Writing this once so I can stop repeating it across threads. It is about alcohol, and it is deliberately narrow — everything I am not confident about is marked as such.
What is actually established
Reduced interest in alcohol is one of the most consistently reported off-target effects, and the mechanism is plausibly the same reward-salience pathway that quiets food noise. The practical part people get wrong is that tolerance changes: less food in the stomach, faster gastric emptying of liquid relative to solids, and a smaller body mean the same two drinks land considerably harder than they used to.
The condition it depends on
If the change has opened a harder question about someone's drinking, that belongs with a service rather than a thread.
What I am not sure about
What I am trying to establish is whether the change in tolerance is the smaller stomach, the smaller body, or something central, and whether it settles. Tell me what I have not thought of.
sarah_nash92 said:Reduced interest in alcohol is one of the most consistently reported off-target effects, and the mechanism is plausibly the same reward-salience…
Agreed, and ALT falling is not the same as fibrosis improving. Enzymes are a crude proxy; FIB-4 or elastography is what tells you about the thing that matters.
I would rather be corrected than agreed with, if it comes to it.
sarah_nash92 said:Reduced interest in alcohol is one of the most consistently reported off-target effects, and the mechanism is plausibly the same reward-salience…
I read this differently from sarah_nash92, on substance rather than tone. This treats a plausible mechanism as a demonstrated one. Plausible is where you start looking, not where you stop.
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Shop Reference StandardsThis one has a reasonably settled answer, so here it is. The liver data is among the strongest non-weight findings in the class. The semaglutide MASH programme reported a large advantage over placebo on MASH resolution, with a substantial minority also achieving fibrosis improvement — and fibrosis is the endpoint that predicts outcomes. Mechanistically it is reduced hepatic lipogenesis, increased fatty-acid oxidation, less hepatic inflammation, and possibly a direct effect on stellate-cell activation.
LarryQC_SD said:Agreed, and ALT falling is not the same as fibrosis improving.
This is my experience too, for whatever a second data point is worth. Posting only so the count is not one.