Kick the soda can and protect your liver

When it comes to liver disease, you don’t want to mess around. While avoiding alcohol, excessive sugar, and keeping your weight in check are top priorities to avoid liver dysfunction, new research finds additional risk with a commonly consumed beverage.

A recent study published in the Annals of Hepatology discovered that drinking less than one can of soda daily may be linked with serious liver dysfunction.

The research evaluated the link between soda intake and liver dysfunction in over 1,750 healthcare workers. Scientists found subjects with liver disease and analyzed their diet habits, ultimately finding that regular soda intake was linked with an increased risk of metabolic dysfunction associated with steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease.

MASLD is a condition of the liver that impacts people with obesity or other metabolic diseases, including type 2 diabetes, hypertension, or high cholesterol, according to Jacqueline Vernarelli, PhD, a nutritional epidemiologist, public health nutritionist, and associate professor at Sacred Heart University. MASLD occurs when excess fat accumulates in the liver due to metabolic health issues rather than alcohol, and can eventually lead to liver inflammation.

Other factors, such as overall diet, lifestyle, and genetics, are also at play. The study discovered that individuals who consumed the most soda had higher rates of liver dysfunction, but it doesn’t prove that soda causes liver disease. Andrew Moore, MD, a gastroenterologist at Endeavor Health, notes, “while there’s strong evidence to support that regular soda consumption is associated with development of MASLD, it’s not causal”.

How do soft drinks hurt the liver? 

Regular sodas contain fructose, a simple sugar used in many processed foods, which is mainly metabolized in the liver. Vernarelli notes, “When the liver is overloaded with fructose, it can lead to the accumulation of fatty acids — a condition known as fatty liver — ultimately increasing the risk of MASLD. 

Accumulation of fat in the liver may also lead to inflammation, which eventually may lead to scarring of the liver (fibrosis). In rare cases, this can progress to late-stage, irreversible liver scarring called cirrhosis, which can greatly increase the risk of liver cancer.

While fructose isn’t used in diet soda, artificial sweeteners such as aspartame, sucralose and saccharin may impact the gut microbiome, which is critical for digestion, inflammation, and liver health. Because of this, artificial sweeteners may add to insulin resistance and the progression of fatty liver, leading to a similar insult to the liver as sugary drinks.

Does moderate soda consumption have a negative impact on the body?

Unfortunately, even moderate soda intake — just one can per day — could have negative effects on the body. Vernarelli states, “Sugary sodas are high in empty calories and don’t promote satiety, potentially leading to overconsumption of excess calories and weight gain.”

Regular soda intake can also lead to insulin resistance, where muscles, fat, and liver don’t effectively respond to insulin. This makes it hard for the body to pull glucose into cells for energy, and may lead to fat deposition. The acid in soda can also damage tooth enamel, promoting the development of cavities.

Compared to those who didn’t consume sugary drinks, the research discovered that moderate soda intake (between 1 and fewer than 3.5 servings per week) was linked with a greater risk of developing fatty liver disease.

“While the occasional soda is unlikely to cause any significant long-term risk of fatty liver disease, there does seem to be an overall correlation with increased frequency of soda use and increased risk of fatty liver development,” Moore says.

This link is still present even after accounting for lifestyle factors including healthy diet, regular exercise, and keeping a healthy weight. Moore advises his patients to skip all sodas (diet AND regular), and drink water or naturally flavored waters.  

Could cutting soda intake improve liver health?

Yes. Avoiding or significantly cutting back on soda can improve liver health over time, assuming liver damage has not moved to advanced fibrosis or cirrhosis. Reducing sugar and fructose intake over time can lower hepatic fat and improve insulin sensitivity. 

In addition, the Mediterranean and DASH diets, which focus on whole foods and limit ultra-processed foods and sugary drinks, has been found to reverse liver fat accumulation, cut inflammation, and improve early-stage fibrosis.

Achievable ways to reduce your soda intake 

Gradually reducing soda intake may be a sustainable way to reduce risk. Limit to every other day while adding healthy alternatives like seltzer water or club soda. From there, have it on weekends only, then one per week, one per month, and hopefully none from there on.

Moore and Vernarelli believe that plain or sparkling water is the best choice over soda — choose naturally flavored, without added sugar or sweeteners. For added flavor, try a squeeze of lemon or lime, or infusing it with fresh fruit or herbs (such as oranges, grapefruit, or mint).

How other drinks compare to soda

Soda isn’t the only drink that can hurt metabolic and liver health. Other popular drinks, like fruit juice, sports drinks, and sweetened coffee or tea — can add high amounts of sugar or sweeteners with few nutrients than they seem to offer. Knowing how these drinks compare to soda can help consumers make better drink choices to support long-term health.

Fruit Juice

Fruit juice might appear better than soda since it contains vitamins and minerals, but it’s devoid of fiber found in whole fruit and still adds a large amount of natural fructose. While not as concentrated as the high-fructose corn syrup added to soda, 100% fruit juice contains no added sugars, making it seem like a healthier choice than regular sodas.

Sports Drinks 

Several sports drinks have added sugars, artificial sweeteners, or both, and can lead to the same health risks as soda when drank often. Vernarelli suggests those without added sugar like Good Sport or Harmless Harvest. 

Coffee and Tea

Coffee and tea have plenty of health benefits, but if they’re heavily sweetened, these may be negated. Opt for unsweetened versions of coffee and tea, or add a little milk of your choice.

Lisa Andrews, MEd, RD, LD

Reference:

Edgar Denova-Gutiérrez, et. al. Soft drink consumption and increased risk of nonalcoholic fatty liver disease: Results from the health workers cohort study, Annals of Hepatology, Volume 30, Issue 1, 2025,101566,ISSN 1665-2681, https://doi.org/10.1016/j.aohep.2024.101566.