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Treatment is indicated in patients with Pagets disease of bone with elevations in serum alkaline phosphatase of two times or higher than the upper limit of the age-specific normal reference range, or those who are symptomatic, or those at risk for complications from their disease [see Clinical Studies (14.5)]

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While carb needs are relatively stable across the population (higher output or larger-bodied athletes need a bit more, but generally carb needs are tied to effort), hydration needs vary wildly

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This combination creates blood sugar volatility (spike from sugar, crash from alcohol liver inhibition) and adds hundreds of empty calories that directly undermine your weight loss progress