The #1 Sweetener To Avoid if You Have Fatty Liver Disease, According to Gastroenterologists

When it comes to gut health, we typically focus only on how our stomach feels. But as gastroenterologist Dr. Treta Purohit, MD, says, there's more to the story.

"Your digestive system is a complex, interconnected ecosystem, not just a tube that food passes through," states Purohit, who's also the medical director at Oshi Health. "Your liver, your gut and the trillions of bacteria living in your intestines are all in constant communication."

A food or drink loaded with added sugar sends the wrong message, even if your taste buds may disagree. "It affects your gut bacteria, your blood sugar and, importantly, your liver," Dr. Purohit explains. "Most people do not realize that the liver is responsible for processing much of what you consume."

Over time, certain sweeteners can alter the balance of bacteria in your gut, increase inflammation and contribute to fat buildup in your liver, all of which can contribute to long-term health concerns. One of these concerns is fatty liver disease, which is not just an issue for people who drink excessively.

"Broadly, fatty liver disease is when you have an increased amount of fat in your liver," reports Dr. Adam Pont, MD, a board-certified gastroenterologist with Medical Offices of Manhattan and a labfinder.com contributor. "Generally, this is caused either by excess alcohol consumption or general metabolic causes such as obesity, or elevated blood sugar, such as in diabetes or high cholesterol."

When you minimize or avoid certain sweeteners, you can lower your risk of fatty liver disease or manage the condition better if you're living with it. Unfortunately, some sweeteners that can worsen or contribute to fatty liver disease are seemingly ubiquitous. Gastroenterologists help us play detective by sharing the number one sweetener to avoid if you have fatty liver disease or want to lower your risk. They also share ways to liven up your meals, snacks and drinks that your taste buds and liver will love.

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The One Sweetener To Avoid if You Have Fatty Liver Disease, Gastroenterologists Say

Gastroenterologists warn that consuming too much high-fructose corn syrup can contribute to worsening fatty liver disease. It can also put people at greater risk for metabolic syndrome, including obesity, type 2 diabetes and Metabolically Active Steatotic Liver Disease (MASLD).

One gastroenterologist warns that high intake of high-fructose corn syrup can increase your chances of developing MASH (metabolic dysfunction-associated steatohepatitis).

"MASH is an aggressive form of MASLD with significant liver inflammation, which can lead to damage and scarring of the liver," states Dr. Lee F. Peng, MD, Ph.D, the chief of gastroenterology and hepatology at Hackensack Meridian Jersey Shore University Medical Center. "Over time, the liver scarring can become severe and irreversible, a state known as cirrhosis, which can predispose patients to liver failure and liver cancer."

A 2020 study of mice in Nature Metabolism suggested that high-fructose intake could damage the intestinal barrier and increase the risk of liver disease.

That's a problem, especially when you consider that high fructose corn syrup is hidden in plain sight on tons of ingredient labels. "High-fructose corn syrup (HFCS) is one of the most widely used sweeteners in the American food supply," Dr. Purohit warns. "You'll find it in sodas, flavored yogurts, salad dressings, bread, cereal, condiments and countless packaged foods-practically everything."

Dr. Purohit shares that the liver processes HFCS differently than other sugars.

"Unlike glucose, which your entire body can use for energy, fructose is processed almost exclusively by the liver," Dr. Purohit explains. "That means when you consume a lot of it, especially in liquid form, like soda or sweetened juice, your liver gets hit with a heavy load all at once."

She says that when the liver is flooded with more fructose than it can manage, it begins to convert it into fat, explaining, "Over time, this contributes directly to the fat buildup that defines fatty liver disease."

That said, Dr. Pont emphasizes that we still need more human studies to determine precisely how harmful high-fructose corn syrup is, especially in people with liver disease (or at a greater risk of it).

"Despite the prevalence of HFCS in the food supply and good data linking HFCS consumption to obesity and diabetes, there is remarkably little human data showing how HFCS affects the liver, either in people with or without fatty liver disease," he says.

The authors of a 2025 review on the subject agreed, finding only one study that met their criteria and calling for more research.

Related: What Happens When Your Liver Enzymes Are Too High?

Other Ways High-Fructose Corn Syrup Can Harm Your Gut Health

Beyond directly contributing to worsening liver disease, gastroenterologists say that high-fructose corn syrup poses other health risks, including insulin resistance.

"Our body needs insulin to help balance and manage the energy load," says Dr. Rucha Shah, MD, a gastroenterologist and hepatologist at HonorHealth. "But when the insulin levels are triggered to such a high degree, the body develops a mechanism by which it no longer responds to insulin, triggering an insulin resistance pathway where the cells no longer use the fat and go into storage mode."

Chronic insulin resistance can trigger prediabetes and Type 2 diabetes. It can also increase the risk of liver disease. Dr. Purohit warns that HFCS can also disrupt the balance of bacteria in your gut.

"A disrupted gut microbiome has been associated with fatty liver disease progression, creating a vicious cycle where the sweetener harms both the gut and the liver, and the damage to one makes the other worse," Dr. Shah says.

Related: The ‘Healthy' Drink That's Silently Damaging Your Liver, According to Hepatologists

Other Sweeteners To Avoid for Better Liver and Overall Health

High fructose corn syrup isn't the only sweetener to avoid if you want to protect your liver and overall health. "Artificial sweetener, such as aspartame, can also have a similar effect when it comes to metabolism and insulin resistance," Dr. Shah says.

Research is mixed, with some studies finding no link between aspartame and insulin resistance. But other studies suggest a potential association between aspartame and liver cancer.

Dr. Purohit also warns against added sugar in general. "HFCS gets the spotlight, but it's not the only sugar that can overload your liver," she says. "Table sugar (sucrose), agave nectar and any added sweetener in excess can contribute to fat buildup."

She reveals that one of the best steps you can take for your liver health is to lower added sugar in your diet. "Sugary beverages are particularly risky because they deliver a concentrated dose of sugar with no fiber to slow absorption."

Related: 2 Supplements You Should Never Take if You Want To Protect Your Liver, According to Hepatologists

Liver-Friendly Ways To Sweeten Food and Drinks

Dr. Purohit says you don't have to deny your sweet tooth any satisfaction.

But you do want to be smarter about where it comes from. "Fresh or frozen fruit is the easiest swap," she tells Parade. "Adding sliced berries, banana or mango to oatmeal, yogurt or cereal gives you natural sweetness along with fiber, vitamins and antioxidants."

She shares that the fiber in whole fruit slows sugar absorption, so you don't get hit with a sugar overload, unlike when you consume sweetened drinks and processed foods.

Dr. Purohit adds that other fun add-ins include:

• Cinnamon
• Vanilla
• Nutmeg
• A small amount of pure maple syrup
• A small amount of raw honey
• Dates

Not feeling fancy? Your local grocery or convenience store may have some liver-approved options.

"Consume beverages, such as water, sparkling water, unsweetened tea or unsweetened coffee, that don't have added sugar," Dr. Peng says.

Up Next:

Related: The Cooking Oil To Avoid if You Have Fatty Liver Disease, According to Gastroenterologists

Sources:

• Dr. Treta Purohit, MD, a gastroenterologist and the medical director at Oshi Health
• Dr. Adam Pont, MD, a board-certified gastroenterologist with Medical Offices of Manhattan and a labfinder.com contributor
• Dr. Lee F. Peng, MD, Ph.D, the chief of gastroenterology and hepatology at Hackensack Meridian Jersey Shore University Medical Center
• Dr. Rucha Shah, MD, a gastroenterologist and hepatologist at HonorHealth
• Fructose stimulated de novo lipogenesis is promoted by inflammation. Nature Metabolism.
• The impact of high fructose corn syrup on liver injury and glucose metabolism: a systematic review. Frontiers in Nutrition.
• Excessive Intake of High-Fructose Corn Syrup Drinks Induces Impaired Glucose Tolerance. Biomedicines.
• Effects of high fructose corn syrup on intestinal microbiota structure and obesity in mice. Nature.
• The Effects of Aspartame on Glucose, Insulin, and Appetite-Regulating Hormone Responses in Humans: Systematic Review and Meta-Analyses. Advances in Nutrition.
• Aspartame increases the risk of liver cancer through CASP1 protein: A comprehensive network analysis insights. Ecotoxicology and Environmental Safety.

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This story was originally published May 6, 2026 at 6:25 AM.