Canagliflozin - A One Month Report, Its Good

I've been using Canagliflozin for the past month and really like it.  It moderates blood glucose levels and makes it really easy to lose weight.  I've lost about 10 lbs in 3 weeks, without really trying.  

I researched it after the report form the NIA ITP study came out last year.  I tried Acarbose before - but the gas it can cause was less than ideal on occasion.  So I've moved over to 100mg of Canagliflozin for the first week, then phased up to 300mg in the morning.  It seems to do a really good job of managing post prandial glucose levels - typically 70 to 120 during the day - see my typical daily CGM results in screen capture attached (Note that GCM measures are typically 10 to 20 points lower than I see on my finger prick blood glucose test).  I eat a fairly low carb diet anyway - but this helps when I include higher glycemic index foods.  

Cost was $2/per 300mg tablet from pharmacy found on Indiamart.com, so a $60/month cost, which I consider reasonable, no prescription required.

Here is the US pharmacy info if you get a prescription:

https://www.goodrx.com/canagliflozin?dosage=300mg&form=tablet&label_override=Invokana&quantity=30&sort_type=popularity

Its a good complement to Rapamycin.  I think I will keep on these for the long term.

 

Recent Studies, Resources:

Latest Peter Attia Update on Rapamycin and other anti-aging drugs:

"There is another drug that is super exciting called canagliflozin" a more elegant version of acarbose that works in the kidney. Extends life of mice in the ITP study almost as much as rapamycin. "Discussion starts at minute 90 on this new podcast:

https://youtu.be/aMyJvxE59DU?t=5396

Canagliflozin extends life span in genetically heterogeneous male but not female mice

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710304/

SGLT-2 Inhibitors as Calorie Restriction Mimetics

https://www.fightaging.org/archives/2019/03/sglt-2-inhibitors-as-calorie-restriction-mimetics/

SGLT2 inhibitors as calorie restriction-mimetics: insights on longevity pathways and age-related diseases

https://academic.oup.com/endo/advance-article-abstract/doi/10.1210/endocr/bqab079/6226811

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  • That's really interesting - thanks for sharing your experience with it so far! Also thanks for the background data on it.

    Agree - $60/month seems reasonable.

    Let us know the next time you do your bloods how they are. Imagine they'll be fine - but am still curious.

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  • Actually the discussion of canagliflozin doesn't start until about 1 hour 50 minutes into that Peter Attia video (but thanks for the link!)

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  • Hi David, 

    Have you checked your ketone levels through biochemical measures? May I ask what your diet is like- carb intake specifically? Even though Peter Attia is taking it, we still do not have a safety and efficacy study done in healthy populations. I would be interested to see a combination of low-carb combined with sglt2 inhibitor (canagliflozin specifically) for primary endpoints on general health markers. I think canagliflozin has great efficacy for the indication of hyperinsulinemia but I'm worried of a dose-dependant effects on insulin + ketones in a healthy, large population sample. 

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      • David
      • Davin8r
      • 9 mths ago
      • Reported - view

      Geoff Welch Did you mean to address your question to the original poster (Brin)?  Regarding your question, what exactly is your concern about insulin + ketones in non-diabetics?  Ketoacidosis?

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      • David
      • Davin8r
      • 9 mths ago
      • Reported - view

      Just did some reading on case reports in the literature involving euglycemic type 2 diabetic ketoacidosis in patients taking canagliflozin.  Sounds like DKA is most risky in type 1 diabetics (unable to produce insulin due to autoimmune disease) or long-standing type 2 diabetics whose pancreas has essentially burned out and is also unable to produce insulin.  That being said, seems like it could still be risky for a non-diabetic taking an SGLPT2 inhibitor to do a full fast or a strict keto diet, although it should also be easy for them to reverse the ketoacidosis by eating/drinking some carbs since their pancreas is fully able to crank out plenty of insulin, *if* they caught it in time and realized what was going on.  I wonder if the typical prescribers of these meds warn their patients to avoid ketogenic diets and fasting?

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      • Karl
      • Karl.1
      • 6 mths ago
      • 1
      • Reported - view

      Geoff Welch are you sure that Dr Attia is taking it himself?

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    • Karl Yes, 100% certain. He currently takes rapamycin and canagliflozin. 

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      • Karl
      • Karl.1
      • 6 mths ago
      • Reported - view

      David remarkably unlikely to happen in anyone not using insulin.

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      • David
      • Davin8r
      • 6 mths ago
      • Reported - view

      Karl time will tell

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  • The side effect I'd be most concerned about from combo SGLT2 inhibitor and rapamycin is bacterial infection, specifically UTI.  Dr. Alan Green (rapa guru in NY) just posted an Oct 2021 update saying he has seen increased risk of bacterial infection in his 760 patients to date on weekly rapamycin.  He recommends everyone taking rapa have a supply of antibiotic on hand for early treatment in case of infection.  The #1 side effect of SGLT2 inhibitors is UTI because of all the glucose being excreted through the urine, and UTIs can be *nasty* (can turn into kidney-damaging pyelonephritis and deadly sepsis).  So the combo of these two raises the risk of UTI and associated problems even higher.  Keep in mind that Dr. Green's recommendation of keeping a Z-pack on hand, while maybe good for broad-spectrum treatment of many bacterial infections, is *not* the best choice for UTI (rather, Bactrim DS or cipro are more appropriate since UTIs are usually caused by E. coli and azithromycin doesn't work well against E. coli).  Anyway, I hope the original poster sees this and strongly considers inquiring with his PCP about getting an antibiotic!

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      • Karl
      • Karl.1
      • 6 mths ago
      • Reported - view

      David Bactria and Cipro, although both commonly prescribed for UTI’s, have a 20-30% failure rate due to bacterial resistance. 

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      • David
      • Davin8r
      • 6 mths ago
      • Reported - view

      Karl only 1.9% resistance to Cipro in this study from 2017 although certainly is on the rise:

      https://pubmed.ncbi.nlm.nih.gov/27234045/

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      • Karl
      • Karl.1
      • 6 mths ago
      • Reported - view

      David interesting. Goes against most other studies and antibiograms.

      https://journals.asm.org/doi/10.1128/AAC.00862-20

      I would not give Cipro to anyone unless it was last resort because of its negative impact on connective tissues.

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      • David
      • Davin8r
      • 6 mths ago
      • Reported - view

      Karl I don't like cipro either (tendon rupture makes me cringe just thinking about it) and Bactrim can also cause nasty allergic reactions as a sulfa drug.  Come to think of it, fosfomycin seems like an excellent choice to have on hand.  There's almost no resistance to it (yet) and it's a single 3gram dose mixed into water.

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  • But beware certain people with health coditions…https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-kidney-warnings-diabetes-medicines-canagliflozin

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  • Been taking 300 mg Canaf for 3 months now.  Cost 86 euros here in Spain for 30 tabs. No Rx needed.  Really has dropped my HbA1c from 6 to 5.  Lost 10 kg.  Lower glucose levels = lower inflammation = less fat, and plaque build up in arteries.  Side-effects:  Noticed very high glucose excertion in urine via urinalysis.  I take my B/P every morning, and my pressure was really dropping. (under 100) Have been on Linsopril for years.  Stopped that and Canaf has controlled my B/P to under 110 which is where I want to be.  After researching found out that SGLt2 inhibitors make you pee more thus contributing to dehydration which causes "hypotension" low blood pressure.  So started drinking more fluid and seem to be very stable.  

    On a side note, have been taking rapa for 5 years, and no infections.  Only a minor mouth sore very rarely.  Currently taking 20 mg. twice a month with GFJ protocol.  75 yo male, 165 lbs. 71"  Pheno Age 62 yo.  As Al m said, these interventions are only for healthy people.  Others should consult there physician.  

    Like 6
  • Thanks for bringing up the topic and including references 

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