Antibiotic Time

Posted on June 9, 2014 by Christy Anderson Brekken

Quick update and tip for childhood illness!

Nora is still doing fine on 3:1. We will step down to 2.75:1 next weekend, right after the last day of school and kindergarten graduation.

Last week Anders came down with strep throat, which was diagnosed very quickly. He got the pink liquid antibiotic of amoxicillin and was feeling better 24 hours later. We were on the look-out for another family member to fall ill, especially Nora.

I started feeling cruddy on Saturday, so I went to urgent care and took Nora with me even though she said she felt fine. They did throat swabs on both of us. The rapid tests came back negative, but Nora’s 24 hour culture came back positive (but not mine! I’m was feeling better the next day.)

Nora has not needed an antibiotic in over 2 years! We referred back to our illness preparedness plan post and found little guidance on how to deal with antibiotics. Ted went to the pharmacy to explain the situation, and thankfully the pharmacist was happy to work with us.

He explained that they mix powdered amoxicillin with the “pink stuff” right at the pharmacy but he did not have any information about the ingredients in the pink stuff. Instead of mixing, we took home plain capsules of amoxicillin. Dosage is 1 capsule in the morning, one at night. Nora doesn’t swallow large pills, so we open the capsule and mix the powder with a bit of yogurt. Nora doesn’t mind the taste, and this is a girl who has taken a lot of medicine mixed in stuff. She knows when it tastes bad and is not afraid to say so. Now we have 9 more days of morning and night doses and we are in the clear. Glad we caught this now so that she is healthy for kindergarten graduation!

Stepping down to 3:1

Posted on May 21, 2014 by Christy Anderson Brekken

Nora has been cruising along as 3.25:1 for the last 3.5 weeks. Her wean schedule calls for going 3 to 4 weeks at each step down. Originally we thought that we would keep 3.25:1 for 4.5 weeks, because we started mid-week and will make changes on the weekends. She is doing so well that we decided to go for the next step down last Saturday. All is well!

We’ve been looking forward to 3:1 from the meal planning angle because many of the whole foods that make up the backbone of Nora’s diet are well above 3:1, like avocados, cream cheese and macadamia nuts. There are a few others that are at or near 3:1 that now will support the ratio instead of dragging it down, like walnuts. I suppose “so much easier” is really a matter of perspective. After doing it for a few days we can see the difference between 3.5:1 and 3:1.

This month’s ratio change brings her up to 26 g of protein, her full requirement for a kid of her age and size. Her carbs will only come up 0.5 g. That means that this month we adjust to getting more cheese and meat in her diet, and the step downs after this will be marching up the carbs while decreasing the fat.

I like to have at-ratio popsicles made for easy afternoon snacks. I didn’t re-do any recipes for first step down, but I redid them last weekend to get to 3:1. It made me realize that we don’t have a lot of at-ratio recipes for her. Instead we build meals around various foods that she requests, adding the necessary fat to the meal in other ways. I recalculated her berry frozen yogurt pops and chocolate chip frozen yogurt pops and made a batch of each at 3:1 this weekend (note that the linked recipes are at 3.5:1, but decreasing the cream or increasing the berries, yogurt or protein powder appropriate changes the ratio). Very little has changed in those popsicles, Nora won’t even notice the difference, but now we have a stash of snacks to get us through a few weeks.

This is a short and sweet update, so here’s a fast keto-fact observation: Nora very rarely ever passes gas. If she does toot or burp, it’s a huge hilarious surprise! Maybe other keto-families have noticed this phenomenon too?

Keto kids make the news

Posted on April 28, 2014 by Christy Anderson Brekken

Last year when Nora was approaching her 1-year seizure free anniversary, I called our local newspaper because I thought they might be interested in her story. They love a good human interest story and I wanted to spread the word about the keto diet as a treatment option for childhood epilepsy. They wrote a great article that surprised us by being put on the front page of the Sunday paper! (Here’s the post on last year’s story).

Nora and Dr. Wray. Photo credit: Amanda Cowen, Corvallis Gazette-Times/Mid-Valley Sunday

This year, approaching Nora’s 2-year seizure-free anniversary, I contacted them again because sometimes they do small “updates” on stories that they have been following. Instead of a small update, they asked if they could send a reporter and photographer to Nora’s doctor’s appointment and this time they told us that it would appear on Sunday’s front page.

But the real news is what else happened in that year–not to Nora, but to another child from a nearby town. Because we told Nora’s story and the newspaper decided it was big news, the Swick family got the resources that they needed, the right diagnosis and started the diet one week later. The story doesn’t say it explicitly, but Jaron has Doose syndrome and the diet is the best treatment. How they made the journey to the diet is in the article, and now Jaron is big news too–and seizure free!

Here’s the article: http://www.gazettetimes.com/news/local/seizure-stopper-word-of-diet-program-spreads-now-helping-philomath/article_ebd16b88-cbd4-11e3-b0bf-0019bb2963f4.html

I’m so relieved for Jaron and his family. We’ve been blogging to reach out to others who need support because we’ve received so much comfort and ideas from other families who have taken this path. May we all pass it forward so that all kids get the right treatment when they need it.

We want to thank Doernbecher Children’s Hospital and Dr. Wray for opening their offices to tell Nora’s story. Dr. Wray joined the practice just when Nora needed him, during her own “crisis mode” moment. We would not be here without his expertise and smile. Going to the doctor is a treat when we get a smile and giggle every time. They are running a top-notch program. We look forward to working with the ketogenic diet program to set up a formal support group this summer, so stay tuned for developments.

And now we wean

Posted on April 23, 2014 by Christy Anderson Brekken

Dr. Nora taking my blood pressure. I strongly encourage this game.

It is a big week in Nora’s world, although I’m sure it seems bigger to us than to her.

Yesterday we went to Portland to see Dr. Wray for her ketoclinic checkup. Tomorrow will be her 2-year seizure-free anniversary. It is a big milestone. The rule of thumb in pediatric neurology is to get 2 years seizure free, any way that works, drugs or diet. If you can do that, there is a 60% chance that the child can come off treatment and never have another seizure again.

That doesn’t seem like great odds to me, but that’s the one-time all-comers study. Every epilepsy, every treatment. There is some indication that idiopathic childhood epilepsy (unknown origin) like Nora’s has a better chance because it may be due to some sensitive window in brain development. If her brain can grow and develop past the window without seizures, it is likely that she is past the problem. On the other hand, we don’t know why it is happening, so there may be some underlying glitch that is not resolved. So maybe we are back at a 60% chance.

Ted and I are the analytical types, so we like some assurances like good probabilities. But we won’t know if her epilepsy is resolved until we try going off the diet, and it is not fair to keep Nora on a treatment that she might not need. So this is the anniversary we have been waiting for. It’s time to try to wean her off the diet!

The Slow Wean Plan

There is no consensus about the exact wean procedure, except for what you should NOT do: an IV of glucose, or a trip to the cotton candy factory, for example. We have had such a good experience and don’t have a rebellion on our hands, so we are choosing the slower-wean route to start. If we stick to this schedule, it will take us about 1 year to get down to a 1:1 ratio and go to a Modified Atkins Diet. We will see what happens after that.

We are going slow to give Nora the best possible chance of successfully coming off the diet, but the down-side is that we will be living with our friend the gram scale for a whole extra year and Nora may not perceive the differences in her diet. But when we look at the schedule for the next 4 months we see the difference.

We will go down on her ratio by 0.25 every 4 weeks. That means that now she gets 3.5 g fat for every 1 g carb + protein. Tomorrow we are changing to 3.25 g fat for every gram carb + protein (3.25:1). In 4 more weeks we will go to 3:1, etc. They will first increase her protein, then after she gets up to her recommended protein intake for her weight they increase the carbs. For example, all at 1350 calories:

4/23-5/24: 3.25:1 ratio, 132 g fat, 23-24 g protein, 17 g carbs
5/25-6/21: 3:1 ratio, 130 g fat, 26 g protein, 17-18 g carbs
6/22-7/19: 2.75:1 ratio, 129 g fat, 26 g protein, 21 g carbs
7/20-8/16: 2.5:1 ratio, 127 g fat, 26 g protein, 25 g carbs

That 25 grams of carbs seems like so much! 2 months after that she would be up to 35 g carbs! See the picture of 1 gram of carb for various fruits, veggies and nuts from the last time we made a diet change. But because it will happen so slowly, I wonder if Nora will really notice the difference and remember what it used to be like. She doesn’t complain about her food, but she wants more freedom of choice, like taking out a snack when she wants to. I will try to give her more of that freedom by keeping more at-ratio snacks around for her to choose from, which I hope is easier with lower ratios.

If all goes well, we can choose to speed up this process. We could go 3 weeks in between steps, or we could jump down by 0.5 on the ratio each time. We will watch and wait.

The “What If” Conversation

We had to ask all of our “what if” questions when we saw Dr. Wray yesterday. We watch and wait. He said that time is the epileptologist’s friend; we will see how she responds to the change over time. The more time that passes, the more information we have. We have to look for patterns. I’m not sure that time is the parents’ friend in this case. We would love some certainty but will have to cope without it.

Nora could have more seizures. If they are a tonic-clonic convulsive seizure, we manage in the moment then wait and see. It might be isolated, so our best strategy will be to wait. She may have more myoclonics. Dr. Wray said that people with a mild myoclonic epilepsy sometimes have a few myoclonics in the morning, but it is not so disruptive that they want an invasive treatment like drugs or diet. Again, we would have to wait and see. We don’t know the cause of Nora’s epilepsy, so we don’t know how this will play out. We only need time to find a pattern and make some decisions. If she develops a pattern of seizures that interferes with her life, we would have the option of diet or drugs again.

The best news is that she is past the window for the devastating degenerative conditions that we all worried about in the beginning. She has developed perfectly, cognitively and neurologically (otherwise) normal, growth on-track, all systems go. That is the comfort and reason to celebrate.

This quote sums up how I feel about it (thanks to keto-mom/friend Fawn for passing it along):

“Nothing is more desirable than to be released from an affliction, but nothing is more frightening than to be divested of a crutch.”

~James Baldwin

Two Takes on the Pizza Crust

Posted on March 28, 2014 by Christy Anderson Brekken

Kids love pizza, and keto kids deserve pizza too. Pizza is also a common quick meal, frozen or delivered, for many families on busy days. But with a keto kid you can’t feed the whole family, so it’s nice to have a fairly simple pizza crust that you can pull together or pull out of the freezer to include your keto kid while you wait for the delivery guy to show up. We’ve spent two years refining our pizza crust techniques, and I think we have 2 winners to share.

The first is a re-purposed version of cheddar crackers, from the Keto Cookbook. It is simply a mix of about equal parts ground macadamia nuts and shredded cheddar cheese. I left out the egg white and it worked fine for a quick crust, but it isn’t very sturdy. It is made of just 2 common ingredients and I don’t have a recipe because you can make it as large or small and vary the proportions as needed to fit in a meal (see examples below).

Mound of cheddar and macadamia nuts on a small pizza plate (left), and after pressed and baked (right).

Simple instructions: Set the oven to 375°F. Measure the shredded cheddar and ground macadamia nuts together, mix well, and press into a small circle on parchment paper placed on a baking sheet. Bake until melted together and barely browned and bubbly. Take out and add toppings, bake again until cheese is melted.

Quick snow-day lunch. Nora pizza (left), frozen pizza (right).

Quick snow-day lunch. Nora pizza (left), frozen pizza for Anders (right).

You can build a meal around it. For an example of proportions, we made a little pizza of 10 g shredded cheddar, 16 g ground macadamia nuts (baked to crust), 10 g tomato sauce, and 14 g whole milk mozzarella (with enough fat on the side to make the ratio correct).

Tostada-crust with hamburger, cheddar, and olives.

We also used this tostada-style with hamburger, cheddar and olives. I used 12 g ground macadamia nuts, 10 g shredded cheddar, mixed and baked the crust as described. Then added 14 g hamburger, 10 g sliced kalamata olives, and 6 more grams of cheddar. With avocado and extra fat (fish oil and cream) on the side. Sour cream would be a great addition, although not loved by our keto kid.

I thought it was easy to make 2 crusts at a time, knowing that I would use one again the next day also. Using the second one the next day helped me keep track of the proportions of cheddar and macadamia nuts.

The second pizza crust winner is from our Toasting Bread recipe. It has been a smash hit recipe for sandwiches and toast, and now as a pizza crust. I experimented with a few other pizza and focaccia recipes also from The Joy of Gluten-Free, Sugar-Free Baking and decided that the toasting bread can’t be beat. It is not a spur-of-the-moment-throw-together crust, but you can make a big batch and put them in the freezer to pull out and use anytime. Weigh, calculate your toppings, and put it in the oven until the cheese is bubbly and the crust is warm. Easy as pizza pie.

Toasting bread and pizza crusts from the same batter.

We are on spring break right and it’s been pouring rain all day, so I spent several hours baking. It is nice to get ahead by having a few items in the freezer for quick meals. Nora asked for toasting bread again and I have found that I like to make it in a small loaf pan instead of the full-sized pan. This time I made a full recipe, put 1/2 of the batter into the small loaf pan, and made the rest into 12 pizza crusts. Because I’ve figured out the nutritional information per baked gram of bread (see original post) I didn’t pre-weigh the crusts. I can just weigh them before using them and build the meal around it.

I like making this bread recipe because it doesn’t require whipping the egg whites until stiff and carefully folding in the other ingredients. It all just goes into the mixer and it is soft and sticky enough to work with. It puffed up surprising nicely in the oven. Each baked crust is solid enough to hold up, not at all crumbly, but with a nice bready texture and nutty flavor.

When I experimented with the other crust recipes we had some fun by pressing the dough into gingerbread cookie cutters. Instead of rolling out the dough and cutting out pieces, I pressed the dough into the shapes and then carefully removed the cookie cutters, using a small rubber spatula to keep the edges in shape. That was fun and Nora liked topping them herself. They are very small, so bigger kids might get 2!

When I figure out the full pizza meal, I weigh out all of Nora’s pizza toppings onto a small plate and let her build her own pizza. She loves the chance to work with her food and make it her way. She also nibbles on the toppings and licks her fingers, a rare pleasure for a keto kid! Because it is all allotted to her meal, it doesn’t matter whether she puts it all on the pizza. I just try to remind her to put enough on her pizza to enjoy it when it comes out of the oven!

It is especially nice to have a pizza crust that can be sliced and eaten in pieces, and will stand up to being carried around. We took an outing to our favorite local pizza place and brought Nora’s pizza along with us. It was a treat to eat out together, which is pretty rare for us. A pizza crust that transports well while still being delicious (not just edible) is a special thing.

Keto Valentine’s Day Love

Posted on February 14, 2014 by Christy Anderson Brekken

Nora woke up yelling “Valentine’s Day!” She loves love. She made her own Valentines for all of her classmates after being inspired by the card she received from Grandma Sheryl. She started with making a heart, and wrote “Happy Heart Day” and just kept rolling until she made one for each member of her class! I only helped with the heart shape, otherwise it was all-Nora.

For a little extra special keto treat to bring to school, I melted her daily B^3 and poured it into a heart-shaped silicone cup to re-harden with the apples on top. I also made a “cookie” of ground macadamia-coconut oil-blueberry to solidify in another heart mold. Easy!

Her teacher sent home a note asking the kids to bring cards to exchange, but she didn’t really specify that candy was not welcome. I’m sure Nora will see some candy today, and we’ve had a talk about it. As an alternative, I made some Lego-guy chocolates from the Charlie Foundation’s Chocolate Candy recipe (with video!). I added a drop of peppermint extract to one batch for a twist. Unfortunately the heads fall off when they pop out of the mold. Good thing they are not long for this world anyway.

Happy Valentine’s Day! Spread the keto-love!

Blueberry Almond Muffins

Posted on February 7, 2014 by Christy Anderson Brekken

Snow days! Two days off school leading up to a weekend, playing in the snow and lots of together time means baking time to keep everyone happy and satisfied.

Nora requested toasting bread for PBJ sandwiches. Anders requested blueberry muffins. But I knew that once Anders had blueberry muffins Nora would want blueberry muffins, so I pulled out The Joy of Gluten-Free, Sugar-Free Baking and tweaked their recipe for Blueberry Hazelnut Muffins to make everyone happy.

And oh. my. good. ness. They are so good!

I made one batch (below) and took out enough batter for 3 muffins for Nora, in pink and purple silicone muffin cups. Then I put a bit of sugar into the leftover batter for the rest of us and re-mixed, added in the blueberries, and put ours in yellow and green silicone cups. They are nutty delicious, either warm and cold.

I’m also sure that the original recipe using milk of any kind instead of heavy cream would also be very good. If you’re into that kind of thing.

Nutrition information for one Blueberry Almond Muffin, by www.caloriecount.com

Blueberry Almond Muffins
(makes 10 muffins)
90 g raw egg (2 eggs)
115 g (1/2 C) Organic Valley Heavy Whipping Cream
7 g (1.5 tsp) vanilla extract
5 g (1 tsp) lemon juice
85 g (3/4 C) Bob’s Red Mill hazelnut flour
85 g (3/4 C) Bob’s Red Mill almond meal/flour
30 g (1/4 C) slivered or sliced almonds
6 g (1 Tbsp) baking powder
3 g (1/4 tsp) salt
40 g frozen blueberries (1/4 cup, or more if diet allows)

Measure egg, cream, vanilla and lemon juice into mixer. If you want to add some liquid stevia or other carb-free sweetener, add it now as well. Mix thoroughly on low in electric mixer, or by hand.

In a separate bowl, combine nut flours, almonds, baking powder, and salt. If you want to add a powdered no-carb sweetener, add it here. Mix well. Add the dry ingredient mixture to the wet ingredients and mix on medium very well, one to two minutes. You want to beat a little air into it to fluff up your muffins. These ingredients are a lot of heavy lifting for the baking powder.

Measure 43 g of batter into each muffin cup. Then add 4 g of frozen blueberries to each cup, pushing them into the batter and smoothing over the top.

Bake at 350° for about 35 minutes or until golden brown on top and springy to the touch.

These are 2.17:1 ratio. Served with 25 g Organic Valley Heavy Cream plus 1 drop of vanilla flavoring and a thinned with a bit of water to make “milk” for a 3.5:1 ratio.

Now we are snowed in and need more baking supplies to make more of these! They will go too fast!

Almond & Orange Florentines

Posted on December 26, 2013 by Christy Anderson Brekken

I like to cook, therefore I like to listen to the Splendid Table. When I saw this Almond Florentine recipe on their website, I knew it would be keto-possible. Worked like a charm!

It is so easy, delicious and look at that fancy little cookie. Who could resist? It was a simple way to make an elegant holiday treat for Nora, and a batch with a little sugar for the rest of us!

A tip of you are making them for the whole family: reduce the sugar by at least half. I reduced the sugar a bit, and found them very very sweet. The orange still comes out, but I would like to taste the almond flavor too. The sugar is only for flavor, because Nora’s came out fine with no sugar at all.

One more tip: Kids like to zest oranges with a cheese grater or zester. Anders did the whole orange for me. Just make sure that they get the colored peel and avoid the white pith. Get them busy in the kitchen!

Nutrition information for 1 almond florentine cookie (recipe makes 10). Nutrition information provided by www.caloriecount.com

Almond & Orange Florentines
(makes 10 servings, 1.43:1 ratio)
30 g Egg whites
100 g Sliced almonds
2 g Orange zest

Preheat the oven to 300°F. Line a heavy baking sheet with a silicone mat or parchment paper brushed lightly with vegetable oil.

Measure and briefly beat the egg whites. Then gently mix them with the sliced almonds and orange zest. Measure 13 g portions of the mix to make little mounds on the lined pan, spaced a bit apart. Dip a fork in a small bowl of water and flatten each mound. Make them as thin as possible without big gaps between the almond slices.

Bake for about 12 minutes, until the cookies are golden brown. Cool completely before serving.

Nora’s cookies on left, rest of family’s on the right.

You can add a drizzle of high-quality dark chocolate for extra flavor. I use Green & Black’s 85% dark chocolate. Melt a square in a small silicone pinch bowl by putting it in the microwave for 30 seconds. Check and microwave again briefly if necessary to melt it.

Put one cookie on the gram scale and tare it. Drizzle the melted chocolate on to the cookie until you reach the desired amount. I used 1.5 grams of chocolate on Nora’s, which added 0.41 g carbs, 0.15 g protein, 0.75 g carbs (9 calories, 1.33:1 ratio).

The ratio is very low for her, so we make “hot chocolate” out of heavy cream and a pinch of cocoa powder, steamed with the espresso machine’s attachment. Lovely holiday treat.

Popcorn!

Posted on December 17, 2013 by Christy Anderson Brekken

Nora gets popcorn! What a revelation! I read on another keto-mom blog that popcorn was her son’s favorite snack, and I was kinda like “shyeah, right. Not gonna work for Nora. Too many carbs.” Sorry I doubted you Sara. Now I’m with it.

I did look up the nutrition facts on popcorn after I saw that blog post and still thought that it wouldn’t work easily. It didn’t have as much fiber as I expected, and Nora could probably only have a few grams. I thought that her few grams would just look pathetic next to a serving that the rest of us would get. And I didn’t have any popcorn in the house, so that was also a big barrier to trying it.

I was motivated to try it again because her class is having a popcorn party tomorrow for their accumulated good behavior. I bought some popcorn to test it out. Super easy way to make plain popcorn for everyone: put some plain kernels in a small paper bag and microwave it for a few minutes, take it out when the popping slows down, or it will burn. That’s it! You will never eat that chemical-laden microwave popcorn again!

For tomorrow’s popcorn snack, Nora will get:
4.5 g popcorn
5.5 g butter (melted on and drizzled on popcorn)
5 g melted coconut oil mixed with 8 g ground macadamia nuts and a drop of banana flavoring, chilled to make a “cookie”

162 calories
3.3 g carb
1.2 g protein
16 g fat
1.3 fiber
3.5:1 ratio

And look at all that popcorn! A near proper bowl! It is super carby per gram, but it’s so light that you get a lot of popcorn per gram. That’s the key to success.

This will be her morning snack at school when everyone has popcorn, so we will load her breakfast with protein and very little carbs so that she is evened out by lunch. She is excited! And it sure helps that she is up to 14 g carbs per day, on her way to 16-17 g. We can easily squeeze in a few extra carbs with snack.

I am sure that popcorn will also become a favorite snack for Nora too.

The simplest keto meals

Posted on December 15, 2013 by Ted Brekken

Ted here. This post is about the very simplest keto meals. Especially from the perspective of the secondary cook.

Christy is a food wizard. She gets food. She can create new things from basic components. She can produce batches of treats for Nora that we can use over the week. That is not an area of significant competence for me, but I can certainly make simple keto meals for Nora. So what do we do when energy and time are low, more complex treats are not available, and Nora needs to eat? Here is our most basic template for an easy lunch (or dinner).

Base:
Start with a base of avocado. Avocados are stellar. They are at about a 3.5:1 ratio on their own, plus they are fibrous. They can be simply diced, or spread as butter. We’ll generally start with 20 to 30 grams of avocado for a meal. Macadamia nuts (see more on them below) can also serve the role of a meal base. Both avocados and macadamia nuts work well to start the meal calculation because they are both high ratio, and give you a solid start on all four of the major constraints: carbs, protein, fat, and fiber.

Carbs:
The major sweet parts of the lunch come from apple, red pepper, carrots or berries (e.g., blueberries, strawberries, and raspberries). Peppers and raspberries get priority because of their high fiber and low carb content (relatively). Apples, blueberries, strawberries, and carrots pack much more of a carb punch, so those are added if the other major constraints are met and there is still a bit of carb to give. Generally there will be 5 to 30 grams of total fruit, depending on the mix.

Protein:
Cheddar cheese is the primary protein base. Nora likes it, it is easy to cut and weigh, and it has a good amount of fat too. It is versatile too in that it can be served sliced, cubed, shredded, melted, or melted and reformed. Something like 10 grams to 20 grams is typical. Sliced turkey and ham are also popular. Ham is nice because it has some fat. Sometimes we’ll put cream cheese and butter on the sliced meat and roll it up to get more fat in there.

Fat:
Cream is our primary fat, either mixed with water and a few drops of vanilla flavoring to make “milk,” or steamed in our espresso machine with a pinch of cocoa powder. The amount of cream will be between 10 and 40 grams, depending on what else is in the meal. We’ll might also look for opportunities to put butter on or in things. The other two big fat delivery mechanisms are macadamia nuts and kalamata olives. Those are especially nice if I want to avoid liquids (i.e., cream) in the meal, for example, with a packed lunch. Macadamia nuts do have some carbs, so it will use up some of that allotment, but their high fat and high fiber content provide a significant tradeoff for that. Kalamata olives are one of very few foods that have both fat and carbs, but no protein, so they make a natural keto complement to meat and cheddar. However, they have no fiber.

Fiber:
The fourth constraint. Generally I check for fiber when I am satisfied with the amount of carbs and the ratio of the meal. If the fiber content is too low — we shoot for about 11 grams of fiber for Nora over the day — then I’ll circle back and see if I can trade something out for more raspberries, macadamia nuts, or Flackers. Flaxmeal is another option, and can be mixed in with any butter in the meal.

Variety:
Lastly, we’ll check to see if there is a reasonable variety of textures and tastes. Meaning, is there something creamy and something crunchy? Is there something sweet and something salty?

A typical, very simple lunch:
8 g apple
15 g avocado
15 g cheddar cheese
8 g Flacker with 8 g butter
15 g macadamia nuts
13 g cream with water and vanilla flavoring to make “milk”
—————————
3.52:1 ratio
2.5 g carbs
6.9 g protein
33.1 g fat
4.4 g fiber
336 calories

At the bare minimum, if I have avocado, cheddar cheese, raspberries, and cream, I can cobble together the most basic tasty meal that satisfies all the constraints. Add some sliced meat, other berries, apples, peppers, carrots, cream cheese, macadamia nuts, kalamata olives, and Flackers, and we can switch things up enough to keep the simple meals interesting from day to day.

Oregon Keto Kids

Ketogenic Diet for Epilepsy