Monday, August 25, 2014

Soft drinks can cause fatty liver disease

In warm, sunny weather, do you like to quench your thirst with a refreshing draught of chilled Coca-Cola, Sprite or Fanta? (Or Pepsi, 7-Up or Mirinda, whichever is more easily available where you live?) You're not alone. Lots of people prefer the addictively sweet taste of these fizzy beverages to plain, boring water. However, indulging the appetite for this "liquid candy" comes with a high price. The more sugary soda you drink, the higher your risk of obesity, diabetes and metabolic syndrome (the combination of abdominal obesity, high blood pressure, elevated plasma glucose and high serum triglycerides). Recent studies also show that drinking large amounts of soft drinks can cause non-alcoholic fatty liver disease.

Let's face it - we're genetically hardwired to love sweet-tasting foods and drinks. Thanks to modern agriculture and industrial production methods, sugar - once a luxury food - has become an everyday commodity for all but the very poorest. In 1776 - at the time of the American Revolution - Americans consumed about 1.8 kg (4 lb) of sugar per person each year. By 1850, this had risen to 9 kg (20 lb), and by 1994, to 54.4 kg (120 lb). In the last 40 years, the per capita consumption of refined sugar in the United States has varied between 27 and 46 kilograms (60 and 101 lb). In 2008, American per capita total consumption of sugar and sweeteners, exclusive of artificial sweeteners, equalled a whopping 61.9 kilograms (136 lb) per year. 

Our collective sweet tooth is being blamed as one of the causes of the worldwide obesity epidemic. However, an increasing body of evidence suggests that the consumption of soft drinks sweetened with sugar and/or high-fructose corn syrup poses a much bigger health risk than sugar in foods. The consumption of sugar-sweetened beverages rose by a startling 38.5 gallons per person between 1950 and 2000 (10.8 gallons per person in 1950 to 49.3 gallons per person in 2000). Controlled trials have now proved unequivocally that consumption of sugary soft drinks increases body weight and body fat. Randomized controlled trials in children and adults lasting 6 months to 2 years have shown that lowering the intake of soft drinks reduces weight gain. 

Non-alcoholic fatty liver disease (NAFLD) is a condition where fat deposits slowly accumulate in the liver in persons who do not consume excessive amounts of alcohol. In the beginning, NAFLD may cause no symptoms at all, or only mild ones (fatigue, vague abdominal discomfort). Nonetheless, this condition poses a significant health problem. Over time, it can progress to non-alcoholic steatohepatitis, a fatty liver with hepatitis. This form of liver injury carries a 20%-50% risk for progressive fibrosis, 30% risk for cirrhosis, and 5% risk for liver cancer.

Meta-analyses suggest that consumption of sugar-sweetened beverages increases the risk of diabetes, the metabolic syndrome, cardiovascular disease, and also of fatty liver. Drinking just two 16-ounce sugar-sweetened soft drinks per day for 6 months induces features of the metabolic syndrome and fatty liver. Scary, huh?

One recent study found that that 80% of patients with NAFLD had excessive intake of soft drink beverages compared to 17% of healthy controls. The NAFLD group consumed five times more carbohydrates from soft drinks compared to healthy controls (40% vs. 8%). Seven percent of patients consumed one soft drink per day, 55% consumed two or three soft drinks per day, and 38% consumed more than four soft drinks per day for most days and over the 6-month period. The most common soft drinks were Coca-Cola (regular: 32%; diet: 21%) followed by fruit juices (47%). 

And while diet soft drinks have only a fraction of the calories compared to the sugar-sweetened variety, artificial sweeteners such as aspartame aren't good for the liver, either. So if you're concerned about your diet and health, cutting out all store-bought sweet beverages - whether they're sweetened with high fructose corn syrup, sugar or aspartame - is your best bet. Get used to plain water, tea (black, green, white or red - there's a huge variety of flavors out there) or fruit teas, and enjoy an occasional cup of honey-sweetened tea or a glass of homemade lemonade as a special treat.


Image courtesy of: Victor Habbick / Free Digital Photos (


Abid A, Taha O, Nseir W, Farah R, Grosovski M, Assy N. (2009) Soft drink consumption is associated with fatty liver disease independent of metabolic syndrome. J Hepatol. 51(5): 918-24.

Bray GA, Popkin BM. (2014) Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes? Health be damned! Pour on the sugar. Diabetes Care. 37(4): 950-6.

Nseir W, Nassar F, Assy N. (2010) Soft drinks consumption and nonalcoholic fatty liver disease. World J Gastroenterol. 16(21): 2579-88.

Wikipedia: Sugar

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