Author Archives: Christy Anderson Brekken

About Christy Anderson Brekken

In no particular order... Instructor and Researcher, Department of Applied Economics, Oregon State University. Educational background: University of MN Law School, 2005. MS in Ag and Resource Economics, Oregon State University, 2011. Teaches: Agricultural Law, Environmental Law. Mother: brilliant 9 year old boy; brilliant 6 year old girl with benign myoclonic epilepsy on a modified ketogenic diet therapy. Married to: Ted Brekken, OSU Department of Electrical Engineering. Ride: Xtra-cycle Edgerunner with kid seat; 400-pound cargo capacity. Grew up: Devils Lake, ND. Lived in: Minneapolis/St. Paul, MN, Pohang, South Korea, Trondheim, Norway, Corvallis, OR. Interests: Cooking, knitting, eating, yoga, laughing, hiking, traveling, staying sane.

Another Milestone

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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.

I scream! You scream!

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[Everybody now!] We all scream for ice cream!

Guess what! Ice cream is primarily made out of a main ingredient in the keto diet–heavy cream! Yay! And now the sad news: to be scoopable, the way ice cream should be, it needs sugar. That’s right, the big no-no. So how to make keto ice cream? This is where I have most read and enjoyed learning about food science. This blog entry should be called, “my mediocre attempts at making keto ice cream that Nora loves anyway.”

Harold McGee’s epic tome, On Food and Cooking, gives my favorite description of the pleasures of cream:

We value cream above all for its feel. Creaminess is a remarkable consistency, perfectly balanced between solidity and fluidity, between persistence and evanescense. It’s substantial, yet smooth and seamless. It lingers in the mouth, yet offers no resistance to teeth or tongue, nor becomes merely greasy. This luxurious sensation results from the crowding of the fat globules, which are far too small for our senses to distinguish, into a small volume of water, whose free movement is thus impeded and slowed. (p. 27-28)

Ice cream is a dish that manages to heighten the already remarkable qualities of cream. By freezing it, we make it possible to taste the birth of creaminess, the tantalizing transition from solidity to fluidity. (p. 39)

Doesn’t that make you want a perfect pint of ice cream? “To taste the birth of creaminess”…it doesn’t get any better than that. And now the science part:

Plain frozen cream is hard as a rock. Sugar makes it softer, but also lowers its freezing point (the dissolved sugar molecules get in the way as the water molecules settle into ordered crystals). (p. 39)

Sadly, I do not own this book (hint hint). I had it on hold at the Corvallis Library for 2 months before I got it, then could not renew it after my time because someone else had it on hold. This is a book originally published in 1984 and updated in 2004. Come on people of Corvallis, you’ve had 8 years to check it out. That says something about this town.

Armed with this knowledge, I moved on to making ice cream with a little help from our friends. Our friend Cora made some keto raspberry ice cream for Nora a few months back and we found out about the “hard as a rock” property. It was tasty, like raspberries and cream, but was solid. I put a butter knife through the side of a plastic container trying to chisel some out. It had a ratio of about 15:1 because she used cream and not many raspberries, so I hoped that the next attempt with many more berries to provide some natural sugar would be a bit softer, Harold’s predictions notwithstanding.

Last month we received an ice cream machine as a gift from our dear neighbors, Connie and Kevin. That gave me my chance to try ice cream for Nora and put some of my food science learning to work.

Raspberry Frozen Greek Yogurt Popsicle

The first recipe was a raspberry frozen Greek yogurt. I decided that Harold knew best, so trying something less conventional might yield better results. Greek yogurt has lots of protein and a decent amount of fat, but few carbs. Protein is also a key ingredient to finessing the texture of ice cream and I was hoping that enough protein would be a recipe for success.

The result was tangy with the flavor of Greek yogurt and had a lot more raspberries than the original recipe, so it was very tasty. But it still froze fairly solid.  If we let it thaw just enough we could give it a quick stir and get an ice cream-like consistency, but thaw too much and it was liquid. Alternatively, I froze it as popsicles. The only problem is weighing the amount of yogurt in each pop and keeping track of each one. But Nora managed to eventually eat the whole batch enthusiastically, about 20 g at a time.

Nutrition facts for 22 g of Raspberry Frozen Greek Yogurt. Nutrition analysis by www.caloriecount.com

Raspberry Frozen Greek Yogurt
200 grams raspberries (about 1.5 cups)
Pinch salt
340 g (1.5 cups) Traditional Plain Greek Yogurt
114 g (0.5 cups) English Double Devon Cream
1/4 tsp cinnamon
1 tsp pure vanilla extract

The nutrition facts are for 22 g, which is about 1 popsicle. You can see that 1.3 carbs is quite a bit at once and it has a 2:1 ratio, so this would have to be paired with other things in a snack to balance it out. It’s not ideal, but yielded fairly good results.

My next attempt was based on a recipe by David Lebovitz, chef and author of The Perfect Scoop. Ice cream expert! I wanted a mint ice cream recipe made with real mint, thinking that I could get great flavor without carbs. This one is the ticket, from his blog: http://www.davidlebovitz.com/2010/05/mint-chip-ice-cream-recipe-chocolate/

I made his version and a Nora-version. Oh my, was it wonderful. It calls for 80 g of mint leaves, which is a lot (believe me, I have a gram scale). I only had about 20 g in my garden that I could harvest, but a little went a long way in this recipe.

It’s a 2-day process, but I was able to follow the recipe once while making 2 versions with a little planning. I used half-and-half instead of whole milk, but otherwise did everything in the recipe EXCEPT adding the sugar: steeped the mint leaves in hot half-and-half and cream, then cooking in the egg yolks according to the recipe (below and at the link). Then I reserved some of the mixture for Nora and added a bit of her Cytra, which is sweetened with saccharine. I then added sugar to the portion for the rest of us while it was still warm so that the sugar would dissolve. Adding the sugar at the end did not affect the quality of the regular version, and I didn’t have to make the recipe twice. Then the mixtures must cool overnight.

Nora's Mint Chocolate Chip Ice Cream

The next day, I froze each version in the ice cream machine. Here is where I saw the importance of sugar firsthand. I put Nora’s version in first. The machine has a frozen bowl to chill the mixture and a rotating arm that scrapes it off the side of the bowl and mixes it so that large ice crystals are not able to form. When I make Nora’s ice cream in the machine, a thick icy-cream layer builds up on the side of the bowl that the rotating arm can’t scrape away. The portion in the middle freezes more like regular ice cream, so I stop the machine, scoop out the middle part, and then wash off the inside of the bowl.

If I am as quick as possible, the bowl is cold enough to make the sugared version immediately after, but just barely. When ice cream made with sugar goes in the machine, it is soft as it freezes and the machine can easily scrape the sides. It takes a lot longer to freeze, as you would expect from the additional sugar which lowers the freezing point of the mixture. Having 2 portions of the same recipe with and without sugar really demonstrated the point.

Nora licks her bowl clean. She spilled some on her shirt, and she tried to lick that too!

The grand finale of this recipe is the “chocolate chips.” I would have never thought of this if not for the Lebovitz recipe. I used a Green & Blacks 80% cocoa dark chocolate bar. Higher cocoa content means less sugar, hence fewer carbs, in the chocolate. Measure out the amount you will put in the keto ice cream (it only takes a few grams, at 0.28 carbs per gram of chocolate in those bars). It melts nicely in a small silicone pinch bowl in the microwave. While the ice cream is in the machine stirring, drizzle in a stream of melted chocolate. It freezes in tiny threads as it hits the cold ice cream. Mmmm, that’s something special. I did the same on some of Nora’s raspberry ice cream another time to give her a little chocolate on top. What a treat.

This ice cream was fabulous. The infusion of real mint leaves gave it an herbal minty quality. Next time I will try to use even more mint. I held back on the sugar so it was not overly sweet. I will definitely make this again, for all of us, when my mint patch recovers.

Nutrition information for 50 g of mint ice cream. Note the different serving size--do not compare directly with other ice cream recipes here. And note that chocolate is not included. Nutrition analysis from www.caloriecount.com

Keto Mint Chocolate Chip Ice Cream
240 g (1 cup) Organic Valley Half and Half
480 g (2 cups) Organic Valley Heavy Whipping Cream
Pinch of salt
85 g (5 large) egg yolks
80 g (2 cups packed) mint leaves

In a medium saucepan, warm the half-and-half, 240 g (1 cup) heavy cream, salt, and mint. Once the mixture is hot and steaming, remove from heat, cover, and let stand for an hour to infuse the mint flavor.

Remove the mint with a strainer, then press down with a spatula firmly to extract as much mint flavor and color as possible. Once the flavor is squeezed out, discard the mint.

Rewarm the infused milk. In a separate bowl, whisk together the egg yolks, then slowly pour some of the warm mint mixture into the yolks, whisking constantly, then scrape the warmed yolks back into the saucepan.

Cook the custard, stirring constantly with a heatproof spatula, until the mixture thickens and coats the spatula. If using an instant read thermometer, it should read around 170ºF (77ºC). Immediately stir the mixture into the remaining 240 g (1 cup) cream, then place over an ice bath until cool.

Refrigerate the mixture thoroughly, preferably overnight, then freeze it in your ice cream maker according to the manufacturer’s instructions.

From: http://www.davidlebovitz.com/2010/05/mint-chip-ice-cream-recipe-chocolate/

The nutrition information above is ONLY for the mint ice cream. The ice cream alone has a ratio of about 7:1, and only 0.7 carbs in a 50 g serving! You can add enough chocolate to reduce the ratio to the desired level. In the future, I will calculate the amount of chocolate I want to add per serving, measure that amount, then melt the chocolate in a silicone pinch bowl (be sure that your bowl is completely dry, as any water in the melted chocolate will cause it to seize and ruin the pourability). Pour the chocolate in threads on the serving of ice cream, stirring as you go. Wa-la, you have chocolate chips in your ice cream!

The last ice cream experiment was of the blueberry variety. It was a simple recipe, but turned out quite different than the rest.

Nutrition information for 3.5:1 Blueberry Ice Cream. Analysis provided by www.caloriecount.com

Blueberry Ice Cream
405 g (2.8 cups) fresh or frozen blueberries
720 g (3 cups) Organic Valley Heavy Whipping Cream
305 g (1.25 cups) whole milk

In addition to these ingredients, I again used Cytra to sweeten the mixture a bit, but you can use any no-carb sweetener you choose. Mix the sweetener in while you crush the berries. Then mix well with the cream and milk (I used a food processor). Then freeze in the ice cream machine.

Like the mint ice cream, I made it side-by-side with a sugar version and it turned out very differently. First, when I crushed the blueberries with sugar for the traditional recipe, the blueberries turned that keep purple-blue that I would expect from the blueberry skins. When I made Nora’s version, the Cytra did not extract the color from the blueberry skins in the same way. The mashed berries looked more green-gray with flecks of dark skin. I have not looked up the food science interaction that causes the color change in the presence of sugar, but I would love to know the secret.

Blueberry Ice Cream, 3.5:1 ratio

As with the mint ice cream recipe, Nora’s non-sugar version formed a thick frozen layer on the outside of the ice cream machine bowl. The sugared version did not do that. And the final product was quite different. Nora’s version froze absolutely solid. I have to chisel it out of the bowl to measure it, or melt it enough. If I chisel it out and mash it up, it has a very dry crystal quality about it, not at all creamy. It’s not unpleasant, but it is not like ice cream either. If you click on the picture to get a larger version, you can see that texture. It also melts quickly, so getting it in as fast as possible is key, although Nora takes care of that herself and licks the bowl clean!

Thus far, I’ve learned that cream alone does not make ice cream. Harold is right–how could I ever have doubted him. Taking sugar off the table, the recipes that included more protein were far more successful than the blueberry ice cream recipe, which was mostly cream and berries. I added whole milk there in order to get some of the milk protein, sugars and solids, but it was not enough to make a difference in the texture.

The custard-type ice creams that include egg yolks are a better bet, but also require a 2-day process because the egg yolks have to cook, then cool down enough to make the ice cream. It’s a plan-ahead endeavor, but the quality of the final product makes it worth it. I will also experiment more with Greek yogurt to see if I can get some better results. But this is all academic to Nora. If it’s called ice cream, she’s thrilled to have it.

Cooking day!

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Some days you realize that you’ve run out of everything. We also have a trip to Portland to the KetoClinic tomorrow, and we are going to the coast for the weekend, thanks to Ted’s colleague, Annette and her family, for letting us use their beach house. It’s so great to have a kitchen! We will also get to see one of Nora’s best little friends, Ingrid, who has been in Eastern Oregon this summer. Lots to look forward to–and we don’t want to stress about food.

In my kitchen today: A new batch of B^3, a new and improved formulation that will include coconut oil in order to boost the fat content a bit more. Now that Nora consistently expects B^3 and apples or carrots for her morning snack, I am changing the formulation to make that whole snack 3.5:1, now that we are in the groove at the new ratio. I am not planning to post the new recipe, but if anyone wants it just let me know. It was time to buy a big new jar of Adams Natural Peanut Butter for another batch. Just mixing in the naturally-separated peanut oil is a job, and it’s only step 1!

I’m also making a new hazelnut-coconut oil breakfast cookie that is 3.5:1. I have not tried my new formula yet, but if it works it will be a great basis for breakfast and we will not have to separately deliver coconut oil. It can also be used for a quick self-contained snack. I had to buy more Bob’s Red Mill Hazelnut Meal/Flour today. That stuff is finely ground gold–$10.99 for a 14 oz bag! At least I don’t have to grind it myself. Unlike macadamia nuts, which are almost $20 per pound and I do have to grind myself.

Cheddar Crackers

Earlier this week I made some cheddar crackers and PBJ muffins. The cheddar cracker recipe is right out of the Keto Cookbook, and they are so good. Anders thinks they taste like cheese puffs, but we do our best to reserve them for Nora. 🙂

I might try my hand at the basic keto pizza recipe from the Keto Cookbook tonight, but I might just be done with cooking by the time I get to it. Step 1 for that recipe will be grinding the macadamia nuts. I will also have to analyze the recipe and put it in our KetoCalculator spreadsheet before Nora can have it. Sigh, I guess that one will probably wait for another time.

Update: The Latest Daily Routine

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How ironic. After I finally make a post about our KetoCalculator spreadsheet, we had a problem this morning. There was some glitch in updating the spreadsheet on Google Docs, so Ted and I were not seeing the same version, and the version showing up on my computer disagreed with our written notebook record of breakfast and snack for the day. It was a very strange mistake and we can’t figure out when or why it happened, but it is another lesson in checking and double checking, keeping good records, and working together.

The good news is that Nora’s meals for the day were not impacted. They were calculated on the correct information. Even with fancy calculating technology, we still have to keep a sharp eye out for anything that just doesn’t look right. Don’t get me wrong, I’m thrilled to have our KetoCalculator and it wouldn’t have happened if Ted had not taken the initiative to build it. It took a little bit of time to transition to using it for all meals, but it has been a great help overall. Now that we have seen our first glitch, we know to double check totals, keep our cool and track down problems.

The Latest Daily Routine

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As we have said before, we’ve really been learning-as-we-go with this diet business. Our daily meal routine has evolved, so I thought I would post our current methods.

During the first few months of the diet, we used a paper and pencil method. We had a small spreadsheet of commonly used foods and their break downs hanging on the fridge and would look up other foods as needed. Each meal was built on the fly with benchmarks for carbs, protein and fat at various times of the day. I knew the breakdowns for typical portions of common foods, so I could build a meal intuitively then add it up, adjust, and check the exact ratio. Each meal was juggled independently. It worked fine and provided us with flexibility, but after the last seizure (11 weeks ago!) and meeting with the dietician we started a more efficient long-term method for meal planning.

Snapshot of the KetoCalculator for meal planning

I first saw the KetoCalculator tool and started an account for Nora a few months ago when I met with Nora’s dietician to tighten up the way we administered her diet. I was reluctant to use it because only particular major brands of foods are available (for more on my reluctance, see About the MKD). But I also learned that the dietician must add all of the foods made from my recipes, and that just seemed like too much work for her and for me.   So we only use the official KetoCalculator as a reference to check the official break-downs for particular foods when necessary, but not as a meal planning tool.

Instead of the official KetoCalculator, Ted devised our very own KetoSheet spreadsheet in Excel. It’s the same idea as the official online tool, but we can customize and adjust it ourselves. We share it with each other via GoogleDocs so that we can both use the most updated version on our own computer, anytime. This lets us enter the number of grams for each food, see the breakdowns, the running total, and make slight adjustments to hit the right ratio for each meal.

Our shared Excel KetoCalculator showing my next plan for breakfast and morning snack, with running totals in yellow at the bottom.

It’s interesting to play with it to build a meal–we can move the ratio with tiny adjustments, like an extra gram of butter or one less gram of raspberries. Making slight adjustments to the paper and pencil method meals meant erasing, re-writing and re-adding. When we adjusted her ratio to 3.5:1, up from 3:1, I realized that I had a great intuitive sense for meals built at the 3:1 ratio. Changing the ratio meant a lot more time fussing over the right measurements for each food. It has really streamlined the process and I think it has helped Ted build meals from scratch as well. We share the meal planning load more evenly now.

After determining what Nora will eat at her next meal with our personal Excel KetoSheet, we write these values down in our little book-o-days. We now have four little notebooks sitting on the shelf full of daily meal records. That’s our permanent running log of Nora’s meals. It’s also far more portable than a laptop. Then we take the little book with the foods and quantities to the kitchen for quick reference when building a meal. We can also look back to previous days and copy a meal for a quicker process.

Gram scale and daily meal record notebook.

Next to the kitchen! We finally got a one-tenth gram scale and are very happy with it. I was afraid that I would spend a lot of time shaving off bits of food to hit the tenth-gram value, but it’s not too fussy. It’s actually kind of fun, especially when you hit it on the first try. There’s a silver lining.

With the meal plan and scale at the ready, we make up the meal. We have several small bowls, some of them silicone for easy mixing and scraping out of things like butter and cream cheese. I also have a few tiny bowls for presenting small amounts of food.

It’s all pretty routine now, but it still takes at least an hour or two to feed Nora each day.

We have a few standard breakfast combinations. The best one at the moment is a pecan breakfast cookie adapted from the KetoCookbook. The original uses ground pecans and butter, but I substituted coconut oil so that we do not have to present coconut oil separately in the meal. Nora doesn’t particularly like eating coconut oil straight or mixed in cream cheese. My next version will be made with hazelnut flour because Bob’s Red Mill has a pre-ground hazelnut flour, so I won’t have to grind the nuts myself.

Nora’s mid-morning snack is B^3 with either 8 grams of apple slivers or 15 g of baby carrots (depending on whether Anders has decimated our apple supply without our knowledge). Nobody better mess with her morning snack. She has come to expect it every day.

Typical lunch and snack: Tuna salad, flacker, cinna-butter, strawberry, avocado, macadamia nuts, and a PBJ muffin. Cytra (the solution to reduce her blood acid level) to drink.

Lunch varies. We have started using more macadamia nuts lately to help boost the ratio with healthy fats. We have also started to rely on butter much more than cream. Lunch always includes flacker and butter, which Nora eats up happily. We also have plentiful raspberries from our garden this time of year, so she eats several small portions of raspberries per day, usually around 10 g each, or 3-4 berries (only 0.57 carbs per serving!). I know, it sounds like so little to the rest of those, but those raspberries are precious sweet rubies to Nora.

On days when we both work, we put together the morning snack, lunch, and afternoon snack for her babysitter. We calculate, weigh and assemble it the night before so that it’s all ready to go.

Dinner and bedtime snack are calculated based on the running total for the day and the foods we have available. There are plenty of food options so we can always put together and easy meal. Or we can easily add something new to our KetoSheet if the rest of us are having something that we don’t often eat. Recently I’ve added pork shoulder, bratwurst, ling code and snap peas, edamame and watermelon to the KetoSheet. I look up values of generic foods on www.caloriecount.com and cross reference it with the official online KetoCalculator if I have any doubts. I create a new line in our spreadsheet and copy and past the formatting from an existing line. Then I add the new food and calculate the carbs, protein, fat and fiber per gram. Bingo-bango, I’ve got a new food to play with. Who says we shouldn’t play with our food?!?

Doctoring Updates

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This is a big doctoring week for Nora. First thing yesterday morning, Ted took her in for her 6-month fasting blood draw to be sure that her body is tolerating the diet well. Having done this a few times now, we know that there are a few people at the lab who are able to get her little tiny veins the first time. That saves a lot of time and misery, but she is so brave and such a good sport.

Right after her blood draw, I took her to her regular pediatrician for her 4-year check up. She’s right on in her growth and development–about 78th percentile height and 72nd weight, healthy BMI. She’s growing as expected; the doctor did not think that the diet has impacted her growth at all so far. Chatty Miss Nora charms everyone with her observations about everything around her. She was also able to do the eye test by reading the letters on the chart!

The lab also needed a urine sample but was not able to get one when Ted had her in for the blood draw, so I was able to catch one after the doctor’s appointment and take it up to the lab on the same trip. As we were on our way out, a lab-coated young man chased after us and asked us to come back for one last thing. The tech made a mistake when doing the first blood draw, and they needed a little more blood to do one more test. Boo. There is one tech who has formed a sweet bond with Nora and chatted her up while they prepped everything. It wasn’t until the needle was about to go in that Nora realized that they were going to poke her again. The super-skilled tech was able to get her vein on the first try and finish it up. He mentioned that there were some rare tests in the order so he mis-calculated the number of vials of blood they needed, as different tests go out to different labs.

As we were packing up I told the techs about Nora’s condition, the diet, and the reason for her many blood tests. They thanked me for sharing and were so happy that she is doing well now. It must be tough for them to see little people come in for big blood tests and have to guess at why they are there, especially when they are so sweet and form a bond with their repeat customers–I am sure they are trained not to ask about medical issues.

Nora was a super champ through it all. She went home with an extra Barbie bandaid for later, another blue tourniquet (seat belts for her babies), and another squishy purple latex glove filled with water. She also told everyone she met that she wants to be a doctor when she grows up. That would be fabulous.

Next we are off to see Dr. Wray at the Keto Clinic at Doernbecher Children’s Hospital in Portland on Friday for a check-up and to go over the blood test results. Nora adores Dr. Wray and keeps asking when she gets to go see him. We will also bring Anders this time and plan to get some fun in on this trip, possibly going to the zoo or OMSI.

Back to our Local Ocean!

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Corvallis is a fabulous place to live. Then add the ability to drive to the Oregon coast in 1 hour, or hike in the coast range or the Cascade mountains on a day trip, and it’s darn near the best place to live in the country, in our opinion. One of our favorite ways to beat the summer heat (for the few days that it visits us in Corvallis) is to go to the coast, which is guaranteed to be 20 degrees cooler. But a coast trip is a good idea any time to play on the beach, hike, eat some seafood and ice cream…although that has all changed during these 6 months on the diet.

Although this picture is 2 years old, it is Nora's typical beach performance art. She has a primal sand worshiping instinct, particularly after sunscreen is applied..

Our family tradition has been to stop by Local Ocean for dinner on our way home from the beach, then let the kids fall asleep in the car. But we have avoided a coast trip with Nora until today because we weren’t ready to navigate real restaurant eating on the diet. Anders MUST have the fish and chips and Nora ALWAYS had the crab cakes. It’s a given that she can’t order the crab cakes on the diet, so we needed another plan.

Our day started with the usual beach packing: extra clothes, beach toys, sunscreen. While Ted was gathering those supplies, I was preparing Nora’s food. I baked a few items, like PBJ cookies, that are a delicious self-contained 3.5:1 ratio, for easy snacking on demand. I also packed cheddar crackers, which is another recipe from the Keto Cookbook that is a 4:1 ratio. I promise to post a round-up of tested Keto Cookbook recipes soon. Lunch was packed in her lunch box for the car ride. Snacks packed separately for later. Dinner portions that we were bringing in a small cooler with ice for later.

I calculated dinner knowing that we would visit Local Ocean. After looking at the menu online and thinking through the options, I decided that crab was the safest choice. They have cooked crab meat at the fish counter and whole crab on the menu. I also thought that it might deflect Nora’s desire to have crab cakes if she stated her preference. I calculated everything that she would eat and tried to allot her as much crab as possible in the meal, which ended up being 30 g, or a little less than 2 legs from the dungeness crab, small guys caught right in the Newport bay. We ordered the 1/2 crab; market price, $19, wowza. Talk about luxury diet. I sacrificed myself and shared it with Nora, along with a cup of soup, instead of ordering a meal. Woe is me! 🙂

Nora holds her prize: the clawed crab leg at Local Ocean!

We told the waitress when we ordered that Nora had a special diet for epilepsy treatment and that we brought some food from home. As I expected, she said that their policy does not allow outside food, but she asked the chef and they decided it was alright. We were prepared to take our order to-go and sit out on the bayfront if necessary, but it was a cool and cloudy day and we preferred to eat indoors. I would hope that all restaurants are as accommodating when parents explain the situation, but I do understand that they are operating under the health code guidelines. I made a point of thanking the waitress when we were leaving and she shared that her nephew has epilepsy which is controlled with medication, but that he also cannot drink soda or other sugary things. I found that very interesting, possibly through trial and observations other epileptics notice that smaller diet changes can affect their seizure control. Anyone else aware of this? Do doctors discuss this with patients? We had not heard anything about it until we started researching explicit diet treatments.

And, wouldn’t you know it, she dropped a big chunk of her pre-weighed butter on the floor while she was eating. We had our scale along for measuring her crab, so we measured the lost bit and asked the waitress if she could bring a pat of butter. They don’t keep packaged pats of butter on hand and only serve garlic butter, but she was able to locate a block of frozen butter and cut off a bit for us. We are so thankful for her understanding and resourcefulness. Now we like Local Ocean even more!

Nora enjoying her homemade crab cake, al fresco. Yes, she dressed herself. And yes, those are leg warmers on her arms. It was her rebellion against my suggestion that she put on a jacket in the morning before we left.

And knowing that Nora likes crab cakes, I have twice made the crab cake recipe from the Keto Cookbook.

The first time I didn’t follow the cooking procedure as directed. I simply mixed the egg whites with the crab (I did use the canned fancy white lump crab meat suggested by the recipe, but could calculate it with fresh cooked local crab as well). I put it in the skillet and formed it into a patty while the egg cooked. The kids went crazy for those crab cakes! I will be making them often. Anders generally eats the same main dish as Nora, as do the rest of us if appropriate (I can’t eat much egg, so this recipe is out for me). It’s a good way to test whether a recipe has staying power, simplifies dinnertime, and helps Nora feel included. The rest of us just don’t add the extra butter or cream to our meal, and we add more veggies.

The second time I followed the recipe’s procedure. I used “Just Whites” powdered egg white (they should go back to marketing and re-consider that product name), whipped the egg whites into stiff peaks, folded in the oil and crab, then fried it in patties. It held together better while going into the pan, but it poofed up then fell as the air came out during frying. They ended up as flat oily slabs. Nora still devoured it, but Anders preferred my “mistake” method and I would have to agree. I also tried using the ring portion of a mason jar lid as a mold in the skillet to maintain the shape. That will be a good strategy going forward with the un-whipped egg whites, but I will oil the ring well to keep the crab cake from sticking to it.

The crab cake recipe is quite simple, as adapted from the Keto Cookbook.

Nutrition information for Crab Cakes. Analysis from www.caloriecount.com

Crab Cakes
20 g Crown Prince Fancy Natural Crab Meat
15 g egg whites
9 g olive oil

Mix together and fry in oiled skillet on medium-high heat.

Makes 1 crab cake, 44 g. The portion in the Keto Cookbook is too big for Nora, so I scaled it down. This is a 2.3:1 ratio, so round out the meal with other sides to achieve the desired ratio for the meal. Our family is not at all fond of mayo, so Nora generally will have plenty of butter on a flacker or her high-fiber tortillas to boost her fat for the meal.

Nora’s Birthday! Raspberry cheesecake, cupcakes and frosting!

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Just after spring officially turned to summer, we celebrated Nora’s 4th birthday. Everything has been going well for Nora these past few weeks and we are all transitioning into summer mode.

Nora’s birthday morning started with an experimental special treat: Cytra jello. I’m not a jello fan myself, and I doubt that I have ever made it at our house, but my kids immediately recognized it. Remember that Cytra is the supplement she takes to counteract the blood acidosis that tends to occur on the diet. It’s sweetened with saccharine and colored with red dye #3. Sounds like the perfect match with gelatine, right?

Nora's Cytra Jello Heart

I bought some plain unflavored gelatine because I saw it in several keto-recipe ideas, so I thought I would have some on hand. On the back of the package was their super simple cheesecake recipe, which I decided to use later (see below). The idea was born to sweeten the cheesecake with Cytra, as she takes Cytra everyday anyway. I made a 1/2 portion of the cheesecake, which required mixing a full package of gelatine with Cytra, then using only 1/2 of the mixture for the 1/2 cheesecake. That left me with 1/2 portion of Cytra + gelatine and–ta da! Cytra jello was born, shaped in 2 heart silicone molds. It was a hit and I have had requests for more Cytra jello.

Gelatine has 2 g of protein per envelope, so each heart contained 0.5 g protein, no carbs or fat.

Nora shares a birthday with her buddy Ian, who is 1 year older. Ian’s family invited us over for a birthday buddy celebration. They were very thoughtful to call with the menu so that we could plan Nora’s dinner. She had her first taste of watermelon on the diet (16 g! 3 tiny chunks!), along with hot dog, avocado, and other normal dinner foods. For dessert they made a raspberry cheesecake, a treat that is relatively easy to turn into a keto-friendly dessert.

I made a keto-pumpkin cheesecake recipe last fall, but the texture didn’t quite fit the bill and I wanted a cheesecake that would hold up to a raspberry sauce on top. I looked at other keto-parent blogs and thought I had found a winner, until I serendipitously happened upon the back of the gelatin box, where I found their “It’s-A-Snap Cheesecake” recipe. The ingredient list was so simple that it was almost perfect without modifications, and because it was no-bake I didn’t have to gamble with texture outcomes by adding more fat. With all of the other birthday prep I was ready for simple.

Nutrition information for 1 serving of No-Bake Raspberry Cheesecake. Nutrition information from www.caloriecount.com. 8 servings.

No-Bake Raspberry Cheesecake
(8 servings)
1 envelope Knox unflavored gelatine
1 cup boiling water
336 g (12 oz) Primrose cream cheese (re-calculate nutrition with your brand)
113.4 g (4 oz) English Double Devon Cream
1 tsp pure vanilla extract
120 g raspberries

Mix gelatine into 1 cup boiling water, adding any no-carb sweetener to your taste (or equivalent to 1/2 c sugar. We used 1/2 Cytra packet.). Stir until gelatine completely dissolves, about 5 minutes.

Beat together cream cheese, double devon cream, and vanilla in a large bowl with mixer until smooth. Slowly beat in gelatine mixture.

Pour into shallow glass dish and refrigerate until firm, about 3 hours.

Nora at the end of the table with her cheesecake, and b-day buddy Ian with candles on the big cheesecake!

Raspberries can be used fresh on the top, mashed and cooked down, or cooked down from frozen. We also added a bit of Cytra for sweetness as well. Next time I might try to add some gelatine to the raspberries then pour over the firm cheesecake, so that each serving is more equally distributed. Just remember to count the gelatine in the recipe, as it adds protein.

 

Makes 8 servings with nutritional information in side panel.

(click on pictures to enlarge)

Nora dug into her cheesecake and loved it! She was almost done with her generous piece before the rest of us got our cheesecake in front of us. Then it was so great, she licked the plate! She was allotted every one of those carbs, so she can get them into her any way she knows how.

I am not a fan of the no-bake cheesecake, so next time I have the energy I will try the more traditional version adopted from another keto-parent blog.

(click on pictures to enlarge)

I am sure that all keto-parents spend an inordinate amount of time preparing for special events because special events are always bound up with special foods. Now that we have our keto-kid as the center of her special event, my goal was to showcase her special food for all of her special people at her birthday party for her friends. My hope was to make her feel normal for a time. When we talked about cupcakes, she said, “do you mean I’m not on my diet anymore?!?” But this time I said, “no honey, you are still on your diet, but now everyone will get to share your special foods!” Although we still had whiny requests for another cupcake, that’s normal. There were no tears today because she had a cupcake that looked the same as everyone else’s cupcake. Little did she know that hers tasted just a little different.

When I made cupcakes for the party, I started by making a double batch of Nora’s Raspberry-Coconut Cupcake batter. I weighed out 6 cupcakes for Nora and baked them up in the special princess cupcake liners that she picked out. Then I added a little sugar back to the batter and cooked up cupcakes for everyone else, in different cupcake liners. Wow, it goes so fast when you don’t have to weigh the batter that goes into every cupcake!

I used the same procedure to make the frosting. First, mix it up perfectly according to the keto-version recipe and frost Nora’s cupcakes. Then mix some powdered sugar back into the rest of the frosting and do the rest. Although Nora’s cupcakes are pretty good on their own, other kids are accustomed to sweet cupcakes. I didn’t want other kids rejecting them for lack of sweetness. Actually, Anders rejected his because he thought it was too sweet! He has never had a sweet tooth (although he seems to be part fruit bat), and now that he doesn’t eat many sweetened foods he can taste the difference.

Many of Nora’s regular foods were on the menu: Hazelnut-Applesauce Mini-Muffins (baked into 16 g mini-muffin liners–that batter works great for measuring), Flackers, cheddar cheese, string cheese, rotolini, PBJ muffins (without added butter for everyone else), raspberries, mini-peppers, seaweed snacks, Macadamia Monster Mash, avocado, carrots, celery, cream cheese, and turkey/ham/cream cheese roll-ups (although I made those on standard tortillas because Nora was not having any, and her low-carb tortillas are expensive!) We pre-measured Nora’s lunch and brought it ready to put on her plate.

The theme was a fancy tea party luncheon, so I bought some mismatched fancy tea cups at a second-hand store along with some linen napkins and doilies. I had a fancy lace tablecloth from home that we put on the picnic table at the park. It looked to be a fancy affair, but it was the best of all worlds–fancy kids, fancy dishes, fancy food, and all fun and games at the park!

The pink cupcakes were also a hit. I found some sparkly pink sprinkles made from gum arabic and food coloring, rather than sugar. My research indicated that gum arabic is almost entirely fiber, so it should have no impact on her diet. I sure hope so. I put just a bit of sprinkles on top of her cupcake. So cute, but not sweet.

I realized at the beginning of the party that we had candles but not matches! Of course, none of us smoke and had no easy way to make fire. It was also fairly windy, so instead of running home for matches we piled on several fancy toothpicks with a crown and a few fairies. Nora asked about the candles but quickly got over it and dug into the cupcake!

Nutrition information for 1 Raspberry-Coconut Muffin. Recipe makes 18 servings. Analysis from www.caloriecount.com

Raspberry-Coconut Cupcakes
(makes 18 cupcakes)
56 g Bob’s Red Mill Organic Coconut Flour
1 tsp baking powder
1/2 tsp salt
84 g European-style butter
300 g (6 large) eggs
1 tsp vanilla extract
60 g Thai Kitchen Organic Premium Coconut Milk
1/8 c water
36 g raspberries

Preheat the oven to 200C/400F degrees.
Combine the coconut flour, baking powder and salt.
In another bowl, mix the butter with a hand mixer until fluffy, then add the eggs, vanilla extract and coconut milk and mix until well combined. Add water after the mixture begins to thicken. Let rest to allow the coconut flour to absorb all the liquid.
Add the dry mixture to the wet and blend well.
Spoon 30 g batter  into regular cupcake liners or silicone molds.
Push 2 g of broken up raspberries into each cupcake.
Bake for 15-20 minutes until firm.

Nutrition information for 20 g of Raspberry Cream Cheese Frosting. Analysis by www.caloriecount.com

Raspberry Cream Cheese Frosting
(Makes 10 servings of 20 g each)
30 g Thai Kitchen Organic Premium Coconut Milk
88 g Primrose cream cheese (substitute your brand and re-calculate)
71 g European-style butter
8 g raspberries

Blend all ingredients until smooth. I wanted to put 20 g of frosting on each cupcake, so I took my recipe and adjusted the number of servings to get 20 g each. If you divided this on to 18 cupcakes, it would be 11 g of frosting each. You can adjust as you like. The nutrition information is for 10 servings of 20 g each.

The cupcake with 20 g of frosting has a ratio of 2.96:1. With a 1/2 tablespoon of cream with tea, it’s perfect for Nora, at a 3.53:1 ratio (she’s at 3.5:1).

We found this fabulous 3-tier cupcake display that captures the spirit of Nora. If you can’t quite read it: “I am fairly certain that given a cape and a nice tiara, I could save the world.” With the cool pig-tailed girl riding her bike with her legs flying out! That’s our Nora (except maybe she would say, “I could RULE the world!”).

Guess How Much I Love Nora

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So much that everything is now heart shaped. Awwww.

Freezing 5 g of coconut oil per heart. We have been measuring 5 g of coconut oil, 3 times per day, for weeks now. Time to do batches!

(above) Baking perfect portions of Nora’s new Pecan Breakfast Cookies, adapted from the Keto Cookbook.

Cookies = Love

 

 

 

 

 

 

(below) Nora enjoying her newest baked goods.

 

 

 

New Keto Resources & PBJ Muffins

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One month ago, I was in Portland and met with Nora’s dietician. Afterward, this analogy came to mind:

Your family is driving in a remote forested area when your car breaks down. It’s cold, you don’t have much food, you don’t have cell phone reception and you have not seen signs of civilization. But you survive. You stay together. You ration your food. You start to burn your tires for warmth. Eventually you get desperate and one of your party strikes out to find help. After only a few hours, your emissary triumphantly returns to tell you that there is a Super 8 motel right over the ridge. Not great digs, but it’s food and shelter!

Now, that is a touch dramatic, but going into the keto diet was a bit like being lost in the woods. We have been doing pretty damn well, if I do say so myself. But that day in Portland, I learned so many details from the dietician that were never communicated to us. Better yet, I found out about The Keto Cookbook. It is written by a parent and a dietician, with form letters for daycare, emergency room/hospital visits and TSA (not that I plan to fly with Nora anytime soon)! Best of all, it is full of beautiful photos of the lovely recipes, all 4:1 ratio meals. This morning Nora and I browsed the pictures of all of the wonderful foods she could have on her diet. Many of the recipes are similar to things that I already make, and more than a few will probably not be appealing to her at the table, but just the chance for Nora feel like her diet was fabulously on display for her perusal was worth the $20.

How did we get lost in the woods? Nora’s dietician and I had that conversation during my visit. We went into the diet kind of “backward.” We tried less restrictive forms of diet therapy first. We experimented with feeding her Low Glycemic Index foods on our own before things got really bad. After the November hospitalization for the 24-hour EEG, we decided to try the Modified Atkins Diet before the Keto diet. Then we found that as we increased her fat ratio, she had better seizure control. We also found that we lost seizure control if her carbs were not carefully distributed throughout the day. So we inched closer to the keto diet by finding out what worked best for Nora. What we found out that the traditional keto diet works very well for Nora, although she still gets good seizure control at a lower ratio and a little more relaxed schedule. Because we eased into it, we didn’t have the hospitalized diet initiation that is standard procedure, so we did not have a full keto training as most families do. We learned on our own as we went, but that meant we were out on our own, unsure of even the questions to ask sometimes. It was not until after the last breakthrough seizures (going on 6 weeks ago!) that we talked about inching even closer to the traditional Keto diet and learning about the gaps in our knowledge.

But things have been going well, so a month passed between my last meeting with the dietician and finally ordering the Keto Cookbook. In that month, we have wrestled with adding other supplements like carnitine and dealing with the blood acidification issue. Now that we were getting comfortable again in a routine that works, I guess I had the energy to try new recipes and resources.

The Keto Cookbook is a great resource, but it’s not the Ritz. I started by reading and implementing their section on kitchen tips and tools to make life easier. We have a lot of the necessary equipment already, but not everything. I had resisted getting silicon bakeware until now because it just kinda creeped me out. Today we had a big shopping trip and I went all out–silicone muffin cups, more little rubber spatulas and pinch bowls, and yes, a teddy bear pancake pan. Anything to make cooking easy or food appealing and fun. Nora and I spent most of the day on my bike going to stores to find the things we wanted, and she got to help pick out the shapes and colors that would hold her food.

The 2-person paper muffin cup technique.

I used the muffin cups today and was quite pleased. Silicone cookware has a few real benefits for the keto diet. It does not absorb fat or liquid, so the amounts that are measured and cooked end up in the food, then in the kid. They are also rigid, so I can put each muffin container on the scale, tare it, and fill it with the correct amount of batter. Every muffin will be the same. Cora and I tried to accomplish that with paper muffin liners recently, with marginal and at times hilarious results. She had the idea to use a pastry bag to fill the muffin liners, but the liners were not strong enough to hold the batter alone on the scale. She would put a liner on the scale and spot it while I filled it to the right weight, then she would deftly transfer it to the muffin tin. We lost a few and it was incredibly labor and time intensive. The silicone is going to save a lot of time and effort. It already has.

Today I made Nora the “PBJ Cookies” recipe from the Keto Cookbook, and learned a thing or two about how to use the book.

First, I still had to enter the recipe into the online recipe analyzer that I use. The cookbook assumes a 4:1 ratio and reports only the calories and carb content of the recipe. I would have to go through some algebraic gymnastics to calculate the protein and fat content of the recipe, although it could be done with the known information. Nora is also on a 3.5:1 ratio, so I can adjust the recipe to reach her ratio. In addition, we use different brands of peanut butter and other products, so I have to use the nutrition information for  the ingredients that I will use. The cookbook gives me a good starting place, but it is not all done for me. That is also how the recipes on this blog should be used for other families. This is all a DIY guide.

I analyzed the PBJ cookie recipe last night, anticipating that I would make it today. Nora and I spent several hours biking around town on our cookware errands, and by the time we got home I was tired and she was ready for a snack. I put the recipe together and got it in the oven as fast as I could. Because the cookbook specifies individual meals and snacks, not batch-cooking, I assumed that I would give her the whole portion. I looked at my nutrition analysis, and it was and appropriate breakdown for a mid-day snack. What I forgot, in my haste, was that I specified 4 servings from the entire recipe in my online recipe analyzer. I forgot that the entire recipe made a 400 calorie meal, not a 100-150 calorie snack. Nora scarfed down all 3 PBJ cookies that I made, then I realized my mistake–instead of having about 1 g carb, she got 3 g carbs total! Luckily, that didn’t push her past 10 carbs for the day yet. It was more like she had an early dinner so everything was ok, but I had my moment of panic. I realized that I was relying on the book rather than thinking it out for myself and I was tired and in a hurry when I made and served her. No harm, no foul today, but a lesson to keep in mind.

The PBJ Cookie recipe was a hit, although the “cookie” was more like a muffin, topped with a peanut butter plus butter “frosting” and a few strawberry bits for the “jam.” I was able to make 2 more batches of the recipe, this time measuring the muffins into 4 equal portions so that they can be used as snacks. Here’s my take on the recipe, adapted from the Keto Cookbook.

1 PBJ Muffin with topping. Adapted from The Keto Cookbook. Nutrition analysis and information from www.caloriecount.com

PBJ Muffins

37 g egg (whip well first then measure)
20 g macadamia nuts, ground
11 g canola oil or walnut oil
5 g Bob’s red mill flaxseed meal
8 g Strauss European Butter
8 g Adams 100% Natural Peanut Butter
12 g strawberries

Measure the egg, ground macadamia nuts, oil and flaxseed meal. Mix well. Measure 18.5 g of batter into each of 4 muffin cups. Bake at 350 for 15-20 minutes.

Mix butter and peanut butter. Frost each cooled muffin with 4 g of the mixture.

Slice the strawberries into small pieces, placing 3 g of strawberry on each muffin.

Enjoy!

Each muffin has:
0.7 g net carbs
2.3 g protein
10.6 g fat
1 g fiber
3.53:1 ratio

If your child needs a higher ratio, increase the butter and decrease the strawberry per muffin until you reach the right ratio.