Use of Expressed Breast Milk With the Ketogenic Diet

Breastfeeding continues to be the recommended mode of infant feeding with numerous nutritive and nonnutritive benefits to both mothers and babies. The ketogenic diet (KD) is a high-fat, adequate protein, and very low carbohydrate diet prescribed for infants and children with treatment-resistant epilepsy. Due to the high carbohydrate content of breast milk (BM) and the extremely low carbohydrate allowance of the KD, these 2 modes of feeding are typically not used together. We report our experience to demonstrate that BM can be part of a successful KD treatment. A retrospective chart review was performed and 4 patients met criteria. They were younger than 2 years and were fed BM before KD initiation. All achieved ketosis at low (2-3:1) ratios and remained ketotic while using BM. The average amount of BM consumed was 139 ± 50 mL/day, equivalent to 11 ± 4.5 grams of carbohydrates per day. Three patients achieved >50% reduction in seizure frequency within 2 months of treatment. Patients continued using BM for an average of 105 ± 50 days. For all cases, BM was discontinued due to maternal preference. BM is a viable, preferred, carbohydrate source for infants prescribed the KD.