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Be Present.

Hype, Hope, and Honest Results: What GLP-1s Are Really Doing

Torree McGowan
Sep 16
3 min read

When GLP-1 medications first arrived, the pitch was simple: slow down your stomach, so you eat less and lose weight. That was supposed to be all that happened. Nobody expected this drug class to end up touching addiction, kidney disease, and even brain health along the way. Some of what researchers have found is genuinely exciting. Some of it turned out to be a letdown. Here is an honest look at both.

Let's start with the wins that have real evidence behind them. Sleep apnea, kidney disease, liver disease, and cardiovascular risk have all shown meaningful improvement in controlled trials, solid enough that some of these are now FDA-approved uses, not just a hopeful side finding. If you are on a GLP-1 for weight loss and also happen to have one of these conditions, the benefit is not incidental. It is part of what makes this drug class worth the hype in the first place.

Alcohol use disorder is where things get more interesting. A Swedish study following over 200,000 people found GLP-1 use associated with fewer alcohol-related hospitalizations, and a separate analysis of 600,000 veterans found lower rates of substance use disorder generally among those taking these medications. Nobody built these drugs to treat addiction. The theory now is that GLP-1 receptors sit in brain regions involved in reward and craving, the same circuitry involved in food noise, and quieting that circuitry may quiet more than just hunger.

Bipolar disorder just emerged as a disease that is showing some changes with GLP1 therapy. A large Swedish registry study of nearly 15,000 people with bipolar disorder found semaglutide associated with a 21 percent lower risk of psychiatric hospitalization compared to periods when patients were not using it. That is a real finding worth paying attention to. It is also, importantly, an observational study, not a controlled trial, and the researchers involved were explicit that a single report does not mean semaglutide is ready to be used as a bipolar treatment. Consider this one a promising research direction, not a reason to seek out a GLP-1 for mood control.

Now for the disappointments, because an honest accounting includes those too. Parkinson's disease looked like a genuinely exciting target on paper. GLP-1 receptors sit directly on the dopamine-producing neurons that Parkinson's destroys, and one 2024 trial of a GLP-1 called lixisenatide showed a modest slowing of motor decline. Then a larger, separate trial of a different GLP-1 found no disease-modifying effect at all. The field is genuinely split right now, and it is a good reminder that one promising trial does not settle a question but researchers are still investigating.

Alzheimer's disease followed a similar arc and landed harder. The theoretical case was strong, chronic inflammation and metabolic dysfunction are both implicated in Alzheimer's, and GLP-1s address both. A large trial of more than 3,800 people tested semaglutide specifically for this and found no significant slowing of disease progression. Sometimes a good theory simply does not hold up in a real trial, and that is worth knowing rather than glossing over.

A couple of smaller, lighter findings round this out. Some physicians have reported an uptick in unplanned pregnancies among patients on GLP-1s, not from any effect on birth control, but because significant weight loss can restore ovulation in women with PCOS who were not previously ovulating regularly. Slowing of the gut and delayed absorption of oral contraceptives with dose changes could also play a role here in unplanned pregnancies, so when you might need a back up method of birth control is an important discussion to have with your doctor.

What all of this adds up to is a drug class still being understood in real time. Some of what gets reported in your social media feed will hold up. Some of it will not, and it is worth remembering that one interesting study is not the same as settled science. If you are curious whether any of this applies to your own treatment, that is exactly the kind of conversation worth having with an actual physician rather than a comment section.

Learn more or reach out with questions at www.presencemd.net. Alcohol use disorder / addiction:

Bipolar disorder signal:

Parkinson's disease (the split evidence):

Alzheimer's disease (the disappointment):

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