GLP-1s and alcohol — why the meds could change how you drink

Once upon a time, people set down their midnight glass of champagne and attempted Dry January — cutting out alcohol for a few days, a week or two, or, for a handful of really dedicated folks, the full month. It used to be an accomplishment to get to February without grabbing a glass of wine or ordering a beer with friends. But in recent years, sobriety and mindful drinking have become more of a year-round pursuit.

That’s because we’re undergoing a major cultural shift over alcohol, and people just aren’t drinking as much anymore. One potential contributor? Well, Ozempic and alcohol — or any GLP-1 and alcohol —  doesn’t exactly jive. An estimated 11% of Americans are now being prescribed these medications, up from 3% in 2024. And as GLP-1s continue to gain popularity, we’re learning more and more about their relationship with alcohol — and how they affect our relationship with alcohol. Here’s what we know so far.

Key takeaways

• Many people report drinking less while on a GLP-1 — often without trying — because the medication can reduce cravings, including cravings for alcohol.

• A Weight Watchers study found 45% of people on second-generation GLP-1s decreased their alcohol intake.*

• Alcohol isn’t automatically off-limits on a GLP-1, but it can worsen GI side effects, add empty calories, and affect blood sugar. People may also find that intoxication may occur at lower amounts than they’re used to and so should drink with caution.

• Less alcohol offers a genuine long-term health win — and a behavior you can lock in with the right support.

You can drink alcohol on a GLP-1 — with some precautions and careful discussions with your healthcare provider. First, know that the side effects of alcohol and GLP-1s tend to overlap (think: nausea and vomiting). So, while there’s limited evidence that combining alcohol and a GLP-1 worsens gastrointestinal side effects, it still might not be a good idea to combine the two if you know you're more prone to them.

Alcohol is also brimming with empty calories, which can negate some of the GLP-1 health benefits you’re getting. From a nutritional standpoint, “there's nothing redeeming about alcohol,” says Charlie Seltzer, M.D., a Philadelphia-based obesity specialist. 

If you choose to have an occasional glass of wine with dinner while you’re on a GLP-1, consider starting small — like with one drink or a small pour. “Because people tend to eat less on GLP-1s, the alcohol hits them a little bit harder,” says Seltzer. So make sure you hydrate with water (which is a good idea even if you’re not on a GLP-1) and avoid consuming alcohol on an empty stomach. If you notice any changes in side effects or how you feel, talk to your clinician.

If you’re taking a GLP-1 alongside other medications, specifically insulin or sulfonylureas drugs, two common diabetes medications, you’ll definitely need to discuss drinking with your clinician. That’s because “your risk of low blood sugar is higher,” Seltzer explains. While there's a pretty low risk of low blood sugar (formally known as hypoglycemia) with GLP-1 drugs and alcohol alone, the risk goes up if you’re also taking insulin or sulfonylureas.

Even though you can drink alcohol on a GLP-1 agonist, you might not even want to. Many individuals taking a GLP-1 report a reduced desire to drink alcohol. 

A Weight Watchers study published in JAMA Network Open found that 45% of people on second-generation GLP-1s like semaglutide or tirzepatide reported a decrease in their alcohol intake.*

What’s driving the drop? On theory has to do with dopamine (or lack thereof). “We don't know the exact mechanisms yet, but our guess is that GLP-1 drugs can reduce the release of dopamine in the brain's motivation center,” says Michelle Cardel, Ph.D., M.S., R.D., a co-author of the Weight Watchers study. The thinking is that by curbing the rush of dopamine, GLP-1s may influence the effect of typically rewarding behaviors.

“It hits the craving control centers,” says Selzer. “People who take GLP-1s tend to have less of a craving for alcohol the same way they have less craving for food.” As a result, the food noise goes quiet, and so does the thirst for a spicy margarita.

This effect isn’t exactly coming out of nowhere. One 2022 study using brain scans found that exenatide, a GLP-1 agonist that was approved to treat type 2 diabetes back in 2005, significantly reduced the alcohol-cue reactivity in the area of the brain related to drug reward and addiction — and significantly reduced the total alcohol intake in patients with obesity in particular. That supports recent theories that GLP-1s may be able to impact all types of addictive behaviors.

Less alcohol isn’t just good for weight loss. It could also provide significant benefits for overall wellbeing. The latest evidence shows that no amount of alcohol is actually “healthy.” A known carcinogen, it’s linked to an increased risk of cancer, even in small amounts. And for heavy drinkers, it’s associated with increased risk of heart disease and dementia. 

Say you’ve cut back on your alcohol intake since being prescribed a GLP-1 — or you’ve given it up entirely. While you may not crave it anymore, not having it in your life can still take some adjusting. “People opting out of drinking still may feel uncomfortable when they elect for a mocktail,” says Elisabeth Crain, Psy.D., a psychotherapist in Sherman Oaks, CA. “There is almost always alcohol at social gatherings and parties, and people opting to be sober at these parties may feel like the odd man out.”

This is one way (of many) that GLP-1s can change your day-to-day life — not just your body. And that aspect of the journey deserves discussion as much as any other. That's what Weight Watchers Med+ so unique. In addition to GLP-1 access, if appropriate, members get a whole lifestyle program that includes nutrition guidance and behavioral coaching plus a whole community of coaches and members. There there to talk about every step of the journey with you — even the vulnerable ones. (Actually, especially the vulnerable ones.)

This foundation of healthy habits and support doesn’t just help you thrive while you’re on a GLP-1, it can set you up for success afterward, too.

GLP-1s have a complicated connection to alcohol — namely, alcohol can mess with the benefits of your GLP-1, amplifying GI side effects like nausea and filling you up with empty calories. The good news? You may naturally find yourself drinking less on a GLP-1 because the “reward” center in your brain has been activated, reducing your food and likely alcohol intake. That's ultimately a huge win for your health. And while the occasional drink might still be right for you, you can sustain your new, sober-ish lifestyle with behavior changes. A program like Weight Watchers Med+ can help you lock in those changes in for the long term.