Semaglutide, sold under the brand names Wegovy and Ozempic, is an injectable drug originally meant to help patients manage diabetes. Since 2021, the drug has been approved by the FDA in the United States for weight loss after studies found obese patients could lose 15% to 20% of their body weight over 68 weeks. But as the drug became increasingly popular, more and more patients and their doctors have noticed that it wasn't just their calorie intake that plummeted -- it was their drinking too.
Speaking to INSIDER, 43-year-old criminal-defense attorney Erin Bradley McAleer from Washington state said he used to chug 8 to 10 beers almost every evening. "If I had one, I had eight," McAleer confessed.
But over the past year he's been on Wegovy after a health scare caused by an eye stroke, McAleer says he's lost his physical desire to drink alcohol.
"I'm just not interested anymore after a couple of beers," McAleer told INSIDER. "I've never had that before."
Loss of appetite for both food and alcohol
Semaglutide is a synthetic version of the human GLP-1 (glucagon-like protein), which increases the release of insulin when blood sugar is elevated, delays gastric emptying, and reduces appetite. Semaglutide is typically prescribed against type 2 diabetes, but since a known side effect is weight loss many doctors are now also prescribing it off-label for weight loss in those without diabetes.
The synthetic version of GLP-1 has been modified so that it is less likely to be broken down and therefore has a longer duration of action. It comes in the form of two different disposable single-use pens in either 0.25mg increments or 1mg increments. The patient can easily self-administer their own injection, typically once a week.
More recently, the GLP-1 system has been shown to play a role in the neurobiology of addictive behaviors, including alcohol seeking and consumption. In one 2020 study on rats, researchers found that semaglutide and liraglutide (another GLP-1 analog for treating diabetes that is also known to cause weight loss) led both to loss of appetite and ethanol intake. But what explains this sudden aversion to alcohol?
The answer could come from another study, where researchers in Sweden found that liraglutide inhibits alcohol’s effect on dopamine production in the brain. In doing so, people drink less because they derive little to no pleasure from alcohol anymore, thereby decreasing their motivation to drink.
“The GLP-1-like substance reduced the alcohol consumption by 30-40 percent in rats that drank large quantities of alcohol for several months” said Elisabet Jerlhag, a researcher at Sahlgrenska Academy, University of Gothenburg, in a 2015 press release.
GLP-1 analogs like semaglutide and liraglutide seem to affect the brain's reward circuit, so things that were once pleasurable suddenly start feeling boring and bland. This seems to be the case for both burgers and cocktails. Internet message boards like Reddit abound in anecdotal evidence supporting this explanation.
"I’ve also found when I’ve tried to drink, it’s absolutely pointless. I can’t even catch a slight buzz. I’m assuming it has to do with the slower absorption side of the medicine. But, knowing there’s no point has definitely influenced my overall desire," Reddit user cjmcgizzle wrote.
"Yes, I’ve totally experienced this. Prior to ozempic I would drink couple of times a month, mainly on weekends to unwind. Now I have no desire to drink at all and if I do drink it takes a very long time to get it down. Sometimes I can’t even finish it. I wish it worked this well for food for me as I am not experiencing much appetite suppression or food aversions," quipped another user by the name cryptoandcake.
But despite this anecdotal evidence, the only double-blind, placebo-controlled trial that investigated the effect of another GLP-1 analog in treating alcohol use disorder came to rather disappointing results. After they received a 2 mg dose of exenatide once a week for 26 weeks, patients with alcohol use disorder did not see a significant reduction in their heavy drinking days.
However, the study did find that "dopamine transporter availability was lower in the exenatide group compared with the placebo group," suggesting GLP-1 analogs hijack the brain's reward pathway. This study was also centered around heavy drinkers. It could be that semaglutide, liraglutide, exenatide, and other glucagon-like proteins have the best suppression of alcohol cravings in more casual drinkers and 'weekend warriors'. Also, these drugs have the most pronounced effects on overweight people. If a patient is thin and suffers from alcoholism, these drugs may not help that much. As such, the potential of these drugs for treating addiction is still on the table -- it's just that we need more research.