Introduction to Liver Disease
A new study found that a popular low-calorie sweetener commonly used in sugar-free gum, candy, and dietary baked goods may increase the risk of serious liver disease. The chronic illness is already having an impact on one in three American adults, and the number of children is increasing rapidly, putting millions of people at greater risk of serious health problems, including heart disease.
What is Sorbitol?
Sorbitol is a sugar alcohol that occurs naturally in several fruits. It is also produced commercially for sugar-free, low-calorie, and diabetic-friendly products. The body can also produce sorbitol when glucose levels rise, which is why this is most often associated with diabetes, a condition in which blood sugar levels can rise.
How Sorbitol Affects the Body
Research shows that intestinal enzymes produce sorbitol when glucose levels rise. The new study suggests that even in healthy people, glucose levels can rise high enough after a meal to trigger sorbitol production. Normally, bacteria in the intestine break down small amounts of sorbitol into a harmless byproduct. However, if you don’t have the right bacteria, it becomes problematic.
The Risks of Sorbitol Accumulation
When sorbitol accumulates faster than the gut microbes can handle, it can happen if you consume too much glucose, too much sorbitol, or both. Once sorbitol levels rise too high, the intestines can no longer break it down, and it is passed on to the liver. There, the body converts it into a form of fructose. Fructose is already known as a fuel for metabolic dysfunction-associated steatotic liver disease (MASLD) because the liver converts excess fructose into fat.
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
MASLD is a widespread condition in the United States, but many people are unaware of their condition because it often causes no symptoms in the early stages. Some may feel more tired than usual or notice mild discomfort or a feeling of fullness in the upper right part of the abdomen, but these signs are nonspecific and easy to miss.
Diagnosis and Treatment of MASLD
Doctors typically detect the condition when routine blood tests show mildly abnormal liver enzymes or when imaging is done for another reason, such as an abdominal ultrasound. Because most people have no symptoms, diagnosis depends on healthcare providers gathering this evidence and checking for metabolic risk factors, namely obesity, diabetes or prediabetes, high blood pressure, and high cholesterol. If caught early, MASLD can often be improved and, in some cases, even reversed. Treatment usually focuses on lifestyle changes, including weight loss, regular exercise, and management of related medical conditions such as diabetes.
Medications for MASLD
While no drugs are approved specifically for MASLD, two medications combat metabolic dysfunction-associated steatohepatitis, or MASH, the more advanced form of the disease. These two medications should be used in conjunction with, and not in place of, lifestyle changes.
