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Sugary Drinks and Liver Disease

Contributors Longgang Zhao, PhD, and Xuehong Zhang, MBBS, ScD
6 minute read
Woman drinking soda.

American refrigerators are often full of sugary drinks. According to the Centers for Disease Control and Prevention (CDC), more than 60% of American adults drink one or more sugar-sweetened beverages a day.

Despite their sweet taste, sugary drinks pose significant health risks. Researchers have already linked the beverages to obesity, diabetes, and heart disease. Now, Mass General Brigham researchers have uncovered a potential new link to another serious condition: liver disease, the ninth leading cause of death in the United States.

Longgang Zhao, PhD, and Xuehong Zhang, MBBS, ScD, of Brigham and Women’s Hospital, found that postmenopausal women who drank one or more sugar-sweetened beverages per day had a higher risk of developing liver cancer and dying from chronic liver diseases than those who drank three or less sugar-sweetened beverages per month.

Drs. Zhang and Zhao made their findings from the Women’s Health Initiative study of nearly 100,000 postmenopausal women between the ages of 50 and 79. Post-menopause begins once a woman reaches menopause, 12 months after their last menstrual period. Their research is rare; few studies have ever examined associations of sugary drinks with liver cancer and liver disease.

“We can’t say sugary drinks cause liver disease,” says Dr. Zhao. “But if a causal link is established, the implications on global public health would be substantial.”

So how do sugary drinks affect the liver? Drs. Zhao and Zhang explain their ongoing research and how the liver functions.

What is considered a sugar-sweetened beverage?

Sugar-sweetened beverages are drinks flavored with added sugars. These sugary drinks include:

  • Soda

  • Sports drinks

  • Energy drinks

  • Sweetened waters

  • Sweetened teas

While ingredient labels can simply list “sugar,” people might not recognize the names of other sugars added to their beverage. Added sugars can appear listed as:

  • Fructose

  • Glucose

  • High-fructose corn syrup

  • Honey

  • Lactose

  • Malt syrup

  • Maltose

  • Molasses

  • Sucrose

How is sugar processed in the body?

People need sugar to fuel cells throughout the body. Cells use this “fuel” to power specific functions.

“The cells in our hearts, brain, muscles — everywhere, really — need sugars to keep us breathing, thinking, and moving,” explains Dr. Zhao. “It’s the body’s version of gas powering a car.”

Unlike plants, which generate sugar from light and carbon dioxide, humans cannot produce sugar on their own. They must extract sugar from carbohydrates, or carbs, in the foods and beverages they eat and drink.

The digestive system breaks carbs into a special sugar called glucose. When glucose enters the bloodstream, a chemical produced by the pancreas called insulin helps deliver the sugar to cells.

Health concerns linked to sugar

Consuming too much sugar can lead to:

  • Weight gain
  • Dental problems
  • Inflammation
  • Energy changes

What is considered too much sugar?

In its Dietary Guidelines for Americans, the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) recommend limiting added sugar to less than 10% of daily calorie intake. A 2,000-calorie diet, for example, would consist of 200 calories, or 50 grams, of added sugar a day.

Since a typical 12-ounce can of soda contains about 39 grams of sugar, one and a half cans would far exceed the daily recommended amount.

“It’s essential to take precautions when selecting sugary drinks to prevent excessive sugar intakes,” says Dr. Zhao. “Check product labels for hidden sugars and opt for healthier alternatives like tea or water.”

Patients with existing liver conditions should seek dietary guidance from their health care provider.

How does the liver process sugar?

The liver regulates sugar entering the bloodstream. It stores excess sugar by turning it into a substance called glycogen. When sugar levels fall too low, the liver releases its excess. The liver also cleans toxic substances, such as alcohol, and creates sugar from food sources other than carbs.

There’s still a lot of work that needs to be done before we can definitively identify a cause for liver disease. What we do know is that it’s always safe to practice moderation when eating and drinking sugary foods and beverages.

Longgang Zhao, PhD


Mass General Brigham

The possible link between liver disease and sugary drinks

According to the American Cancer Society, liver cancer cases have tripled over the past 3 decades in America. Tens of thousands of people receive a liver disease diagnosis each year. The role sugar-sweetened beverages play in these conditions remains a mystery.

Dr. Zhao explains several leading explanations:


Drinking too many sugar-sweetened beverages can increase the likelihood of obesity, a strong risk factor for liver cancer and liver disease.

Too much fructose

Sugar-sweetened beverages are a major source of fructose, an added sugar commonly found in fruits and fruit-flavored drinks. The liver rapidly stores fructose, but in an unusual way. Instead of storing fructose as glycogen, the liver tends to store excess fructose as fat.

Fatty liver disease is one of the most common chronic liver diseases. It can lead to liver cancer, as well as:

  • Insulin resistance and inflammation
  • Poor gut health
  • Cirrhosis, or scarring of the liver

Rapid absorption of sugar and other chemicals

The body processes sugar from drinks much quicker than it does from foods. Frequent spikes in blood sugar from sugar-sweetened beverages can lead to liver problems.

Recently discovered chemicals in sugar-sweetened drinks might also play a role. Chemicals found in these drinks that can harm the body include:

  • Caramel coloring
  • Citric acid
  • Natural flavoring

How could fewer sugary drinks improve health?

A definitive link between sugary links and liver disease would have major implications for diets worldwide. It would suggest that drinking fewer sugary drinks can reduce the risk of future health complications. Such complications would not only include liver disease but also obesity and diabetes.

Dr. Zhao says that — based on previous literature — cutting one sugar-sweetened beverage from a daily diet could reduce annual weight gain by approximately 25%.

Future research on sugary drinks

Drs. Zhang and Zhao will use two innovative techniques to better understand the relationship between sugary drinks and liver disease. One technique will investigate chemical reactions occurring within cells and tissues, particularly those used to create fuel from food particles. The other will investigate the structure and function of proteins used to help the liver process sugar.

The research team will need to observe a similar link between liver disease and sugary drinks in men and younger women.

“There’s still a lot of work that needs to be done before we can definitively identify a cause for liver disease,” says Dr. Zhao. “What we do know is that it’s always safe to practice moderation when eating and drinking sugary foods and beverages.”

Longgang Zhao, PhD