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<\/a>Cartoned cream can be clumpy.<\/strong> \u00a0A great deal of fat can be left behind, stuck to the sides of the paper carton. \u00a0We open the carton, scrape out the solid cream stuck to the sides, and transfer it all into a mason jar.\u00a0There we mix it up gently as best we can. Then, we like these reCap lids<\/a> for pouring cream out of the mason jar (get the right size for your jars).\u00a0Nora had a bout of breakthrough seizures after several seizure-free months early on the diet, and I strongly suspect this was part of the problem. \u00a0Because of all the fat being left behind in the carton,\u00a0her ratio would have effectively been quite a bit lower than our target of 3.5:1 at the time.<\/li>\n- \n
- Base: avocados, macadamia nuts<\/li>\n
- Sweets: raspberries, strawberries, blueberries, dark chocolate (85%), red peppers<\/li>\n
- Protein: cheddar, eggs, ham, turkey, bacon<\/li>\n
- Flavorings: no-carb peppermint and vanilla flavorings, and cocoa powder for making cream in to “milk” or chocolate “milk”<\/li>\n
- Fiber:\u00a0low-carb high-fiber tortillas<\/a>, raspberries, avocados, Flackers<\/a>, flax meal<\/li>\n
- Fat: butter, cream, macadamia nuts, coconut oil, kalamata olives<\/li>\n
- Low-carb: pickles, seaweed snacks<\/li>\n
- See this post, Quick Keto Meals<\/a>,\u00a0too.<\/li>\n<\/ul>\n<\/li>\n
- Fiber. \u00a0<\/strong>We consider fiber to be the fourth macronutrient (along with fat, carbs, and protein). \u00a0It serves three\u00a0very important functions: helping with constipation; helping to give weight and texture to a meal; effectively increasing the amount of sweet tasting foods. \u00a0This is because “net carbs” are what matter; that is, the total carbs minus the fiber. \u00a0This is one reason why raspberries are such keto superstars: they have plenty of carbs and delicious berry goodness, but they have a very high fiber content, which reduces their effective net carb count, which in turn allows Nora to have a lot of them.<\/li>\n
- Equipment.<\/strong>\n
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- The US Balance US-TT1000 scale is great. \u00a0It’s easy to use for home, and it has a built-in protective lid and runs on batteries for taking on travel or to a restaurant.<\/li>\n
- Small rubber spatulas help you scrape the full measured amount of food out of a dish and serve it to your child.<\/li>\n
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<\/a>Small silicone pinch bowls. We like these, made by NorPro<\/a>. \u00a0They are microwave-safe, so you can melt a small amount of butter, coconut oil or dark chocolate for drizzling over other foods. You can thaw a small amount of frozen berries to mix into cream or yogurt. They are sturdy but flexible, so you can cream butter into cream cheese or nut butters for a smooth high-fat spread. You can scrape them clean with a butter knife or spreader to get all of the fat out. And they are cheap! Order them online or buy at a kitchen store. We have 8 and use ours everyday.<\/li>\n![\"Screen](\"http:\/\/blogs.oregonstate.edu\/modifiedketogenicdietforepilepsy\/files\/2014\/09\/Screen-Shot-2014-09-20-at-10.09.01-AM-300x197.png\")
<\/a>Small spreaders<\/a>\u00a0(also called cheese spreaders or hors d’oeuvres knives) pair nicely with the small silicone pinch bowls. We have these cheap ones and they have worked fine. If you have a small child who can self-feed, they can use the spreaders themselves to put butter+nut butter mixture on a Flacker, for example. They work perfectly for scraping the silicone bowl clean.<\/li>\n- Ice cream pop holders are wonderful. You can make very simple ice pops or add a bit of no-carb drink, one crushed raspberry, or cream to make a quick frozen treat. Any frozen keto treat will freeze solid, so you might as well make it a pop and let your child eat it slowly. For kids adjusting to the diet, this can be a real treat and make them feel like they are getting more to eat because it lasts longer. You can find more on our ice cream pop mold recommendations here, our post Cook’s Little Helpers.<\/a><\/li>\n
- We have also collected a lot of small dishes. We actually use one of the IKEA play sets<\/a> daily.<\/span>\u00a0They are ceramic, food-safe, dishwasher-safe and microwave-safe. Serving sizes are smaller on the keto diet and it’s ridiculous to put Nora’s servings into regular sized bowls. \u00a0Kid-sized plates and bowls are\u00a0psychologically helpful as it makes the keto meal look fuller. \u00a0They also fit nicely on the scale.<\/span><\/li>\n
- On the topic of dishes, we often let Nora choose\u00a0a small dish if we are out shopping and need a little reward pick-me-up for good behavior. Many grocery stores carry some dishes. Maybe a little whisk, cream pourer, ramekin, or even a pretty napkin or candle that she can pick out. Several fun dishes have entered our collection, and the small meals made in the special dishes make the food feel a little more fun and special.<\/li>\n<\/ul>\n<\/li>\n
- Restaurants.<\/strong> \u00a0You can eat out at restaurants if you are careful and have appropriate expectations. \u00a0Sushi and seafood restaurants work great as salmon sashimi, edamame and crab\u00a0are all\u00a0very keto friendly (be careful with fish, to be sure it is only grilled or poached). \u00a0Another good option is to order a burger at a grill with no bun for your keto-kid. \u00a0Typically we have the meal pre-calculated and pre-packed except for the protein portion, which will be supplied by the restaurant. \u00a0 We’ll weigh what we need of sashimi or hamburger\u00a0at the table using our portable scale. \u00a0There is of course some risk of hidden carbs, but we find it to be reasonably safe if we are at a restaurant with a menu we know well. \u00a0I think meat from the restaurant — as opposed to something carby — tends to be a safer bet overall as it is usually prepared with nothing additional other than some fat or oil for cooking. However, many restaurants with a kid menu will have carrot or celery sticks as a side option, or possibly apple slices. Salads with dressing on the side can also get you greens and cucumbers to incorporate into the meal. \u00a0You can always ask the server or cook if any additional \u00a0information is necessary. It is also courteous to inform your server that your child has dietary restrictions, so they understand why you are dissecting her meal and giving her a little extra food from home, such as cream that you have brought with.<\/li>\n
- Consistency.<\/strong> \u00a0There is no cheating on the ketogenic diet. \u00a0Early in the diet, ketosis is fragile and the metabolism is eager to switch back to glucose-mode. \u00a0Even a small amount of extra carbs can open the door for breakthrough seizures. \u00a0Consistency allows for better troubleshooting too. \u00a0Which brings us to…<\/li>\n
- Breakthrough seizures. \u00a0<\/strong>Expect\u00a0breakthrough seizures and a few rough periods even after extended periods of success. \u00a0It seems that everyone we have talked with has had the experience of several weeks or months of good seizure control, followed by a period of loss of seizure control, followed by regaining seizure control. \u00a0When this happens, keep your spirits\u00a0up and look for any recent changes or anomalies (such as the clumpy cream issue). \u00a0Be strict and rigorous and keep going. \u00a0Seizure control will likely come back.<\/li>\n
- Even daily ratio. \u00a0<\/strong>Consider applying the ratio evenly throughout the day. \u00a0Early on in Nora’s treatment, before we went to a full ketogenic diet, we were very lax about what the ratio was during any particular meal, so long as the ratio was met over the course of the day. \u00a0This means you could have a very carby, low-ratio morning and a very fatty, high-ratio afternoon, for example. \u00a0It seems that seizure control improved when we evened things out. \u00a0The one exception is at dinner and bedtime, where dinner is usually low on the ratio, and bedtime is higher, so that we can get a last chunk of fat into her to last all night. \u00a0We made this change\u00a0after some early morning tonic-clonic seizures in the spring of 2012.<\/li>\n
- Routines and expectations.<\/strong> \u00a0Establishing routines and expectations ease the day-to-day grind. \u00a0For example, Nora has three routines around supplements: baking soda in the morning after breakfast and in the evening during teeth-brushing before bed; calcium in her bedtime cream; and a multivitamin and calcium in her morning snack B^3. \u00a0She’s not crazy about taking the baking soda and the calcium, but now that it is a well-established routine, there is no more fighting about it.<\/li>\n
- Keto-friendly alternative sweets. \u00a0<\/strong>When possible, try to have a keto-friendly alternative for your child at birthday parties and other events where ice cream, cupcakes, etc…are served. \u00a0This requires forethought and planning, but is huge for the psychological aspect for your child. If you can find out what kinds of treats will be served, you can make something similar. However, Nora now likes to just pick her favorite treat to bring along, even if it is different from the party treat. It’s still natural for her to admire the other treats, but you can help to…<\/li>\n
- Help your child understand the restrictions. \u00a0<\/strong>We are very sensitive to this and we stress frequently to Nora that although her diet imposes some limits, it is still a very healthy diet with many truly delicious meals, and many people have some sort of diet restriction. \u00a0When we first started the diet, Nora really took to a book called “The Princess and the Peanut Allergy.” \u00a0She strongly identified with the food restrictions of the main character and the struggles and efforts of her friend to accommodate her. \u00a0Try to help your child see the diet restrictions amongst your family and friends to help them understand that having some sort of restriction — whether it is a nut allergy, gluten intolerance, upset stomach after eating certain foods, low-sodium diet, etc… —\u00a0is normal.<\/em><\/li>\n
- Solidarity! \u00a0<\/strong>Eat keto-friendly yourself. \u00a0Eating meals that look similar to what your child eats will help them feel better about the diet. \u00a0Skip the bread and sugar; eat nuts, protein, vegetables, and fruit. \u00a0As a happy side-effect, you may very well feel better and lose weight. \u00a0Christy and I have both dropped about 15-20 pounds when we modified our eating to be more like Nora’s. \u00a0Honestly, there have been many times after putting Nora’s dinner together (e.g., skillet-fried ham-and-cheese, avocado, red pepper, nuts), I’ve thought “I want that!” (Christy says: It takes all of my willpower to not\u00a0eat Nora’s cheddar crackers!) Also, don’t eat the birthday treats at a party. It’s better for you and helps her feel like she’s not the only one.<\/li>\n
- Don’t expect miracles. \u00a0<\/strong>Be happy with improvements in quality of life. \u00a0We were one of the lucky ones that got full seizure control. \u00a0But even if Nora still had some seizures (and I must accept that she might have more seizures at some point in her life), her quality of life would be much better than it was before the diet. \u00a0If you are considering the ketogenic diet, chances are you are in the difficult group of epilepsies. \u00a0Many of these epilepsies come with other problems too. \u00a0The ketogenic diet may not be a miracle cure, but it could still be a great help.<\/li>\n
- It’s not “hard.” \u00a0It is different. \u00a0<\/strong>If you think the ketogenic diet might help your child, don’t accept any statement\u00a0that the diet is “hard” as a reason for not trying it. \u00a0I wouldn’t say the diet is hard. \u00a0Epilepsy is hard. \u00a0The diet is a tool that may improve your child’s quality of life and development. \u00a0(Remember that if your child has failed two anti-epileptic drugs, the diet is statistically more likely to help than a trial on a third drug. Also, certain epilepsies respond particularly well to the diet.) However, the diet does require some changes to your thinking and expectations. \u00a0Once you get your routines down and everyone gets a few months to adjust, the diet is not significantly harder than having other\u00a0diet restrictions. \u00a0Just different.<\/li>\n<\/ul>\n
I’d like to make this \u00a0a “living” list. \u00a0To all of our keto comrades, I invite you to email us or comment on your particular lessons learned. \u00a0I’ll add them to the list above.<\/p>\n","protected":false},"excerpt":{"rendered":"
Lessons learned on the ketogenic diet, in no particular order: Cartoned cream can be clumpy. \u00a0A great deal of fat can be left behind, stuck to the sides of the paper carton. \u00a0We open the carton, scrape out the solid … Continue reading