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Comment by throwaway041207 | Hacker News Reader

I have been on compounded GLP-1 for a month, prior to this I was a highly functional alcoholic, basically starting drinking after work every night and going until I passed out. I've drunk well over 50 beers (probably more) a week for the last 20 years. I have not had a drink since going on it.

I have been reading obsessively about this drug since going on it. I have been fortunate enough not to suffer side effects on it, save for one -- frustration with the cynicism around it. A cynicism I shared prior to experiencing its effects.

I am convinced that, barring any life threatening long term side effects, this is the most important drug of our lifetime (from a first world perspective) or until a silver bullet cancer drug is found. The potential to be the tide that lifts so many boats and alleviates so much physical and emotional pain and suffering on a population level is almost overwhelming to think about.

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> barring any life threatening long term side effects

There's the rub. We have not been prescribing semaglutide very long, and I won't trust it until we've had enough time to suss out long term side effects.

My father was on a long-term maintenance dose of immunosuppressant (I think prednisolone, but I could be misremembering) following his kidney transplant. When it was first prescribed to him, the long term side effects were either not known at all or not widely known. By the time these side effects were more widely known, it was too late, as he was already losing his vision (cataracts) and mobility (cartilage was being destroyed). He spent his last few years in pain.

I am very cautious about the potential for damaging long-term side effects.

> There's the rub. We have not been prescribing semaglutide very long, and I won't trust it until we've had enough time to suss out long term side effects.

We've been prescribing GLP-1s for almost 20 years now. Not to say they all should behave identically, but from a Bayesian inference perspective these things really do appear to be quite safe.

https://www.drugwatch.com/legal/ozempic-lawsuit/

Wow, someone experienced an adverse effect from a drug and are suing?

This adds literally zero information.

Gastroparesis is a serious, life-threatening side effect.

It occurs in a small number of patients, sure, but maybe that just means I am more risk averse than you. My calculus is simple. I don't need wegovy. I can lose (and am losing) weight without it. Sure, it would be easier with wegovy, but it is not necessary. I am not going to take an unnecessary drug that has a nonzero chance of killing me.

>I can lose (and am losing) weight without it

Excellent! A huge chunk of people try and fail to do this for a wide variety of reasons.

If you can lose weight without the help of a GLP-1 drug, then yeah, that is likely the safest option. But most people aren't choosing between using a GLP-1 drug to lose weight or losing weight without it - they're choosing between staying fat and using the GLP-1.

Risk factors for NAION are basically all the things that you go on these drugs to treat - type 2 diabetes, sleep apnea, cardiovascular disease, blood pressure, etc. One observational study that shows some correlation isn't enough for me to be particularly concerned about it.

> As of March 31, only 4 cases of gastroparesis were recorded for semaglutide—the active ingredient in Ozempic and Wegovy—in the FDA Adverse Event Reporting System (FAERS), a surveillance database updated by healthcare professionals, consumers, and manufacturers. For tirzepatide—the active ingredient in Mounjaro and Zepbound—there is just one case logged.

I don't have more recent numbers, but these seem pretty low.

I don't think anyone is saying that there is no chance of significant side effects in people, but when measured against the risks of being obese, they'd have to be very bad and impact a significant number of people taking the drug.

>We've been prescribing GLP-1s [for diabetes] for almost 20 years now

The dosage though for losing weight is 3 or 4 times the dosage for diabetes.

> I am very cautious about the potential for damaging long-term side effects.

This is fair. But I'll ask you this: how long would it take for you to trust it? Assuming there are no side effects beyond what we know now, which are:

* gastroparesis is a small number of patients

* elevated thyroid cancer risk in mice

* nausea and general uncomfortableness when taking it (some percentage, not all)

* muscle and bone loss which seems to be roughly on par with any rapid weight loss approach

* a small percentage of people develop malaise, anhedonia and suicidal ideation

* a propensity to gain some percentage of weight back and/or relapse in addictive behavior when going off the drug

These are the side effects we know about with over a decade of prescribing GLP-1 agonists. Assuming these continue to be the primary side effects, how long would you wait until you are comfortable in trusting they are the only ones?

Exenatide, a GLP-1, was approved in 2005.

We've been prescribing semaglutide since 2017 and the predecessor since 2010.

We need to keep in mind that this drug address pretty much all of the biggest killers in the West. Not just one, but almost all of them. You name it - heart disease, obesity, alcoholism, smoking.

These things we already know are dangerous, and we also already know they're the most prevalent. We're not treating mesothelioma here.

Agreed. The constant cynicism about everything, framed by some stupid moral hazard nonsense, is exhausting.

It reminds me of the British reaction to the famine in Ireland - the good ministers were concerned about the moral health of the Irish. If they were provided with charity food, it would be a terrible tragedy if they became dependent. Just let them starve to death, with a clean soul.

do you have adhd, and do you think your drinking is at all related to adhd/lack of executive function? just curious, not implying.

I do not have ADHD. I am not sure exactly why I drink so much -- there are a number of alcoholics on both sides of my family, but I also spent many years drinking in bars in a big city, living a very social life. During COVID I became much more of a solitary drinker and over the last five or so years I have drank out of a sense of malaise. Every morning became the day I was going to take a break and every night there was an excuse to start drinking again.

The strange thing about GLP-1s effect on my desire to drink is how it manifests: I just don't care about drinking. I actually _could_ drink and be fine I think, I haven't tested it. I don't go through life with the burden of the knowledge of my own addiction. I don't have to be vigilant about triggers and self-assess my actions. I just don't drink.

how long did you keep drinking after starting? thanks for response

No prob.

I noticed that I did not want to drink the day after my first shot. It was that fast. If anything the closest I came to drinking came from routine, not desire. That is to say, what is an afternoon watching football if not with a beer in hand? But I was able to move past that.

One thing I should make clear, no matter how heavy a drinker I have been at times in my life, including with liquor, I have never had a physical addiction. A person deep in the throws of physical addiction will need to approach this carefully.

If you are interested in this topic, I highly recommend reading this newsletter: https://recursiveadaptation.com/

There is a lot of great writing on this subject and some real world testimonies in there. Also happy to answer any more questions here.

Did you have any withdrawal symptoms after stopping alcohol so suddenly?

I did not, but like I said above I've never had physical addiction such that it caused serious withdrawal symptoms (night sweats, seizures, etc have never been an issue for me), so I'm lucky in that respect. Mostly just tremors or what not when I'm on a string of binge drinking nights. I'm a big guy so I don't know if that's why, or just that I am lucky. In the last decade or so I primarily drink beer, mostly because I'm a very fast drinker and I will drink everything under the roof when I get a full head of steam, so I defensively avoid keeping liquor around.

My sleep has been pretty hosed up since I started but it wasn't like it was great before. I am also probably suffering from sleep apnea and I'm hoping to address that soon as I probably have another 4-6 months at the current weight loss rate before I am at a normal BMI.

good luck friend, i am so happy for your recovery and that you're feeling so good about the results. that's really lovely to hear.

Calling it: It’s because it’s antiinflammatory. (It is antiinflammatory. Calling it: That’s the reason.)

2.5mg?

Still titrating up, will be there in a month.

Can you describe what happened that you don't want to drink?

Edit: oh, I see you describe it elsewhere in the thread. Thank you for sharing.

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