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-Pretzels!

I hate to build this up too much, but these might be the best keto-recipe yet! Nora agrees, but she is also very persuadable. They taste great, look fun, and are easy to make–an all-round great addition to our keto-friendly line-up.

I’m trying recipes out of The Joy of Gluten-Free, Sugar-Free Baking by Peter Reinhart and Denene Wallace. My sister, Jen, sent it to us after she got a review copy for her nutrition education work, Nutrition in Action (you can find the book for a great price from the Nutrition in Action website! Linked above). Free cookbooks are a nice perk of her work and I’m thrilled that I get the benefits too! In exchange, I try out the book and give her a review. This is the first of a few recipes that I will post.

When I opened the cookbook for the first time I knew it would be a great resource because the recipes are nut-meal based. That is the key to uniting low-carb and gluten-free cooking. It sure helps that the cookbook is also sugar-free! The main recipe modification required for keto-cooking is using heavy cream instead of milk. I also tend to omit the sugar substitutes for Nora, or use some of her saccharine Cytra-K for a little sweetness. I’ve made just a few of the recipes so far, and they have been a hit! I’ve made Nora-versions of some recipes and a few some for myself, like the biscotti recipe. For myself, I sub in reduced levels of real sugar. I have more recipes to post in the coming weeks, so stay tuned.

It also helps to have my new stand mixer. I burned out my hand mixer on one of the bread recipes in this book, paving the way for Ted and the kids to give me the stand mixer for my birthday. The instructions for most of the recipes in this cookbook allow for hand mixing, but with big sticky dough it’s wonderful to have the right tool for the job. Some of the recipes require an electric mixer to adequately aerate the dough to make a soft and airy loaf of bread or cake. I was a little surprised about how excited I was to use it. It makes keto-cooking much easier and more enjoyable.

On to the pretzels! This recipe does not call for milk or sweetener, so I did not have to make any of those substitutions. The authors discussed their attempt to make these as much like traditional “Philly” soft pretezels as possible, which required an odd ingredient: “butter sprinkles.” I was skeptical. I found them in the grocery store one day, and they do not qualify as “real food” in my opinion. They had some carbs, and I wasn’t sure that I was willing to include them in this recipe. Didn’t people make real soft pretzels before “butter sprinkles” existed? I’m not going to take the time to do the research to answer that question, but I did have to decide how to work around them in this recipe. I’m glad that I made great pretzels with my “butter sprinkles” substitute ingredient: real butter. Imagine that.

And for another bit of reality, it’s also impossible to replicate the texture of real soft pretzels without gluten. As with all gluten-free baking, you have to accept a new but good texture and taste as a substitute for the gluten version. The cookbook authors came up with a very good texture and taste here with some clever ingredients. These are soft but not crumbly, but also not chewy like traditional soft pretzels. One key ingredient in many of these recipes is xanthan gum, which is a soluble fiber. Does not add to the net carbs (yippee!) but it does improve the texture. If anyone wants to experiment with these recipes, I have about 1 pint of xanthan gum from the Bob’s Red Mill package, but I’m using about 1/2 tsp at a time. I’m happy to share.

The pretzels taste pleasantly of sunflower seeds, even though that is not the main ingredient. The yeast is added purely for the flavor–it is not the leavening agent with these ingredients. It adds a bit of carbs, but is worth it for that satisfying slightly-yeasty taste. And oh, they are pretty! Note that the plate in the picture is just a little saucer, so it makes just a little pretzel (see picture of Nora with pretzel above for scale). I made them 1/2 of the size called for in the recipe as an appropriate portion for Nora (see below). I actually cut the whole recipe in half, then made 12 pretzels out of it as in the original recipe, so ended up with 1/2 sized pretzels.

I served a pretzel with cheese dipping sauce, made of 12 g of cheddar cheese and 15 g (1 T) heavy cream. Pop it in the microwave for 30 seconds and you have cheese sauce. The pretzel itself is 1.57:1 ratio; with the cheese sauce it is only about 2.5:1, so more fat is needed on the side to get up to Nora’s 3.5:1 ratio requirement. However, it was no problem to get there when included with everything else in her lunch.

Nutrition information for 1 plain Keto-Pretzel. Nutritional analysis by www.caloriecount.com

Keto-Pretzels
Dough
110 g Bob’s Red Mill Almond Meal
25 g sunflower seeds, finely ground
25 g sesame seeds, finely ground
4 g baking powder
0.5 g Bob’s Red Mill xanthan gum
1.5 g salt
16 g Strauss European-style butter, frozen
50 g egg
4 g active dry yeast
15 g warm water

Egg Wash
12 g egg
0.5 g baking soda
8 g water

Salt to taste, or see other topping options below.

Preheat oven to 350° for soft pretzel or 375° for a crispier topping.

Measure the sunflower seeds and sesame seeds then grind in a spice grinder or coffee grinder until fine like flour. Combine with almond meal, baking powder, xanthan gum and salt. Cut the frozen butter into tiny pieces that are still whole. Combine well with the dry ingredients; try to keep the butter bits solid but well distributed throughout.

Put the weighed egg in your stand mixer bowl or another large separate bowl and whisk. In another small bowl, measure the warm water and dissolve the yeast into the water. You don’t have to wait for it to bubble up because it is not the main leavening agent. Add the yeast mixture in with the egg and combine well.

Add the dry mixture to the wet mixture and stir by hand until well combined or mix on low to medium speed for less than 1 minute. Scape down the sides of the bowl and mix again briefly. The dough will be thick but sticky.

Lightly oil a silicone baking mat or parchment paper on a baking sheet. You can also lightly oil a small bowl to measure portions of dough. I found that once I started working with the dough, it wasn’t too sticky.

Weigh 20 grams of the dough and roll into a ball, making 12 balls. Technically, you should have 20.9 g of dough each if you weighed everything correctly, but I’ve found that I lose just a bit of dough in the mixing process and it’s safer to shoot a little low when I measure out portions so that I don’t end up with a much-too-small ball at the end. This way, the actual food will also have slightly fewer carbs than you plan for, putting you on the conservative side of measurement error.

Roll each 20 g ball of dough into a rope about 10-12 inches long on your oiled baking sheet. I found that the dough was fairly easy to work with. If it breaks a bit, just mush it back together. Then form the pretzel shape out of each rope as shown. Place them on the baking sheet. They don’t have to be spaced too far apart because they won’t spread much.

Whisk up the egg wash. The cookbook authors suggest adding baking soda to get the traditional alkaline taste of lye. I adjusted the recipe to make just enough egg wash for the whole batch. If you distribute it approximately equally, the nutrition information is accurate and you should have no egg wash left over. Again, you will lose a bit of egg wash to your pastry brush and pan but that will only make your nutritional estimate appropriately conservative.

Sprinkle with course salt if you have it. I just used sea salt because it was all I had and my kids love salty foods. You could also add other toppings, including them in your calculations, such a sesame seeds, poppy seeds, herbs, etc. I added 1 g of grated parmesan to several of the pretzels, as you see in the picture. I will add that into Nora’s meal calculation when I serve it. You could add cheddar or any other topping you can imagine!

Bake for 6 minutes, then turn the pan and bake for another 6 minutes or until the pretzels are evenly browned. Remove from oven and transfer immediately to a wire rack to cool. They are excellent served warm!

I’m going to explore modifying the recipe again to include some of the brown rice protein powder that I have in my pantry. These would be a nice vehicle for including a little extra protein, and with the cheese sauce could be the only protein Nora needs in a meal.

These could also be the basis for a sweet-and-salty treat. The buttercream recipe posted on the Charlie Foundation site is excellent. When I made it for the keto-gingerbread house; I flavored it with a ginger-spice tea that was delicious. Topping these with buttercream icing would easily pop it up to a 3.5:1 or 4:1 snack close to 150 calories (that’s off the top of my head, but very doable). The top of my head was wrong! The buttercream recipe is 4:1 at best (I got mine up to 5 to 1) so you need over 20 g of frosting per pretzel (which are around 20 g themselves), which is just plain ridiculous. A better bet would be the caramel sauce or decorating icing from ketocook.com, which are methods of serving pure fat. I’ve been putting 8 g of the buttercream frosting on pretzels for a big snack for Nora, along with 1.5 T of cream in tea to get 3.5:1. She loves them so much she demands another immediately, although I have to deny that request. She did have another with her dinner last night though!

As I’ve said before, it’s a great time to be a keto-kid.

Update:

US Measurements for our gluten-free friends. I will give you the full recipe here, not the half-recipe that I used above (so if you try to compare this with the grams above, this will be double):

Dough
2 cups almond flour
1/2 cup sunflower seed flour (grind then measure)
1/2 cup sesame seeds flour (grind then measure)
2 Tbsp butter or coconut oil, very cold and chopped into tiny pieces
1.5 tsp baking powder
1/4 tsp xanthan gum
1/4 tsp salt
2 eggs
2.25 tsp (1 package) instant or active dry yeast
2 Tbsp warm water

Egg wash
1/2 egg (or less, you will have leftovers)
1/2 Tbsp water
1/4 tsp baking soda (optional)

Other toppings: course salt, sesame seeds, cheeses, etc.

Makes 8-12 large soft pretzels, or 24 small Nora-sized pretzels : )

Follow directions above.

 

Chicken ala Bacon

It appears that we still have some work to do civilizing the boy child. At least he picked up the fork.

We have a new way of measuring the deliciousness of food in our house. It’s called the POB scale: Plate of Bacon. The deliciousness of a Plate of Bacon sets the benchmark at 10/10, and all food can be expressed as a number out of 10 that compares to a perfect plate of bacon. The scale was derived the night that I made this recipe, which got a 9.5/10 on the POB scale from Anders. Hence, I have named it Chicken ala Bacon, and it includes the world’s best version of bacon, pancetta. I made it last night to rave reviews so I did a quick encore tonight to make sure it was a winner. Also eaten with gusto tonight. Hurrah!

It looks pretty fancy, but it’s not so complicated. The best part is that it can be assembled in a baking pan and put in the oven to cook. No intermediate cooking steps. And it works for everyone in the family. The recipe itself is not high ratio (slightly less than 1:1) but it is very low-carb, so it can be worked into a ketogenic diet meal with added fat on the side.

1 serving Chicken ala Bacon, cut in half and pancetta removed on left half so you can see the flax and parmesan “breading.” Served with avocado and kalamata olives. Cream and fish oil also included in the meal not shown.

The recipe below is formulated for Nora, who gets a smaller portion of protein at each meal than a bigger kid or adult. Scale it up for bigger people. Anders had a portion on top of noodles for dinner tonight, with a little extra parmesan on the noodles. You can see that I made 6 portions here, but I don’t really expect Nora to eat this 6 days in a row so I gave Anders a portion too. It was just easier to make them all the same instead of keeping track of the Nora-weighed ones. In addition, I made a non-weighed pan of the recipe in a big batch using the same ingredients. The rest of us will have leftovers this week too!

The pancetta is optional; the recipe works wonderfully without it. I had to omit it from Nora’s portion on the first night I served it because it put her over her protein needs for the day. If you leave off the pancetta, the top of the chicken cooks up nicely in the oven kind of like oven-fried chicken, with just the flax and parmesan on top. However, I would estimate that without the pancetta the POB rating drops to about 8. Tradeoffs can be difficult. 

1 serving of Chicken ala Bacon. Nutritional analysis by www.caloriecount.com

Chicken ala Bacon
30 g Chicken thigh, raw and boneless
20 g zucchini, raw, cut into thin medallions
2 g Bel Gioioso Parmesan
2 g Bob’s Red Mill Golden Flaxmeal
5 g olive oil (estimated)
5.5 g Applegate Farms Pancetta (~1 slice)

Preheat oven to 400 degrees. Coat the baking pan with a thin layer of oil.

Cut the zucchini into thin medallions and measure 20 g per serving. Make a small mound of zucchini in the pan; if you are making more than 1 serving you can make several separate small mounds in your pan to accomodate each serving.

Front row: Zucchini slices with flax and parmesan.
Middle row: Chicken on top
Back row, left: Flax and parmesan on top of chicken
Back row, right: Topped with a slice of pancetta

For each serving, measure 1 g flaxmeal and 1 g parmesan, then sprinkle it over the zucchini slices with a sprinkle of salt. Next, lay the chicken on top. Sprinkle the top of the chicken with another 1 g of flaxmeal and 1 g of parmesan. Finally, top with a slice of pancetta. You can see each step in the photo, eventually making 6 servings in this pan.

Cook for about 20 minutes. The pancetta will be crispy when done and everything will be cooked through.

Transfer to serving plate and let cool. Scrape up some of the oil to be served with the meal and drizzle it over the chicken. It is difficult to make sure that the correct amount of oil makes it on to the plate, so if you need more precision you should cook this whole meal in separate ramekins or other small ovenproof dishes so that you know all of the oil is incorporated into the meal.

I am storing the individual servings in the refrigerator for easy meals this week. To reheat, microwave for 30 seconds to 1 minute.

 

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Chez Nora

We enjoyed a great Christmas-New Year vacation at home with lots of keto-goodies and many tried-and-true recipes. Nora is still doing great, seizure-free, and growing up before our eyes. I’ve been intending to write this post for the past month and finally have a moment to get to it.

It is probably natural that a child who’s diet requires so much specialized cooking will take an interest in cooking. Especially an independent 4 year old like Nora. Last quarter, I spent at least 1 day per week home with Nora, when I did a lot of cooking for her. In early December Nora took up the creative task of cooking also.

Recipe 1: Chez Nora Olive Pie

One day Nora came out of the kitchen holding a jar of jam, proclaiming that she was ready to bake a pie. I had to talk her out of the jam, but told her that we could make another kind of pie that would work with her diet. Next, she brought out a jar of kalamata olives and lemon juice. Hmmm, we could work with that.

It took some time and negotiation to convince Nora that she needed my technical expertise to make anything that would be edible and fit into her diet. I suggested that she could make something like a quiche, an egg and olive pie. She agreed that would be good, and suggested it would be good with chicken in it too. Then she decided to add some fish oil to the recipe so that she didn’t have to drink it separately that night. I could go with that too.

I let Nora weigh everything on the scale and do the mixing. I told her when she had weighed enough of an ingredient so that she would like the final result. She mostly went along with my suggestions and I recorded the weight of everything that she included in her recipe.

After we weighed everything and assembled her olive pie, she made one for Papa and one for Anders for dinner too. I let Nora weigh and mix theirs but didn’t require precision. I also let her omit the fish oil from their portions. Unfortunately, egg dishes are not on my special diet (my stomach can’t tolerate much egg.) She could relate to that explanation. I had an alternative meal that evening.

Although Anders was skeptical at first, everyone was very pleased with their olive pie! Nora was especially proud to present it to Ted and Anders. It was adorable. She made me hide them for as long as possible until Ted was at the table to receive his meal. He was very gracious and complementary, much to Nora’s delight.

Chez Nora Olive Pie. Nutritional information from www.caloriecount.com.

Chez Nora Olive Pie
2 g Fish Oil
8 g Kalamata Olives, chopped
6 g Napoleon Chopped Green Olives
12 g egg
0.5 g lemon juice
3.5 g Heavy Whipping Cream
10 g chicken thigh, chopped

Measure egg and cream into a small ramekin and whisk well. Fold in remaining ingredients and mix. Bake at 325 for 10-15 minutes or until set. Cool and enjoy.

Recipe 2: Blueberry Monster Mash

One Saturday morning, Nora and I were home together and I was making up a batch of Macadamia Monster Mash. Nora likes to run the food processor when we make recipes like this one. She was inspired to make another recipe with the ingredients that we had on hand and another one of her favorite foods: blueberries.

Again, I tried to guide her on amounts as she measured the ingredients on the gram scale. I would say, “that’s enough!” then record the weight on the scale. Thankfully, she wanted to include coconut oil in this recipe, which worked great!

Blueberry Monster Mash
50 g blueberries
100 g macadamia nuts
10 g coconut oil
0.5 g salt
1/2 T lemon juice
1/2 T water

Measure and process in food processor until smooth. Enjoy!

Nora likes to call this “ice cream” and has offered to share it with friends. Of course, it’s not ice cream by most kids’ standards, but it’s pretty yummy anyway.

Keto-tastic Kristmas: Gingerbread House

Sorry, couldn’t resist the aliteration again 🙂

We also couldn’t resist Dawn’s gingerbread house from www.ketocook.com. We started the recipe yesterday, but then Nora got an unhappy surprise from the vomit elf. Thankfully, she felt better in just a few hours and is fine now. We are still wondering what happened. We have all felt just a bit off the last few days, so maybe it is just a little virus. We also opened a new pint of cream which seemed fine right away, but the second time Nora had some she complained that it tasted bad. It was bitter. We think it was just beginning to sour, so maybe that was the culprit? But Nora has been fine since so all is well today.

It’s also Nora’s half birthday today! She’s 4 1/2! To celebrate, we put a candle in her gingerbread house as the chimney and she ate the roof for breakfast. And in 2 days it will be her 8-month-seizure-free anniversary! So many celebrations!

Nora can’t eat the whole thing because it is far too many carbs and calories. To serve, I pre-weighed the pieces of the house. I made sure each matching piece was the same weight–the 2 roof pieces, the 2 side walls, and the 2 peaked walls. She ate both roof pieces for breakfast, so I knew how much dough went into each piece of cookie, and the amount of frosting needed to get the ratio to 3.5:1. She can eat the rest of the house for snacks today and tomorrow and I will know how to account for it.

I adjusted Dawn’s recipe to decrease the carbs a bit. I substituted hazelnut meal and a bit of flaxseed meal for the almond flour. My gingerbread looks a little more rustic as a result. I also made a triple-batch of dough out of spur of the moment laziness. The recipe called for 20 g of egg, and the egg that I cracked was right on 60 g. It seemed easiest to just triple it instead of holding on to the extra 40 g of egg and finding another use for it. Of course, that bought me more work in the long run, but Nora got more gingerbread!

Because I made more dough, I had more to work with when I rolled it out. I tried to follow Dawn’s general dimensions but mis-measured the walls  and ended up making a bigger house than Dawn’s. If you look at the picture of Nora’s house and make Dawn’s recipe, just know that you won’t have enough dough in a batch to make a house that is this big. I overdid it. As you can see, I weighed the cut pieces of dough before baking them. The chilled dough was sturdy enough to move from scale to cookie sheet and back again. I could also weigh each matching piece and adjust to make them the same weight.

I also made the buttercream frosting recipe for the icing. This was so good! And it used up 23 g of our protein powder making the 4:1 ratio recipe! Yippee! To add some flavor, I made some Celestial Seasonings Gingerbread tea and used that for the 50 g of water called for in the recipe. I also added a packet of Nora’s Cytra-K for it’s sweetness. As you can probably tell, my frosting is not white, but light warm brown. It looks good and it tastes wonderful. If I make the frosting again for other treats, I might use peppermint tea or another flavor in place of the water, depending on the recipe.

The buttercream frosting is also great because it hardens when chilled. I had to keep the frosting around room temperature to work with it, then we put it in the fridge to harden. Works like a dream.

Nora directed the decorating on the gram scale. I calculated that I needed a little more weight in frosting than weight in cookie to make this a 3.5:1 ratio snack. Because I knew the weight of the baked cookies, I knew the total weight that the whole house should be when finished (baked cookies plus weight of required frosting). We could assemble it right on the gram scale, adding the walls and roof as necessary, and adding frosting until we reached the required total weight.

We also cut some mini gingerbread people and trees with the rest of our dough. I made sure that they were all 4 grams of dough so that they could be served without weighing and calculating. Then I frosted them all with 2 g of frosting because that would fit easily on the cookie. They are not at-ratio snacks so we will have to serve with tea and cream.

We have a very full fridge of Keto Kristmas Kookies! And a happy Nora. I told Ted that I am done baking for awhile, and in the next moment I realized that we are out of some of Nora’s other daily baked goods, like fiber rolls and pumpkin bars for breakfast. Sigh. She will be eating gingerbread for breakfast this week. I think I will try to hold off on more baking until I find out if we are getting a stand mixer for Christmas 🙂

Candy Cane Cookies

What does your kid do when innocently offered sugar? What do you do?

We are lucky that Nora informs people that she has a “special diet.” She doesn’t make a fuss. I make sure we thank them for the gift or offer, give a short explanation and try to re-direct the conversation.

This week, the kids’ swimming teacher gave them 3 candy canes each, of different flavors, wrapped with a ribbon. It was nice of her and she didn’t know about Nora’s diet. There is not reason for her to know the details, they just swim! Nora took the candy canes but said she had a special diet. Anders and I gave the short explanation, which usually is something like “she has epilepsy and can’t have sugar.” To redirect, I suggested that we could use them as decorations on our Christmas tree. The kids thanked her for the present.

Anders really does a good job for a 7 year old, but he can’t help but blurt out, “but I can eat one later, right?” I try to tell him that we will discuss it later, but he can’t help but bring it up repeatedly. Somewhere in there I remembered making candy cane Christmas cookies in the past, and suggested that we could make some for Nora so that she can have a “candy cane” too. Then I was committed.

We had already made the Coconut Cut-Out Cookies from www.ketocook.com into Christmas Cookies, so I knew I already had a recipe. We just had to make the shape.

I made a double batch of the Coconut Cut-Out Cookie recipe and divided it into 2 balls of 101 g each. FYI, this time I increased the coconut oil to 16 g and the butter to 29 g to make it a 3.5:1 ratio for Nora. I also do not add as much no-carb sweetener as called for in the original recipe.

One ball I left in it’s original color and flavor. For the other ball, we added 4 drops of red food coloring and a few drops of peppermint extract, mixing well to get it fully incorporated.

Then I weighed out 8 g balls of each mixture, so that each cookie is made from 16 g of dough. That makes serving them much easier because they are a uniform weight.

If you have older children, they will like to help you shape the cookies. Just like soft playdough, roll each 8 g ball into a long snake shape, about 5 inches. You will have 1 pink string and 1 “white” string. Then carefully twist them around each other and form into a candy cane shape. I found the the dough tended to break a bit, but you can easily keep smushing it back together to get a compact cookie. As you wrap the strings around each other, press together to form a single compact stick of dough.

Forming each one took 2-4 minutes so the dough tended to dry out. Part way through I realized that I should keep the dough moist and put a damp dishcloth over the top of everything, both the formed and un-formed dough.

Nora wasn’t able to do that fine motor work with the precision needed to make a candy cane shape and just wanted to play with it. I let her try to form hers, then we just mashed her dough together into a round pink and white cookie because it was beyond repair. It will still taste the same.

The double-batch of dough with 16 g per cookie made 12 candy cane cookies. Because they were a bit thick, they took 8-10 minutes to bake through. They turned out quite sturdy! a few broke when they were picked up and waved around (4 year olds tend to do that), but they were not crumbly at all. Nora was able to dip hers in tea. I tried the littlest cookie made from leftover dough and it tasted good. I think the coconut flour gives it a bit of a dry texture, even with all of that fat, so it is perfect for dipping. Anders and his friend Henry really really really wanted to try one even though I offered them sugared snickerdoodles, so I let them split one and they liked it too! That’s the ultimate taste test! Also, it signals that food that looks fun is always good to eat.

With less than a week left until Christmas, I’m going to dole these out slowly so that I don’t have to make them again until next year. They were fun, but time consuming. Make it a fun holiday activity with your keto kid and enjoy the smiles.

Mexican Chocolate Protein Cupcakes

Holiday goodie #4: Mexican Chocolate Protein Cupcakes! The texture of these cupcakes is near perfect for a gluten-free, low-carb cupcake. I am proud that I seem to have nailed a recipe on the first try. I was due for some good luck.

Mexican Chocolate Protein Muffin and Raspberry Cream Cheese Frosting. Click on the picture for a larger view to see details and the texture of the open cupcake.

This was inspired when Nora was invited to a birthday party for her friend Fiona that would feature chocolate cake and pink frosting. I have been reluctant to make any chocolate baked goods for Nora because one of her breakthrough seizures early in the diet therapy came after I made her MAD-approved brownies. She has since been having cocoa periodically with no problems: occasionally a touch of cocoa in her cream to make her hot chocolate and 4 g of 85% dark chocolate in her Chocolate Chip Keto Ice Cream Pops. I was careful in making these cupcakes not to give her any more cocoa than she has already been having in other treats. I know it’s likely superstition at this point, but I have no interest in tempting any breakthrough seizures.

To round out the flavor profile, I added cinnamon in equal parts with the cocoa powder. Hence, the Mexican chocolate flavor and a nice warm holiday ambiance.

And the protein? That was partly to balance the carbs and proteins in this snack to make it more keto-diet friendly, partly to use the 2 pounds (that’s ~900 g) of whey protein isolate in my pantry. 5. Grams. At. A. Time.

I know your next question: “Why in the blazes do you have 2 pounds of whey protein isolate in your pantry?” I think the answer is obvious, but I will indulge you: I aspire to make Nora into a body builder. Ok, you got me, that’s not really the reason. I aspire to be a body builder. In another lifetime.

Now for the truth. When we started Nora on the MAD diet 1 year ago, the lower ratio meant a much higher protein requirement each day. We felt like we were stuffing her full of protein constantly, so I looked for ways to replace carbs with protein wherever possible. I also read on gluten-free blogs that whey protein produced superior baked goods, so I wanted to experiment with recipes. The only whey protein isolate in town that was free of added sweeteners or flavors came in a 2 pound tub at Stoker’s VitaWorld (that’s right, it’s as groovy as it sounds). As Nora moved to the higher ratio keto diet, she needed much less protein and more fat. Actually, she was happier and able to eat about the same number of calories on a higher ratio when we replaced protein with fat. Everyone was happier and closer to seizure-freedom.

But I was left with almost 2 pounds of whey protein! The recipes I made back then were not clear winners because they didn’t stay with us. I should find some of them and try again. In the meantime, I’m happy that I was able to incorporate a bit of it into these cupcakes. Slowly but surely I will use it. It’s good through November 2013. One more year on the diet, one more year to use the whey protein.

My starting point for this recipe was the Basic Chocolate Cake recipe at www.ketocook.com, but I wasn’t comfortable with it because of the high cocoa content. As you can see I made some substantial changes to create this recipe, but followed the general proportions of dry to wet ingredients. I frosted them with my Raspberry Cream Cheese Frosting, made at a slightly higher ratio than I’ve used before, which is posted below as well. To achieve a 3.5:1 ratio, I used 1 cupcake and 20 g of frosting. Varying the amount of frosting will achieve different ratios.

As always, use this as a starting point for your own recipes and re-calculate using your exact ingredients.

Mexican Chocolate Protein Cupcake. Ratio is 2.3:1. Nutrition per 47 g cupcake (whole recipe makes 3 of these). Nutrition analysis by www.caloriecount.com

Mexican Chocolate Protein Cupcakes
10 g Bob’s Red Mill Organic Coconut Flour
5 g Ultimate Nutrition whey protein powder
3 g Rapunzel Organic Cocoa Powder
3 g cinnamon
pinch sea salt
1 g baking soda
28 g Strauss European style butter, melted
20 g Thai Kitchen Premium Coconut Milk
20 g Organic Valley Heavy Whipping Cream
50 g egg, beaten

Preheat oven to 325 degrees.

Mix dry ingredients well. If you want your cupcakes more chocolatey, you can certainly add more cocoa powder, up to 5 to 6 grams will probably be good. I also added about 1 gram of Sweet Leaf Stevia Sweetener, and you can add sweetener of your choice. Remember to re-calculate with your ingredients and measurements.

In a separate bowl, whisk together the wet ingredients: Melted butter, coconut milk, cream and egg. Pour the dry ingredients into the wet and stir well, removing lumps.

Divide into 3 silicone cupcake molds, 47 g of batter in each. Bake for 14-17 minutes or until done. If you depress the top of a cupcake lightly, it will spring back. Or when a toothpick inserted in the center comes out clean.

Check it out. One of these beautiful full-sized cupcakes has only 1.8 g net carbs. I kept waiting for them to fall, but they didn’t! They kept their perfect cupcake shape and popped out of the silicone molds like a dream (you have to turn them inside out after they cool). They had a nice dense but airy cupcake texture, and you know that a keto cupcake will never be too dry.

 

Nutrition breakdown for 20 g of Raspberry Cream Cheese Frosting. This is the amount that I add to the Mexican Chocolate Protein Cupcake to take the ratio of the whole snack to 3.5:1, 243 calories

Raspberry Cream Cheese Frosting
30 g Organic Valley Heavy Whipping Cream
88 g Primrose cream cheese
70 g Strauss European style butter
12 g raspberries

Blend all well with a mixer and serve. Full recipe makes 200 g of frosting, or 10 servings at 20 g per cupcake.

You can add a no-carb sweetener to taste. I often use a touch of Nora’s Cytra-K for sweetness and pinkness. You could also use food coloring if it is approved by your dietician and ok for your kid.

Ratio is 10.8:1. I have used it to top the Coconut Cutout Cookies and other treats. When refrigerated, it hardens nicely so you don’t have to worry too much about smashing it. Leave at room temperature to soften.

I know that www.ketocook.com also has a buttercream frosting recipe that uses protein powder. I will have to give that one a try as a new way to use the whey (heh).

Holiday Cookies

Tis the season for holiday treats! Nora and I have been experimenting with several great recipes. At the moment she has 4 different types of goodies in the fridge to choose from!

Three cookie recipes come from www.ketocook.com. The fourth is a new chocolate cupcake recipe that I concocted this weekend, which I will put in a separate post. I am including the links to the original cookie recipes and you can get the recipes and nutritional information there.

Coconut Flour Cut-Out Cookies

This recipe made lovely dough. It was rollable and easy to cut and work with, at least compared to traditional Christmas cookie recipes I have made in the past. I was able to help Nora roll the dough, she cut the shapes, and I could scrape them carefully from the parchment paper and move them to the baking sheet.

How to weigh and serve different cookies was my conundrum. Of course, each cookie will be a different weight because of differences in thickness, even if you were to cut only 1 shape. But who wants 1 shape?!? What to do? How to serve?

Dawn at ketocook said that she makes and serves 1 batch of dough at a time. Then they can cut any shapes as long as they get all of the dough into the cookies. But Nora is smaller and I don’t want to serve her a whole batch at a time. I could halve the batch or do some other portion for each snack. That’s totally doable. But I tried something more complicated (I know, you are not surprised). This is my method for serving other batch recipes that I have been experimenting with, so you will see this again.

As Nora cut the cookies, I weighed them on the scale and recorded the pre-cooked weight for each pan of cookies. We lost about 1 gram of dough to the parchment paper and cutters out of 194 g in our double-batch. With wetter dough it would be necessary to weigh the amount of dough going into the oven (which is just a preview for a future bread post).

After each batch was baked and cooled, I weighed them again. They each lost about 10-12% of their weight in the oven, due to water cooking out. We went from 194 g of dough to 172 g of cookies.

Now we could figure out the nutritional content of each gram of baked cookie. We took the nutritional information of the total dough and divided it by the total baked grams of cookie. To give an example for net carbs, if you calculate the nutritional information per gram of dough, you have o.06 g net carbs per gram of dough (12.6/194). When you divide the nutritional information by the total baked grams of cookie, you get 0.07 net carbs per gram of cookie (12.6/172). Cooking makes them a bit more dense. So if you are baking then weighing out cookies before you serve them and calculating per gram of dough, your estimating error is causing your kid to eat a bit more carbs than you were planning. With these cookies it doesn’t make a big difference, but I am experimenting with using this method for wetter batch doughs in the future where it will make a bigger difference.

Now when we serve Nora these cookies, we can let her choose 1 or 2 of them, weigh them, then figure out the right amount of icing to add to them to bring the ratio up to 3.5:1 for her. For the cookies pictured, I used the cream and coconut oil icing recipe from ketocook.com, although I confess that I didn’t get it to smooth and harden properly because I was in a hurry when I was making it for the first time. I also blended in some strawberry for color. It would be worth another try when I have the time and patience.

The sprinkles are Cake Sparkles by Wilton, made from gum arabic and artificial coloring. My independent research told me that gum arabic is a fiber so it does not add to the carb content and we add just a pinch to her cookies. I don’t know if this has been keto-approved by the Charlie Foundation, so ask your dietician before using. We have had no problem with them. We now have them in pink (pictured), green and red.

This cookie-by-cookie method is not a time saver. You have to frost each cookie individually with the right amount of icing to be at ratio. You can do that each time you serve them, or pre-frost them, but then you have to keep track of how much is in each cookie. Last night I frosted the last 5 cookies so that they are ready to go, and taped a cheat sheet to the container: “red ornament, 7.2 g cookie, 1.5 g icing”… etc. Next time I would do Dawn’s batch version and serve them as a stand-alone snack. Nora is happy. Live and learn!

I would also make this recipe for the rest of the family with a bit of sugar. I liked the coconut flour, but they are a little flat to my taste without the sweetener and I personally don’t like the taste of the little bit of stevia sweetener that I added to Nora’s, about 1/3 of the amount called for in the original recipe. Nora doesn’t mind a bit. Pretty = Delicious

Melt Away Cookies, a.k.a. Russian Tea Cakes or Snowballs 

This was the first holiday cookie I tried because it’s fast. I don’t have a picture, and the picture at the link is much prettier than the cookies I made!

Again, you can serve these as a whole batch for a snack, but I made them 5 g each and pressed them into little holiday candy molds. They are in my Excel database as 5 g cookies so I can serve as many as makes sense for Nora’s snacking needs. They are not at ratio for Nora, so I serve them with tea and cream to make a complete ratio snack.

Snickerdoodles!

Nora loves this recipe! I love this recipe!

I brought this recipe up to 3.5:1 by increasing the butter to 25 g in a batch.

To make these, I bought a Cookie Press hoping that it would make pretty cookies at a uniform weight. I tend to be resistant to buying more kitchen gadgets, but this was already 40% off with other Christmas items at the beginning of December. Seemed like it was worth a shot at $6. But I’m still astounded that they already discounted the holiday stuff and had aisles filled with Valentine’s stuff. In a few years the new holiday merchandise is going to be hitting the shelves in July and discounted in August. Good grief.

The Cookie Press worked fairly well. It works like a caulking gun. You put the dough into a cylinder and a plunger pushes the dough out through your chosen mold at the bottom. It is 1 click per cookie, so it is quite uniform. We refrigerated the dough so that it was a bit firm, but not hard. We put a small piece of parchment paper on the gram scale and Nora gave the Cookie Press one squeeze directly on to the gram scale. Then we had to hold the parchment paper down while pulling the Cookie Press away, leaving the cookie behind. It has helpful to have 4 hands working on it!

Doing it on the gram scale let us weigh each cookie easily. After the first cookie, the rest were close to 6 g each for both of the shapes we made. If it was slightly above or below 6 g, I just took a dab away or added a dab more dough. Then we moved the small piece of parchment paper with cookie to the cookie sheet and did the next. It was quite easy and Nora enjoyed it. Now we have cookies that were made with 6 g of dough each so we can calculate the nutrition per cookie and serve easily. And they are at ratio!

The original recipe tells you to make small balls, roll in cinnamon, then flatten. That is also an easy way to make uniform sizes. I was not able to roll them in cinnamons because of the Cookie Press shapes, so I had a clever idea (if I do say so myself): I put the cinnamon into a tea ball and sifted it over the shaped cookie dough. It worked great!

I made one batch for Nora and they were eaten over the course of the day that I made them. So I made 2 more batches later that day and have about 20 in the fridge for easy snacking.

I also made the same recipe for the rest of us, with a bit less butter and about 1/4 c sugar. They are so good! And so much easier to plunk them straight onto the cookie sheet when I don’t have to weigh each of them. Oh joy! I will be making them for myself again very soon. The first double batch for the family disappeared over the first day–and not only into me, mind you, I also have a 7 year old boy to feed. I will be making more for the rest of us very soon too.

Thanks Dawn and Tiffany at ketocook.com for the fabulous recipes! You make keto-parent life easier and many happy keto-kids.

And now it’s December…

About 1 year ago now Nora first entered ketosis. Oh, those were a first few bad days. She would lie on the floor moaning for toast. I thought that she might chain herself to the refrigerator until we gave her toast and jam. But we survived a long difficult weekend and came out the other side, to ketosis and the first glimmer of Nora getting better after 3 months of myoclonic seizures.

Now she has been seizure-free for over 7 months. Her seizures did not stop right away. We eased into diet therapy by starting with the Modified Atkins Diet, tightening the ratio and spreading her carbs more evenly through the day because we notice that it helped. On Christmas Day last year we had been having success for several days, but decided to celebrate by giving Nora 1/4 piece of toast as some of her carbs for the day. By the afternoon, she was having myoclonics again. So we learned to feed her a more traditional keto diet by trial and error, while consulting with her dietician. After tightening up the diet her myoclonics stopped, but she had a few more early morning tonic-clonics every month or two. After the last one in April 2012 we tightened her ratio to 3.5:1 and she has been seizure-free ever since. What a relief.

Nora has been great lately. We haven’t posted much because life has been busy and we’ve been chugging along with the daily routine. This is a case of “no news is good news.” Nora has been happy with her same-old recipes for the most part. I had done a lot of baking before our quarter started at OSU, so we had plenty of food in the freezer to make it through these busy weeks. I’ve done a bit of baking since then, but the recipes are waiting for another try before I post anything new. On top of it, a recipe for a flaxmeal-based bread fried my hand mixer (there was smoke), so that recipe will have to await new technology at our house!  Nora loved the bread and got to have some PBJ sandwiches, so I hope I can make it again and post the recipe soon.

Our one bit of news is that the kids were both sick about 1 week ago. Nora threw up once before bedtime after complaining of a stomach ache, but she was keeping down all of her Cytra so we didn’t feel that we needed to call the doctor. The next day we reduced her calories and fed her as simply as possible while maintaining her ratio and Cytra rations, but thankfully she kept everything down and felt better. A minor illness was nothing more than a few days of watchfulness and worry, but I felt more at ease because I had just created our illness preparedness plan!

For Thanksgiving dinner I made Nora smashed celery root with cream, cranberry sauce, stuffing made from her most recent flax bread, and chicken. She complained about the whole meal and we had to spoon it into her. I just had to attribute it to the pickiness of a 4-year-old. She had her Keto-Perfect-Cheesecake for dessert, so all’s well that ends well.

Now that our quarter at OSU is over, we are getting ready for the holiday season. I’m going to make some of the cookie recipes from Dawn and Tiffany at ketocook.com as the new treats for this month. I may stick with those tried-and-true recipes, but if I come up with anything new and interesting you will find it here.

Now that we are 1 year into the diet, we can look back at our ups and downs. We can be grateful that we have come this far, and the year ahead doesn’t look so uncertain and daunting. We are finally starting to believe this is really working in the long term, although there will always be a bit of uncertainty about Nora’s seizure threshold. I’m sure that will always be with us. But most of all we are so very grateful to be here with hope for the coming year. Being in the groove never felt so good.

 

Illness Preparedness Plan

Disclaimer: This is not personalized medical advice. It is intended to raise awareness of potential implications of treating illness while on the ketogenic diet. Contact your ketogenic diet team and primary care doctor to set up individualized protocols in the event of illness.

It’s cold and flu season. We’ve already been through a few minor colds this fall and early winter, but we are thankful that none of us have suffered much beyond a cold. It feels a little unfair when your keto-kid, who is already under medical treatment and scrutiny everyday (as much as we try to be “normal”), suffers from a virus or bacteria that takes over and makes her feel miserable.

But for a keto-kid, a typical virus or bacterial infection has the potential to spiral into a prescription to treat it, acidosis and/or a hospital stay.  If not handled properly, a medication or hospital stay has the potential to spiral into a loss of ketosis. A loss of ketosis has the potential to spiral into new seizures. All from a little virus? Yes, so be prepared.

Some of this information was gleaned from the Charlie Foundation Symposium on the Ketogenic Diet, which I attended in September. Other information came from our ketogenic diet doctor in the letter that he sent to Nora’s pediatrician after our last appointment with him (it’s nice that he copies us on the coordination of care letters). I’ve been intending to create a 1-page cheat sheet of do’s and don’ts in the event of an illness that goes beyond the sniffles, and I think every keto family should be aware of these issues if your medical team has not brought it up with you.

Talk to your doctors and make a plan for illnesses. As the parent, you are the one that is constantly in the room when your child is receiving medical care, and you are the last line of defense in making sure treatment is consistant with the ketogenic diet.

Prevention Prevention Prevention!

Ted has instituted a strict hand washing policy at our house, and it’s reinforced by both me and Nora’s nanny, Laura. Nora is indoctrinated: after using the bathroom and before eating, wash hands while singing ABCs. We also remind them to wash hands after we come back home from anywhere. We meet occasional resistance, particularly when Nora is hungry. We also meet sibling rivalry when both of them want to crowd into the sink at the same time (sheesh). But clean hands are the most effective way to avoid illness.

Get a flu shot! Our whole family had their flu shots as soon as possible this year. During our last visit to the keto clinic in October we asked about the risks and benefits of getting a flu shot, and Dr. Wray overwhelmingly was in favor of getting the shot. He tried to arrange for both kids to get the shots before we left his office, but the hospital wasn’t ready with the kids shots yet (he was frustrated!) They had to wait a few more days, but got their shots at their home clinic and had no problems beyond a sore arm. A dose of prevention.

Medications

The Charlie Foundation Symposium included a great talk by Michelle Welborn, PharmD (Doctor of Pharmacy). She went through several drug interactions and considerations for kids on the ketogenic diet. It didn’t occur to me before this talk that there might be common prescriptions to avoid. When Nora is sick and we have to take her in to urgent care or the pediatrician, I would not expect them to be aware of these details of the ketogenic diet so I will bring in my list of “don’ts” so that we can find the best possible course of treatment.

Many viral or bacterial infections in the respiratory system lead to inflammation which is commonly treated by steroids. However, be aware that steroids are anti-ketogenic. Using a steroid may decrease ketosis, which could potentially lead to a resurgence of seizures. Make sure that your pediatrician is aware of that fact and consult with your ketogenic diet team. The benefits of the steroids might be worth the risks of decreasing ketosis, but your team might have other treatments or give other recommendations for maintaining ketosis while on steroids.

Antibiotics are also commonly used to treat bacterial infections, from ear infections to pneumonia. Of course, the children’s formulations of the pink liquid will be full of carbs, so you will have to find an alternative delivery method (which we have thankfully not explored yet, but it’s worth noting). Michelle said that a class of antibiotics called cephalosporins (e.g., Keflex) are known to increase seizure activity in general. I’ve tried looking for more information about other antibiotics to avoid but have not found anything, so ask your doctor if there are antibiotics to avoid, based on his or her experience treating kids on the ketogenic diet.

As an aside, Michelle also noted that acetaminophen suppositories are available for pain relief. Thankfully, we have not had to go there. Of course, children’s acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) liquid formulas are full of carbs, so to administer a pain reliever to Nora we have crushed up the appropriate amount of an adult tablet (ask your pediatrician for the dosage based on your child’s weight before an illness strikes). It doesn’t taste good, but it can be taken with a shot of liquid or bite of cream cheese or butter. Michelle Welborn also noted that carbs can be absorbed rectally, so don’t try the children’s liquid formula as a suppository (I would not have been creative enough to consider it, but apparently someone has!)

The Charlie Foundation also maintains a list of low-carb and carb-free products, including typical over-the-counter products needed to treat an illness. Keep it handy.

Vomiting and Hospitalization

As we have mentioned before, many keto kids have high blood acid levels. It’s a common side effect of the diet. Nora runs a baseline high blood acid level now, even though she is on 2 packets of Cytra-K per day to bring it down (alternatively, the doctor refers to it as a low bicarb level). It is not at a level that makes her ill now, but if it gets lower she could get very ill from blood acidosis.

After our last visit with Dr. Wray at the keto clinic, his letter to Nora’s pediatrician gave this recommendation, which he stressed to us during the appointment as well:

If there is nausea or vomiting, she may promptly need IV fluids given her acidosis. Increasing her Cytra has not brought her bicarb up, it does not seem to be affecting her now, but certainly as we enter the viral season this may be an issue. Certainly if she is vomiting up her Cytra-K, she could fairly rapidly become excessively acidotic and may require help. If she does go to the emergency room, it is important that she not get intravenous fluids with dextrose or lactated Ringer’s as these will take her out of ketosis.

If Nora starts vomiting, our first call will be to Dr. Wray’s office to make sure he is aware of the situation and he can be in contact with the primary care doctor if necessary. Symptoms of blood acidosis are lethargy, vomitting … pretty much the stuff of the flu. So it would be difficult to impossible to tell if she is suffering from further acidosis if she gets sick. Dr. Wray is recommending to err on the side of precaution and get her extra fluids via IV if she cannot keep anything down.

If he recommends going to the ER for IV fluids, we will be sure to verify that her IV fluids do not contain glucose, dextrose, nor that they use a lactated Ringer’s solution, all of which are listed as contraindications in his last set of notes. I quickly looked up lactated Ringer’s solution and learned that it is a fluid containing dextrose and several minerals (potassium, sodium, calcium, chloride). Presumably she should have an IV solution containing minerals but without the dextrose, or with a much smaller concentration of sugar/starch. That is a question that I will put to Dr. Wray so that we know what she should get in her IV. If they have to mix a special solution, that will take time so we should know which off-the-shelf bag of fluids should be used immediately.

I was especially grateful to get these specific notes from Dr. Wray because this was also a topic of concern at the Charlie Foundation Symposium. Emergency rooms have done some real damage to keto kids because they do not have training in this special sub-set of medical issues. The technical discussion of appropriate IV solutions at the symposium was over my head, but keto teams around the world have experience in treating keto kids with an IV, so appropriate solutions are known. As the parent, you are the advocate in the room and have the final say on the treatment of your child. Usually a nurse or other tech comes in the room to administer the IV bag, so check with them before they start fluids and refuse to start the IV if the bag contains any of the contraindicated ingredients or solutions and get in contact with the doctor on-call. If you can go in with as much information and instructions as possible, you can stop mistakes before they happen.

Reminding the pediatrician and doctor on-call about these issues will start them down the right path, and getting your ketogenic diet doctor consulting as soon as possible will be critical. Writing this up still leaves me with some questions, so I have a little homework to do to continue to prepare our family for inevitable illness. In any case, there is value in knowing the where the dangers lie so that you can get the answers you need when you need them. And even better to be prepared ahead of time.

To borrow from an old bit of wisdom: Knowing is half the battle (GI Joe!)

Update: Dr. Wray responded to my unresolved questions about IV solutions: normal saline, or some dilution thereof with potassium are fine. The ER physicians will know this, and if not, can call the ketogenic diet team. He also said that he tries to avoid oral steroids, but inhaled ones and are fine if a kid has asthma or other needs. As for antibiotics, they are typically all fine (even the cephalosporins) as pills, as any break-through seizures are more due to the intercurrent illness, not the drugs to treat them.

Thanks Dr. Wray!