#463

This might actually be one of the best ones to get from within the U.S. from a cost perspective.

For example you can get 90 x 100mg acarbose pills for $29 at Walgreen with a GoodRx coupon (https://www.goodrx.com/acarbose?)

Or if you want to simplify and get the prescription baked in at a somewhat higher, but not crazy, cost, Healthspan seems to have plans starting at 30 dollars a month.

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#464

For the reason (cheap in the US) you mentioned, I have been trying to get a prescription set up via Push Health. Waiting for their medicine man to get back to me. If he accepts my proposal to pay $100/year for a prescription, then goodrx price at RiteAid is $109 for 540 100mg tabs. (3 meals x 180 days = six month supply, works out to less than twenty cents/tab.)

And just now, I signed up for Healthspan, and went through the application process to get acarbose. That $30 month is for one 25mg tab/day, on a six-month prescription. I proposed a custom plan matching what I mentioned above. Will see what they come up with for price.

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#465

Sounds like you really are on top of things here. Please let us know what you hear back from Push and Healhspan respectively.

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#466

Have you tried your doctor at Kaiser? When I was with Kaiser I asked my doctor about a Metformin prescription - he said sure, no problem, but they wouldnā€™t cover it (i.e. insurance wouldnā€™t cover it, but it was only something like $15 for 3 months supply). You might try asking your doctor at Kaiser about getting a prescription for Acarbose. They might just give it to you without any hassles.

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#467

My experience says there is no chance. Nonetheless, I put in a request.

I predict that the response will be: ā€˜Acarbose is for diabetics, you are not diabetic, have a nice day.ā€™ Letā€™s see.

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#468

Any update from Push Health? Do they need any bloodwork to make the decision (I generally have low fasting glucose and low HbA1c so my normal doc did not feel comfortable)

#469

Prescription from PH has been sent to local pharmacy. I havenā€™t been informed that itā€™s ready yet. Would like to see that my goodrx coupon is honored before declaring this a good process.

Doc didnā€™t ask for any blood work. I told him I was already getting it from India. But I donā€™t think he would have asked for blood work in any case.

I think I uploaded a copy of passport, plus the doc asked for selfie, as this suffices for an ā€˜examinationā€™ in California.

Although the PH website says the max prescription allowed is for three months, he wrote for 540 (180x3) 100mg, and then one refill. So should cover me for more than a year, as a practical matter.

I never actually got the guy to quote a price for the prescription. Maybe you can do better.

I proposed, $100 for 6 months + refill. I didnā€™t know he would accept my price until PH made a bill for $100 to generate a prescription. Since I had used him initially to get cgm ($70 for ninety days prescription), needed to get a price for this prescription.

Just say how much you want, and how may refills. I wouldnā€™t volunteer anything beyond that. See what the response is. According to PH support, if you donā€™t like his price for the prescription, you can contact PH to get assigned to another doc.

If you havenā€™t enrolled in PH, you will be charged some amount to sign up for whatever it is you want. That should include the prescription. Thatā€™s likely less than what I paid, if you can get enough refills included. After the initial sign-up fee, whatever you pay for other prescriptions is according to the docā€™s requirement.

But if you havenā€™t used acarb at all, I recommend getting some from India first. Experience the gas, see if itā€™s tolerable. From my experiments, grinding the tab, then mixing with food, or mixing in drink (doesnā€™t really dissolve, stir periodically) to take with food where food mixing is not practical, greatly reduces the gas.

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#470

@anon16510610 thanks for this informative and rich answer.

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#471

I picked up my 540 acarbose 100mg from RiteAid for $110. Theoretically a six month supply. One refill allowed before this time next year. So one year works out to $110x2 + $100 for the PH prescription = $320 / 1080 tabs = a bit less than $.30/tab. Which seems competetive with some of the Indian suppliers listed in the spreadsheet seen elswhere.

Of course, itā€™s made in India. (ā€˜Strides Pharma Scienceā€™.)

Did not pursue with Healthspan beyond initial signup. One 25mg/day for one year would cost $300, so not competetive.

As for getting it through Kaiser, I asked, but then was asked too many follow-on questions. I donā€™t really want to interact with my PCP any more than I have to.

One more thing about Push Health. It says at the bottom of my payment form that the doc fee is being donated. So s/heā€™s working for free, just to generate donations?

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All this may be an exercise in futility for me in particular, as I was reminded somewhere in the reading today that acarbose didnā€™t help old mice. :sob:

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#472

More importantly, the intestinal flora may develop adaptability to acarbose, which means it may become less effective after prolonged use.You can try berberine, which may be the best alternative, as it regulates the gut microbiota normally with only very small absorbed doses.

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#473

Do we know how much the effectiveness goes down?

If it goes down by say 30% or even 50% something it could still be effective and one could perhaps compensate by upping the those a bit.

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#474

Iā€™ve seen no evidence that the effectiveness of acarbose decreases at all over time. Where is that coming from?

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#475

Inactivation of the antidiabetic drug acarbose by human intestinal microbial-mediated degradation

https://www.nature.com/articles/s42255-023-00796-w

Drugs can be modified or degraded by the gut microbiota, which needs to be considered in personalized therapy. The clinical efficacy of the antidiabetic drug acarbose, an inhibitor of Ī±-glucosidase, varies greatly among individuals for reasons that are largely unknown. Here we identify in the human gut acarbose-degrading bacteria, termed Klebsiella grimontii TD1, whose presence is associated with acarbose resistance in patients. Metagenomic analyses reveal that the abundance of K. grimontii TD1 is higher in patients with a weak response to acarbose and increases over time with acarbose treatment. In male diabetic mice, co-administration of K. grimontii TD1 reduces the hypoglycaemic effect of acarbose. Using induced transcriptome and protein profiling, we further identify an acarbose preferred glucosidase, Apg, in K. grimontii TD1, which can degrade acarbose into small molecules with loss of inhibitor function and is widely distributed in human intestinal microorganisms, especially in Klebsiella . Our results suggest that a comparatively large group of individuals could be at risk of acarbose resistance due to its degradation by intestinal bacteria, which may represent a clinically relevant example of non-antibiotic drug resistance.

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#476

Ah - good find. Thanks for posting! So some questions I have are:

  1. whether this degradation has an impact on the lifespan extension effects of rapamycin
  2. Are these microbiota also seen in the mice they do the ITP studies on? (If they are, then perhaps the degradation doesnā€™t matter, as the mice still lived longer)
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#477

I personally understand that the lifespan of mice is much shorter than that of humans, so it must be very difficult to determine the long-term disturbances in the gut microbiota. Additionally, the human gut is the largest immune organ in our body, with the combined weight of the microbiota in our gut being as much as that of a liver. Furthermore, each personā€™s microbiota is unique. Therefore, the long-term benefits of taking acarbose for healthy individuals, those whose blood sugar is already healthy, may need to be slowly verified over time.

Acarbose basically disables the enzyme that breaks down certain complex carbs into glucose in your small intestines. For example, sucrose is two sugar molecules bound together, a glucose and a fructose. The enzyme (alpha-glucosidase) sitting on your intestinal villi that is supposed to cleave complex carbs down to glucose has been disabled by Acarbose. So the sucrose goes into your large intestines and gets digested by your gut bacteria.This is the drug which limits the bodyā€™s ability to process carbohydrates.

This is why the gut microbiota changes when taking acarbose, but I have always been conservative about whether these changes are beneficial in the long term. Normally, our small intestine should break down carbohydrates, but this step is blocked by acarbose. I think itā€™s similar to gallbladder removal surgery. Normally, the bile secreted by our liver is stored directly in the gallbladder. After gallbladder removal, the bile secreted by our liver flows continuously into our intestines, stimulating our intestinal wall 24 hours a day. Therefore, many people who have had their gallbladders removed are several times more likely to develop colon cancer than those who have not. At the same time, more bile refluxes into our stomach, stimulating our gastric mucosa, causing intestinal metaplasia of the gastric wall

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#478

Why would you think that? Leftover carbohydrates are digested by gut bacteria if you take Acarbose or not, it is the normal process of digestion. It produces some (or a lot) gas and short-chain fatty acids. If you take Acarbose you do not completely block the digestion of carbohydrates in small intestine. You just add some carbs to be digested by bacteria in large intestine.
SCFAs are generally considered beneficial. They play important roles in various physiological processes, including energy metabolism, immune function, and gut health. They help maintain the integrity of the gut barrier, regulate inflammation, and support the growth of beneficial gut bacteria. Additionally, SCFAs have been associated with various health benefits, such as improved insulin sensitivity, reduced risk of inflammatory diseases, and protection against colon cancer.

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#479

Our intestinal bacteria can produce short-chain fatty acids (SCFAs) themselves, and it is not necessary to take acarbose to produce them. Furthermore, there are several types of SCFAs, for example, Butyric acid can be directly produced by Butyric acid bacteria, Faecalibacterium prausnitzii can produce Propionic acid, and so on.

#480

That is what I said, Acarbose or not, but with Acarbose bacteria have more carbohydrate sources to produce more SCFAs.

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#481

How much carbohydrate absorbtion does acarbose really block?

#482

Metformin also can lower IGF1 slightly and that hasnā€™t been shown to extend lifespan so I donā€™t buy the IGF1 theory.

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