High fat intake sustains sorbitol intolerance after antibiotic-mediated Clostridia depletion from the gut microbiota

Cell. 2024 Feb 29;187(5):1191-1205.e15. doi: 10.1016/j.cell.2024.01.029. Epub 2024 Feb 15.


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.

Keywords: Clostridia; antibiotics; carbohydrate intolerance; gut microbiota; high-fat diet; polyol; sorbitol intolerance.

MeSH terms

  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Butyrates
  • Carbohydrate Metabolism, Inborn Errors*
  • Clostridium
  • Escherichia coli
  • Gastrointestinal Microbiome*
  • Mice
  • Sorbitol* / metabolism


  • Anti-Bacterial Agents
  • Butyrates
  • Sorbitol