Monthly Archives: October 2012

Chocolate Chip Keto Ice Cream Pops

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After adding this to the list of Nora’s Top 15 foods, I realized I may be over compensating a bit. Does anyone else get a homemade chocolate chip ice cream pop almost every day?

But her devotion to this snack is an indication of just how good it is. I tasted the un-frozen vanilla ice cream mixture when I was making it last time, and it is even better than commercial vanilla ice cream in my opinion; more creamy and less sweet. Add in the Green & Black’s 85% Dark Chocolate, and it’s decadent.

You might wonder how Nora gets to eat something like fancy chocolate. The answer lies in the nature of a good chocolate bar: it’s cocoa, sugar and cocoa butter (fat) plus a bit of other ingredients for texture. The darker the chocolate, the more cocoa and less sugar is added into the chocolate bar. The darker and fancier the better! And the cocoa powder in the bar actually has a bit of fiber! Nora’s 4 g of 85% dark chocolate has 1.1 g of net carbs. To compare, 4 g of Green & Black’s Milk Chocolate has 2.3 g carbs, twice as much. Granted, one square of chocolate is about 4 g, and 1 of those per day delivers just over 10% of Nora’s carbs for the day. But what a nice way to have your carbs, no? If it were me, I’d pick the square of chocolate too.

The fancy chocolate also comes in a vanilla ice cream package, enough to boost the ratio to almost 4:1 per ice cream pop.

Happy ice cream eaters! Anders get some of the standard ice cream recipe which I put into the ice cream machine to freeze. With sugar, it works like a charm. I create the chocolate chips by melting about 8 squares of chocolate, then drizzling it into the top of the ice cream machine while it is still churning and almost frozen. Mmmmm.

Making this kind of rich custard-style ice cream is a time intensive process, so I will walk through the steps. I simultaneously make 1 quart of Nora’s ice cream and 1 quart of the regular sweetened ice cream for the rest of us (be prepared by buying an extra 2 pints of heavy cream and an extra dozen eggs). But Nora’s quart lasts a whole lot longer. I can get 18 pops out of Nora’s recipe. That’s almost 3 weeks worth of ice cream if she eats it almost every day. I can usually space it out over about 1 month, although there is complaining on non-ice-cream-days.

This is the Vanilla Bean Ice Cream recipe, adapted from David Lebovitz. When I add 4 g of Green & Black’s 85% Dark Chocolate, the nutritional information becomes 1.89 g carbs, 1.68 g. protein, 14.01 g fat, 0.4 g fiber. You can adjust the final numbers by choosing a more or less chocolate or a different addition for flavor.

Vanilla Bean Keto Ice Cream. Nutritional analysis by www.caloriecount.com

Vanilla Bean Keto Ice Cream
250 ml (1 cup) whole milk
500 ml (2 cups) Organic Valley heavy cream
102 g (6 large) egg yolks
3/4 teaspoon vanilla extract
1 vanilla bean
Pinch of salt
No-carb sweetener as desired (I use a bit of Nora’s Cytra-K)

 

 

 

Plenty of Nora recipes call for egg whites, but you can also freeze them in ice cube trays and use them when you need them. They freeze very well.

Gently warm the milk, 250 ml (1 cup) of the cream and salt in a medium saucepan. Scrape the seeds from the vanilla bean into the warm milk and add the bean as well. Cover, remove from the heat, and let steep at room temperature for 30 minutes.

Measure the egg yolks. One benefit of doing 2 batches at the same time is that any extra yolk from the keto batch can be added to the conventional batch. You will be left with a lot of whites, so have a plan (see picture).

In a separate medium bowl, whisk together the egg yolks. Slowly pour a bit of the warm milk and cream mixture into the egg yolks, whisking constantly, then scrape the warmed egg yolks back into the saucepan.

Pour a bit of the warm cream mixture in with the egg yolks and combine, then dump back into the pan to cook.

Stir the mixture constantly over medium heat with a heatproof spatula, scraping the bottom as you stir, until the mixture reaches 170 degrees and thickens to coat the spatula. I use an instant-read thermometer to be sure that it reaches a safe temperature, because this is the only time you will cook the egg yolks before they will be consumed. This step takes at least 5-10 minutes, so be sure that your children are occupied. It would be a pity to burn this glorious mixture. When I make 2 separate batches, I do not cook them simultaneously. One at a time. Ice cream is too important to rush.

Strain the mixture to capture the vanilla bean shell and any egg white solids that hitched a ride in with the yolks. It won’t hurt to leave them in, but you might find the funky texture occasionally if you don’t strain it out.

Meanwhile, put the remaining 250 ml (1 cup) cream into a large bowl with a fine mesh strainer on top. After reaching 170 degrees, pour the custard through the strainer and stir it into the cream in the bowl (see picture). Add the vanilla extract and any desired sweetener, and stir until cool over an ice bath or put into the refrigerator immediately to cool and stir periodically while cooling. Chill thoroughly.

At this point, I just put the keto version of the ice cream into the freezer and stir throughout the day. Because it doesn’t have any sugar, it still has a higher freezing point so it will immediately ice and collect on the sides of the ice cream machine. It just doesn’t work. Even if you were to stir constantly, it would freeze solid and never get that scoopable ice cream texture, so why bother? I just try to break up the ice crystals periodically as they are forming by stirring periodically and keeping the vanilla beans suspended throughout the mixture for flavor.

When the ice cream is semi-frozen you can weigh it out then create the chocolate chips in each serving. This can be a few hours after you’ve initially frozen it, or you can take it out of the freezer anytime and let it soften until you can get some out of the container. I do 4 pops at a time, so it gets frozen and softened several times before the final pops of the batch are eaten. It does not seem to effect the quality of the ice cream.

First, weigh out 44 g of the ice cream (according to my calculations–you could re-calculate for your purposes).

Next, weigh out 4 g of Green & Black’s 85% Dark Chocolate (or other according to your calculations) in a small silicone pinch bowl. The bowl must be completely dry, or else the chocolate will seize when heated. Microwave for 20-30 seconds and it will be completely melted. Be careful, because the bowl may be hot when you remove it from the microwave.

Drizzle the chocolate over the bowl of cold ice cream. It will solidify again when it hits the cold ice cream. Then you can mix it up, breaking the chocolate apart more and making chips!

You could certainly serve it just like this. Nora likes to see the chocolate on the top. But to make several servings at a time it’s nice to make them into ice cream pops. The pops also avoid the too-solid vs. too-liquid states of keto ice cream. It just doesn’t get that nice in-between-liquid-and-solid state of conventional ice cream with sugar (I discussed this issue in a previous post, so we find ways to work with the properties that we’ve got (which is frozen solid) instead of working against it.

After you have drizzled the melted chocolate on the cold ice cream, mix to incorporate, breaking the chocolate further into the “chips” familiar from commercial ice cream. Finally, you have a bowl of chocolate chip ice cream. Re-freeze for a bit and serve with a spoon (if you freeze it solid again you will have to let it soften before serving). Or scrape it into ice cream pop molds to serve later. These are Tovolo molds, made to look like an ice cream cone! They hold up to about 52 g of ice cream, in my experience, and work well with the 48 g of ice cream here. I make up 4 at a time, weighing and mixing them one after the other, so that they are ready to take out of the freezer on demand. And they are in demand!

 

 

6 months seizure free!

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It’s Nora’s 6 month seizure free anniversary!

We had the Charlie Foundation’s Silver Dollar Pancake recipe for dinner, with berries and cream. This is a gem of an original recipe. Mmmm, macadamia nuts. They are a decadently delicious gluten-free alternative for pancakes if you haven’t tried them yet. Nora is not deprived in the least.

To mark the occasion I also made bacon. Mmmmm, bacon.

For those keeping score at home, this meal was:
35 g Silver Dollar Pancake batter
16 g Wood Family Farm smoked bacon
10 g strawberries (warmed from frozen)
10 g raspberries (warmed from frozen)
15 g cream (1 T, spread on pancake)
1 gelatine Cytra heart + 1/2 T cream
Sleepytime Vanilla Tea (no carb)

Nora licked her plate clean. The rest of us had buckwheat pancakes because macadamia nuts cost a fortune and I still had some mix to use. Although we were out of syrup, so we had berries and applesauce on top.

Happy pancake eaters!

 

Fiber Roll Tips

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When we were living in Norway, we took a trip way up north to Tromsø, a beautiful city that is home to the world’s northernmost university and beer brewery, and where we saw the most spectacular display of the Northern Lights. We travelled with some other exchange students from Germany, a few from the former East Germany. One of the interesting observations we made of the Germans was their method for choosing bread. They went around the bread section of the grocery store looking for the heaviest bread in the smallest package, in other words, the densest bread possible. Note that we were in Norway, where bread was already dense and hearty by American standards. But they were horrified that we ate the goat cheese (geitøst), so we learned to respect our differences.

Making fiber rolls for the first time reminded me of the Germans, which isn’t a good sales pitch for fiber rolls. The bad news is, when Nora first looked at the fiber rolls, her reaction was, “yuck!” The good news is, when she tasted them her reaction was “yum!” They are so tasty and bread-like that the density didn’t turn her off on the first attempt. On the second attempt I changed my procedure and made them lighter, and now they are in the list of Nora’s Top 15 Foods.

Dawn Martenz at ketocook.com is the keto-genius mom behind the recipe. I didn’t even think about attempting keto-bread, but Dawn came up with a clever combination of ingredients that really works. Her instructions are simple and easy to follow, but if you are a scattered mama like me, it might not occur to you that the procedure for making these rolls will matter a lot to the outcome. Here I will share my more detailed procedure for maximizing the rise in the rolls to create the illusion of more bread and more surface area and air pockets for spreading butter!

The Fiber Roll Recipe is approved by the Charlie Foundation and can be found at http://www.charliefoundation.org/recipes/item/978-high-fiber-rolls.html. The psyllium husks can absorb liquid, including oils, so it can carry an amazing amount of fat without feeling greasy. The original recipe gives several ratio options; I use the 3:1 ratio. The recipe also notes that the recommended daily intake of psyllium husks for children ages 6-12 is 1 tsp, or 3 g. Because Nora is only 4, I divided the recipe into 6 rolls instead of 4 to reduce the psyllium husks to 2 g per roll. Therefore, the nutrition label that you see below reflects those changes to the recipe. Each roll contains 18.4 g of dough.

Nutritional Information for Fiber Rolls, 3:1, 6 servings. Analysis by www.caloriecount.com.

Fiber Rolls, 3:1 (6 servings)
50 g egg
24 g olive oil
4 g apple cider vinegar
5 g water
12 g Whole Psyllium Husk (bought as a fiber supplement at natural food stores)
13 g Flaxseed Meal
1 g baking powder
1 g baking soda
pinch salt and dried thyme

Preheat oven to 300. You definitely want your oven preheated when the rolls are ready to pop in, so turn it on before making the rolls.

Mix egg, oil, vinegar and water very well. Add the psyllium husks and let the dough rest and stiffen to the consistency of oatmeal. This is where I deviate from the original recipe, and here’s why. It’s food science time.

Yes we did do the volcano a few summers ago, and it was underwhelming. But it did very slowly engulf the Lego Star Wars villans in it’s watery pink lava. Mission accomplished.

Normal bread rises because of the action of yeast eating up the sugars and releasing carbon dioxide into the elastic glutenous dough. That takes some time to accomplish and the gluten can take the stretch, which is why you let dough rise. But these rolls are not elastic and not using yeast; they are a “quick bread,” in part using baking soda and vinegar to create the air bubbles in a fast-acting chemical reaction that is over in less than 1 minute. Remember making a “volcano” explode in school, or with your kids? You mix together baking soda and vinegar and it poofs the liquid out of your volcano by releasing carbon dioxide bubbles. But that reaction doesn’t last very long–you put the ingredients together, it fizzes out of the volcano, it’s over in a flash, and you are left with a watery mess that will take 10 times as long to clean up than the cheap entertainment it provided. Imagine that happening inside your fiber rolls.

The recipe also calls for baking powder, which has slow-acting chemical leavening agents that work when heated. That’s why you have the oven pre-heated. You want to take advantage of that fast-acting reaction between the baking soda and vinegar, getting it into the oven to cook, trap the air inside the rolls, and get the baking powder action to continue to hold it up while it solidifies. That’s how you get the maximum air into your fiber roll bread. But it requires you to act fast.

Notice that you didn’t put the baking soda or baking powder in with the psyllium husks and liquid ingredients in my instructions; you are keeping them away from the vinegar to minimize the amount of time between starting that chemical reaction and getting them into the oven. The original recipe says to put everything together and let it sit for 5 minutes to absorb the liquids, but it will take at least 5 minutes to weigh out your rolls. By allowing the psyllium husks to absorb the liquid first, you don’t let the chemical reaction blow itself out before you get the rolls in the oven. That was my mistake the first time. After I changed my procedure, the rolls were at least 50% bigger and much airier.

The dough before it goes into the oven.

Back to the recipe instructions:

While the psyllium husks are absorbing the liquid, in a separate bowl mix together the flaxseed meal, baking soda, baking powder, salt and thyme (or other dried herb of your choice for flavor). This is your dry mixture. When the psyllium husk mixture is thickened, quickly stir in the dry flaxseed meal mixture. Don’t wait–weigh out the dough for each roll, 18.4 g in my recipe making 6 rolls. They don’t need any extra handling, just ball them up gently. Put them on to your baking sheet lined with parchment or silicone baking surface, and into the oven as fast as possible!

Bake 30 minutes.

See the air bubbles? Good for holding more butter! It has the texture of a hearty bread and a nice flavor from the flax seed.

Not only is it amazing to make a satisfying bread with 0.2 net carbs (in my 6-roll version), but getting it at a 3:1 ratio without feeling heavy or greasy is astounding. We can make a meal with a buttered fiber roll and several other moderate-ratio ingredients and you would never think so much fat would be hiding in there.

And Anders likes them too! I  know that we have several readers that are using the Modified Atkins Diet or who have low-carb and/or gluten-free diets for other health reasons. Here is the recipe for the MAD version at a 1.25 ratio in standard US measurements. If you want the short version of the instructions, see below. Only the measurements of the ingredients are different.

Nutrition for 4 Everyday Fiber Rolls at 1.25:1 ratio (MAD version). Analysis by www.caloriecount.com. Net (effective) carbs = 0.2 g per roll.

Everyday Fiber Rolls
1 large (50 g) raw egg, beaten
1 tsp (4 g) olive oil
1 tsp (4 g) apple cider vinegar
1 Tbsp + 1 tsp (25 g) water
2 Tbsp (12 g) Whole Psyllium Husk (bought as a fiber supplement at natural food stores)
2 Tbsp (13 g) Flaxseed Meal
1/4 tsp (1 g) baking powder
1/4 tsp (1 g) baking soda
pinch salt and dried thyme

Preheat oven to 300 degrees.

Thoroughly combine egg, oil, vinegar and water. Mix in psyllium husks and let it absorb the liquid until thickened.

Meanwhile, combine the flaxseed meal, baking powder, baking soda, salt and herbs in a separate bowl and mix well.

Quickly incorporate the flaxseed meal dry mixture with the thickened wet mixture. Quickly form into desired number of rolls (4 in the original recipe at 28 g each, if you are measuring). Place on parchment lined baking sheet or silicone baking surface. Bake for 30 minutes.

Enjoy fresh from the oven!

 

Nora’s Top 15 Foods

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If you’ve followed Nora’s Special Diet, you know that I try out a lot of recipes. Some of them are one-hit-wonders. Some will come back for a special occasion or a change of pace. They’ve also been following seasonal availability of different vegetables over a year of the diet. But I thought it would be useful to peruse Nora’s daily food log and see what she eats on a regular basis and share that with you.

If you are thinking about the starting the diet or moving from Modified Atkins to a higher ratio, I find it helpful to think about the great foods that you CAN eat on the diet instead of all of the things you can’t eat. So many creative cooking parents have made great substitute for kids’ favorite foods, so eating keto doesn’t seem so weird after all! Nora’s list is a mix of regular natural foods right from the grocery shelf and great recipes created by parents. As always, double-check the nutritional information on the products you use and check with your dietician when in doubt.

I was also guided by my recent experience of being away from home for a few days in the last month, so I made sure that Ted had the go-to foods so that he can easily pull together meals while parenting 2 kids. It turned into a “top 15” list which is not particularly elegant, but I couldn’t exclude anything that made the cut, and couldn’t think of any more! Ranked unscientifically by my intuition about the frequency, ease, and deliciousness of each food. Drumroll, please………….

#1: B^3and 8 g apples

Our B^3 recipe has evolved since the original post, but I don’t think it’s particularly useful to post the changes. We’ve just jiggered the proportions as Nora’s ratio has increased and added coconut oil. This is her daily morning snack, also delivering her daily vitamin supplements.

1 snack serving of B^3 and 8 g apple. The silicone bowl we use is on the right and the tablespoon and apple are for size reference.

It is worth explaining how Ted has changed the B^3 portioning procedure to make it more efficient. He has taken over the B^3 lately and his way is pretty clever. First, liquefy the B^3 by warming it up (placing the container in a bowl of hot water works well). Measure each portion by pouring into a smooth-sided small silicone bowl. It’s darn nice to have about 7 or 8 of these. Crush each day’s supplement with a mortar and pestle and mix into the liquefied B^3. Place the silicone bowls in the refrigerator until hardened. Pop them out of the bowls and into a container–they will hold their shape! Dole out 1 per day with the appropriate amount of apple, 8 g for Nora to get her 3.5:1 ratio snack. No more daily crushing of vitamins. Save it for your weekend fun.

And this is a MUST HAVE snack for Nora. Don’t you mess with her PB and apples. The practicality plus frequency and love is why it’s #1. She is still capable of major meltdowns, and missing this morning snack has been grounds for a major meltdown. We can now substitute 12 g of carrots for the apples if Anders has eaten us out of our apples supply (which happens regularly).

#2: Flackers

Fabulous food, fabulous name: flax+crackers=flackers. They are simply pressed, baked flax seeds. We can buy them in the store and they are ready to go. Nora likes the rosemary version. I have not looked at the nutritional info for the new flavors (currant sounds good and carbier). Nora gets about 8-10 grams with a meal, at least once per day, which is about 2 crackers (they are about 4 g each but we weigh it out on the gram scale). Per gram of flacker, they have 0.04 g carbs, 0.2 protein, 0.3 fat, and 0.28 g fiber. By themselves, they are a 1.33:1 ratio and will hold 4-5 g of butter each to bring up the ratio of the whole meal. They have been with us since the beginning and we are addicted to Flackers.

#3: Bandon Natural Medium Cheddar Cheese

Who doesn’t love cheddar? Ok, the lactose intolerant and dairy allergies among us. Sorry. But for a kid who loves dairy, it has no carbs, 1.3:1 ratio of fat to protein. Chunks of cheddar for protein in a meal is easy, or shred it to top other foods.

#4: Olive Tapenade

We found a brand of kalamata olives (Peloponnese) with a 4.5:1 ratio so we are sticking to it. I have been surprised about the variation in the nutritional information on kalamata olives, so I think the brine must be important to the carb count. We serve the pitted kalamatas on their own as part of a meal, but I also made a recipe for Olive Tapenade with a 7.9:1 ratio because of the extra olive oil. It’s great to serve with Flackers and other lower-ratio foods to get the meal up to 3.5:1. I will post it soon!

#5: Tuna salad

I use Sea Star Tuna direct from the Oregon Coast and highly recommend using very high-quality canned tuna steaks. They are more expensive than your “chicken of the sea” variety, but I think it’s worth it for flavor and texture. We mix it with full-fat Greek yogurt and English Double Devon Cream because we don’t like mayo at our house, but there are plenty of recipes out there with mayo if you prefer. Nora eats it with a spoon.  My version is 2.1:1 ratio, but we sometimes stir in a little more butter to boost the ratio and Nora doesn’t notice the difference. I will also post our Tuna Salad recipe soon.

#6: Strawberries & Raspberries

I’m grouping them together because they have the same carb profile in our calculations (0.06 g net carbs per gram of berry) and we use them almost interchangeably (which is not true of blueberries, which have twice the carbs per gram of berry at 0.12 g net carbs). Fresh or frozen, Nora eats between 12-20 g of berries for a bedtime snack with her steamed cream and coconut oil every night. She often gets some berries with meals as well, and they are a incorporated in many other recipes.

#7: Steamer Creamer

Many keto kids drink heavy cream as a major source of fat. We use Organic Valley Heavy Whipping Cream, as our dietician said it is the only major brand that consistently has no carbs. Each tablespoon delivers 6 g of pure fat. To be sure we get all of the fat evenly distributed, we dump the carton into a pint mason jar and mix in any fat that congealed at the top or stuck to the sides. We put cream into Celestial Seasonings Sleepytime Vanilla Tea (carb and caffeine free) to accompany some meals. In the beginning, we heated it in a pan with a little cocoa powder for hot chocolate, or heated it in the microwave. Until…

One day we were visiting our friends Cora and Mike, who have a fancy espresso machine. They steamed Nora’s cream and she declared, “this is REAL hot chocolate!” Mike and Cora had been considering getting an even fancier machine, and we relieved their guilt and gave them a reason to buy the new one by taking their old one as a hand-me-down. Now Nora gets steamed cream every night, with coconut oil and a crushed calcium tablet mixed in. The steaming does a nice job of emulsifying the additions, and you can add a drop of vanilla flavoring or a touch of cocoa powder for flavor as well, but she doesn’t mind it straight up. Lately Ted has put 1 piece of her strawberries in for flavor.

And mama gets espresso at home: win-win-win. Thanks Cora and Mike.

#8: Avocado

Nature’s wonder keto food: 3.62:1 ratio, high in fiber and fat, low in carbs. Cut, weigh and eat. Comes in bio-degradable packaging.

#9: Red Pepper

Or orange or yellow, Nora’s not a fan of green. High in flavor and fiber and low in carbs (lower than berries at 0.04 g net carbs per gram of pepper). Nora probably averages 14 g of red pepper per day, which is about 2-3 spears for the rest of us. It’s a little package of vitamins and yum that really makes a meal feel normal and healthy.

#10: Fiber rolls

Roaring into the “top foods” category are little dinner rolls of “bread!” And any ratio! I make the 3:1 version. And 2.5 g fiber! Developed by keto-mom extraordinaire Dawn at ketocook.com, approved by the Charlie Foundation, gluten-free and really delicious. Even Anders agrees. Last time I made them, he saw one on Nora’s plate said whined, “awww man, why does just Nora get one? Can I have one too?” Honestly. I’m going to post an ode to fiber rolls with my tips on getting them to rise to their fullest.

#11: Cytra & Cream Gelatin Hearts

Nora gakes 2 packets of Cytra-K crystals each day, dissolved in about 2 cups of water and served at meals. It is a prescription formula of potassium citrate to combat high blood acid levels that are a side effect of the diet. The crystals are flavored with saccharine and colored with red dye. As you can tell by my “top foods” list, I would normally not include this in Nora’s diet but the alternative is to make her drink baking soda water. We tried that, and it’s horrible.

Nora loved her Cytra drink at first (it’s pink and sweet!) but it has lost its shimmer after drinking it daily. Lately she is thrilled when I make it into gelatin snacks in her heart-shaped molds. She gets 3 Cytra gelatin hearts per day with meals, with cream mixed in for an easy delivery of fat. Unflavored gelatine is pure protein, so it’s easy to incorporate into the diet. Again, I will post that recipe soon too.

#12: PBJ Muffins

This is a recipe from the Keto Cookbook. I adjusted the recipe (see link) for a 3.5:1 snack for Nora. In the Keto Cookbook, they use 1 batch as a 400 calorie meal. I weigh out the muffin batter so that they are all the same, and make it into a 110 calorie snack. No need to weigh the muffins, just grab and go (although we do have to weigh the topping of PB/butter and berry, less convenient). I make a few dozen at a time and freeze some. This is one that Nora has requested to eat even after her diet is over, and I agree. They are delicious.

#13: Cheddar Crackers

Cheddar Crackers

Also from the Keto Cookbook. I weigh out 5 g of batter for individual crackers and dole out the number of crackers that work in a meal or snack. We have quantified them on a per-cracker basis in our database rather than by the gram, because they are pre-measured (so convenient). I have made up to 60 crackers at a time, and frozen some for later use. I use the original 4:1 ratio in the recipe, so I can add another low-ratio foods, like some berries or some cheddar cheese to balance out a meal or snack. Again, this is one that Nora and I will continue to make after the diet is over. Then I will also be free to eat them and no pre-weighing! I admit to snacking on a cheddar cracker now and then, but I know I have to save them for Nora.

#14: Keto Pizzas

And another hit from the Keto Cookbook! I make 4 pizzas at a time when I have the ingredients out. Nora has 1 for dinner and I freeze the other three. Pull one out of the freezer and put it in a 400 degree oven for 5-10 minutes. Happy Nora, happy mama on a night when I just don’t want to cook or when we have a babysitter. It’s pretty much perfect for a whole meal.

#15: Chocolate Chip Ice Cream Pops

This one made the list because Nora is demanding one for every afternoon snack lately. And who can blame her? They have chocolate chips made with fancy 85% dark chocolate and the ice cream is made with real vanilla bean. They are a labor of love, but I’ve figured out how to make a big batch so I don’t have to do it so often. And I make a batch of ice cream for the rest of us at the same time. It’s win-win again! Recipe and procedure to be posted soon!

I’ve promised you 4 recipes: Olive Tapenade, Tuna Salad, Cytra-Cream Gelatin Hearts, Chocolate Chip Ice Cream Pops, and my tips on Fiber Rolls. I really wasn’t trying to hold out on you, honest. I’ll get right on that. Ted has also been scheming a post with the daily routine. He has been putting together Nora’s lunches in preparation for days when we are at work.

And as an aside, we’ve noticed that Nora’s diet is almost 100% gluten free by default. Macadamia nuts are the secret ingredient in the baked goods. She used to eat a low-carb, high-protein tortilla, but she hasn’t wanted it lately and the last time she ate one, she had a rash on her face the next day. We are keeping an eye on that and will try an elimination diet approach: remove all gluten again for several weeks until her face is clear and offer gluten again to see what happens.

Finally, here is a typical meal and the breakdowns to get a sense of a meal with these foods. Seven out of the 15 are here, plus butter (which is a daily thing but didn’t deserve to make a “top food” list). Values all in grams. This was lunch on October 6: 350 calories, 2.5 g net carbs out of 10 g total for the day.

Food Net Carbs Protein Fat Fiber Ratio
Fiber Roll 0.20 1.50 5.30 2.50 3.12:1
6 g butter 0.00 0.00 5.14 0.00 —
2 T (30 ml) heavy cream 0.00 0.00 12.0 0.00 —
14 g avocado 0.30 0.28 2.10 0.70 3.62:1
14 g kalamata olives 0.93 0.00 4.20 0.00 4.50:1
18 g cheddar 0.00 4.50 5.79 0.00 1.29:1
20 g strawberry 1.14 0.00 0.00 0.29 0.00
1 Cytra gelatin heart (no cream) 0.00 1.00 0.00 0.00 0.00
Totals (g) 2.58  7.28  34.53 3.49 3.50:1

And for the visual (cream not pictured):

 

 

More thoughts on latest doctor’s visit

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I love Ted’s graph! A year ago at this time we were in the worst place for Nora, through October and November until we started trying the Modified Atkins Diet in December of 2011. We are so thankful that everything fell into place as it did: Dr. Wray joined Doerbecher Pediatric Neurology and started the ketogenic diet program (which was almost non-existant before then) just when Nora decisively failed her 2nd drug trial (first Keppra, then Depokote).

Dr. Wray was clearly delighted with Nora’s progress. When we discussed the “what if” scenarios of either a return of seizures or when she should be weaned off the diet, he said, “at this point, I’m learning about the diet from Nora. She’s teaching me.” He has never had a patient with myoclonic seizures that is doing as well with physical and cognitive development, and she is probably responding to the diet better than any other patient he has had on the diet. Nora is a mystery and we can only wait and see what unfolds for her. We can only be thankful that we are on the good side of this mystery.

And although she is only 4, he offered to relax her ratio if and when she is having trouble with compliance. With her great seizure control so far, he said that the ratio can be an open conversation between Nora and the rest of us. She’s happy, so I have no need to experiment to see what happens. As long as we can keep her happy and healthy on the diet, I’m happy keeping the 2 year clock ticking.

He was also pragmatic about when we start counting the 2 years. He said that she was responding to the Modified Atkins Diet last December, so he would potentially start counting from last December, even though she wasn’t seizure free until mid-April.

I have been very pleased with Dr. Wray’s pragmatic approach. We are all on the same team. But Ted and I are going to be extremely conservative on this. As long as Nora is happy and seizure free, I expect her to be in the diet at 3.5:1 until April 2014. If we have some indication that we can stop earlier or start reducing the ratio, all the better. If Nora gets ill or unhappy with the diet, we can reduce her ratio and see what happens. If she has a breakthrough seizure, we can hold the course or increase to 4:1. Decent drugs are still on the table if necessary. It’s good to know that we have somewhere to go. We have options.

After the Charlie Foundation Symposium, I came home wanting to know the underlying cause of Nora’s epilepsy even more strongly. If we know the cause, it will tell us something about why the diet is working for her and whether she is likely to develop out of it in 2 years. If we knew that the cause is something that she won’t grow out of for a long time, or ever, we can prepare ourselves and avoid the trauma of trying to go off the diet and finding out that she needs to stay on. So we will keep looking and learning. Until then, we are thankful for our good fortune of trying the diet early and keeping our fabulously unique, sharp and creative Nora.

I’m glad that Ted talked about advocacy, because now that Nora is out of crisis mode we are moving into advocate mode. I’m so glad that we started this blog, after so much encouragement from friends and family. At Nora’s last appointment with Dr. Wray, we also proposed starting a parent support group at Doernbecher Children’s Hospital in Portland. We’ve heard that this is the only keto diet program between Seattle and San Francisco, and there is no parent-to-parent support system. We felt alone when we started, but this is so much easier if we share the burden. We can reduce the start-up burden of the diet and help parents quickly surmount the learning curve, so they can move from difficult-diet-with seizures-mode into tedious-diet-routine-reduced-seizures-mode. It’s high investment, high reward if it works: saving your kid’s brain.

At the Charlie Foundation Symposium, there was a paper by Claire Chee, RN, at the Children’s Hospital of Philadelphia. We need our wonderful pediatric neurologists and dietitians on our team, but as Ms. Chee said: “We are the ‘professionals;’ parents are the ‘experts.'” We have the deepest gratitude to all of the other keto parents who have commented on our blog, giving us encouragement. Thanks for being on our team too. And thanks for including us on your team. We are here for you.

Neurologist visit and update

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Last Friday we went to visit Nora’s pediatric neurologist at Doernbecher Children’s Hospital in Portland.  The visit went well and I certainly get the feeling the medical team there is delighted to see Nora doing well.  I imagine that is both for her sake, and also as a welcome break from dealing with parents and patients that are still struggling, or just starting down the hard road of developing epilepsies and the hunt for seizure control.

Nora is doing very well.  She is about 5.5 months free of tonic clonics, and about 6.5 months free of myoclonics.  She is now 3 months off of anti-epileptic drugs, with the diet (and several supplements) as her only treatment.  Her physical skills and development are normal.  Her vitamin D excess has resolved itself (or was a faulty test result).  Her blood is still a bit on the too-acidic side, but the doctor felt that more potassium-citrate (Cytra) would probably not correct it, and since she is feeling fine, there is no need to treat it.  Because she is doing so well the doctor offered to try her on a lower ratio!  I was very surprised by this.  It’s an intriguing possibility, but both Christy and I feel that since Nora is healthy and having no issues with diet compliance, we’ll hold steady at 3.5:1 for the time being.  But it is nice to know that our medical team is open to trying a lower ratio should we run in to any compliance issues or blood acidosis issues.

We also had an interesting discussion on what would we would do if Nora had breakthrough seizures.  The doctor said that first, he wouldn’t necessarily escalate her therapy if there a few breakthrough seizures.  And he wouldn’t necessarily re-start the two year seizure-free clock!  (All this of course depending on the severity and number of seizures.)  This is a very interesting point.  To give you some background, one of things doctors and families strive for in epileptic kids is to get them two years of seizure freedom.  Exactly two years is of course a somewhat arbitrary guideline (e.g., why not 1.75 years, or 2.5?) but it is a fairly ubiquitous standard across pediatric epilepsy.  If a kid can go two years seizure free, there is (statistically speaking) a very good chance he or she will remain seizure free, even off of anti-epileptic therapy.  But this two year goal has a funny affect on parents: when you are in a period of seizure freedom, you fear not only the return of the seizures for the sake of your child’s well being, but also the “restarting” of the clock.  It’s the boulder of Sisyphus tumbling back down the mountain.  Each week, each day, each hour of seizure freedom is so hard-earned.  There is so much energy and work and stress invested in getting to that two year goal.  To have it start over can feel like such a defeat.

But for keto kids, the expectation from the start is that they will be on the diet for only a finite amount of time.  A typical course of treatment is 6 months to 3 years, depending on the age of the child, the efficacy of the diet and the cause or type of epilepsy, if known.  Also, most keto kids are on the diet for the very reason that they have not had complete success with drugs.  This all comes together to make a more fluid and complex treatment timeline than the “two years of Keppra and you’re done” route that some kids take (to paraphrase our first pediatric neurologist).

So our plan for now is, in the event of breakthrough seizures: hold the course to see if it is just a transient (e.g., diet administration error).  If the seizures persist, increase the ratio.  If the seizures still persist, try Lamictal.  (Honestly it would feel like a major setback to put her back on a drug, but it does comfort me a bit to learn that Lamictal is not too bad.  It has a rare but severe reaction you have to watch for initially, but otherwise it seems people tolerate it well.)  It is comforting to know we have a reasonable plan in place in the case of a relapse.

The doctor said another interesting thing: that there are not many kids in the world like Nora.  There are not many kids that have drug resistant myoclonic seizures without accompanying cognitive and physical problems.  It is a bit of a mystery, but after so much bad luck with Nora, we are grateful for this bit of good luck.  In fact, the doctor said he would consider further genetic testing on Nora and compare her with the very few other kids like her to see if there is some common genetic cause for their unusual course.  I also wonder if Nora benefited from getting her on the diet quickly.  Perhaps she would have developed more cognitive and physical problems if we chased her with drugs for years before turning to the diet.  In an interview with Jim Abrahams, he laments this: that although the diet was miraculous for his son, he wishes they had known about it sooner in the course of his treatment.

Hopefully as the medical community learns more, they can quickly identify metabolic therapy candidates and get them on it right away, instead of turning to it as a last resort after years of seizures and failed drug cocktails.  There is some advancement on this already.  In some epilepsy centers, the ketogenic diet is the first line of treatment for a very serious and severe form of epilepsy known as Infantile Spasms:  http://www.hopkinschildrens.org/tpl_news.aspx?id=5324 and http://www.youtube.com/watch?v=_1Jia_2HAp0.  In this type of epilepsy early diagnosis and treatment with the ketogenic diet can effectively “cure” the epilepsy.

Let me reiterate that we advocate the diet assuming it is the right therapy for a given patient.  In many cases, modern drugs will provide good control and effective treatment.  We advocate the increased acceptance and use of metabolic therapy for patients that are good candidates for success, and that doctors consider trying it earlier in the treatment, instead of as a last resort.

Back to Nora though: we are ecstatic to be where we are.  One year ago, Nora was having many seizures from week to week, and I was a wreck.  But we fought and pushed and although much uncertainty remains, we have come so far.

Here is her updated chart.

Seizure free for almost 6 months.   Diet ratio was nominally 3:1 from Jan 2012 through April 2012.  It has nominally been at a 3.5 ratio starting at the end of April; we have not recorded the actual daily ratios.