I would have hardly expected a strappy, workout-oriented 27-year-old to have grade 2 fatty liver, which is moderate fat accumulation in the liver. He didn’t drink alcohol and was particular about his fitness discipline. Still he complained of low energy, fatigue, bloating after meals, unexplained mild nausea and loss of appetite. A test showed that his liver enzymes were elevated. What was spiking them? Then I studied his diet in detail and found that while he ate healthy and clean, he was into diet soda and sports energy drinks. He thought these went well with his post-workout hydration needs. Besides, advertised as zero calorie, he thought he could have them anytime of the day. What he didn’t know is that low- or sugar-free sweetened drinks were actually associated with a higher risk of liver disease. In fact, a latest study that tracked over 100,000 participants from the UB Biobank, found that having even one can of diet or zero-sugar drinks was associated with a 60 per cent higher risk of developing MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) or what we generally understand as non-alcoholic fatty acid. This study also found that diet drinks were linked to a higher risk of dying from liver disease. No such association was found between sugary drinks and liver-related death. MRI scans confirmed that both beverage types were associated with greater fat content in the liver. Why diet sodas can still trigger calorie buildup in the body Zero-calorie sodas use artificial sweeteners like aspartame and sucralose. Normally, their sweet taste triggers the sweet taste receptors in the tongue, which in turn signal the brain that calories are being consumed. The brain feels cheated when the expected calories are not found and stokes more hunger and craving. That’s why you end up eating more. Not only that. Sweet diet sodas may blunt your taste of natural sugar and push you towards more processed foods. That’s how sweeteners encourage calorie build-up. And excess calories are converted to fat and stored in the liver. How diet soda can change insulin response Despite not being caloric, these sweeteners can still affect the body’s insulin response, which plays a critical role in how the body stores fat. The sweet flavour causes a small, temporary burst of insulin. This is called cephalic phase insulin release, a small secretion in anticipation of sugar as a result of sensory cues like the sight, smell, or taste of food. If this happens continuously, it blunts the body’s insulin response, causing the pancreas to produce more insulin to manage blood sugar. This increase in circulating insulin, a hormone that promotes fat storage, can encourage the body to store more calories as fat. The rewiring of the gut-brain axis Both aspartame and sucralose can alter gut microbes. Artificial sweeteners travel largely unabsorbed to the large intestine, where they interact with the gut bacteria unfiltered. This interaction can alter the gut microbiome in ways that promote weight gain. Some studies show that sucralose and aspartame can change the balance of gut bacteria, favouring microbes linked to obesity and metabolic disease. Research has also found that sucralose can lead to a reduction in beneficial bacteria, the key warriors that prevent inflammation. What then to drink? Clearly, non-sugar sweetened beverages are best limited and avoided. In fact, coconut water can give you a natural energy boost as it is a natural source of electrolytes like potassium and magnesium that are easily lost through sweat. Natural electrolyte drinks can be easily prepared with coconut water, any natural juice and a sprinkle of salt. Infused water is yet another option. Besides, natural caffeine and antioxidants can be found in various kinds of tea, coffee and herbal teas. (Dr Tickoo is Director Internal Medicine, Max Healthcare)
