Podcast episode 139 (in German)
The GLP-1 wave – semaglutide between heart protection, quiet in the head and the black market
November 16, 2026
Semaglutide is among the best-studied drugs of all: 14.9 percent less weight in the large approval trial, fewer heart attacks and strokes in people with heart disease. On top of that, users talk about something no scale measures, and counterfeits are circulating online.
What it is about
GLP-1 is a gut hormone that signals to the brain that food has arrived and slows the stomach; in the blood it breaks down after 1 to 2 minutes. The road to the drug led via the venom of a lizard and via a trick: an attached fatty acid lets semaglutide ride along on albumin, so that one injection per week is enough. The episode goes through the major trials, on weight, on the heart and on what happens after stopping. Then come the users: many report that the constant thinking about food becomes quieter, some drink less alcohol, and both are only now being measured specifically. In the end there is an effective prescription drug that works as long as you take it, and a gray market to which none of these figures apply.
Key points
- In STEP 1, 1,961 adults without diabetes lost 14.9 percent of their weight after 68 weeks on semaglutide, 2.4 percent under placebo; half lost at least 15 percent.
- In SELECT with 17,604 people with cardiovascular disease and overweight, cardiovascular death, heart attack or stroke occurred in 6.5 instead of 8 percent over a little more than 3 years, a relative reduction of one fifth.
- The extension of STEP 1 followed 327 participants for another year after stopping: of 17.3 percent weight loss, 11.6 points came back, and blood pressure and blood sugar followed.
- As a report: in a manufacturer-funded survey of 550 people on semaglutide, food noise on a questionnaire scored up to 20 fell from 13 to 6 points; they estimated the before value from memory.
- In just under 1,600 Reddit posts about alcohol, 7 of 10 describe less craving or less drinking; a randomized trial with 48 people found less craving over 9 weeks, but not fewer drinking days.
- Test purchases from illegal online pharmacies: the pens never arrived, the 3 vials delivered contained around one third too much active ingredient at 8 to 14 instead of 99 percent purity, plus bacterial residues in every sample.
- Across 76 studies, diseases of the gallbladder and bile ducts were 37 percent more frequent; since June 2025 the European Medicines Agency lists a circulatory disorder of the optic nerve as a very rare side effect.
Where the data stop
The big figures apply to the tested product with medical supervision. Heart protection has its price too: in SELECT, one in six on semaglutide stopped because of adverse events, one in twelve under placebo. The effect lasts as long as you take it, which is why stopping belongs in the conversation with the doctor just as much as starting. Anyone whose vision suddenly worsens sees a doctor immediately.
The user reports deserve attention but are not measurements: forums do not count frequencies, and those who have problems are more likely to write. A preprint on 410,000 Reddit posts names menstrual cycle changes as well as chills or hot flashes that do not appear as such in the package leaflet, that is, signals that need to be tested specifically. There is no randomized trial on microdosing, and none of the figures apply to vials from the internet. Weight-loss drugs have been excluded from statutory health insurance coverage since 2004, unchanged as of September 2026: anyone who wants to lose weight pays themselves.
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Published on November 16, 2026.
The topic in the database
- The blockbuster among the “weight-loss injections”: approved as Ozempic/Wegovy, highly effective for weight and with proven cardiovascular benefit – a legal, medic…Semaglutide (Ozempic / Wegovy)
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Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in the hands of a physician. Last updated: 2026-09-25.