Acarbose Dosing Regime

I am finding mixed messages regarding how frequently to take Acarbose. I just started taking it this week, one time before my first meal, and have no negative effects. I have seen fewer glucose spikes (zero to one vs. 2 to 3 without acarbose), and my average glucose level has dropped a bit. It’s now ~90, which is an improvement of 5 to 10. I am debating whether I should keep it to one in the morning before breakfast and call it good for the day, or should I also take one before dinner? Are there pros/cons?

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I have the same question here.

The answer is it depends. However, understanding the mechanism of how acarbose works it makes it easier to understand how and when to dose.

Acarbose works by lowering the glucose spike following a meal. If you only had one dose per dose, you should take acarbose with the meal that is highest in carbohydrates. Imagine you had a pure protein meal in the morning, or more of a keto meal for that matter, it doesn’t make sense to take acarbose with that meal.

Acarbose works by blocking an enzyme called alpha-glucosidase, which helps digest and absorb carbohydrates in the small intestine. By inhibiting this enzyme, acarbose slows down the digestion and absorption of carbs, which can help regulate blood sugar levels and prevent spikes in blood glucose. If there are no carbs, there is no reason take acarbose.

By understanding how acarbose works, you can then make a decision on how to dose it. I, for example, typically use it as follows:

  1. Breakfast: I usually have eggs, or I fast. I don’t have any carbohydrates during breakfast, so I don’t need to take acarbose.

  2. Lunch and dinner: I have a salad with protein and some starch. I typically take acarbose with lunch and dinner to blunt the postprandial glucose levels.

Another important thing to understand is that acarbose confers some of its longevity benefits through its effects on the microbiome. Acarbose increases the amount of resistant starch that could not be broken down by the intestinal enzymes. Resistant starch enters the colon, where it is fermented by the gut microbiota, leading to an increase in the production of short-chain fatty acids (SCFAs). SCFAs may play a critical role in extending longevity and may also produce other signaling molecules that have been associated with longevity benefits.

The relevance of this underlying mechanism is that even when you are not eating a meal with a lot of processed foods but are still eating a carbohydrate, acarbose converts the carbohydrate into a starch that improves the microbiome.

Here is a full article where we talk about the underlying mechanisms of acarbose:

https://gethealthspan.com/blog/articles/acarbose-and-rapamycin-longevity/4wxxj7itxktmmnrxuwmulj/

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Thanks Daniel. That’s super helpful. I am going to test taking it twice a day on days when I have more than one high card meal. I’ll track the impact with my CGM and see how it goes.

Thank you for the information on Acarbose , I switched from Metfirmin to Acarbose because of side effects . With using Acarbose once or twice a day my glucose level has dropped to 93 from 110 + I have no side effects from Acarbose .

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when am I going to lose weight?

So if one is eating zero carbs there is probably no reason to take acarbose then for any longevity reasons?

@MS121269 For all intents and purposes, all of the conferred benefits come from blunting the post-prandial spikes in glucose levels that are derived from blocking an enzyme called alpha-glucosidase, which helps digest and absorb carbohydrates in the small intestine. By inhibiting this enzyme, acarbose slows down the digestion and absorption of carbs, which can help regulate blood sugar levels and prevent spikes in blood glucose.

Acarbose increases the amount of resistant starch that cannot be broken down by intestinal enzymes. Resistant starch enters the colon, where it is fermented by the gut microbiota, leading to an increase in the production of short-chain fatty acids (SCFAs).

This is all incumbent on blocking the digestion of an ingested carbohydrate. So if you are eating zero carbs there would be no longevity benefits.

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Do you think it would be beneficial to eat carbs so that your gut can make short-chain fatty acids (SCFAs)? And would doing that while taking rapamycin, still be good for your longevity?

One approach to optimize the benefits of short-chain fatty acids (SCFAs) in your system is through the integration of complex carbohydrates in your diet while administering acarbose. This aligns well with current best practices.

@charles, could you please provide some insight into your present dietary regimen? Specifically, it would be beneficial to understand if you are currently consuming carbohydrates or if your are abstaining completely. We do not have a hard take on diet, but we can provide some guidance based on your current diet.

We generally prescribe acarbose in combination with rapamycin, an approach guided by the findings of the Intervention Testing Program (ITP). It is important to note that to experience the potential health benefits of acarbose, carbohydrates need to be part of your diet.

A recommended regimen for longevity could consist of a balanced diet that includes complex carbohydrates, along with the combined use of acarbose and rapamycin. However, please bear in mind that individual responses can vary and it’s important to monitor your progress closely and adjust the treatment plan as needed.

I am swallowing my daily Acarbose tablet. Are you supposed to chew it?

What is the advantage of Acarbose over just avoid glucose spikes and increasing one’s resistant starch intake? I ended up getting a CGM and learned how to eat to avoid spikes. You can really learn about food’s actual GI/GL or how combining/timing foods affects GI/GL. Once you figured out your routine, you probably wouldn’t need the CGM or Acarbose for the rest of your life.

Hi @MBWiener er, it’s perfectly fine to simply swallow your acarbose at the start of your meal containing carbohydrates. Some patients, including Dr. Cohen, sprinkle their acarbose on their meal (in the case of a smoothie and or cereal/oatmeal for example). Let us know if you have any additional questions that we can address for you.

Hi @Dr.Bart those are in fact the main two benefits. Downstream from increasing resistant starch are benefits to remodeling gut microbiome and increasing short chain fatty acids. We wrote about this subject here:

Let us know if we can address any other questions you have about the underlying science.

What’s the recommended dose of ACARBOSE please for people starting out on this Healthspan path ?

i Recommend starting with 25mg tablets 3x daily with breakfast, Lunch, and Dinner meals. I usually swallow my tablets right before my first bite of food. I made the mistake of starting out on 50mg 3x daily and it created a lot of gas and non-solid stool. however, now it’s a lot better. I think 50mg 3x daily is the sweet spot dosage from the study I saw. 50mg gave somewhere around a 0.7% reduction in A1c. I take my Acarbose with Rapamycin and I’m still on my older Metformin prescription 500mg 2x daily with breakfast and dinner. Mostly using Metformin for fat loss and some cardiovascular disease prevention. I do plan to drop Metformin at some point though in the near future. I wouldn’t mind replacing it with the SGLT2 inhibitors, like Canagliflozin. However, it won’t be available in generic for a while, whereas Dapagliflozin should be available October 2025. I just don’t like the fact that Metformin impedes nearly 50% of the benefits of exercise on the mitochondria and hasn’t shown any lifespan extension in mice/animals.