Quotes from this post:
Withholding added sugar from a fetus or child still seems like a bit of a radical idea…
Three hundred years ago sugar was an expensive luxury…
…a comparison of two groups, one of which was exposed to a real life condition, in this case sugar rationing…
American parents and caregivers have no way to know that they are usually giving their babies primarily refined sugar and not natural lactose.
During gestation, sugars the mother consumes are available to the fetus through the placenta and have a “secondhand sugar effect.”
Take a folic acid supplement if you are trying to get pregnant; don’t drink, smoke, or take drugs during pregnancy; hold and love your baby and use breast milk if available. Talk to your infant a lot. These we know.
New evidence about the health effects of sugar in the first 1,000 days
With the appearance of a new study, the evidence is now very strong for another recommendation that should be on the list already but is not always expressed by an obstetrician, pediatrician, or other relied on sources of pre- or neonatal information. It should be a must-add: don’t feed your fetus, baby, infant, or toddler added sugar.
Withholding added sugar from a fetus or child still seems like a bit of a radical idea today, even as we have established the role of refined sugar as a cause of obesity, but there was a time it wasn’t a choice.
George Washington did okay without sugar
Three hundred years ago sugar was an expensive luxury for the tea cups of the rich. Few kids or adults had much opportunity to enjoy it. The neural pathways of fetuses and babies were not re-shaped by exposure to sugar, because there were very few houses with a sugar bowl on the table and none with highly-processed food in the pantry.
That changed during the course of George Washington’s lifetime. Born in 1732, our first President likely ate little sugar as a child. That deprivation didn’t stop him from growing exceptionally tall, very athletic, and into a great leader. But by the 1800s and its industrial innovations in processing, sugar had transformed into a commodity, produced cheaply in massive quantities by enslaved labor on plantations in Haiti, Cuba, Mississippi, Louisiana, Brazil, and Java. Sugar had become part of most people’s diets. Today the pleasure, acceptance, and assumption of refined sugar in the diet is engrained in parents, great-grandparents, obstetricians, pediatricians, politicians, and, unfortunately, nutritionists and public health scientists, including me, around the globe. What’s a baby to do?
The evidence brought forward by several papers in the last few years provides compelling reasons for us grownups to do more.
Here’s the clever way this evidence has come together.
War time rationing in the UK: babies who had sugar and babies who didn’t
From the wartime rationing of 1942 all the way until 1953 each person in the United Kingdom, rich or poor, received about 1 cup of sugar a week and 3 ounces of sweets. Children two and under received no ration. Sugar rationing ended throughout the UK on one day in September 1953, and families could suddenly buy as much sugar as they wanted, and they immediately bought a lot.
The UK Biobank has medical and biological data for a half-million people. A large number of these spent their first 1,000 days of development just before, just after, or right through the abrupt end of sugar rationing. Those 1,000 days from conception through the second birthday are a critical period for child development. What happens in those first 1,000 days has been tied to obesity, cardiovascular disease, asthma, mental health, diabetes, and cancer.
A “natural experiment”
The way the Biobank data overlapped with the end of sugar rationing allowed our sugar researchers what is called a natural experiment, a comparison of two groups, one of which was exposed to a real life condition, in this case sugar rationing, and other not exposed.
Using the Biobank in this way was such a good idea that several groups did it, each analyzing a group of 60,000 to 65,000 people, the ones that bracketed the end of sugar rationing.
Evidence of disease from the data of people born as sugar rationing ended
First, Gracner and team found that those who spent their first 1,000 days with restricted sugar had better outcomes later in life for type 2 diabetes and high blood pressure.
Two more teams followed with a look at the data for cardiovascular outcomes, finding that heart failure, cardiovascular disease, myocardial infarction, atrial fibrillation, and stroke were all a greater risk for those whose sugar consumption had not been restricted in their first 1,000 days.
Cancer and sugar in the first 1,000 days
Next, researchers Chen Zhu and Weilong Zhang went back to the same Biobank data and asked if restricting sugar in the first 1,000 days could reduce the risk of cancer? They found that, yes indeed, restricting sugar from womb to 2 years old is very protective. The adults who started life before sugar rationing ended had a reduced chance of cancer for each cancer they looked at: 69% for liver, 40% for rectum, 41% for lung, 52% for prostate, and 36% less chance of breast cancer.
What can explain these good results? The authors found that five decades after birth, sugar-restricted people ate less sugar and less food, and their diets were healthier and more diverse. They also had reduced levels of chronic inflammation. They also found that the telomeres of these folks had aged 2.2 years less than the telomeres of the people who came on board life after sugar rationing stopped.
Longer chromosome “shoelaces” with less sugar
What are telomeres you might ask?
Telomeres are the bits at the ends of chromosomes that protect the genetic data when a cell divides. They’re like the plastic tips of a shoelace. The telomeres get shorter every time a cell divides. Eventually the telomere gets too short and the cell dies. Getting an extra 2.2 years of telomere life is a good thing, sort of like when you buy a tire that’s rated for an extra 10,000 miles. Except that tires can be replaced, and some cells, like brain cells, once they’re gone, they’re gone.
So, to recap, Zhu and Zhang found that restricting sugar during pregnancy up to the second birthday caused, and they use the word “cause”, a reduction in cancer, chronic inflammation, and cellular aging as those children turn into adults.
This, combined with reductions in diabetes, high blood pressure, heart disease and stroke, makes a convincing case for adding a recommendation to restrict, if not eliminate, sugar exposure in the first 1,000 days.
Lots of recommendations not to feed added sugar before age two
But wait, the American Heart Association recommended no added sugar for children under two in 2016, ten years ago! And the American Academy of Pediatrics followed suit in 2019! And the Dietary Guidelines for Americans said this in 2020!
Whew! I guess new moms and dads already know what to do when it comes to sugar.
Unfortunately, the FDA does not regulate the carbohydrate content of baby formula or require amounts or types of added sugars to be stated on the label. This is not the case in other parts of civilization or for adult food in America. If knowing added sugar content is helpful for adult nutritional health, surely it’s helpful to make sure infants are getting the best nutrition?
Why the FDA needs to act
The FDA’s lack of ingredient control and labeling matters a great deal. According to a study published last year, of the 73 infant formula products available in the U.S. across three major brands, one smaller brand, and some store brands, only a few have naturally occurring lactose as their primary carbohydrate. Lactose is a sugar designed by evolution for mammals at an early stage of life. Almost all of the carbohydrate in human milk is lactose. Natural lactose is bound to fats and proteins in the mother’s milk and is digested somewhat slowly.
Added refined lactose is an added sugar and acts like it
A little more than half the formula products in the U.S. use added lactose which is refined. Refined lactose is like other refined sugars and isn’t bound to the fat and protein in the formula. It absorbs into the baby’s blood fast, spiking blood sugar and then insulin in response. And lots of formula products use other refined sugars apart from lactose, like glucose, maltose, or sucrose, all with refined lactose’s fast absorption and insulin response.
American formula is primarily added sugar
With no FDA requirements to use primarily natural lactose and to provide details of the carbohydrate ingredients, American parents and caregivers have no way to know that they are usually giving their babies primarily refined sugar and not natural lactose. I could not tell the proportion of natural to refined lactose from reading any of the formula containers I checked.
The Wirecutter doesn’t get it
Parents are not getting the info. In June, the Wirecutter section in the New York Times rated the six best infant formulas on the market in the U.S., in their opinion. They claim to have read 20 scientific articles in their research, but five of the six papers they cited were published nine or more years ago. Their seven expert interviews were mostly from 2022 or before, and more than half were with formula makers, none of whose formula sales websites said anything about natural lactose versus refined.
In essence, The Wirecutter reported that the FDA had baby needs covered, and all U.S. sold formulas were good. Wirecutter completely missed both that there is an important difference between natural lactose and refined and that FDA-approved formulas contribute to later obesity, and are not adequate for normal growth as The Wirecutter claims, unless obesogenic is the new normal.
U.S. baby formula is obesogenic: it promotes obesity
A whole lot of education needs to happen, even for New York Times writers.
It’s good to remember that parents might use formula early in their baby’s life for reasons including low breast milk production, medical issues, lack of paid family leave, a need to get back to earning, or their baby is adopted.
Natural lactose is more costly than refined lactose, but if the potential health differences between natural and refined lactose were publicized, I would expect there would be a larger market for natural. If the FDA were to up-regulate the natural lactose content of formula, some consideration would be needed so that access for families with less income would not be limited.
Corn syrup is a prominent ingredient in formula
Natural lactose is the most costly carbohydrate to meet the requirements of formula. Corn syrup, corn syrup solids, and other refined sugars are widely used, replacing some or all of the lactose. These sugars are not only cheaper than both refined and natural lactose, they are sweeter. Babies on formula tend to drink more than babies who are breastfeeding. The reward of sweetness increases consumption of a food in adults and might be true in babies. Formula makers are ultraprocessed food makers, and ultraprocessed food makers generally are happy to sell more product by increasing consumption.
Does corn syrup sell more formula?
I am perhaps jaded by the global formula behemoth Nestlé’s completely unethical, infanticidal marketing that contributed to hundreds of thousands of child deaths over decades for children who were receiving formula when they should have been breastfed. To me, the level of evil of Nestlé in this marketing of formula was considerably worse than that of Perdue Pharmaceuticals in marketing deadly opioids. It was, after all, babies dying from drinking formula made with unclean water when breast milk was available.
So forgive me for wondering if adding cheap, very sweet sugars instead of lactose is seen as both a cost-saving and a revenue-increasing recipe by the American formula makers, some of whom have a business relationship to Nestlé.
Operation Stork Speed: putting on the brakes?
Soon after RFK, Jr. was confirmed as Secretary of Health and Human Services, the FDA announced Operation Stork Speed, an effort to review infant formula nutrients for the first time since 1998, and to increase testing for contaminated formula. The Request For Information period closed a year ago, but there has been no announcement yet of any conclusions or actions to improve the nutrition of formula.
There is a clear pattern of delays in major action in Trump’s HHS as the ultraprocessed food industry pulls strings to protect its interests. This delay in updating formula regulation cannot be for a lack of clear evidence of ways to improve formula. Forbidding corn syrup and similar sugars, like the Europeans do, would be a first step, along with labeling that details the amount and types of added sugars. These are low hanging fruit.
Is Big Formula involved in a delay of the first phase of re-regulation of U.S. formula?
A recent FDA press release says there will be a phased approach to nutrient review based on available evidence, but perhaps it neglected to say that enacting a plan might depend on the degree of resistance from the Big Formula lobby. In fact, while the release failed to announce progress on the review of nutrient content and labeling, it played up a focus on potential formula contaminants, an area in which the formula industry is cooperative.
European formula imported for quality
There was a shortage of formula in America in 2022 as bacterial infections caused factory closings for Similac and other Abbott brands making up 40% of the U.S. supply. To help ease the crisis, individuals were allowed to import European formula for personal use. Today, some people who can afford it, import European formula because it is organic or because it forbids corn syrup as an ingredient.
Lots of sources for added sugar in the first 1,000 days
But it is not just formula that can be a source of added sugar in the first 1,000 days. Snacks, baked goods, fruit-concentrates, flavored yogurt, fruit-flavored beverages, sweetened milk, and breakfast cereals are all sources of added sugars.
Mom’s added sugar is “secondhand sugar” for the baby
During gestation, sugars the mother consumes are available to the fetus through the placenta and have a “secondhand sugar effect.” The 1,000 day sugar-rationing studies found that sugar levels delivered in utero had a role similar to post-natal sugar consumption.
It has been 10 years since the American Heart Association told us no added sugar should be given in the first two years after birth, and six years since the Dietary Guidelines followed suit.
2025 Dietary Guidelines: no added sugar up to age 10. Radical?
And the new 2025 Dietary Guidelines for Americans recommend, rather radically, no added sugar up to age 10. Now it is time for the government to cut their teeth and start biting down on those recommendations.
Thank you for reading. You can support Eating In America in many ways, all of which are appreciated: being a free subscriber or a paid subscriber helping make possible the research and production expenses, sharing these podcasts and posts with your acquaintances, and liking and commenting as the mood moves you.
References
Zhu C, Zhang W. Early-life sugar restriction causally reduces adult cancer incidence and slows biological aging. Proc Natl Acad Sci U S A. 2026;123(32):e2610287123. doi:https://www.pnas.org/doi/abs/10.1073/pnas.2610287123
Xu A, Guerlich K, Koletzko B, Grote V. Nutrition interventions in the first 1000 days and long-term health outcomes: a systematic review.
Gracner T, Boone C, Gertler PJ. Exposure to sugar rationing in the first 1000 days of life protected against chronic disease. Science. 2024;386(6725):1043–1048. doi:https://www.science.org/doi/10.1126/science.adn5421
Zheng J, Zhou Z, Huang J, et al. Exposure to sugar rationing in first 1000 days after conception and long term cardiovascular outcomes: natural experiment study. bmj. 2025;391doi:http://dx.doi.org/10.1136/bmj-2024‑083890
Tang H, Zhang X, Huang J, et al. Sugar rationing during the first 1000 days of life and lifelong risk of heart failure. Nature Communications. 2026/01/21 2026;17(1):1894. doi:https://doi.org/10.1038/s41467-026-68713-9
Chadwick L. Telomeres. National Human Genome Research Institute, NIH. Updated August 29, 2026. https://www.genome.gov/genetics-glossary/Telomere
Vos MB, Kaar JL, Welsh JA, et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American
Rips-Goodwin AR, Jun D, Griebel-Thompson A, Kong KL, Fazzino TL. US infant formulas contain primarily added sugars: An analysis of infant formulas on the US market. Journal of Food Composition and Analysis. 2025/05/01/ 2025;141:107369. doi:https://doi.org/10.1016/j.jfca.2025.107369
Szalinski C. The Wirecutter: The Best Baby Formula. New York Times. June 12, 2026. https://www.nytimes.com/wirecutter/reviews/best-baby-formula/
Uwaezuoke SN, Eneh CI, Ndu IK. Relationship Between Exclusive Breastfeeding and Lower Risk of Childhood Obesity: A Narrative Review of Published Evidence. Clinical Medicine Insights: Pediatrics. 2017;11:1179556517690196. doi:https://journals.sagepub.com/doi/abs/10.1177/1179556517690196
Kong KL, Burgess B, Morris KS, et al. Association Between Added Sugars from Infant Formulas and Rapid Weight Gain in US Infants and Toddlers. The Journal of Nutrition. 2021/06/01/ 2021;151(6):1572–1580. doi:https://doi.org/10.1093/jn/nxab044
Anttila-Hughes J. Mortality From Nestlé’s Marketing Of Infant Formula In Low And Middle-Income Countries. 2018. 24452. https://www.nber.org/system/files/working_papers/w24452/w24452.pdf
HHS, FDA Announce Operation Stork Speed to Expand Options for Safe, Reliable, and Nutritious Infant Formula for American Families. U.S. Health and Human Services Department; March 18, 2025, 2025. https://www.fda.gov/news-events/press-announcements/hhs-fda-announce-operation-stork-speed-expand-options-safe-reliable-and-nutritious-infant-formula
Food and Drug Administration. Operation Stork Speed. U.S. Health and Human Services Department. Updated July 13, 2026. https://www.fda.gov/food/infant-formula-homepage/operation-stork-speed
Goran MI, Plows JF, Ventura EE. Effects of consuming sugars and alternative sweeteners during pregnancy on maternal and child health: evidence for a secondhand sugar effect. Proc Nutr Soc. Aug 2019;78(3):262–271. doi:https://doi.org/10.1017/s002966511800263x
