Does Breastfeeding Help Lower LDL Cholesterol?
Yes, breastfeeding (lactation) significantly improves the mother's lipid profile by lowering LDL cholesterol levels, particularly when continued for at least 3 months, with the most pronounced benefits occurring at 12 months postpartum.
Evidence for Maternal LDL Reduction During Lactation
Lactation for ≥3 months improves maternal LDL cholesterol compared to no lactation or short-duration breastfeeding, with a 3-year study demonstrating that women who did not lactate had LDL-C increases of +6.7 mg/dL, while those who breastfed for ≥3 months had LDL-C decreases of -0.8 mg/dL 1. This translates to a 14-21% reduction in coronary heart disease risk for women who breastfeed for at least 3 months 1.
The lipid-lowering effect follows a dose-response pattern:
During active lactation (2-6 months): Total cholesterol decreases by an average of 1.35 mmol/L (approximately 52 mg/dL) from delivery levels, with LDL cholesterol, VLDL cholesterol, triglycerides, and apolipoprotein B all declining significantly during this period 2.
At 12 months of continuous breastfeeding: Women actively breastfeeding show higher HDL-C (41.74 mg/dL vs. 35.11 mg/dL), lower triglycerides (80.45 mg/dL vs. 119.11 mg/dL), and lower VLDL-C (16.31 mg/dL vs. 23.09 mg/dL) compared to women who breastfed for <6 months 3.
After cessation of lactation: Cholesterol levels rapidly rebound within 2 months of stopping breastfeeding, rising from 4.8 mmol/L during lactation back to 5.7 mmol/L post-weaning 2.
Long-Term Cardiovascular Benefits
The cardiovascular benefits extend well beyond the immediate postpartum period. A systematic review and meta-analysis of over 1.19 million parous women found that breastfeeding is associated with an 11% reduced risk of overall cardiovascular disease, 14% lower risk of coronary heart disease, 12% reduced risk of stroke, and 17% reduced risk of fatal cardiovascular disease 1.
Long-term follow-up studies demonstrate that subjects who were breastfed as infants have sustained cardiovascular health benefits in adulthood, including lower cholesterol levels, lower BMI, reduced prevalence of type 2 diabetes, and lower carotid intima-media thickness 1.
Mechanism and Duration Considerations
The lipid-lowering effect appears related to the metabolic demands of milk production, which requires approximately 670 kcal/day and mobilizes maternal fat stores 4. Each additional month of breastfeeding duration is significantly and inversely associated with triglycerides and VLDL-C, and positively associated with HDL-C 3.
The threshold for meaningful cardiovascular benefit appears to be at least 3 months of lactation, with optimal benefits occurring at 6-12 months of exclusive or predominant breastfeeding 1. Women who breastfeed for <2 months show significantly higher rates of excess body weight and adverse metabolic profiles compared to those who breastfeed for ≥6 months 1.
Clinical Implications
For women with elevated LDL cholesterol or cardiovascular risk factors, breastfeeding should be strongly encouraged as a non-pharmacologic intervention to improve lipid profiles 1. However, it is critical to note that statins must be discontinued during breastfeeding, as they are contraindicated during the lactation period 1, 5.
The American Heart Association and American Academy of Pediatrics recommend exclusive breastfeeding for the first 6 months of life, with continued breastfeeding to at least 12 months with the addition of complementary foods 1. This recommendation aligns with both infant health benefits and maternal cardiovascular risk reduction 1.
Important Caveats
While breastfeeding improves maternal lipid profiles during lactation, the effect is temporary and reverses rapidly after weaning 2. Therefore, breastfeeding should be viewed as one component of comprehensive cardiovascular risk reduction, not as a replacement for other evidence-based interventions such as dietary modification, physical activity, and appropriate pharmacotherapy when indicated 1.
For women with diabetes or gestational diabetes, breastfeeding provides additional metabolic benefits, reducing the risk of developing type 2 diabetes by 32% (OR 0.68) 1. These women should receive specific counseling about maintaining adequate nutrition (minimum 1,800 kcal/day) and monitoring for hypoglycemia during nursing sessions 1, 6.