America’s breakfast tables are currently filled with glasses of orange juice. Possibly yours. It appears innocuous—bright, high in vitamins, the kind of food you were told was healthy growing up. However, hepatologists are becoming more concerned about it, and it is worthwhile to take a moment to consider their concerns.
Fruit juices should be consumed in moderation, according to Dr. Lee F. Peng, chief of gastroenterology and hepatology at Hackensack Meridian Jersey Shore University Medical Center. Doctors don’t speak in such a casual manner. “Gulping down fruit juices with every meal can result in weight gain and insulin resistance,” adds Dr. Abdul Nadir, a gastroenterologist specialising in hepatology with HonorHealth. He claims that drinking too much juice can cause fat to build up in the liver and eventually cause cirrhosis, a condition that leaves scars. He characterizes the repercussions as potentially fatal.
The fruit isn’t the main issue. It is the result of removing the fiber. Whole fruit slows down how quickly sugar enters your bloodstream. That’s not what juice does. Without any of the braking mechanisms that make whole fruit safer, it delivers a concentrated hit of fructose—the same sugar found in high-fructose corn syrup—directly into the body. The fructose is transformed into fat once it reaches the liver. That fat accumulates inside liver cells over time, stressing them and progressively reducing their capacity to filter toxins. Ohio State researchers discovered that fatty liver disease can be brought on by consuming even one sugary drink daily for five to seven years.
It’s worth taking a step back and considering how long this went unnoticed by the general public. The juice industry has done an extraordinary job positioning its products as health foods — and in fairness, fruit juice does contain vitamins. However, most people are unaware of the metabolic similarities between a can of cola and a carton of apple juice. Both deliver fructose without fibre. The same type of liver stress is produced by both. Juice’s purported health benefits have always been somewhat dubious, but the evidence now supports the hunch.
According to Dr. Peng, this is a direct cause of what is now known as metabolic dysfunction-associated steatotic liver disease (MASLD), which is a rebranding of what most people still refer to as non-alcoholic fatty liver disease. After alcohol-related cirrhosis, MASLD is now the second most common cause of liver transplants in the US. Liver transplants for cirrhosis caused by MASLD have increased from about 5% to almost 25% of cases over the last 20 years. That figure is startling, and it doesn’t appear to be decreasing.
None of this implies that you will never be able to consume fruit juice again. Both Dr. Nadir and Dr. Peng are clear that occasional consumption is fine. The daily habit of treating the morning glass as a nutritional pillar when, in reality, it’s more akin to a dessert is the issue. Dr. Peng believes that choosing whole fruit—fresh, frozen, or canned in its own juice with the liquid drained off—is a wiser choice. Two servings a day provide the fibre that juice strips away, and fibre, it turns out, is doing a lot more for your liver than most people give it credit for.
There’s something almost ironic about this moment. For many years, the main focus of public health messaging regarding liver disease was alcohol. And there is no denying that alcohol is actually harmful. However, a blind spot has been exposed by the quiet rise of MASLD. The liver doesn’t much care whether the fructose overload came from a cocktail or a glass of “100% natural” juice. Both are processed in the same manner. As you watch this happen in real time, it’s difficult not to think that a major reset in the discussion of liver health is long overdue.
