Last week was time to order another box of Cytra-K (for background, see The Blood Acid Chronicles). But the manufacturer is out! Our pharmacy called all 14 other pharmacies in town, and there was none to be found.

The back-up plan is to give Nora 1/2 tsp of baking soda twice per day. But Nora absolutely hates it. We dissolve it in a little bit of water, but we have to fight to get her to take it. Ted has discovered that Arm & Hammer tastes better than the kind sold in bulk at our co-op, but it is little comfort to Nora.

I put a tiny bit in her hot chocolate without telling her to see if she could taste it. It’s like the princess and the pea.

Nora’s doctor has a fax on his desk that he will find first-thing Monday morning asking for a substitute. Any suggestions for other substitutes for preventing blood acidosis?

Word on the keto-street is that Organic Valley Heavy Whipping Cream is the only brand that consistently has no carbs. Their process is good enough to take only the fat and leave all of the lactose behind. And it’s organic–even better.

But we have a problem. We’ve notice that the Organic Valley cream we get from our local co-op is often very clumpy, while the Organic Valley cream that we get from another grocery store is consistently smoother.

So what’s going on in that clumpy container? In “On Food and Cooking: The Science and Lore of the Kitchen,” Harold McGee says it simply: “you agitate a container of cream until the fat globules are damaged and their fat leaks out and comes together into masses large enough to gather.” I suspect that the creamery trucks need better shocks to avoid all of that agitation.

The clumps that we find are baby butter. We try to stir them back into the cream, but we are really just breaking them up for a more even distribution. When we heat cream with clumps, they turn into yellow pools of butter. When Ted found a very clumpy carton this weekend, his idea was to put it in the microwave to heat, then it would re-distribute itself better. After heating and stirring, he put it in the fridge. When it came out of the fridge, there was a butter disk on top! (It was half-eaten by the time I took a picture. No, I didn’t eat it.)

Now, that’s cool, right? But we have a problem. We just extracted fat from the cream. We could do a rigorous weighing and calculation to determine how much fat was removed from the container to calculate and use the “thin” cream for Nora. But instead we bought a new carton and I will drink the thin cream in my coffee this week. Everybody wins.

Lesson: Buy smooth cream if possible. If your cream is clumpy, don’t heat it. Redistribute the clumps as well as you can for reliable fat measurement.

Me: “Mmmm, Nora. These pumpkin bars are so good. You are the luckiest keto-kid on the block.”
Nora: “No, I’m the only keto-kid on the block.”

And that pretty much sums up the social issue with starting school. Nora has been so amazingly compliant about her diet that the last 20 months has been relatively easy emotionally. Also, she has been home with her beloved Laura while I’m at work, socializing mostly with other families that we know and who know Nora. And if someone offers her food, our assertive little Nora clearly states: “no thanks, I can’t, I’m on the ketogenic diet for epilepsy.” I have heard it with my own ears. But I was also there to step in if Nora did not assert herself. When she is at school, she is on her own.

Starting kindergarten means that everything is new. All new people and kids who eat together 3 times per day. Nora is in school from 8:15 to 2:40, where they eat breakfast, snack and lunch together. Of course, Nora’s teacher and school staff are informed about her diet (I will address that in part 3), so it is not up to a 5 year old to explain it to the adults.

But she is her own advocate with her peers and she is well aware that she is the only keto-kid on the block. Other kids have other food issues to navigate, such as nut, dairy and gluten allergies. Plenty of other kids bring their own lunches and a few opt-out of breakfast. But after just the first day she was aware that *everyone* was drinking milk with their breakfasts and lunches and she wanted milk too.

I was trying to avoid liquids in her school meals, which are only asking to be spilled. But when she really wanted to have “milk,” I felt like it was more important to honor her wishes than avoid the risk of spilling. We’ve been giving her “keto milk” made with cream (an amount needed to achieve the ratio in the meal), diluted with water and with a drop of vanilla or other flavoring (she also likes banana). Our standard packing method is an 8-oz mason jar, the kind you use for canning jam. This summer I punched a hole in the top of a lid to fit in a straw. To make it spill-proof in a lunch bag, you just add a second solid lid under the screw cap, then to serve remove the second lid and insert a straw.

The straw is great for avoiding big spills while drinking, but I think that the changing of the lids is a bit much for a 5 year old who has 25 minutes to eat while surrounded by other kids. After the first day of school I tested her on unscrewing the lid to drink directly from the jar like a cup, which worked fine for the few days that we tried it.

I also started searching for small travel-and-kid-friendly cups that we could send to school. We came up with these reCAP mason jar lids and have used them successfully for the last week. They are plastic and have a rubber gasket to create a good seal. Nora can pop open the pouring lid herself. I am still nervous that the pour top will not stay closed in a lunchbox, but so far, so good. I check and double check it before I send her off.

I also brought in 6 of her Mexican Chocolate Protein Cupcakes with frosting and put them in the school freezer, so that she has a snack on hand if the class has a special treat. The question will be whether everyone remembers that she has a treat in the freezer. But if I tell Nora about it, she will be sure to inform everyone. Next I have to figure out how I will be informed that she had the extra snack at school. I suspect that I will hear it from Nora first, and they are at-ratio so if I don’t hear about it the ratio is fine, she just gets lots of extra calories that day.

She has been to school for 8 days now, and every day she comes back with empty food containers and no stories of spilling. It all seems to be working so far from her end. I feel pretty confident that Nora will tell me her wishes so that her lunches are appealing and easy to eat with her class, because the top priority is to keep her happy and independently choosing to stay on the diet.

The only mishap so far was one day when the whole class did not get morning snack because their schedule was rushed. When I picked her up the teacher reported that she had an emotional day, then when we got home I discovered that she had not touched her morning snack. She was adamant that no one ate snack, so the next day I told her teacher that if they don’t eat snack she needs to get that food at lunch time. Her calories are apportioned over the day, and missing some will make a girl cranky. It’s in everyone’s best interest to feed Nora.

and don’t feed me cupcakes…unless they are keto-cupcakes! Just to make the point, Nora is holding one of her 4:1 cupcakes in the photo!

We ordered these great keto t-shirts through http://www.ketogoods.com/SHOP.html. Proceeds from each order go to The John M. Freeman Pediatric Epilepsy Center at John Hopkins Hospital to support research and efforts for the ketogenic diet.

They came with 5 stickers with the same message: “Please don’t call me cupcake and DO NOT feed me cupcakes. I’m on a special diet for epilepsy.” The stickers will be great to put on Nora’s lunch boxes, just as an extra reminder to everyone.

Nora got another purple shirt (more her size) that says “Hey, I’m on a magic diet for epilepsy so please do NOT feed me.” I like that one, but Nora preferred the cupcake one, of course.

My t-shirt says: “Someone I love is on the ketogenic diet for epilepsy.” Because it’s true.

We so rarely go out to eat at a restaurant with Nora. We have probably been out with her about 10 times since she has been on the diet, and I can only think of 2 occasions when she ate some of the food at the restaurant–only when we have been at the coast eating seafood. Usually we pack her food and bring it into a friendly place. Last night Nora started asking to eat at a restaurant out of the blue, and as it was the last day of winter quarter and spring break is here, we decided to go out for a sushi celebration and honor her request.

Going out for sushi feels pretty safe because the food is minimally prepared. Both of our kids love salmon sashimi and edamame is awesome for Nora. Have I mentioned that before? Edamame is awesome! I forgot about it for a long time until I found some in the freezer earlier this week. Here’s the nutrition snapshot of 30 grams of Cascadian Farm shelled edamame. It’s not high ratio but it’s low carb, and you don’t find even that much fat in most veggies. This is fairly representative of the nutrition information from other brands and generic versions that I can find listed online.

Edamame in the shell is also awesome because it keeps Nora busy and happy.  Last night she got 30 g of edamame, pretty much all of her dinnertime carbs. We calculated her portions before leaving home then brought along the gram scale to measure it out. To serve it, I estimate the number of beans she can eat in 30 g then count out the beans in the shells.

After the edamame is ready, I pop some beans out of the pods and add them to the scale until I get up to 5 g (it’s usually 6 to 7 beans, depending on the size). To serve 30 g, I need 6 times that number of beans. Then I count out the beans in the shells for her. Last night she got 40 beans, so at 2 or 3 beans per pod she ended up with about 15 pods. Doing it that way is an estimation, but it averages out the variability in the bean size by weighing a sub-sample of the beans in the serving. Nora loves popping them out of the shell and it keeps her busy at the restaurant or kitchen table.

For the rest of her meal, she got about 1 slice of salmon sashimi (25 g). We brought some flacker (6 g) with butter (7 g) and some “hot chocolate” (steamed cream and cocoa powder) to round out the fat in her meal. Everyone was happy. Anders loves sashimi too. We got 1 order of sashimi to split between the kids because Nora gets only 1 slice. We could have weighed more for her and compensated with more fat when we got home, but she was feeling “fat and satisfied.” Anders ate the rest of that order of sashimi, the miso soup, some edamame, and most of another order of sashimi because he was still hungry. He’s not a cheap date!

Then we went home and finished off our Japanese-themed evening by watching Ponyo together. A fun and easy night was had by all and Nora was happy to go to a restaurant. She loved the room with the traditional short tables. She kept exclaiming that the room was so small. She felt like a giant! And the waiter was super tall and skinny because he had to crouch down to serve us! It’s always fun to see the world anew through a child’s eyes.