And now we wean

Dr. Nora taking my blood pressure. I strongly encourage this game.

Dr. Nora taking my blood pressure. I strongly encourage this game.

It is a big week in Nora’s world, although I’m sure it seems bigger to us than to her.

Yesterday we went to Portland to see Dr. Wray for her ketoclinic checkup. Tomorrow will be her 2-year seizure-free anniversary. It is a big milestone. The rule of thumb in pediatric neurology is to get 2 years seizure free, any way that works, drugs or diet. If you can do that, there is a 60% chance that the child can come off treatment and never have another seizure again.

That doesn’t seem like great odds to me, but that’s the one-time all-comers study. Every epilepsy, every treatment. There is some indication that idiopathic childhood epilepsy (unknown origin) like Nora’s has a better chance because it may be due to some sensitive window in brain development. If her brain can grow and develop past the window without seizures, it is likely that she is past the problem. On the other hand, we don’t know why it is happening, so there may be some underlying glitch that is not resolved. So maybe we are back at a 60% chance.

Ted and I are the analytical types, so we like some assurances like good probabilities. But we won’t know if her epilepsy is resolved until we try going off the diet, and it is not fair to keep Nora on a treatment that she might not need. So this is the anniversary we have been waiting for. It’s time to try to wean her off the diet!

The Slow Wean Plan

There is no consensus about the exact wean procedure, except for what you should NOT do: an IV of glucose, or a trip to the cotton candy factory, for example. We have had such a good experience and don’t have a rebellion on our hands, so we are choosing the slower-wean route to start. If we stick to this schedule, it will take us about 1 year to get down to a 1:1 ratio and go to a Modified Atkins Diet. We will see what happens after that.

We are going slow to give Nora the best possible chance of successfully coming off the diet, but the down-side is that we will be living with our friend the gram scale for a whole extra year and Nora may not perceive the differences in her diet. But when we look at the schedule for the next 4 months we see the difference.

We will go down on her ratio by 0.25 every 4 weeks. That means that now she gets 3.5 g fat for every 1 g carb + protein. Tomorrow we are changing to 3.25 g fat for every gram carb + protein (3.25:1). In 4 more weeks we will go to 3:1, etc. They will first increase her protein, then after she gets up to her recommended protein intake for her weight they increase the carbs. For example, all at 1350 calories:

4/23-5/24: 3.25:1 ratio, 132 g fat, 23-24 g protein, 17 g carbs
5/25-6/21: 3:1 ratio, 130 g fat, 26 g protein, 17-18 g carbs
6/22-7/19: 2.75:1 ratio, 129 g fat, 26 g protein, 21 g carbs
7/20-8/16: 2.5:1 ratio, 127 g fat, 26 g protein, 25 g carbs

That 25 grams of carbs seems like so much! 2 months after that she would be up to 35 g carbs! See the picture of 1 gram of carb for various fruits, veggies and nuts from the last time we made a diet change. But because it will happen so slowly, I wonder if Nora will really notice the difference and remember what it used to be like. She doesn’t complain about her food, but she wants more freedom of choice, like taking out a snack when she wants to. I will try to give her more of that freedom by keeping more at-ratio snacks around for her to choose from, which I hope is easier with lower ratios.

If all goes well, we can choose to speed up this process. We could go 3 weeks in between steps, or we could jump down by 0.5 on the ratio each time. We will watch and wait.

The “What If” Conversation

We had to ask all of our “what if” questions when we saw Dr. Wray yesterday. We watch and wait. He said that time is the epileptologist’s friend; we will see how she responds to the change over time. The more time that passes, the more information we have. We have to look for patterns. I’m not sure that time is the parents’ friend in this case. We would love some certainty but will have to cope without it.

Nora could have more seizures. If they are a tonic-clonic convulsive seizure, we manage in the moment then wait and see. It might be isolated, so our best strategy will be to wait. She may have more myoclonics. Dr. Wray said that people with a mild myoclonic epilepsy sometimes have a few myoclonics in the morning, but it is not so disruptive that they want an invasive treatment like drugs or diet. Again, we would have to wait and see. We don’t know the cause of Nora’s epilepsy, so we don’t know how this will play out. We only need time to find a pattern and make some decisions. If she develops a pattern of seizures that interferes with her life, we would have the option of diet or drugs again.

The best news is that she is past the window for the devastating degenerative conditions that we all worried about in the beginning. She has developed perfectly, cognitively and neurologically (otherwise) normal, growth on-track, all systems go. That is the comfort and reason to celebrate.

This quote sums up how I feel about it (thanks to keto-mom/friend Fawn for passing it along):

“Nothing is more desirable than to be released from an affliction, but nothing is more frightening than to be divested of a crutch.”

~James Baldwin

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Two Takes on the Pizza Crust

Kids love pizza, and keto kids deserve pizza too. Pizza is also a common quick meal, frozen or delivered, for many families on busy days. But with a keto kid you can’t feed the whole family, so it’s nice to have a fairly simple pizza crust that you can pull together or pull out of the freezer to include your keto kid while you wait for the delivery guy to show up. We’ve spent two years refining our pizza crust techniques, and I think we have 2 winners to share.

The first is a re-purposed version of cheddar crackers, from the Keto Cookbook. It is simply a mix of about equal parts ground macadamia nuts and shredded cheddar cheese. I left out the egg white and it worked fine for a quick crust, but it isn’t very sturdy. It is made of just 2 common ingredients and I don’t have a recipe because you can make it as large or small and vary the proportions as needed to fit in a meal (see examples below).

Mound of cheddar and macadamia nuts on a small pizza plate (left), and after pressed and baked (right).

Mound of cheddar and macadamia nuts on a small pizza plate (left), and after pressed and baked (right).

Simple instructions: Set the oven to 375°F. Measure the shredded cheddar and ground macadamia nuts together, mix well, and press into a small circle on parchment paper placed on a baking sheet. Bake until melted together and barely browned and bubbly. Take out and add toppings, bake again until cheese is melted.

Quick snow-day lunch. Nora pizza (left), frozen pizza (right).

Quick snow-day lunch. Nora pizza (left), frozen pizza for Anders (right).

You can build a meal around it. For an example of proportions, we made a little pizza of 10 g shredded cheddar, 16 g ground macadamia nuts (baked to crust), 10 g tomato sauce, and 14 g whole milk mozzarella (with enough fat on the side to make the ratio correct).

IMG_4285

Tostada-crust with hamburger, cheddar, and olives.

We also used this tostada-style with hamburger, cheddar and olives. I used 12 g ground macadamia nuts, 10 g shredded cheddar, mixed and baked the crust as described. Then added 14 g hamburger, 10 g sliced kalamata olives, and 6 more grams of cheddar. With avocado and extra fat (fish oil and cream) on the side. Sour cream would be a great addition, although not loved by our keto kid.

I thought it was easy to make 2 crusts at a time, knowing that I would use one again the next day also. Using the second one the next day helped me keep track of the proportions of cheddar and macadamia nuts.

 

The second pizza crust winner is from our Toasting Bread recipe. It has been a smash hit recipe for sandwiches and toast, and now as a pizza crust. I experimented with a few other pizza and focaccia recipes also from The Joy of Gluten-Free, Sugar-Free Baking and decided that the toasting bread can’t be beat. It is not a spur-of-the-moment-throw-together crust, but you can make a big batch and put them in the freezer to pull out and use anytime. Weigh, calculate your toppings, and put it in the oven until the cheese is bubbly and the crust is warm. Easy as pizza pie.

IMG_2954

Toasting bread and pizza crusts from the same batter.

We are on spring break right and it’s been pouring rain all day, so I spent several hours baking. It is nice to get ahead by having a few items in the freezer for quick meals. Nora asked for toasting bread again and I have found that I like to make it in a small loaf pan instead of the full-sized pan. This time I made a full recipe, put 1/2 of the batter into the small loaf pan, and made the rest into 12 pizza crusts. Because I’ve figured out the nutritional information per baked gram of bread (see original post) I didn’t pre-weigh the crusts. I can just weigh them before using them and build the meal around it.

I like making this bread recipe because it doesn’t require whipping the egg whites until stiff and carefully folding in the other ingredients. It all just goes into the mixer and it is soft and sticky enough to work with. It puffed up surprising nicely in the oven. Each baked crust is solid enough to hold up, not at all crumbly, but with a nice bready texture and nutty flavor.

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When I experimented with the other crust recipes we had some fun by pressing the dough into gingerbread cookie cutters. Instead of rolling out the dough and cutting out pieces, I pressed the dough into the shapes and then carefully removed the cookie cutters, using a small rubber spatula to keep the edges in shape. That was fun and Nora liked topping them herself. They are very small, so bigger kids might get 2!

IMG_2967When I figure out the full pizza meal, I weigh out all of Nora’s pizza toppings onto a small plate and let her build her own pizza. She loves the chance to work with her food and make it her way. She also nibbles on the toppings and licks her fingers, a rare pleasure for a keto kid! Because it is all allotted to her meal, it doesn’t matter whether she puts it all on the pizza. I just try to remind her to put enough on her pizza to enjoy it when it comes out of the oven!

It is especially nice to have a pizza crust that can be sliced and eaten in pieces, and will stand up to being carried around. We took an outing to our favorite local pizza place and brought Nora’s pizza along with us. It was a treat to eat out together, which is pretty rare for us. A pizza crust that transports well while still being delicious (not just edible) is a special thing.

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Keto Valentine’s Day Love

Nora woke up yelling “Valentine’s Day!” She loves love. She made her own Valentines for all of her classmates after being inspired by the card she received from Grandma Sheryl. She started with making a heart, and wrote “Happy Heart Day” and just kept rolling until she made one for each member of her class! I only helped with the heart shape, otherwise it was all-Nora.

IMG_4547

For a little extra special keto treat to bring to school, I melted her daily B^3 and poured it into a heart-shaped silicone cup to re-harden with the apples on top. I also made a “cookie” of ground macadamia-coconut oil-blueberry to solidify in another heart mold. Easy!

Her teacher sent home a note asking the kids to bring cards to exchange, but she didn’t really specify that candy was not welcome. I’m sure Nora will see some candy today, and we’ve had a talk about it. As an alternative, I made some Lego-guy chocolates from the Charlie Foundation’s Chocolate Candy recipe (with video!). I added a drop of peppermint extract to one batch for a twist. Unfortunately the heads fall off when they pop out of the mold. Good thing they are not long for this world anyway.

Happy Valentine’s Day! Spread the keto-love!

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Blueberry Almond Muffins

Snow days! Two days off school leading up to a weekend, playing in the snow and lots of together time means baking time to keep everyone happy and satisfied.

IMG_4517Nora requested toasting bread for PBJ sandwiches. Anders requested blueberry muffins. But I knew that once Anders had blueberry muffins Nora would want blueberry muffins, so I pulled out The Joy of Gluten-Free, Sugar-Free Baking and tweaked their recipe for Blueberry Hazelnut Muffins to make everyone happy.

And oh. my. good. ness. They are so good!

I made one batch (below) and took out enough batter for 3 muffins for Nora, in pink and purple silicone muffin cups. Then I put a bit of sugar into the leftover batter for the rest of us and re-mixed, added in the blueberries, and put ours in yellow and green silicone cups. They are nutty delicious, either warm and cold.

I’m also sure that the original recipe using milk of any kind instead of heavy cream would also be very good. If you’re into that kind of thing.

Screen Shot 2014-02-07 at 2.04.24 PM

Nutrition information for one Blueberry Almond Muffin, by www.caloriecount.com

Blueberry Almond Muffins
(makes 10 muffins)
90 g raw egg (2 eggs)
115 g (1/2 C) Organic Valley Heavy Whipping Cream
7 g (1.5 tsp) vanilla extract
5 g (1 tsp) lemon juice
85 g (3/4 C) Bob’s Red Mill hazelnut flour
85 g (3/4 C) Bob’s Red Mill almond meal/flour
30 g (1/4 C) slivered or sliced almonds
6 g (1 Tbsp) baking powder
3 g (1/4 tsp) salt
40 g frozen blueberries (1/4 cup, or more if diet allows)

Measure egg, cream, vanilla and lemon juice into mixer. If you want to add some liquid stevia or other carb-free sweetener, add it now as well. Mix thoroughly on low in electric mixer, or by hand.

In a separate bowl, combine nut flours, almonds, baking powder, and salt. If you want to add a powdered no-carb sweetener, add it here. Mix well. Add the dry ingredient mixture to the wet ingredients and mix on medium very well, one to two minutes. You want to beat a little air into it to fluff up your muffins. These ingredients are a lot of heavy lifting for the baking powder.

Measure 43 g of batter into each muffin cup. Then add 4 g of frozen blueberries to each cup, pushing them into the batter and smoothing over the top.

Bake at 350° for about 35 minutes or until golden brown on top and springy to the touch.

IMG_1401These are 2.17:1 ratio. Served with 25 g Organic Valley Heavy Cream plus 1 drop of vanilla flavoring and a thinned with a bit of water to make “milk” for a 3.5:1 ratio.

Now we are snowed in and need more baking supplies to make more of these! They will go too fast!

 

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Almond & Orange Florentines

I like to cook, therefore I like to listen to the Splendid Table. When I saw this Almond Florentine recipe on their website, I knew it would be keto-possible. Worked like a charm!

IMG_4313It is so easy, delicious and look at that fancy little cookie. Who could resist? It was a simple way to make an elegant holiday treat for Nora, and a batch with a little sugar for the rest of us!

A tip of you are making them for the whole family: reduce the sugar by at least half. I reduced the sugar a bit, and found them very very sweet. The orange still comes out, but I would like to taste the almond flavor too. The sugar is only for flavor, because Nora’s came out fine with no sugar at all.

One more tip: Kids like to zest oranges with a cheese grater or zester. Anders did the whole orange for me. Just make sure that they get the colored peel and avoid the white pith. Get them busy in the kitchen!

Nutrition information for 1 almond florentine cookie (recipe makes 10). Nutrition information provided by www.caloriecount.com

Nutrition information for 1 almond florentine cookie (recipe makes 10). Nutrition information provided by www.caloriecount.com

Almond & Orange Florentines
(makes 10 servings, 1.43:1 ratio)
30 g Egg whites
100 g Sliced almonds
2 g Orange zest

Preheat the oven to 300°F. Line a heavy baking sheet with a silicone mat or parchment paper brushed lightly with vegetable oil.

Measure and briefly beat the egg whites. Then gently mix them with the sliced almonds and orange zest. Measure 13 g portions of the mix to make little mounds on the lined pan, spaced a bit apart. Dip a fork in a small bowl of water and flatten each mound. Make them as thin as possible without big gaps between the almond slices.

Bake for about 12 minutes, until the cookies are golden brown. Cool completely before serving.

Nora's cookies on left, rest of family's on the right.

Nora’s cookies on left, rest of family’s on the right.

You can add a drizzle of high-quality dark chocolate for extra flavor. I use Green & Black’s 85% dark chocolate. Melt a square in a small silicone pinch bowl by putting it in the microwave for 30 seconds. Check and microwave again briefly if necessary to melt it.

Put one cookie on the gram scale and tare it. Drizzle the melted chocolate on to the cookie until you reach the desired amount. I used 1.5 grams of chocolate on Nora’s, which added 0.41 g carbs, 0.15 g protein, 0.75 g carbs (9 calories, 1.33:1 ratio).

The ratio is very low for her, so we make “hot chocolate” out of heavy cream and a pinch of cocoa powder, steamed with the espresso machine’s attachment. Lovely holiday treat.

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Popcorn!

Nora gets popcorn! What a revelation! I read on another keto-mom blog that popcorn was her son’s favorite snack, and I was kinda like “shyeah, right. Not gonna work for Nora. Too many carbs.” Sorry I doubted you Sara. Now I’m with it.

I did look up the nutrition facts on popcorn after I saw that blog post and still thought that it wouldn’t work easily. It didn’t have as much fiber as I expected, and Nora could probably only have a few grams. I thought that her few grams would just look pathetic next to a serving that the rest of us would get. And I didn’t have any popcorn in the house, so that was also a big barrier to trying it.

I was motivated to try it again because her class is having a popcorn party tomorrow for their accumulated good behavior. I bought some popcorn to test it out. Super easy way to make plain popcorn for everyone: put some plain kernels in a small paper bag and microwave it for a few minutes, take it out when the popping slows down, or it will burn. That’s it! You will never eat that chemical-laden microwave popcorn again!

For tomorrow’s popcorn snack, Nora will get:
4.5 g popcorn
5.5 g butter (melted on and drizzled on popcorn)
5 g melted coconut oil mixed with 8 g ground macadamia nuts and a drop of banana flavoring, chilled to make a “cookie”

IMG_4310

162 calories
3.3 g carb
1.2 g protein
16 g fat
1.3 fiber
3.5:1 ratio

And look at all that popcorn! A near proper bowl! It is super carby per gram, but it’s so light that you get a lot of popcorn per gram. That’s the key to success.

This will be her morning snack at school when everyone has popcorn, so we will load her breakfast with protein and very little carbs so that she is evened out by lunch. She is excited! And it sure helps that she is up to 14 g carbs per day, on her way to 16-17 g. We can easily squeeze in a few extra carbs with snack.

I am sure that popcorn will also become a favorite snack for Nora too.

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The simplest keto meals

Ted here. This post is about the very simplest keto meals. Especially from the perspective of the secondary cook.

Christy is a food wizard. She gets food. She can create new things from basic components. She can produce batches of treats for Nora that we can use over the week. That is not an area of significant competence for me, but I can certainly make simple keto meals for Nora. So what do we do when energy and time are low, more complex treats are not available, and Nora needs to eat? Here is our most basic template for an easy lunch (or dinner).

Base:
Start with a base of avocado. Avocados are stellar. They are at about a 3.5:1 ratio on their own, plus they are fibrous. They can be simply diced, or spread as butter. We’ll generally start with 20 to 30 grams of avocado for a meal. Macadamia nuts (see more on them below) can also serve the role of a meal base. Both avocados and macadamia nuts work well to start the meal calculation because they are both high ratio, and give you a solid start on all four of the major constraints: carbs, protein, fat, and fiber.

Carbs:
The major sweet parts of the lunch come from apple, red pepper, carrots or berries (e.g., blueberries, strawberries, and raspberries). Peppers and raspberries get priority because of their high fiber and low carb content (relatively). Apples, blueberries, strawberries, and carrots pack much more of a carb punch, so those are added if the other major constraints are met and there is still a bit of carb to give. Generally there will be 5 to 30 grams of total fruit, depending on the mix.

Protein:
Cheddar cheese is the primary protein base. Nora likes it, it is easy to cut and weigh, and it has a good amount of fat too.  It is versatile too in that it can be served sliced, cubed, shredded, melted, or melted and reformed.  Something like 10 grams to 20 grams is typical. Sliced turkey and ham are also popular. Ham is nice because it has some fat. Sometimes we’ll put cream cheese and butter on the sliced meat and roll it up to get more fat in there.

Fat:
Cream is our primary fat, either mixed with water and a few drops of vanilla flavoring to make “milk,” or steamed in our espresso machine with a pinch of cocoa powder. The amount of cream will be between 10 and 40 grams, depending on what else is in the meal. We’ll might also look for opportunities to put butter on or in things. The other two big fat delivery mechanisms are macadamia nuts and kalamata olives. Those are especially nice if I want to avoid liquids (i.e., cream) in the meal, for example, with a packed lunch. Macadamia nuts do have some carbs, so it will use up some of that allotment, but their high fat and high fiber content provide a significant tradeoff for that. Kalamata olives are one of very few foods that have both fat and carbs, but no protein, so they make a natural keto complement to meat and cheddar. However, they have no fiber.

Fiber:
The fourth constraint. Generally I check for fiber when I am satisfied with the amount of carbs and the ratio of the meal. If the fiber content is too low — we shoot for about 11 grams of fiber for Nora over the day — then I’ll circle back and see if I can trade something out for more raspberries, macadamia nuts, or Flackers. Flaxmeal is another option, and can be mixed in with any butter in the meal.

Variety:
Lastly, we’ll check to see if there is a reasonable variety of textures and tastes. Meaning, is there something creamy and something crunchy? Is there something sweet and something salty?

A typical, very simple lunch:
8 g apple
15 g avocado
15 g cheddar cheese
8 g Flacker with 8 g butter
15 g macadamia nuts
13 g cream with water and vanilla flavoring to make “milk”
—————————
3.52:1 ratio
2.5 g carbs
6.9 g protein
33.1 g fat
4.4 g fiber
336 calories

At the bare minimum, if I have avocado, cheddar cheese, raspberries, and cream, I can cobble together the most basic tasty meal that satisfies all the constraints. Add some sliced meat, other berries, apples, peppers, carrots, cream cheese, macadamia nuts, kalamata olives, and Flackers, and we can switch things up enough to keep the simple meals interesting from day to day.

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Keto clinic checkup and diet changes

On Monday we made our way to Portland for another keto clinic check up with Dr. Wray. Nora continues to thrive. She is in her 20th month of seizure freedom! Her growth rate is right on track even after 2 years of diet therapy, 60th percentile for height and 75th for weight (I think she’s ready for a growth spurt). Dr. Wray reviewed her history and genetic testing and feels that there is no reason to keep her on a carb-restricted diet in the long term. Very good news.

Her labs were all fine. For those of you keeping score at home, her cholesterol panel was good at 188, triglycerides at 54, LDL (bad) minimally elevated at 135 and HDL (good) normal to good at 42. Her blood bicarb level was at 21, which is normally low but not too low.

We still can’t get Cytra-K in crystal form as before, so we will continue with baking soda (6 g dissolved in water given over the course of the day). She has avoided stomach upset after we learned to give small amounts of baking soda solution between meals. It seems to be a problem on an empty or full stomach. We have the option of using Cytra K oral solution (great cherry flavor!), but the stats I got from the dietician suggest that it has 3 g of carbs in her daily dose. We don’t think that’s a good trade off, when she could be getting 3 g of carbs through fruits and veggies. We will stick to the baking soda for as long as Nora tolerates it.

The biggest news is that we are going to adjust her diet to prepare for weaning her in April after her 2 years seizure-free. For the last 6 months she has been getting about 11 g carbs, 25-26 g protein and about 130 g of fat per day, which is 1300-1350 calories at a 3.5:1 ratio (fat to carb+protein).

That’s a small amount of carbs even by keto diet standards for this number of calories. When we increased her calories last time, the dietician suggested going up to about 16-17 g carbs, which felt like a big jump from 10 g of carbs, so we only increased it to 11 g at that time. Now we are going to keep the calories and ratio the same, but bring her carbs up to 16-17 g per day. That gives us a new daily target of 16-17 g carb, 20-21g protein, 128-133 g fat.

We will increase it by a gram every few days, so that she is up to 16 or 17 by the holiday break. Today she is up to 13 and is fine so far! When we told her that we were going to let her have more fruits and veggies she was so excited! It’s tiny baby steps to coming off the diet, but slow changes give us peace of mind. Slow but significant for Nora. Although she won’t do it all at once, going from 11 g to 16 g of carbs will feel pretty good!

I often get the question about “what does 1 g of carbs look like?” Of course, it depends on the food. It’s hard for me to answer on the fly because now I think in grams, not number of blueberries or baby carrots. Today I calculated one gram of carb for several of Nora’s regular foods. Some of them have significant fat and protein as well (so they are bigger servings), for those I listed their ratio too:

IMG_43031 g of carbs in:
8 g blueberry
17 g macadamia nuts (5.43:1 ratio)
8 g apple
14 g carrot
11 g almonds (1.63:1 ratio)
46 g avocado (3.62:1 ratio)
15 g kalamata olives (4.5:1 ratio)
16 g strawberry (not pictured)
18 g raspberry (not pictured)

With 5 extra grams of carbs per day, Nora can have about 6 more baby carrots per day, or 40-50 small blueberries! That’s a lot!

Dr. Wray continues to be delighted by Nora, and to delight us. Anders joined us for the appointment because of a no-school snow day. Dr. Wray made a note of Anders presence in his follow-up report we received in the mail, and that is name is “pronounced with a soft A, which is the Norwegian articulation of his name.” See doc, we read these things with care. Anders thanks you.

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Blueberry Panna Cotta

Oh panna cotta! Where have you been hiding for the last 2 years? Why has it taken so long to discover you?

I’ve been a little obsessed with a cookbook put out by a fabulous restaurant in Portland, Toro Bravo. I haven’t even eaten there personally, but I’ve heard a lot about it. One of my life goals is to eat there. It’s 2 hours away, and often a 2 hour wait. It’s an attainable life goal; I like to have a few like that.

I’m reading this amazing, honest, detailed and hilarious cookbook, which has all of 7 dessert recipes, and start reading about panna cotta. John Gorham, owner, chef and author (who is free with cussing), tells about tasting the best ever panna cotta made by a pastry chef he worked with. The pastry chef replied:

This is the simplest recipe known to man. You can’t fuck it up. You can’t make it not amazing. It has four ingredients and takes five minutes and is foolproof so long as you pay attention.

Nora's Thanksgiving panna cotta, extra fancy.

Nora’s Thanksgiving panna cotta, extra fancy.

I’ve made custard. I’ve made ice cream. I’ve heated and stirred and cooled cream-based desserts. Panna cotta means “cooked cream.” I just assumed that something so Italian and so revered had to be difficult. The secret is out, and I’m making panna cotta. It was our Thanksgiving dessert.

The beautiful thing about panna cotta is that it doesn’t require sugar to make food-science magic. For ice cream, you need sugar to lower the freezing point. In baked goods, sugar plays a role in texture. In jams it makes the pectin gel. But all panna cotta really needs is cream and gelatin, and it gives back a soft luscious creamy dessert that can be flavored any way you want it.

The Toro Bravo recipe calls for gelatin sheets, which he claims are the key to success but require attention to detail. Contrary to the pastry chef’s opinion, it is “fuckupable” (his word, I’m just quoting here). I couldn’t find gelatin sheets at our fancy grocery store and I’m an old hand at powdered gelatin, so I found a recipe from another of my favorite chef-bloggers, David Lebovitz (and his recipe). He uses powered gelatin, and that’s good enough for me.

I’m up to 6 ingredients here. You have to use water with the powered gelatin, so that adds 1. I also included a bit of that whey protein I’m trying to use up. This recipe has so much fat that adding enough berries to get it to a 3.5:1 ratio was a heck of a lot of carbs at a time for Nora. The whey protein is undetectable in the panna cotta, but provides some needed protein to lower the ratio.

I used blueberries because Nora loves them and they are beautiful, but you can use any berries you like. Just adjust the amount of berries to get the correct nutritional breakdown. Blueberries are the highest-carb berry that we use, so if I substituted strawberry or raspberry it would be even more berrylicious!

Nutrition information for 1 serving of Blueberry Panna Cotta (recipe makes 8 servings). Nutrition information by www.caloriecount.com

Nutrition information for 1 serving of Blueberry Panna Cotta (recipe makes 8 servings). Nutrition information by www.caloriecount.com

Blueberry Panna Cotta
(makes 8 servings)
250 g Organic Valley heavy whipping cream
180 g Frozen blueberries
3 g Vanilla extract
2 g Gelatine powder
40 g Cold water
4 g Ultimate Nutrition whey protein powder

Warm and cream, vanilla and blueberries together in a small saucepan until the blueberries start to give up their juice and all is warm. Blend and mash them together so that they are well distributed.

When making a batch recipe, I’m concerned that one of the servings will be carb-heavy and often add the carb component separately to each serving. You can certainly warm the blueberries separately and divide them evenly on top of the cooled panna cotta, which I would recommend if your kid is very sensitive or just starting the diet. You need to be sure that every serving is what it says it is. I’m now comfortable doing this for Nora, but I was not always and I’m still careful.

Measure the cold water into a medium sized bowl, so that the water is broad but not very deep. Evenly sprinkle the gelatin powder over the surface of the water and let it sit, undisturbed, for 5 to 10 minutes.

If you want to be able to turn your panna cotta out on to a plate to serve, lightly grease 8 small cups with coconut oil. I just served ours in the cups. We used wine glasses for our fancy Thankgiving dessert, but I did the rest in ramekins and small tea cups.

Pour the warm cream mixture into the water and gelatin and stir well, so that the gelatin can dissolve completely and evenly. You won’t be able to tell, so stir a little longer than you normally would just to be sure.

Divide evenly into the 8 prepared cups, about 60 g each. Depending on how long you warmed the cream, you might have lost a bit of water. You could measure them at 59 g each to be safe and not come up short. If you incorporated the blueberries into the cream, make sure you get about the same number of chunks in each cup (this will depend on how big your blueberries are. If you are really uptight, count them and divide by 8!)

Chill for at least 2 hours to set until firm. If you make David Lebovitz’s recipe for the rest of the family, I think he skimps a bit on the gelatin, or ours just had to sit much longer to get a firm gel. Add a bit more gelatin than he suggests if you want to be able to eat it sooner rather than later.

One last tip: If your cream is clumpy and separated, you will probably get a thin layer of grainy butter at the top of your panna cotta. It’s doesn’t ruin it, but you should know. Keep the lumps out if you can.

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Bringing Keto to Kindergarten, Part 3

It’s almost half way through the school year!

When things are going along fine but you know there are potential problems lurking, it’s hard to feel really at ease. You can’t really know that things will be fine until something goes wrong and you see how everyone handles it. We had our first real keto-problem at school yesterday. It was handled perfectly. We have a new kind of peace of mind about Nora at school.

We have been sending her “milk” in a small mason jar with a drink/pour lid. I’ve always been afraid that it will pop open and spill all over the lunch box, losing all of that necessary fat to make up her ratio. It didn’t spill yesterday–the jar broke! Nora opened her lunch box to cream and broken glass. Yikes.

The school called me, but I was teaching and my phone was off. They called Ted next, who was much more clever than I would have been. When I heard their message I was ready to jump on my bike and get new cream over there. Luckily I called the school back first and found out that it was taken care of.

When Ted got the call, he asked if they had any butter at the school. They did not (really? not part of a healthy school lunch, I guess). The secretary suggested that they have olive oil in the teacher’s break room, so Ted calculated that 2 teaspoons of olive oil would do the trick. Nora wasn’t happy about it, but she took it and no one had to leave work.

On a related note, we still have not made a formal 504 plan with the school. The nurse has not contacted me about it again, and in the rush of daily life I have not pushed it. It is comforting to know that her teacher (who was part of the chain of command) and the school staff were aware of her needs and worked with us to find a solution.

Nora also had her routine blood draw yesterday for Monday’s keto clinic appointment with Dr. Wray. Ted took her in when the lab opened at 7:30, so she was a little late to school. When she came into her classroom some of her friends came over to give her hugs and brought her to the rug where they were singing and dancing their morning songs. Ted left with a warm and happy feeling about Nora’s school. That’s another wonderful kind of peace of mind.

Many thanks and muchas gracias to the wonderful people of Garfield school who take care of Nora every day!

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