Fiber is our friend. It is counted as a carb on nutritional labels, but we can subtract it out of the “total carbs” to get effective “net carbs.” It lets Nora eat fabulous things like La Tortilla Factory’s Smart and Delicious Low Carb, High Fiber Tortillas. Nora eats some of these tortillas every day, either in 1/8 sections (4.5 g) or 1/4 sections (9 g). They are big, so that little part of a tortilla goes a long way. I know the nutritional specs by heart–1/4 of a tortilla has:
1.5 g net carbs
2 g protein
0.75 g fat
3 g fiber

Wowza. And they taste good, in addition to being quite sturdy. Nora eats them with her “cinnabutter” (butter mixed with a bit of cinnamon, sometimes also delivering coconut oil), as a quesadilla several times a week, as a pizza “crust,” and in our latest version, a “dogsadilla,” wrapped around a hot dog.

Fiber is also our friend for reasons that we all know and love: it gets the poop out. As we have learned the hard way, constipation = seizures. I don’t fully understand the technical explanation (it has to do with the vagus nerve), but our keto doctor says that it is extremely common, in addition to jiving with our experience.

And the keto diet is quite constipating. We’ve tried several things suggested by the dietician. Miralax is a gentle laxative, but we are wary and have not had great luck. We have given Nora a magnesium supplement called Calm that comes in a no-carb “lemonade” flavor, which helps to relax the muscle walls to ease the poop out. We have mixed the lemonade version with the unflavored version at a 2:1 ratio to get more supplement and less flavorings. Nora likes having something tasty to drink. We took a break from Calm supplements for awhile because of a separate acidity issue (more next week on that), but Nora seems a bit constipated again, and I’m wondering if the break from Calm is the culprit. We’ve started giving her 1 teaspoon mixed in water in the morning and 1 tsp in the evening again.

We also give her baths in epsom salts as a way to absorb more magnesium. Ted is a big fan of the epsom salt baths, and it’s darn nice for her.

Back to fiber. The last time she was constipated, we talked to the dietician about her fiber requirements. Looking back, it seems odd to me that they don’t make this part of the keto calculations. If constipation is a problem–let fiber do the job! More bulky yummy foods! Have your red peppers and avocados and raspberries and eat them too!

The dietician said that a rule of thumb for a child’s fiber requirements is to take the child’s age and add 5. So Nora needs 8 grams of fiber per day. We had started tracking it just before talking to the dietician, and she wasn’t too far away from that. Since then, we have tracked fiber along with her carbs, protein and fat. She normally gets 9-12 g of fiber per day now. But another thing to remember: Fiber bulks up the stuff passing out, so can be a constipation threat if you don’t drink enough water. So keep on the water requirements too.

Nutrition information for 1 Tbsp of Bob's Red Mill flaxseed meal.

Nora now eats several high-fiber fruits and veggies per day, and we pick up extra fiber in other ways, like her fabulous tortillas. As I mentioned in the B^3 post, I add flax meal to recipes to up the fiber content. I add some flax to almost everything I bake. The carbs in flax are purely fiber, so it adds nothing to the carb count, only to fiber, protein and fat. In addition, it has all kinds of great fats. Look at that nutritional information! 0 net carbs, 2 g fiber! When we need to push more fiber, we mix it in to butter and serve it on a flacker. Oh! Flackers are awesome too! Crackers made out of flax seeds, pressed and baked together. They are tasty. I know the nutrition info of 1 flacker without looking too:
0.35 net carbs
1.65 protein
2.65 fat
2.33 fiber

As a rule of thumb, I now look for fruits and veggies that have net carbs equal to fiber. So at least 1/2 of the total carbs come from fiber. Avocados are the gold standard. Red pepper has been Nora’s go-to veggie for months now. We have just discovered the amazing raspberry. Unfortunately, I have the impression that many frozen raspberries are pre-sweetened, so check your brands. We are lucky to live in the heart of berry growing country (along with growing almost everything else), and we can get frozen Stahlbush Island Farm unsweetened raspberries all year. A few raspberries have been Nora’s reward for drinking her baking soda water (more on the acid issue later). I’m also planning on making raspberry scones tomorrow. I suspect that there is not more raspberry-love in the low-carb community because of a lack of unsweetened frozen berries. I will sing their praises here.

For other fruits and veggies, we note the fiber but it’s not so great. Apples are not so great, but Nora won’t give up her 10 g of apples (3 tiny slivers = 1.25 net carbs, 0.25 fiber). She was pining after our sweet potato one evening (funny how that happens with this diet), so I measured and gave her a chunk. I don’t remember the numbers, but it was a big chunk of her carbs in a very small (but tasty) package. We don’t eat sweet potatoes in front of her anymore. We had our first spring asparagus tonight, and I was happy that it met my rule of thumb, although Nora was not enthusiastic.

My message to keto familes–make fiber happen!