Weaning the Ketogenic Diet: A Guide for Patients and Caregivers

By: Laura Dority, MS, RD, LD

Edited by: Amy Merwarth, RD, LD 

Weaning off the ketogenic diet (KD) is a highly individualized process. While this guide provides general suggestions, every patient’s journey will be unique. Always consult your ketogenic diet team to create a personalized plan that fits your needs.

The ketogenic diet significantly alters metabolism, so a gradual transition is usually recommended. A slow, structured approach can help minimize side effects and ensure a smooth shift back to a balanced diet.

General Guidelines for Weaning

1. Take It Slow

The longer someone has followed the ketogenic diet, the more gradual the transition should be.

• Short-term use (3–4 months): Can often be discontinued within 1–2 weeks.

• Long-term use (1+ years): May require 3–6 months or longer for a safe transition.

Some families may prefer an even slower approach, which can be accommodated based on tolerance and medical guidance.

2. Adjust the Ketogenic Ratio Gradually

For those on a classic or modified ketogenic diet, which are prescribed as a ratio of fats to proteins and net carbohydrates (e.g., 4:1, 3:1, 2:1), weaning typically involves lowering this ratio step by step over time.

• Reduce the ratio by 0.25 to 0.5 steps every 2–4 weeks.

• Monitor for any symptoms and slow the process if needed.

A gradual reduction helps prevent electrolyte imbalances and ensure a smoother transition out of ketosis.

3. Reintroduce Carbohydrates Wisely

For individuals following a Modified Atkins Diet (MAD) or Low Glycemic Index Treatment (LGIT), reintroducing carbohydrates should be done carefully. Increasing daily carbohydrate intake by 5–10 grams per day, focusing on complex carbohydrates like whole grains, legumes, fruits, and starchy vegetables, supports a smooth transition out of ketosis. Avoid adding excessive sugars or processed foods too quickly.

4. Liberalize Food Choices

As you transition off KD, begin incorporating a wider variety of foods:

• Swap heavy cream for whole milk.

• Increase lean proteins (chicken, fish, tofu, eggs).

• Introduce more vegetables and fiber-rich foods.

A gradual shift prevents digestive discomfort and helps maintain balanced nutrition.

Monitoring During Weaning

Even after reducing ketosis, it’s important to monitor for side effects like fatigue, digestive discomfort, and seizure activity. If concerns arise, consult your medical team promptly.

After Weaning: What to Expect

• Seizure Monitoring: If seizures return, discuss treatment options with your provider.

• Balanced Nutrition: Continue focusing on whole, unprocessed foods.

• Medication Adjustments: If the ketogenic diet led to reduced use of seizure medications, adjustments to medication dosages may be needed during weaning.

Final Thoughts

Every patient’s weaning process is different; therefore, working closely with your ketogenic team is key. Open communication, patience, and careful monitoring will help ensure a safe and successful transition. If you have any concerns, don’t hesitate to reach out to your medical provider—you are not alone in this journey!

Keto Hope Blog: Keto Super Stars: Meet Eleanor

Author: Hilary Bassett

How the Ketogenic Diet Transformed My Daughter’s Life: A Journey with Ring 14 Syndrome

When I first learned about the ketogenic diet, I had no idea how profoundly it would change my daughter Elee's life. Elee has been on the keto diet for over 2 years now, since she was 11 months old, and it has been nothing short of life-changing. But our journey didn’t start with a simple decision to try a new diet; it began with a heartbreaking and terrifying health crisis.

A Challenging Beginning: Elee’s Diagnosis and Struggles with Seizures

Elee was diagnosed with Ring 14 Syndrome, a rare genetic disorder that causes a wide range of developmental and physical challenges, including severe seizures. Her first seizure occurred at 9 months old in October 2022. We went to the hospital by ambulance for treatment. Unfortunately, her seizures didn’t respond to rescue medications and she was hospitalized for more than a month, not leaving until December 2022. Despite all medical efforts, we couldn’t seem to gain control over the frequency or severity of her seizures.

For a child as young as Elee, watching them go through such a traumatic experience was heart-wrenching. Before her seizures began, Elee had been a happy, healthy baby who loved exploring new foods. She had been exclusively breastfed and began baby-led weaning at 6 months. Her love for food knew no bounds, from pizza and chicken to broccoli and steak. But as the seizures took over, she lost her appetite, and her eating habits regressed drastically.

The Turning Point: Introducing the Ketogenic Diet

The turning point came right before Thanksgiving in November 2022, when we made the decision to start Elee on the ketogenic diet. Through the lens of social media, we had already seen how some children with epilepsy experienced remarkable improvements in seizure control through this high-fat, low-carbohydrate approach. I was intrigued by the idea of using food as a form of “pharmacology,” especially since traditional medications hadn’t worked for her.

At the time, Elee had gone as long as 72 hours without a seizure, but that was her longest streak. When we began the keto diet, something miraculous happened. Elee went a record 52 days without a seizure! She was still on several anti-epileptic medications, but the combination of the ketogenic diet and her meds seemed to work synergistically, giving her the control we had longed for. Even though she still occasionally experiences seizures, they are now limited to once a month, a far cry from the constant struggle we faced before. She is currently experiencing her longest seizure free streak and is at 84 days today!

Rebuilding Her Strength and Love for Food

When we started the keto diet, Elee had regressed to only taking breast milk in bottles. To help her regain her strength and confidence in eating, I introduced her to a medical ketogenic formula mixed with breast milk. Slowly but surely, she regained the energy to start eating real food again. For her first birthday, I made her a homemade 4:1 keto cake, which she absolutely adored. Little by little, Elee started eating whole foods again, and today at 3 years old, she’s thriving on a 2.5:1 ratio.

I’m constantly in awe of how she’s able to enjoy a wide variety of delicious keto foods, from her favorite chopped veggie sub salad with oil and mayo, homemade cheesy goldfish snacks, and spinach bites, to salmon and steak. I use ingredients like cream cheese, butter, olive oil, avocado oil, heavy whipping cream, and MCT oil to keep the fat content high, ensuring she stays within her keto ratio.

The Reality of Managing the Keto Diet for a Toddler

As much as the ketogenic diet has been a miracle for Elee, managing it is no small feat. I’m a huge advocate for the diet, and I’m passionate about sharing her journey on her Instagram page, @pawsforelee. I make all her food from scratch, with the occasional exception of a hot dog (which she loves paired with pimento cheese). To make her meals more exciting, I use dozens of silicone molds to create themed snacks for each week’s learning focus in preschool. I also use these molds for birthday parties and other social events, ensuring Elee has something she can eat while other kids are enjoying their treats.

However, despite the success we’ve had with the keto diet, there are many challenges. The process of calculating her meals and ensuring her fat-to-protein-to-carbohydrate ratio is precise is still a significant hurdle. I use an app for meal planning, but its ingredient database is limited, and I often find myself doing manual calculations to ensure everything is accurate. Many parents I’ve spoken to have given up on the keto diet for their children due to these difficulties, and I understand why. The burden of calculating ratios and creating balanced meals by hand can be overwhelming.

What I’ve Learned and My Hopes for the Future

Looking back, I’m incredibly grateful for the keto diet and how it has helped Elee, but I know there’s room for improvement. I’ve learned that making my own recipes is not only doable but also becomes easier with time. It’s a labor of love, and while it takes effort, I know it’s making a world of difference in Elee’s health. My hope for the future is that as she grows older, the keto diet will become her primary form of seizure control, with fewer medications required.

In an ideal world, there would be better tools for parents managing the keto diet for children. I’m in conversations with a keto app developer to add ratios to their program, which would make the process significantly easier. If we could have unlimited access to a comprehensive ingredient database, meal calculations could be automated, and more parents may find success with the ketogenic diet.

Final Thoughts

Elee’s journey has been nothing short of miraculous, and while there are still challenges to overcome, the ketogenic diet has given us hope and a sense of control we didn’t have before. If you’re considering the ketogenic diet for your child, my advice is simple: it gets easier with time, and creating your own recipes is entirely doable. The results are worth the effort!

Elee’s story is one of perseverance, love, and the transformative power of food. While the ketogenic diet is not a one-size-fits-all solution, it has certainly been life-changing for our family. And for that, I’m forever grateful.

A Year in Review: Celebrating Milestones at Keto Hope Foundation

As 2024 comes to a close, we at the Keto Hope Foundation are reflecting on a year filled with meaningful accomplishments and inspiring connections. It’s been a journey of growth, learning, and impactful moments that strengthen our commitment to supporting families managing epilepsy through ketogenic therapies. Let’s take a look back at some of this year’s highlights.

Published Research: Advocating for Caregivers and Families

This year marked a significant milestone with the publication of two research articles close to our hearts.

In June 2024, we shared our heartfelt voices in Pediatric Research with our article, “Family reflections: A candid view from caretakers of patients with pediatric epilepsy”. This piece offers an intimate glimpse into the triumphs and trials of caregivers, highlighting their resilience and need for understanding from the broader healthcare system.

Then in July 2024, our literature review, “Support for caregivers of children on the ketogenic diet for epilepsy and other neurologic disorders”, was published in Epilepsy Behavior. This work sheds light on the challenges caregivers face, emphasizing the importance of providing accessible resources and emotional support. We hope it serves as a foundation for future discussions and solutions within the medical community.

Both publications are milestones in advancing the conversation around caregiver and family support—a topic central to our mission.

Keto Talk Podcast: Sharing Our Story

We had the privilege of being interviewed on the Keto Talk podcast. This platform allowed us to connect with a wider audience, sharing insights into ketogenic therapies and our dedication to empowering families. The experience was a reminder of the importance of advocacy and education in transforming perceptions about medical ketogenic diets. Listen to the podcast here. 

GLUT1 Deficiency Summit: Building Community

In June, our team attended the GLUT1 Deficiency Summit in Dallas, Texas. This incredible event brought together families, healthcare professionals, and researchers united by a shared goal: advancing the understanding and management of GLUT1 Deficiency.

The opportunity to meet so many amazing individuals—families courageously navigating rare conditions and clinicians pushing the boundaries of care—was profoundly inspiring. The Summit reminded us of the power of collaboration and the strength that comes from community.

Looking Ahead: Exciting Developments

While reflecting on the past, we’re equally excited about the future. On March 8th, we’ll host a special fundraiser in Charleston, South Carolina. While we can’t reveal all the details just yet, we promise an event that will celebrate our mission and community while raising critical funds to support families. Stay tuned for updates—this is one event you won’t want to miss!

Thank You for Supporting Us

None of this would have been possible without the unwavering support of our community. To the families, caregivers, healthcare providers, and supporters who walk this journey with us: thank you. Your dedication fuels our efforts and inspires us to keep striving for better resources, stronger connections, and a brighter future.

As we close the chapter on 2024, we look forward to continuing this work together. Here’s to making 2025 just as impactful!

Image: Jessica Lee & Laura Dority (Keto Hope Foundation Co-Founders) 

Image: Daisy Argudin (Keto Hope Foundation Program & Social Media Manager) 

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Low-Carb Loaves: Our Review of Keto-Friendly Bread You Can Buy or Bake

Recipe & Content Contributor: Taylor Parrish, RDN, LD

For anyone following a ketogenic diet, giving up bread can feel like one of the biggest sacrifices. Whether for sandwiches, toast, or a snack, bread is a staple many of us miss when transitioning to a low-carb, high-fat diet. Luckily, keto-friendly bread options are out there to help fill the gap. We’ve taste-tested both store-bought and homemade versions to bring you a comparison of the best keto breads on the market.

When it comes to finding a bread alternative, consider the following: 

1. Texture: Many kids like the softness of wheat-based bread. Traditional breads use yeast, which gives them volume and texture. Yeast is typically not used in keto breads. Additionally, some keto breads can get chewy when toasted. It may take some trial and error to find the right one.

2. Fiber: Keto breads often use fiber to achieve "0 g net carbs," but some kids may be sensitive to it. Monitoring blood ketones after introducing high-fiber products can help assess tolerance.

3. Ingredients: Some keto breads contain GMOs and additives for emulsification and preservatives for longer shelf life. While not always ideal, these ingredients offer convenience. Freezing bread can extend shelf life, but it may affect texture after thawing.

4. Homemade vs. Store-Bought: Baking at home can be nostalgic, but homemade keto bread may not match the texture or taste of store-bought options. We found that Scotty's Keto Homemade Bread Mix was the closest homemade alternative.

5. Freezing Tips: Slice bread into individual servings, place parchment paper between slices, and freeze. Toasting frozen bread helps improve texture after thawing.

6. Fat Absorption: When choosing a keto bread, consider how it absorbs fat, especially if the bread contains protein, carbs, and minimal fat. Toasting it in butter on a skillet can help determine absorbency. Softer breads generally absorb fat better.

1. Adding flavored fats like nut butters as a topping can enhance both flavor and fat content.

2. Homemade breads made with coconut flour and xanthan gum absorb fat better than those made with almond flour, which is grainier and contains less fat.

7. Flavor: Homemade keto breads often taste "eggy." Adding a sweetener like Stevia can help balance this without making the bread too sweet. You can also top the bread with low-carb jelly alternatives, chia jams, or Dillman Farm Organic No Sugar Added Apple Butter. 

8. Egg Whites in Keto Breads: Egg whites add volume when whipped to stiff peaks, making them a key ingredient in keto breads. However, mixing them with other ingredients can reduce their volume. They also brown faster than wheat flour, so lower cooking temperatures or covering with foil during baking are often needed to prevent over-browning. 

Let’s move on to the fun stuff… store-bought bread highlights & tasting feedback!

#1: Aunt Millie’s Live Carb Smart White Bread

• Soft and most absorbent

• Tastes like regular bread

• Easy to find in stores

• Contains inulin (may cause GI upset) & resistant starches

• Allergens: Soy, wheat, sesame 

• Nutrition per slice (28g): 30 kcals, 0.5 g fat, 3 g protein, 11 g total carbohydrate, 9 g fiber (2 g net carbs) 

• More information

#2: Lewis Healthy Life Hawaiian Keto Bread 

• Third most absorbent but not as soft

• Sweeter than normal bread 

• Easy to find in the store

• Contains resistant starches and chicory root fiber (a fiber but also used for sweetness) 

• Allergens: Wheat 

• Yellow in color (has added turmeric)

• Contains 1 g allulose*

• Nutrition per slice (28 g) = 35 kcals, 1 g fat, 5 g protein, 9 g total carbohydrate, 8 g fiber (1 g net carbs*) 

• More information

*Check with your keto team if you should subtract allulose as part of your net carb calculation. 

#3: Aldi L’Oven Fresh Keto Friendly White Bread

• Second most absorbent

• Tastes like normal bread

• Only found at Aldi’s 

• Contains inulin (can cause GI upset) & resistant starches

• Allergens: Soy, wheat, sesame 

• Nutrition per slice (28 g) = 35 kcals, 1 g fat, 4 g protein, 10 g total carbohydrates, 10 g fiber (0 g net carbs)

• More information 

#4: Base Culture Original Keto Bread

• Least absorbent but with 7 grams of fat per slice, you may not need to add as much extra fat 

• Doesn’t taste like normal bread and very grainy 

• All whole food ingredients

• Allergens: Eggs, tree nuts

• Only found at Whole Foods in the frozen section & expensive

• Nutrition per slice (30 g) – 100 kcals, 7 g fat, 3 g protein, 8 g total carbohydrates, 4 g fiber (4 g net carbs)

• More information

Don’t love any of these store-bought options? That’s okay, let’s look at some homemade bread recipes.

#5: “The Best Keto Bread Recipe”

Recipe Credit: Keto Connect 

• Not absorbent 

• Eggy texture and taste

• Yellow in color 

• All whole food ingredients (optional Stevia, but didn’t help with egg taste) 

• Allergens: Tree nuts, eggs, dairy

• Volume depends on stiff egg whites 

Nutrition information for entire recipe**: 1846 kcals, 164 g fat, 74 g protein, 18 g net carbohydrates, 12 g fiber (1.8:1 keto ratio)

Full recipe information here.

#6: Wholesome Yum Keto Bread

Recipe Credit: Wholesome Yum 

• Somewhat absorbent 

• Coconut flavor with good texture 

• All whole food ingredients

• Allergens: Tree nuts, eggs

• Best to bake on a baking sheet and then cut in half once cooled

• Volume depends on stiff egg whites 

Nutrition information for ½ recipe**: 1167 calories, 109 g fat, 37 g protein, 11 g net carbohydrates, 9 g fiber (2.3:1 keto ratio) 

Full recipe information here.

#7: Scotty’s Keto Bread Mix 

You can bake a great homemade bread mix as a quick mix without yeast (no rise time needed) or add yeast for a more traditional way of making bread. 

• Most absorbent of all homemade bread options 

• Mild flavor with an airy and soft texture (similar to angel food cake) 

• Allergens: Egg 

• Doubled in size when baked (removed from oven early due to large volume increase) 

• Expensive 

Nutrition information as a quick mix (1 bread mix package + 2 Tbsp olive oil)**: 564 kcals, 36 g fat, 36 g protein, 24 g net carbohydrates, 168 g fiber (0.6:1 keto ratio)  

Full product information here.

Image note: Image reflects a product that was not fully cooked due to large volume increase. The volume will increase the longer the cook time. 

#8: Microwave Bread Recipe

Dry Bread Mix Recipe (makes 10 servings): 

• 30 g baking powder

• 2 g xanthan gum 

• 2 g nutritional yeast

• 50 g dried egg white 

• 116 g almond flour 

Nutrition information for dry ingredient mix (entire batch)**: 905 kcals, 62 g fat, 66 g protein, 20 g net carbohydrates, 10 g fiber (0.7:1 keto ratio) 

Directions: Mix all ingredients together. Combine 20 grams of mix with 2 Tbsp water and 10-20 grams of fat (depending on ratio) in a microwave-safe dish. Microwave for 1 minute and 40 seconds. Let cool and then slice down center. 

Image shows bread as part of a grilled cheese sandwich. 

Note: I used an air fryer at 350°F for 9 minutes in a container since I don’t have a microwave.

• Buttery flavor with a grainy & oily texture that is not soft

• Allergens: Egg, tree nuts 

• You can vary the amount of fat added – we tried 10 g and 20 g but found 20 g was too much

• Easy to make a batch recipe to have a dry bread mix on hand then just add water and butter when needed. 

• A quick option since you can make it in a microwave.

And the Winner Is……?

This photo showcases breads #1-7 from left to right (#8 not pictured). The top row features the "raw" breads (not toasted and without added fat), the middle row displays the toasted bread, and the bottom row highlights the bread toasted slowly on a skillet with 15 grams of butter.

Most of my crew liked Aunt Millie’s Live Carb Smart White Bread, which was the softest option and absorbed fat the best—making it our overall winner! Most of the store-bought options we tried were well received, except for Base Culture Original Keto Bread, which no one liked. The Aldi L’Oven Fresh Keto Friendly White Bread came in second for both softness and fat absorption, making it an excellent and easily accessible choice if you have an Aldi nearby.

Among the homemade options, the Wholesome Yum bread was the overall favorite, though it had a distinct coconut flavor that might not appeal to everyone. Scotty’s Keto Bread Mix was also popular for its flavor, softness, and absorbency. In general, the homemade bread options did not absorb fat as well as the store-bought, which is important if you're following a high-keto diet that requires a lot of added fats.

My family had a great time experimenting with these bread options and we certainly met our fiber goals in the process. Please share your favorite keto-friendly bread recipe or product, and let us know what food adventure you'd like us to explore next!

**KetoDietCalculator was used to calculate nutrition information for homemade bread recipes. Exact nutrition information will vary based on specific ingredient brands used. 

Disclaimer: This blog post is not sponsored and the opinions reflected in this article are our own. Availability of products at retailers is subject to change.

Organizing Medical Records: A Vital Piece of Caregiver Support

Author: Jessica Lee

One crucial aspect of caregiver well-being is the importance of feeling organized and in control with the ability to easily and quickly access pertinent information about our loved ones. Since electronic medical records often do not “talk” to each other, managing medical documentation ensures continuity of care and empowers families with information that can significantly impact their loved one’s health.

Traditional Methods: Paper vs. Binders

If you are like me, you have relied on traditional methods like storing medical records on paper and organizing them in binders. This method offers a tangible, accessible format that is easy to annotate and personalize. However, it comes with its challenges. Paper records can quickly become cumbersome, filling multiple binders over time. They are also prone to wear and tear and organizing them in a meaningful way can be labor-intensive. Not to mention the lengthy post-visit process of obtaining radiology or surgical reports from the hospital. 

Embracing Digital Solutions

In recent years, the invention of digital solutions has transformed how families manage medical records. Online platforms and applications provide a streamlined approach to record-keeping. One such innovative tool that I came across is mejo® (available at mymejo.com), founded by a dad whose son has a rare genetic disorder. I decided to take a look for myself…

Benefits of mejo®

mejo® offers several advantages over traditional methods:

• Centralized Storage: All medical records can be stored digitally in one place, eliminating the need for multiple binders and reducing clutter.

• Accessibility: Information is available at your fingertips, anytime and anywhere with an internet connection, making it easier to share with healthcare providers, babysitters, or teachers.

• Customization: Families can personalize their records, make notes, adding important details, and organize information in a way that suits their unique needs.

• Sharing Capabilities: One of the standout features of mejo® is its ability to share selected information with caregivers, ensuring everyone involved in the care process is informed and updated.

Challenges and Considerations

While digital solutions like mejo® offer significant benefits, they do require upfront effort to input all information accurately. Families may need to spend time initially to ensure all medical history, treatment plans, and dietary records are uploaded correctly. However, the time saved in accessing and sharing information later can outweigh this initial investment.

I would love to see a tracking feature, especially for the epilepsy community. A section dedicated to seizure types, symptoms, frequency, and timing would be helpful. I would also like a section where pictures could be uploaded. This could be PDFs that include information on seizure emergency protocols or images from an MRI or a wound.

Making the Choice

When deciding between traditional methods and digital solutions, families need to consider their specific needs and preferences. Some may find comfort in the tangible nature of paper records despite their limitations, while others may appreciate the convenience and accessibility offered by digital platforms like mejo®.

Organizing medical records is a fundamental step for a caregiver. Whether choosing traditional paper methods or embracing digital solutions, the goal remains the same: to empower families with the tools they need to manage their loved one’s health effectively and efficiently. 

For more information on how we support families, please visit us at www.ketohope.org.

I receive no payment or other compensation for reviews of products or services.  All opinions stated are my own. 

Weathering the Storm: Ensuring Your Child's Ketogenic Diet During Inclement Weather

Author: Laura Dority, MS, RD, LD 

Editor: Amy Merwarth, RD, LD 

As caregivers of children on a medical ketogenic diet for epilepsy, preparation is essential, especially when faced with the unpredictability of inclement weather. Power outages, hurricanes, and other natural disasters can pose significant challenges, but with careful planning, you can ensure your child's dietary needs are met without interruption.

1. Stock Up on Non-Perishable Keto-Friendly Foods

Having a supply of non-perishable, keto-friendly foods is crucial. These foods do not require refrigeration and can be lifesavers during extended power outages. Review your child’s ketogenic meal options and make a list of non-perishable items that your child will eat. Then get with your ketogenic dietitian to compile a handful of meal options using these non-perishable options. 

Here are some examples of non-perishable food options that can work in a ketogenic diet: 

• Nuts and Seeds: Almonds, walnuts, macadamia nuts, chia seeds, and flaxseeds are excellent sources of fats and can be easily stored.

• Nut Butters: Almond butter, peanut butter, and other nut butters (without added sugar) are convenient, nutrient-dense, and shelf-stable.

• Canned Meats and Fish: Canned salmon, sardines, tuna, and chicken provide protein and healthy fats.

• Olives: These can be included as high-fat snacks that require no refrigeration.

• Coconut Milk and Cream: Full-fat coconut milk or cream can be used in place of dairy and provides a good source of fat.

• Shelf-Stable Cheeses: Hard cheeses like Parmesan can last longer without refrigeration. Consider cheese crisps or shelf-stable cheese snacks as well.

• Oils (olive, avocado, coconut): Great options to get the necessary extra fat needed to stay in ketosis and can be used in place of butter in most meals. 

• Dehydrated or Freeze-Dried Vegetables: These can be rehydrated and used in meals.

• Pork Rinds & Low-Carb Jerky: These are excellent snacks that can fit perfectly into a keto diet. Aim for products with no added sugars and preservatives.

• Medical Ketogenic Formula: Even if your child does not rely on ketogenic medical formula on a regular basis, consider having a small supply on hand for inclement weather situations. These medical formulas can provide your child with all of their nutrition needs in a shelf-stable product. 

2. Maintain an Adequate Supply of Medical Formula

For many children on the ketogenic diet, medical formulas are a vital part of their nutrition. Ensure you have a sufficient supply to last through potential disruptions by regularly checking your inventory and reordering before you run low, especially during seasons of inclement weather. Talk to your supplier about the process for emergency ordering due to weather and delivery timelines. Store the formula properly by keeping it in a cool, dry place, and check expiration dates regularly.

3. Plan for Power Outages

Power outages can jeopardize refrigerated and frozen keto foods. Here’s how to stay prepared if you have some warning of an impending storm (such as a hurricane):

• Coolers and Ice Packs: Have coolers and ice packs ready to keep perishables cold if the power goes out. Try and have several meals weighed and ready-to-go if you know your area might be impacted by a storm. 

• Dry Ice: Consider purchasing dry ice, which can keep items frozen for a longer period.

• Non-Electric Kitchen Tools: A manual can opener and battery-operated or hand-crank blender can be useful for preparing meals without power. A portable gas stove or grill can be used to cook or reheat foods when there’s no electricity.

4. Emergency Meal Planning

With the help of your ketogenic dietitian, develop a list of simple, keto-friendly meals that can be prepared with minimal ingredients and no cooking. Here are a few ideas:

• Tuna Salad: Mix canned tuna with mayonnaise and serve with olives.

• Nut Butter with Dark Chocolate: Spread nut butter on a piece of dark chocolate for a quick snack.

• Avocado & Salt: Slice an avocado and sprinkle with salt for a nutritious and easy option.

• Salmon & Avocado: Canned salmon mixed with avocado (shelf-stable if uncut) and a handful of nuts.

• Sardines & Olives: Sardines with olives, drizzled with olive oil, and a side of pickles.

5. Medication & Supply Management

Ensure all medications are filled and up-to-date. In an emergency, access to pharmacies may be limited, so having a sufficient supply is critical. For those kiddos on g-tubes and fed through a pump, consider having gravity bags and/or 60 cc syringes so that you can still provide formula without the necessary power a pump requires. Also, be sure to have an adequate supply of glucose or ketone monitoring devices and supplies if these are a part of your ketogenic monitoring plan. 

6. Hydration & Electrolytes

Maintaining proper hydration and electrolyte balance is crucial, especially during stressful situations. Stock up on:

• Water: Be sure to have an ample supply of bottled water for hydration and medication administration. 

• Electrolyte Supplements: Powdered or tablet forms are convenient and can help you stay hydrated. Check with your ketogenic diet team on best electrolyte supplements for your unique needs. 

• Broth or Bouillon Cubes: These are great for maintaining sodium levels and can be made into a quick drink.

7. Create a Disaster Kit

Assemble a disaster kit that includes:

• First Aid Supplies: Basic first aid materials and any specific items related to your child's condition.

• Flashlights and Batteries: To navigate in the dark and prepare meals using your gram scale. 

• Contact Information: Keep a list of essential contacts, including your healthcare provider and dietitian.

By preparing thoroughly, you can help ensure your child's ketogenic diet remains uninterrupted during inclement weather, reducing the risk of seizures and maintaining their health. Stay safe and proactive, and always reach out to your healthcare team with any concerns or questions.

Remember, preparation is key to navigating any storm successfully. Stay safe and take care!

Low-Carb French Fry Favorites: Satisfy Your Cravings on Keto

Author: Taylor Parrish, RDN, LD
Editor: Laura Dority, MS, RD, LD

Craving the crunch and flavor of classic French fries while sticking to your keto lifestyle? Look no further! In this blog, we share 5 keto-friendly French fry recipes that have been taste-tested and approved, ensuring you can enjoy your favorite snack without compromising your low-carb goals.

Let’s get started with jicama, turnips, and celeriac root! The goal was to add enough oil to get to around a 1:1 ketogenic ratio. The celeriac root has the most carbs and least amount of fiber so more oil was needed to achieve this goal. If you need a ketogenic ratio higher than a ~1:1, pair the fries with a high fat condiment, dip, or drizzle with oil after cooking. Adding more oil to the recipe doesn’t always work because the vegetables can only absorb so much oil during the cooking process. Any high cooking temperature oil will work in these recipes such as refined avocado or olive oil. 

Jicama Fries

Recipe Credit: Victoria’s Keto Kitchen

Start by cutting your jicama into fry-like sticks and then boil the cut jicama in water for 30 minutes until soft. Some of the sticks may turn darker brown during boiling but it’s important to boil until soft before “frying” or the middle will still be crunchy after cooking. After boiling, weigh out 141 grams jicama, 8 grams oil, and salt to taste. Then cook them at 400 F° in the air fryer for 16-19 minutes (flipping halfway). Be sure to watch closely the last few minutes so they don’t burn. For a salt and vinegar taste, add vinegar to the water when you are boiling the jicama.

Nutritional Information (full recipe):

125 calories, 8 grams fat, 12.5 grams carbohydrate, 7 grams fiber, and 1 gram of protein for a ~1.3:1 ketogenic ratio

Review:

The jicama fries had a very satisfying crunchy texture and a sweeter flavor which is characteristic of jicama…almost like a tropical potato. The vinegar was a nice change in flavor so be sure to try that option.

Turnip Fries

Recipe Credit: Dr. Axe

Turnips are a great fry option because they look, feel, and cook just like potatoes yet have significantly less carbohydrates/starch. For this recipe, start by peeling the turnips and then cut into sticks. Boiling the sticks for about 5 minutes until soft is helpful. Combine 158 grams (2 small turnips), 10 grams oil, garlic powder, and salt in a bowl and toss to coat. For this experiment, I baked half of the mixture in the oven and air-fried the other half. From the original recipe, I lowered the temperature to 400 F° to prevent the fries from browning too quickly and baked for 20 minutes, flipped, and then baked for another 15-20 minutes.

Nutritional Information (full recipe):

133 calories, 10 grams fat, 10 grams carbohydrate, 3 grams fiber, 1.5 grams protein for a for a ~1.2:1 ketogenic ratio

Review: The turnip fries tasted most like a French fry but had a “chemical” aka turnip flavor aftertaste. By boiling the turnips, the aftertaste can be reduced. While these tasted most like a French fry, they were not very crunchy and had a soggier texture. Due to the taste, turnips likely make for a great mashed potato alternative versus a fry.

Celeriac (Celery) Root Fry

Recipe Credit: Taylor Parrish

First, peel the celeriac root and use a mandolin slicer (if available) to create sticks. Then measure out 221 grams of celeriac root, 25 grams of oil, and salt to taste. If baking in the oven, bake at 425 F° for 15 minutes flipping halfway through the cooking time. For the air fryer, cook at 420 F° for 10 minutes, flip, and cook for another 6 minutes or so. The air fryer created a crunchier product compared to the oven.

Nutritional Information (full recipe):

314 calories, 26 grams fat, 20 grams carbohydrate, 4 grams fiber, and 3 grams of protein for a 1:1 ketogenic ratio

Review: The celeriac root fry had a subtle celery taste but ultimately tasted most like a French fry with a great natural flavor that didn’t require a lot of seasoning. Unfortunately, it was not crunchy and didn’t “look” like a fry. 

Now let’s move on to almond and coconut flour options! For these, during the cooking process I did spray the fries with olive oil but I didn’t calculate any of the oil into the nutritional information. These will not absorb oil well during the cooking process. You will need to pair these with a high fat dip, condiment, or additional oil after cooking to boost the ratio.

Almond Flour Fry

Recipe Credit: Ketofocus

For this recipe, I halved the original recipe so I started with 50 grams of blanched almond flour, 6 grams of xanthan gum, and 3 Tbsp of water. Combine these ingredients and knead together. Place the mixture between two pieces of parchment paper and roll out until about 1/8” thick and then put in the freezer for 30-45 minutes until firm. If you skip this step, the dough will be sticky. Using a pizza cutter, cut the dough into sticks. I used the air fryer for cooking but the original recipe also has instructions for frying and baking. For the air fryer, lay the sticks flat on the cooking sheet, spray with oil, sprinkle with salt (to taste), and bake at 400 F° for 6 minutes.  

Nutritional Information (full recipe):

288 calories, 18 grams fat, 21 grams carbohydrate, 10 grams fiber, and 13 grams of protein for a 0.75:1 ketogenic ratio

Review: These were not as flavorful as the other options but were easy to add onion or garlic powder and rely on sauce for flavor. Ultimately, these had a look and mouthfeel closest to a French fry but mimicked a breadstick in texture.

Coconut Flour Fry

Recipe Credit: Low Carb Love

For the coconut flour option, I used the same recipe and technique as the almond flour recipe but with more xanthan gum and water because coconut flour absorbs water more than almond flour (50 grams coconut flour, 12 grams xanthan gum, and ½ cup water). After combining all ingredients, cook in the air fryer at 400 F° for 5 minutes. These did result in more browning than the almond flour, so less cooking time was needed.

Nutritional Information (full recipe):

255 calories, 5 grams fat, 41 grams carbohydrate, 27 grams fiber, and 11.5 grams of protein for a 0.2:1 ketogenic ratio

Review: The coconut flour is prominent and the mouthfeel is like a crispy breadstick.

Don’t Forget Your Condiments

As important as the fries, be sure to pair your fries with keto-friendly condiments. Here are a few suggestions to help guide you:

Keto Friendly Chick-Fil-A “ish” Sauce

Alfredo Sauce

Homemade Mayo

Sugar-Free Ketchup Mixed with Mayo

Sir Kensington’s Truffle Garlic Aoili (1 gram net carbs per Tbsp) 

Primal Kitchen Dipping Sauce: Special Sauce (1 gram net carbs per Tbsp) 

Charlie Foundation Condiment Recipes

Special Sauce (Makes ~13 Tbsp)

½ cup avocado oil mayo

1 tsp no sugar added dill pickle juice

2 T sugar-free ketchup

2 T chopped-up dill pickle (no sugar added)

2 tsp Dijon mustard (emulsifier)

1 ½ tsp coconut aminos

½ tsp onion powder

½ tsp garlic powder

½ tsp paprika

Mix all of these together and store in fridge up to two weeks.

Nutrition Information (per Tbsp): 67 calories, 7 grams fat, 1 gram carbohydrate, 0 grams fiber, 0 grams protein for a 7:1 ketogenic diet ratio

General Tips To Elevate Your Keto Fries

• If possible, cut all the fries the same size and thickness. This will prevent having some crispy overdone “fries.”

• If you like fries, invest in a mandolin slicer.  This will make the process easier by creating uniform sizes.

• Watch the fries closely towards the end of cooking time. They can burn quickly.

• Let the fries rest for a few minutes before eating – this will help with the crunch factor.

• Be sure to salt before baking but to prevent burning, add remaining seasonings after baking.

Overall, both the almond and coconut flour options look most like fries but had a breadstick mouthfeel which could pair great with a high fat dip! The vegetable-based fries tasted most like a fry. I would make celeriac root fries and jicama fries again and keep turnips as an alternative for mashed potatoes. None of the fries absorb a lot of fat during the cooking process so don’t rely on oil added during the cooking process to meet fat goals. Be sure to utilize keto friendly condiments, dips, or added fat after cooking to boost the ketogenic ratio and get in adequate fat for your keto plan!  

Disclaimer: Cooking times and nutritional information will vary based on ovens/air fryers and specific brands of ingredients chosen in these recipes.

Mission Meats: A Savory Keto Friendly Treat

Mission Meats got high marks in our adult taste panel and was the favorite savory snack. Overall this company is truly just great! They use all grass-fed beef, do not add nitrates or nitrites, offer free shipping on all orders and donate 10% of proceeds to charity. Let’s dive a little deeper into their products!

The Grass Fed Beef Sticks Tasty Original are sold in a large number of different options from a 12 pack which cost $23.95 ($2.00 each) to a 144 pack for $254.95 ($1.77 each). Each 1 oz stick contains 80 calories, 6 grams of fat, 1 gram of carbohydrate and 7 grams of protein so just under a 1:1 ratio. The child size version is 0.5 oz and contains 40 calories, 0.5 grams of carbohydrates, 3 grams of a fat and 4 grams of protein.  They also offer Tasty Original flavor Beef Bites which were my personal favorite. Warning: The bag contains 4 servings…it would be very easy to eat the entire package at one time.

The Blazin’ Pepper and Hoppin’ Habanero are other good options for keto – with a much spicier taste than the original flavor. In 1 oz this product contains 80 calories, 6 grams fat, 1 gram of carbohydrate and 8 grams of protein so also under a 1:1 ratio. These go great with guacamole which would easily increase your fat intake. 

The Hardwood Smoked Bacon Pork Stick has a little bit more fat compared to the beef sticks but also contain slightly more carbohydrates due to a small amount of maple sugar for flavor. Each 1 oz container is 110 calories, 8 grams of fat, 2 grams of carbohydrates, and 8 grams of protein (about a 1:1 ratio). The Cracked Pepper Pork Stick has 100 calories, 9 grams of fat, 1 gram of carbohydrate and 7 grams of protein (a little over a 1:1 ratio).

They offer the Ultimate Keto Sampler Pack which is a great option for first time buyers. It includes a variety of products but to be aware that some turkey products are included. Don’t get me wrong the turkey is still delicious but they do contain significantly less fat (about 1.5 grams) compared to 6 to 8 grams in the beef and pork products.

Overall Mission Meats is a top-notch company that makes a great product. If you have further questions about their products, they were very quick to respond to our inquiry and extremely helpful so reach out to them! 

FatSnax: Get In My Belly Cookies

One of the great aspects of FatSnax is that the founder, Jeff Frese, was motivated to produce a great tasting keto snack after following a ketogenic lifestyle himself. During this journey he discovered a lack of keto snacks so went off to make his own.  His passion to that mission has definitely paid off because not only does FatSnax make one delicious cookies…they actually make four. The company has a subscribe and save option that will save you 5% on your orders. A variety pack contains 12 packages (each package has 2 cookies) for $28.49 ($2.37 per package).

Each package contains 2 cookies but keep in mind that 1 cookie is a serving. These cookies are sweetened with erythritol (sugar alcohol), xylitol (sugar alcohol) and stevia.  Keep in mind that erythritol is more keto friendly than xylitol because only a very small amount is absorbed. Compared to regular sugar that provides 4 calories per gram, erythritol provides 0.2 calories per gram and xylitol provides 2.4 calories per gram. In other words, the erythritol will impact ketosis much less than xylitol. Because of these differences in sugar alcohol absorption, the epilepsy community following a keto diet generally does not subtract them from total carbs. In addition some individuals report sensitivity to sugar alcohols in terms of the potential to trigger a seizure. Always check with you keto team about sugar alcohols for your individualize situation. 

Let’s look at the nutrition profile of the cookies. The chocolate chip cookie has 90 calories, 9 grams fat, 7 grams of total carbs, 2 grams of fiber, 3 grams of sugar alcohols and 2 grams of protein. It is important to be aware that the FatSnax team does subtract sugar alcohols from their net carb labeling. Meaning you will see on the website that the cookies have 2 grams of net carbs but in the keto for epilepsy world we generally recognize that we only subtract fiber so we would say this product has 5 grams of net carbs (7 grams of total carbs minus 2 grams of fiber). 

The peanut butter cookie has 110 calories, 9 grams of fat, 6 grams of total carbs, 2 grams fiber, 3 grams sugar alcohol and 3 grams fiber. The lemon cookie has 90 calories, 8 grams of fat, 6 grams total carbs, 2 grams fiber, 3 grams sugar alcohol and 2 grams of protein. And finally the double chocolate chip has 100 calories, 9 grams fat, 7 grams total carbs, 2 grams fiber, 3 grams sugar alcohols and 2 grams protein. All of the cookies are about a 1.3:1 keto ratio.

In addition to the cookies, FatSnax also makes keto friendly tea in three flavors -  matcha, pu-her, and yerba.  Each product contains 0 grams of sugar, 1 gram of net carbs and 4 grams of fat in the form of C8-MCT (medium chain triglyceride). MCT sources of fat are more keto friendly compared to other fats by providing a quick boost of fat energy. The teas can be mixed into hot or cold water and contain 30 mg of caffeine.  This may be the perfect substitute for keto coffee for those tea drinkers out there!   

Navigating Disney with Epilepsy: The DAS Pass Solution

Author: Daisy Argudin 

Disney Parks are known for their magic, but the unpredictability of seizures can make planning outings, like a trip to Disney, daunting. We had been waiting and waiting to go because we were unsure of how we would navigate the potential for extra seizures from the heat, or excitement, or just a bad seizure day. However, the Disability Access Service (DAS) pass offers a solution by providing accommodations that cater to individual needs. 

How does the DAS pass work?

There are 2 ways to sign-up; online or at the park. It is a simple process where they ask about accommodations needed. Online: After you purchase your tickets you can register up to a month before you visit the park. Your child will need to be on camera but if it's a surprise, like it was for our kid, they are very accommodating and won't mention anything about Disney. In person: once you enter the gate you visit Guest Relations, any cast member can show you where it is. They will ask the same things as with the online option and help you set up your party in the app as the pass is good for the person and up to 5 other people in your party. You will use your phone and the Disney app to manage everything.

Scheduling Benefits 

The pass allows guests to schedule return times for attractions on the Disney app, minimizing the need to wait in long lines. For someone with epilepsy, this can be a game-changer. Long queues, crowded spaces, and flashing lights on rides can trigger seizures or exacerbate symptoms especially in the Florida heat. With the DAS pass, individuals can wait in a quieter, less stimulating area until it's their turn to experience the attraction, reducing the risk of overstimulation.

Flexibility Benefits 

One of the key benefits of the DAS pass is its flexibility. It's not a front-of-the-line pass; rather, it provides an alternative to standing in line. This means guests can still enjoy the park at their own pace without feeling rushed or pressured to adhere to strict ride schedules. For someone managing epilepsy, this flexibility can help alleviate stress and allow for a more enjoyable experience. The DAS pass isn't just about rides. It can also be used for character meet-and-greets, shows, and other attractions.

Inclusivity Benefits

Another aspect of the DAS pass worth noting is its inclusivity. Disney strives to create an environment where everyone feels welcome and accommodated. Cast members undergo training to assist guests with disabilities sensitively and efficiently. This commitment to inclusivity fosters a sense of belonging and empowerment for individuals with epilepsy, allowing them to focus on creating lasting memories with their loved ones. Our keto kid had a seizure while with a character and we felt heard when we said we didn't want any help. They also didn't rush us, they remained calm and once he was OK they started all over and let him have the full experience.

By providing the DAS pass Disney ensures that everyone can experience the magic of the parks to the fullest. So, whether you're embarking on a once-in-a-lifetime trip or visiting your favorite Disney destination, know that the DAS pass is there to help you navigate the adventure with ease and enjoyment.

Navigating Artificial Sweeteners on a Ketogenic Diet

Authors: Laura Dority, MS, RD, LD & Taylor Parrish, RDN, LD  

Editor: Amy Merwarth, RD, LD 

While a ketogenic diet can be a highly effective option for epilepsy, it also comes with challenges and nuances of adhering to this low-carbohydrate, high-fat dietary approach.  A common question that arises is the role of artificial and non-nutritive sweeteners which are often found in “keto-marketed” convenience foods.  Are sweeteners friends or foes in the realm of ketosis? 

Let's delve into the science and practical considerations.

First, what are artificial and non-nutritive sweeteners? Artificial and non-nutritive sweeteners are sugar substitutes that provide sweetness without the calories and carbohydrates of sugar. 

One advantage of artificial and non-nutritive sweeteners is their minimal impact on blood sugar and insulin levels. Since they are not metabolized in the same manner as sugar, they generally do not cause significant fluctuations in blood glucose, making them potentially suitable for those striving to maintain ketosis.

How do sweeteners work? Sweeteners bind to the receptors that register sucrose (sugar) molecules. This activates a signal to the brain that registers a sweet taste. Sweeteners are processed by the body differently than real sugar. Some are broken down into less desirable products while others aren’t broken down at all and may cause GI discomfort and impact gut health. 

It’s important to approach all sweeteners cautiously. Some individuals may experience cravings or increased appetite after consumption. Additionally, while these sweeteners are deemed safe for most people, some individuals may have sensitivities or adverse reactions to specific types.

Among the myriad of sweeteners available, some popular options include sucralose, aspartame, and saccharin. Non-nutritive sweeteners such as stevia, monk fruit extract, allulose, and erythritol are also favored choices among ketogenic enthusiasts. With any of these options, always be mindful of hidden sources of carbohydrates in products, such as fillers or bulking agents, which could potentially disrupt ketosis.

Let’s dig into each of these a little bit deeper. 

• Sucralose (Brand name: Splenda) is an artificial sweetener that is 600 times sweeter than sugar. It is not absorbed or digested but instead is excreted in the stool. It has zero calories but is often combined with filler ingredients such as dextrose or maltodextrin that can add carbohydrates and calories. 

• Aspartame is an artificial sweetener that is 200 times sweeter than sugar. You may see it used in conjunction with acesulfame potassium (Ace K). Many keto RDs advise patients to avoid aspartame. However, it can be difficult to meet hydration goals for some kids without the typical aspartame-sweetened beverages such as Crystal Light, Powerade Zero, or Propel Fitness Water. Your ketogenic team may suggest you double dilute these beverages to help cut back on intake while also achieving proper hydration. Aspartame is not heat stable so it should not be used in baking or any cooking method. 

• Saccharin (Brand name: Sweet-N-Low) is an artificial sweetener that is 300 times sweeter than sugar but has a bitter or metallic aftertaste. You may see it used in conjunction with other sweeteners- such as aspartame. The body cannot metabolize saccharin, so it is excreted in the urine.

• Stevia is a non-nutritive sweetener extracted from the leaf of the steviol glycoside plant. Depending on the form and brand, it is 150-300 times sweeter than sucrose. It generally has a slower onset of sweetness and a longer duration compared to sugar. Some forms have a bitter aftertaste so you may see stevia used in conjunction with other sweeteners- specifically erythritol. The least bitter-tasting form is stevia glycerite. 

• Allulose & Tagatose are newer sweeteners in the keto world. They have a similar look, mouthfeel, and sweetness level to sugar. Allulose is naturally found in figs, raisins, and maple syrup while tagatose is found in milk and some fruits. Neither are fully metabolized and are excreted primarily in the urine. However, they do contain a small amount of carbohydrates and calories (0.4 calories per gram) so check with your keto team before using these products to determine if you should count any carbohydrates when consuming products with large amounts. 

• Monk Fruit Sweetener (also known as Luo Han Guo) is a non-nutritive sweetener extracted from the fruit of a monk fruit tree native to Southern China. In its pure form, it is 300 times sweeter than sugar but has an unpleasant aftertaste. During processing the bad aftertaste is removed, and the final product is available in a liquid extract or powder. 

• Sugar Alcohols are a broad category of sweeteners you may find in keto products. Sugar alcohols are made through a fermentation process and contain varying amounts of calories and carbohydrates. They are NOT all created equal. Xylitol, sorbitol, mannitol, and erythritol are the most common. Even moderate amounts of sugar alcohol can lead to GI upset, specifically loose stools. 

• Erythritol is excreted in the urine, leads to less GI distress, and is considered the most keto-friendly. You will often find erythritol combined with other sweeteners such as stevia and/or monk fruit. Erythritol is not as sweet as these options, so it is added for its sugar-like crystalline appearance and texture while the stevia and monk fruit add the sweet taste. Some keto programs advise avoidance of all sugar alcohols (including erythritol) while other programs may allow a small amount of erythritol but advise you to count a small percentage in your carbohydrate limit. 

If you are looking for guidance on exact sweetener products that are keto-friendly check out this “Using Sweeteners on the Ketogenic Diet” guide from the Ketogenic Dietitians Research Network. 

How much do we absorb? Although most sweeteners are not absorbed and claim to be 0 calories, they can still cause GI side effects and harm the gut microbiome potentially triggering a glucose/insulin hormone response. This is different from the way sugar raises glucose but can still have an impact on ketosis. Your gut microbiome is as unique as your fingerprints so responses to sweeteners are individualized. 

Are sweeteners safe? There is limited long-term data (especially in children) about the use of sweeteners. Study results are inconclusive and often contradict each other. We know that excessive amounts of sugar are not good for overall health and certainly not epilepsy, but less is known about artificial and non-nutritive sweeteners. 

The U.S. Food & Drug Administration (FDA) has approved some sweeteners under the Generally Recognized as Safe (GRAS) category of food additives for use below what they call an acceptable daily intake (ADI). The FDA sets these levels based on amounts that have the potential to cause cancer or mutations.  A GRAS approval typically means that a product has not caused cancer in lab studies of animals.  Therefore, the amount needed to impact taste alterations or disrupt the gut microbiome is likely much less. 

Most of these ADIs are at a high level and likely will not be reached by children on a ketogenic diet. However, younger patients may be at risk for consuming amounts above the recommended guidelines if they rely heavily on keto-processed foods. If you want to learn more about the FDA’s stance on sweeteners, check out this resource.  

You can think of sweeteners as you would sugar, they are best consumed in moderation as excessive long-term ingestion may cause issues. Even plant-based or “natural sweeteners” which are often perceived as “healthier” may not be ideal. Many plant-based pharmaceuticals have side effects and the plants used can be toxic. 

The good news about most of these sweeteners is they are significantly sweeter than sugar so a small amount goes a long way in terms of flavor. 

How do I know how much sweetener is in a product? Unfortunately, unless it is a sugar alcohol, the manufacturer does not have to list the amount on the nutrition label. You will find the sweetener listed in the ingredient list, but the amount won’t necessarily be included.  

When should I introduce sweeteners to my ketogenic diet? When interviewing several ketogenic dietitians, it became clear that the utilization of sweeteners on a ketogenic diet is individualized. Some clinicians allow the use of sweeteners right away while others will wait a month to introduce them. Others will allow sweeteners once ketosis is achieved and then evaluate any change in ketosis with consumption. 

The consensus of the group was that it was up to families if they wanted to incorporate sweeteners into the plan. If having some sweeteners  make the ketogenic diet more feasible/attainable and seizure improvement was achieved, then the benefits likely outweigh the negatives. 

Here are some other take home tips we gleaned from our interviews with clinicians:   

• Consume products with sweeteners in moderation (or not at all if you can),  try to limit to 1 serving or less/day.  

• For beverages with sweeteners, dilute them. Beverages are the largest contributor of artificial sweeteners. 

• Reserve consumption of sweeteners for special occasions (holidays, birthdays, parties). 

• When in ketosis, the desire for sweets (aka cravings) tends to go away as glucose levels stabilize so don’t assume you will need sweet-tasting food on your keto journey. 

• If you are craving something sweet, try cinnamon for a more subtle, natural sweetness. 

• Keep in mind consuming sweeteners may lead to increased sweet cravings which could lead to non-compliance issues on the diet. 

In conclusion, sweeteners have a certain place and can be valuable tools for those following a ketogenic diet, offering a way to enjoy sweetness without compromising blood sugar control or ketosis. However, they are not all created equal and can impact each person differently because of the unique composition of our gut microbiome.  Sweeteners should be used mindfully and in conjunction with a balanced, whole-foods-based approach to nutrition. As always, consult with your ketogenic diet team to provide personalized guidance and support on navigating the intricacies of your ketogenic lifestyle.

References (or some light reading): 

• Moriconi E., et al. Neuroendocrine and Metabolic Effects of Low-Calorie and Non-Calorie Sweeteners. Front in Endocrinol(Lausanne). 2020;11:444. 

• Suez J., et al. Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell. 2022;185(18):3307-3328. 

• Richardson I. and Frese S. Non-nutritive sweeteners and their impacts on the gut microbiome and host physiology. Front Nutr. 2022;9:988144.

The Ultimate Guide to Eating Enough Fat on a Ketogenic Diet

Author: Laura Dority, MS, RD, LD  

Edited by: Amy Merwarth, RD, LD 

Hey there, fellow keto enthusiasts! Today, let's dive deep into one of the fundamental aspects of the ketogenic lifestyle: fat consumption. We all know that fat is king when it comes to fueling bodies on this low-carb, high-fat journey. But sometimes, getting enough fat can be tricky. I'm excited to share a compilation of expert tips from ketogenic dietitians on how to ensure you're getting ample fat while enjoying a variety of delicious options.

Embrace Healthy Fats & Variety: Be sure to prioritize healthy fats like avocados, nuts, seeds, and olive oil. These fats not only provide essential nutrients but also contribute to overall heart health. It’s difficult to meet fat goals by using just one fat option, so be sure to mix and match your fats. At each meal, incorporate fats from a variety of sources.  

Start with Full-Fat Foods: Opt for full-fat versions of dairy products such as cheese, yogurt, and cream. These dairy delights are rich in fat and offer a creamy texture that can elevate any dish.

Heavy cream is often a staple in many keto plans but drinking it day after day can get boring.  Try these tips:

• Dilute with water and add liquid sugar-free sweeteners and/or vanilla extract*.  

• Whip into a fluffy cream and serve with low-carb berries, sugar-free Jell-O*, and/or low-carb yogurt.  

• Flavor with sugar-free syrups and/or flavorings (such as DaVinci)*. Then freeze to make ice cream or popsicles. 

• Combine with butter and tomato sauce or butter, garlic, and cheese to create creamy sauces. 

• Combine with a small amount of dry sugar-free pudding powder* to make mousse. 

Mayonnaise is another high-fat option that can add flavor to your keto diet.

• Mix with a pinch of herbs and salt and serve as a dip for low-carb veggies. 

• Mix liberally into chopped chicken, eggs, or tuna to make a “salad”. 

• Whip into raw scrambled eggs and then cook. 

• Mix into keto waffles or pancakes to give a light, fluffy texture. 

Cook with Coconut Oil: Coconut oil is a fantastic source of medium-chain triglycerides (MCTs), which are easily converted to ketones by the liver, providing a quick energy boost. Use it for sautéing, baking, or adding a tropical twist to your keto smoothies.

Butter Can Be Your Friend: While butter shouldn’t be the only fat in your keto plan, it can certainly make meeting fat goals easier.

• Soften and mix with a sugar-free flavoring (Walden Farms, DaVinci) or liquid stevia*. Then place into molds or ice cube trays and store in the fridge or freezer to harden.

• Blend into full-fat cream cheese for a high-fat dip. 

• Mix a pinch of herbs with 2-3 Tbsps. of melted butter for a topping with meats and vegetables. Try refrigerating this mixture for 3 days to enhance the flavor. 

• For something sweet, mix with unsweetened applesauce and/or low-carb yogurt to boost the fat content. 

Incorporate Fatty Fish: Fish such as salmon, mackerel, and sardines are loaded with omega-3 fatty acids, which support brain health and reduce inflammation. Aim to include fatty fish in your meals at least twice a week.

Snack on Nuts and Seeds: Keep a stash of nuts and seeds like macadamia, almonds, walnuts, and chia seeds on hand for convenient, high-fat snacks. Just be mindful of portion sizes as they do contain small amounts of carbohydrates which can add up.  

• Mix chia or flaxseeds with heavy cream or unsweetened almond milk and let chill to make breakfast porridge. Add sugar-free flavorings* or low-carb berries for extra sweetness. 

• Create trail mix by combining nuts, seeds, cacao nibs, and unsweetened shredded coconut flakes. 

• Make “flackers” by mixing ground flaxseeds with oil, dried herbs, and water. Spread flat on a sheet pan and bake until crispy. 

• Grind macadamia nuts or almonds into flour and use in keto waffles or pancakes.

Avocado Everything: Avocados are a keto dieter's best friend. Mash onto low-carb toast, add to eggs, use as a dip, blend into smoothies, or simply slice them up for a satisfying snack. Their creamy texture and rich flavor make them a versatile addition to any meal. For more ways to work avocados into your keto diet, check out Avocados All the Way handout. 

Dress with Olive Oil: Ditch the store-bought salad dressings and opt for homemade vinaigrettes made with extra virgin olive oil. Not only does olive oil add flavor to your salads, it's also packed with heart-healthy monounsaturated fats. You can also add olive oil to applesauce, soups, low-carb yogurt, or nut butters to boost the fat content. Use liberal amounts when cooking meats and/or vegetables and add to chicken, egg, or tuna salad in addition to mayonnaise.  

Enjoy Nut Butters: Indulge in almond butter, peanut butter, or cashew butter for a deliciously satisfying fat boost. To add even more fat, mix butter with nut butters in a 50/50 breakdown. Spread on celery sticks, drizzle over low-carb pancakes, or simply enjoy by the spoonful. Choose “natural” varieties or make your own! Always read the nutrition label on nut butter products as some do add sugar and other forms of carbohydrates. 

Experiment with Fat Bombs: Fat bombs are small, high-fat snacks perfect for keeping you fueled between meals or a way to add more fat into meals. With a short ingredient list and one-bowl prep, they are a cinch to whip up. Make a large batch at the beginning of the week and enjoy them all week long. They can be made in a variety of ketogenic ratios and calorie levels. If you are looking to boost ketones or fat content of meals, be sure to choose a fat bomb that has a high ratio. Get creative with flavors such as chocolate, coconut, or peanut butter to satisfy your sweet cravings while staying on track with your macros. They are also a great option for a bedtime snack if you need to boost ketones overnight.  Looking for fat bomb recipes,- check out The Ultimate Fat Bomb Guide. 

Remember, the key to success on a ketogenic diet is finding a balance that works for you. By incorporating a variety of healthy fats into your meals and snacks, you can ensure you're meeting your fat goals while enjoying a delicious and satisfying eating experience. So go ahead, embrace the fat, and fuel your body for success on your keto journey!

*Be sure to check with your ketogenic diet medical team about the appropriateness of sugar-free products and artificial/non-nutritive sweeteners and your unique nutritional needs. 

References: 

• Charlie Foundation Parent’s Guide Booklet 

• Carb Manager. “How to Get Enough of the Right Fats on Keto (and Avoid the Bad Ones).” Accessed February 22, 2024. 

• UVA Health: UVA Ketogenic Diet Clinic Tips by Ingredient to Increase Fat Intake 

Unraveling the Mysteries of Fats: A Comprehensive Guide to Keto-Friendly Fats

By: Laura Dority, MS, RD, LD

Fats, often misunderstood and unfairly vilified, play a crucial role in our diet, especially for those embracing the ketogenic lifestyle. It's time to demystify the different types of fats, understand their sources, and appreciate the health benefits each type brings to the table.

Monounsaturated Fats

Sources: Olive oil, avocados, nuts (especially almonds), seeds (pumpkin, sesame)

Health Benefits: Monounsaturated fats are associated with heart health, as they can help lower bad LDL cholesterol levels while maintaining or increasing good HDL cholesterol. They are also rich in antioxidants, supporting overall well-being.

Smoke Point: Moderate (suitable for light sautéing and low to medium heat cooking)

Omega-9 Fatty Acids 

Sources: Olive oil, avocados, almonds.

Benefits: Omega-9s are monounsaturated fats associated with heart health. While they are not classified as essential (meaning the body can produce them), incorporating omega-9-rich foods into your diet can still have positive effects on cardiovascular health.

Saturated Fats

Sources: Butter, coconut oil, animal fats (beef, pork, lamb), cheese

Health Benefits: Contrary to popular belief, saturated fats are not the villains they were once considered to be. They provide a stable source of energy, aid in hormone production, and contribute to the structure of cell membranes. Additionally, they can increase levels of beneficial HDL cholesterol.

Smoke Point: High (good for cooking at higher temperatures)

Medium Chain Triglycerides (MCTs)

Sources: Coconut oil, palm kernel oil, MCT oil.

Health Benefits: MCTs are a unique type of fat that is rapidly absorbed and metabolized by the body, providing a quick source of energy. They are popular in the ketogenic community for their potential to enhance ketone production, aiding those following a low-carb diet.

Smoke Point: Varies (coconut oil has a higher smoke point than MCT oil).

Polyunsaturated Fats

Sources: Fatty fish (salmon, mackerel), flaxseeds, chia seeds, walnuts, sunflower seeds

Health Benefits: Rich in essential fatty acids, particularly omega-3 and omega-6, polyunsaturated fats are vital for brain function, cardiovascular health, and reducing inflammation. They are considered heart-healthy when consumed in balance with other fats.

Smoke Point: Varies, generally moderate (be cautious with high-temperature cooking)

Omega-3 Fatty Acids

Sources: Fatty fish (salmon, mackerel, sardines), flaxseeds, chia seeds, walnuts

Benefits: Omega-3s are renowned for their anti-inflammatory properties, supporting heart health, brain function, and joint health. They play a crucial role in reducing the risk of chronic diseases.

Omega-6 Fatty Acids

Sources: Sunflower seeds, safflower oil, corn oil, soybean oil

Balance is Key: While omega-6s are essential, the Western diet often contains an imbalance of omega-3 to omega-6 ratios, contributing to inflammation. Aim for a balanced intake of both for optimal health.

Tips for Adding Healthy Fats to Your Ketogenic Diet: 

1. Cooking with Healthy Oils

• Use olive oil for salad dressings or light sauteing.

• Cook with coconut oil for its high smoke point and unique flavor. 

• Incorporate MCT oil into smoothies and other beverages for a quick energy boost. 

2. Include Fatty Fish in Your Diet

• Enjoy salmon, mackerel, or sardines a few times a week for a rich source of omega-3s. 

3. Snack on Nuts and Seeds

• Almonds, walnuts, and chia seeds make for convenient and nutritious snacks. 

4. Avocado Love

• Add slices of avocado to salads, omelets, or enjoy it on its own as a satisfying snack. 

• Please be sure to check out our recently released clinician handout, Great Ways to Eat Avocados, for more ideas on incorporating avocados into your ketogenic diet. 

5. Cheese, Please

• Include moderate amounts of cheese for both flavor and fat content but be aware of serving sizes as cheese is also high in protein. Exceeding protein on your ketogenic diet may lead to poor ketosis and negatively impact outcomes. 

Understanding the nuances of fats is a fundamental aspect of a successful ketogenic journey. By embracing a variety of healthy fats in your diet, you not only support your nutritional needs and ketogenic ratio but also unlock a world of culinary possibilities. Remember, diversity and balance are key as you navigate the diverse landscape of fats on your ketogenic journey.  Be sure to check out our free Fat Bomb handout that includes some great and tasty fat bomb recipes and ideas.

Empowering Lives: Keto Hope’s Commitment to Quality Education in 2024

By: Laura Dority, MS, RD, LD

As we step into the promising year of 2024, the Keto Hope Foundation is gearing up for an exciting initiative to help make it easier for clinicians to educate patients and caregivers on the ins and outs of ketogenic diet therapy for epilepsy. Focused on empowering patients and caregivers, our primary goal is to provide invaluable resources in the form of quality and user-friendly handouts. We know as clinicians you are incredibly busy and finding the time to create educational handouts for your facility or private practice can be nearly impossible. We hope our free educational materials will help lighten your load!

The Power of Knowledge

For individuals facing epilepsy, the journey can be challenging, and understanding the intricacies of dietary interventions is crucial. The Keto Hope Foundation recognizes this need and is committed to bridging the gap through carefully crafted handouts. Our mission is to empower patients and their caregivers with the information they need to be successful on the ketogenic diet.

Monthly Releases for Ongoing Support

In 2024, the Keto Hope Foundation will embark on a monthly release schedule, unveiling a series of handouts covering a variety of topics. Each handout will be curated and edited by ketogenic dietitians, ensuring accuracy, relevance, and accessibility. By adopting a systematic approach, we aim to create a comprehensive library of resources that covers various aspects of the ketogenic diet, from its basics to practical implementation. If you have handout topic ideas, please send them our way at info@ketohope.org.

Tailored Resources for Clinicians

Recognizing the critical role clinicians play in guiding patients on their ketogenic diet journey, our monthly handouts will be tailored to serve as practical tools for healthcare professionals. These resources will offer practical tips for implementation and address common challenges that may arise during the process. By arming clinicians with the right information, we hope to strengthen their ability to support and guide their patients effectively.

Patient-Centered Approach

Our commitment to quality extends beyond just accuracy; it encompasses a patient-centered approach that prioritizes the unique needs and challenges faced by individuals with epilepsy. The handouts will not only provide information but will also serve as motivational tools, fostering a sense of hope and resilience within the epilepsy community. By acknowledging the human side of healthcare, we hope to inspire individuals to embrace the ketogenic diet with confidence and optimism.

Accessible and User-Friendly

Understanding the diverse audience we aim to reach, the handouts will be crafted with simplicity and user-friendliness in mind. Complex scientific concepts will be presented in a digestible manner, ensuring that all patients/caregivers can benefit from the resources. Our commitment to accessibility also extends to multiple formats, making the handouts available in print and digital forms for easy dissemination.

As we embark on this transformative journey in 2024, the Keto Hope Foundation invites you to join us in the pursuit of knowledge, empowerment, and improved outcomes for individuals facing epilepsy. Through our monthly handouts, we aspire to create a ripple effect of positive change, ultimately fostering a community where the ketogenic diet becomes an accessible and well-understood option for epilepsy management. Together, let's turn hope into reality. Head on over to our handout page and check out our first release, Ketogenic Resources, which provides a list of books, recipe websites, blogs, and social media influencers to help support you on your journey!

Breaking Down the Macros: Analyzing the Nutritional Content of Keto Yogurt

Recipe & Content Contributor: Taylor Parrish, RDN, CLC, LD

In the US alone, there are over 100 yogurt production businesses. When it comes to the world of yogurts, you’ve got options… flavors, textures, ingredients, and nutritional content are all areas where yogurts can differ! All of these options and differences can make it difficult to determine the best keto yogurt.  When following a ketogenic diet, macros matter so how do we determine which yogurt to choose? 

Do all yogurts contain probiotics? 

Most (not all) yogurts contain probiotics but keep in mind that the good bacteria in yogurt must be alive at high enough levels to provide a potential health benefit. Some yogurt products are heat-treated after the culturing process, which damages or destroys the microbes.

Traditional bacterial strains used to make yogurt are Streptococcus thermophilus and Lactobacillus bulgaricus. In addition to these two strains of bacteria, some yogurts have added additional bacteria strains to help support gut health such as Lactobacillus and Bifidobacterium. Keep in mind that added probiotics may cause the flavor to be more sour.  

Common Types of Yogurt Used in Keto 

• Standard yogurt, just like cow’s milk, standard yogurt contains carbohydrates from the milk sugar “lactose” but often a lot of added sugar is present as well.

• Greek yogurt contains a lower amount of carbohydrates and a higher amount of protein than standard yogurt. The fat content of Greek yogurt typically maxes out at 5% milk fat. Greek yogurt (if eaten plain and unsweetened) can have a slightly sour taste and is very thick. Think sour cream but more protein and less fat.

• Coconut/almond yogurt is made with coconut and almond milk instead of cow’s milk. They check the box for plant-based options that can be beneficial for those with a dairy allergy/intolerance. Keep in mind that nut-based yogurts may not naturally have calcium or probiotics so be sure to buy a brand that adds these two components. In general, nut-based yogurts contain more calories, less protein and carbohydrates, and significantly more fat compared to cow ’s-based yogurt. 

Note: Always keep in mind that nutritional information varies widely between different yogurts. Always read the label closely. 

Onto flavoring, there are natural flavors, added sugar, added fruit, added candy/cookies (mix-ins), artificial sweeteners, and extracts all with the goal of creating more flavor – sweetness being one of those. Since carbohydrates are limited on a ketogenic diet, the yogurts that typically work best would be the ones utilizing artificial sweeteners or the plain, unsweetened versions. With plain, unsweetened, there’s always the option to add your own sweetener of choice, and/or natural ways of sweetening/altering the flavor. 

Topping ideas to increase fat and add some texture: 

• Unsweetened Coconut Flakes

• Nuts: Pecans & Macadamia 

• Keto Granola (NuTrail, for example)

• Peanut Butter Mousse

• Chocolate Chips: Lily’s or Choc Zero

Kids like mix-ins, so being able to add something to break up the thicker mouthfeel will help with acceptance. The coconut yogurts will be higher in fat and lower in protein so are easier to incorporate mix-ins without adding more fat.

Flavoring ideas: 

• Choc Zero or Walden Farms Syrups

• Extracts: Maple, Vanilla, Almond

• Sweetener Drops: Stevia or Monk Fruit (usually 2-3 is more than enough)

We dug into 6 “keto-marketed yogurts” that might be available in your area and determine if; 

1.) Are they truly suitable for a ketogenic diet?

2.) Can we alter them to make them higher in fat? 

We focused on a variety of different yogurts- some milk-based while others are nut-based (coconut and almond). We used coconut oil to add fat as well as pure vanilla extract and liquid Stevia to add some sweetness. We did some taste testing by adding strawberries and pecans. 

Culina Plain and Simple

• Creamy, light but thick

• Very mild taste – no sour taste 

• Does not taste “tropical”

• For 50 g serving, 1-2 drops of Stevia is enough 

• High fat at a 5.75:1 ratio so it is easy to add carb/protein source to lower the ratio (a rare find) 

• Great yogurt option that isn’t super high in protein like most keto yogurts 

• This needs mixed – some harder areas with some thinner liquid underneath – kind of like coconut cream but lighter and less fat-tasting

• Dairy-free option

• Creating a 1:1 ratio: 50 grams yogurt, 97 grams strawberries (95 calories, 7 grams fat, 1.5 grams protein, 6 grams net carbs) 

• Creating a 2:1 ratio: 50 grams yogurt 37 grams strawberries (78 calories, 7 grams fat, 1 gram protein, 2.5 grams net carbs) 

• Creating a 3:1 ratio: 50 grams yogurt, 18 grams strawberries (73 calories, 7 grams fat, 1 gram protein, 1.5 grams net carbs) 

Silk Unsweetened Vanilla Almond Milk

• Watery, thin, and mild flavor 

• As a yogurt, it would need to be thickened with add-ins

• May be a great option for keto baking as a substitute for regular yogurt

• Brownish hue color

• Dairy-free option

• Unaltered = 1.5:1 ketogenic ratio

• Creating a 2:1 ratio: 50 grams yogurt, 16 grams strawberries, 3.5 grams coconut oil (88 calories, 8 grams fat, 2 grams protein, 2 grams net carbs) 

• Creating a 3:1 ratio: 50 grams yogurt, 15 grams strawberries, 7 grams coconut oil (120 calories, 11.5 grams fat, 2 grams protein, 2 grams net carbs) 

Two Good Strawberry

• All flavors have 2 grams net carbs

• Thicker yogurt similar to that of Greek yogurt

• Lower in fat & higher in protein 

• Absorbs coconut oil well

• Uses Stevia to sweeten – slightly less sweet compared to the Ratio brand but more artificial-tasting 

• Unaltered = 0.13:1 ratio 

• Creating a 1:1 ratio: 50 grams yogurt, 2.5 grams coconut oil (90 calories, 7 grams fat, 4.5 grams protein, 2 grams net carbs) 

• Creating a 2:1 ratio: 50 grams yogurt, 18 grams strawberries, 5 grams pecans, 9.5 grams coconut oil (150 calories, 14 grams fat, 4.5 grams protein, 2 grams net carbs) 

• Creating a 3:1 ratio: 50 grams yogurt, 10 grams strawberries, 7 grams pecan, 14 grams coconut oil (205 calories, 20 grams fat, 5 grams protein, 2 gram net carbs) 

Ratio Keto Strawberry

• All of the keto flavors have the same macros

• Cultured dairy product with added probiotics 

• Very sweet - uses Sucralose as the sweetener and beet juice as coloring agent

• Pinkest color compared to the other artificially flavored strawberry yogurts tested 

• It has added liquid fat, so the texture is the closest to a typical yogurt (not Greek)

• Coconut oil whipped in well

• Unaltered = 0.88:1 ratio 

• Creating a 2:1 ratio: 50 grams yogurt, 15 grams strawberries, 4 grams pecans, 6.5 grams coconut oil (160 calories, 14.5 grams fat, 5.5 grams protein, 2 grams net carbs) 

• Creating a 3:1 ratio: 50 grams yogurt, 6 grams strawberries, 4 grams pecan, 12 grams coconut oil (205 calories, 20 grams fat, 5.5 grams protein, 1 gram net carbs) 

Carb Master Strawberry (Kroger Brand)

• Cultured dairy product, uses some actual fruit for flavor as well as sucralose

• Macros vary between flavors

• Best mouthfeel compared to other yogurts

• Tastes more artificial compared to other yogurts

• It is thinner in texture, but a smaller amount of liquid fat added could still work

• This yogurt does have a few little bits of fruit within the container

• Unaltered = 0.12 ketogenic ratio 

• Creating a 1:1 ratio: 50 grams yogurt, 35 grams strawberries, 5 grams pecan, 3 grams coconut oil (96 calories, 7.5 grams fat, 4 grams protein, 3.5 grams net carbs) 

• Creating a 2:1 ratio: 50 grams yogurt, 18 grams strawberries, 5 grams pecans, 8 grams coconut oil (136 calories, 12.5 grams fat, 3.5 grams protein, 2.5 grams net carbs) 

• Creating a 3:1 ratio: 50 grams yogurt, 16 grams strawberries, 5 grams pecan, 14 grams coconut oil (188 calories, 18 grams fat, 3.5 grams protein, 2.5 grams net carbs) 

]CoCoJune

• For those looking for some probiotics to aid with gut health, this is a great option

• Plant-based and organic

• Thinner in texture, so adding cream or a liquid oil would not work as well

• It has no flavor or sweetener added, so adding a keto-approved sweetener is definitely recommended

• Higher in fat, so mix-ins like berries and keto chocolate chips can help make this more palatable

• Unaltered = 1.5:1 ketogenic ratio (flavored) & 3:1 (unflavored) 

• Creating a 2:1 ratio using unflavored: 50 grams yogurt, 20 grams strawberries (88 calories, 8 grams fat, 1 gram protein, 3 grams net carbs) 

• Creating a 3:1 ratio using unflavored: 50 grams yogurt, 20 grams strawberries, 4 grams coconut oil (124 calories, 12 grams fat, 1 gram protein, 3 grams net carbs) 

Recipe Tips:

• Don’t buy yogurt in bulk until you know if your kiddo likes it. Yes, it saves you money in the long run, but you end up wasting it if it’s not liked.

• If you add hard coconut oil into a cold yogurt, it will solidify and get chunky. If you melt the coconut oil and let it cool – it won’t resolidify. Whip the coconut oil into the yogurt. If needed, put it back in the refrigerator to help harden.

• If you want to thicken the yogurt, utilize a hard fat at room temp (or at least when cold). If you want to thin out the yogurt, utilize a mild flavored oil like avocado oil, MCT oil, or cream.

• It may take trying a few different yogurts until you find one your kiddo likes so don’t give up on the first try! 

Overall, my family really liked the Culina product. It was already the highest in fat (5.75:1 ratio) so we were able to add the most strawberries which in turn I think really helped with palatability. It really gives the most versatility to work with all different ratios and the countless fun things you can add are endless. For one of the lower ratio products, Two Good was a great option. They have a ton of flavor variety and to increase the ratio coconut oil was an easy addition. We would love to hear about your favorite keto-friendly yogurt so drop us a comment below! 

Disclaimer: This blog post is not sponsored and the opinions reflected in this article are our own. Availability of products at retailers is subject to change.

Sick Day Survival Guide: Keto Hacks for a Safer Illness

By: Taylor Parrish, RDN, LD & Laura Dority, MS, RD, LD

We made it…. the kiddos are back in the school routine and life is feeling a bit more organized…manageable even! That is until the first illness hits! Unfortunately, illness is inevitable regardless of diagnosis. Being sick while on a ketogenic diet is sort of a double whammy! It’s important to keep in mind that illness can lower the threshold for seizures so you may see that your child has more seizures during a period of illness – regardless of ketone and glucose levels and maintenance of a ketogenic diet.  

It is still very important to have a game plan before your child becomes ill so that you are prepared to maintain ketosis and most importantly hydration until your little keto hero is back to his/her healthy self. Now before you read on for some illness tips, please do not take the information in this blog as medical advice. This blog is just a place to get started for sick day guidance. All specific advice for your keto superstar needs to come from your keto team! 

What Can I Do Before My Child Is Sick? 

This is the most important aspect of a sick day…planning! Make sure you have the resources at your disposal when you need them. 

• Ask your keto team for your child’s unique sick day plan that should include the following: 

• Hydration Goals & Appropriate Use of Electrolyte Liquids such as Pedialyte 

• Ketone Goals

• Glucose Goals (if measured) 

• Easy to Tolerate Keto Meals (oral eaters) 

• Half Strength Tube Feeding Recipe (if applicable)  

What Can I Do When My Child Is Sick? 

• Check ketones and make note of any changes from non-sick days 

• Track seizures 

• Focus on hydration. When your child is having diarrhea or vomiting, they are losing important fluids. Dehydration can occur more quickly in the keto population. 

• Encourage fluid intake and offer fluids frequently. 

• Encourage calorie-free, caffeine-free fluids.

• Monitor signs of dehydration closely such as decreased urine output, fewer wet diapers, dry mouth/cracked lips, or lack of tear production when crying.  

• Follow your keto team’s guidelines on fluid goals and when electrolyte solutions or liquids may be needed. Keep in mind it’s about keeping glucose levels stable during times of poor oral intake, vomiting, diarrhea, and/or tube-feeding intolerance. You don’t want to go overboard with glucose-containing electrolyte solutions such as regular Pedialyte. Something like Pedialyte Zero Sugar may be a better choice for short periods of illness while regular Pedialyte may be appropriate for longer periods of illness. 

• Choose tablets & capsules for any necessary medications to eliminate unnecessary carbohydrate content. Check with your pediatrician and/or pharmacist for appropriate dosing. If a liquid or chewable medication is recommended or prescribed by your pediatrician, be sure to check with your keto team to see if it’s appropriate. Keep in mind that sugar-free does not necessarily mean carbohydrate-free. A must-have resource for low-carb/carb-free medications is the Charlie Foundation for Ketogenic Therapies No and Low Carb Personal Care Products Guide. 

What Can I Expect When My Child Is Sick? 

Due to the body’s natural response when fighting an illness, it is not unusual to experience a drop in ketosis before and during illness. When we are ill, the nervous system activates a stress response. Stress hormones are released – including cortisol which promotes the formation of glucose in turn increasing blood glucose levels and lowering ketone levels. Keep in mind (and remind your pediatrician) that normal glucose levels on ketogenic diet therapy are generally 50-70 mg/dL. 

On the other hand, ketones may also increase due to dehydration during times of illness. Hydration is the number one goal to focus on during illness. 

Due to the fluctuating ketone and glucose levels, seizure control may be impacted. Unfortunately, in most cases of illness, you may only have minimal control over ketone and glucose levels due to the body’s normal response. Try to avoid chasing ketone levels as this will likely lead to frustration without benefit. Keep your focus on hydration and helping your kiddo overcome illness versus obsessing over ketone levels. 

If your kiddo is not having any vomiting or diarrhea but struggling with some early satiety or decreased oral intake, consider offering meals where every bite is at the goal ratio. That way it’s not as important (short-term) if they finish the whole meal. 

How Do I Manage Vomiting & Diarrhea? 

When your child is sick and has vomiting and diarrhea, you may notice an increase in ketones due to dehydration and inadequate intake. You may also notice more lethargy and fatigue. If your child is not eating, it is important to keep your child well-hydrated. 

Know your child’s fluid goal and offer your child clear liquids every hour. Clear liquids such as water, broth, electrolyte beverages, ice chips, Pedialyte Zero Sugar, Propel, Powerade Zero, and sugar-free gelatin all count as fluids and are great focal points for the first 24 hours of illness. Of note, your keto team may advise you to dilute some of these items such as Pedialyte, Propel, and/or Powerade Zero with additional water. 

If tolerating fluids and vomiting/diarrhea has improved, start with ½ of a keto meal without the added fat (butter/oil) then advance to the ½ meal with the fat included, and finally back to goal meals as able.  If your kiddo is struggling with getting back to goal keto meals, try baked chicken and soft, cooked vegetables without the fat source (or a reduced amount of fat). Cauliflower rice with chicken and a little butter is a great option. This is also where chicken or vegetable broth can be well-tolerated. 

For those on a tube feeding once fluids are tolerated, start with ½ strength ketogenic formula and advance back to your goal as able. 

Most of the time both oral and tube-fed children can be back to their goal keto plans within 2-3 days. Keep in mind that appetite recovery can take longer. When you think about an individual who is not on a ketogenic diet, we expect a decreased appetite during illness. Keto kids are no different! So, it’s okay if you work back up to goal calories slowly, but symptoms of vomiting and diarrhea should not be persistent. If your child is unable to advance to ½ strength formula or meals after clear liquids for 24 hours, call your medical team. 

What Are Some Tips for Combating Nausea? 

• Offer smaller more frequent meals. Not eating anything can often worsen nausea. Even just sipping on broth can help settle the stomach. 

• Try carb-free herbal teas such as mint or ginger 

• Reintroduce foods starting with broths, chilled avocado with olive oil, plain scrambled eggs, keto crackers (such as these flax-hemp crackers from the Charlie Foundation), nuts or nut butters, chia seed pudding, or flaxseed porridge  

• Stick to cool/cold or room temperature foods 

• Foods with less or no odor may be better tolerated

• Try carb-free, carbonated beverages such as diet ginger ale 

• If MCT oil is part of your plan, titrate up slowly (even start at 5 mL every other meal) because small volumes have less of a chance to adversely affect nausea. 

How Long Should I Let My Child Have Vomiting or Diarrhea Before Telling Someone?

Let your keto team know anytime your keto superstar is vomiting or having diarrhea. They should know on day 1 to best guide on preventing dehydration and maintaining ketosis versus reacting to treatment of dehydration. 

What Are Symptoms of Illness That Are Alarming? 

If your child experiences any indications of excessive ketosis such as the combination of flushed cheeks, increased work of breathing, increased heart rate, vomiting, lethargy, and/or a decreased appetite you should notify a healthcare provider.  When these symptoms present together, an ER visit for hydration and monitoring may be necessary. Staying hydrated is your best defense against excessive ketosis. 

What Will Happen If We Are Admitted to the Hospital Due to Illness? 

If you are admitted to the hospital due to illness, plan to bring at least a day’s worth of keto food/formula (longer if admitted on the weekend) to the hospital already prepared. Hospital cafeteria hours vary, and food service staff may not have all the necessary food needed for an unplanned hospital admission. This is particularly true if you are admitted in the evening or weekend. 

If you are at the hospital facility that is the same as your keto team, your keto RD will likely follow your admission closely and provide the medical team with guidance on oral hydration, IV fluid, lab work, and advancement of diet. If you are at a hospital facility that does not have a specific keto program, ask the local team to contact your keto team for guidance. 

Always remind the medical team that your child is on a ketogenic diet and should not have any liquid medications unless discussed with your keto team. In addition, in settings like the ER or other areas of the hospital that may not be as familiar with ketogenic diet therapy, gently remind them that IV fluid (if needed) should not contain dextrose or at most be a dextrose 2.5% solution to prevent a rapid rise in glucose. The standard dextrose solution in any hospital is 5% dextrose which is generally not compatible with a ketogenic diet. 

Glucose levels may be checked during a hospital admission. Keep in mind that normal glucose for a ketogenic diet is 50-70 mg/dL – For those kiddos not on a ketogenic diet generally glucose goals are >70 mg/dL so there is a difference here. The medical team may need reminding that slightly lower glucose levels are expected for ketogenic diet therapy but again – too low of glucose levels (<40 or 50 mg/dL depending on your keto goals) can happen during illness and should be treated.

Final Advice….

Unfortunately, keto superstars are not immune from getting sick…it’s bound to happen! Remember to stay calm, call your keto team to give them a heads up that your little one is feeling under the weather, reference your sick day plan frequently, focus on hydration, and most importantly give your little one some extra snuggles until they feel back to their amazing self! 

References: 

• Ketogenic Diet Therapies for Neurological Disorders Pocket Guide: 4th Edition by Beth Zupec-Kania, Lisa Vanatta, & Meredith Johnson 

• Our Journey with Ketogenic Diet Therapy App from the Emily Center at Phoenix Children’s Hospital 

Disclaimer: 

The advice mentioned in this article is not medical advice and should not be taken as medical advice. You should always check with your medical provider if your child is experiencing any form of illness.   

Keto Superstars: Where Are They Now?

The Keto Hope team has met some truly amazing kiddos and families over the past six years. These kids are true superheroes. But the moms, dads, grandparents, aunts and uncles who tirelessly prep and cook keto meals or provide keto tube feedings for their kiddos several times a day also possess super powers.  We see you….we know it’s not easy! We want to take a few minutes to highlight some of the keto super stars we have met over the years and see what they are up to!

Superhero: McKinley

Question: What was the age of McKinley when she started the ketogenic diet and how old is she now? 

Answer: McKinely was 5 months old when she started the diet and she is now 4 ½ years old. 

Question: Which ketogenic diet did you use? 

Answer: We used the classic ketogenic diet at a 4:1 ratio.  

Question: Are you still currently on a ketogenic diet? 

Answer: We are still on the diet and plan on being on it for as long as it helps. She’s currently at a 2.5:1 ratio. 

Question: For parents starting their keto journey, what is your # 1 piece of advice for success? 

Answer: It can be very intimidating but remember it gets easier with practice. For us, once McKinley started purées, doing bulk batches was and continues to be my number 1 tip. Mashed avocado freezes perfectly! 

Question: Knowing what you know now and looking back, what would you have done differently at the start of your journey? 

Answer: I wish I had discovered a more knowledgeable team from the start versus nearly 2 years in. Our original team lacked in many areas and without my consistent research, I feel the diet would not have been successful with them. I’m glad I found Denise Potter and glad I found a local team that was more knowledgeable.

Question: What do you wish you would have known before you started your ketogenic diet journey? 

Answer: I wished I would have known that Topomax and keto don’t play nicely. That combo landed us in the hospital many times for the first year because of recurring acidosis. Glad we realized it eventually and weaned off that AED.

Mckinley’s story has always been one of our top posts. We invite you to  Meet Mckinley, CDLK5  Warrior! Mckinley inspired her parents to start mightyinchstones.com , a community-driven platform dedicated to celebrating small victories on the special needs journey.

Superhero: Rosemary 

Question: What was Rosemary’s age when she started the ketogenic diet and how old is she  now? 

Answer: Rosemary started the diet at 4 months old and is now 9 years old. 

Question: Which ketogenic diet did you use? 

Answer: Rosemary was on a classic 4:1 ketogenic diet. 

Question: If you have weaned off the ketogenic diet, please tell us a bit about that experience.

Answer: Rosemary was slowly weaned off the ketogenic diet by decreasing her ratio. The full wean process took a few months. For the first few years after the diet we remained very strict about sugar intake (only allowing on special occasions and in moderation). Now we still limit sugary treats and desserts but mostly for general health reasons (although the seizure/carb threshold still lingers in our minds). We avoid processed foods, artificial colors/dyes, and sugar sweetened beverages.

Question: For parents starting their keto journey, what is your # 1 piece of advice for success? 

Answer: Find an organization and preparation system that works for you. By planning, you reduce the stress of being caught in a situation where you don’t have access to food options. For example, we did all our meal prep on Sunday evenings. We pureed vegetables, measured out fruit portions and cooked recipes for the week and froze in large batches. 

Question: Knowing what you know now and looking back, what would you have done differently when you were on your ketogenic diet?

Answer: MCT oil wasn’t around for us, so we relied heavily on butter and coconut oil. I wish we had relied more on olive oil/avocado oil.

Question: What do you wish you would have known before you started your ketogenic diet journey? 

Answer: We were lucky that our daughter was a “super responder” but in hindsight, I should have asked more about what “success” on the diet meant. That a 50% reduction in seizures is considered a success-that may not be clear to everyone initiating the diet, and could lead to unfulfilled expectations. Maybe I was told this early, but as you know, in those first visits, a lot of what is said may not be “heard” by families who are still reeling from the diagnosis.

Superhero: Roman

Question: How old was Roman when he started the ketogenic diet and how old is he now? 

Answer: Roman was 9 years old when we started the diet and he is now 12 years old. 

Question: Which ketogenic diet did you use? 

Answer: We have used both a modified Atkins diet and a low glycemic index diet.  

Question: Are you still currently on a ketogenic diet? 

Answer: Yes, Roman is still on the low glycemic index diet. 

Question: For parents starting their keto journey, what is your # 1 piece of advice for success? 

Answer: Read everything you can about the diet. 

Question: Knowing what you know now and looking back, what would you have done differently at the start of your journey? 

Answer: I would have tried the diet and meds separately. We started both at the same time and don’t really know which was working. 

Question: What do you wish you would have known before you started your ketogenic diet journey? 

Answer: I wish we knew more about the long term health implications of a high fat diet. I still feel like I’m having to choose between heart disease and epilepsy. 

If you want to learn more about Roman and his ketogenic diet journey, check out this amazing blog post: Keto Hiking Adventure explaining how he and his family walked 275 miles of the Appalachian Trail over 6 weeks all while Roman was on a ketogenic diet. 

Superhero: Jonah 

Question: How old was Jonah when he started on the ketogenic diet and how old is he now? 

Answer: Jonah was 3 years old when he started the diet and he is now 9 years old. 

Question: Which ketogenic diet did you use? 

Answer: Jonah was started on the modified Atkins diet at a 30 grams or less net carb restriction. 

Question: Are you still currently on a ketogenic diet?

Answer: Yes he remains on a modified Atkins diet with <30 grams of net carbs a day. We have had several conversations over the years with our healthcare team about weaning. Our concern has always been that if we wean and his seizures worsen there may be a chance that he would not get the same seizure control if he resumed the diet.  

Question: For parents starting their keto journey, what is your # 1 piece of advice for success? 

Answer: Come prepared for your initial appointment. Do your research about the diet beforehand so that you can ask questions and have an informed conversation with the healthcare team.  

Question: Knowing what you know now and looking back,  what would you have done differently at the start of your journey? 

Answer: I would not have taken for granted the 6 months of seizure freedom he initially had when we started the diet. We just assumed since the diet worked really well from day 1 that it would work for 2 years and then we would wean off to a non-seizure life. But that isn’t how it worked out. Remember to be realistic. For example when kids are sick you may see more seizures or when they cheat on the diet (and this does happen), they may have more seizures. 

Question: What do you wish you would have known before you started your ketogenic diet journey? Which question do you wish you would have asked your medical team that maybe you didn’t think of asking? 

Answer: I wish I would have asked more questions about the blood work frequency and results and their impact on the ketogenic diet plan as well as his overall health. I would have asked for more nutrition related baseline blood work to be completed so we had more comparative values. 

We interviewed Jonah at age 7 and got a child's perspective of being on the ketogenic diet for epilepsy. We highly recommend you watch it here. 

Thank you to everyone over the years who has shared their stories with us! These are only a few of the amazing superheroes we have been blessed to meet. If you would like to share your keto journey, please e-mail us at info@ketohope.org. If you are new to a ketogenic diet, be sure to request a support parent through our Keto Friends program.  You can learn more about our support programs on our website at www.ketohope.org/familysupport. 

Avocados, Avocados, Avocados: The Perfect Keto Food

By: Laura Dority, MS, RD, LD

Are avocados the perfect food for the ketogenic diet? The answer may very well be yes…or at least close to the perfect food and here is why: 

• Rich in healthy monounsaturated fat

• Contain omega-3 fatty acids 

• High in fiber and low in net carbohydrates

• Fun Fact: They have the highest fiber content of any fruit. 

• Loaded with vitamins including C, E, K, B6, riboflavin, niacin, folate, pantothenic, magnesium, and potassium.

• Fun fact: Avocados have 60% more potassium than bananas. 

The nutrition stats for ½ an avocado (approximately 100 grams) is 160 calories, 15 grams of fat, 2 grams of protein, 8.5 grams of carbohydrate, 6.5 grams of fiber, and less than 1 gram of sugar (net carbs 2 grams) which is a ~ 3.75:1 ketogenic diet ratio of fat grams to protein and net carb grams combined. 

Overall avocados contain a wide range of nutrients and may have various health benefits. These include improving digestion (poop, poop, poop) and supporting optimal cholesterol patterns for heart health.  There’s evidence to show that including avocados daily in a (regular) diet lowers cholesterol and triglycerides.

Different Kinds of Avocados

The Hass avocado is the most common variety available in the US and is higher in fat as well as fuller in flavor compared to Florida avocados.

Hass avocados generally come from California and Mexico and have dark green or black skin that is bumpy.

Florida avocados are grown in Florida (as the name implies) but also in the Caribbean islands. The Florida avocado is generally larger than the Hass avocado and has bright green skin that is relatively smooth. 

The main difference between these 2 types of avocados is that the Hass avocado has a higher fat content; therefore, a higher calorie content and in most cases has a softer/creamier texture.  

General Buying & Storing Tips 

• Color alone is not the best way to determine ripeness. While a Hass avocado will turn dark green or black as it ripens, Florida avocados generally retain their light-green skin even when ripe. 

• The best way to tell if an avocado is ripe is to gently squeeze the fruit. Ripe, ready-to-eat avocados will be firm but give way to gentle pressure. 

• Firm avocados will ripen faster when stored next to other fruit (within 2-3 days) – especially an apple or kiwi fruit due to the ethylene these fruits give off that naturally promotes ripening.  

• You can also speed up ripening by placing the avocado in a paper bag and storing it at room temperature (2-5 days). 

• Only refrigerate ripe or soft avocados. These can be refrigerated until it is eaten and should last for at least 2 more days. 

• After cutting open the avocado, leave the pit inside and the skin on to help keep the remainder fresh. 

• You may freeze cut-up avocado by wrapping it with plastic wrap to avoid air contact. Exposure to air will cause the avocado to brown due to oxidation. While the brown color may visually not be as appealing as green, there is no harm in eating a browning avocado.  

• You can also squeeze a few drops of lemon juice on the exposed surface of the avocado. The citric acid from the lemon juice can help prevent browning.

Check out the California Avocado Commission website for more great tips on buying, storing, & freezing avocados. 

Eating Avocados 

And now onto the fun part…. eating the avocado! However, we know it might be hard to get your kiddos to even try an avocado let alone eat them consistently as part of their daily (sometimes multiple times a day) ketogenic meals. 

The key is to be creative and not give up. Keep in mind sometimes it takes up to 20+ offerings for a kiddo to try new food! Don’t forget to get the kiddo involved in the prepping and cooking process to facilitate independence and excitement when trying new foods and eating their keto meals (if age and developmentally appropriate of course). 

Avocados can be worked into meals: 

• As part of a: 

• Salad

• Soup: 

• You can make a soup focusing on avocados as the main ingredient or just add chunks of avocados to other soups. 

• Scrambled Eggs: 

• When scrambled eggs are about halfway done, add diced avocado. You can also add them after the eggs are cooked and cool. Top with cheese and herbs. 

• Pancakes: 

• Add avocado to your low-carb pancake mix to provide extra fiber and fat. 

• Smoothies: 

• Combine avocado with green, leafy vegetables, berries, low-carb yogurt, and/or nut-based milk. 

• Check out this Avocado & Hazelnut Smoothie from Matthews Friends and this Shamrock Smoothie from the Charlie Foundation. 

• Sauces: 

• Avocados make for a very creamy sauce. They pair well with tomato sauces as well as an easy addition to cauliflower mac and cheese. 

• Dips 

• Hummus: Add avocado to your hummus mixture to increase the creaminess, fat, and fiber content. 

• Try this Avocado Dip from Matthews Friends 

• Simply seasoned with salt and pepper

• Cut the avocado into chunks and drizzle with olive oil, balsamic vinegar, pepper, and/or salt. You can also try adding paprika, cayenne pepper, or lemon juice. 

• Stuffed

• Fill an avocado with an egg and bake for 15-20 minutes at 425° F. Add crumbled bacon and season with fresh herbs. 

• Here is another stuffed avocado recipe: Avocado Boats from Matthews Friends 

• Note: This recipe calls for double cream which is ~48% fat content compared to ~36% in heavy cream. Double cream can be difficult to find in the US. You may need to use more heavy cream in this recipe to make up for the difference in fat content. 

• As toppings

• Use for toppings of keto sandwiches, tacos, or pizza. 

• Try this Avocado Toast from Ketolicious Kid 

• Grilled 

• Cut the avocado in half and remove the seed. Drizzle with lemon juice and olive oil. Place cut side down on grill and cook for 2-3 minutes. Season. 

• Pickled 

• Place 1 cup of white vinegar, 1 cup of water, and 1 tablespoon of salt in a saucepan and bring the mixture to a boil. Pour the mix into a jar and add three diced, unripe avocados. Seal them with a lid and let them marinate for a few days before eating. 

Here are some great dessert-like avocado recipes: 

Charlie Foundation 

• Avocado Ice Cream 

• Chocolate Avocado Truffles

Matthews Friends 

• Avocado Brownie

• Avocado Pudding

• Chocolate Avocado Pudding 

• Avocado Ice Lollies 

In addition, check out our old blog post, Beat The Heat with Keto Popsicle Treats, where we list several popsicle recipes that incorporate avocado with formula but honestly, you can switch the formulas out for heavy cream and/or nut-based milk. 

Are you still struggling to get your little one excited about avocados?  Try rewarding him/her with these non-food-related items to get your kids on Team Avocado!  

• Avocado Plush

• Avocado Pop-It 

• Avocado Squishy Stress Ball 

• Avocado Bricks  

• Avocado Smash Game 

This is only the tip of the iceberg for all the great ways you can incorporate avocados into your ketogenic diet journey. Leave us a comment with your favorite idea or avocado recipe!

Epilepsy-Related Reading List

By: Laura Dority MS, RD, LD & Daisy Argudin (parent advocate)

Epilepsy is hard… it’s hard for everyone… siblings, parents, grandparents, friends, and especially the kiddo with seizures. Epilepsy is complicated… there isn’t just one cure… one medication that works for one person doesn’t work for another…there are numerous different kinds of seizures and epilepsy syndromes. 

Epilepsy is not easy to explain… especially to younger children, so we compiled a list of books to help! 

Keto-Related

Krazy for Keto by Brandon Kopp (2023) 

The story of a young boy's successful journey on the medically prescribed Ketogenic Diet for Epilepsy. Based on the real-life experience of the author. 

After traditional medications failed to control his seizures, Brandon was admitted to the hospital where he initiated the Ketogenic Diet for Epilepsy in hopes of finding some seizure control. 

Brandon bravely learns how to acclimate to his new life on this restrictive diet while still attending school and socializing with other children. 

While not specific to keto, Gordy and the Magic Diet by Kim Diersen is a good option for children following any type of medically restricted diet. Unfortunately it is difficult to find but you may be able to find a copy at your local library or a used bookstore. Based on this list, it looks like the world could use more keto-specific books for children…..are you up for the challenge? 

For the next section of this blog, we have divided the list into a few subcategories:

• Epilepsy-Related (for the patient) 

• Epilepsy-Related (for friends and peers) 

• Epilepsy-Related (for siblings) 

These books will help support your kiddo with epilepsy by giving them understanding and courage on their epilepsy journey. 

The Adventures of Buzz Bee by Jacqueline Ann Gibson (2015)

• Buzz Bee has been feeling strange lately. He's been flying into flowers, falling over in the hive, and the worst thing of all: he has no idea why. After a visit to Dr. Glowden, Buzz Bee and his mommy finally find out what's going on - Buzz Bee has been having seizures. 

• If your child is suffering from epilepsy, or has someone in their life with the condition, this book is a fantastic way to teach them about the disorder and how it's treated. 

• It also reminds readers that those who suffer from epilepsy or any other disorder are just as normal as any other bee in the hive. 

The True Life Adventures of Spunky Monkey, The Magical Poodle by Lauren Michell Ruehring (2012)

• Spunky Monkey The Magical Poodle is a dog with epilepsy who wanders off while at the park with his family and em"barks" on a day-long journey of self discovery. 

• As he tries to find food, friends and medicine, he encounters a cast of funny, caring, helpful friends who give him hope, confidence and courage to find his way home. 

• The True Life Adventures series uses real-life dogs to explore the issues of illness, disability and other life lessons from a gentle, entertaining and uplifting perspective that all children can relate to.

The Great Katie Kate Explains Epilepsy by M. Maitland DeLand (2014)

• Jimmy and the other young patients in the neurologist's office get     a visit from the Great Katie Kate, a spunky redheaded superhero who appears when kids get worried. Katie Kate takes the children on a medical adventure to learn about the various forms of epileptic seizures and treatments.

• This superhero saga provides an entertaining and indispensable tool for parents and medical professionals who are seeking a positive way to help young epilepsy patients understand their condition and deal with their fears. 

I Have Epilepsy. It Doesn’t Have Me by Jamie Bacigalupo and Judy Bacigalupo (2012)

• Follow eight year old Jamie on her journey from being diagnosed with Benign Rolandic Epilepsy at age five. 

• Jamie persevered and overcame her epilepsy and went on to help other children by starting her own non-profit that provides gifts to children in over five states.

Mommy, I Feel Funny! A Child’s Experience with Epilepsy by Danielle M. Rocheford (2009)

• Based on a true story, Mommy, I Feel Funny! introduces the reader to Nel, a little girl who is diagnosed with epilepsy. 

• The story takes you through the days following Nels first seizure. Suddenly, Nel and her family are faced with thoughts, fears and emotions that come with the discovery, understanding and acceptance of epilepsy.

Let’s Learn with Teddy about Epilepsy by Dr. Yvonne Zelenka (2008)

• A book to help children and their families identify some of the symptoms of epilepsy and understand in an illustrative and enjoyable manner the doctor's visit. 

• The book tells the story of a young boy first diagnosed with epilepsy, the doctor's visit, the different tests and possible treatment and his relationship with his parents and friends.

And Down Went Poss & Poss’s School Days Book by Anne Little

• And Down Went Poss is a book that examines the feelings of a baby possum when he is first diagnosed with epilepsy. Little Poss feels sad and unhappy, but with help from a special friend, he comes to realise that we are all different and that life can still be full of fun. 

• Poss’s School Days Book is the sequel to And Down Went Poss. It looks at what happens when Poss has a seizure one day at school. 

• These books include ideas for activities which enhance the child’s understanding of the story.

Going to school and making new friends when you have epilepsy can be scary and intimidating.  Your kiddo might be concerned with fitting in. Other children’s exposure to epilepsy and therefore knowledge may be limited and incorrect. These books are great options for the classroom and friend groups to help support inclusivity and understanding. 

Did You Know That I Have Epilepsy? by Stacey Crouch (2020)

• A true story of a boy named Cody, who has been diagnosed with epilepsy. 

• It was written to help kids learn more about seizures and what could happen from a child’s perspective. 

• It’s easy for children to understand and has colorful, engaging pictures.

Milo’s Day At School by Shawnee Walker (2020)

• This book shares a heartwarming, informative story about a child who has a seizure at school.

• The author informs young readers about epilepsy, and what to do if they see someone have a seizure in a kid-friendly language. 

Zeeba and the Seizure by Michaela Barnes (2020) 

• A children's book that promotes seizure and epilepsy awareness. 

• Zeeba Zebra planned to have a regular school day but began feeling unwell. Something unusual and scary happens that leads to an unexpected field trip to the hospital. 

• A story that encourages children to embrace empathy, friendship, and courage.

Andie and the Storm by Lexie Griffiths (2021) 

• Simplistic for young children to learn about seizures and how to help

• Rhyming makes it fun to read aloud as a family, class, or as friends

• Written and illustrated by a mom with first-hand experience and knows how difficult it can be to explain seizures to children

Taking Seizure Disorders to School: A Story About Epilepsy (Special Kids in School) by Kim Gosselin (2001)

• This story dispels the myths and fears surrounding epilepsy in a positive, upbeat and entertaining style while explaining seizures in an understandable fashion.

Is Epilepsy Contagious? by Julie Devinsky (2011)

• This book brings the story of epilepsy alive with easy-to-understand text and illustrations that are both informative and interesting for many questions kids ask about epilepsy. 

I Know Someone with Epilepsy (Understanding Health Issues) by Vic Parker (2011)

• This book introduces readers to what epilepsy and other seizure disorders are, how they affect people, and what they can do to be a good friend to someone living with epilepsy.

Can I tell you about epilepsy? A guide for friends, family and professionals by Kate Lambert (2012)

• Ellie, a young girl with epilepsy, invites readers to learn about epilepsy from her perspective. 

• Ellie helps children to understand the obstacles that she faces by telling them what it feels like to have epilepsy, how it affects her physically and emotionally, how epilepsy can be treated and how the condition is often misunderstood. 

• Ideal introduction for children, parents, friends, and professionals to make sense of the condition in its varying forms and will be an excellent starting point for family and classroom discussions.

We know it can be hard for siblings to have a brother or sister with epilepsy or any kind of special health care need. They may feel left out, scared, or even helpless to help their sister or brother. This list will help normalize their emotions and give ideas on how they can be brave and courageous for their sibling with epilepsy. 

Becky the Brave: A Story about Epilepsy by Laura Lears (2002) 

• This story dispels the myths and fears surrounding epilepsy in a positive, upbeat and entertaining style while explaining seizures in an understandable fashion.

• A story about a young girl's struggles with epilepsy. Becky is always helping her younger sister, Sarah. Sarah looks up to her brave older sister - until one afternoon when Becky suffers a serious seizure. When Becky recovers, she retreats into herself and refuses to return to school, anxious that her condition not be revealed to her new classmates. It is now Sarah's turn to be brave for her sister.

If you come across any other books that you think should be included, please leave us a comment and let us know!

Note: Only books that were available on Amazon as of 4/2023 were included on this list.

Quality Nutrition Sources - Why Quality Matters?

By: Kayla Hansmann, MS, RD, LD, CLC

When thinking about diet quality – across the spectrum of all diets, you’d be hard-pressed to find someone who would argue that the quality of what we’re eating isn’t important. While that might not be one of the first steps in implementing a medically prescribed ketogenic diet, it can certainly take precedence down the road once some of the other critical boxes are checked and everyone is feeling comfortable with how to navigate this new way of eating.

Dietary choices and lifestyle habits can be daunting to implement all at once so most dietitians will recommend some initial tweaks and changes to get you on your way to the desired diet endpoint. When doing so, most individuals and practitioners note that even these simple (yet consistent!) nutrition changes up front result in better control of seizures as well as improved behavior overall. The underlying theme in these changes includes reduced amounts of processed and packaged foods, no added sugar, and less concentrated sources of carbohydrates overall. 

Let’s dig into this a little further. Stripping away processed foods leaves us with whole, natural foods that provide higher satisfaction for both our palate and our body’s systems. Processed foods are more likely to include ingredients that are: 

• harder for our bodies to digest

• more likely to lead to abdominal distress (constipation or diarrhea)

• prone to causing glucose spikes that lead to energy rollercoasters (often exhausting our body’s insulin)

• more likely to lead to bloating and/or increased gas

• providing an excess of calories and/or unhealthy fats without a ‘place to go’

…in other words: likely to increase inflammation which can increase our prevalence of acute or chronic illness and undesirable weight trends.

One easy way we can look at creating a plate or a day’s worth of meals that prioritize whole, natural foods is by following the “one ingredient rule”. Even if a food isn’t fresh or raw, you can flip over to the ingredient list to ensure each of the ingredients listed is just ONE ingredient, or itself, in whole-unadulterated form. Cut out the ingredients, cut out the processing! 

Once you’ve successfully gotten the majority of your meals and snack to encompass the one ingredient rule, you will notice your body starting to crave these foods more and a reduced desire to grab or reach for its other processed counterparts. Our bodies are smart and adapt—once you get to a certain point, your body CRAVES what it is actually eating!

Let’s recap, ways to add quality to our diet and why it matters, with an emphasis on keto-friendly sources:

Proteins

• Aim for minimally processed proteins (i.e. whole chicken, eggs, ground turkey, various cuts of steak) – these foods are satiating and can keep us feeling full longer while also contributing important and highly available amino acids, B vitamins, iron, zinc, and choline. When possible, choose pasture-raised poultry for the higher amounts of omega 3’s found in the eggs and meat. 

• Choose high-fat dairy which is also helpful in terms of satiety but also a good source of calcium, phosphorus, and vitamin D for strong bones, growth, and development.

• Try and work in fresh fish a few times a week – omega 3 city! The EPA and DHA (omega-3 fatty acids) provide tremendous benefits for your heart, brain, lungs, and circulation.

Carbohydrates: 

• Fruits & veggies – think: The higher the fiber, the lower the net carbohydrates. Fiber is not only FILLING but feeds the healthy bacteria in our gut (a happy gut = better absorption of important nutrients and increased bowel motility).

Fats: 

• Nuts & seeds – great ways to add crunch with a fantastic mix of healthy fats, fiber, and often a better source of sodium to naturally “salt” our diet. A favorite keto staple is flaxseed and chia seeds which are loaded with alpha-linolenic (ALA) fatty acids – a commonly forgotten omega-3!

• MOST IMPORTANTLY FATS – think half solid, half liquid. If we can make at least 50% of our fats unsaturated (usually liquid) and the other 50% or less saturated (usually solids: butter, coconut oil, fats from animals), we are on our way to improved fasting blood levels of triglycerides and cholesterol. Butter/ghee is a great way to pack a punch, but we want to ensure that we’re incorporating mono- and omega-3 poly-unsaturated fats to boost our HDL cholesterol and provide protection against heart disease as well as packing a dose of potent antioxidants. Amazing monounsaturated fat sources are extra virgin olive oil and avocados. 

The final trick to adding quality? Self-love and self-regulation! Without these two essential ingredients, we’ll be cycling through the roundabout of shame and guilt that will make it very difficult to lead to healthy habits long-term. A calm and stress-free environment helps us digest food better, enjoy food more, and be more likely to grab the more nutritious choice time after time.