Cutting liver fat by cutting added sugars – could it be that simple?

Cutting sugar cuts liver fat

Fatty liver disease is a silent epidemic. The Centers for Disease Control estimates that one in five American adults and one in ten adolescents have non-alcoholic fatty liver disease — it’s a bit of a mouthful, and often abbreviated with the acronym NAFLD. That makes NAFLD more common than diabetes, Alzheimer’s and breast or prostate cancer, yet we hear little about this disease and the real, long-term damage it can cause.

The search for drug treatments that reduce NAFLD or improve its symptoms have not been fruitful. Could something as simple as eliminating added sugars from our diets be the answer?

A new study published in JAMA (and out of the University of California San Diego and Emory University schools of medicine) shows that adolescents who cut out added sugars, but do little else to change their diets, can quickly improve their health, reducing liver fat by 31% on average in just two months.

The New York Times: To fight fatty liver, avoid sugary foods and drinks

In this randomized clinical trial, 40 adolescent boys with a diagnosis of NAFLD were randomized into two groups. The children in the control group received the usual care, which is advice to exercise and eat healthy foods.

The kids in the experimental group received an impressive intervention to eliminate added sugars from the diet of the entire family. Dietitians customized eight weeks of meal plans for each household that respected the families’ food habits and preferences, while eliminating added sugar. Sugary beverages (including juice) were replaced with water, milk and unsweetened iced tea. To make it easier for families, and improve the researchers’ control and certainty of compliance, meals were prepared by dietitians and delivered to the study participants.

How did the children do on this carefully enforced, no-added-sugar diet? Extremely well. The New York Times provides a summary:

After eight weeks, the low-sugar group had gotten their added sugar intake down to just 1 percent of their daily calories, compared to 9 percent in the control group. They also had a remarkable change in their liver health. They had a 31 percent reduction in liver fat, on average, compared to no change in the control group. They also had a 40 percent drop in their levels of alanine aminotransferase, or ALT, a liver enzyme that rises when liver cells are damaged or inflamed.

Note that the point of this study was to look at the role that added sugar plays in NAFLD and discover whether eliminating just that might be an effective treatment. This was not a low-carb study. Weight loss was not a goal and the children lost only, on average, about three pounds. But for the liver health of these adolescent boys, the power of simply eliminating added sugars was obvious — even dramatic.

Other small studies with adult subjects have shown large, rapid reductions of liver fat using a ketogenic diet, which eliminates not only added sugar but most naturally occurring sugars and starches, too. Studies show keto can also lead to meaningful weight loss… a bonus of sorts for those seeking a healthier liver!

This work was funded in part by the Nutrition Science Initiative, a non-profit co-founded by journalist and low-carb advocate Gary Taubes. The National Institutes of Health, as well as participating research universities also provided funding.

We are grateful for this evidence that speaks directly to the damage to our children that can be reversed by eliminating sugar.


Groundbreaking study: low carb is an effective treatment for fatty liver

New study: Can low carb help reverse a fatty liver?

Fatty liver disease fastest-growing reason for transplants in young U.S. adults


The science of low carb and keto



  1. Diane Welland
    As a registered dietitian working with the Juice Products Association, I would like to point out that this is preliminary research, which requires more data before any conclusions can be drawn. Why? First, the study was conducted on a small population of Hispanic adolescent boys with a specific liver condition. It is not clear if you would get the same results in girls. Second, while the 8-week study did find positive results, it did not show levels in the normal range. Thus long-term studies need to be done to determine if a. this approach is cost-effective and b. it is beneficial. Finally, in this study a research team, planned, purchased and provided all foods for the family, which also means the study was not blind. This is not practical in a real-life setting. All of these factors make these results interesting, but not conclusive enough to make recommendations.

    Please keep in mind that 100% juice does not contain added sugar – just the natural sugars found in the fruit it is squeezed from. Studies demonstrate that healthy people who drink 100% juice have higher quality diets, eat more whole fruit, and have either comparable or higher total dietary fiber in their diets as well as lower intakes of saturated fat, total fat, sodium and added sugar than non-juice drinkers. Therefore, there is no reason to eliminate appropriate servings of fruit juice from the diets of healthy children. Learn more at

    Reply: #7
  2. Carol
    As Janet pointed out in another article, Diane is new to trolling. She must think she’s the only dietician to have ever been a paid mouthpiece for a big food company. We’re not buying it Diane. Do some research Dianne.....Come back to us when you have watched Robert Lustig’s YouTube video.
  3. 1 comment removed
  4. Kent
    I see a lot of issues with fatty liver in patients along with high triglycerides and I have seen many times when decreasing the carb load improves triglycerides and fatty liver.
  5. Viv
    Diagnosed with NAFLD September ‘18. Started low carb/ high fat diet immediately and got all clear in January. Have been low carb/ high fat ever since and no problems. Would have eaten high carb/sugar for 50 years previous. I have no doubt what caused my NAFLD !
  6. Kathy Miller
    Foie Gras, an expensive goose liver pate, is made by force feeding grains to geese to enlarge their liver. The literal translation of foie gras is fat liver.
    It is sugar/carbs that causes non alcoholic fatty liver disease, not fats.
  7. everett versteeg
    I'm thankful that Diane was up front about her commercial bias. There is a difference between willful ignorance and complacent denial that sometimes confuses the argument. I think we can agree that glucose and fructose are the same whether they are added to a product or are naturally occurring in the product's ingredients. (wouldn't it be nice if we didn't eat products?). The liver is the primary tissue in the body to metabolise fructose - so it would make sense that fruit might play a bigger role in NAFLD than we credit. Removing the starch that slows down the absorption of that fructose (by drinking your fruit) - will only intensify the work of the liver.

    Fruit could probably stay in the diet of healthy children - but juice? You state that studies show people that drink juice have a higher quality diet than (presumably) those who drink pop? - A bit confounded. Maybe you can provide those data?

  8. ruighp
    Fructose is the Devil in fatty.liver disease. When I stopped eating sugary food and drinking juices and eating fruits high in fructose my liver blood test became normal. The food I ndustry puts sugar in everything.
  9. Jennifer
    My cousin in another country had a liver transplant. She was obese all her life. When I stayed at her home, there were lots of bananas, milk, and processed starchy foods. Nothing green at all. When she was in the hospital, she was drinking orange squash. She had been injecting herself with insulin since she was young ( she called it adult onset diabetes), and I remember her telling me how you have got to eat! She never touched alcohol. Shortly after she came home from hospital, her husband, also obese and diabetic, developed brain cancer out of the blue, and died quite suddenly. Broken hearted, she survived a few more months before she too passed on. I know how sick she was from the liver disease, but I also know that the sugars and carbs in her lifestyle killed her (and likely her husband). I live in Canada and have studied diet and life style all my life. I too have been diagnosed with diabetes type2, and am ruthless about avoiding carbs and processed foods. No one ever gave her anything other than traditional dietary advice to eat regularly, snack on bananas, bread and breakfast cereals, and prescriptions for insulin. It is a tragic story!
  10. Kate
    Diane.surely you must know that fruit is designed to be eaten,not drunk out of packaging and paying big companies for our ill health.

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