If you have MASLD or MASH, forms of metabolic dysfunction-associated steatotic liver disease, you probably already know that diet is very important to help you manage the condition. Your health care team may have told you to limit or even avoid alcohol, and to eat a diet that’s low in calories and saturated fat.
But there’s another important part of your eating style — avoid sugar. Research shows sugar can worsen fatty liver, MASLD.
“Patients don’t realize that sugar drives fat buildup in your liver,” says Grace Derocha, RDN, CDCES, a national spokesperson for the Academy of Nutrition and Dietetics in Detroit.
Unfortunately, sugar is everywhere when it comes to our food content. The average American eats about 17 teaspoons of added sugar a day — that’s about 270 calories.
You may get some natural sugar like honey, but most of the time you get it from eating processed and prepared foods. Thankfully, there are ways to make smarter choices, healthier sugar swaps, and avoid added sugar.
Here’s a closer look at how sugar affects your MASLD, plus ways to cut back on the sweet stuff in your diet. And lower sugar in your diet can contribute to reversing your fatty liver disease, too.
The MASLD-Sugar Connection
When you eat something with added sugar, your body breaks it down into glucose — your body’s primary source of energy. But any unused glucose turns into fat. And your body can store extra fat in your liver.
Over time, your regular liver cells are replaced with fat cells, which leads to MASLD. This can happen even if you are at your target weight or don’t have other medical problems.
In one study, 94 healthy men drank a beverage that was sweetened with 80 grams of either:
- Glucose, the natural sugar your body uses for energy
- Fructose, found in fruits
- Sucrose, table sugar
After seven weeks, the men who drank fructose or sucrose had twice as much liver fat as those who just drank glucose.
“The [type of] added sugars found in so many processed foods affect our livers in ways we don’t realize, even if we are otherwise healthy,” says Derocha.
Sugar has other effects on your liver, too. Especially if your body has a harder time using, storing, or controlling sugar.
If you eat too much added sugar, your body can:
- Releases inflammatory chemicals
- Build up inflammatory chemicals in organs such as your liver over time
- Have organ damage caused by the inflammatory chemicals
When your liver is injured, it doesn’t work as well as an otherwise healthy liver.
Studies show that the more added sugars you eat, the more likely you are to develop MASLD. People who drink three and a half servings of soft drinks a week, for example, are 42% more likely to develop fatty liver.
Hidden Sources of Sugar
When you think of sugar, you may first think of sweet treats such as candy, ice cream, soft drinks, and cookies. But sugar is in many everyday foods that you may not realize, says Derocha.
“Certain foods like yogurt have health halos around them, but some brands have a lot of added sugar, especially if they are sweetened with fruit,” she says.
Watch out for the total amount of sugar in foods such as:
- Ketchup
- Barbecue sauce
- Salad dressings
- Protein bars
- Milk and coffee creamers
- Breakfast cereals
- Sports and energy drinks
- Coffee drinks
- Iced tea
The best way to avoid surprise sources of sugar is to become a sleuth at reading nutrition labels. Look for the words “total sugars” on the label.
This will show you the combined amount of natural and added sugar in your food. For example, a product may have 15 grams of total sugar, but only 7 of those are added sugars. The rest are natural sugars.
Here are some other tips when it comes to nutrition labels.
Look at the top three ingredients
Nutrition labels list ingredients from the highest amount to the smallest amount. If some type of sugar is right on top, that’s a good clue that it’s high in added sugar.
Know keywords
Look for some keyword sugary ingredients, such as:
- Cane sugar
- Confectioner’s sugar
- Turbinado sugar
- Corn syrup
- High-fructose corn syrup
- Rice syrup
- Molasses
- Caramel
- Juice
- Honey
- Agave
Check for sugary words that end with “-ose” such as:
- Fructose
- Lactose
- Maltose
- Dextrose
- Sucrose
These are all forms of added sugar. The American Heart Association recommends that men consume no more than 36 grams, and women consume no more than 25 grams of added sugar each day. If you have MASLD, it’s smart to aim for even less, says Derocha.
How to Cut Back on Sugar
As soon as you cut back on added sugar, your liver will begin to benefit, says Amon Asgharpour, MD, a liver specialist at Virginia Commonwealth School of Medicine in Richmond.
“Inflammation in your liver starts to decrease, and as you lose weight, there will be a decline in liver fat,” says Asgharpour.
If you add in other healthy habits, such as regular exercise, you’ll help your liver even more. But if you're not sure how to cut back on your daily sugar intake, here are some ideas to get you started.
Slowly stop using sugar in your food
Do you add sugar to your cereal, coffee, or tea? Try to stop slowly. First, cut the amount you use in half. Once your taste buds adjust, you can stop it entirely.
Use natural sweetness
Use fruit to add some sweetness to everything from cereal to yogurt to ice cream. You can use fresh, frozen, dried, or canned fruits.
But if you opt for canned fruit, make sure it’s packed in water or its natural juice, not syrup.
Dried fruit packs a calorie punch, so stick to small amounts. Or spice up a dish with ginger, cinnamon, or nutmeg.
Pick low-sugar options
When you’re at the grocery store, opt for packaged foods that have less added sugar, like plain low-fat yogurt or unsweetened applesauce.
Control cravings
If you find that you want to snack on something sugary, try drinking a glass of water instead.
“Sometimes, being thirsty or dehydrated can lead to cravings,” says Derocha.
You may also be able to satisfy your sweet tooth with a piece of fruit or a small square of dark chocolate. If you crave something specific — say, a chocolate milkshake — make a substitute smoothie that contains low-fat yogurt, cocoa powder, and fruit.
Smoothies can be rich in protein and fiber, which will help you feel full and satisfied, says Derocha. But not all smoothies are full of protein and fiber. So make sure to choose healthy, nutritious ingredients.
Get enough sleep
When you don’t get enough shut-eye, your body can make:
- Less leptin, a hormone that makes you feel full
- More ghrelin, a hormone that makes you hungry
Most adults need at least seven hours of sleep a night.
Smart Sugar Substitutes
When you cut back on sugar, every little bit counts. You can make some easy swaps by skipping the top sweet offenders to choose a healthy alternative.
Are Zero-Calorie Sweeteners Okay?
Sweeteners known as low-calorie sweeteners (LCS) contain no calories. But often, the sweeteners can taste much sweeter than regular sugar.
Zero-calorie sweeteners are often used by people who want to lose weight or lower their blood glucose levels. Some common types of artificial sweeteners include:
- Aspartame (Equal and Nutrasweet)
- Sucralose (Splenda)
- Erythritol (found in Truvia)
- Steviol glycosides (found in Stevia and Truvia)
Some early research shows they may harm your liver. One study found that people who frequently drank diet soft drinks had twice the risk of developing MASLD. Other research links them to liver cancer, but it’s still unclear.
If you do have a craving for something sweet, Derocha suggests using small amounts of natural sweeteners:
- Honey
- Molasses
- Agave syrup
Small amounts of natural sweeteners have been shown to lower liver inflammation compared to low-calorie sweeteners in laboratory animals. But keep in mind that these count towards your total sugar quota–and have calories, too.
“Remember, you can still have added sugars in your diet, but in moderation,” says Derocha. “If you keep it to under 10% of your total calories, you can still enjoy some sweetness, while keeping your liver healthy.”
