I’m not sure. The studies indicate that empagliflozin does lead to weight loss over time but the effect is not as strong as expected. Maybe it’s related to your body becoming more metabolically efficient and thereby lowering your metabolic rate or maybe you just start craving carb-rich food more.
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N=1, but I didn’t lose weight (it’s been four months now that I’m on dapagliflozin), and I don’t crave carbs. I assume that, contrary to semaglutide, SGLT2is don’t make you lose weight if you’re not overweight. I don’t have data on my metabolic rate 
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Is there a reason to stop empagliflozin if you are doing OMAD intermittent fasting? This is what my father does and he is considering starting empagliflozin for health purposes (his HBA1C is close to pre-diabetic at 5.5). Thanks!
SGLT2i use is considered safe during Ramadan: Canagliflozin - Another Top Anti-aging Drug - #687 by adssx
So OMAD might be safe as well? I would ask a doctor though.
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Hydration seems important when on SGLT2i’s:
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According to the meta-analysis, patients receiving SGLT2I had lower pneumonia incidence (OR=0.62, 95% Cl, 0.51-0.74) and pneumonia risk (OR=0.63, 95% Cl, 0.60-0.68, P=0.000) compared to those receiving DPP4I. The same situation occurs in mortality rate of pneumonia (OR=0.49, 95% Cl, 0.39-0.60) and pneumonia mortality risk (OR=0.47, 95% Cl, 0.42-0.51) . Lower mortality of COVID-19 (OR=0.31, 95% Cl, 0.28 -0.34), and a lower hospitalization rate and incidence of mechanical ventilation (OR=0.61, 95% Cl, 0.56-0.68, P=0.000, OR=0.69, 95% Cl, 0.58-0.83, P=0.000) due to COVID-19 in patients with type 2 DM receiving SGLT2I.
(poke @DeStrider)
The University of Kansas did a very short (12 weeks!) trial of dapagliflozin 10 mg in Alzheimer’s (NCT03801642). The results haven’t been published in a peer-reviewed journal yet, but here’s the data presented at the CTAD conference (October 24-27, 2023):
CTAD Poster Dapa in early AD .pdf (223.3 KB)
Also available page S86 here.
After only 12 weeks on mostly non-diabetic patients (91.3%) with a mean age of 71.2 years and mean BMI of 28.3 kg/m2:
- Trend to increased NAA concentrations (p=0.06)
- “Increase in brain glutathione (GSH), a major brain antioxidant that represents cerebral antioxidant defences and is lower in AD (p<0.05)”.
- Improvement in executive function (Stroop Interference) compared to the placebo group (mean difference +4.1 points, p=0.03). Not on other cognitive tests.
- No treatment-related effects on fasting levels of beta-hydroxybutyrate, glucose, insulin, and cholesterol (total, LDL, and HDL).
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@adssx My empagliflozin is being shipped as I write this. I ended up getting the 25 mg version and will split it in half to take 12.5 mg. My father will be taking it as well. Maybe even my mother.
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Curious why you are splitting the dose?
The lowest dose is 10 mg, which is what I was aiming for. Buying the larger dose is almost the same price and the flozins don’t lose efficacy when split. So, buying the larger dose and splitting it gives you 25% more than a 10 mg dose at half the price.
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It’s hard to argue with this logic. I’ve gone between splitting my 25mg tabs and taking a full tab. The only reason I’m taking a whole tab daily currently is because even though glucose excretion in the urine doesn’t increase appreciably from 10mg to 25mg, I wonder if the higher dose might still better inhibit SGLT2 in other tissues, producing more potent anti-aging/anti-disease effects. Just a thought. It’s certainly so much more cost effective to do the half-tab dose.
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My first thought was, is their data that suggests the lower dose will likely be effective for the purpose you are taking the drug?
My second thought was similar to @Davin8r and that you might need a higher dose for a glucose effect if your serum glucose is on the lower end of the specturm (lets say less than 150 for a non-diabetic). For the sake of argument if you have 10 SGLT2 molecules and you block 5 of them in the setting of high glucose reputake you might send a significant amount of glucose into the urine because all transporters are necessary to reuptake the large amount of glucose (eg Diabetes).
However if you are in the setting of lower glucose and the 5 free transporters can take care of the load you may have no effect. So you might need to block 90% of the receptors in the setting of low serum glucose (by low I mean non-diabetic levels like 130 for example).
I’m not sure what your overall goal is but lets say it is to decrease your HbA1c. I would think the higher dose would be necessary to see any change in a non-diabetic. All this assumes you do not have side effects on either low or high dose.
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Regardless of who is right regarding the optimal dose (I think no one knows), the side effects are dose dependent so it’s best to start with the lowest dose and, if desired, increase it after a few weeks.
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It’s easy to split doses, just buy a good pill splitter for every medication then split a tablet, take one half right then and another half the next day that is still in the splitter. Doing that for 20 mg atorvastatin even though it is dirt cheap, will do the same for ezetimibe too when I probably start it soon.
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After my latest blood work, I went from HBA1C 5.7 to 4.9 with 500 mg daily Metformin. Now I’m questioning whether I need an SGLT2I? What are your thoughts @adssx
Are there still enough reasons to take an SGLT2I outside of glucose control?
The positive effects have pretty much nothing to do with glucose control.
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I think that a lot of the benefits are from glucose control, but there are also other benefits. I just want to get others opinions. 
Honestly, it’s cheaper than many supplements I take, so if it can help my kidneys, heart or brain, I’m all for it.
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It’s probably not because other glucose lowering medications don’t have the same effects and they are too rapid for heart failure for example.
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HR 0.45 ACM for SGLT2 vs metformin: Canagliflozin - Another Top Anti-aging Drug - #705 by adssx
SGLT2 alone might be as good as SGLT2 + metformin: Canagliflozin - Another Top Anti-aging Drug - #658 by adssx
And as noted by @AnUser, many of their positive effects are unrelated to glucose control (that’s why SGLT2is perform better than metformin and DPP-4is). In particular, they protect your heart and kidney (does metformin do that?) and potentially also your brain and liver.
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Risks for mortality (HR 0.76, 95% CI 0.62-0.92) and a cardiovascular composite of stroke, myocardial infarction, or all-cause mortality (HR 0.81, 95% CI 0.70-0.95) were also lower for empagliflozin initiators.
Empagliflozin was associated with a lower risk of the primary outcome in patients with CKD (HR 0.68, 95% CI 0.53-0.88) and those without CKD (HR 0.79, 95% CI 0.67 - 0.94). In conclusion, initiation of empagliflozin was associated with a significantly lower risk of kidney and cardiovascular outcomes compared with DPP4i over a median of just over 1 year. The association with a lower risk for clinical outcomes was apparent even for people without known CKD at baseline.
@DeStrider: paper just published showing that empagliflozin protects your kidneys even if you don’t have CKD (but have T2D).
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