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A 2026 study found that, among adults hospitalized for allogeneic hematopoietic cell transplantation (allo-HCT), higher intake of sweets and sugar during antibiotic treatment was associated with greater disruption to the gut microbiome. Mouse experiments supported a possible link. But the study did not show that eating less sugar improves symptoms or other health outcomes, and it does not establish the same effect in otherwise healthy people taking routine antibiotics.
What did the study find?
Dai and colleagues reported that, in the allo-HCT patients they studied, sugar-rich intake during broad-spectrum antibiotic exposure was associated with lower gut microbial alpha diversity—a measure of the variety and relative balance of microbes in a sample—and greater expansion of Enterococcus. The paper was published in Nature on 30 September 2026.
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One model estimated an additional 24.1% decrease in mean alpha diversity per 100 g of sweets intake after broad-spectrum antibiotic exposure, compared with samples without previous antibiotic exposure. The 95% credible interval was 7.7–38.1%. In a separate analysis of the antibiotic-by-sugar interaction, the estimated further mean decrease was 20.6% per 100 g of sugar, with a 95% credible interval of 2–35.6%.
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These are model-based group estimates, not predictions that an individual will lose a particular amount of diversity after eating 100 g of sweets. In another analysis, each additional 100 g of sweets after antibiotic exposure was associated with a 0.89-unit increase in centered log-ratio-transformed Enterococcus faecium abundance relative to samples without previous antibiotic exposure; the 95% credible interval was 0.22–1.58.
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Who was studied, and how?
The researchers tracked 9,419 meals eaten by 173 people hospitalized for hematopoietic cell transplantation at Memorial Sloan Kettering Cancer Center in New York between 2017 and 2022. The longitudinal microbiome analysis used paired samples from 158 patients, drawing on 1,009 stool samples. The human dietary analysis was observational: it examined links between what patients ate, antibiotic exposure, and microbiome measurements rather than assigning patients to eat more or less sugar.
The authors also tested sucrose supplementation in mice. In those experiments, sucrose increased and prolonged antibiotic-induced Enterococcus expansion. This provides experimental support for a possible mechanism, but animal findings do not establish that changing diet will improve outcomes in people.
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Does this mean eating less sugar protects everyone taking antibiotics?
No. The human participants were adults receiving intensive allo-HCT treatment, not a representative sample of people taking antibiotics for common infections. Memorial Sloan Kettering notes that the finding has not been definitively established in otherwise healthy people taking antibiotics. The study also describes possible confounding related to why broad-spectrum antibiotics were started and incomplete records of food eaten outside the hospital.
The results concern microbiome measurements. They do not prove that reducing sugar prevents diarrhea or infection, shortens antibiotic treatment, or improves survival. The authors say, “In the context of HCT, prospective trials are needed to test whether corresponding dietary modulation improves clinical outcomes.”
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Should you change what you eat during treatment?
The paper suggests that avoiding a diet rich in simple sugars during antibiotics might reduce microbiome disruption, but it does not define a sugar limit or demonstrate a clinical benefit. It is not a basis for stopping prescribed antibiotics or making a blanket calorie restriction plan.
Nutrition needs can be especially important during cancer and transplant treatment, when poor appetite, nausea, mouth sores, weight loss, or higher calorie needs may make food and nutrition drinks part of care. Jonathan “Tsoni” Peled, a bone marrow transplant specialist and cellular therapist at Memorial Sloan Kettering, said patients who feel unwell or are not eating much are often advised to use smoothies, sports drinks, or nutrition shakes to get fluids, protein, and electrolytes. If you are receiving oncology or transplant care, ask your clinical team before changing a medically recommended nutrition plan.
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What the evidence does—and does not—support
- Supported: In adults hospitalized for allo-HCT, higher sweets or sugar intake during antibiotic exposure was associated with lower microbial diversity and more Enterococcus.
- Supported in mice: Sucrose increased and prolonged antibiotic-related Enterococcus expansion.
- Not established: That eating less sugar improves symptoms, prevents complications, or changes other clinical outcomes in people.
- Not established: That the association applies to otherwise healthy people taking routine antibiotic courses, or that a particular sugar threshold is safe or beneficial.
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