I could learn so many things.
         | 
         | But, even if it's 60 years I want them to be healthy. So I do
         | the things I am supposed to to age more slowly because aging is
         | causative to ill health. My things I do is eat reasonable
         | amounts of healthy food and exercise regularly. I supplement a
         | few things like magnesium and taurine, that I specifically do
         | better taking than not.
         | 
         | But if they came out with a "never age until you die" pill I
         | would take it immediately.
         | 
         | But I think you're confusing long life with long health span. I
         | don't think anyone dreams of living a long full life is hellish
         | degenerative ill health.
        
           | riehwvfbk wrote:
           | So who will pay for your long healthy life? The default
           | answer is: you will, by working longer. Any other answer has
           | this problem: why is this magic source of funds not currently
           | available to cover even our current shorter lifespans?
           | 
           | OK, so we've established that you have to continue working.
           | Are you sure that you as a geriatric man on artificial life
           | extension will be competitive with a younger guy who can go
           | crazy and use the same tech to, say, never sleep - never mind
           | that he'll die at 40? And even if we aren't talking extremes:
           | you as a pill-supported walking corpse have to be ever
           | vigilant of your own mortality. Someone younger can afford to
           | take more risks.
        
             | daedrdev wrote:
             | Your argument is easily applied to all medical
             | advancements, do you think we should stop using
             | antibiotics? Vaccines? Maybe you should let the individuals
             | determine what's best for themselves instead to trying to
             | prescribe your strange anti capitalism ideology for them.
             | 
             | Anyway medical research is focused on giving us on better
             | quality of life as we age, which is what people objectively
             | value, not whatever you think they are trying to do.
        
               | logifail wrote:
               | > Anyway medical research is focused on giving us on
               | better quality of life as we age
               | 
               | Polite correction: medical research is focussed on
               | returns for those funding said research.
               | 
               | Treating Americans is definitely a cash-cow for Big
               | Pharma, indeed if a potential new drug can't/won't make
               | it past the FDA then it will likely be killed off
               | regardless of what the rest of the world might
               | want/need/approve.
               | 
               | Check out US healthcare spend per capita compared with
               | everywhere else on the planet.
               | 
               | (Source: friend in Big Pharma)
        
         | mullingitover wrote:
         | The bigger problem with extending lifespans beyond what
         | evolution has optimized for is that you end up competing
         | against your offspring for resources, and you give pathogens a
         | non-moving genetic target to attack (which defeats the whole
         | point of sexual reproduction).
        
           | inglor_cz wrote:
           | "you end up competing against your offspring for resources"
           | 
           | This was relevant in the pre-agriculture era. We _already_
           | live in densities several orders of magnitude higher than
           | evolution optimized us for.
           | 
           | I am more concerned about the somewhat artificial _societal
           | resources_ , such as top jobs. We might get a very ossified
           | elite. We almost saw a presidential election with two ancient
           | guys competing. With longevity widespread, this may become a
           | pattern.
           | 
           | "you give pathogens a non-moving genetic target to attack"
           | 
           | True, but we generally try to manage new infectious diseases
           | by scientific means, not by "0.6 per cent of population is
           | resistant to this, let the rest croak". See: AIDS, Covid.
        
             | mullingitover wrote:
             | > This was relevant in the pre-agriculture era. We already
             | live in densities several orders of magnitude higher than
             | evolution optimized us for.
             | 
             | I mean, keep in mind that we're living in a snapshot of
             | time that's very much not stable or sustainable. It's like
             | we're all embers born in a massive forest fire that started
             | a few days ago. Everything seems normal and stable for us
             | in this situation because our frame of reference is
             | effectively a few seconds. However, this forest fire will
             | eventually consume all the available fuel and things will
             | return to baseline, no matter how hard we fantasize that
             | we're going to somehow spread the forest fire to other
             | planets.
             | 
             | Any temporary victories we've made over evolution are just
             | that. We've already seen how absolutely vicious pathogens
             | can be toward monoculture biomasses. Just ask the Gros
             | Michel banana.
        
               | inglor_cz wrote:
               | Yeah, of course tomorrow a global plague may eradicate us
               | all, or "all except Sentinelese people".
               | 
               | Nevertheless, looking at our prehistory, the worst
               | bottleneck of the human race was probably some 900
               | thousand years ago, way, way before we had anything
               | resembling civilization.
               | 
               | https://www.nhm.ac.uk/discover/news/2023/august/human-
               | ancest...
               | 
               | So, at least for me, the question of whether we are more
               | resilient as civilization vs. as primitive people in
               | their pristine state, is very much open. Too many people
               | seem to be sure that going with the natural flow is long-
               | term better. But it feels a bit like the Noble Savage
               | myth reiterated for current sensibilities.
        
           | lottin wrote:
           | What makes you think that our current life expectancy is
           | optimal?
        
           | jjk166 wrote:
           | Not if your offspring also live longer.
           | 
           | You have kids at 1X, Grandkids at 2X, die at 3X, doesn't
           | matter if X=25 or X=30 or X=100, the population dynamics are
           | the same.
        
         | willcipriano wrote:
         | Are you the sort of person who feels life is awesome?
         | 
         | Knowing the name of a assisted suicide company off the top of
         | your head seems to suggest not.
         | 
         | If you were, why would you want that to end?
        
         | riehwvfbk wrote:
         | The people who want to extend their lives are the ones whose
         | lives tend to be pretty good. The CEO plotting world domination
         | kind of archetype. The rest of us are expected to be expendable
         | biorobots who serve them. Unfortunately, this won't play out
         | the way their fantasies tell them. The rich and powerful will
         | be trapped by the need to always maintain their fragile lives.
         | This in turn will slow down progress and open up the gates to a
         | younger and more daring group to come to power.
        
           | datavirtue wrote:
           | This is true. Shifting a populations life expectancy up to
           | suspend biological aging would be a panic moment for most
           | governments that are tied to huge benefit systems based on
           | age. Good luck changing the retirement age, again.
        
         | gamepsys wrote:
         | Life is great, who wouldn't want more of it?
         | 
         | I'm old enough to see some the advances in medical care
         | different family members were able to receive when they became
         | very ill over the decades. I'm young enough to be optimistic
         | that when it's my turn the treatments available will be even
         | more significant.
         | 
         | There's a certain quality of life I wouldn't want to spend a
         | prolonged time in. I understand your point about not wanting to
         | be in bad health. Most of the activities I do that will likely
         | prolong my life (diet, exercise, manage stress, build social
         | bonds, supplements, pharmacology, screenings) will also
         | increase my likelihood of prolonging the amount of time I have
         | in good health.
         | 
         | Why am I interested in living longer? I think it's better than
         | the alternative.
        
           | darby_nine wrote:
           | > I think it's better than the alternative.
           | 
           | I mean, why? Longer lives are not necessarily any happier. In
           | fact, old age seems pretty physically miserable.
        
             | gamepsys wrote:
             | There's miseries in all stages of life. I've known people
             | that still enjoyed life into their 80s and even 90s. I'm
             | not very afraid of being physical uncomfortable, and I
             | enjoy being here enough to want to fight for more time.
        
             | elzbardico wrote:
             | This is personal and depends on your perspectives.
             | Obviously the people who want to live longer don't share
             | the same point of view as you. And it is ok, as long as you
             | are not forced to adopt their point of view and vice-versa.
        
         | elzbardico wrote:
         | Nobody expects to live longer and have dementia. People are
         | betting that they will escape that and there's a good
         | probability that they will do. Not to mention that if you are
         | around your 30s or 40s it would be terrible to not care about
         | your general health just to find out in the next 10 or 20 years
         | that science found a cure to dementia but now your body is too
         | much fucked to take advantage of that.
        
           | logifail wrote:
           | > Nobody expects to live longer and have dementia
           | 
           | I think we can generalise that statement to "nobody expects
           | to have dementia". Until you get it :/
           | 
           | There are people taking lots of vitamins, but with apologies
           | to any vitamin-takers, that hypothesis seems to have been
           | thoroughly debunked.
           | 
           |  _For healthy adults, taking multivitamins daily is not
           | associated with a lower risk of death_
           | https://www.nih.gov/news-events/news-releases/healthy-
           | adults...
        
             | elzbardico wrote:
             | Living is risky, yeah, I know it. A lot of it is a fucking
             | gamble, your profession, the place you decide to live, the
             | people you enter relationships with.
             | 
             | Nothing is assured.
             | 
             | Yeah, maybe we will be all unemployable and miserable due
             | to LLMs taking our jobs and failing to create others. Maybe
             | we shouldn't have reproduced as our kids will never get to
             | become adults due to a nuclear war or a fucking serious
             | pandemic with a virus that will make SARS-COV-2 look like
             | nothing.
             | 
             | Who knows?
        
             | klingoff wrote:
             | Cabbage also doesn't work, but what does that have to do
             | with a theory that:
             | 
             | Metformin exerts a substantial neuroprotective effect,
             | preserving brain structure and enhancing cognitive ability.
             | 
             | We obviously want additions or replacements to physical and
             | mental exercise depending on how much we get.
        
         | yieldcrv wrote:
         | I don't want to live longer _with dementia_
         | 
         | I want the entire system to have longer maintenance and repair:
         | skin smooth, head of hair, muscles not atrophied, bones not
         | brittle, oxygenated blood circulating and keeping a brain well
         | functioning without its own independent deterioration, risk of
         | cancer mitigated, but also easily repairable if its occurring
         | 
         | I look at the London borough checklist of what people died from
         | in the 1600s, and it makes me optimistic that the things people
         | currently die of will be solved
         | 
         | I just don't want to be felled by _those_ things. Its nice that
         | solving for them includes a high probability of centenarian
         | lifespans, I'm fine crossing that bridge when we get there.
        
         | pdimitar wrote:
         | Why are you conflating long lifespan with miserable last 10-20
         | years of the life?
         | 
         | I aspire to be like that French gym trainer who was in near-
         | perfect health and an optimal presence of mind at 96 years old
         | when he died suddenly (I think of heart attack).
        
         | elzbardico wrote:
         | I find life awesome. I truly fucking enjoy it. I am not rich, I
         | can't retire and probably will never be able to do so, but I
         | also enjoy my work even if not all the time. I think the world
         | is moving towards a terrible inflexion point, I think we are in
         | a fucking crisis right now, and still, fuck that. I don't want
         | to leave this boat.
         | 
         | Now that said, I completely accept that not everyone shares my
         | point of view, and I also accept that probably I wouldn't
         | understand their reasons for doing so.
         | 
         | Maybe you should stop worrying about it. Some people would
         | eagerly take any opportunity to live a few more years, it makes
         | no sense to you, but it makes to them. It is not like they are
         | forcing you to also live more than what you want.
        
           | Unbeliever69 wrote:
           | I totally get where you're coming from. I voluntarily left
           | the workforce and now we live off my wife's income as a
           | public school teacher. She's got about 15 years until
           | retirement, and while we're not rich, we're definitely
           | comfortable. Surprisingly, we've managed to do better
           | financially on a single income than we did with two.
           | 
           | Leaving the traditional workforce was an easy decision for
           | me. COVID had me working from home, and my startup didn't
           | make it through the pandemic--raising capital was tough. Once
           | I experienced working from home, I knew I couldn't go back to
           | the office or work for anyone else.
           | 
           | I feel the same way about retirement. While my wife supports
           | us financially, I support her by managing the household. I
           | take care of the pets, make her lunch, clean, help with her
           | lessons and emails, and handle groceries and errands. I
           | really enjoy this role. It frees me up to work on personal
           | projects like novel-writing and developing a SaaS product I'm
           | passionate about.
           | 
           | I get a lot of satisfaction from making my wife's life
           | easier, especially since being an elementary school teacher
           | is no walk in the park. Thanks to my support, she's been able
           | to raise over $60k for a unique program at her school in just
           | two years. She's sharing her success stories at conferences
           | worldwide, and seeing her thrive makes me happy too.
           | 
           | I'm not spending my time golfing or vacationing. I keep my
           | mind sharp and enjoy the work I do. Yes, I worry about the
           | future--like the fear of being so sick that I become a
           | burden, and no, I don't have enough saved up for that
           | possibility.
           | 
           | I feel like my generation (X) is in a tricky spot, but for
           | now, I'm content.
        
         | rscho wrote:
         | IMO, americans are very afraid of death, for some reason. Much
         | more so than europeans or Asians, in my experience. So there's
         | a culture of lasting as long as possible, including through
         | very debilitating treatment. It was my biggest surprise from a
         | healthcare culture standpoint, when I went to practice in the
         | USA.
        
           | dgfitz wrote:
           | Wow. Hope you went back to wherever you came from.
           | 
           | What a fucked up thing to say.
        
             | EVa5I7bHFq9mnYK wrote:
             | What he is saying is true, doctors and everyone else
             | involved try to squeeze as much money as possible from
             | dying people.
        
               | rscho wrote:
               | I don't really have a comparative opinion about that.
               | What I mean is that I've seen countless examples of US
               | patients and docs willing to go to extremes of treatment
               | that would be considered unreasonable elsewhere. But I
               | was just a bloke in one big university hospital, so YMMV
               | I guess. Still, the culture gap was pretty surprising.
        
             | asimovfan wrote:
             | What's fucked up about it? I didn't get it?
        
               | dgfitz wrote:
               | That American humans are more scared of dying than other
               | humans. Almost seems... well...
        
               | homebrewer wrote:
               | Read "Being Mortal" and you might come around to a very
               | different viewpoint.
        
             | rscho wrote:
             | Yes, I went back to a country with socialized medicine
             | where patients as well as doctors are still relatively
             | courteous to each other. It was a huge relief to leave the
             | US, professionally speaking. BTW, I don't really get why
             | you're so riled up.
        
               | stickfigure wrote:
               | If my doctor said "don't be afraid of death", I would get
               | a new doctor.
        
               | rscho wrote:
               | It's natural to be afraid. I'm afraid too, at times. But
               | people are only willing to suffer so much. In this
               | regard, US people offer an interesting contrast: they
               | tend to view as normal not to suffer at all in routine
               | care (minor surgery, for example), but are willing to
               | accept an incredibly bad quality of life in desperate
               | situations. In Europe for example, it tends towards the
               | opposite. Again, I'm just one guy. YMMV.
        
           | numpad0 wrote:
           | Doubt it, besides there aren't a lot of reasons for us all to
           | not just casually choose death had it been for humans' innate
           | fear of death, which I think is kind of good thing.
        
           | imarg wrote:
           | I think this comment generalizes too much. I do not think
           | Europeans are all the same on this (and probably Asians too).
           | 
           | As an example I have the impression that what you wrote is
           | true for Dutch people (I don't know if it's true but I've
           | heard/read they are more on the side of making elderly people
           | comfortable in their last moments rather than trying to treat
           | them with expensive procedures).
           | 
           | While here in Greece we do try to prolong the life of even
           | the most hopeless situations (that might be changing). It's
           | not rare to have our elderly parents/grandparents bedridden
           | at home for years.
           | 
           | Of course I might be generalizing also.
        
             | rscho wrote:
             | Yeah. It's just my experience. Not claiming anything beyond
             | my personal perception. In my country, we also tend to put
             | quality of life first.
        
           | 4star3star wrote:
           | Partly, I think that the culture is more affected by the lack
           | of history than most people realize. If you've lived in
           | Europe, and I'm sure elsewhere, you understand your mortality
           | implicitly from the centuries-old buildings and streets. At
           | least that's what I got out of it.
        
         | eqvinox wrote:
         | "decelerates aging clock" implies slowing down processes of
         | decreasing health, not just living longer in a frail state at
         | the end. In particular if you click the link, the first thing
         | it says is:
         | 
         | * Metformin prevents brain atrophy, elevating cognitive
         | function in aged male primates * Metformin slows the pace of
         | aging across diverse male primate tissues * Metformin
         | counterparts neuronal aging, delivering geroprotection via Nrf2
         | in male primates
         | 
         | It doesn't even say you'd live longer. If I could get something
         | that doesn't extend my life at all, just keeps my brain fresher
         | into my old age, I would jump on that as well.
        
         | inglor_cz wrote:
         | People are interested in _slowing aging_ , which means _living
         | longer in good health_.
         | 
         | The ultimate goal would be negligible senescence.
         | 
         | Dementia and other chronic diseases that plague our end days
         | now are consequences of aging. They don't just come randomly,
         | they are a result of the aging process, which is nothing but
         | slow deterioration, possibly a programmed one.
         | 
         | Of course people want to get rid of that.
        
         | desireco42 wrote:
         | I think you are looking at this the wrong way. I turned 50
         | recently. I have ADHD and I was fairly immature for a long
         | time.
         | 
         | I finally understand so much about life, I genuinely am helping
         | a lot of people and to be honest, want to continue living and
         | enjoying life.
         | 
         | There are so many books to read, experiences to have.
         | 
         | Yet I can feel that my body is no longer how it used to be.
         | 
         | If there was something that could bring back to clock, 5-10
         | extra years. Totally worth it.
        
         | StanislavPetrov wrote:
         | I certainly wouldn't want to live forever one way or the other,
         | but most people who talk about living longer mean slowing or
         | halting the aging process, not simply surviving more years as a
         | decaying husk.
        
         | jjk166 wrote:
         | Your Father and Father-in-laws conditions are due to the
         | process of aging, not the number of years they have lived. It
         | is the process of aging which anti-aging advocates want to
         | delay or eliminate. Living longer doesn't mean tacking on years
         | at the end, continuing the aging process for longer; it means
         | adding years to the middle before aging begins, as well as
         | lessening the effects of aging when that time eventually comes.
        
         | monkeyfun wrote:
         | To flip your question around, why are you living right now?
         | 
         | I developed a severe intestinal disorder in my 20s. Some people
         | can get it or ones like it in their teens, others their 30s,
         | 40s, 50s, etc. and many won't ever develop such issues,
         | although they're reasonably common to a less severe extreme
         | than my case.
         | 
         | Knowing this, and that I could explain my disorder for years
         | being debilitating and putting me in agonizing pain and
         | suffering, why would you want to live any longer when it
         | _could_ happen to you too?
         | 
         | Not everyone is going to develop such cognitive disorders as
         | you discuss, and often they're a result of complex genetic and
         | lifestyle factors, as well as likely having to do with aspects
         | of aging like reduced function of organs. So it's quite
         | possible these diseases and disorders aren't inevitable simply
         | as a consequence of living long enough, or could be treated and
         | reversed as medical science advances.
         | 
         | If I sound bitter by the way, I am slightly, but do mean for
         | this to still be conveyed productively.
         | 
         | To hear someone asking "why are people interested in living
         | longer?" makes me genuinely want to know why you're interested
         | in living longer. You could die right now and free up resources
         | for the rest of us, or donate resources to younger people than
         | you who are in need, or simply give it to me since I'm neither
         | senile nor old (not even 30) nor have a family history of such
         | disorders as you mentioned, nor would I put it to poor use.
         | 
         | I suspect you want to live. The simple fact is, it's that same
         | desire to live and to continue enjoying life to the fullest
         | that makes those of us with foresight interested in prolonging
         | our healthy lives.
        
       | huqedato wrote:
       | My PhD coordinator advised me to approach any study originating
       | from China with the utmost caution even if peer reviewed.
        
       | non- wrote:
       | So if Metformin is used to treat high blood sugar levels, would
       | we get the same cognitive benefits by just consuming less sugar?
       | 
       | Can't see the full paper to see if they compared the results of
       | metformin vs a low-sugar diet.
       | 
       | EDIT: Already brought up and discussed here
       | https://news.ycombinator.com/item?id=41522931#41523725
        
       | aanet wrote:
       | I haven't read the CELL paper yet (would love to, if somebody has
       | a PDF to share).
       | 
       | But I'm surprised I yet haven't seen a mention of Dr. Michael
       | Greger's book [1] _How Not to Die_ , which does an excellent job
       | of elaborating how various diseases -- including cardiovascular
       | diseases, diabetes, etc -- result in death.
       | 
       | I found it immensely helpful in plugging a lot of holes in my
       | understanding of my own health (FWIW: 40s, no chronic diseases,
       | but tendency towards high(er) A1C, cholesterol)
       | 
       | He has subsequently released other books -- How Not To Age, How
       | Not to Diet, etc -- which one might call as capitalizing on the
       | trend, not to put too fine a point on it. [However, I do find his
       | books, videos and discussions quite informative, and not too
       | technical, without going into the hyper-masculine, pseudo-
       | science-y word salad territory waded into by, say, Huberman.]
       | 
       | There's a brief video [2] on side effects of metformin as a life
       | extension drug, which seems relevant to the CELL paper above.
       | 
       | [1] https://nutritionfacts.org/book/how-not-to-die/ [2]
       | https://nutritionfacts.org/video/side-effects-of-metformin-a...
        
       | KaiserPro wrote:
       | My wife did geriatric care when she was a student doctor. When I
       | told her about this article she said and I quote: "I've met loads
       | of old people on metformin, its not done anything for them"
        
         | unsupp0rted wrote:
         | Isn't this like saying "I've seen a lot of pilots come back
         | with damage to this part of the fuselage"?
        
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