Key Points:
- Dr. Barzilai says these four drugs have been classified as gerotherapeutics—drugs that extend disease-free life (healthspan) and lifespan in mice, treat more than one disease in humans, and reduce the risk of mortality in humans.
- SGLT2 inhibitors treat diabetes and cardiovascular disease, metformin treats diabetes and enhances immunity, bisphosphonates work against osteoporosis, and GLP-1 agonists (like Ozempic) counter obesity.
Dr. Nir Barzilai, the director of aging research at Albert Einstein College of Medicine, thinks it is absurd that so many people are using supplements instead of FDA-approved drugs that may work against aging. In a Longevity.Technology interview, he names four FDA-approved drugs that have shown safety and efficacy, which also lower overall risk of death: SGLT2 inhibitors, metformin, bisphosphonates, and GLP-1 agonists.
Dr. Nir Barzilai Believes We Should Give More Attention to FDA-Approved Potential Aging Interventions
In the interview, Dr. Barzilai criticizes people’s preference for supplements over FDA-approved drugs to counteract the effects of aging:
“That is crazy,” says Dr. Barzilai. “We don’t know much about supplements. We don’t know much about the combination of supplements.”
In contrast to supplements, FDA-approved drugs have been established as effective against human diseases, and the possibility looms that they work to counter aging. Dr. Barzilai refers to the four drugs as “gerotherapeutics.” The criteria he uses to establish which drugs fall under this designation are that they do the following:
- Extend the healthspan and lifespan of animals
- Target one or more hallmarks of aging
- Treat multiple diseases in humans
- Reduce mortality in humans
According to Dr. Barzilai, the four gerotherapeutics he mentions reduce overall mortality in humans, according to clinical studies lasting about five years. The importance of these findings lies in that the reductions in mortality were not only related to conditions that the drugs were designed to target. Rather, these four drugs have been found to diminish overall mortality—death coming from any cause. This lends support to the notion that these drugs could be targeting underlying aspects of aging to reduce chances of dying and could ultimately extend lifespan.
Details On the Four FDA-Approved Drugs
As for what these drugs do, SGLT2 inhibitors are antidiabetic drugs that are also prescribed to non-diabetic patients for kidney and cardiovascular disease prevention. Metformin is another drug originally prescribed for diabetes but has been associated with enhanced immunity. Bisphosphonates are typically prescribed to prevent bone loss in patients with osteoporosis but also work against some types of cancer. Last, GLP-1 agonists like Ozempic were originally designed to counteract diabetes but have also been associated with weight loss.
Intriguingly, Dr. Barzilai shared data regarding about a 4% increase in overall mortality among those who use multivitamin supplements. Also, he says that there may be adverse interactions among supplements that we do not know about which could facilitate higher mortality.
Tailoring the Four Drugs to Individual Health-Related Needs
The good news, according to Dr. Barzilai, is that we have the four FDA-approved drugs that we can use as tools to extend our healthspan. He says that we can tailor these drugs to individual health needs in aged people.
“Doctors can repurpose drugs all the time. It’s legal,” says Dr. Barzilai.
He continues, saying that if you have a condition like osteoporosis or obesity, you can start by taking bisphosphonates or GLP-1 agonists, respectively. Otherwise, say, if you have prediabetes, you could start by taking metformin or an SGLT2 inhibitor, based on your doctor’s judgment.
“We have those drugs,” says Dr. Barzilai. “We have to choose the right drugs for the right people and start educating doctors that you can prescribe those drugs, and they’ll have real effects.”
Considering Use of an FDA-Approved Aging Intervention
If evidence continues to compile that these FDA-approved drugs lower mortality in humans, future research should be dedicated to examining how they may delay death. In other words, finding out which hallmarks of aging they may improve could help refine their mechanisms of action to enhance these drugs and/or design new ones that are even better.
Dr. Barzilai seems to believe that we do not need to take our chances by taking supplements with unproven efficacy. Instead, he thinks that we need to, perhaps, pay more attention to the possible aging intervention drugs that have already been approved by the FDA, which have undergone more rigorous testing.
On the other hand, running counter to Dr. Barzilai’s argument, it may be somewhat difficult for those not experiencing a chronic condition like diabetes or being overweight to get a prescription for these drugs. For those without such a condition, taking a supplement may be an accessible option in an attempt to delay aging. Furthermore, some studies have suggested that taking vitamin supplements like vitamins E and C may contribute to increased life expectancy and a reduced risk of chronic diseases. Thus, the position that Dr. Barzilai takes against using supplements remains, to some degree, inconclusive.
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