Keep the Apple, Rethink the Juice
I read something this week that made me want to stand up and cheer in my kitchen. It comes from Dr Hirsh Trivedi, a liver specialist at Dell Medical School in Texas, who writes a newsletter called Inherited Risk on Substack. His article is titled "Fructose and the Liver: Why the Source Matters More Than the Sugar", and it opens with a patient telling him she had given up fruit to protect her liver. She was sipping a sports drink as she said it.
He sees this every week, he says. People give up bananas and keep the juice. They skip honey and eat snack bars sweetened with syrup. The worry is reasonable. The swap is the wrong way around.
Why fructose gets the attention
Fructose is the sugar that makes fruit sweet, and it is also half of ordinary table sugar and a big part of the syrups used in fizzy drinks and packaged foods (on UK labels, look for "glucose-fructose syrup").
Dr Trivedi explains that the liver handles nearly all of it. Other sugars are shared around the body and have a braking system. Fructose has no brake. When a lot arrives at once, the liver turns the surplus into fat and stores it right there. Over years, that can wear the liver down.
So why is fruit fine?
Because an apple is not a glass of sugar water. The fructose in whole fruit comes wrapped in fibre and water, alongside natural plant compounds. You chew it. It reaches the liver slowly, a little at a time. A sweet drink delivers the same sugar all at once with nothing to slow it.
The research he cites backs this up. A pooled analysis of nearly half a million people linked eating more fruit and vegetables with healthier livers. A 2026 Finnish study found no link between fructose from fruit and berries and fatty liver. A Dutch study found the opposite for fruit juice and sweetened drinks: more of those went with more fat in the liver.
His order of concern, in plain words
Most worth cutting back: fizzy and energy drinks, sweetened teas, packaged snacks, sauces and flavoured yoghurts. Next comes fruit juice, even the 100% kind, because juicing removes the fibre and you drink several oranges in a few gulps. Honey, maple syrup and table sugar sit in the middle, fine in small amounts within a mostly whole-food diet. Whole fruit is the reassuring one, berries especially.
What this means for all of us
Dr Trivedi's closing line is "Change the source and you change the signal." Same sugar, different package, different effect on the body.
So keep the fruit bowl. Eat the orange instead of drinking it. And have a look at what you sip through the day, because that is where most of the fructose hides.
This is how I cook and eat already, and it's the thinking behind every MKD recipe: whole foods, with their fibre left in. I have berries with yoghurt and nuts most mornings, and I'm not giving them up.
Source: Hirsh D. Trivedi, MD, MS, "Fructose and the Liver: Why the Source Matters More Than the Sugar", Inherited Risk (Substack), 30 September 2026. https://inheritedrisk.substack.com/p/fructose-and-the-liver-why-the-source
Studies cited in his article: Saarinen RH et al., The Journal of Nutrition, 2026 (Kuopio Ischaemic Heart Disease Risk Factor Study, Finland); Buziau AM et al., Diabetes Care, 2022 (the Maastricht Study); Wang Y et al., Frontiers in Nutrition, 2024 (meta-analysis of fruit and vegetable intake).
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