Patients with hepatitis C often want to know what to eat, what to avoid, and how to be healthier. I am frequently asked, “Is sugar bad for the liver? What about stevia or agave? Is honey good for the liver?” I’ll try my best to answer these frequently asked questions.

Since hepatitis C is a liver disease, I’ll start with some basic physiology and an explanation of the effects of sugar on the liver. The liver is the body’s chief industrial plant, and everything goes through it — whether you eat it, drink it, inhale it, or put it on your skin.

The Liver: Chief Metabolizer

One of the liver’s biggest jobs is to help us digest and metabolize what we eat. The liver processes fats, proteins, and carbohydrates, turning these into energy and other necessary components to keep us alive. Our energy levels rely on the liver’s ability to do its job.

Our primary source of energy comes from glucose. The liver acts as the body’s glucose fuel tank and regulator, and helps to keep our circulating blood sugar steady and constant. The liver both stores and manufactures glucose depending upon the body’s need.

The liver doesn’t do this completely on its own — it relies on insulin to guide it. After eating, blood glucose levels rise, which in people without diabetes triggers the pancreas to release insulin into the blood. Insulin signals the body to absorb glucose from the blood, which cells use for energy.

When levels of glucose and insulin are high in the blood, the liver absorbs glucose and stores it as glycogen. The liver is like a warehouse for excess glucose. The liver dispenses this when we need it. In people with diabetes, the liver doesn’t process and produce glucose normally.

The Liver and Sugar

Sugar is a simple carbohydrate; it is composed of two molecules — glucose and fructose. Glucose can be metabolized by every cell in the body and if we don’t get it from the diet, our bodies make it. Glucose is essential to life.

Fructose is different. The liver is the only organ that can metabolize sugar. If your liver has stored all the glycogen it needs, the fructose will be turned into fat. This fat can be redirected as blood triglycerides, but most will be stored in the liver and may cause fatty liver disease.

If you have hepatitis C, your liver is already working hard, so it won’t like any additional work. Add in fatty liver disease and you have a formula for disaster.

What about Agave, Honey and Stevia?

I love honey, so I’ve looked for any medical reason to use it. Unfortunately, honey is still sugar. The body doesn’t like it any more than table sugar. However, since honey is sweeter than sugar, one may be able to use less, and in that way, it is slightly better. The same is true for agave. However, from the liver’s standpoint, it is better to skip these altogether.

As for stevia, I don’t know what to tell you. The Food and Drug Administration (FDA) declared stevia as "generally recognized as safe" (GRAS). What disturbs me about stevia is that the products we get commercially have been processed. It isn’t like we are in Paraguay sucking on stevia plants. I avoid stevia because I don’t like eating processed food. I want my liver to get real food. It’s my bottom line.

We all have our own bottom lines, and you have to decide what yours are. Avoiding added sugar or at least limiting added sugar is a good bottom line if you can do it. Fruit has natural sweetness and can satisfy a longing for sweets. Try adding cinnamon, ginger, or vanilla for a sweet flavor.

For years, I blamed my fatigue on hepatitis C, but after I eliminated sugar, I noticed my energy levels were higher. On the rare occasions I eat sugar, I feel exhausted after. I missed it at first, but not anymore. Feeling good tastes better than sugar ever did.

Click here to watch an excellent, short video explanation of how the liver metabolizes sugar.