Acarbose for Longevity

What the evidence says

Acarbose inhibits intestinal alpha-glucosidases, slowing carbohydrate digestion and reducing post-meal glucose excursions. It is approved to improve glycemic control in type 2 diabetes, not to slow aging in otherwise healthy people.^[5]

The National Institute on Aging Interventions Testing Program found longer median lifespan in genetically heterogeneous mice, with a much larger effect in males. Replicated animal survival is stronger than a single mechanistic experiment, but sex-specific mouse results cannot establish a human dose or benefit.^[1]

In STOP-NIDDM, people with impaired glucose tolerance assigned acarbose had less progression to diabetes during treatment. A Cochrane review found that alpha-glucosidase inhibitors may delay or prevent diagnosis compared with placebo, while evidence for patient-important complications and durability after withdrawal was limited.^[2][4]

The ACE trial randomized 6,522 Chinese adults with coronary disease and impaired glucose tolerance. Acarbose reduced diabetes incidence but did not reduce the primary composite cardiovascular outcome, setting a direct limit on claims that flatter glucose curves necessarily produce longer life.^[3]

Gas, diarrhea, and abdominal discomfort are common because unabsorbed carbohydrate is fermented in the colon. It is contraindicated in several intestinal disorders and cirrhosis; when combined therapy causes hypoglycemia, glucose rather than sucrose is needed because acarbose delays sucrose breakdown.^[5]