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ForumsMASH / Liver DiseaseQuit drinking AND started sema - liver is thanking me — need advice

Quit drinking AND started sema - liver is thanking me — need advice

DanielChem_CHI Thu, Jan 9, 2025 at 5:08 PM 13 replies 1,776 viewsPage 1 of 3
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DanielChem_CHI
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Jan 9, 2025 at 5:08 PM#1

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 · corrections welcome and will be edited into this post with credit
14 9fiona_VT, denise_HTX, raj_cambridge and 11 others
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InsuranceTom
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Jan 9, 2025 at 5:36 PM#2
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.

13 8lucas_SP_BR, lisa_labSD, adam_van and 10 others
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TirzTom
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Jan 9, 2025 at 6:04 PM#3
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.

12 7Dr.EndoIndy, tom_AK, josh_phd_bmore and 9 others
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TinaHashiRN
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Jan 9, 2025 at 6:32 PM#4

Taking 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.

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Dr.EM_Chicago
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Jan 9, 2025 at 9:05 PM#5
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.

Last edited: Jan 10, 2025 at 1:05 AM
10 5lisa_labSD, adam_van, Dr.SurgeonPGH and 7 others
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