r/science • u/Wagamaga • Feb 12 '25

Neuroscience The first clinical trial of its kind has found that semaglutide, distributed under the brand name Wegovy, cut the amount of alcohol people drank by about 40% and dramatically reduced people’s desire to drink

https://today.usc.edu/popular-weight-loss-diabetes-drug-shows-promise-in-reducing-cravings-for-alcohol/
19.7k Upvotes

97% Upvoted

691 comments sorted by

View all comments

Show parent comments

61

u/Fat_Ryan_Gosling Feb 12 '25

I feel bad for laughing at this, but you're right. This isn't magic, there have to be some trade-offs somewhere.

197

u/Tall_poppee Feb 12 '25

GLP1 drugs have been around for a couple decades, and there isn't any indication that they cause long term harm or cause say alzheimers or cancer.

280

u/Ouaouaron Feb 12 '25

No, there doesn't. "too good" is not something reality cares about. Sometimes you discover antibiotics, or you make a vaccine and eliminate an entire disease.

Maybe there will be some terrible long-term consequence (in addition to the current side effects), but that's not some sort of karmic guarantee.

55

u/Fried_puri Feb 13 '25

I completely agree. Despite the agonizingly frustrating anti-vax rhetoric these days, vaccines are the closest thing to a miracle that mankind has ever created. It was and is astonishing at what we were able to accomplish with vaccines, and remain one of if not the most important advancements in public health in human history.

This may actually be the wonder-drug. We need to continue testing but for now things are looking so, so promising.

50

u/_Caustic_Complex_ Feb 12 '25

Technically speaking, antibiotics have a trade off in the creation of superbugs

7

u/Mindless_Cucumber526 Feb 13 '25

Or fluoroquinolone antibiotics which disable you for life. R/floxies

13

u/Ouaouaron Feb 12 '25

If the only downside to antibiotics is that some things can't be killed by antibiotics, that's not a trade off, that's just a lack of perfection.

Imagine if you were starving to death, and I offered to give you food. I tell you that if you accept this offer, it will come with a terrible downside: the food doesn't include dessert.

19

u/_Caustic_Complex_ Feb 12 '25

Well no, we’re inadvertently bioengineering bacterial diseases that have the potential to wipe out significant portions of the human race, especially those in city centers. COVID on steroids that cannot be stopped or treated.

It’s more like I’m starving now so you offer me free food in perpetuity, with the caveat that after X years of eating your food, no food will nourish me anymore.

15

u/mud074 Feb 13 '25

I was under the impression that the problem with antibiotics was it produces antibiotic resistant bacteria which would result in the return of that disease as a major problem, not that it makes bacteria all-powerful.

17

u/jaggederest Feb 13 '25

Antibiotic resistant bacteria are, in general, less fit than regular bacteria. Antibiotic resistance isn't free, so if you eliminate a particular antibiotic for a while (a few years at least) in a given area, resistance drops back to near zero, because the bacteria stop wasting their energy on it.

7

u/Wischiwaschbaer Feb 13 '25

Also the resistant bacteria become much, much more vulnerable to phages. So if we actually put resources into finding the right phages, we could kill most resistant bacteria. But money is as always more important than lifes.

39

u/appleshaveprotein Feb 13 '25

I mean, the trade off with antibiotics is that they tend to kill off a lot of your important gut biome. Bacteriophages have taken a back seat unfortunately, which could be better at targeting specific bacteria. Antibiotics sometimes nuke your gut.

9

u/mynewaccount5 Feb 13 '25

On one hand I won't die from infection, on the other hand I may have an ouchy stomach for a few days.

8

u/appleshaveprotein Feb 13 '25

It definitely goes beyond an ouchy stomach. Some of your gut bacteria take months to come back after being killed off from antibiotics. And having a balanced gut biome is really important for things like digestion, mood, sleep, and a bunch of other stuff.

So as you can imagine, the more frequently you take antibiotics, the more problematic it becomes for your health.

6

u/Havelok Feb 13 '25

Killing off your gut biome without replenishment can have long term, serious side effects. Thankfully, most people accidentally eat probiotic foods (fermented foods, probiotic yogurt etc) so they aren't chronically affected. Some people go years without figuring out the cause of their constant GI issues.

-5

u/[deleted] Feb 13 '25

[deleted]

9

u/RhettGrills Feb 13 '25

Then you should probably revisit broad spectrum antibiotics and gut microbes

3

u/oxgon Feb 13 '25

I found this on a ask science and saved it

"Probably will get buried but I'm finishing my PhD and I study antimicrobial resistance in wastewater as a proxy for a community microbiome. I can talk a little bit about how the gut bacteria respond to antibiotics. This is such a cool topic, so great question!

TONS of studies exist in pretty much every species from earthworm to orangutan, with a lot of similar results. Essentially the gut microbiome is a super complex community of bacteria, some in competition and some working together. In the gut, and in most microbiomes, we see a thing called functional redundancy. This means that a lot of bacteria have the same metabolic functions - they use the same foods or produce the same products, but are not necessarily in competition. Higher gut diversity is protective.

When we take a broad-spectrum antibiotic, we have to take the whole course in order to raise the concentration in our bodies up to a sufficient level for a sufficient amount of time. With that first dose, we often don't reach the "minimum inhibitory concentration" of the drug, or the level that kills susceptible bacteria. Low levels of antibiotics can drive mutations for drug resistance.

So, we randomly push for mutations in ALL the bacteria, not just the harmful ones, but some have a better tendency to survive or are already inherently resistant... and this happens differently in every single person. Some bacteria survive antibiotic exposure, both the good and the bad, and these can repopulate the gut.

Now the gut has genes for antibiotic resistance, and the composition of the community is less diverse. Often the person doesn't experience negative side-effects because of the functional redundancy - all processes continue as normal, even if some species are entirely wiped out. The gut then can be repopulated overtime with the foods you consume (not just probiotics), the water you drink, and even the things you touch.

Sometimes, with reduced diversity your gut is more vulnerable - you no longer have the second string of bacteria that can help with essential processes. Other times too much gets wiped out and then the gut has trouble recovering essential functions of nutrient digestion and absorption.

Studies look at the impact of gut microbiome composition on obesity, depression, autism, mortality, cancer survival, bipolar, immune system strength, infants' growth rates, sleep quality, psoriasis, and more!

However, most studies suggest that above all, DIET MATTERS. Some studies show that eating foods high in alkaloids and inulin, in probiotic bacteria (like yogurt, kimchi, other fermented foods), and higher vegetable and fruit consumption, all promote gut diversity, which can restore gut health after antibiotics and can keep the gut healthy.

Sources: "The influence of antibiotics and dietary components on gut microbiota" Dudek-Wicher et al.; "Distinct impact of antibiotics on the gut microbiome and resistome: a longitudinal multicenter cohort study" Willmann et al.; "Fecal microbial diversity and structure are associated with diet quality in the multiethnic cohort adiposity phenotype study" Maskarinec et al.; "Diet-microbiome-disease: investigating diet's influence on disease resistance through alteration of the gut microbiome" Harris et al.

TL;DR: Diversity matters, diet matters. Eat more veggies."

46

u/guydud3bro Feb 12 '25

The question is what are the trade offs vs. obesity, which we know is linked to all kinds of long term health problems.

14

u/Fat_Ryan_Gosling Feb 12 '25

Sure, yes. I mean running for exercise will eventually damage your knees, but proportionally the net effect of running for years and years on the rest of your body will be more than worth the cost of some cartridge. I just hope it's going to be in a similar vein rather than "double Alzheimer's."

40

u/CatInAPottedPlant Feb 12 '25

running for exercise will eventually damage your knees

this isn't true either. it's a common myth, but it's the opposite if anything%2C%20says%20Dr.)

43

u/ParsivaI Feb 12 '25

Well the thing is it doesn’t make you lose weight any differently than normal methods. You just eat less while on it. The chemical itself is found in nature.

Sure look, if i grow another arm I’ll let you know haha.

35

u/SquareVehicle Feb 13 '25

Life isn't a videogame, not everything has a tradeoff because it would throw the game mechanics off. And there have been plenty of "magical" drugs like antibiotics, vaccines, satins, and more.

21

u/octocuddles Feb 12 '25

But aren’t there some scientific/medical studies that are just great discoveries? Like acetaminophen or ibuprofen, or antibiotics, or the cure to polio? Not to say that painkillers like that don’t have minor stomach risks , or that antibiotic resistance isn’t a thing, but overall I don think there was ever “the other shoe” that just dropped. They just…. Changed and became part of our world. 

-2

u/Wischiwaschbaer Feb 13 '25

But aren’t there some scientific/medical studies that are just great discoveries? Like acetaminophen

Acetaminophen doesn't work better than placebo at reducing pain. Works well at lowering fevers though.

7

u/__STAX__ Feb 13 '25

no there doesn’t have to be some trade off. Why would chemical reactions care about what they do to our bodies. There’s no more reason they would be actively harmful than helpful.

39

u/CatInAPottedPlant Feb 12 '25

that's not how science works, there's absolutely no requirement for trade offs, at least deal breaking ones (since no medication is free from side effects).

what's the tradeoff for insulin? penicillin? the covid vaccine? what about the smallpox vaccine?

it's reasonable to be skeptical, but the notion that "it's too good to be true" is rooted in some fundamental principles is wrong, there's tons of medicines that you could consider too good to be true because they saved millions of lives and reduced countless amounts of suffering and government expense. I don't see why that's not potentially the case here.

3

u/Character-Pin8704 Feb 13 '25

Though it's pedantic, the covid vaccine killed a non-zero amount of people and had serious side effects in some part of the population. As with any vaccine. Unlike insulin which is necessary to keep staying alive for pretty much everyone you proscribe it to, some of the people who had negative vaccination outcomes otherwise might have been fine. That then constitutes a trade-off that does have to be examined; do we gain more from vaccination overall and you know, what is it's negative outcome rate vs. benefit. Several covid vaccines specifically were pulled because they basically failed that test (and we had available alternatives).

17

u/CatInAPottedPlant Feb 13 '25

like I said, no medicine is free from side effects.

however let's be clear, my point was about relative good. when someone says "it's too good to be true, I'm just waiting for the bad stuff to come out", they're not talking about some marginal percent of people who experience side effects, they're talking about something serious and wide spread enough to outweigh the benefit of a drug entirely and pull it from use.

if we use "some people have negative outcomes" as our metric like you said, then I'd argue literally every medicine ever invented is "too good to be true". but that's clearly not what people mean when they say this in relation to GLP1 medications.

22

u/Why_You_Mad_ Feb 12 '25

They said the same thing about statins decades ago, turns out there are in fact miracle drugs.

8

u/CatInAPottedPlant Feb 13 '25

Yet there's still no shortage of misinformation spread around making people fear/hate statins. You really can't win with the general public, many of whom seem eager to dismiss modern medicine even if they're the ones who would benefit the most.

4

u/Qadim3311 Feb 13 '25

Hey, maybe you can tell me something I don’t know yet; my mother has this idea that statins are somehow causative of Alzheimer’s disease and I have no idea where she got that from nor any concept of what I would be arguing against specifically. Is this some known myth that I just missed?

10

u/Why_You_Mad_ Feb 13 '25

I hadn't heard of any link between Alzheimer's and statins, but according to the most recent research I can find, they can help to reduce the likelihood of dementia and Alzheimer's. That's not super surprising, given that one of the hallmarks of dementia and Alzheimer's is inflammation, and statins improve upon that by improving vascular function.

https://academic.oup.com/eurjpc/article/29/5/804/6454065?login=false https://pmc.ncbi.nlm.nih.gov/articles/PMC2995387/

I would think that it's unlikely that something that improves vascular health by reducing bad cholesterol would be detrimental to mental health, simply due to how much overall brain health depends on having good vascular health.

3

u/Qadim3311 Feb 13 '25

Thanks for pushing some resources I can look into!

I’m probably gonna end up arguing with a wall again, but I appreciate you being responsive.

8

u/Withermaster4 Feb 13 '25

Does there?

What's the trade off of vaccines?

4

u/IceMaverick13 Feb 13 '25

The trade off of vaccines is that society collectively gets frequent reminders that anti-vaxxers exist.

Sometimes the tradeoff is more metaphorical than physiological.

10

u/SteffanSpondulineux Feb 12 '25

The catch is that you need to keep taking it forever

21

u/dragon-queen Feb 13 '25

Well, that’s the case with many other drugs, like drugs for arthritis, or insulin, or blood thinners.  

9

u/IceMaverick13 Feb 13 '25

I've not heard of this one being reported.

My anecdotal counter is my mother got taken off her script for semiglutide after her blood sugar and weight levels reached healthy levels and as far as I've spoken to her about it, she's been off of it for 2 years now with the only issue being that she needs to eat like some fruit or something between dinner and bedtime to not feel hungry by the time she goes to bed at like 1AM. But she's maintained her levels ever since the doctors took her off of it and hasn't noticed any side effects other than the "new normal" semiglutide made her dining routine feel has since returned to baseline human levels.

2

u/exiledinruin Feb 13 '25

how long was she on it? I wanna get on it but I would have to pay for it out of pocket. I can do that for a while but indefinitely is problematic

2

u/IceMaverick13 Feb 13 '25

She was taking it for about a year and a half.

3

u/A1000eisn1 Feb 13 '25

You don't have to. Getting off the drug doesn't directly cause weight gain. If you maintain the same eating habits when not medicated you won't gain weight. Your appetite will just return to normal which is what causes the weight gain.

1

u/SteffanSpondulineux Feb 13 '25

Yeah but you won't maintain the same eating habits

1

u/Fat_Ryan_Gosling Feb 12 '25

Now that is a catch!

2

u/bsubtilis Feb 13 '25

It may seem like magic when it's only righting a wrong in the body. People with other malfunctioning issues take medicines to correct theirs, this would be no different.

Also, when your body is malfunctioning too much as a base state, the possible side effects of medication are often well worth it. I say this as someone on multiple medications that risk harming my heart, and I really do not want that. The life quality I have on the medications unfortunately are well worth the tradeoff.

2

u/Jimmy_McNulty2025 Feb 13 '25

Not really—there aren’t dramatic tradeoffs for penicillin, despite it radically extending human life. Some drugs are just unmitigated goods.

1

u/fcocyclone Feb 13 '25

Of course its not magic. What it does is make it easier for people to do the right things consistently. There doesn't "have to be some trade offs". In the case of both food and alcohol, you're talking about the messages that would otherwise push compulsive activities, whether food, alcohol, or other things, being quieted down so someone can get a handle on their own behavior.

1

u/LingonberryReady6365 Feb 13 '25

A medicine without trade offs is not magic. Uncommon, sure. But totally within the realm of possibility.

1

u/zninjamonkey Feb 13 '25

Why do you wish for that?

1

u/gay_manta_ray Feb 13 '25

there doesn't have to be any trade offs in biology

1

u/Wischiwaschbaer Feb 13 '25

These drugs also make you lose musculature, far beyond what you'd lose during reegular weight loss. Actually good for the heart, which leads to all the positive heart-health effects, but not great for skeletal musculature. You kinda need that to keep your body going and everything from hurting. So if you are on them, weight training is basically a must.

Other than that, I doubt we'll see a lot of negative side effects.

1

u/Sillypenguin2 Feb 13 '25

Sometimes medicine does work well. Lipitor, insulin, polio vaccine.