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.

What goes up…

Seems that we are looking at a seizure pattern. Nora had another tonic-clonic in her sleep around 5 am again this morning. Grandma Sheryl was sleeping with her. Poor thing.

This one was also about 1 minute, but seemed a little stronger. Nora slept much longer into the morning and was a little more wobbly than usual in her mood, speech and movement. Just like she was very very worn out.

After she had breakfast she started to perk up and was out on the trampoline by 9:20 in her poofiest fairy dress. I had already decided to work from home today, so I’m hanging out in the bedroom trying to do some class reading and listening to them play in the living room. She seems to be back to herself.

We are looking at some reasons for another seizure, as usual, but all we have is a series of weak links, no major failures. Maybe she has a bodily rhythm that tries to reject the diet and its benefits, and it breaks through when she is in her vulnerable transitions between sleep stages. She was pining for my toast this morning again, but she hasn’t tried to take me down and devour it herself. She has some uncommon self restraint.

More chats with the dietician and doctor ahead. We will see if there are any pearls of wisdom, but I expect more shoulder shrugs. We keep moving on. She is still far and away beating all of the benchmarks for diet success. One seizure every 2-3 weeks surpasses the 50% reduction of seizures that is considered success.

The Virtues of Fiber

Fiber is our friend. It is counted as a carb on nutritional labels, but we can subtract it out of the “total carbs” to get effective “net carbs.” It lets Nora eat fabulous things like La Tortilla Factory’s Smart and Delicious Low Carb, High Fiber Tortillas. Nora eats some of these tortillas every day, either in 1/8 sections (4.5 g) or 1/4 sections (9 g). They are big, so that little part of a tortilla goes a long way. I know the nutritional specs by heart–1/4 of a tortilla has:
1.5 g net carbs
2 g protein
0.75 g fat
3 g fiber

Wowza. And they taste good, in addition to being quite sturdy. Nora eats them with her “cinnabutter” (butter mixed with a bit of cinnamon, sometimes also delivering coconut oil), as a quesadilla several times a week, as a pizza “crust,” and in our latest version, a “dogsadilla,” wrapped around a hot dog.

Fiber is also our friend for reasons that we all know and love: it gets the poop out. As we have learned the hard way, constipation = seizures. I don’t fully understand the technical explanation (it has to do with the vagus nerve), but our keto doctor says that it is extremely common, in addition to jiving with our experience.

And the keto diet is quite constipating. We’ve tried several things suggested by the dietician. Miralax is a gentle laxative, but we are wary and have not had great luck. We have given Nora a magnesium supplement called Calm that comes in a no-carb “lemonade” flavor, which helps to relax the muscle walls to ease the poop out. We have mixed the lemonade version with the unflavored version at a 2:1 ratio to get more supplement and less flavorings. Nora likes having something tasty to drink. We took a break from Calm supplements for awhile because of a separate acidity issue (more next week on that), but Nora seems a bit constipated again, and I’m wondering if the break from Calm is the culprit. We’ve started giving her 1 teaspoon mixed in water in the morning and 1 tsp in the evening again.

We also give her baths in epsom salts as a way to absorb more magnesium. Ted is a big fan of the epsom salt baths, and it’s darn nice for her.

Back to fiber. The last time she was constipated, we talked to the dietician about her fiber requirements. Looking back, it seems odd to me that they don’t make this part of the keto calculations. If constipation is a problem–let fiber do the job! More bulky yummy foods! Have your red peppers and avocados and raspberries and eat them too!

The dietician said that a rule of thumb for a child’s fiber requirements is to take the child’s age and add 5. So Nora needs 8 grams of fiber per day. We had started tracking it just before talking to the dietician, and she wasn’t too far away from that. Since then, we have tracked fiber along with her carbs, protein and fat. She normally gets 9-12 g of fiber per day now. But another thing to remember: Fiber bulks up the stuff passing out, so can be a constipation threat if you don’t drink enough water. So keep on the water requirements too.

Nutrition information for 1 Tbsp of Bob's Red Mill flaxseed meal.

Nora now eats several high-fiber fruits and veggies per day, and we pick up extra fiber in other ways, like her fabulous tortillas. As I mentioned in the B^3 post, I add flax meal to recipes to up the fiber content. I add some flax to almost everything I bake. The carbs in flax are purely fiber, so it adds nothing to the carb count, only to fiber, protein and fat. In addition, it has all kinds of great fats. Look at that nutritional information! 0 net carbs, 2 g fiber! When we need to push more fiber, we mix it in to butter and serve it on a flacker. Oh! Flackers are awesome too! Crackers made out of flax seeds, pressed and baked together. They are tasty. I know the nutrition info of 1 flacker without looking too:
0.35 net carbs
1.65 protein
2.65 fat
2.33 fiber

As a rule of thumb, I now look for fruits and veggies that have net carbs equal to fiber. So at least 1/2 of the total carbs come from fiber. Avocados are the gold standard. Red pepper has been Nora’s go-to veggie for months now. We have just discovered the amazing raspberry. Unfortunately, I have the impression that many frozen raspberries are pre-sweetened, so check your brands. We are lucky to live in the heart of berry growing country (along with growing almost everything else), and we can get frozen Stahlbush Island Farm unsweetened raspberries all year. A few raspberries have been Nora’s reward for drinking her baking soda water (more on the acid issue later). I’m also planning on making raspberry scones tomorrow. I suspect that there is not more raspberry-love in the low-carb community because of a lack of unsweetened frozen berries. I will sing their praises here.

For other fruits and veggies, we note the fiber but it’s not so great. Apples are not so great, but Nora won’t give up her 10 g of apples (3 tiny slivers = 1.25 net carbs, 0.25 fiber). She was pining after our sweet potato one evening (funny how that happens with this diet), so I measured and gave her a chunk. I don’t remember the numbers, but it was a big chunk of her carbs in a very small (but tasty) package. We don’t eat sweet potatoes in front of her anymore. We had our first spring asparagus tonight, and I was happy that it met my rule of thumb, although Nora was not enthusiastic.

My message to keto familes–make fiber happen!

Cheddar Bread

When Nora first started a diet therapy, we began with the least-extreme diet that has worked for treating epilepsy: the Modified Atkins Diet (MAD). As part of my education, I borrowed the Atkins weight loss book from the library (the man knew how to sell an idea) and several Atkins/low-carb cookbooks. This is a modification of a recipe from one of those sources.

I made it quite a long time ago (which in my world, is 2 or 3 months). Nora requested it again last week, so I made it up for her. She really likes it. I don’t like the taste of the rice protein powder, but my taste doesn’t matter one bit!

Nutritional information for Cheddar Bread. Based on 8 servings. Analysis by www.caloriecount.com

Cheddar Bread

1/3 c (37.4 g) Bob’s Red mill Soy Flour
1/3 c (42.6 g) Source Natural’s Brown Rice Protein Powder
1/2 tsp baking powder
2 large eggs
1 Tbsp (14 g) Greek Gods Traditional Plain Greek Yogurt*
1 Tbsp (14 g) English Double Devon Cream*
2 tbsp (27 g) olive oil
38 g shredded cheddar cheese

Preheat oven to 375. Butter 8×4 inch loaf pan.

Combine soy flour, rice protein and baking powder in a small bowl.

With hand mixer, combine eggs, yogurt, double cream and olive oil until smooth. Add dry ingredients and beat until just combined. Fold in half of cheddar.

Pour batter into pan and sprinkle remaining cheddar on top. Bake 25 minutes or until cake tester comes out clean.

Refrigerate.

*The original recipe called for sour cream, and I did make it with sour cream the first time. This time I did not have any sour cream at home, so I substituted and adjusted the recipe. If you want to use sour cream instead, substitute 2 T for all of the yogurt and English Double Cream. Re-calculate nutritional information.

As always, I gave you the brands that I used for each ingredient. If you use a different brand of soy flour or protein powder, you should adjust your nutritional information accordingly. I don’t see why whey protein powder wouldn’t work, but I have not tried it.

Nutrition based on 8 slices, at 30 g each. Nora normally eats a smaller slice, maybe 15 g. But I have found that if I make portion sizes too small in this recipe analysis tool, it will drop small values, like fiber. We both use the fiber number to see the “net carbs” in a food, and to keep track of how much fiber Nora is getting daily. So sometimes my recipes intentionally show larger portions, and I re-calculate based on this info for Nora.

Nora’s typical 15 g serving would be:
0.65 g net carbs
2.35 g protein
4.1 g fat
0.25 g fiber

And I would normally serve with a teaspoon of butter. The bread is not crumbly (hmmm, could it be the fat and cheese?) so it is nice to put a slice in the toaster (carefully) or under the broiler after taking it out of the fridge. Nora really digs the “toast” consistency.

The caloriecount website gave this recipe a B-! That is the highest rating I’ve seen for any of Nora’s recipes. Normally, they get a D. Good points are always that they are low in sugar (yeah) and bad points are that they are high in saturated fat (yeah too). It is interesting to always see how this external “health” and weight loss site views the diet that is so effective for my kid. If only they knew.

Efficiency is Life

Nora needs several supplements everyday, some multiple times a day. It’s tedious to crush tablets and add them to foods on a meal-by-meal basis, so here’s one of my time saving processes to ease the daily grind.

Peanut butter (B^3) and apples (10 g = 1.25 g carbs) is Nora’s morning snack, and nobody better mess with it. It’s also a great fat and supplement delivery system.

First, I make a big batch of B^3 (that’s B-cubed, aka, B*B*B for those not math-inclined). Peanut butter, sunflower seed butter, and butter. Give it a bit of body and fiber by adding some flax:

Nutrition for B^3

Nutrition information for 1 Tbsp B^3 from www.caloriecount.com

B^3
1 cup butter
1/2 cup Adams 100% Natural Peanut Butter
1/2 cup Sunbutter Organic Sunflower Seed Spread
1/2 C Bob’s Red Mill flax meal

Soften by bringing all ingredients to room temperature, then blend well. I am careful not to whip too much air into the mixture, as I measure it by the tablespoon. Of course, it may also be weighed for precision.

I think this completely filled up a quart jar last time I made it. Refrigerate and it will keep a long time. At 1 tablespoon a day, it lasts a while.

The B^3 is now ready to be made into 1 tablespoon servings and loaded with supplements. It’s a great delivery system because the taste of the supplements is masked by the nut butters.

Adding supplements to B^3

Nora gets 1/4 of an adult Centrum every day (her diet does not guarantee her the required vitamins and minerals), 1 tablet of carnitine (an amino acid that helps with processing fats), and 200 mg of folic acid (helps with thinning hair due to the medication). She also gets calcium supplements, but we do not add them here. Any chewable kids vitamins have carbs to make them tasty, so those are out of the picture for Nora. Of course, we can’t expect a 3 year old to swallow pills, so we crush them into a powder with a small mortar and pestle and incorporate them into her food.

I start an assembly line process by measuring 1 tablespoon of B^3 into 4 small dishes. I crush 1 day’s supplement tablets into a powder and add it to each bowl of B^3. That way, she gets a consistent daily dose. I mix in the supplements and put the little bowls in the freezer to harden.

Frozen B^3 + Supplements

When the mixture is hard (it does not have to be frozen solid), I use a melon baller to scoop it all up into a little ball.

Then I put each ball into a container and keep it in the refrigerator. That keeps the mixture solid enough to stay separate, but gets pliable quickly when it is ready to eat.

It is a bit of work, but I love having little balls of B^3 to grab out of the fridge when I’m preparing each day’s meals. Meal preparation is enough of a chore without getting out 3 more supplements to add to Nora’s food. We can put a few week’s worth in the fridge and keep it on hand.

Finished B^3 + Supplements

Productivity is happiness. Maybe that statement is a little too strong. Concentrated tedium is preferable to daily tedium.

 

 

So far, so good today.

Quick update since yesterday’s early morning tonic-clonic seizure:

Nora is going strong. She had a great day yesterday, and is her regular self today. Her ketone level seems fine and we have not seen any waking myoclonic seizures. She has had 1 after falling asleep at nap and bedtime, but we don’t really count those because she is in the a sleep transition stage when myoclonics are most expected and normal for everyone. We do use them as a kind of signal that she is still vulnerable, but thankful that they are not breaking through when she is most robust while awake. We are hoping that this bump is much smaller than the one about 1 month ago.

We suspect that the timing of her food and fat delivery in the last week is the culprit, particularly the 2 days leading up to the tonic-clonic. She had not been eating much lunch with her babysitter for a variety of timing reasons, so she would get a big slug of calories all at once after I got home in the afternoon instead of spreading it out throughout the day. She was also eating fewer overall calories as a result, so there were fewer grams of fat required in her bedtime snack. Yesterday we were very conscious to leave a large amount of fat for her bedtime snack so that she would have enough ketones to sustain her until the morning.

A special thanks to Grandma Margie for visiting this week. It’s been great to have extra help and support here, and Nora sure loves her G’ma Gigi. She’s a delightful playmate!

The dance continues

Nora had another tonic clonic in her sleep at 6 am this morning. Grandma Margie had just returned for a visit and was sleeping with her.

On the bright side, it was very short and mild. It’s also a vulnerable time for the brain–the brainwave changes in and out of sleep states in the early morning make seizures more likely. We have other anecdotal evidence of early morning seizures in people on the ketogenic diet, both because of the sensitive sleep state and ketosis is lowest early in the morning. I’m not too terribly worried about it, but it’s always disconcerting to see a seizure.

Nora slept for about another hour after the seizure and had a very mild postictal state also. No more vomiting or sleeping on and off for hours. She seemed a little slower in the morning, not quite bursting with energy as usual, but we took her to gymnastics at 9 and she had a great time. Seems like it will be a normal day. She seemed to have high ketones when we tested her this morning, so hopefully that will protect her from myoclonics returning.

However, when this happened 5 weeks ago she also had a great day-after. Then the myoclonics started again on day 2 and lasted for 2 weeks. Tomorrow will tell whether we are in seizure-land again for awhile. But I hope that this time will be milder and shorter than last time, until this eventually fizzes out for good.

But we are disappointed, particularly because we were counting down to a seizure-free deadline. Last time we saw Dr. Wray, he said that if she stayed seizure-free for 2 more weeks, which would have been Friday, he would probably start weaning her off Depokote. I’m curious to see how this changes his decision on that issue.

In another side-light, Nora’s blood test from last Friday turned out well, except that the HCO3 levels in her blood were low. I’m a little confused on this issue because I received differing information on the phone from the nurse and from the doctor via email. In any case, her blood is a little too acidic, which is somewhat expected on this diet, but if it gets out of control it can lead to a serious illness (metabolic ketoacidosis, as I understand).

We’ve been dancing around the issue all week because we can’t get an appropriate supplement to neutralize the acid. The first one called into the pharmacy was a “delicious grape flavor,” which is code for “CARBS” to me. In fact, it seemed to be carb-free but had sorbitol, a sugar alcohol that interferes with ketosis for some people. We did not give her any of it (and it wasn’t covered by insurance AND it can’t be returned). The doc called in a different formula, but that apparently has been discontinued. We can give her baking soda (dissolved in water or other fluid), but it doesn’t taste good. We will keep working on that issue, but in the meantime she does not seem to have any symptoms of the acidic blood issue and the doctor says it is highly unlikely that was related to the seizure this morning.

Updates to follow as this dance continues. Never know what the DJ will be cranking out next.

The Keto-Raw-Food-Vegan Diet

This diet has not been challenging enough, so Nora’s now going raw food vegan too.

Happy April Fools Day!

I did find a fabulous hummus-substitute for Nora on the raw food vegan website of some of our favorite musicians, Jónsi of Sigur Rós and his partner Alex. Together they make music and art in Reykjavík, Iceland, and shared some of their raw food vegan recipes on their website. Click on the cool hand-drawn cookbook on the right to “flip” through the recipes. They’ve also made videos to demonstrate their “cooking” techniques (remember–this is raw food). I find it touchingly earnest and adorable somehow.

Macadamia nuts are often used in the ketogenic diet because they have a tremendous amount of “good” vegetable fats and low carbs. And they are totally delicious and cost their weight in gold (almost). I keep them in the fridge to be sure to keep them fresh. Nora has not been a huge fan of eating the nuts themselves, but I’ve tried to get them into her diet in other creative ways, like this.

I like the idea of putting Macadamia Monster Mash in half of a small pepper and broiling some cheese over the top (damn, I forgot about that vegan thing. And that raw food thing). But because Nora is only 3, she still isn’t a big fan of mixing her foods. One day she will appreciate a more complex presentation.

Here’s the recipe (I amended it a bit for Nora’s taste) and video for Macadamia Monster Mash:

Macadamia Monster Mash

Nutrition Information for Macadamia Monster Mash. From www.caloriecount.com

200 g macadamia nuts (about 1 cup, but for the diet I weigh it for precision)
1 tsp dried parsley
1 Tbsp lemon juice
1/3 c water

Mix in food processor or blender until creamy.

0.5 g net carbs
0.7 g fiber
0.7 g protein
6.3 g fat

The original recipe adds a clove of garlic and salt, which will slightly alter the nutritional information.

Nutritional information is based on a 12 g serving, about 1 tablespoon, but I weigh it on the scale instead of measuring it with a tablespoon.

Served on a flacker or low-carb tortilla, roll a little ball of Madacamia Monster Mash in some shredded cheddar cheese, spread on a slice of turkey and roll it up, or just eat it with a spoon. I’ve also mixed her coconut oil into it for easy serving.

One little sidelight: when I was making the recipe the first time, I realized that although water does not add any macro-nutrients, I need to specify the amount of water that I use in the recipe to get the correct nutritional information per serving. Why? Because the water adds weight/mass to the serving, in a sense “diluting” the other ingredients. A 12 g serving with water has different values than a 12 g serving without water. Details, details.

Hazelnut Applesauce Bread

Yesterday was baking day again, and Nora requested this Hazelnut Applesauce Bread. It’s the 3rd time I’ve made it–a hit! Nora enjoys it for breakfast, topped with a mixture of her morning coconut oil mixed with a bit of butter.

The recipe calls for baking it in a small loaf pan, but I find it a little unwieldy to store and cut in that form so I tried baking it in a wide shallow baking pan instead. It came out nicely. With all of the fat, the edges get kind of browned and crispy. Mmmm.

This recipe is an adaptation of Candice’s Low Carb Almond Flour Applesauce Spice Pound Cake [11/13: her site has moved and that recipe seems to be gone: http://tmstrevival.wordpress.com/]. If you look at her recipes, she always uses Splenda or another no-carb sweetener. We try not to add any of those sweeteners to Nora’s diet. It’s unclear whether they interfere with ketosis for her, and we don’t want to take any chances. I also don’t care for their flavor (they always have a bitter edge to me). I try to choose recipes with naturally sweet and delicious ingredients so that extra sweeteners are not necessary. Nora is not accustomed to sweet things anymore, so this bread (and her other baked goods) taste sweet enough to her. We call it “applesauce bread” for the sales pitch, and the applesauce does add a nice touch of sweetness, with the nutty taste and cinnamon flavors as well. We are going for flavor, not sweetness.

The original recipe calls for almond flour. The first time I made it, I was out of almond flour but had ample hazelnut flour. Did you know that 99% of all hazelnuts grown in the United States come from the the Willamette Valley in Oregon–right here where we make our home? And when you move to Oregon, you learn that hazelnuts are also called “filberts.” Know the local code to find the local deliciousness.

It is possible to substitute any nut flours for these kinds of recipes, but remember to always re-check the nutritional information. To boost the fiber and cut a little more carbs, I also substituted 1/4 cup flax meal for some of the nut flour, which I do with most recipes.

One additional word of caution for keto-families, which applies to all of my recipes with nutritional information: Make sure to re-calculate nutritional information for the ingredients that you use if they are different from mine. I use Bob’s Red Mill nut and seed flours. Check the nutritional information for the applesauce you use and make sure it is unsweetened. If you are grinding your own nut flours (which you can do in a coffee grinder), you can weigh the quantities to be sure of your measurements. I am measuring things in cups here, but as you know that creates more room for error. If you measure according to the recipe, weigh, and calculate based on weight you will get more precise nutritional information for the recipe that you feed your child.

I also use an online recipe analyzer because we don’t use a keto-calculator (we are on a “modified” keto diet without as much rigor as administered by most neurologist’s offices). My nutritional labels are for your reference to determine if you want to try a recipe.

Hazelnut Applesauce Bread

Hazelnut Applesauce Bread. Nutritional analysis from www.caloriecount.com

3/4 cup unsalted butter, room temperature
5 large eggs
1/3 cup UNSWEETENED apple sauce
1 teaspoon pure vanilla extract
1.75 cups Hazelnut Meal/Flour
0.25 cups flaxseed meal
1 T Organic Coconut Flour
2 tsp baking powder
1 teaspoon ground cinnamon
1 teaspoon ground ginger
1/2 teaspoon ground nutmeg

Preheat oven to 350F

Grease & flour a 8”x4” loaf pan with butter and dust with coconut flour.

In small bowl combine hazelnut flour, coconut flour, baking powder and spices. Set aside.

Beat butter with an electric mixer until fluffy and smooth. Add eggs one at a time, beating well after each addition. Add vanilla extract and apple sauce and continue to beat until smooth.

Add hazelnut flour mixture to egg mixture. Mix on low until combined. Then turn mixer up to high and beat until smooth.

Pour into prepared loaf pan and bake at 350°F for about 1 hour or until done. (When I made it in the wide shallow pan, it cooked for about 45 minutes).

Let cool in pan for about 10 minutes then take out and and cool on wire rack. If you don’t take it out of the pan, it will solidify in there and will break if you take it out when cold. There is a lot of butter in this recipe and it does solidify.

Note that 1 serving is 16 g (I cut and weigh each piece of bread). It’s a rather small but dense serving. The recipe creates 48 servings at 16 g each, so it’s wise to freeze half of a loaf because it will get moldy before we use all of the 48 servings (unless the rest of the family is eating it too!)

A 16 g serving contains:
0.7 g net carbs
0.8 g fiber
1.4 g protein
6.2 g fat

To the Keto-Klinic

I couldn’t resist the double K’s again.

We are on our way to Portland this morning for a Keto Clinic checkup. They schedule these on the 2nd and 4th Fridays of the month, to get the personnel and keto kids all scheduled in a row. I think we meet with the dietician and Dr. Wray to check in, ask questions and get standard blood tests.

It feels like such a waste to drive 4 hours round trip just for that, but we don’t have any other go-to activities in Portland when we just have Nora will us. But if this is quick and easy, we should probably consider taking Anders with in the future and making a day of it. Any suggestions for future trips? Either quick trips or longer whole family trips?