Sweeteners in Breastmilk
by Anne Eglash MD, IBCLC, FABM
The number of natural and artificial sweeteners is overwhelming. Avoiding them used to be as easy as avoiding diet sodas and diabetic candy. Now, they are added to several products that are considered ‘healthy’ such as sports drinks, low carb snacks, and low sugar dark chocolate bars. There have been concerns that they may alter metabolism and increase the risk of obesity and insulin resistance. So, if sweeteners can have these effects on the consumer, what about the infant who is consuming these products via breastmilk? In this week’s article, ‘How Sweet It Is: Sweeteners in Breast Milk’ Dr. Phillip Anderson summarizes our current knowledge regarding the transmission of sweeteners into breastmilk. We have some data on several sweeteners, but none so far on stevia and monkfruit.
Fructose in the maternal diet has caught the attention of researchers because intake of high fructose sweeteners such as high fructose corn syrup, honey, and agave syrup in the maternal diet increase fructose levels in breastmilk.
- Aspartame does not appear in breastmilk because it is broken down into 2 amino acids in the gut.
- Sorbitol in the maternal diet has been shown to cause diarrhea in the infant.
- Breastmilk fructose levels are associated with infant body weight and body composition at 6 months of age.
- There is evidence that increased sweetness of breastmilk increases an infant’s risk of increased sugar intake and obesity.
- The sweeteners acesulfame, saccharin, and sucralose are found in breastmilk after maternal ingestion, at variable levels considered safe.
See the Answer
The obesity epidemic in the United States and other countries has increased the use of artificial sweeteners. However, their effectiveness in reducing blood glucose and in promoting long-term weight loss as well as their safety in preventing obesity in children have been questioned because studies are inconsistent in their designs and findings. This column reviews the available information on the use of various sweeteners in nursing mothers. Additional references on specific sweeteners can be found in the corresponding LactMed records.
All of the sweeteners listed in this article can be found in the National Library of Medicine LactMed database.
The sugar alcohols, including sorbitol, mannitol and xylitol, can cause diarrhea when consumed, but so far we don’t have evidence that they are detectable in breastmilk. Aspartame levels are not present in breastmilk because it is broken down in the maternal gut into aspartic acid and phenylalanine, which are amino acids.
There is preliminary research evidence that a maternal diet high in fructose may increase body weight and fat mass in breastfed infants. When mothers consume foods or beverages high in fructose, the level of fructose rises in breastmilk. This is not true for glucose, because maternal insulin rapidly normalizes the maternal glucose level after glucose ingestion. Insulin does not moderate the fructose level like it does for glucose.
And increasing sweetness of breastmilk via artificial or natural sweeteners in the maternal diet might predispose to later obesity. This may be partially mediated by an alteration in the gut microbiome by the sweeteners.
Perhaps it is time to increase awareness of maternal sweetener intake, especially regarding fructose sweeteners, in order to lower the risk of childhood obesity.
Ñora Klein says
Useful info. Best bet is to stick to simple fresh foods.
Kathryn Peris says
I disagree with the wording of the answer D:
There is evidence that increased sweetness of breastmilk increases an infant’s risk of increased sugar intake and obesity.
While we know that breastmilk tastes sweet naturally, it alone does NOT predispose an infant to obesity in later life. Maternal consumption of foods containing high levels of sugars, especially artificial ones, can produce milk higher in glucose in the breastmilk. Hopefully, as you mentioned, this dietary indiscretion on the mother’s part may be mediated by altering the gut microbiome.
Stating it the way you did may lead someone to believe that breastfeeding produces obese babies, when the opposite is true in reality.
Anne Eglash says
I agree, this could have been worded with greater clarity. There is evidence that increasing the sweetness of breastmilk by maternal ingestion of various sweeteners is associated with increased infant weight. The reference for this is Araujo JR, Martel F, Keating E. Exposure to non-nutritive
sweeteners during pregnancy and lactation: Impact in programming of metabolic diseases in the progeny later in life.
Reprod Toxicol 2014;49C:196–201.
LactMed, a database supported by the National Library of Medicine, is an excellent source of information regarding drugs and chemicals that may have possible adverse effects for nursing infants. Because human data for rebaudioside A and acesulfame-potassium are not available, LactMed states that the risk to the breastfed infant appears to be low, but an alternate artificial sweetener with more data available may be preferred. Aspartame is described as not detectable in breast milk, yet mothers are encouraged to be prudent in avoiding aspartame when nursing an infant with phenylketonuria due to its metabolism into aspartic acid and phenylalanine. Sucralose is reportedly poorly absorbed after oral ingestion ( Schiffman and Rother, 2013 ) and thus not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Only saccharin levels after ingestion of a saccharin-containing beverage were previously measured in human breast milk ( Egan et al., 1984 ). Since NNS consumption is common and may be used for maternal postpartum weight loss, and because data on NNS in breast milk are not available or sparse, the aim of this study was to determine the presence and concentrations of sucralose, acesulfame-potassium, and saccharin and confirm the absence of aspartame in human breast milk.