While managing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) often involves limiting alcohol and adopting a low-calorie diet, experts emphasize another critical dietary change: avoiding sugar.

The Direct Link Between Sugar and Liver Fat Buildup

Grace Derocha, RDN, CDCES, a national spokesperson for the Academy of Nutrition and Dietetics, notes that many patients do not realize sugar actively drives fat accumulation in the liver.

When you consume added sugar, your body converts unused glucose into fat, which can then be stored in the liver. Over time, this process replaces healthy liver cells with fat cells, leading to MASLD. This can occur even in individuals who are at a healthy weight or have no other underlying health issues.

Sugar's Hidden Impact on Liver Health

Derocha explains that the added sugars prevalent in processed foods negatively affect the liver in ways that are often overlooked, even among generally healthy people. Furthermore, sugar contributes to the buildup of inflammatory chemicals within organs, including the liver.

When the liver becomes injured due to this inflammation, its functionality is compromised compared to a healthy organ. The average American consumes approximately 17 teaspoons of added sugar daily, equating to about 270 calories, primarily sourced from prepared and processed foods.

Understanding Nutrition Labels to Avoid Added Sugars

To make informed choices, it is essential to identify added sugars on food packaging. Look out for ingredients ending in “-ose,” such as sucrose, and high-fructose corn syrup.

Nutrition labels list ingredients by weight, from highest to lowest concentration. If any form of sugar appears near the top of the ingredient list, it signals a high added sugar content. Labels show total sugar, but it is crucial to distinguish between natural and added sugars.

The American Heart Association advises men to consume no more than 36 grams of added sugar daily, and women no more than 25 grams. Derocha suggests that individuals with MASLD should aim for an even lower daily intake.

Benefits of Sugar Reduction for MASLD Reversal

Liver specialist Amon Asgharpour, MD, of Virginia Commonwealth School of Medicine, confirms that reducing added sugar intake yields immediate benefits for the liver. Inflammation begins to decrease, and liver fat declines as weight is lost.

Dr. Asgharpour adds that incorporating other healthy habits, such as regular exercise, will further support liver health. If you are unsure how to begin cutting back, several practical strategies can help.

Practical Tips for Cutting Back on Sweeteners

  • Tapering Habits: If you add sugar to coffee or cereal, try halving the amount you use initially. Allow your taste buds to adjust before attempting to eliminate it completely.
  • Natural Sweetness: Use fresh, frozen, dried, or canned fruits to naturally sweeten foods like yogurt, ice cream, or cereal.
  • Smart Grocery Swaps: Choose packaged items with lower added sugar, such as unsweetened applesauce or plain low-fat yogurt.
  • Hydration Over Sugar: When a sweet craving hits, try drinking a glass of water first. Satisfy the urge with a piece of fruit or a small piece of dark chocolate instead.
  • Healthy Substitutes: For cravings like a milkshake, create a substitute smoothie using low-fat yogurt, cocoa powder, and fruit. Derocha advises ensuring these smoothies are rich in protein and fiber for satiety.

The Debate Over Low-Calorie Sweeteners

Low-calorie sweeteners contain zero calories and are significantly sweeter than regular sugar, often used by those managing weight or blood glucose levels. However, some early research raises concerns about their long-term effects on the liver.

One study indicated that frequent consumption of diet soft drinks doubled the risk of developing MASLD. Other research has linked these sweeteners to liver cancer, though the connection remains inconclusive.

Conversely, small amounts of natural sweeteners have shown a reduction in liver inflammation in laboratory animals compared to low-calorie options. Derocha reminds everyone that natural sweeteners still count toward your total sugar allowance and contain calories.

She concludes by stating that enjoying some sweetness is possible while maintaining liver health, provided added sugars remain under 10% of total daily calories.