Article by Olivier Sanchez ND, NT Dip, Ir
Recent studies show that high intakes of both sugar-sweetened and artificially sweetened drinks are strongly linked to fatty liver disease and even liver-related deaths.
Previously, we delved into how sugary drinks stress your liver, in this article we explore what counts as a sugary drink, what happens inside your liver when you cut them out, and how this simple change can support your long-term metabolic health.
In practice, the following beverages are typically included in 'sugar‑sweetened beverages' in research:
When scanning labels, the ingredients to watch include:
Many guidelines set a sensible upper limit of 25–30 g of free sugar per day for adults; this can be easily exceeded by one standard can of regular soda (≈35–40 g of sugar) alone.
The liver and gut are connected by the portal vein, so everything absorbed from your intestines heads straight to the liver first. Disturbed gut health is now recognised as a key driver of fatty liver:
Dysbiosis (an unbalanced gut microbiota) can increase the production of endotoxins such as Lipopolysaccharides, which enter the bloodstream and trigger liver inflammation.
Certain microbial patterns are associated with higher liver fat and insulin resistance, while fibre-rich, plant-based diets tend to support a more protective microbiome.
Artificial sweeteners may alter the gut microbiome in ways that worsen glucose tolerance and metabolic risk, which is one plausible mechanism behind their link to MASLD in cohort studies.
Both NAFLD (non‑alcoholic fatty liver disease) and MASLD (metabolic dysfunction‑associated steatotic liver disease) therefore arise from a mix of excess energy (especially liquid sugar), insulin resistance, and gut‑driven inflammation rather than alcohol alone.
The liver is an important portal of exchange between the gut and the systemic circulation. Directly from the intestinal tract, the portal vein channels most of the hepatic blood supply, carrying nutrients, environmental antigens and a wide variety of molecules produced by the gut microflora (including alcohol and endotoxins), as well as pathogenic microorganisms that managed to enter the bloodstream. Increased intestinal permeability plays a crucial role in increasing the liver’s workload.
Some research shows that high‑alcohol–producing bacteria, such as Klebsiella pneumoniae, were capable of generating the equivalent of up to about 1 litre of 5% beer per day, leading to liver inflammation and fat accumulation similar to alcoholic liver disease. These bacteria are found in excess in 60% of patients with NAFLD.
Liver-induced inflammation can also spread to other organs, including the brain, and cause symptoms, such as fatigue, lethargy, weight loss, and decreased social interaction
Reducing sugary (and diet) drinks has benefits that show up well beyond the liver:
Swapping a daily soda or diet drink for water, unsweetened tea, or sparkling water is associated with measurable reductions in MASLD risk. Some people argue that they don’t like drinking water. This may partly be due to excessive sugar intake (or to avoiding tap water because they do not have a filtering system), but it is easy to add flavour to water with lemon juice, mint leaves, or cucumber slices. There are now very affordable water filters that effectively remove 99% of unwanted substances. So there is no excuse not to drink more water. Learn why hydration matters.
You can’t change the past, but you can change the pressure you put on your liver from today:
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