Sugar Alternatives and Liver Health: New Insights

Perhaps it’s time to reconsider the benefits of sugar substitutes.

Recent research links artificially sweetened drinks to a greater likelihood of developing metabolic dysfunction-associated fatty liver disease (MASLD), which is the most prevalent liver condition in the U.S. Surprisingly, those consuming these drinks were found to be at even higher risk than those drinking regular sugary sodas.

“Our findings indicate that low- or no-sugar beverages may not be as benign as previously thought,” stated Lihe Liu, a graduate in gastroenterology from Soochow University in China. This is noteworthy, as diet drinks have long been marketed as healthier options due to their lower sugar and calorie content.

“These results challenge the commonly held belief that these beverages are harmless,” Liu added, suggesting a need to reevaluate their impact on diet and liver health.

Growing evidence increasingly connects artificial sweeteners to heightened risks of metabolic syndrome, type 2 diabetes, and cardiovascular issues. Some alternatives are also believed to harm gut health and interfere with blood sugar management while promoting clot formation.

“Regularly consumed sugary drinks have undergone extensive scrutiny, leading many to perceive their ‘diet’ counterparts as healthier,” Liu explained. However, the effects of both types on liver health remain largely unclear.

Liu’s research analyzed data from 123,800 UK residents who reported their beverage intake from 2009 to 2012. Participants were asked about the quantity of soft drinks they consumed—specifically recalling how many 250 mL portions they had the previous day.

Those being tracked for over ten years were monitored for the onset of MASLD, a condition characterized by fat accumulation in the liver, which can lead to inflammation. Symptoms often include fatigue, discomfort, and abdominal pain.

Notably, drinking more than one slim can of diet soda daily raised the risk of developing MASLD by 60%, whereas regular soda increased the risk by 50%. Both types of beverages contributed to liver obesity, but only the diet versions were associated with a higher risk of death related to liver disease.

“High sugar content in sugary drinks can lead to rapid spikes in blood sugar and insulin, promoting weight gain and increasing uric acid levels, which contribute to liver fat accumulation,” Liu noted. “On the other hand, diet drinks might negatively impact liver health through alterations in gut bacteria and may even trigger sweet cravings and insulin release.”

Approximately 38% of adults are estimated to have MASLD, a figure projected to exceed 55% by 2040, driven by rising rates of obesity and diabetes.

The findings were presented during the United European Gastroenterology Week in Berlin. However, Liu mentioned that the study did not specify which brands or artificial sweeteners were consumed, which limits its conclusions.

Despite that, there’s a silver lining: replacing sugary or diet drinks with water can reduce MASLD risk by 12.8% and 15.2%, respectively.

“The safest route is to cut down on both sugar and artificially sweetened beverages,” Liu recommended. “Water is the optimal choice as it eases metabolic demands, prevents liver fat accumulation, and hydrates the body well.”

In future research, Liu’s team aims to investigate the interactions between sugar, its substitutes, and intestinal bacteria concerning liver disease.