Sugar, sugar

The behemothic bag of Halloween candy my kids have acquired over the last few days of trick-or-treating has been inducing some serious salivation and requiring my family and I to exercise some serious self-control. 

Our ancient bodies can’t help but gravitate toward this once-limited form of energy— sugar. 

In the spirit of Halloween and Dia de los Muertos, where sweet treats abound, let’s explore a few sugary-concepts as they relate to infant feeding.  

Sugar Replacements 

The obesity epidemic in the United States and other countries has increased the use of artificial sweeteners. Philip O. Anderson’s How Sweet It Is: Sweeteners in Breast Milk summarizes current knowledge regarding the transmission of sweeteners into human milk. 

Dr. Anne Eglash of the Milk Mob points out in her Clinical Question of the Week

Photo by Dane Deaner on Unsplash

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.

Human milk sugars and the microbiome 

Vanderbilt University assistant professor of chemistry Steven Townsend and colleagues’ work, Sugars in Breast Milk Help Babies Ward Off Infection, shows that the complex sugars (called human milk oligosaccharides or HMOs)  in human milk appear to provide a growth advantage for good bacteria. 

Townsend notes, “…breastfed infants have a microbiome rich in two species of bacteria: Bacteroides and Bifidobacteria. Both species are symbiotes, meaning they live with us on a daily basis, but typically cause no harm. They live in the human gut where they use human milk oligosaccharides as energy sources to grow, whereas pathogens do not.” 

Moreover, their work demonstrates that HMOs prevent the growth of Group B strep and have antibiotic properties against a number of additional pathogens, including staph.

Interestingly, Townsend and colleagues found that different women produce HMOs with varying levels of antibiotic activity.

Low carb diet and lactation 

Similar to the increase in alternative sweeteners, varying diets that limit sugar intake have become particularly popular. 

“The ketogenic diet is a weight loss strategy involving a diet that is high in fat, adequate in protein, and very low in carbohydrates,” Dr. Eglash explains in another Clinical Question of the Week. “By eating low carbs, the body is forced to break down body fat for energy, causing a rise in blood and urinary ketones.” 

When blood ketones become too high, blood pH becomes too low, resulting in a sometimes life-threatening condition called ketoacidosis. 

While an average non-lactating individual on a keto diet probably wouldn’t reach a high enough level of blood ketones to become dangerous, lactating women are at a higher risk for ketoacidosis because of the energy expenditure required by lactation, Dr. Eglash continues. 

She concludes: “Based on the cases in the literature, it would seem wise to advise breastfeeding mothers to avoid a strict low carb diet, particularly in situations of very high energy demand, such as if she is exercising heavily, donating extra milk, or nursing multiples.” 

Candy and formula companies 

Avoiding or limiting sugar intake in today’s world is quite a challenge, and so is being an ethical consumer. 

If you do succumb to that Stone Aged craving or simply like to indulge in velvety-chocolate decadence, you might like to know that many candy companies are owned by formula companies that don’t have maternal child health in their interest. 

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