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 actually want to know is whether the change in tolerance is the smaller stomach, the smaller body, or something central, and whether it settles. Practical detail welcome, however dull — the duller the better.
DanielChem_CHI 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.
Ask again with the specifics and you will get a better answer than this one.
DanielChem_CHI said:Reduced interest in alcohol is one of the most consistently reported off-target effects, and the mechanism is plausibly the same reward-salience…
Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. Pushing back on the consensus forming here. Consistency is not the same as correctness, and a board that agrees with itself quickly is usually agreeing with the first person who sounded certain.
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Shop Reference StandardsTaking the question as asked, rather than the general version of it. 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.
InsuranceTom said:Agreed, and ALT falling is not the same as fibrosis improving.
This matches mine closely enough to be worth saying so out loud.