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Liver Habits Score

Added sugar is almost gram for gram as hard on your liver as alcohol.

Everyone knows that alcohol is bad for their liver, but few recognize that added sugar is a similar villain that’s worthy of just as much focus.

Brooks Powell

November 27, 2021


In a book titled “Every Body Matters”, the author, Gary Thomas, talks about a peculiar experience he once had when visiting a church while on vacation. The sermon that the minister was delivering was on the evils and dangers of tobacco. While he agreed with the sentiment, he couldn’t ignore the fact that the man delivering the sermon was 300+ pounds, likely diabetic, short of breath while delivering the message, and sweated so profusely that he had to constantly reach for a handkerchief in his pocket to wipe the wetness from his forehead.

Gary thought to himself: “Smoking may be bad… but chances are that many smokers will likely outlive this man by a few decades…”

The irony was painful. The man giving the sermon couldn’t have been more passionate about the dangers of tobacco on one’s health—and he wasn’t misguided in that mission. However, not once did he even bother to discuss the importance of diet, exercise, or other elements of one’s habits and how they relate to living a long, healthy, and happy life.

When it comes to liver health, many people similarly only focus on alcohol as the problem, without considering other elements of their habits that may be just as detrimental.

It’s not hard to imagine a similar situation where you could be having dinner with your teetotaling Southern Baptist aunt, who is one of the 40% of American women well within the category of obese, as she gives you a lecture about the dangers of alcohol while chomping down on a huge, quarter-pie slice of homemade apple pie that has so much sugar that the crust is gritty to the bite. All while gulping down sweet tea that is nearing a syrup level viscosity from the sugar in it.

While it’s true that alcohol is not good for your liver, and you should strive to consume less of it, and with a reduced frequency, the fact of the matter is that in many people’s minds alcohol may receive too much focus, and other aspects such as diet, exercise, BMI, and other aspects such as added sugar consumption receive too little focus. The truth is that just because you don’t consume alcohol does that mean you’re not damaging your liver.

While we won’t deny that alcohol comes with its own problems, our intent with the Liver Habits Score is trying to fill in the full picture of how to take care of your liver. One major aspect of this is how added sugar consumption is potentially just as bad for your liver as alcohol—if not even more so. And therefore, if you’re going to be someone that has alcohol as part of your regular life habits, you need to ensure that you’re watching sugar consumption extremely carefully so as to not deliver a double dose of stress on your liver.

Sugar isn’t the only culprit of fatty liver disease, but it is one of the main ones.

With content for the Liver Habits Score, we have written a number of articles on the problem of liver fat and how it’s the first stage of many types of liver disease, the link between BMI and risk of liver disease, and how Americans continue to get more obese at an alarming rate.

Currently, 1/3rd of American adults are obese, and unless something dramatically changes in this new decade, 1/2 of all Americans will be obese by 2030.

In other articles we have dealt with the inverse correlation of exercise and liver fat, the correlation between alcohol and liver fat, and the best diet to combat liver fat. However, added sugar is such a problem, that it’s necessary to write an entire article dedicated solely to this aspect of someone’s diet. As can be seen in the chart above, there is a direct correlation between Americans’ consumption of sugar and obesity. This rise in sugar consumption is not only linked to obesity, but also the rate of fatty liver disease—especially so since as we will see, sugar is unique in its stresses on the liver through one of its molecules called fructose. (Note: For studies finding direct links between sugar calories and metabolic disorders, see those done by Robert Lustig and the University of California San Francisco.)

The aphorism of “a rising tide lifts all boats” is fitting here. Increased sugar consumption, poor diet, and little to no exercise all work together to increase levels of obesity and widespread fatty liver disease—of which, an estimated 80–100m Americans already have. All of these aspects are creating a situation in which the tides are rising dramatically and creating a perfect storm for future liver disease in the American population. (This “perfect storm” is more generally known as “metabolic syndrome”—formerly known as “Syndrome X.)

As we will see, for drinkers, the problem with added sugar consumption is two-fold when it comes to liver disease:

  1. It increases calories and obesity—which is bad for the liver.
  2. It is comprised of fructose—which can only be processed in the liver and directly leads to the storage of fat in the liver.¹

The science of added sugar and what it’s made of.

Before we can dive into the detriments of fructose on the liver, we must first understand where it comes from.

When people think fructose, they often think: “fruit”. While this is true, let us be clear, we do not believe that fruit is the problem. Yes, fructose is the primary thing in most fruits that makes them sweet. However, as we will explain, consuming detrimental levels of fructose through whole foods such as fruit and vegetables is a very hard task and should be the least of your concerns. And, fruits and vegetables are loaded with fiber, which negates many of the problems of fructose. Most people consume way too little fruit and vegetables, and we want to be sure not to fuel any hysteria that they are in some way problematic.

When it comes to problematic levels of fructose consumption, the main culprit is added sugar, not fruit.

As can be seen in the chart above, sweeteners are typically a combination of both glucose and fructose.

Table sugar is sucrose. A sucrose molecule is comprised of a glucose ring and a fructose ring. Thus, table sugar is 50% glucose and 50% fructose. These two rings separate from each other almost immediately once consumed. High-fructose corn syrup (HFCS) also breaks down into glucose and fructose, albeit at different levels. HFCS 42 breaks down into 42% fructose and 68% glucose. HFCS 55 breaks down into 55% fructose and 45% glucose. However, while the above chart only mentions 42 and 55 versions of HFCS, it’s important to know that these aren’t the only HFCS formulas. For example, there’s a formula which goes as high as HFCS 90, which as you can surmise, is 90% fructose and 10% glucose.

In the 1980s, Coca-Cola began removing sugar (sucrose) from its beverages and instead switched it out with HCFS. Why? Two reasons: 1) it’s sweeter than table sugar, and 2) it’s cheaper to manufacture than sugar. According to a 2010 article in the LA Times, many soft drinks contain HFCS that are around 60–65% fructose. When it comes to HFCS, soft drinks aren’t the only culprit. As can be seen in the chart above, fruit juices are laden with it and are often not only equally as bad as soft drinks, but often can be more so. As far as how hard your liver has to work, you could be better off having a nice dry (and near sugar-free) cabernet than a large glass of grape juice. (If you’re telling your Southern Baptist aunt this, be sure to have studied this subject deeply beforehand, because many people will fight you tooth and nail on this point.)

Because of nutrition and ingredient labeling guidelines that are determined by the FDA, it’s virtually impossible to tell the amount of fructose in any given product. All that is required to be labeled is total sugars, including “added sugars”, and the ingredients that they come from. For example, I walked to my panty and grabbed a box of my wife’s favorite cereal: Honey Nut Chex.

On the label we can see that each serving contains 9g of total sugars (coming from 9g of “added sugars”). We can also see that it contains: “sugar”, “honey”, molasses”, “natural flavor”, and other ingredients. Therefore, based on this label, we can suspect that the added sugars are likely coming from these ingredients. If something is labeled with HFCS, such as a Coca-Cola, it’s safe to say that it’s fructose percentage is likely greater than 50%. However, for the most part, we find it best to always just divide the “added sugar” portion by 2 to get an estimate at how many grams of fructose there is in the product. Thus, in this case, each serving will have about 4.5 grams of fructose.

If we were to look at the nutrition facts on a 20z serving of Coca-Cola, we can estimate that there are roughly 27.5 grams of fructose (but likely a bit more, since they’re likely using a HFCS that’s 55–65% fructose)… so let’s call it 33g of fructose per serving of 20oz Coca-Cola.

Now let’s put this in the context of fruit. A “medium” banana has about 100 calories and contains roughly 7 grams of fructose. Therefore, to get to the same amount of fructose of a single 20oz Coca-Cola, you’d have to eat a whopping 5 bananas! When was the last time you had that much fruit?

Chances are, you’ve probably never eaten problematic levels of fruit in your life. Fruit and vegetables should essentially never be a concern of yours.

For the sake of keeping this article on the briefer side, we won’t discuss the fact that fruit and vegetables contain a lot of fiber, which a number of studies have shown buffers many of the negative effects of fructose.² But long story short, eating whole fruits and vegetables aren’t a problem. (The caveat to this is juice pressing, which may result in filtering out the fiber. When in doubt, eat your fruits and vegetables, don’t drink them. The fructose is your treat for eating your fiber. A good rule of thumb is “no fiber, no fructose”.)

When it comes to fructose consumption, fruits and vegetables are not the problem, added sugars are.

If you are a drinker, which means you additionally tax your liver through alcohol, you should always pay a large amount of attention to your liver’s other taxes, such as your sugar intake—and thereby, your fructose intake.

Added sugar is in nearly everything. One review of the consumer packaged food market revealed that over 80% of all goods contained added sugar.

Early on in the COVID pandemic, I found myself dealing with the initial pressures of a poor economy with cheap beer and junk food. I had stopped going to the gym, was eating too much garbage, drinking too much beer, and overall living a very liver-unhealthy life. I went to my doctor and found out that my triglyceride levels, which are closely related to liver fat percentage, had soared to over 400 in just a few months of poor habits. Studies have shown that major changes in lipid profiles can happen in as little as two weeks. While scary, the silver lining of this is that the liver is a regenerative organ, and there are many lifestyle changes one can make to reverse this, up until a certain point.

A close friend of mine that was worried about me gave me a few hundred bucks if I agreed to try the ketogenic diet—a diet consisting of extremely little carbohydrate intake (which, because sugars are a carb, means no sugar). I tried it out for about two months. I switched from beer to hard alcohol and limited my carbohydrate intake to under about 20g a day. My alcohol consumption likely even increased due to the fact it became my treat in place of a sugary dessert each night. I didn’t even necessarily switch to healthy food either, I consumed more than a healthy amount of red meats and saturated fats. After two months, I went to the doctor and found that my blood pressure had returned to a healthy level, I had dropped about 15 pounds, and my triglycerides had dropped to under 150mg/dl.

While this is hardly a scientific study as I was the only participant (n=1), what was so interesting about this experiment was that I had not altered my drinking habits at all. At 21+ drinks a week, I found that I could reduce my triglyceride levels to a healthy level by merely cutting out simple carbohydrates and added sugars. In the below section, you will see why this was so effective at reducing my blood triglycerides (and through extension, my liver fat percentage) through a process of hindering something called de novo lipogenesis.

(Note: There’s a number of studies showing the efficacy of low-carbohydrate diets on triglycerides and dyslipidemia overall. How? Because it grinds de novo lipogenesis to a halt—i.e., it essentially turns off the body’s ability to create fat from other sources, such as sugar, and thus can lower the amount of fat in the bloodstream in total despite a higher fat diet.)

I have since given up on keto, as the lack of carbohydrates led to problems in the gym—I personally lost a lot of strength. The only time I allow myself to consume sugar is in the middle of a workout where my muscles can use it immediately and very little can be stored as liver fat.

However, what I learned from the experiment was very simple: it’s very hard to avoid added sugars. On a few occasions during my keto experiment I returned from the grocery store only to look at the nutrition label of things like bacon, sausages, garlic roasted chicken, etc. to find generous amounts of added sugar in each of them. If you start paying attention, you will be shocked to find large amounts of added sugars in things you would have never expected.

If you’re going to be a drinker, and thus work to balance out the risks of your alcohol consumption by reducing other detrimental habits in other areas of your life, you will need to become extremely interested in nutrition labels of the things that you eat. As we have discussed in another article, you need to earn the right to drink through making other healthy habits.

Enter Fructose: It’s ‘Alcohol without the buzz’

So far we have established that added sugar is in nearly everything and that roughly half of sugar is fructose. But why is fructose so bad for you—specifically your liver? To understand that, we can turn to Robert Lustig, arguably the most prolific researcher on fructose and metabolic syndrome.

Lustig started his journey as a pediatrician specializing in endocrinology and childhood obesity. Metabolic syndrome is closely related to obesity, and they generally overlap. However, metabolic syndrome is unique in that you can have it without being overweight. Metabolic syndrome was originally called “Syndrome X” and is often defined as: “A cluster of conditions that increase the risk of heart disease, stroke, and diabetes.” And that: “Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The syndrome increases a person’s risk for heart attack and stroke. Aside from a large waist circumference, most of the disorders associated with metabolic syndrome have no symptoms.” (Mayo Clinic)

One thing that is so interesting, and also alarming, about metabolic syndrome is that it can occur without the presence of being overweight (either on a scale or visually). The reason for this is that metabolic syndrome often presents itself as visceral fat rather than subcutaneous fat.

Subcutaneous fat is the fat that you can see. Or better yet, “pinch”. If you had to pick between subcutaneous and visceral fat based on health considerations, you would much prefer to have subcutaneous fat.

Visceral fat is the fat that exists within your abdomen, below the muscles typically thought of as your “core”. In theory, this means that you could have a six pack, but also have a large amount of visceral fat, if you happen to be a heavy drinker that also exercises regularly and eats low amounts of calories from other sources. It is however generally unlikely, as we have discussed elsewhere that exercise is at odds with liver fat, and thus the exercise often offsets the visceral fat. It’s worth noting however that there is a large amount of “normal weight” people that have metabolic disorder. And therefore, even if you’re normal weight, your alcohol or sugar consumption habits alone can put you at risk for visceral fat and metabolic disorder in general.

What Lustig found in his practice was that there was an extremely strong link between the consumption of sugar and the prevalence of metabolic syndrome. His research throughout the past decade has gone to show just how accurate this observation is. Lustig often is looking at the systemic diseases that typically kill the most people, such as diabetes, hypertension, heart disease, cancer, etc. However, as drinkers, one of the main overlaps between our concerns and those of Lustig come in the form of liver disease.

Of Lustig’s research, one of his articles stands out above others for those who drink: “Fructose: It’s ‘Alcohol Without the Buzz’”.

In this article, Lustig sheds light on a number of various topics. For our purposes, one of the main takeaways it quite simple:

Aside from effects in the brain (i.e., the “buzz” that comes from alcohol), alcohol and fructose are almost identical metabolically. And thus, are very similar in their effects on liver health.

In this article, Lustig and his team of researchers go to great lengths to show the metabolic pathways of 1) glucose, 2) fructose, and 3) alcohol. And that the metabolic pathways of fructose and alcohol are nearly identical.

Here’s glucose’s:

Here's alcohol's:

And here's fructose's:

Lustig explains: “Of an ingested glucose load, 20% is metabolized by the liver.” He then goes on to explain that of an ingested alcohol load (ethanol), “80% reaches the liver”. And then finally, he explains that of an ingested fructose load, “100% of the fructose is metabolized by the liver.”

In total, Lustig explains:

“Of an ingested sucrose (“sugar”) load, 20% of the glucose and 100% of the fructose is metabolized by the liver.”

In another article, we explained that the liver is inherently a “metabolic organ” in the sense that while one of its core functions is to filter the blood of toxins (such as acetaminophen, which has no caloric value, but can kill liver cells in an overdose), it also has the core function of metabolizing macronutrients. In another article, we discussed that at the heart of many types of chronic (long-term) liver disease, liver fat buildup is the starting point, and that it’s very hard to progress to later stages of chronic liver disease without first having high liver fat. One thing that is so interesting about alcohol is that its own toxicity isn’t as damaging as some of the events that it causes. (I.e., a single binge drinking session under normal circumstances is not going to destroy your liver.) Rather, alcohol in chronically large doses over time will build up liver fat, which then leads to swelling, and then scarring, and then cirrhosis where the liver can no longer function due to the buildup of scar tissue.

Therefore, one way to empirically measure the stress someone is putting on their liver via consumption-related habits is that of calories reaching the liver that have to be processed by it.

In one of Lustig’s lectures, which at the time of writing this article has been viewed over 12 million times, Lustig points to this fact:

In Lustig’s lecture, Lustig uses a can of Coca-Cola vs a can of Schlitz beer as a matter of comparison when discussing the metabolic load of a beer vs a coke. Schlitz is a relatively low alcohol percentage beer that contains a hefty dose of calories from other carbohydrates.

For the sake of a simpler explanation, let’s focus instead on Coca-Cola vs a shot of hard liquor, which only contains calories from the alcohol molecule itself.

As we saw above, a 20oz serving of Coca-Cola contains 55g of sugar. While we can’t get the exact amount of fructose from this label due to the way the FDA requires labels to be presented, we can make a pretty accurate guess that a bottle of Coca-Cola contains 33 grams of fructose and 22 grams of glucose.

A gram of carbohydrates contains 4 calories. Therefore, 88 calories of the 200 calories are coming from glucose and 132 of the calories are coming from fructose. (Why the FDA allows this to be labeled as 200 calories instead of 220 calories is beyond the scope of this article.)

According to Lustig’s research, only about 20% of the glucose is metabolized by the liver. Therefore, of the 88 calories coming from glucose, 17.6 calories are being processed in the liver. However, as Lustig explains, 100% of the fructose is metabolized in the liver. Thus, from fructose are 132 calories that must be metabolized in the liver. In total, drinking a 20oz bottle of Coca-Cola leads to a total hepatic (liver) metabolic load of 149.6 calories that the liver must directly process. For simplicity’s sake, let’s call this 150 total calories that reach the liver.

In contrast, let’s consider a standard US drink of hard alcohol which is generally regarded as 1.5oz of 80 proof alcohol (or 40% alcohol-by-volume “ABV”). A US standard drink contains 14g of pure ethanol (alcohol). A gram of pure ethanol contains 7 calories. Thus, in a standard US drink of hard alcohol, there are 98 calories. According to Lustig’s research, 80% of the calories coming from ethanol reach the liver. Therefore, the total metabolic load to the liver from a shot of hard alcohol is 78.4 calories.

In comparison, this means that the total metabolic load experienced by the liver from a 20oz bottle of Coca-Cola is about double that of a shot of hard alcohol!

In a very real sense, as far as liver stress goes, two shots of hard alcohol is about the same as that stemming from a single bottle of Coca-Cola. In a very on the nose statement in Lustig’s now famous lecture on the metabolic problems of fructose, Lustig says: “How many people would give their kid a can of beer and think it’s ok? Yet we don’t give it a second of thought to give our kids a can of soda. What’s the difference?”

In our article on exercise and liver health, we explained how alcohol creates liver fat through the process of “de novo lipogenesis (DNL)”. DNL literally translates to “new fat creation” from Latin. It is the process by which the body creates fat from other substances. DNL is how someone can consume a low-fat diet and yet still have dyslipidemia (high triglycerides, LDL, etc.) Fatty liver disease for a long time was more or less only found in alcoholics because of the fact that alcohol increases the storage of liver fat. What Lustig and his colleagues have pointed out is that fructose creates DNL in the exact same way that alcohol does, and because fructose has become so prevalent in modern society through added sugar, and has created unhealthy levels of liver fat in roughly 1/4 of the American population, this is precisely why the medical community now has a term called “non-alcoholic fatty liver disease (NAFLD)” to distinguish between fatty liver disease stemming from alcohol reasons and diet/exercise reasons.

This distinction then creates an obvious problem—what do we do with non-alcoholic drinkers that have fatty liver disease? As we have discussed elsewhere, 25% of Americans consume enough alcohol to create liver-related problems (i.e., “heavy drinking”). However, you’d be crazy to expect that just because someone drinks heavily that they don’t also consume large amounts of added sugar and vice versa. Therefore, when it comes to the Liver Habits Score, we work as hard as possible to express that non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) are often seen together and do compound on each other’s effects. To help illustrate this we instead just present everything as fatty liver disease (FLD). Because, except for in the extremes, most people’s fatty liver disease exists on a spectrum between diet-related (e.g., sugar) and alcohol-related reasons. For some people, 80% of their liver fat may stem from sugar, and 20% stems from alcohol. For other people, 80% of their liver fat may stem from alcohol, and only 20% stems from sugar.

As a bit of an aside, Lustig goes so far as to say that he actually believes that alcohol may be less dangerous to the general population than fructose from added sugar. Why? Because he feels that alcohol is self limiting. While not impossible, it’s hard to consume 10+ drinks a day and maintain a steady job, relationships, etc. With alcohol, you have to deal with the fact that it can make you drunk, and it’s pretty hard to be drunk all the time. On the other hand, fructose doesn’t have this central nervous system limitation. You can have it all day long, every day, without getting drunk. Breakfast, lunch, dinner, snacks, etc. Therefore, fructose can become chronic way more easily than alcohol consumption by the mere fact that it can’t make you drunk like alcohol. In other words, you’re going to notice that your alcohol drinking has become a problem long before you notice your consumption of added sugar has become a problem.

Adding up what matters: total calories metabolized by your liver (“total hepatic metabolic demand”)

So far we have discussed a few key points:

In this last section of the article, we want to focus on major thing: watching the combined metabolic load you’re putting on your liver through your diet and alcohol consumption habits.

The average American consumes 186 grams of sugar each day (66 grams of which come from added sugar). That’s 744 calories a day stemming from sugar in general, and 264 calories that come from added sugar. Of these calories, we can fairly estimate that half of them come from fructose. In total, this means that 74.4 are reaching the liver from glucose, and 372 are reaching the liver from fructose, for a combined total of 446.4 calories that are being metabolized by the liver. In terms of added sugar, 26.4 calories are reaching the liver from glucose and 132 are reaching the liver from fructose, for a combined total of 158.4 calories that are being metabolized by the liver. In general, to perform this calculation, just take the amount of calories coming from sugar and multiply it by .6 to get the number of how much is processed by the liver.

Remember, a US standard drink of hard alcohol is 78.4 calories that reach the liver

To put this in visceral terms (pun intended, as both sugar and alcohol lead to visceral fat) through converting this to alcohol in the form of standard US drinks, total sugar consumption by the average American is the equivalent hepatic (liver) metabolic demand of 5.7 shots of hard alcohol each day. You’re reading that right… the modern American consumes the hepatic metabolic equivalent demand of nearly six US standard drinks. The added sugar in food alone accounts for a total hepatic metabolic demand of 2.0 US standard drinks.

To put this in perspective, that’s roughly 15x the amount of sugar that humans were consuming just three centuries ago.

If you’re wondering why the prevalence of fatty liver disease has exploded by such a large amount, this sugar consumption is one of the main problems in creating this “perfect storm” for liver disease. When you put sugar consumption in terms of alcohol consumption, all of a sudden the connection between sugar and liver disease becomes painfully apparent.

In the above we calculated the hepatic metabolic demand equivalents of average American sugar intake to alcohol. However, given the fact that 80–100m Americans are currently estimated to have fatty liver disease, this is an awful goal. Americans lead the world in sugar consumption by a long shot.

In general, 100 calories of sugar leads to 60 calories of hepatic metabolic demand (50 glucose calories * .2 + 50 fructose calories * 1 = 60 calories processed by the liver). The US CDC recommends that Americans consume no more than 10% of their diet from added sugar. The US CDC recommends that women consume roughly 2000 calories a day and 2500 a day for men. Thus, they suggest no more than 200 calories from added sugar a day for women and 250 calories a day for men. That’s the hepatic metabolic demand equivalent of 1.5 drinks a day for women and 1.9 drinks a day for men. In other words, if you were to cut out added sugar completely from your diet, you could “afford” to have an additional 10–13 drinks per week.

There is however, one major caveat to this. Major sugar researchers, such as Lustig, recommend that women consume no more than 25g a day of sugar for women and 38g a day for men. That’s the equivalent total hepatic metabolic demand of .75 US standard drinks a day for women and 1.2 US standard drinks for men. To be on the safer side, if you cut out sugar completely from your diet, women could consume an additional 5.25 US standard drinks a week and men could consume an additional 8.25 US standard drinks a week.

One thing that we want to be careful to explain is that for the purposes of this article we are focusing on the liver through the concept of “total hepatic metabolic demand”. Sugar and alcohol come with risks beyond that of liver disease, such as an increased risk of cancer. In summary, our goal with this article is to make one thing very apparent: you should do your best to consume less of both sugar and alcohol. We account for this in the Liver Habits Score as both sugar and alcohol consumption independently negatively affect your score.

Final thoughts on the concept of total hepatic metabolic demand

In this article we have focused solely on alcohol and sugar. We want to be very clear: these are not the only macronutrients that create stress on the liver. Instead, because of the high amount of calories that sugar and alcohol provide which must be processed in the liver (100% of fructose and 80% of alcohol), they are the low-hanging fruit. Also, it’s also worth pointing out that not all hepatic metabolic demand is inherently bad—the liver has a bonafide biological purpose, and thus it should be used… we’re just showing that it should not be overused.

To get a true “total hepatic metabolic demand” someone would have to calculate every calorie that they consume, their sources, and what percentage of those must be processed by the liver. This means that for each bowl of pasta, each hamburger, etc. that someone consumes, they would have to try calculating the total that is being processed in the liver and then work to reduce that. One of the main goals of the Liver Habits Score is simplicity and sustainability. We do not believe that monitoring your food intake that closely is something that most people could sustain for their whole lives. Instead, what we’re making a point of is to simply monitor the main culprits—the low hanging fruit: sugar and alcohol.

In this article we only discussed “import” of calories into the liver without discussing “export”. In our article on exercise, we instead focused on export instead of discussing import. The fact of the matter is that since the liver is inherently a metabolic organ, and any unused energy, depending on the source, gets stored as fat (alcohol actually can’t be stored as fat, instead it’s used for energy in place of fat—which means that alcohol still functionally leads to fat storage), this means that it is a balancing act.

Eddie Hall, the UK’s “strongest man”, winner of the 2017 World’s Strongest Man competition, and world record holder of the heaviest deadlift (1,102 pounds, or 500kg), weighed at his peak 410 pounds at 6' 3" and reportedly consumed 10,000 calories a day. The most decorated Olympic athlete of all time, Michael Phelps, who had a completely different body type and was 6'4" and weighed 194 pounds, reportedly consumed around 12,000 calories a day in his prime. They likely have very healthy livers despite extreme intake (“import”). How did they not have huge amounts of liver fat? Because they exercised so much—i.e., huge amounts of “export”. In other words, they balanced their import to their export and vice versa depending on their needs.

The point we’re trying to make here is simple: to be healthy, you need to work to balance your total hepatic demand (import) to your exercise and caloric needs (export).

In practice this is quite simple. Is it the holidays and you’re consuming a lot of sugar? You should be mindful of that and work to drink less alcohol so as to tax your liver less. Or vice versa, is it the summer and you’ve been drinking a lot while on vacation? You should likely skip some desserts and work to eat healthy. Are you consuming more than you should? You should work to exercise and potentially take some time off from alcohol and sugar altogether for a week or two.

It’s ok to have a piece of pie every once in a while. It’s also ok to drink and go to happy hour. These are things that make life enjoyable—unless health is your only goal, then it’s worth enjoying some pleasures in life. The point that we’re trying to make here is that liver health is about balancing the good with the “bad” over the long haul of your life.

This is the whole point behind our Liver Habits Score. If you haven't taken the quiz yet and received your score, you can do so here.

¡Salud! (“Cheers” in Spanish. It literally means “to health”.)

This blog provides general information and discussions about health and related subjects. The information and other content provided in this blog, website, or in any linked materials are not intended and should not be considered, or used as a substitute for, medical advice, diagnosis or treatment. This blog does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. We cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this blog or website.

If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment immediately. Never disregard professional medical advice or delay in seeking it because of something that you have read on this blog, website or in any linked materials. If you are experiencing a medical emergency, please call 911 or call for emergency medical help on the nearest telephone immediately.


¹The gut shields the liver from fructose-induced damage. Penn Medicine. (n.d.). Retrieved October 6, 2021, from 

²Mazur, A., Gueux, E., Felgines, C., Bayle, D., Nassir, F., Demigné, C., & Rémésy, C. (1992). Effects of Dietary Fermentable Fiber on Fatty Acid Synthesis and Triglyceride Secretion in Rats Fed Fructose-Based Diet: Studies with Sugar-Beet Fiber. Proceedings of the Society for Experimental Biology and Medicine, 199(3), 345–350.

About Cheers

Cheers is the leading alcohol-related health brand focused on developing products that support your liver and help you feel great the next day. As a student at Princeton, Cheers’ founder Brooks Powell discovered the potential advantage of incorporating the natural plant extract Dihydromyricetin (DHM) into an after-alcohol consumption regimen and began working with his professors to make products that addressed the unique challenges of alcohol-related health. . Since its official launch in 2017, Cheers has sold more than 13 million doses  to over 300 thousand customers. The research-backed line of products includes three versions of supplemental pills and powders – Restore, Hydrate and Protect. Cheers is now releasing read-to-drink versions of their products—starting with Cheers Restore. Each product is equipped to meet different health needs such as rehydration, liver support, and acetaldehyde exposure. Cheers places an equal emphasis on the responsibility and health aspects of its mission and vision. The brand’s mission is bringing people together by promoting fun, responsible, and health-conscious alcohol consumption. The vision is a world where everyone can enjoy alcohol throughout a long, healthy, and happy lifetime. For more information, visit or join the social conversation at @cheershealth.