To fight severe coronavirus disease and even aging, make metformin an OTC drug, now!
For more than a month now, the COVID-19 epidemic that struck China and risks spreading globally has understandably captured the attention of much of the world. While apparently less fatal than its close relative SARS, COVID-19 is much more easily spread and, like the former, capable of causing severe lung pathology and aberrant immune responses that kill 1–3% of the patients and probably cause serious disability in those with severe illness who recover.
As Zumla et al. note in the recent Lancet piece, much of the response so far has understandably been aimed at arresting the spread of the disease from central China, however, this should not undermine the urgency of developing treatments against it, especially its severe form. While Gilead’s novel anti-Ebola drug remdesivir has shown glimpses of promise against COVID-19 and could even see mass production in China in generic form, according to Zumla et al., there is another, extremely cheap and widely available drug that could potentially help those that need help the most. The drug in question is the wonder-drug against diabetes type II, metformin:
Specific drugs to treat 2019-nCoV will take several years to develop and evaluate. In the meantime, a range of existing host-directed therapies that have proven to be safe could potentially be repurposed to treat 2019-nCoV infection. Several marketed drugs with excellent safety profiles such as metformin, glitazones, fibrates, sartans, and atorvastin, as well as nutrient supplements and biologics could reduce immunopathology, boost immune responses, and prevent or curb ARDS [acute respiratory distress syndrome — D.G.].
Thus, even though metformin is not a direct treatment for the Wuhan coronavirus itself, it is quite possibly a means of preventing severe, potentially fatal complications in the already infected people, which is a significant benefit, in my book.
There is even more to this drug, however, than its role in treating diabetes and potentially helping save people with COVID-19.
Basic facts and history of metformin
Metformin is the most widely used treatment against diabetes type II. As David Sinclair, tells us, “Metformin is a derivative of a natural molecule called a “biguanide,” from a flower called Galega officinalis, also known as “goat’s rue” or “French lilac.” It has been used as an herbal medicine in Europe for centuries. In 1957, Frenchman Jean Sterne published a paper demonstrating the effectiveness of oral dimethyl biguanide to treat type 2 diabetes. Since then, the drug has become one of the most widely taken and effective medicines on the globe.” Metformin’s mechanism of action in diabetes is through decreasing glucose production in the liver.
It is one of the cheapest medicines and is universally considered as highly safe and effective, and only causes the severe complication of lactic acidosis in a small proportion of users, usually those with impaired renal and (or) hepatic function. Some researchers think that it may actually not cause lactic acidosis at all.
Metformin, aging and diseases of aging
Even though the exact mechanism of how metformin might slow down aging is not well-understood, it has been known at least since 2002 that its administration activates the AMPK pathway, at least in the human skeletal muscle cells of type II diabetics.
The most fascinating hint that metformin could have significant anti-aging benefits in humans has been provided by the recent study conducted by Bannister et al. In it, they compared the mortality of British diabetics who were prescribed metformin to those who were prescribed another drug and that of non-diabetics. Astonishingly, the results suggest that people taking metformin could live longer than even non-diabetics, even though diabetes is supposed to be a systemic, debilitating disease.
Another extremely impressive result that directly relates to humans comes from the study in which metformin was one of the three drugs administered to nine volunteers for a year (the other two were human growth hormone and dehydroepiandrosterone (DHEA)). Astonishingly, the volunteers have shown signs of reversal of their epigenetic age as measured by their epigenetic clocks (by on average 2.5 years).
Finally, metformin is a potential drug candidate against several severe particular pathologies of aging such as Alzheimer’s, some cancers, heart disease, chronic inflammation and leaky gut. Even outside aging, it could help treat debilitating conditions like inflammatory bowel disease.
Metformin’s restricted status is a global disgrace
The fact that metformin could help save people struck by severe Wuhan coronavirus disease, that it could prolong people’s lives and make them better able to benefit from more revolutionary anti-aging treatments down the road, while being safe for the vast majority of people makes it astonishing, jaw-dropping, if you will, that there is apparently only one country in the world where it is officially available over-the-counter — Thailand.
To say that this situation is outrageous would be a severe understatement. There is no remotely reasonable justification under any possible risk model to continue classifying metformin as a prescription drug. The only plausible result of doing that is massive suffering and premature deaths. Public health authorities all over the world must follow the example of Thailand and release metformin over the counter.
The World Health Organization (WHO) must play its role, too. It lists metformin among the world’s essential medicines but the best possible way of ensuring access to it, if it is so sorely needed and safe, is to make it an OTC drug. It should call upon countries to do just that. The WHO’s position on aging also needs to be thoroughly revised. Its current approach is to promote something called “healthy aging.” It should lead in recognizing that aging is a pathology, and the one that causes the most suffering at that. Aging cannot be healthy by definition.
Recognizing aging as the pathology it is would quickly pave the way to making drugs like metformin available to everyone who would like to try to prolong their lives.