Author Archives: Christy Anderson Brekken

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.

Keto Crepes

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Just like crepes, only keto! Yum!

Krepe Kids

We usually fill them with ham and cheese and roll them up. But the coconut meal gives them a little more body than a real crepe, and they are a little spongy too, so they are kind of a cross between a crepe and a pancake.

They make a great meal because Anders and Ted like them too (but they have too many eggs for me. My own little food glitch).

Tonight Nora had some extra carbs coming, so we filled them with cheddar and 18 g of apple slices! She normally gets about 10 g of apple at a time. What a treat. Of course, she wanted to separate it and eat the apples first, so I let her eat 1/2 of the apples, then made her eat 1/2 of the crepe. Although I didn’t hear any complaining and she ate up every bite.

They would also work great as a dessert or breakfast crepe with some sliced strawberries and whipped cream. Nora claims to dislike whipped cream, but it is because I ruined it by trying to hide her medicine in it once. And she never forgets. Whipped cream will be ruined for her forever. What a shame.

I can also make a batch of batter, which makes about 6 crepes, and use 1/2 at one meal and save the rest for another meal. That helps with the meal-time-crunch on some days.

I have had some problems with getting them to turn out right. It’s the flipping. Tonight I got it right, so here’s my procedure: I use my small frying pan and melt plenty of butter (1/2 T) over medium. Just when the butter gets bubbly, I make sure that it is coating the pan and pour 1/4 cup of batter all around and turn to coat the pan with batter. Maybe it helps if the batter is cold to start–I haven’t experimented on that point much. The batter and butter will co-mingle (good for those ketones). When the crepe is getting quite dry on top, loosen all around the edges. If it’s working, it should be able to move freely in the pan. Then flip and cook to brown on the other side. Right after flipping, put in the fillings to melt cheese and warm everything up. Roll immediately; they will begin to break if you try to roll them when cool. Or just fold in half or serve as a pancake.

And note that these are also gluten free! Coconut meal makes them taste sweetish and contains a lot of fiber. For anyone who wants to try a lower-fat version, use milk instead of heavy cream.

Nutrition facts for Keto Crepes. 1 serving = 1/4 cup of batter. Analysis from caloriecount.com

Keto-Crepes
Makes 1.5 cups of batter = 6 servings of 1/4 c batter each
4 eggs
1/4 tsp pure vanilla extract
pinch nutmeg
1/4 C heavy cream
1/4 C water
1/4 C Coconut Flour (Bob’s Red Mill)
1/2 Tbsp butter

See procedure below.

Keto Crepes under the gram recipe, updated 2/24/2014.

Keto Crepes under the gram recipe, updated 2/24/2014.

In grams, makes 7 servings, 49.4 g each:

28 g Organic Coconut Flour
200 g eggs
0.5 g pure vanilla extract
0.1 g nutmeg
60 g Heavy Whipping Cream
50 g water
7 g Butter

Whisk eggs, vanilla, nutmeg and cream. Sift and stir in coconut meal. Let stand 5-10 minutes for coconut meal to absorb the liquid. Thin with water to your desired consistency.
Heat frying pan to medium and melt butter. Pour 1/4 C batter into hot pan, spreading to desired thin and cover bottom of pan.
Cook until top is drying, flip and fill with ham and cheese, etc.
Remove from pan and roll or fold over.

Peanut Butter-Coconut Cookies

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October 2014 Note: This is one of my first attempts to make a cookie recipe for my child on the ketogenic diet. It was better than I expected, but certainly not the same as a non-keto cookie. Coconut meal, in particular, has a very different texture than flour and some people don’t like it. Because this blog is also something of a record of our lessons learned and progress, I choose to keep it here even though it was not a perfect replica of a non-keto peanut butter cookie. You could also try the linked recipe, which was the original inspiration. The recipes developed more recently have been much more successful, so I recommend going to the 2013 or 2014 recipes that have been tried and true. 

One word on Netiquette: Remember that when you are commenting on a blog, you are communicating with a real person and you should be respectful and aware of the impact of your words. Several comments on this post were not approved because they were rude or disrespectful. In all communications, be kind and thoughtful; write and speak in a way that you would like to be addressed. I’m a mom, not a professional cook. I’m doing my best.

Mmmm, cookies. What else is there to say?

I guess I should say that these also contain 4.5 g of coconut oil, the prime MCT oil. Nora gets 5 g of coconut oil, 3 times per day. What a nice way to get it.

The cookies also have 1 gram of fiber each. Coconut meal has very low net carbs because of all of the fiber.

I have tried a few peanut butter cookie recipes. My recipes have improved by modifying the recipes from this great low-carb baker blog. She has many amazing recipes, some of which will not work for Nora because they still have too many carbs, but if you are doing low-carb or gluten-free baking, I would highly recommend her recipes.

http://tmstrevival.wordpress.com/ [link updated on 11/26/2013]

Peanut Butter Coconut Cookies

Nutrition Information for Peanut Butter Coconut Cookies from caloriecount.com

½ cup Adams Natural Peanut Butter
¼ cup butter
2 eggs
2/3 cup coconut oil
1/2 tsp pure vanilla extract
½ tsp baking soda
¼ tsp sea salt
1/2 c Coconut Flour (Bob’s Red Mill)

Cream together PB, butter, eggs, coconut oil and vanilla.
Mix with flour, baking soda and salt.
Form balls of 1 tablespoon and press with fork on to baking sheet (makes 32 cookies).
Bake 11 minutes at 350.

 

Baked Eggs

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Nora says "yum!" to baked eggs.

Nora has enjoyed baked eggs on 2 occasions, which qualifies for a recipe post.

I’ve seen lots of baked eggs recipes–and they don’t even need to be modified for Nora! I make 3 portions at a time for the boys too (I can’t eat eggs, so I’m the one with the alternative meal on these nights). Next time I will crack 2 eggs into Ted’s cup for a larger portion. You could also throw in a bit of veggies, salmon, or vary the cheese option to your taste, although within the acceptable ranges for someone on the keto diet. Also be aware of the egg size that you are using. The nutrition facts here assume a large egg.

Nutrition analysis for baked eggs from caloriecount.com

Baked Eggs
1 egg
1 Tbsp heavy cream
7 g grated cheddar cheese
pinch of thyme

Lightly grease a small ovenproof ceramic dish or ramekin with butter. Pour in 1/2 Tbsp of cream, sprinkle in 1/2 of the cheddar cheese and a dash of thyme. Crack the egg into the dish, and top with the remaining 1/2 T heavy cream, cheese, and sprinkle again with thyme and salt or pepper to taste.

While preparing the egg cups, boil a teapot of water and preheat the oven to 375º F. In a large heatproof pan (I use my glass cake pan), put in the egg cups and place in the oven. Then pour the water from the teapot into the large pan, surrounding the egg cups (I don’t like to risk sloshing or dropping a heavy pan full of hot water). Bake for 10-14 minutes, depending on how firm you like your egg yolks. When finished, I take the ramekins out with a big tongs first and cool a bit, then take the pan of hot water out of the oven later. Safety first!

For dinner, Nora had her baked egg, an 1/8 of her high-protein, high-fiber tortilla with 2 tsp of double cream cheese mixed with 1 tsp of ground flax and a sprinkle of cinnamon, and 21 g of red pepper.

Welcome back, ketosis

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Seizure control seems to be mostly back, after 2 weeks away. They have been decreasing in strength and frequency. We only saw 1 or 2 yesterday and 1 so far today, so hopefully they will die out again completely.

On Friday afternoon, I caught the first whiff of ketones in Nora’s urine again. Gross, I  know, but it seems to be the best overall measure of ketosis. We are getting more 160+ readings on the ketostix, but still see an occasional low reading, possibility when her urine is dilute.

Her doctor also gave us a prescription for carnitine, the protein supplement to help her process long-chain fats. She had her first dose today. I am glad that her seizure control improved before starting the carnitine, so that we can  better understand the cause-effect relationship of the diet and supplement. I hope that the carnitine can provide a kind of insurance-policy against future loss of ketosis, helping her to process those long-chain fatty acids into energy.

 

Kale chips, aka, seaweed-of-the-land-snacks

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The Brekkens have now found another veggie option. Ted’s words. We will not get any more excited than that, because it is still kale.

But it is kale that we are now happy to eat. Yesterday when I was weighing a piece of kale for Nora, Ted later admitted that he thought (but did not say):  “8 grams of kale, 10 grams of yuck.” I do take the blame for ruining kale, because I probably never cooked it right. After he tasted this recipe, he admitted that this is an acceptable way to make kale. And both kids liked it too! We could eat 1 bunch of kale at one meal with this recipe.

Kale isn’t a superstar for Nora’s diet, but it is full of wonderful veggie goodness so it’s nice to fit it in. It is very similar to the seaweed snacks that she likes, and made at home.

Find the recipe here, to give a well-deserved nod to the original post: http://www.weeatreal.com/2009/11/roasted-kale-chips.html

To measure it for Nora, I weighed 1 piece of raw kale (which came in at 6 g) and used the nutrition breakdown for that, which was 0.5 carbs (0.1 fiber), 0.2 protein, 0 fat (although the olive oil adds a bit of fat). Because it is baked in this recipe, it becomes like thin paper and the only thing that it loses is water, so the nutrition information from the raw kale should be the same as the baked kale. Please correct me if that is a mistaken assumption.

We press on

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Nora is still having a few myoclonic seizures a day, 10 days after we lost seizure control. It is frustrating because we have been checking and re-checking and following the diet to the letter. We have not been able to regain the hard ketosis that worked so well before. On top of it, she seems quite constipated, which is a known seizure trigger.

I spoke with her dietician today. We talked through the situation and decided on a plan of action. And I was reassured that we should plan to suffer through another week. If it breaks sooner, we shall rejoice.

On the issue of regaining ketosis, she suggested that we add coconut oil into Nora’s diet, a medium-chain triglyceride. This kind of fat is much easier for the body to convert into ketones and can help strengthen the keto response more quickly than long-chain fats. As a happy side effect, it is also a mild laxative. We will be adding 5 g of coconut oil, 3 times per day. I had made some peanut butter coconut oil cookies a month ago and froze some, so I took them out today and Nora was a happy camper and she got at least 4.5 g of coconut oil to boot. If they work out this week, I will post the recipe.

Yesterday Ted went on a fiber crusade for the constipation, but fiber only works if she drinks enough fluid to move it through. The dietician said that the fiber rule-of-thumb for kids is her age plus 5, so Nora should get 8-9 grams of fiber. She has already been pretty close to that number on a daily basis because she gets lots of flax, carrots and red peppers in her diet, so we will keep on top of that number too.

We’ve also been reading about a protein called carnitine that is required to get long-chain fats into the mitochondria to be converted to energy (but medium-chain fats do not need this protein to move in, which makes them easier to convert, hence the coconut oil). In ketosis, this protein can be depleted because so much fat is being synthesized. The medical community is not clear on whether ketogenic diet and/or Depokote users need carnitine supplements: some prescribe it as a matter of course, others will not prescribe it unless carnitine levels are measurably low (which is the view taken by Nora’s doctor). For now, we will leave that on the table and consider trying a supplement if the coconut oil and time do not resolve the issue soon.

We will go up to Portland to the keto-clinic to meet with Nora’s doctor and dietician at the end of the month. I’m sure that they will check all of her blood levels also. As a side benefit, it seems that a trip to the doctor always magically resolves all issues. Two weeks is just the right amount of time to fix it all up.

As to why this happened, we will remain in the dark. The dietician said that seemingly small changes can make a big difference–like getting too many calories and having new brownies in the same day. Or it could be something internal to Nora–a growth spurt or development phase. Whatever the cause, it is common to take several weeks to get control back, so we will continue on the path.

Sun through rain and snow

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Outside our windows today. Interesting weather here lately.

Nora still had a few myoclonics yesterday. I slept with her again last night, and either she slept very peacefully or I slept very soundly, because she didn’t wake me up.

I had mentioned that she had a keto reading on the low end of the high range (80) on Sunday and Monday mornings. In the evening it would shoot to the highest reading (160+). This morning we tested her again and she just hit the 160 mark, so we are hopeful that she is getting back into hard ketosis all of the time.

We will not know what exactly knocked her out of ketosis in the first place, but the pan of brownies is going in the garbage (no, I am not going to eat them). I’ve learned my lesson about faux-sweet things and/or caffeine.

I spoke too soon…

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[Insert your worst curse word(s) here. Responses will vary.]

Nora had more myoclonic seizures today, 5 total. It was hard to see them come back. They were clustered in the afternoon and she had none in the evening, so I’m hoping that we are regaining ground. I took another keto reading this evening, and she is in hard ketosis (160+). Whatever happened to our seizure control, please let us find it again quickly. Ted pointed out that yesterday’s lower reading in the morning was probably too low. We had not monitored it for awhile, but the last time we were consistently checking she was also in hard ketosis in the mornings.

We have read similar stories of setbacks by other parents, so we know that it can slip away mysteriously sometimes and take time to get seizure control back, and that it is entirely possible. It is hard to have a setback, but it will happen and we keep moving forward.

Ted is wondering about the recent addition of pickles, but I still have my stink-eye on the brownies. This morning as Nora was waking up, she was talking in her sleep: “Give me my cookies back! I want my cookies!” When she woke up she told me, “I want something, but you will be mad.” I assured her that I wouldn’t be mad, so she told me what she wants, “a really delicious sweet to eat treat.”And I was not mad.

Of course, it is entirely likely that the loss of seizure control and her desire for sweet foods is coincidental. But if she had a blood-sugar-like response to the brownies (both no-carb stevia sweet and caffeine), then maybe her body’s glucose-energy system kicked in again: her pancreas released insulin to unlock the sugars and were bopping around telling her to eat some damn sugar. No one knows how exactly the diet works, but if it works by suppressing the whole glucose-for-energy system and its hormones, and her system was re-awakened, maybe that explains the loss of seizure control.

My theories are not entirely made up (only the connection to seizures part): “The tongue recognizes ‘sweet’ flavors as sugars or carbohydrates, and it signals the body to start producing insulin to help regulate blood sugar levels. Well, when we drink diet soda, there is sweet flavor but no actual sugar going into the system, so our bodies now crave sugar as our blood sugar levels have become unstable. This brings on food cravings and sugar cravings in particular. For this reason, diet soda also causes diabetes and pre-diabetic conditions. Awesome.” From Diet Soda Makes You Fat.

Wow, better get out of my armchair. That’s too much biochem doctoring for me tonight. I feel like I need a disclaimer here–and if anyone else has a better idea, I’d love to hear it.

 

And a brighter tomorrow

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Nora slept well on Sunday night. I slept with her again to keep a closer “ear” on her. She had a few bigger myoclonics in her sleep, which I am sure is still pretty usual for her and no tonic-clonics.

This morning she was her bright and shiny usual self. When Laura came to take care of her for the day, Nora became a mermaid and insisted on hopping around the house on her tail (rejecting Laura’s clever suggestion that she is a magic mermaid that gets legs on land).

There are also a few good suspects, or a confluence of factors, that probably explain this seizure. On the top of my list is the brownies I made for her on Saturday and their caffeine content. Although she got a small amount of caffeine in absolute terms (maybe 10 mg), it is probably 4 to 8 times more caffeine than she is accustomed to. Caffeine is a known seizure trigger for some people and she was sleeping restlessly, although she has had restless nights with a seizure in the past so it is impossible to know the causal connections.

We are fairly sure that she is still strongly in ketosis after we tested her urine on Sunday morning. I don’t think that she ate anything that we didn’t know about, although the Atkins diet points out that caffeine can trigger the same insulin response as sugar, so it mimics an increase in blood sugar even in the absence of carbs. I haven’t looked for any other verification on that point, but it is an interesting consideration for someone on this diet.

While we pondered the reality of another seizure yesterday, I’ve come to several conclusions:

  • Nora has epilepsy. And she always will. It is likely that she will always have a lower seizure threshold, even if she “grows out” of her strong tendency to have seizures now.
  • And we will always worry about her. For many good reasons.
  • Even with another tonic-clonic on her record (her last one was 6 months ago, before the myoclonics started), she is still vastly beating the medical benchmark of a 50% reduction in seizures thanks to the diet. I am assuming that the docs will count all seizures equally, because tonic-clonics are a less troubling type of seizure overall. We’ve got our questions in with the doctor now.

Thanks again for all of the support and kind words from our friends. Nora is still our example of resilience and energy.

Here in the dark

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Last night at 3 am Nora had another tonic-clonic seizure.

She was stirring in her sleep around 11pm and I was still awake, so I went in to lay with her. I decided to stay in her bed. She slept fitfully, was having bad dreams, so I did not sleep soundly either. I woke at 3 am and knew she was having a seizure. It lasted around 1 minute as usual; when it stopped she slept peacefully on my chest for the next hour. The time from 3-6 am passed slowly, every little twitch and jerk maintaining my adrenaline levels. I probably dozed occasionally.

Around 6 am she woke up complaining that one eye and one foot hurt. Then slept a bit again. Ted found us with the lamp on and heard the news. When she woke again she was irritable, but now seems to be feeling better with constant parental attention. She is singing and chatting with Ted as they read books and he feeds her breakfast.

I had plenty of time to ponder “why?” in the dark. The brownies I made yesterday? There was nothing new in them, although she had more cocoa and stevia yesterday than usual. Too many calories? We ate lunch at the co-op with her usual foods, but I estimated amounts by eye. Maybe I missed something? Did she eat something that I didn’t see? Is the window gel cling that she ate last week haunting us? Constipation? Lack of sleep? She didn’t nap yesterday and was not sleeping well.

Ted has been on edge for a few days, feeling that something was off. I made the decision to sleep with her last night. Can we see the subtle signs? Maybe that is a good thing, but can we keep track of the times when we were anxious and nothing happened?

What now? We are on edge again. Today the anxiety will be the worst, and it will subside if there is no more seizure activity today. What about tomorrow? Should she go to swimming lessons tomorrow? Should I stay home with her instead of having the babysitter spend the day with her? How do we add this to the graphs? We haven’t been plotting tonic-clonics. I don’t want to see another data point (that’s a joke. haha.)

Long term, why a tonic-clonic? We haven’t seen one since August–what does this mean? I can’t help but be disappointed that the clock re-starts today on the 3-month-seizure-free goal to end the medication, and the 2-years-seizure-free goal to grow out of it.

There will always be more questions than answers. As I pondered this from 3-6am, I thought that this experience is like falling into a deep pit. I feel like we hit the bottom in November. Now we are trying to climb out, but will lose a foothold and slide back down a few times before we finally make it to the top. At least we aren’t alone down here in the dark.