The human mammary gland is capable of de novo synthesis of glucose and galactose (hexoneogenesis); however, the carbon source is incompletely understood. In this study, we investigated the role of acetate, glutamine, lactate and glycerol as potential carbon sources for hexoneogenesis. Healthy breastfeeding women were studied following a 24-h fast on two occasions separated by 1-3 wk. Five women were infused with [U-13 C]lactate or [1,2-13 C2]glutamine and five women with [U-13 C]glycerol or [1,2-13 C2]acetate. Enrichments of 13 C in plasma and milk substrates were analyzed using GC-MS. Infusion of labeled lactate, glycerol, glutamine, and acetate resulted in plasma glucose being 22.0 Ϯ 3.7, 11.2 Ϯ 1.0, 2.5 Ϯ 0.5, and 1.3 Ϯ 0.2% labeled, respectively. Lactate, glutamine, or acetate did not contribute to milk glucose or galactose (0 -2%). In milk, 13 C-free glycerol enrichment was one-fourth that in plasma but free glycerol concentration in milk was fourfold higher than in plasma. Using [U-13 C]glycerol and by accounting for tracer dilution, glycerol alone contributed to 10 Ϯ 2 and 69 Ϯ 11% of the hexoneogenesis of milk glucose and galactose, respectively. During [U-13 C]glycerol infusion, the ratio of M3 enrichment on 4 -6 carbons/M3 on 1-3 carbons of galactose was higher (P Ͻ 0.05, 1.22 Ϯ 0.05) than those of glucose in plasma (1.05 Ϯ 0.03) and milk (1.07 Ϯ 0.02). Reanalysis of samples from a previous study involving [U-13 C]glucose infusion alone suggested labeling a portion of galactose consistent with pentose phosphate pathway (PPP) activity. We conclude that, although lactate contributed significantly to gluconeogenesis, glycerol alone provides the vast majority of substrate for hexoneogenesis. The relative contribution of the PPP vs. the reversal Embden-Meyerhof pathway to hexoneogenesis within the human mammary gland remains to be determined. galactose; lactose synthesis; gluconeogenesis; pentose phosphate pathway; stable isotopes GC-MS WE PREVIOUSLY DEMONSTRATED (26) that plasma glucose is the predominant but not the exclusive carbon source of milk lactose (80% during the fed state and 60% following 24 h of fasting). Thus, the mammary gland is capable of de novo synthesis of glucose and galactose, a process we termed hexoneogenesis. During feeding, hexoneogenesis contributes 20% of the carbon in lactose (10 and 30% of glucose and galactose, respectively) (20,26,27). Over a 14-to 42-h fast, hexoneogenesis increases to account for ϳ40% of lactose production (ϳ30% of glucose and ϳ50% of galactose) (18,20,21,26,27). However, the precursor carbon source for hexoneogenesis remains largely unknown.We hypothesize that those traditional gluconeogenic substrates for hepatic glucose production will also serve as precursors for hexoneogenesis. Lactate, a predominant gluconeogenic precursor in humans, accounts for 50 -70% of the total gluconeogenic flux in normal humans (3,12). Another significant precursor of glucose synthesis (particularly in the kidney) is glutamine, which together with glutamic acid are the most ab...