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.
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.
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.
Each muffin has:
0.7 g net carbs
2.3 g protein
10.6 g fat
1 g fiber
If your child needs a higher ratio, increase the butter and decrease the strawberry per muffin until you reach the right ratio.