Hazelnut Applesauce Bread

Yesterday was baking day again, and Nora requested this Hazelnut Applesauce Bread. It’s the 3rd time I’ve made it–a hit! Nora enjoys it for breakfast, topped with a mixture of her morning coconut oil mixed with a bit of butter.

The recipe calls for baking it in a small loaf pan, but I find it a little unwieldy to store and cut in that form so I tried baking it in a wide shallow baking pan instead. It came out nicely. With all of the fat, the edges get kind of browned and crispy. Mmmm.

This recipe is an adaptation of Candice’s Low Carb Almond Flour Applesauce Spice Pound Cake [11/13: her site has moved and that recipe seems to be gone: http://tmstrevival.wordpress.com/]. If you look at her recipes, she always uses Splenda or another no-carb sweetener. We try not to add any of those sweeteners to Nora’s diet. It’s unclear whether they interfere with ketosis for her, and we don’t want to take any chances. I also don’t care for their flavor (they always have a bitter edge to me). I try to choose recipes with naturally sweet and delicious ingredients so that extra sweeteners are not necessary. Nora is not accustomed to sweet things anymore, so this bread (and her other baked goods) taste sweet enough to her. We call it “applesauce bread” for the sales pitch, and the applesauce does add a nice touch of sweetness, with the nutty taste and cinnamon flavors as well. We are going for flavor, not sweetness.

The original recipe calls for almond flour. The first time I made it, I was out of almond flour but had ample hazelnut flour. Did you know that 99% of all hazelnuts grown in the United States come from the the Willamette Valley in Oregon–right here where we make our home? And when you move to Oregon, you learn that hazelnuts are also called “filberts.” Know the local code to find the local deliciousness.

It is possible to substitute any nut flours for these kinds of recipes, but remember to always re-check the nutritional information. To boost the fiber and cut a little more carbs, I also substituted 1/4 cup flax meal for some of the nut flour, which I do with most recipes.

One additional word of caution for keto-families, which applies to all of my recipes with nutritional information: Make sure to re-calculate nutritional information for the ingredients that you use if they are different from mine. I use Bob’s Red Mill nut and seed flours. Check the nutritional information for the applesauce you use and make sure it is unsweetened. If you are grinding your own nut flours (which you can do in a coffee grinder), you can weigh the quantities to be sure of your measurements. I am measuring things in cups here, but as you know that creates more room for error. If you measure according to the recipe, weigh, and calculate based on weight you will get more precise nutritional information for the recipe that you feed your child.

I also use an online recipe analyzer because we don’t use a keto-calculator (we are on a “modified” keto diet without as much rigor as administered by most neurologist’s offices). My nutritional labels are for your reference to determine if you want to try a recipe.

Hazelnut Applesauce Bread

Hazelnut Applesauce Bread. Nutritional analysis from www.caloriecount.com

3/4 cup unsalted butter, room temperature
5 large eggs
1/3 cup UNSWEETENED apple sauce
1 teaspoon pure vanilla extract
1.75 cups Hazelnut Meal/Flour
0.25 cups flaxseed meal
1 T Organic Coconut Flour
2 tsp baking powder
1 teaspoon ground cinnamon
1 teaspoon ground ginger
1/2 teaspoon ground nutmeg

Preheat oven to 350F

Grease & flour a 8”x4” loaf pan with butter and dust with coconut flour.

In small bowl combine hazelnut flour, coconut flour, baking powder and spices. Set aside.

Beat butter with an electric mixer until fluffy and smooth. Add eggs one at a time, beating well after each addition. Add vanilla extract and apple sauce and continue to beat until smooth.

Add hazelnut flour mixture to egg mixture. Mix on low until combined. Then turn mixer up to high and beat until smooth.

Pour into prepared loaf pan and bake at 350°F for about 1 hour or until done. (When I made it in the wide shallow pan, it cooked for about 45 minutes).

Let cool in pan for about 10 minutes then take out and and cool on wire rack. If you don’t take it out of the pan, it will solidify in there and will break if you take it out when cold. There is a lot of butter in this recipe and it does solidify.

Note that 1 serving is 16 g (I cut and weigh each piece of bread). It’s a rather small but dense serving. The recipe creates 48 servings at 16 g each, so it’s wise to freeze half of a loaf because it will get moldy before we use all of the 48 servings (unless the rest of the family is eating it too!)

A 16 g serving contains:
0.7 g net carbs
0.8 g fiber
1.4 g protein
6.2 g fat

…And Back Again

Today’s visit to the keto-clinic went well.  Nora was bright and shiny for the doc.  The bottom line is that we’ll hold the course for a few more weeks.  If we can continue to demonstrate good seizure control during that time, we’ll consider reducing the Depakote.

I also asked the doc about Nora’s prognosis.  It basically all boils down to her cognitive development.  With myoclonic seizures, the concern is the horrible Progressive Myoclonic Epilepsies (PME).  The nastiest of those are characterized by regression and cognitive impairment.  The doc said that it would be very rare for Nora to have gone this far, had this many myoclonic seizures (over 1000 of them over 7 months by my count), and not have shown cognitive impairment if she did in fact have a PME.  So that is good.

We also asked about how long we anticipate Nora will be on the ketogenic diet.  The doc said an interesting thing: 1 to 2 years, probably, but that is not limited by the effectiveness of the treatment, but by the patient’s tolerance of the diet.  Most people just can’t handle the KD for too long, and eventually the desire for a more normal, carb-balanced diet becomes too strong.  In short, the length of our treatment of Nora with the KD depends largely on Nora.  If we stop the diet prior to 2 years, it will be because Nora cannot tolerate it anymore, and we will not be able to tolerate administering it to her.  The good news is that it seems that many people retain the benefits of the diet when they eventually go off of it.  For some people, it seems the diet either effects a lasting change in seizure threshold, or else buys time for the brain to develop out of the seizures.  There are also varying degrees of the diet, so it could be that if Nora eventually cannot tolerate the current formulation, we will move to a more gentle formulation, perhaps 2:1 instead of the current 3:1 (fat to carbs+protein).

In any case, we feel more comfortable with our current situation.  I feel like the silver-lining of the relapse a few weeks ago was that it showed us a few changes to make with regards to ketosis and constipation that have improved the treatment for Nora.  But of course, we’re likely to get a few more curveballs, at least.  But I hope we can continue to make tweaks and changes to keep up with her.

To the Keto-Klinic

I couldn’t resist the double K’s again.

We are on our way to Portland this morning for a Keto Clinic checkup. They schedule these on the 2nd and 4th Fridays of the month, to get the personnel and keto kids all scheduled in a row. I think we meet with the dietician and Dr. Wray to check in, ask questions and get standard blood tests.

It feels like such a waste to drive 4 hours round trip just for that, but we don’t have any other go-to activities in Portland when we just have Nora will us. But if this is quick and easy, we should probably consider taking Anders with in the future and making a day of it. Any suggestions for future trips? Either quick trips or longer whole family trips?


They are good, like Krispy Kream. You can tell because the words all start with K’s.

Krepe Kids

We are calling them crepes, because we usually fill them with ham and cheese and roll them up. But the coconut meal gives them a little more body than a real crepe, and they are a little spongy too, so they are kind of a cross between a crepe and a pancake.

They make a great meal because Anders and Ted like them too (but they have too many eggs for me. My own little food glitch).

Tonight Nora had some extra carbs coming, so we filled them with cheddar and 18 g of apple slices! She normally gets about 10 g of apple at a time. What a treat. Of course, she wanted to separate it and eat the apples first, so I let her eat 1/2 of the apples, then made her eat 1/2 of the crepe. Although I didn’t hear any complaining and she ate up every bite.

They would also work great as a dessert or breakfast crepe with some sliced strawberries and whipped cream. Nora claims to dislike whipped cream, but it is because I ruined it by trying to hide her medicine in it once. And she never forgets. Whipped cream will be ruined for her forever. What a shame.

I can also make a batch of batter, which makes about 6 crepes, and use 1/2 at one meal and save the rest for another meal. That helps with the meal-time-crunch on some days.

I have had some problems with getting them to turn out right. It’s the flipping. Tonight I got it right, so here’s my procedure: I use my small frying pan and melt plenty of butter (1/2 T) over medium. Just when the butter gets bubbly, I make sure that it is coating the pan and pour 1/4 cup of batter all around and turn to coat the pan with batter. Maybe it helps if the batter is cold to start–I haven’t experimented on that point much. The batter and butter will co-mingle (good for those ketones). When the crepe is getting quite dry on top, loosen all around the edges. If it’s working, it should be able to move freely in the pan. Then flip and cook to brown on the other side. Right after flipping, put in the fillings to melt cheese and warm everything up. Roll immediately; they will begin to break if you try to roll them when cool. Or just fold in half or serve as a pancake.

And note that these are also gluten free! Coconut meal makes them taste sweetish and contains a lot of fiber. For anyone who wants to try a lower-fat version, use milk instead of heavy cream.

Nutrition facts for Keto Krepes. 1 serving = 1/4 cup of batter. Analysis from caloriecount.com

Makes 1.5 cups of batter = 6 servings of 1/4 c batter each
4 eggs
1/4 tsp pure vanilla extract
pinch nutmeg
1/4 C heavy cream
1/4 C water
1/4 C Coconut Flour (Bob’s Red Mill)
1/2 Tbsp butter

See procedure below.





Keto Crepes under the gram recipe, updated 2/24/2014.

Keto Crepes under the gram recipe, updated 2/24/2014.

In grams, makes 7 servings, 49.4 g each:

28 g Organic Coconut Flour
200 g eggs
0.5 g pure vanilla extract
0.1 g nutmeg
60 g Heavy Whipping Cream
50 g water
7 g Butter

Whisk eggs, vanilla, nutmeg and cream. Sift and stir in coconut meal. Let stand 5-10 minutes for coconut meal to absorb the liquid. Thin with water to your desired consistency.
Heat frying pan to medium and melt butter. Pour 1/4 C batter into hot pan, spreading to desired thin and cover bottom of pan.
Cook until top is drying, flip and fill with ham and cheese, etc.
Remove from pan and roll or fold over.

Peanut Butter-Coconut Cookies

October 2014 Note: This is one of my first attempts to make a cookie recipe for my child on the ketogenic diet. It was better than I expected, but certainly not the same as a non-keto cookie. Coconut meal, in particular, has a very different texture than flour and some people don’t like it. Because this blog is also something of a record of our lessons learned and progress, I choose to keep it here even though it was not a perfect replica of a non-keto peanut butter cookie. You could also try the linked recipe, which was the original inspiration. The recipes developed more recently have been much more successful, so I recommend going to the 2013 or 2014 recipes that have been tried and true. 

One word on Netiquette: Remember that when you are commenting on a blog, you are communicating with a real person and you should be respectful and aware of the impact of your words. Several comments on this post were not approved because they were rude or disrespectful. In all communications, be kind and thoughtful; write and speak in a way that you would like to be addressed. I’m a mom, not a professional cook. I’m doing my best.

Mmmm, cookies. What else is there to say?

I guess I should say that these also contain 4.5 g of coconut oil, the prime MCT oil. Nora gets 5 g of coconut oil, 3 times per day. What a nice way to get it.

The cookies also have 1 gram of fiber each. Coconut meal has very low net carbs because of all of the fiber.

I have tried a few peanut butter cookie recipes. My recipes have improved by modifying the recipes from this great low-carb baker blog. She has many amazing recipes, some of which will not work for Nora because they still have too many carbs, but if you are doing low-carb or gluten-free baking, I would highly recommend her recipes.

http://tmstrevival.wordpress.com/ [link updated on 11/26/2013]

Peanut Butter Coconut Cookies

Nutrition Information for Peanut Butter Coconut Cookies from caloriecount.com

½ cup Adams Natural Peanut Butter
¼ cup butter
2 eggs
2/3 cup coconut oil
1/2 tsp pure vanilla extract
½ tsp baking soda
¼ tsp sea salt
1/2 c Coconut Flour (Bob’s Red Mill)

Cream together PB, butter, eggs, coconut oil and vanilla.
Mix with flour, baking soda and salt.
Form balls of 1 tablespoon and press with fork on to baking sheet (makes 32 cookies).
Bake 11 minutes at 350.


Nora Update: March 17, 2012

Seizures per day before the diet:  17.5
Seizures per day now:  1.1
Reduction:  94%
Half-life:  13.3 days

After a bumpy two weeks, I am happy to report that we are back in total seizure control. We have made a few changes to Nora’s regimen. We have added a carnitine supplement, which may help Nora stay in ketosis. Carnitine is a vitamin of sorts that helps the body process fat into energy. There is some thought that perhaps both Depakote and the ketogenic diet cause a depletion of carnitine, which can then impede ketosis. As a happy side effect, it can act as a laxative. We have also added some coconut oil, which as a medium chain triglyceride, is more easily processed into ketones. That, also happily, is a mild laxative as well. We are hopeful that these new measures will simultaneously stabilize Nora’s ketosis while also keeping the constipation at bay.

Otherwise Nora is doing well. She has not been sleeping great, but hopefully that’s just a passing adjustment or developmental phase. She is in general sharp, articulate, and happy.

Daily seizure count with exponential model fit.


Daily seizure count with diet metrics.

Baked Eggs

Nora says "yum!" to baked eggs.

Nora has enjoyed baked eggs on 2 occasions, which qualifies for a recipe post.

I’ve seen lots of baked eggs recipes–and they don’t even need to be modified for Nora! I make 3 portions at a time for the boys too (I can’t eat eggs, so I’m the one with the alternative meal on these nights). Next time I will crack 2 eggs into Ted’s cup for a larger portion. You could also throw in a bit of veggies, salmon, or vary the cheese option to your taste, although within the acceptable ranges for someone on the keto diet. Also be aware of the egg size that you are using. The nutrition facts here assume a large egg.

Nutrition analysis for baked eggs from caloriecount.com

Baked Eggs
1 egg
1 Tbsp heavy cream
7 g grated cheddar cheese
pinch of thyme

Lightly grease a small ovenproof ceramic dish or ramekin with butter. Pour in 1/2 Tbsp of cream, sprinkle in 1/2 of the cheddar cheese and a dash of thyme. Crack the egg into the dish, and top with the remaining 1/2 T heavy cream, cheese, and sprinkle again with thyme and salt or pepper to taste.

While preparing the egg cups, boil a teapot of water and preheat the oven to 375º F. In a large heatproof pan (I use my glass cake pan), put in the egg cups and place in the oven. Then pour the water from the teapot into the large pan, surrounding the egg cups (I don’t like to risk sloshing or dropping a heavy pan full of hot water). Bake for 10-14 minutes, depending on how firm you like your egg yolks. When finished, I take the ramekins out with a big tongs first and cool a bit, then take the pan of hot water out of the oven later. Safety first!

For dinner, Nora had her baked egg, an 1/8 of her high-protein, high-fiber tortilla with 2 tsp of double cream cheese mixed with 1 tsp of ground flax and a sprinkle of cinnamon, and 21 g of red pepper.

Welcome back, ketosis

Seizure control seems to be mostly back, after 2 weeks away. They have been decreasing in strength and frequency. We only saw 1 or 2 yesterday and 1 so far today, so hopefully they will die out again completely.

On Friday afternoon, I caught the first whiff of ketones in Nora’s urine again. Gross, I  know, but it seems to be the best overall measure of ketosis. We are getting more 160+ readings on the ketostix, but still see an occasional low reading, possibility when her urine is dilute.

Her doctor also gave us a prescription for carnitine, the protein supplement to help her process long-chain fats. She had her first dose today. I am glad that her seizure control improved before starting the carnitine, so that we can  better understand the cause-effect relationship of the diet and supplement. I hope that the carnitine can provide a kind of insurance-policy against future loss of ketosis, helping her to process those long-chain fatty acids into energy.


Kale chips, aka, seaweed-of-the-land-snacks

The Brekkens have now found another veggie option. Ted’s words. We will not get any more excited than that, because it is still kale.

But it is kale that we are now happy to eat. Yesterday when I was weighing a piece of kale for Nora, Ted later admitted that he thought (but did not say):  “8 grams of kale, 10 grams of yuck.” I do take the blame for ruining kale, because I probably never cooked it right. After he tasted this recipe, he admitted that this is an acceptable way to make kale. And both kids liked it too! We could eat 1 bunch of kale at one meal with this recipe.

Kale isn’t a superstar for Nora’s diet, but it is full of wonderful veggie goodness so it’s nice to fit it in. It is very similar to the seaweed snacks that she likes, and made at home.

Find the recipe here, to give a well-deserved nod to the original post: http://www.weeatreal.com/2009/11/roasted-kale-chips.html

To measure it for Nora, I weighed 1 piece of raw kale (which came in at 6 g) and used the nutrition breakdown for that, which was 0.5 carbs (0.1 fiber), 0.2 protein, 0 fat (although the olive oil adds a bit of fat). Because it is baked in this recipe, it becomes like thin paper and the only thing that it loses is water, so the nutrition information from the raw kale should be the same as the baked kale. Please correct me if that is a mistaken assumption.