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.

And now she is a teenager!

Where does the time go? Our spunky strong little keto kid is now an official teenager. She loves animé, cosplay, and her friends. She finally got to dye her hair blue for her birthday. In our experience, kids take a huge running leap into teen years, then let the time catch up with them.

Nora’s last seizure was in April 2012; she is over 9 years seizure free. She eats a normal diet now, but hangs on to some of her keto habits. She still likes to eat her cereal with half and half, no plain old milk will do. She also takes tiny IKEA playset bowls of ice cream — the same ones you will see in old pictures on the blog — and eats it with a half-teaspoon measuring spoon to enjoy it slowly. She has grown tall and strong, kind and smart.

When she had her first seizures, the doctors hoped it was a fluke. Lots of kids have seizures. But when it happened again, they prescribed keppra. After 6 months, we weaned her off keppra and seizures came back. Then she started having myoclonics…it wasn’t a fluke anymore. We were scared and didn’t find many resources for mystery epilepsy (which is my way of describing her diagnosis: idiopathic benign myoclonic epilepsy). When keppra and depakote didn’t work, we learned that the ketogenic diet was more likely to work than a third drug. Thankfully, Dr. Wray was just starting at OHSU and became her doctor. The diet worked with some trial and error, and her seizures stopped. After 2 years of seizure-freedom on the diet, she weaned slowly to MAD, then fully off, and has been seizure free ever since. Grateful.

We started this blog for all of the parents who feel alone and scared for their precious kiddos. We also started it for ourselves, to document what we were going through and communicate with others. We’ve connected with a lot of parents through the blog over the years, met with a few families, exchanged many emails and texts and phone calls. We see you, and we hope that Nora’s story can be a ray of hope. We know that the diet doesn’t work for everyone and each child has a unique path. Look for the helpers, find support, and be an active member of your child’s medical team. You know your child better than anyone else and you have the strength and ability to help your child. Don’t give up. You’ve got this.

When we asked Nora’s first doctor about the ketogenic diet, he said “it’s really hard.” But you know what’s really hard? Watching your kid have seizures and wondering what that means for their development and life. The ketogenic diet was nothing compared to that stress and anxiety.

But the doctor was also right. The ketogenic diet is hard. It’s a grind. On top of learning, measuring, weighing, calculating, it’s helping your kids through the emotional turmoil of saying “no” to every fun food that other kids are having. It’s helping siblings through the fear and sometimes jealousy when the keto kid gets something “special.” It’s helping them figure out how to manage their own emotions, when you are managing your own. Sometimes the best answer is just to be empathetic. Affirm that this is really hard, and we are doing our best. It’s a good life lesson. Everyone struggles with something.

If your child has epilepsy and you are struggling to find the right treatment, or if you are just learning the diet, or if you are exhausted from the grind over many years: it’s hard. We’ve been there, we know what you are going through. You are doing your best. Be kind to yourself.

Nora is 11!

Nora turned 11 in June, which is a lucky birthday because it is her favorite number and the year that witches and wizards get their admissions letter for Hogwarts…still waiting on that! There are many books focused on 11 year olds, so it must be an important transition year in a person’s life. As a future author, Nora pays attention to these things. 11 should be a great year!

Nora is now over 7 years seizure free. Her last seizure was in April 2012. We held steady at a 3.5:1 ratio for 2 years after that, started weaning her from the diet in April 2014, then kept her on MAD until she was about 5 years seizure free. You can see the general progression in Nora’s Epilepsy Story. Now she eats like any other kid, making herself mac-and-cheese and snacking on ice cream. We still try to steer her away from sugar bombs (marshmallows, suckers, etc.) and toward sweets with some fat (chocolate!). She still prefers half-n-half on her breakfast cereal rather than milk, go figure. Now we stress that the most important thing is to keep up a health balanced diet.

One concern that I had about the diet was creating control issues with food. There are 2 ways to worry: first, that she would go wild after she was “off” the diet, or second, that she would be super controlling over food into her future and develop an eating disorder. I am happy to say that I don’t see any of those dynamics playing out.

Nora has amazing self control when it comes to snacks and sweets. On the diet, both she and her brother would use strategies to enjoy a small portion of a treat, like putting ice cream into a small bowl and using a tiny spoon to eat it a bit at a time to really enjoy it. She would eat a square of chocolate so slowly that she would get a very characteristic chocolate streak in the corner of her mouth. She usually still has Halloween candy in her room 6 months later. When we were at the Oregon coast last week, each kid got a bag of 10 saltwater taffy, and Nora still had some in her bag when we got home. She has definitely not gone hog wild, and she does not deny herself treats. One reason that the diet went smoothly was her amazing self control, even when she was so young. We all negotiate our relationship to food throughout our lives, but for now Nora seems to have it down.

Nora has grown so much lately, she is getting tall and is still lean. Next year she will go to middle school, continuing with the dual-immersion program with her Spanish language arts class. She still enjoys theater, deepening her writing and directing interests. She recently created an adaptation of the original Alice in Wonderland story. The “readers theater” version that she performed for us was about 20 minutes (perfect), and she has recruited several friends to play the parts while she directs. They set a performance date in September, and based on the sustained interest among her and her friends, I think it will actually happen! Nora continues to amaze and delight us. We are so thankful for her beautiful healthy brain.

Words of Wisdom Worth Repeating

With Nora’s long seizure-freedom, she has become a regular spunky 10 year old girl. We will forever be grateful for the ketogenic diet and the difference it made in her life, and the difference it made in our lives as her parents. I’m still happy to be a supportive friend to any parents who are on this journey with their own child–if you are out there, feel free to comment and we can email or talk.

Now I’m helping a family member on her journey into careful low-carb eating. Her pancreas had to be removed, and now she is diabetic and entirely dependent on insulin. It is essential to get a healthy low-carb eating plan in place.

I revisited our own blog to find some recipes and nutritional information–like leaving myself a message in a bottle! I’m baking a version of the Blueberry Almond Muffins for a healthy on-the-go snack. I will do a lot of baking and freeze lots of low-carb treats!

As I was looking through recipes, I came across this post by Ted: Lessons Learned. Just, wow. Practical tips, plus words of wisdom on navigating the marathon of epilepsy. Marathon makes it sound a little too easy (not that I’m ever running a marathon, sounds hard to me). More like a marathon with archers and club-weilding trolls jumping out of the bushes randomly. They may knock you down, but you get up and keep on moving. If you don’t read the full post, this is the pearl of wisdom for all of us:

It’s not “hard.”  It is different.  If you think the ketogenic diet might help your child, don’t accept any statement that the diet is “hard” as a reason for not trying it.  I wouldn’t say the diet is hard.  Epilepsy is hard.  The diet is a tool that may improve your child’s quality of life and development.  (Remember that if your child has failed two anti-epileptic drugs, the diet is statistically more likely to help than a trial on a third drug. Also, certain epilepsies respond particularly well to the diet.) However, the diet does require some changes to your thinking and expectations.  Once you get your routines down and everyone gets a few months to adjust, the diet is not significantly harder than having other diet restrictions.  Just different.

That is a beautiful, resilient frame of mind for any life challenge. Thank you, Ted. I can tell you in person that you are amazing, but let’s all take a public moment to recognize your amazingness.

We are happy to be a resource for parents on this journey. Leave a comment and we can converse here, or we can be in touch by email.

September is Back to School Time!

As everyone heads back to school, we think about everything our kids need on a daily basis and communicating those needs to their teachers and school staff. When Nora was on the keto diet, we shared our experience in 3 parts:

Bringing keto to kindergarten, part 1
Bringing keto to kindergarten, part 2
Bringing keto to kindergarten, part 3

Now that she is a big 5th grader who has been seizure-free for 6 years (whoo!), back to school time is a little less stressful.

However, she is still a special little one. I got a call from the school district nurse during the first week of school, which took me by surprise. She was again checking in to see if Nora had any new seizures or treatments that the school should be aware of. I was grateful for the call, and reminded of the importance of continuing communication with the people around her. I told them that although we have weaned her from the keto diet, and from MAD, we still think about what “eating healthy” looks like for Nora, which is avoiding high sugar intake–the possible “sugar bombs” that can come with school events (although her school has adopted a smart “healthy snacks” policy that should work for her now too!). Nora is also a pro at evaluating food presented to her, and politely declining if she is in doubt. She also has some preferences developed through her diet experience that we are happy to continue to support.

For breakfast, she asked me to make some of her MAD About Granola about a month ago. However, it largely sits untouched (I eat it with yogurt some days), because she has discovered a kind of cornflakes that she really likes. But she still prefers half and half on her cereal! She has tried whole milk, but doesn’t like it as much. So each day starts with a bowl of cereal with half and half.

She still packs a lunch for school each day, which she does herself. Her Mission Balance Low-Carb tortilla are still her favorite, usually with butter, peanut butter and a drizzle of honey. She often takes cheese and a piece of fruit on the side.

After school snacks are now much more conventional. She loves Coconut Bliss ice cream (preferably chocolate peanut butter) or bars (chocolate). The ratio is quite good, even though it has more carbs than she used to get a day. We have also had apple pie and apple crisp around the house, thanks to our apples and pears trees this year. We are happy to let her eat those homemade treats now, and more open about similar kinds of treats in small servings, preferably paired with some fat.

We are still getting used to the idea that she can eat a typical diet, although we want to hang on to the healthy aspects of the keto diet. It’s a nice lesson to reiterate that a healthy diet is low in sugar. But I don’t want to give either of our kids food/control issues as they enter their teen years. We continue to strive for a healthy relationship with food, remembering that “healthy” can mean something different for everyone, depending on their food allergies, intolerance, treatments, and preferences.

Chocolate Poundcake and Nora is 8!

IMG_4422Nora is 8 years old! She had a fabulous birthday celebration with friends. Her artistic side is shining through, with musical theater as her birthday party theme and top summer activity. With a little moxy and a lot of help from our friends, we pulled off an impromptu version of Suessical the Musical, with Nora playing Gertrude McFuzz and singing the songs herself. Her birthday wish came true and she was fabulous!

The birthday week also brings check up time: we paid a visit to her regular pediatrician, who finds Nora in perfect health and 50th percentile in height and weight. The keto diet did not seem to slow her down after all of those years. We also visited the dentist who gave her a clean bill of dental health. Back in the keto days she got several fillings, which I still wonder about–could it be that her saliva was more acidic like her blood at that time? Because it certainly was not related to sugar consumption!

Nora is now over 4 years seizure-free and it has been about 1 year since she officially moved on to the Modified Atkins Diet (MAD). She still eats like she is on MAD, but we don’t weigh or measure food. Our new rule is to restrict all refined sugar and carbs, which is how we should all be eating for health anyway. As a matter of fact, it’s how our whole family has learned to eat – almost, her 11 year old brother doesn’t restrict himself in all settings – but at home we eat whole fruits, veggies, nuts, eggs, meats and dairy.

This Chocolate Poundcake recipe has been our go-to cupcake recipe for about a year now. I make a big batch and frost them with cream cheese whipped with a drop of vanilla and a splash of cream, then freeze them for birthday parties. I also make sure to keep several in the school freezer for those days when a classmate brings in a treat. Nora’s teacher sends her down to the teacher’s lounge to take one out of the freezer in the morning, then she’s ready to celebrate with the rest of her class when they have a special treat at school. These cupcakes are moist and chocolatey, just as rich and delicious as a cupcake should be.

The MAD version is 1.45:1 ratio, but topped with whipped cream cheese the ratio is even higher – which is great! To make the keto version with a higher ratio, I have included substitutions and nutritional facts below. We’ve also made these in other flavors, for example, omit the cocoa powder and add bits of raspberries for vanilla-raspberry muffins. Use your imagination! This recipe was  adapted from The Joy of Gluten-Free, Sugar-Free Baking.

Chocolate Poundcake Nutritional Facts, 1 cupcakes (makes 10) from www.caloriecount.com

Chocolate Poundcake Nutritional Facts for 1 cupcake (recipe makes 10) from www.caloriecount.com

MAD Chocolate Poundcake
Makes 10 cupcakes

1 2/3 cup (180 g) Almond meal
1 Tbsp (10 g) Show Me the Whey Protein Powder (could substitute other brand)
1/2 tsp (2 g) baking powder
1/4 tsp (1 g) salt
1/4 cup (20 g) cocoa powder
2 large (100 g) eggs
1/4 cup (60 g) Whole Milk
1 tsp (5 g) vanilla extract
6 Tbsp (80 g) butter, melted
1 Tbsp (20 g) honey

Preheat oven to 350 degrees and set out 10 silicone cupcake molds on a baking sheet.

Mix together the dry ingredients–almond meal, protein powder, baking powder, salt, cocoa powder. The almond meal can be clumpy, so break it up and mix well.

In a separate bowl (your stand mixer, if using one), measure the eggs, vanilla and milk (or cream, see below). Mix on low to combine wet ingredients. Meanwhile, melt the butter in a microwave-safe bowl, then add the honey to the melted butter and combine. Add the butter and honey to the mixing bowl and combine with the eggs and honey. Then add the dry ingredients to the mixing bowl and mix on medium for 1-2 minutes, until well combined.

Scoop batter into 10 silicone muffin cups (49 grams each). Bake for 10 minutes, then rotate baking sheet and cook for another 10 minutes, until a toothpick comes out clean.

For the keto version, substitute heavy cream for the milk, and stevia for the honey (liquid stevia will go in with the eggs, cream and vanilla, powdered with go in with the dry ingredients). With those substitutions, each cupcake will have 47 grams of batter, 2.9 g carbs, 6.5 g protein, 19.2 g fat, for a ratio of 2.04:1. Use your favorite keto frosting to bring up the ratio of the whole treat.

Nora Update & Lemon Bread

Nora and her prosciutto-pear pizza, crust made from a Mission Carb Balance tortilla.

Nora and her prosciutto-pear pizza with olive oil and mozzarella, crust made from a Mission Carb Balance tortilla.

How did 2016 sneak up on us? I have been meaning to write an update for months, but busy family schedules just kept pushing it back. It’s also a case of “no news is good news,” because Nora is happily humming along with her Modified Atkins-style diet, growing and learning and being her true self.

In our last diet update about 9 months ago, we were still holding carbs to 40 g per day and weighing carb foods on the gram scale to make sure that we were not exceeding that limit, but allowing unlimited protein and fat and not calculating the ratio anymore. Now we are not weighing anything (except for making a few recipes where I still find it easier to weigh than to measure in volume, but it is rare).

We are thinking of this as the long-term maintenance phase of Nora’s diet and have taught her to eat by a simple rule: If you have a sweet food, like fruit, match it with a protein/fat food, like cheese or nuts. We are so fortunate that she has made her food choices part of her identity. I don’t worry about her cheating when she is out of our sight. She goes to friends’ houses to play and I know she will make good choices. She is making new friends and I realized that I forgot to tell the parents about her diet limitations on the first visit. We are also fortunate that we live in a time when people are very sensitive to food allergies and don’t question food limitations, and sometimes even ask up-front.

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Nora was Pippi Longstockings for Halloween! She has a flare for drama and adventure! The Halloween Fairy took away her candy and left her a “horse head on a stick” (Nora’s words!), now named Eponia.

Nora still does not get foods with added refined sugar or other starchy foods, like crackers. Gluten-free is a good rule of thumb, but many gluten-free foods are full of just another kind of starch and are not a good choice, and conversely, her low-carb tortillas do have wheat in them. A rule of thumb that I follow for meal choices is to look for paleo products and recipes because they tend to be lower carb, while still reading labels. We are also fortunate to live in a time when there are so many healthy low-carb options at our fingertips.

Nora still feels like she is on a special diet, just a bit, but because of the many special diets in the world she doesn’t feel like such an oddball. I still make fancy cupcakes and store them in her school’s freezer in the teachers’ break room, so that if the class has a birthday celebration she has something special too. She doesn’t seem to mind at all and had one last week–the only evidence I had of it was the wrapper that came home. I send along a treat to a birthday party, or pack extra healthy snack for her and friends if they have a playdate. For her birthday, we made 3-layered fruit popsicles for her backyard pool party with no added sugar. We are finding lots of things that work for everyone now that her diet is so much more relaxed. Nora’s food is still part of daily life, but it is much easier than before and the rest of life has taken over our time and energy.

We made our snickerdoodle recipe to share for Christmas treats.

We made our Snickerdoodle recipe to share for holiday  treats.

She also has very fond memories of her special diet. Just last weekend, she took the Keto Cookbook off the shelf and was reminiscing about foods that she wants to make again and wanted to try some recipes that we had never tried! That book was such a gift to us when we first started. I remember lying in bed with Nora after we got it, looking at the pictures of the food that we could make on her special diet. She could imagine pretty delicious things and be excited about food.

One new recipe that Nora and friends like is this Paleo Lemon Bread, adapted from Good Morning Paleo by Jane Barthelemy. I picked it up at the library–it has several good ideas for breakfast and lunch. This comes together quickly in the food processor, but you can mix by hand as well. They freeze well so we make a big batch and take them out as special snacks for a trip or outing with friends. She is still devoted to her MAD About Granola with half and half for breakfast, which is one recipe I still make religiously, twice per month.

Nutritional analysis for one lemon muffin, by www.caloriecount.com

Nutritional analysis for one lemon muffin, by www.caloriecount.com

Paleo Lemon Bread
Makes 24 servings
Ratio: ~1:1, 4.8 carbs/serving

1.5 cups (170 g) almond meal/four
1 tsp (5 g) baking soda
1/4 tsp (1.5 g) salt
3/4 cup (200 g) Coconut Butter
5 large (250 g) eggs
1/3 cup (80 g) lemon juice
1 tsp (5 g) apple cider vinegar
2 tsp (9 g) Vanilla Extract
1/4 cup (85 g) honey

Preheat oven to 325 degrees. If using mini-loaf pans, line with parchment paper. Or set out 24 silicone muffin cups to bake.

Place almond meal, baking soda and salt in food processor, pulse to combine. To measure the coconut butter: it will be solid at room temperature, so scoop out to measure by weight, or melt it by warming in the microwave or in a bowl of warm water to measure out 3/4 cup. Add to almond flour mixture and combine well. Add eggs, again pulse to combine. Measure the remaining liquid ingredients in a separate bowl (it can help to warm the honey also), and add to the food processor. Combine all into a thick batter.

Bake in 2 mini-loaf pans 20-25 minutes or in 24 muffin cups for 15-20 minutes. Remove when slightly brown and a toothpick inserted in the center comes out clean.

If you want to reduce the carbs, reduce or eliminate the honey and add no-carb sweetener. You can also add a few berries to each muffin before baking for an extra pop of flavor.

Refresh & Welcome the Swicks

This week we are refreshing our blog! After almost 5 years of living with the reality of epilepsy, treatment and recovery, we are taking stock and updating our blog to reflect where we have been and where we are going.

Keto Parent Meeting. Photo credit: Amanda Cowen, Corvallis Gazette Times

Keto Parent Meeting. Photo credit: Amanda Cowen, Corvallis Gazette Times

You will notice the new look at the new name: Oregon Keto Kids. Now that Nora is almost 3 years seizure free and we are weaning her from the diet, we are turning our attention toward supporting other families as they use the ketogenic diet to overcome epilepsy. Of course, this blog is always for everyone, no matter where you live, but it is also a central part of the more hands-on support group we will form for parents who are starting the diet at OHSU Doernbecher Pediatric Neurology’s Ketogenic Diet Program. The first step is working with other families who are emerging from their journey with the ketogenic diet armed with the experience to reach out to support others.

Thus, we welcome Amanda and Jason Swick as co-bloggers at this space. Their son, Jaron, was diagnosed with Doose Syndrome when Nora was about 1 year seizure-free. They connected with us after Nora’s story was in our local newspaper. We are all grateful that our story was told and that another little person and family could use the ketogenic diet to overcome epilepsy. The Swicks are an amazing family and they are also ready to reach out and support others.

During the next few weeks I will be updating many of our main pages. I haven’t looked back at them in ages, and see how out of date they are!  It’s time to re-write Nora’s story and call on our experience to re-write the other general informational pages.

It’s an interesting experience to look back at those times, remember what we were feeling and experiencing, and to see the journey to now. We are thankful that it went as well as it did. Ted and I feel that we don’t have a lot more to say on a regular basis and are not making as many recipes anymore, so maybe we will spend some time curating the blog for the “best of” and doing some summary posts of the challenges that we faced.

Amanda will be blogging about Jaron’s experience (you can read Jaron’s Epilepsy Story now, and look for updates in the future). She also has experience with Doose Syndrome, the Keto Calculator, reflux, kidney stones, camping and more, so you will learn a lot from her experience and perspective.

Our blog-refresh plans are not done yet, so we will keep you posted as we make changes so that you can stay in touch. We are always happy and grateful to hear from other parents and supporters.

And we are looking for support! If you want to help get the support group off the ground, we will be looking for volunteers to help us get donations to buy basic supplies for families, print a welcome packet, buy books about living with food restrictions for kids, etc. We would also like to contact some of the companies that make good keto foods to get coupons or other discounts (for coconut oil, macadamia nuts, nut flours, cream, etc.) Please contact us if you want to pitch in; donations will go through the Doernbecher Foundation and will be tax deductible!

March 2015 Keto Clinic Appointment

We visited Dr. Wray at Doernbecher yesterday for Nora’s 6-month Keto Clinic appointment. She is now 35 months seizure free and weaned to the Modified Atkins Diet. As usual, she ran through the standard clinic neurological checks and passed with flying colors.

IMG_5329Her blood and urine tests still have a few remnants of the diet that we hope will continue to resolve as we continue to liberalize her diet. Her blood acidosis level is still a little high and she still has the beginnings of kidney stones. The treatment for both of those issues are compatible and simple: plenty of water intake, and we can add some dietary citrate. I’m still doing some research into the citrate options; she already takes calcium citrate and we will have to decide if we start supplementing with magnesium or potassium citrate.

We will continue to wean her from the diet slowly by changing how we administer the diet. At this point, she is getting 40 grams of carbs per day and has no limits on protein or fat. We are only weighing and tracking her carb intake to make sure that she doesn’t exceed her 40 g limit, but we are not tracking her daily ratio anymore.

Our next step will be to estimate carb portions, much like diabetics are taught to do. Then we can shoot for an estimated 8-10 grams of carbs per meal, 5 times per day (still plenty of snacks in her day). We will give up the precision of the weighed foods, with the understanding that her carb intake will fluctuate more from day to day but will stay comfortably lower than a traditional US diet.

Nora will not see a big difference in her diet, but I hope that it frees Ted and I a little more. We have appreciated our little friend the gram scale, but I look forward to throwing together quick meals without consulting the spreadsheet and the scale first.

This is also an opportunity to start teaching Nora to feed herself. She would love more freedom and has appreciated the ability to get herself a piece of cheese anytime she is hungry. As she gets older she will appreciate more freedom, and we all need to learn healthy eating habits for our own bodies.

We have been going back to Doernbecher for check ups every 6 months, and now we will wait a whole year until we go back again, and Dr. Wray thinks that we won’t have to do those big nasty blood draws anymore! Nora is very happy to hear that news!

IMG_5310We do enjoy our trips to Portland. This time Nora wanted to go to the Japanese Gardens and brought her Japanese robe and umbrella that she got for Christmas. We also met up with another keto kid, Annie, who is moving from MAD to a higher ratio to get better seizure control. It is so important for families to support each other through this, because we have so much to give to each other that our doctors and dietitians don’t have experience to help us with: the daily grind of meal preparation and the learning curve. As we continue to wean Nora from the diet and wean ourselves from the gram scale, we plan to ramp up the support group.

IMG_4668We made it a Japanese themed day (on St. Patrick’s Day, no less, but at least we beat the crowds!). We had sushi at Masu Sushi, which felt like a fancy place but was low-key for lunch. Nora can eat edamame and sashimi until her belly is content, and here we found some dungeons crab rolls that both kids adored (Anders got the rice from Nora’s, a win-win).

After lunch we walked down to the renowned Powell’s City of Books. We found a fabulous book of Japanese folk tales, several other books picked by each kid, and a few games. Good times in the big city. Now we will have to plan to come back once and awhile just for fun.

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Back to Modified Atkins Diet

When we began diet therapy for Nora, we started out easier with the Modified Atkins Diet (MAD). We could see that it helped, but didn’t completely control her seizures at the time, so we kept stepping up the ratio over several months until she was on a 3.5:1 ratio ketogenic diet. Now we are through the wean and back to Modified Atkins again. We just keep taking steps and all is well. Still seizure-free, growing and full of energy!

In early December her ratio was lowered down to 1:1, which is Modified Atkins Diet, but we were still calculating and weighing all of her food. When the kids got out of school for winter break we took another step: we are only calculating and weighing the carbs that Nora eats, but giving her any protein and fat that she wants. Although we are still using the gram scale, we spend a lot less time working out each of Nora’s meals and she is happy to eat cheese or nuts when she wants to.

We also moved her up to 40 grams of carbs, just another baby step up, but it has allowed her to have yet more fruits and vegetables.

Eventually we will be estimating all of her foods, even the carbs. But after calculating and weighing to the gram for so long, we realized that we really don’t know portion sizes! We weigh things without really looking at how much is there. We are using this time as a chance to re-learn portion sizes so that we can eyeball meals that will be a good balance for Nora.

Ted reconfigured the spreadsheet that we use to calculate meals for our latest step. Now we enter the number of carbs we want to give her from various available foods, and the spreadsheet tells us how many grams of each food to serve. It’s pretty sweet. He color coded it so that we learn which foods are “danger zone,” “caution,” and “almost-free.” The coding is based on the number of carbs per calories in the food. For example, if she were to eat her whole 40 g of carbs from raisins in a day, she would only get 13% of her day’s calories and would need a lot of other foods. If she got her hands on the raisin box and went to town, she would stuff way too many carbs into herself before she was full. But if she ate her whole 40 g allotment of carbs by eating macadamia nuts, she would get 379% of her calorie needs in the day! In other words, she would naturally stop eating macadamia nuts before she could get close to 40 g of carbs because she might explode. Ted is so clever.

There are several foods that fall into the “almost free” category, which we may just remove from the spreadsheet altogether soon and make them free. Macadamia nuts, walnuts, cream cheese, string cheese, avocado, flacker. Of course, any carb-free food is free too. As long as we get some of these “almost free” and carb-free foods with fat into her every day, we have no problem keeping her at a 1:1 ratio. During the first several days of estimating we double-tracked it using both of our spreadsheets. We calculated her carbs and estimated her meat, cheese and fat portions, then weighed them and put the amounts served into our old spreadsheet to find the ratio over the day. We were easily at or above a 1:1 ratio as long as we were mindful about the basic ratio of each food.

Our Foods by Ratio post has helped us to keep her ratio on track. The big danger-food in that list, in my experience, is cottage cheese. Even full-fat cottage cheese has a very low ratio. During one of our MAD transition days, I gave her a meal of cottage cheese, turkey, and applesauce. I knew immediately that it would be very low fat, so supplemented with some tea and cream and added cream to her cottage cheese too. She actually prefers her “soupy” cottage cheese anyway!

Transitioning her to a more normal diet has been interesting. She loves having more banana and a bit of honey with her peanut butter. Now she eats her MAD About Granola every morning with whole milk! The granola is over 1:1 ratio, so adding whole milk at a 0.4:1 ratio can balance it out to 1:1. Whole milk is still pretty carby; it is in the “danger zone” category of foods but she loves it.

Other new foods get surprising results. I offered her a bit of rice, maybe a tablespoon, equal to around 5 grams of carbs. She wouldn’t eat it! She had a big bowl of edamame instead, and some sweet potato. Another night I offered her a fried Korean dumpling, 6.6 g carbs per dumpling and most of her dinner allotment for carbs. She took one bite and didn’t want any more. It is interesting how her tastes have changed, or maybe she is just nervous about trying too many new things, which is expressed in disliking the food. I’m not in any hurry as long as she is happy.

Although it is supposed to be easier than the ketogenic diet, I remember feeling like MAD was harder because Nora couldn’t eat all of the protein. It is 2-3 times the daily protein requirements for a child her age. Now that she is free to eat or not eat the protein that we serve, she seems happier. Although I still don’t understand how a child can refuse her whole serving of our Christmas ham (honestly, “do I have to eat the ham?” what the heck?). She does not refuse bacon, however.

IMG_5239For Christmas brunch I made the basic waffle recipe from The Joy of Gluten Free, Sugar Free Baking with minor modifications. I was able to use whole milk and the whole family ate it. No more 2-recipe mornings for pancakes or waffles for us!

 

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Nutrition facts for 1 mini-waffle, 29 g of batter. Nutritional analysis by www.caloriecounts.com

Hazelnut Waffles or Pancakes
110 g (1 cup) Bob’s Red Mill Hazelnut Flour
110 g (1 cup) Bob’s Red Mill Almond Flour
2 tsp baking powder
100 g (2 large) eggs
110 g (1/2 cup) Organic Valley Whole Milk

Mix the dry ingredients in a medium bowl and the wet ingredients in a small bowl. Combine and mix very well until the batter has a uniform consistency. Alternatively, you can put all ingredients in an electric mixer and mix on medium for about 3 minutes, stopping to scrape down the bowl. If you are making large waffles, whip the batter well until it is foamy and aerated.

Cook as pancakes or in a waffle iron as usual.

If you like, you can add a no-carb sweetener, cinnamon or nutmeg for flavor. After weighing and cooking some for Nora, I added maple syrup to the batter to make pancakes for the rest of the family.

We made mini-pancakes and waffles, 29 g of batter each, as shown in the nutrition facts. Then each pancake has 2 grams of net carbs and a 1.5:1 ratio. We paired it with ham, a dollop of cream cheese, and blueberries with a touch of maple syrup (wow!). Nora is all about Celestial Seasonings Country Peach tea with cream these days, a nice way to add a little decadent fat as a treat.

Help, Thanks, Wow

Ann Lamott wrote a book called: “Help, Thanks, Wow: The Three Essential Prayers.” I’m sure she is not the first one to notice. Honestly, I haven’t read the book (yet). But now that I know to look, I’m seeing the pattern.

Exactly 4 years ago, the day before Thanksgiving, we entered the “help” phase when Nora had her first seizure. We saw doctors, started keppra, got lots of help from our community. Then she was seizure free for quite a long time, until they came back and the myoclonics appeared. At this time three years ago we were practically shrieking “HELP!” from the rooftop because nothing was working. Then we found the ketogenic diet, Dr. Wray joined OHSU, and we got started.

It worked. We started her on the Modified Atkins Diet (MAD) and saw improvement. Thank you. After breakthrough seizures we started increasing the ratio. Fewer seizures with each increase in ratio until we reached 3.5:1 and held steady there. Since her last seizure in April 2012 we have been counting the seizure free days. Thank you! By July of 2012 she was weaned off of all antiepileptic drugs and she was growing and developing normally. THANK YOU! In April 2014, after 2 years seizure free, we started a slow wean off the diet.

IMG_2288Now, we enter “WOW.” Almost 3 years on diet therapy, 2 years and 7 months seizure free, and Nora is weaned back to the 1:1 ratio of the Modified Atkins Diet. We have come full circle and are re-learning MAD again. When we do the ketostix urine test at home, she still has some ketones but it is very weak now.

Not that we don’t continue to say “help.” Nora’s kidneys have been acting up again. She complained that her “side hurt,” and when we asked her to show us she put her hand right over her kidney and drew a line around to her bladder. She had a urine test earlier in the week–yep, crystals were present, maybe stones. Maybe a small stone had already passed; we will never know. This isn’t a major threat, but a bummer. We are so close to the end of the diet and she is otherwise great. Skipping is her latest hobby and she is excited for swimming lessons because she likes going in the deep side of the pool now. Her ultrasound was normal, so her pediatrician wants to wait on further testing while keeping her hydrated to help stop any stones from forming.

Normally I don’t get too down about this stuff and didn’t this summer with her kidney issues, but it wears a person down over time. When you know a family with a health problem, especially a child, your heart goes out to them for the anxiety and fear for the beloved one’s health and safety. But one thing I’ve learned is that it is not just the fear of the health consequences, but also the sheer amount of time and energy that goes into coordinating doctors, tests, advocating to get something done in a reasonable time, making sure that lab work contains an order for the right information, sorting out what is meaningful and what it not, doing the research to ask the right questions and understand the answers. I’ve learned the hard way that you should double check things up-front instead of making the trip back to the clinic for another blood draw. I feel grateful that Ted and I are in this together and Nora is such a trooper about it, but at the end of the day it still leaves you exhausted and saying “help” even when there is nothing left to do.

Looking for more reasons to say “thank you” is a powerful strategy. As long as I was in contact Dr. Wray regarding her kidneys, I asked if we could do a blood test to check her blood acidity (see The Blood Acid Chronicles post for more info). She is still taking baking soda dissolved in water twice per day and would be a happy girl if weaning the diet means that she can stop taking baking soda. She was a super champ about the blood draw (despite requiring 2 pokes) and we brought flowers to Erika, our favorite phlebotomist, because she is changing jobs and we won’t get to see her anymore. Erika and I cried, but not Nora. Even after all of that, Nora lost it when I dropped her off at school because she was late. Thank goodness for teachers who say, “I’ve got this.”

The next day we got to “thank you” again: Nora’s blood acidity is back in the normal range. She can wean off of baking soda in the next 2 weeks….IF she has no kidney stones. The baking soda helps to keep stones at bay too. If Nora doesn’t complain about the side pain anymore then we will make sure she stays hydrated and start weaning the baking soda too. Wow!

I can hardly believe that Nora is a 1:1 again. We will continue to calculate and weigh food for the next 3 weeks, as scheduled, to get a feel for MAD portions. Then we will start estimating some meals without weighing if all is still going well. We still have her carbs capped at 38 g per day, which has been the limit for the last 3 weeks. At some time we will start moving up the carbs and down on the protein to try to stay around 1:1, but as we start estimating meals those numbers will be less precise.

We have to feel this out and keep watching Nora, which brings me back to HELP! all over again. Not that there is anything imminently wrong, but I’m holding my breath and hold the hope tight in my heart like a small fluttering bird. I know we have been in the hopeful watching and waiting before as we began the first count of seizure-free days. I hope that one day 3 months from now, then 6 months from now, then 1 year from now the reality of that monumental passage of time will hit me and I will live in a place of Thank You! and WOW! But right now we wait in hope for those days. Help! Thank you! and Wow! all come and go through the same revolving doors through our lives and right now they are making me a little dizzy.