Antibiotics Missing gut microbes after antibiotics may be to blame for ‘sorbitol intolerance’ (Feb 2024, mice) High fat intake sustains sorbitol intolerance after antibiotic-mediated Clostridia depletion from the gut microbiota

Michael Harrop

Active member
Jul 6, 2023


  • Low fecal SDH is a potential biomarker for sorbitol intolerance
  • High fat intake after antibiotics impairs microbiota recovery to lower fecal SDH level
  • Abundant sorbitol-consuming probiotics deplete sorbitol to protect against intolerance
  • Activating epithelial mitochondria promotes microbiota recovery to rise fecal SDH levels


Carbohydrate intolerance, commonly linked to the consumption of lactose, fructose, or sorbitol, affects up to 30% of the population in high-income countries. Although sorbitol intolerance is attributed to malabsorption, the underlying mechanism remains unresolved.

Here, we show that a history of antibiotic exposure combined with high fat intake triggered long-lasting sorbitol intolerance in mice by reducing Clostridia abundance, which impaired microbial sorbitol catabolism. The restoration of sorbitol catabolism by inoculation with probiotic Escherichia coli protected mice against sorbitol intolerance but did not restore Clostridia abundance.

Inoculation with the butyrate producer Anaerostipes caccae restored a normal Clostridia abundance, which protected mice against sorbitol-induced diarrhea even when the probiotic was cleared. Butyrate restored Clostridia abundance by stimulating epithelial peroxisome proliferator-activated receptor-gamma (PPAR-γ) signaling to restore epithelial hypoxia in the colon.

Collectively, these mechanistic insights identify microbial sorbitol catabolism as a potential target for approaches for the diagnosis, treatment, and prevention of sorbitol intolerance.

Sorbitol, a sugar alcohol, is used in sugar-free gum, mints, candy and other products. It is also found naturally in apricots, apples, pears, avocadoes and other foods. At high levels, sorbitol can cause bloating, cramps and diarrhea. For some people, even a small amount causes digestive upset, a condition known as sorbitol intolerance.
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