Cook’s Little Helpers

They say that non-compliance is the main reason that people stop the diet, not lack of efficacy (although it doesn’t work so well for everyone). Non-compliance seems to mean that the kid won’t accept eating like this, but getting compliance must depend heavily on what you are asking the kid to comply with. That puts a lot of pressure on the parent to get compliance. It’s a lot of responsibility. And the best thing we can do for ourselves as parents is to make our job as easy as possible.

Some kitchen equipment just adds a lot of work to your life. Maybe it takes a long time to clean. Maybe it is difficult to get the food in or out. Maybe a recipe makes too many dirty dishes and takes too many steps. Those are the gadgets and recipes that won’t survive the test of time. Weed them out. Let them fall by the wayside, because you have enough work to do.

Here are 3 kitchen gadgets that I’m very happy I found:

(Starting top right): Tovolo Ring Pops, Tovolo Ice Cream Pop Molds, Silpat baking mat

  • Silpat silicone baking mat: I had been using parchment paper or silicone muffin cups for baking individual portions. I felt like some of the fat was left on the parchment paper, and the food didn’t slide easily on the paper when putting the batter down, making it difficult to work with. Making each portion of something small and thick enough to bake on a sheet, like cheddar crackers (pictured, recipe from the Keto Cookbook) just made a lot of dishes to wash. Now, I use one of my little silicone pinch bowls to measure out a 5 g portion of cheddar cracker, transfer it to the Silpat, then measure the next, and so on. Once they are all on the mat, press each down into a small cracker shape. Sounds like a small thing to change this procedure, but when you are making 20 crackers at 5 g each, every little saved motion and moment helps. It costs about $30, which gave me pause on previous equipment buying trips, but it was worth it. Beautiful results, easy to use and clean, and will last forever.
  • Tovolo Ice Cream Pop Molds: I saw these at the store a few months ago but did not buy them because they seemed kind of large and I couldn’t estimate the amount that they would hold. Thanks to Dawn at the ketocook blog, I learned that they hold about 50 g of popsicle each. Making her strawberry popsicles in these are a little on the large side for Nora’s snack and contain a lot of carbs for her in one serving, but she loves them and they are worth planning them into her day. I’ve adjusted the recipe just a bit for Nora to bring down the carbs. At around $10, they are sturdy, fun and wonderful to get a kid happy about her food.
  • Tovolo Jewel Pop Molds are also great fun, but they are less functional. They are made of cheaper plastic and I find them a bit hard to take out after frozen. They hold around 30 g of strawberry popsicle, but because they are different shapes I haven’t wanted to keep track of how much each one holds. The few times I have used them for ice cream, I’ve just made a few of the same weight to keep track. Instead of using them for ice cream, I make CALM lemonade pops with 1 g of raspberry each. The CALM lemonade is a “free” drink for Nora, a mild magnesium-calcium laxative with a bit of lemon flavor, sweetened with stevia. I can keep track of that 1 gram of raspberry, but could be made without it. She can also have a few of them if she wants to because that little bit of raspberry can be easily absorbed into a snack or meal for her (I know some kids are more sensitive and would probably need that balanced out). It’s something I can give to her on demand and she can choose her ring pop shape, which gives her some satisfaction and a small bit of control.

We are still somewhat amazed that Nora is so compliant with the diet, but I think that a few things have contributed to her acceptance. First, we started experimenting with the low-glycemic index approach, then officially started diet treatment with the Modified Atkins (MAD) version of the diet, which meant less immediate dramatic changes to the way she eats. We’ve eased into a stricter form of the diet over time, which has let us experiment and find what works for her. We did not have to learn this whole process overnight.

Our gradual process also allowed us to start with a focus on what she accepted in her diet, rather than starting with a “prescription” diet formulated from the outside. Recipes could be adjusted and new recipes discovered that met the requirements of stricter forms of the diet. Favorite foods could be accommodated or amended. Everything that we presented to her was “sold” with an emphasis on what she likes about it. That is not to say that everything was a hit, but kept a focus on the positive.

Once we were motivated by the diet’s seizure control success and we knew that we were in it for the long haul, we’ve made these small changes and purchases to make everyday life a little easier. We discovered other resources, like the Keto Cookbook and the ketocook blog and started putting more effort into streamlining our process. I have definitely favored “easy” recipes along with favorite recipes.

Compliance should refer to parental compliance as much as child compliance. This treatment is relentless, and it’s all up to the parents. Every day, every snack, every meal. It seems like it never ends (taking a page from Nora’s playbook here). There is always more to learn and more to discover, but what really matters is what works for your kid, both in seizure control and acceptance, and also what works for you, the parent, to get a great meal or snack on the table 3 to 5 times per day. Be kind to yourself and be as easy as possible.

Another Milestone

We are happy to report another milestone in Nora’s diet therapy success: 14 weeks seizure-free–over 3 months! And even better, one week Depakote-free!

She had her last dose of Depakote last Tuesday night, July 24. Since then we have continued with the same bedtime snack and ritual, minus the Depakote “sprinkles.” As we eliminate Depakote, her doctor also wants us to eliminate her carnitine and folic acid supplements; he saw them as combatting the side effects of Depakote, not necessarily the diet itself. She is down from 3 carnitine tablets per day to 1 now, although I think we will keep that one for a while longer, as our supply lasts. Some doctors also use carnitine as a matter of course with the diet itself, and it is a simple dietary supplement that does not have unwanted side effects. We will update the Current Therapy page with the new routine.

Ending her anti-seizure medication mades us anxious, of course. There is extra pressure to be hyper-vigilant with the diet to maintain seizure-freedom. But it also makes me think ahead to the day when we wean her from the diet as well. I imagine even more anxiety and anticipation for all of us, except maybe Nora. She is happy to be done with her “sprinkles” medication, but it’s absence is not a cause of celebration every day now. It’s just the new normal. Just like being seizure-free.

Sometimes Nora says, “I’m going to be on my diet forever.” We also heard this about taking Depakote sprinkles (and cleaning up toys). My strategy is to remind her that it will not be forever, certainly not until the end of her natural life plus all eternity, but it will be for awhile longer. Her four-year-old-self can’t conceive of measures of time like months or years, or all eternity for that matter. After the reminder that it will not be forever, I try to turn the sentiment around for her by emphasizing the good things in her diet, although mentioning seizure-freedom is a little lost on her too. Instead I emphasize the good parts of the diet that she does experience every day, and last week I got confirmation that it works sometimes:

Nora [whining]: I’m going to be on my diet for-EV-er.
Christy: It’s not forever, darling, but it is awhile longer. And just think of all of the good things that you have on your diet. You like your PBJ muffins, right? And cheddar crackers?
Nora: Yeah. Will you still make me PBJ muffins when I’m done with my diet? And cheddar crackers?
Christy: Of course I will. They are really good, aren’t they. I like them too.

Nora helps mix up a batch of PBJ muffins

Except when she is off the diet, I will not mix the peanut butter down with an equal amount of butter. And I won’t weigh out 5 g portions before baking the cheddar crackers; I will just plop down little blobs of dough on the baking sheet. That will be a good day. And I will share some too.