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What did the study find?
Dai and colleagues reported that sugar-rich food intake during antibiotic exposure was associated with lower gut-microbe diversity and greater expansion of Enterococcus faecium in adults undergoing allogeneic hematopoietic cell transplantation (allo-HCT). The paper, published in Nature on 30 September 2026, also reported mouse experiments in which sucrose increased and prolonged antibiotic-related Enterococcus expansion.
These are findings about the gut microbiome, not evidence that reducing sugar prevents infections, diarrhea, or other complications, or improves survival.
Who was studied, and how?
The human cohort consisted of adults treated at Memorial Sloan Kettering Cancer Center in New York between 2017 and 2022. Researchers tracked 9,419 meals eaten by 173 hospitalized transplant patients. For the longitudinal microbiome analysis, they used 1,009 stool samples from 158 patients who had paired samples.
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The diet analysis in patients was observational: it identified associations between reported intake, antibiotic exposure, and microbiome measurements rather than testing a prescribed low-sugar diet. The researchers separately tested sucrose supplementation in mice. The PubMed record provides the study’s bibliographic details.
How should the numerical results be read?
The study reports model estimates, not guaranteed changes for an individual. In its analysis of sweets after broad-spectrum antibiotic exposure, each additional 100 g of sweets intake was associated with a model-predicted additional 24.1% decrease in mean alpha diversity compared with samples without previous antibiotic exposure (95% credible interval 7.7–38.1%). Alpha diversity describes the variety of microbes within a sample.
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A separate macronutrient analysis estimated a further 20.6% mean decrease in alpha diversity per 100 g of sugar for the antibiotic-by-sugar interaction (95% credible interval 2–35.6%). These are distinct analyses; neither establishes a daily sugar limit or predicts the effect of a specific meal on one person.
For E. faecium, the researchers estimated a 0.89-unit increase in centered log-ratio-transformed abundance per additional 100 g of sweets after antibiotic exposure, relative to samples without previous antibiotic exposure (95% credible interval 0.22–1.58). A centered log-ratio value is a transformed measure of relative abundance, not a count of bacteria or a clinical risk score.
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Does this apply to everyone taking antibiotics?
That remains unproven. The human participants were receiving intensive allo-HCT treatment in hospital, not taking ordinary antibiotic courses as a representative sample of the general population. Memorial Sloan Kettering’s summary of the study notes that the finding has not been definitively demonstrated in otherwise healthy people taking antibiotics.
The authors also describe possible confounding factors, including why clinicians started broad-spectrum antibiotics, and incomplete records of food consumed outside the hospital. Because the patient evidence is observational, these factors limit what can be concluded about cause and effect.
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Should you change what you eat during a course of antibiotics?
The study does not provide a sugar threshold or prove that dietary changes produce a clinical benefit. For a generally healthy person taking a routine course, it is not enough evidence to treat sugar restriction as a way to prevent antibiotic complications.
Nutrition needs can be different during cancer or transplant treatment. Poor appetite, mouth sores, nausea, weight loss, and increased calorie needs can make fluids and calorie-containing nutrition support important. Jonathan “Tsoni” Peled, a bone marrow transplant specialist at MSK, said patients who are unwell or eating little are often advised to use smoothies, sports drinks, or nutrition shakes to get fluids, protein, and electrolytes.
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If you are receiving transplant or oncology care, ask your clinical team before changing your diet or stopping a recommended nutrition drink. When choosing foods, consider not just sugar content but also whether the choice meets your nutritional needs and fits your treatment plan; the study did not establish that any particular snack prevents microbiome disruption.
What evidence is still needed?
The authors say, “In the context of HCT, prospective trials are needed to test whether corresponding dietary modulation improves clinical outcomes.” Such trials would help determine whether changing sugar intake affects outcomes that matter to patients, beyond measured microbiome changes.
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