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.
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).
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.
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
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.
|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|
And for the visual (cream not pictured):
That’s a great post.
With regard to #7, let me reiterate the importance of re-mixing the cream. Early on in the course of the diet treatment for Nora, we went through a bout of breakthrough seizures and anomalously low ketosis readings. In trying to hunt down the reason for loss of ketosis, we discovered that if you pour the cream directly from the cardboard container, a huge amount of the fat sometimes stays stuck to the inside. Now we take a new cream container, open it all the way up and scrape all the fat off the sides with a rubber spatula. Then we pour everything into a new glass container and mix it well. Every time I take the glass container out of the fridge, I gently agitate it to make sure everything is well mixed.
Every time I use cream now, I check its consistency to make sure it is not too watery. A few times I have been using the last of the cream from the glass container and I thought it looked a little watery. I just tossed it out and used new cream. It’s worth it for the piece of mind.
Great post! I’ll be printing this and putting in my son’s dietary binder of recipes. I love these ideas!
Great ideas, all 15 of them. I already copied them away, printed it out and will hang it on our fridge… well done
First of all thank you so much for sharing so much info. We are starting our almost 4 year old Cora on MAD. We are starting out at a very high 50 carb a day diet and decreasing by 10 carbs per week until we see some siezure control. Cora has not been a good eater since she started meds 1 1/2 years ago. I think it’s due to meds. These past few days since starting the diet she hasn’t eaten much at all, even at a high carb level. My question is how do you get a 3 year old to eat things like Flackers and olives foods that are so different from her normal diet? And drink so much fluid when juice is off limits. Did Nora refuse for awhile? We will talk to her dietician tomorrow for some advice. I have ordered some of the tools you have recommended (ice cream pops) ect. so hoping that will help, we are struggling to get the fat and protien in her .
Also I have tried a few recipes that call for ground macadamia nuts (pancakes, muffins) but when I tried to grind them in food processor and Vita Mix it turns into nut butter or is a grainy, greasy consistancy. Any hints? I was hoping if we could come up with a go-to breakfast we would be doing a little better. Sorry to ramble feeling a little overwhelmed by it all. It took so many months of waiting and appts. before we could start I guess it is sinking in “this is it”. Really appreciate any advice.
First, it’s hard hard hard to start. Hard on everyone. You are not alone. But have hope that you will get through to a better place with it, both for Cora and for your family. Nora started on a Thursday or Friday and spent a miserable weekend of feeling cruddy and not eating. She begged for toast for quite a while, weeks to months, really. It just doesn’t feel good to enter ketosis, but once Cora is over that hump her energy should return and the craving for carbs should stop. It took some time before anyone in the house was able to make toast because Nora could identify it by smell, but now she doesn’t care at all.
I would also say that Nora was not a good eater on MAD, and in retrospect I see that she was just getting so much protein to make up her calorie needs for the day. I think she did better and better, in both seizure control and satisfaction with eating, as we increased her ratio. I know that sounds odd because the ketogenic diet is considered “so hard”, but it’s true. Remember that there are 9 calories per gram of fat and 4 per gram of protein, so having more protein make up her calorie requirements for the day is a lot of mass and volume for a little body to eat. We had to hand feed her for a very long time and try to get that last bit of protein in her, try to hide it in other things (like protein powders), etc. So if you start thinking about moving closer to the ketogenic diet, there might get better seizure control and willingness to eat.
I guess she just started eating new foods little by little, as we discovered them. I think flackers were satisfying because it was crunchy and we could spread something yummy on top, like cream cheese. At that time, we didn’t have anything else cracker-like. My kids like salty foods, so olives were always in our diet. Like all kids, it may take awhile to introduce new foods, so making it as familiar as possible will help, including the name you give it.
Nora doesn’t have a liquids requirement, but it’s important for managing constipation. Watch out for that and make sure she is getting enough fiber too. Nora does drink water, but also no-carb, caffeine-free tea for something with flavor. She likes Celestial Seasonings Sleepytime Vanilla, but there are many choices. I just look to be sure that there is no dried fruit in the tea bag, so it should be no-carb. It’s also nice if you need to add some extra fat, to put some heavy cream in with the tea.
Yes on the macadamia nuts–that’s the way it is. They are great for the diet because of all of that fat, but it is like a nut butter, never like a flour or other nut meal. Just work with it that way! They do have such a nice flavor, but Nora didn’t like to eat them plain right away. She also got used to them.
A go-to breakfast and morning snack really helps with our daily routine. I’ve been making the pumpkin cheesecake muffins for breakfast for a long time now and Nora still wants them. I made the hazelnut breakfast cookies for a long time but she got tired of them, so we try to switch it up as she dictates. It makes the day so much easier to just take 1 thing out the the fridge and serve it up for breakfast. And for morning snack she gets b^3 plus apple. We don’t have to think about it, and 3 to 4 year olds are creatures of habit.
I hope all of that helps and wish you and Cora the best of luck! We have a grown-up friend named Cora, such a pretty name! I think Nora just felt so much better being seizure-free and in ketosis that everything became easier, and she also grew from 3 to 4 which helped a lot too. Have hope, we’ve been there and made it through. You can too.
Lot of good ideas I’m eager to try for myself. Question: what is B^3?
The first B^3 reference in the post has the link to the blog post about it: http://blogs.oregonstate.edu/modifiedketogenicdietforepilepsy/2012/04/15/efficiency-is-life/
We have played with that recipe a lot for Nora–now we are on version 5. I have not posted all of the variations because they are all basically the same thing: nut butters, butter, coconut oil, and flaxmeal. It’s a delivery system for vitamins supplements and other stuff for little ones that can’t swallow pills, but even without the supplements it’s a good way to be able to boost the fat in a PB and apple snack!
Yes, sounds like a good plan. Have you tried almond butter?
We use almond butter a lot more now, because it is lower carb than peanut butter. I think it took a little while for Nora to adjust to the different taste, but now we are on it!
Can this diet work for adults as well!!!! I have a close friend who has epaleptic episodes about every 6 months and I didn’t know if this would help him because he is 21 years old and nothing has seemed to work!!!! What do you think worth a try????
I have met adults that use the ketogenic diet or a more relaxed version called the Modified Atkins diet and it works for some, although it might not be as effective in adults as it is in kids. It’s definitely worth talking to his doctor and/or finding an epilepsy clinic that does the diet to talk to him about it.