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-Perfect Cheesecake

Happy Birthday Papa Ted!

We celebrated Ted’s birthday last weekend. Luckily, his favorite dessert is keto-compatible–cheesecake! I am not a seasoned cheesecake baker, so I found a recipe for a self-described “perfect” cheesecake at Simply Recipes:  http://www.simplyrecipes.com/ recipes/perfect_cheesecake/

In addition to the promise of a perfect cheesecake for Ted, the ingredient list lent itself to a simple keto-version. I just scaled everything down proportionately for a 4-inch springform pan (from Michael’s), made a simple macadamia nut crust, and substituted some of Nora’s saccharine-sweetened Cytra-K for a touch of sweetness. I also omitted the sour cream topping and used plain berries. The recipe for the cheesecake alone is 4.2:1, so add berries to adjust the ratio down to your requirements. Nora gets 13 g of strawberries per 1/4 of the cheesecake to make it 3.5:1.

One full recipe of Keto-Perfect Cheesecake. Analysis by www.caloriecount.com.

Keto-Perfect Cheesecake

20 g ground macadamia nuts
10 g melted butter
100 grams Primrose cream cheese
1 g pure vanilla extract
22 g egg
20 g Organic Valley Heavy Whipping Cream
20 g Straus Sour Cream

Wrap the springform pan in one continuous sheet of foil to keep it water tight for baking (see link to original recipe above for detailed instructions). Mix together the ground macadamia nuts and melted butter and press into bottom of pan. Bake for 10 minutes at 350º or until slightly browned.

With a hand mixer, cream together the remaining ingredients with any desired no-carb sweetener until very smooth, scraping down sides and bottom of bowl to evenly incorporate all ingredients. Turn oven down to 300º and boil a pot of water. Pour cake batter into springform pan on top of the crust and smooth the top. Place in a larger roasting pan in the oven, and fill the larger pan around the cheesecake with about 1 inch of the boiling water. This is why you protect the pan with the foil, so that the water doesn’t get into the cheesecake pan and ruin the crust. Bake for about 1 hour, or until firm. Turn oven off and open the door so that the cheesecake can cool gently, about 1 hour.

Nora's Keto-Perfect Cheesecake.Place cheesecake in the refrigerator to chill completely, at least 2 hours. Carefully run a dull knife around the edge of the cake to loosen from the sides of the pan. Release the springform pan to serve the cake. I placed a few slices of strawberry and a raspberry to decorate the cake, just remember to factor those into your calculations. Cut the strawberry length-wise to get heart shaped pieces. Awwww. I pre-weighed each piece so that they were all 3 g of berry. I don’t trust my memory these days.

Nora ate 1/4 of the cake for a serving, with 3 g of strawberry on each 1/4. I included the nutritional information for the whole recipe above. As always, re-calculate with the exact ingredients that you use.

I made both Nora’s cheesecake and Ted’s cheesecake at the same time, side by side in the oven. That saved a lot of time. I also fully appreciated the contents of a perfect traditional cheesecake, knowing that Nora’s and Ted’s were proportionately identical, except that Ted’s included a lot more carbs. That said, it was delicious and perfect, as advertised.

Nora’s cake batter did not have the same consistency as the original. Nora’s batter was less runny, but only lacked the sugar. There is some food science going on there that I have not researched. Going into the pan and during baking, Nora’s was also thicker. I had a tiny taste from the knife and it was good, but a thicker consistency than Ted’s traditional cake. Even so, I have not heard a single complaint from Nora. She has 1/4 left awaiting her in the fridge. It’s a great keto snack!

Tips and Tricks: Saving money!

One of my first images of the ketogenic diet is the picture used in the NYT magazine article, Epilepsy’s Big Fat Miracle:

Stephen Lewis for The New York Times; Food Stylist: Brett Kurzweil

That made my stomach turn a little bit. Now that Nora has been on the diet for 8 months, we know it’s not quite like that. We eat bacon about once a month. Nora gets about 4 slices total over a few days when I make up a package. She eats WAY more butter than this, but less cream nowadays. And WAY more macadamia nuts. And avocados aren’t in the picture! So I’ll update the picture with one of my own, from last night’s stock-up grocery shopping trip:

Feeding a kid on the ketogenic diet is not cheap, particularly if you are looking for high-quality fats. Pictured are some of the big-ticket items that I picked up for Nora last night. Some will last for several months, like the coconut oil. I’m not sure if this 5-pound bag of macadamia nuts will last us the month, but it will come close.

Now the saving money part: On the second Tuesday of every month, our local natural foods co-op, First Alternative, has Owner Appreciation Sale Day. Member-owners get 10% off their entire purchase! Even better, member-owners can order a case of any product for a 10% discount. Pick it up on owner sale day, and you get the additional 10% sale day discount off the discounted case price. Genius. They don’t hide this possibility, but I’m not sure that many people know about it. Your local co-op or grocery store might offer similar discounts on case orders; it’s common at all of the co-ops I’ve shopped. And it doesn’t hurt to ask.

I’ve mentioned before that I bought English Double Devonshire Cream in a case of 12. At $8.89 per jar, that’s some savings. Now that we are using less Double Devonshire Cream (Nora no longer eats “Norgurt” every day now that she is off Depokote sprinkles), I just buy a few at a time on owner sale day to last the month. It’s my mayo substitute (we hate mayo). I have been ordering a case of Primrose cream cheese, which comes in a 3-lb brick and costs $12.87, so we save $1.29 on the case discount and another $1.16 on owner sale day, for a $2.45 savings.

But that is small potatoes. We have dramatically increased our use of other high-priced items in recent months. Coconut oil and macadamia nuts are now staples, and we go through them like crazy. A 12-16 oz jar of coconut oil will cost between $8 and $12. This month I ordered a 7.5 pound jar of coconut oil, pictured above. It will keep indefinitely, so I will refill our smaller jar for daily use. The original price for the whole jar is $65.18, or $8.69 per pound. The case discount subtracts $6.51, then the sale day discount takes off another $5.37, for a total savings of $11.88. Now we’re talking savings.

We’ve also been going through macadamia nuts like crazy. After grinding them into butter, they are the main ingredient of many of Nora’s baked goods. Ted went to the store and bought some from bulk one day, which sell for $18-20 per pound, depending on the store. When the cashier weighed them, they came to over $40. She suggested that he could put some back (some friends will remember that Ted came home with a $40 bag of arborio rice the size of his head one day, so he’s got a reputation for “bulk” buying). But in the case of the macadamia nuts, we needed them all and he declined the opportunity to put some of them back.

The 5-pound bag of macadamia nuts pictured is a case, ringing in at $89.45, which is $17.89 per pound. The case discount is $8.94, then the sale day discount takes off another $7.55. That’s a $16.49 savings! Now I can justifying buying a nice bottle of wine for after the kids are in bed.

A few other things above that I did not buy in a case, but add up to significant savings with 10% off on owner sale day:

  • 2 bottles Double Devon Cream: $17.78; $1.78 savings
  • 2 Rotolini, reg, $8.89, on sale for $7.39 before discount; $5.48 total savings
  • Greek Gods Traditional Plain Yogurt: $2.99; $0.30 savings
  • Almond Oil (trying for the first time): $10.99; $1.10 savings
  • Small bottle Carlson Fish Oil: $22.69; $2.27 savings
  • Avocados: on sale 2 for $3; $0.30 savings
  • Organic Valley Heavy Cream: $3.79; $0.38 savings

Adding up everything I bought yesterday for the whole family, I saved $34.08 on the owner sale day discount and a total of $21.05 on the case discounts. $55.13 total savings, not including sale prices on some of our regular products. That helps the food budget a whole lot.

 

And now, the dentist

Nora is no stranger to medical check-ups and procedures. In the times she has visited the dentist (the first time for chipped teeth at the age of 2), she is a cheerful breath of frilly fresh air in the office. She is fascinated by the tools and procedures. She wants to be a doctor when she grows up. Her yearly check-up 2 weeks ago was no exception to her happy visits, but came with bad news: cavities. 4 cavities.

How, you may ask, does a child who eats no refined sugar and consumes 10 g of carbs per day, with only part of that in the form of natural sugars, get cavities? I am still asking myself that question, but the only answer seems to be genetics. My genetics. Ted has crooked teeth of steel. I have straight teeth of marshmallow. I always have cavities and always feel guilty, like I somehow should be able to prevent this, but even with my best efforts they still show up. When your kid has cavities, the guilt is magnified. What kind of parent has a 4 year old with cavities? Yes, as a matter of fact, I DO brush her teeth daily. Will they call child protection?  Although they do not say or suggest such things, I can’t help but feel at fault.

Now that Nora has cavities while consuming no sugar, I will forever attribute our cavities to genetics. The dentist conceded as much last time I was under the drill. Anders as escaped so far, he must have Ted’s iron teeth and they seem to be straight. Poor Nora will probably get the worst of our genetics, cavities and braces. Sorry, kiddo.

Nora was a peach at her checkup when they found the cavities, so they scheduled her for a cleaning and fluoride last week to get her used to working in her mouth. She was a super-star for the cleaning too. No problems at all. Before the cleaning, the dental office showed me the packages for the polish and fluoride varnish at my request. One had xylitol and another had sucralose. To be safe, Nora’s dietician recommended that we decrease her carbs by 3 g on the day of the cleaning to account for the tiny bit of carbs (or blood sugar effects) in those non-sugar sweeteners. Everything went smoothly and Nora stayed in ketosis. We were relieved.

The dentist recommended that we wait until January to fill her cavities because they were so small. That way she could have one more cleaning to get comfortable. But after her first great experience, I moved up the appointment to today. She was positive about the dentist, so I decided to just get it done this summer when we are less stressed by work and school.

With such small kids, the dentist prescribes an oral sedative that contains sorbitol (a sugar alcohol). Again, Nora’s dietician recommended decreasing her carbs by 3 g today to account for the carb-like affects of the sugar alcohol. This was a little more stressful because Nora was not allowed to eat for 3 hours before the appointment. She went into the office on an empty stomach, drank the sedative, then it was over an hour until we were home and could give her some fat to balance her ratio. She was also starving, on top of being miserable from the fillings. I made her 2 T of heavy cream mixed into a bit of vanilla tea as soon as I could and she sucked it down through a straw (spilling some from her numb lip). She also ate up 50 g of avocado and kept asking for more food. When I did a keto reading in the evening, she was still at a solid 160+; strong ketosis. Hopefully we averted any possible loss of ketosis, but we should know by morning.

After taking the sedative, it was like Nora was drunk. She couldn’t walk straight but demanded to be put down. When she got into the chair and chatted with the hygienist, she started listing her friends, “Sabina, Dalya but she moved away to a town for away and I can’t see her anymore, Connie, I play with her toys, and Kevin, he lives with Connie, and Ingrid, she has 2 beds and a big sister, and Cora and Mike…” She went from being kind of a belligerent drunk to a sentimental happy drunk to an angry drunk by the end of the appointment.

And I don’t blame her much for that. The dentist went as quickly as he could, but it’s still a long time for a little person to sit in the chair with her mouth held open. They gave her novocaine and nitrous oxide as well, so she had the “monkey nose” on her face the whole time. By the end she definitely felt something as he was working, but he was so close to being done that he finished with the filling and didn’t give her more novocaine. I know how she feels. It was agony to watch her have to endure it. I held her hand at the end and picked her up as soon as I could, but she was an unhappy camper. I’ve seen this kid through some torturous procedures for a little person, and I’m ready to be done with it. She’s ready to be done with it.

When he started with the fillings, he called me closer and said that there were 2 more tiny cavities starting in 2 other molars. She ended up with 6 fillings today, rather than coming back and do the next 2 more in 6 months or 1 year. These are baby molars, so she will lose them. I hate to be pessimistic, but that’s only an opportunity for more cavities. Now that we know this about Nora, I’m all about as much prevention as possible. Regular fluoride varnish, sealants, whatever it takes. I’m on prescription super-fluoride toothpaste myself now. Time will tell if any of it will make a difference. Maybe by the time Nora has kids, they can opt for bionic teeth from the get-go or do gene therapy to ensure iron teeth. I’d give that to my kids if I could.

 

Ricotta Tart

I bought whole-milk fresh ricotta cheese on a whim because I had seen it used in low-carb and ketogenic diet recipes, but didn’t have a particular plan for it. With busy summer days it sat in the fridge, unopened, until finally I decided it was now or never. I knew Nora would eat just a small amount of ricotta at a time in a recipe, so I went looking for a way that all of us could enjoy it.

Raspberry-Pancetta Ricotta Tart

I found another great recipe from David Lebovitz: Herbed Ricotta Tart. Fabulous recipe for half of the ricotta. The adults at the table were satisfied, to say the least.

For Nora, I modified the ricotta mixture in his recipe just a bit by using all heavy cream instead of the whole milk, omitted the crust, and added some other fillings to make it Nora-friendly. Here we have Raspberry-Pancetta Ricotta Tart. The basic tart filling can be supplemented with whatever your kid will enjoy! The ratio is 2.12:1 and ~150 calories, so there is room to supplement a meal with Flacker and butter or other fat to reach the appropriate meal ratio.

Nutrition information for 1 serving of Raspberry-Pancetta Ricotta Tart. Analysis from www.caloriecount.com

Raspberry-Pancetta Ricotta Tart

50 g egg (1 large)
240 g (1 cup) Organic Valley Heavy Cream
213 g Galbani Ricotta Fresca
60 g pancetta
30 g raspberries

Combine the egg, cream and ricotta. Measure 50 g into a tart dish, or other small baking dish. Drop in pieces of raspberry. Break up the pancetta into smaller bits and drop into mixture. You want them near the top so they get a little crisp in the oven.

Bake at 400º F for 10-15 minutes, until the top is brown. It will be bubbly, so give it a few minutes to cool and solidify before serving.

You can also subtract 0.19 g of fiber for net carb calculations (is dropped from label when it gets that small).

1 recipe makes 10 servings. 10 servings is a lot, but the filling keeps in the refrigerator for about 1 week. The rest of the family can also enjoy this recipe–I did–twice!

As always, re-calcualte the recipe for yourself if you are using different brands. It’s one thing that I find very time consuming and frustrating about the diet–looking for or manually entering the nutrition information into the recipe analyzer tool that I use. But it’s absolutely necessary. These recipes and nutritional information are intended only as a guide.

One berry, two berry

Pick me a blueberry…
Under the bridge and over the dam
Looking for berries, berries for jam!
~Bruce Degen, Jamberry (1983)

Oregon’s Willamette Valley bursts with wonderful things to eat all summer long. We are so fortunate to live here. Every year, the kids and I go off on U-pick adventure, mostly for blueberries. We freeze them by the gallon for winter oatmeal toppings, muffins and pancakes. But I mostly make jam, normally at least 5 dozen 8-oz and 12-oz jars. We always have the makings for peanut butter and jelly sandwiches, although our consumption fell off greatly in the last year between Nora’s diet and Anders’ newfound love for hot lunch. This year we had around 2 dozen jars left by summertime, so I only made about 15 fresh jars of blueberry jam last week.

August 6, 2010. This is what a jam-making day looked like 2 years ago, pre-keto.

I feel like there is a homesteading pioneer woman (or a squirrel) inside of me, urging me to put aside enough food for winter. My family might not make it through the cool rainy days here in Oregon without my homemade jam to provide us with vitamin C and lift our spirits. It would have felt wrong to not make jam this year, so I took Anders out picking with friends for a day to gather all of the blueberries, and a few blackberries, to make our jam. Nora stayed home that day because surrounding her with blueberry bushes and not allowing her to eat them would be cruel and I did not want to closely supervise her (although she is amazing about not eating things). Anders is a super-picker and between the two of us, we can get enough blueberries for several batches of jam in a few hours of picking.

Nora stirring the berries for her jam.

Nora has been enjoying the fresh and frozen berries with meals (4 or 5 at a sitting), but I wanted I could make her some jam too. I always use a low-methyoxyl citrus pectin (brand name Pomona’s Universal Pectin, but I buy it in bulk at our co-op). It is sugar-free, preservative-free and uses calcium as the bonding agent, so recipes do NOT require sugar to gel (unlike typical pectin products). Instead of sugar, you add a bit of calcium citrate to the recipe (comes in the box or also available in bulk). Seemed like I should be able to make Nora some sugar-free jam, but I hit a roadblock. I couldn’t find any definitive nutrition information on the pectin. I saw references to it as a form of soluble fiber, but without specific numbers I did not feel comfortable factoring it into a recipe.

I went for the other jam option that I’ve heard about but never tried: gelatin-based freezer jam. It’s keto-genius! Berries are already low-carb when eaten alone, but for gelatin jam you add in a substantial amount of water and gelatin is all protein. No added carbs, and the carbs in the berries get diluted in a larger volume of food. The final product has fewer carbs-per-weight that the berries themselves, with all of the flavor and satisfaction of eating jam just like everyone else. Win-win-win!

And another big win–it’s easy and can be made in batches that store for a long time in the freezer. The only caveat is that once opened, you have to keep it refrigerated and use it fairly quickly (I would guess 1-2 weeks) because it does not have sugar to act as a preservative. Divide it into small containers–I used 8 oz jars. This goes for all low- or no-sugar jams like my usual homemade versions, so we are accustomed to using our small jars quickly. And your keto kid will like it so much, it won’t hang around long.

Nutrition information for 1 full batch (524 g) of mixed berry gelatin jam. Divide all amounts by 524 to get the per-gram breakdown and see blog post for calculations. Nutrition information from www.caloriecount.com

Mixed Berry Gelatin Jam

70 g Blueberries
70 g Strawberries
70 g Raspberries
70 g Blackberries
1 envelope Knox Unflavored Gelatine
1 cup cold water

In a large saucepan, crush berries. They will break down more as you increase the temperature. Add water and gelatin, mixing well. You can add any no-carb sweetener to taste.

Over medium heat, slowing increasing temperature, bring mixture to boiling while stirring constantly. Reduce heat to low and simmer for 2 minutes.

Finished jar, after an overnight in the fridge.

Pour into jars, allow to cool and then cover. If you leave it out at room temperature it will take a long time to gel, so don’t be discouraged if it’s very liquid for some time. Put in the refrigerator overnight and it will be the right consistency in the morning.

Can be stored in refrigerator for 1-2 weeks, or frozen.  It is not shelf-stable unless you process in a hot water bath (which I normally do for pectin jam), so keep this in the freezer for long-term storage. I would suggest stirring before using a new jar, as the fibrous skins and bits fall to the bottom.

Perfect jam consistency!

Per gram nutritional breakdown:
Total carbs: 0.058 g
Fiber:  0.021 g
Net carbs: 0.036 g
Protein: 0.02 g
Fat:  0.002 g

Per 10 gram serving:
Total carbs: 0.58 g
Fiber: 0.021 g
Net carbs: 0.37 g
Protein: 0.2 g
Fat: 0.02 g

 

 

Just compare that to berries alone: Raspberries are great at 0.056 net carbs per gram, and the jam beats them by 0.02 g net carbs. Blueberries have the most carbs, at 0.12 g net carbs per gram of blueberries, four times more carbs than the jam. I know, seems like small gains here, but cutting a bit more carbs means a bit more yummy food to eat. The ease and convenience of having the jam in the freezer or fridge meets all of my criteria for top Nora foods.

Now, to make a truly keto food: mixed berry cream cheese. I overshot the ratio here at 4.25:1, so it can be put atop a lower-ratio baked good and balance out for a perfect ratio treat. You could decrease the ratio by adding more jam or omitting the coconut oil. I’m always trying to sneak in coconut oil because Nora gets 15 g spread out throughout the day and I get tired of mixing it into other things at mealtime. This will be a regular breakfast food, containing 1 gram of coconut oil per 10 g serving.

Nutrition facts for 1 batch of mixed berry cream cheese. See blog post for per serving break down. Nutrition facts from www.caloriecount.com

Mixed Berry Cream Cheese

140 g Primrose cream cheese (adjust your nutrition facts for the brand that you use)
20 g coconut oil
50 g Mixed berry jam (above)

Mix with a hand mixer and serve!

Note that I also show the nutrition label for 1 full batch here so that you can see the fiber content. I calculate the per-gram and per-serving values with net carbs, but if I break it down into smaller servings in the recipe analyzer that I use, the fiber line gets dropped because it is so small.

 

Mixed berry cream cheese

Per gram nutrition information:
Total carbs:  0.025 g
Fiber:  0.005 g
Net carbs: 0.02 g
Protein:  0.052 g
Fat:  0.31 g

Per 10 g serving:
Total carbs: 0.25 g
Fiber: 0.05 g
Net carbs: 0.2 g
Protein: 0.52 g
Fat: 3.1 g

 

Good stuff. I love batch cooking. Nora loves jam and cream cheese.

As I have said before, efficiency is life. But that isn’t really the most important part of this food story. The most important part was finely expressed by Voltaire: “Nothing would be more tiresome than eating and drinking if God had not made them a pleasure as well as a necessity.”

And talk about the necessity of eating. Food is good medicine, quite literally for our keto-kids.

Cook’s Little Helpers

They say that non-compliance is the main reason that people stop the diet, not lack of efficacy (although it doesn’t work so well for everyone). Non-compliance seems to mean that the kid won’t accept eating like this, but getting compliance must depend heavily on what you are asking the kid to comply with. That puts a lot of pressure on the parent to get compliance. It’s a lot of responsibility. And the best thing we can do for ourselves as parents is to make our job as easy as possible.

Some kitchen equipment just adds a lot of work to your life. Maybe it takes a long time to clean. Maybe it is difficult to get the food in or out. Maybe a recipe makes too many dirty dishes and takes too many steps. Those are the gadgets and recipes that won’t survive the test of time. Weed them out. Let them fall by the wayside, because you have enough work to do.

Here are 3 kitchen gadgets that I’m very happy I found:

(Starting top right): Tovolo Ring Pops, Tovolo Ice Cream Pop Molds, Silpat baking mat

  • Silpat silicone baking mat: I had been using parchment paper or silicone muffin cups for baking individual portions. I felt like some of the fat was left on the parchment paper, and the food didn’t slide easily on the paper when putting the batter down, making it difficult to work with. Making each portion of something small and thick enough to bake on a sheet, like cheddar crackers (pictured, recipe from the Keto Cookbook) just made a lot of dishes to wash. Now, I use one of my little silicone pinch bowls to measure out a 5 g portion of cheddar cracker, transfer it to the Silpat, then measure the next, and so on. Once they are all on the mat, press each down into a small cracker shape. Sounds like a small thing to change this procedure, but when you are making 20 crackers at 5 g each, every little saved motion and moment helps. It costs about $30, which gave me pause on previous equipment buying trips, but it was worth it. Beautiful results, easy to use and clean, and will last forever.
  • Tovolo Ice Cream Pop Molds: I saw these at the store a few months ago but did not buy them because they seemed kind of large and I couldn’t estimate the amount that they would hold. Thanks to Dawn at the ketocook blog, I learned that they hold about 50 g of popsicle each. Making her strawberry popsicles in these are a little on the large side for Nora’s snack and contain a lot of carbs for her in one serving, but she loves them and they are worth planning them into her day. I’ve adjusted the recipe just a bit for Nora to bring down the carbs. At around $10, they are sturdy, fun and wonderful to get a kid happy about her food.
  • Tovolo Jewel Pop Molds are also great fun, but they are less functional. They are made of cheaper plastic and I find them a bit hard to take out after frozen. They hold around 30 g of strawberry popsicle, but because they are different shapes I haven’t wanted to keep track of how much each one holds. The few times I have used them for ice cream, I’ve just made a few of the same weight to keep track. Instead of using them for ice cream, I make CALM lemonade pops with 1 g of raspberry each. The CALM lemonade is a “free” drink for Nora, a mild magnesium-calcium laxative with a bit of lemon flavor, sweetened with stevia. I can keep track of that 1 gram of raspberry, but could be made without it. She can also have a few of them if she wants to because that little bit of raspberry can be easily absorbed into a snack or meal for her (I know some kids are more sensitive and would probably need that balanced out). It’s something I can give to her on demand and she can choose her ring pop shape, which gives her some satisfaction and a small bit of control.

We are still somewhat amazed that Nora is so compliant with the diet, but I think that a few things have contributed to her acceptance. First, we started experimenting with the low-glycemic index approach, then officially started diet treatment with the Modified Atkins (MAD) version of the diet, which meant less immediate dramatic changes to the way she eats. We’ve eased into a stricter form of the diet over time, which has let us experiment and find what works for her. We did not have to learn this whole process overnight.

Our gradual process also allowed us to start with a focus on what she accepted in her diet, rather than starting with a “prescription” diet formulated from the outside. Recipes could be adjusted and new recipes discovered that met the requirements of stricter forms of the diet. Favorite foods could be accommodated or amended. Everything that we presented to her was “sold” with an emphasis on what she likes about it. That is not to say that everything was a hit, but kept a focus on the positive.

Once we were motivated by the diet’s seizure control success and we knew that we were in it for the long haul, we’ve made these small changes and purchases to make everyday life a little easier. We discovered other resources, like the Keto Cookbook and the ketocook blog and started putting more effort into streamlining our process. I have definitely favored “easy” recipes along with favorite recipes.

Compliance should refer to parental compliance as much as child compliance. This treatment is relentless, and it’s all up to the parents. Every day, every snack, every meal. It seems like it never ends (taking a page from Nora’s playbook here). There is always more to learn and more to discover, but what really matters is what works for your kid, both in seizure control and acceptance, and also what works for you, the parent, to get a great meal or snack on the table 3 to 5 times per day. Be kind to yourself and be as easy as possible.

Another Milestone

We are happy to report another milestone in Nora’s diet therapy success: 14 weeks seizure-free–over 3 months! And even better, one week Depakote-free!

She had her last dose of Depakote last Tuesday night, July 24. Since then we have continued with the same bedtime snack and ritual, minus the Depakote “sprinkles.” As we eliminate Depakote, her doctor also wants us to eliminate her carnitine and folic acid supplements; he saw them as combatting the side effects of Depakote, not necessarily the diet itself. She is down from 3 carnitine tablets per day to 1 now, although I think we will keep that one for a while longer, as our supply lasts. Some doctors also use carnitine as a matter of course with the diet itself, and it is a simple dietary supplement that does not have unwanted side effects. We will update the Current Therapy page with the new routine.

Ending her anti-seizure medication mades us anxious, of course. There is extra pressure to be hyper-vigilant with the diet to maintain seizure-freedom. But it also makes me think ahead to the day when we wean her from the diet as well. I imagine even more anxiety and anticipation for all of us, except maybe Nora. She is happy to be done with her “sprinkles” medication, but it’s absence is not a cause of celebration every day now. It’s just the new normal. Just like being seizure-free.

Sometimes Nora says, “I’m going to be on my diet forever.” We also heard this about taking Depakote sprinkles (and cleaning up toys). My strategy is to remind her that it will not be forever, certainly not until the end of her natural life plus all eternity, but it will be for awhile longer. Her four-year-old-self can’t conceive of measures of time like months or years, or all eternity for that matter. After the reminder that it will not be forever, I try to turn the sentiment around for her by emphasizing the good things in her diet, although mentioning seizure-freedom is a little lost on her too. Instead I emphasize the good parts of the diet that she does experience every day, and last week I got confirmation that it works sometimes:

Nora [whining]: I’m going to be on my diet for-EV-er.
Christy: It’s not forever, darling, but it is awhile longer. And just think of all of the good things that you have on your diet. You like your PBJ muffins, right? And cheddar crackers?
Nora: Yeah. Will you still make me PBJ muffins when I’m done with my diet? And cheddar crackers?
Christy: Of course I will. They are really good, aren’t they. I like them too.

Nora helps mix up a batch of PBJ muffins

Except when she is off the diet, I will not mix the peanut butter down with an equal amount of butter. And I won’t weigh out 5 g portions before baking the cheddar crackers; I will just plop down little blobs of dough on the baking sheet. That will be a good day. And I will share some too.

I scream! You scream!

[Everybody now!] We all scream for ice cream!

Guess what! Ice cream is primarily made out of a main ingredient in the keto diet–heavy cream! Yay! And now the sad news: to be scoopable, the way ice cream should be, it needs sugar. That’s right, the big no-no. So how to make keto ice cream? This is where I have most read and enjoyed learning about food science. This blog entry should be called, “my mediocre attempts at making keto ice cream that Nora loves anyway.”

Harold McGee’s epic tome, On Food and Cooking, gives my favorite description of the pleasures of cream:

We value cream above all for its feel. Creaminess is a remarkable consistency, perfectly balanced between solidity and fluidity, between persistence and evanescense. It’s substantial, yet smooth and seamless. It lingers in the mouth, yet offers no resistance to teeth or tongue, nor becomes merely greasy. This luxurious sensation results from the crowding of the fat globules, which are far too small for our senses to distinguish, into a small volume of water, whose free movement is thus impeded and slowed. (p. 27-28)

Ice cream is a dish that manages to heighten the already remarkable qualities of cream. By freezing it, we make it possible to taste the birth of creaminess, the tantalizing transition from solidity to fluidity. (p. 39)

Doesn’t that make you want a perfect pint of ice cream? “To taste the birth of creaminess”…it doesn’t get any better than that. And now the science part:

Plain frozen cream is hard as a rock. Sugar makes it softer, but also lowers its freezing point (the dissolved sugar molecules get in the way as the water molecules settle into ordered crystals). (p. 39)

Sadly, I do not own this book (hint hint). I had it on hold at the Corvallis Library for 2 months before I got it, then could not renew it after my time because someone else had it on hold. This is a book originally published in 1984 and updated in 2004. Come on people of Corvallis, you’ve had 8 years to check it out. That says something about this town.

Armed with this knowledge, I moved on to making ice cream with a little help from our friends. Our friend Cora made some keto raspberry ice cream for Nora a few months back and we found out about the “hard as a rock” property. It was tasty, like raspberries and cream, but was solid. I put a butter knife through the side of a plastic container trying to chisel some out. It had a ratio of about 15:1 because she used cream and not many raspberries, so I hoped that the next attempt with many more berries to provide some natural sugar would be a bit softer, Harold’s predictions notwithstanding.

Last month we received an ice cream machine as a gift from our dear neighbors, Connie and Kevin. That gave me my chance to try ice cream for Nora and put some of my food science learning to work.

Raspberry Frozen Greek Yogurt Popsicle

The first recipe was a raspberry frozen Greek yogurt. I decided that Harold knew best, so trying something less conventional might yield better results. Greek yogurt has lots of protein and a decent amount of fat, but few carbs. Protein is also a key ingredient to finessing the texture of ice cream and I was hoping that enough protein would be a recipe for success.

The result was tangy with the flavor of Greek yogurt and had a lot more raspberries than the original recipe, so it was very tasty. But it still froze fairly solid.  If we let it thaw just enough we could give it a quick stir and get an ice cream-like consistency, but thaw too much and it was liquid. Alternatively, I froze it as popsicles. The only problem is weighing the amount of yogurt in each pop and keeping track of each one. But Nora managed to eventually eat the whole batch enthusiastically, about 20 g at a time.

Nutrition facts for 22 g of Raspberry Frozen Greek Yogurt. Nutrition analysis by www.caloriecount.com

Raspberry Frozen Greek Yogurt
200 grams raspberries (about 1.5 cups)
Pinch salt
340 g (1.5 cups) Traditional Plain Greek Yogurt
114 g (0.5 cups) English Double Devon Cream
1/4 tsp cinnamon
1 tsp pure vanilla extract

The nutrition facts are for 22 g, which is about 1 popsicle. You can see that 1.3 carbs is quite a bit at once and it has a 2:1 ratio, so this would have to be paired with other things in a snack to balance it out. It’s not ideal, but yielded fairly good results.

My next attempt was based on a recipe by David Lebovitz, chef and author of The Perfect Scoop. Ice cream expert! I wanted a mint ice cream recipe made with real mint, thinking that I could get great flavor without carbs. This one is the ticket, from his blog: http://www.davidlebovitz.com/2010/05/mint-chip-ice-cream-recipe-chocolate/

I made his version and a Nora-version. Oh my, was it wonderful. It calls for 80 g of mint leaves, which is a lot (believe me, I have a gram scale). I only had about 20 g in my garden that I could harvest, but a little went a long way in this recipe.

It’s a 2-day process, but I was able to follow the recipe once while making 2 versions with a little planning. I used half-and-half instead of whole milk, but otherwise did everything in the recipe EXCEPT adding the sugar: steeped the mint leaves in hot half-and-half and cream, then cooking in the egg yolks according to the recipe (below and at the link). Then I reserved some of the mixture for Nora and added a bit of her Cytra, which is sweetened with saccharine. I then added sugar to the portion for the rest of us while it was still warm so that the sugar would dissolve. Adding the sugar at the end did not affect the quality of the regular version, and I didn’t have to make the recipe twice. Then the mixtures must cool overnight.

Nora's Mint Chocolate Chip Ice Cream

The next day, I froze each version in the ice cream machine. Here is where I saw the importance of sugar firsthand. I put Nora’s version in first. The machine has a frozen bowl to chill the mixture and a rotating arm that scrapes it off the side of the bowl and mixes it so that large ice crystals are not able to form. When I make Nora’s ice cream in the machine, a thick icy-cream layer builds up on the side of the bowl that the rotating arm can’t scrape away. The portion in the middle freezes more like regular ice cream, so I stop the machine, scoop out the middle part, and then wash off the inside of the bowl.

If I am as quick as possible, the bowl is cold enough to make the sugared version immediately after, but just barely. When ice cream made with sugar goes in the machine, it is soft as it freezes and the machine can easily scrape the sides. It takes a lot longer to freeze, as you would expect from the additional sugar which lowers the freezing point of the mixture. Having 2 portions of the same recipe with and without sugar really demonstrated the point.

Nora licks her bowl clean. She spilled some on her shirt, and she tried to lick that too!

The grand finale of this recipe is the “chocolate chips.” I would have never thought of this if not for the Lebovitz recipe. I used a Green & Blacks 80% cocoa dark chocolate bar. Higher cocoa content means less sugar, hence fewer carbs, in the chocolate. Measure out the amount you will put in the keto ice cream (it only takes a few grams, at 0.28 carbs per gram of chocolate in those bars). It melts nicely in a small silicone pinch bowl in the microwave. While the ice cream is in the machine stirring, drizzle in a stream of melted chocolate. It freezes in tiny threads as it hits the cold ice cream. Mmmm, that’s something special. I did the same on some of Nora’s raspberry ice cream another time to give her a little chocolate on top. What a treat.

This ice cream was fabulous. The infusion of real mint leaves gave it an herbal minty quality. Next time I will try to use even more mint. I held back on the sugar so it was not overly sweet. I will definitely make this again, for all of us, when my mint patch recovers.

Nutrition information for 50 g of mint ice cream. Note the different serving size--do not compare directly with other ice cream recipes here. And note that chocolate is not included. Nutrition analysis from www.caloriecount.com

Keto Mint Chocolate Chip Ice Cream
240 g (1 cup) Organic Valley Half and Half
480 g (2 cups) Organic Valley Heavy Whipping Cream
Pinch of salt
85 g (5 large) egg yolks
80 g (2 cups packed) mint leaves

In a medium saucepan, warm the half-and-half, 240 g (1 cup) heavy cream, salt, and mint. Once the mixture is hot and steaming, remove from heat, cover, and let stand for an hour to infuse the mint flavor.

Remove the mint with a strainer, then press down with a spatula firmly to extract as much mint flavor and color as possible. Once the flavor is squeezed out, discard the mint.

Rewarm the infused milk. In a separate bowl, whisk together the egg yolks, then slowly pour some of the warm mint mixture into the yolks, whisking constantly, then scrape the warmed yolks back into the saucepan.

Cook the custard, stirring constantly with a heatproof spatula, until the mixture thickens and coats the spatula. If using an instant read thermometer, it should read around 170ºF (77ºC). Immediately stir the mixture into the remaining 240 g (1 cup) cream, then place over an ice bath until cool.

Refrigerate the mixture thoroughly, preferably overnight, then freeze it in your ice cream maker according to the manufacturer’s instructions.

From: http://www.davidlebovitz.com/2010/05/mint-chip-ice-cream-recipe-chocolate/

The nutrition information above is ONLY for the mint ice cream. The ice cream alone has a ratio of about 7:1, and only 0.7 carbs in a 50 g serving! You can add enough chocolate to reduce the ratio to the desired level. In the future, I will calculate the amount of chocolate I want to add per serving, measure that amount, then melt the chocolate in a silicone pinch bowl (be sure that your bowl is completely dry, as any water in the melted chocolate will cause it to seize and ruin the pourability). Pour the chocolate in threads on the serving of ice cream, stirring as you go. Wa-la, you have chocolate chips in your ice cream!

The last ice cream experiment was of the blueberry variety. It was a simple recipe, but turned out quite different than the rest.

Nutrition information for 3.5:1 Blueberry Ice Cream. Analysis provided by www.caloriecount.com

Blueberry Ice Cream
405 g (2.8 cups) fresh or frozen blueberries
720 g (3 cups) Organic Valley Heavy Whipping Cream
305 g (1.25 cups) whole milk

In addition to these ingredients, I again used Cytra to sweeten the mixture a bit, but you can use any no-carb sweetener you choose. Mix the sweetener in while you crush the berries. Then mix well with the cream and milk (I used a food processor). Then freeze in the ice cream machine.

Like the mint ice cream, I made it side-by-side with a sugar version and it turned out very differently. First, when I crushed the blueberries with sugar for the traditional recipe, the blueberries turned that keep purple-blue that I would expect from the blueberry skins. When I made Nora’s version, the Cytra did not extract the color from the blueberry skins in the same way. The mashed berries looked more green-gray with flecks of dark skin. I have not looked up the food science interaction that causes the color change in the presence of sugar, but I would love to know the secret.

Blueberry Ice Cream, 3.5:1 ratio

As with the mint ice cream recipe, Nora’s non-sugar version formed a thick frozen layer on the outside of the ice cream machine bowl. The sugared version did not do that. And the final product was quite different. Nora’s version froze absolutely solid. I have to chisel it out of the bowl to measure it, or melt it enough. If I chisel it out and mash it up, it has a very dry crystal quality about it, not at all creamy. It’s not unpleasant, but it is not like ice cream either. If you click on the picture to get a larger version, you can see that texture. It also melts quickly, so getting it in as fast as possible is key, although Nora takes care of that herself and licks the bowl clean!

Thus far, I’ve learned that cream alone does not make ice cream. Harold is right–how could I ever have doubted him. Taking sugar off the table, the recipes that included more protein were far more successful than the blueberry ice cream recipe, which was mostly cream and berries. I added whole milk there in order to get some of the milk protein, sugars and solids, but it was not enough to make a difference in the texture.

The custard-type ice creams that include egg yolks are a better bet, but also require a 2-day process because the egg yolks have to cook, then cool down enough to make the ice cream. It’s a plan-ahead endeavor, but the quality of the final product makes it worth it. I will also experiment more with Greek yogurt to see if I can get some better results. But this is all academic to Nora. If it’s called ice cream, she’s thrilled to have it.

Cooking day!

Some days you realize that you’ve run out of everything. We also have a trip to Portland to the KetoClinic tomorrow, and we are going to the coast for the weekend, thanks to Ted’s colleague, Annette and her family, for letting us use their beach house. It’s so great to have a kitchen! We will also get to see one of Nora’s best little friends, Ingrid, who has been in Eastern Oregon this summer. Lots to look forward to–and we don’t want to stress about food.

In my kitchen today: A new batch of B^3, a new and improved formulation that will include coconut oil in order to boost the fat content a bit more. Now that Nora consistently expects B^3 and apples or carrots for her morning snack, I am changing the formulation to make that whole snack 3.5:1, now that we are in the groove at the new ratio. I am not planning to post the new recipe, but if anyone wants it just let me know. It was time to buy a big new jar of Adams Natural Peanut Butter for another batch. Just mixing in the naturally-separated peanut oil is a job, and it’s only step 1!

I’m also making a new hazelnut-coconut oil breakfast cookie that is 3.5:1. I have not tried my new formula yet, but if it works it will be a great basis for breakfast and we will not have to separately deliver coconut oil. It can also be used for a quick self-contained snack. I had to buy more Bob’s Red Mill Hazelnut Meal/Flour today. That stuff is finely ground gold–$10.99 for a 14 oz bag! At least I don’t have to grind it myself. Unlike macadamia nuts, which are almost $20 per pound and I do have to grind myself.

Cheddar Crackers

Earlier this week I made some cheddar crackers and PBJ muffins. The cheddar cracker recipe is right out of the Keto Cookbook, and they are so good. Anders thinks they taste like cheese puffs, but we do our best to reserve them for Nora. 🙂

I might try my hand at the basic keto pizza recipe from the Keto Cookbook tonight, but I might just be done with cooking by the time I get to it. Step 1 for that recipe will be grinding the macadamia nuts. I will also have to analyze the recipe and put it in our KetoCalculator spreadsheet before Nora can have it. Sigh, I guess that one will probably wait for another time.

Update: The Latest Daily Routine

How ironic. After I finally make a post about our KetoCalculator spreadsheet, we had a problem this morning. There was some glitch in updating the spreadsheet on Google Docs, so Ted and I were not seeing the same version, and the version showing up on my computer disagreed with our written notebook record of breakfast and snack for the day. It was a very strange mistake and we can’t figure out when or why it happened, but it is another lesson in checking and double checking, keeping good records, and working together.

The good news is that Nora’s meals for the day were not impacted. They were calculated on the correct information. Even with fancy calculating technology, we still have to keep a sharp eye out for anything that just doesn’t look right. Don’t get me wrong, I’m thrilled to have our KetoCalculator and it wouldn’t have happened if Ted had not taken the initiative to build it. It took a little bit of time to transition to using it for all meals, but it has been a great help overall. Now that we have seen our first glitch, we know to double check totals, keep our cool and track down problems.