Our Daisy Garland Ketogenic Dietitian, Vicki Whiteley, goes Keto! Vicki Whiteley, our amazing Daisy Garland Ketogenic Dietitian from Royal Manchester Children's Hospital, is going keto to find out how children feel when they start the diet and to trial lots of yummy ketogenic recipes for us! Vicki tells us more... Disclaimer: The ketogenic diet is a medical-led diet which should only be used under the strict guidance of a qualified dietitian to ensure the diet is safe and nutritionally adequate. The experience of following a ketogenic diet for only a few weeks has been really valuable. As well as calculating and planning my diet, I had to plan and calculate my husbands, who was also on the ketogenic diet, and then make normal meals for my daughter. I found using low carbohydrate vegetables to replace my usual starchy carbohydrates the most useful tip from one of the members of Daisy’s Keto Café and we still used roasted radishes as a side to our Sunday dinners! I learnt quickly that I needed to plan ahead, particularly before going to the supermarket, to make sure I wasn’t buying foods that might go to waste and also to balance parenting, work and the diet. It’s not an easy task, and at first it was daunting, but it did get easier! But the biggest lesson was around how I felt, moving into ketosis and once I was ketotic. I didn’t do a gradual introduction, which I advise for my patients, so I moved in to ketosis quickly. I did feel lethargic and had a headache for the first 48 hours, but this soon passed and was managed with some extra fluid. Because of the rapid move to ketosis my blood glucose levels did dip a little, so its definitely advisable to introduce the diet slowly! But once I was through the transition period, I felt good, I had good energy levels, and rarely felt hungry. This experience has given more insight into how my patients and families feel when they embark on the ketogenic diet, and I feel better able to support them, with hints and tips I picked up along the way. I trialled the modified ketogenic diet this time, and in the future I think I will try the classical diet and the modified MCT diet, to experience and understand the differences with these plans. Saturday and Sunday (19th and 20th June) "I have just finished another weekend of keto and I have been on keto for 11 days now. This weekend I went to the supermarket and found a selection of fab low carb vegetables that I am going to experiment with! I have celeriac, Dudhi, chayote, mooli and swede! After a tough day on Friday of half home school and then work as well I ended the day with a Kimchi omelette. I was so pleased to find that kimchi wasn’t too high in carbohydrate, being predominantly cabbage based, and the added bonus of probiotics, was fab! The omelette was soo tasty that I didn’t even have time for a photo! On Saturday I wanted to cook a special meal. I searched through my Yotam Ottelenghi recipe books to see if there were any adaptable recipes.. I found quite a few! I opted to make Celeriac steaks with Café Du Paris (cream with herbs and capers) with marinated tofu on the side. For dessert I made roasted rhubarb with extra thick double cream and toasted ketoclassic savoury. It was amazing! I was so proud of myself, and after a hectic couple of days at the end of last week it really reinvigorated my cooking! I enjoyed the rhubarb so much (with added Truvia) that I have made it into a breakfast with Alpro soya no sugars yogurt and extra thick double cream for my breakfasts since which has been really enjoyable. My ketones are still good and I am feeling good. The things I have noticed… I am drinking a lot more than normal, but this isn’t a bad thing. Rhubarb is amazing and I am going to buy some more after work. I am using soooo many eggs! So I will need to buy more of those this evening as well. Extra thick double cream is great because it saves time. Only a few more days planned for keto and I am not sure how I feel about this... We might keep going a little longer to keep experimenting with the recipes I have found and also the new vegetables!" Wednesday, Thursday and Friday (16th - 18th June) So just as I thought I had it all in hand, meals planned, ketones good, I got that dreaded text from my daughters school ‘there has been a positive covid case and your child needs to be collected from school and will need to isolate for 10 days.’ We received this message on Wednesday morning, so straight away myself and my husband went in to organisation mode, working out our shifts for childcare/home school and work. One parent taking the morning and one the afternoon early evening. With a clinical caseload this is always so stressful as you want to be able to provide the same support and care for patients and families but you also have to put you own family first, so it’s a juggle between working from home and flexible hours to try to manage it all. And this is without thinking of maintaining a ketogenic diet. I have to admit, that first day the plan for evening meal went out of the window and instead of a jackfruit curry with cauliflower rice, I opted for Omelettes as a quick and easy go to recipe. I tried to spice it up a bit by adding some feta, mint and aubergine, and actually it was really tasty, and a comfort meal we all needed. After the dust settled and we developed our plan of action for the 10 days ahead everything seemed a bit more manageable… Although cooking with Zelda joining in was a little trickier.. trying to be accurate with weighing and measuring is much harder! On Thursday I made garlic roasted radishes with salmon (baked with lime and ginger) and broccoli on the side. Well, roasted radishes are a taste sensation, they were amazing and at only 2.2g of carbohydrate per 100g they were a fantastic low carb option. The peppery/bitterness of raw radish completely disappears once they are cooked so we will definitely have these again, keto or not! After the meal success of yesterday I tried a cauliflower couscous salad with Avocado and marinated tofu for lunch which was also really tasty.. and now I am feeling more confident again I am going to try some Korean inspired recipes. We love Korean food so I have been missing this, the meals are often rice based so I am challenging myself to Kimchi pancakes with a noodle (or swoodle) accompaniment and I will try a Bibimbap style meal using cauliflower rise in place of the normal rice base. Wish me luck! Monday and Tuesday (14th and 15th June) "So I have now completed a week of keto and my levels have been steadily in the 3s and 4s for the last couple of days. I am so thankful I planned lunches and evenings meals for the week over the weekend because a week at work is always so busy alongside the juggle of school and after school activities. On Monday I started the day with a strawberry yoghurt (made with Alpro No sugars and double cream), lunch was a Greek salad with avocado and seeds and I thought I would try a new recipe for dinner. A family favourite in our house is a courgette pasta with pine nuts and balsamic vinegar so I had a go at adapting the recipe. I ribboned the courgette and sautéed then with spring onion, garlic and parsley. Once they softened I added toasted pine nuts, balsamic vinegar and parmesan, it was really delicious! I served this with seasoned tofu and it was a really delicious meal (although maybe the picture doesn’t do it justice). On Tuesday I discovered the Bounty Vegan coconut drink which Sara recommended, is a delicious breakfast drink and had this along side a Ketoclassic bar [Ketocare]. As I was working from home I opted for an omelette with cheese an chives for lunch. After the creative success of Monday evening I embarked on making Chef Derek’s ketocal [Nutricia] chocolate buttons which worked perfectly! And the made fish goujons (ketoclassic savoury bread crumbs) and celeriac chips. This was a really great meal! Some things I have noticed this week so far… The dish washer is being used more frequently I need to get up earlier to prepare breakfast and then lunches for 3! There are a lot of foods I eat with out even realising… pinching a crisp from my daughter, finishing off half eaten apples, eating the toast crust, tasting the pasta/beans to check they are ready etc. I have had to be conscious of this! Overall I am feeling really well, my energy levels are good and I think I might even go for a run this week!" Saturday and Sunday (12th and 13th June) "So this was my first weekend on the ketogenic diet. Saturday morning started with some amazing ketones at 3.0 mmol/L and I was feeling good, no shakiness, so felt my body had adjusted to ketones as my primary energy source. I started the day with a yoghurt made with Alpro Soya No Sugar yoghurt with some strawberries and whipped double cream added. Saturdays are a busy day here with classes in the morning and a supermarket shop so I packed a Ketoclassic bar [Ketocare] as a snack and headed off to Karate and then gymnastics. We then went to the supermarket and spent a looong time looking at lots of labels and what interesting foods we could try or include in the diet plan... and ended up spending about £20 more than usual which I am sure is common on that first keto trip! I made the mistake of not planning the meals for the week ahead to know exactly what I needed, so think I overbought and have had to have a look at labels and freeze some things to avoid wastage. I will definitely be doing the meal planning on Friday night next week! After the shop I made a tasty omelette with double cream and cheese and we set off for the park. I packed myself a snack but as it was such a lovely day we were in the park much longer than I had anticipated and by the time we were heading home I was low in energy and my ketones had dropped to 1.1 mmol/L... I hadn't eaten enough fat to keep my energy levels up! For dinner I made another noodle dish but this time I used some Tofu marinated with lime, coriander and chilli and served this with ‘Swoodles’ cooked with garlic and soya, and some broccoli [Swoodles - spiralised swede noodles from Tesco found in the chilled, prepared vegetable section]. I dressed the meal with sesame oil and sesame seeds. Swoodles were a taste sensation, really delicious! The slight peppery flavour really added to the meal and we will definitely have these again! Dessert was half a keyo [Vitaflo], which was a lovely sweet treat to end the day. Sunday, I woke to ketones of 2.6 mmol/L and decided to get a bit more creative with MCT Procal [Vitaflo] pancakes, these didn’t go so well… I didn’t let the pan heat up (as per the directions) and I made some funny looking scrambled mixture... I went back to the recipe book and decided to make the MCT Procal [Vitaflo] waffles, which were delicious with some Waldens pancake syrup (kindly provided by Team Daisy). I will definitely try these again, such a great way to start the day! I was feeling full of energy and headed to my Goat Yoga lesson, which was great fun! Goat Yoga powered by ketones! To avoid my mistakes of yesterday I packed my snacks of a FattBar butter cookie and Cathedral City mini, so no energy lull! Then we went to a friends garden party for the England football match. I treated myself to a Gin and Slim Line tonic (a lovely keto friendly treat!) and enjoyed Salmon, halloumi and field mushrooms from the BBQ. Unfortunately many of the vegetarian burgers and sausages have carbohydrate in, so I didn’t have that option, but if I was a meat eater, I would have had a feast! After a lovely afternoon enjoying the sun and time with friends, which is so important after the last year, I rounded off the day with an adapted salad Nicoise; Tuna mayo, avocado, boiled egg, salad and some superseeds to add a tasty crunch. I went to bed with ketones of 2.2 mmol/L and a meal plan for the rest of this week. I am looking forward to trying courgetti spaghetti, jackfruit curry and cauliflower rice, fish fingers and more Swoodles!" Thursday and Friday (10th and 11th June) "I started full keto on Thursday, after having my carb reduction for 3 days beforehand. I managed well at work with snacks of nuts, cheese and olives, keeping my carbohydrate intake low but boosting my fats. I met some very inspiring ladies in The Daisy Garland Keto Cafe Coffee Morning and got some excellent tips, which I am very grateful for. Thursday is always a busy day, I have to rush out of work to get my daughter Zelda from school and then its a rush to the leisure centre for her swimming lesson. It was very hot in the leisure centre and I was starting to feel a little low in energy. As I watched Zelda swimming I was struggling to think what to make for dinner. Zelda requested beans on toast, and I would have loved to have joined her but I was struggling to think of what might be quick to prepare providing just what I needed. We got home and I was really feeling tired, but the postman had brought us a box of total joy! Lots of Keto goodies from Sara and the amazing team at The Daisy Garland, I opened up my Daisy Welcome Box and found a Butter Cookie (www.livefatt.com<http://www.livefatt.com>) and it was delicious and just what I needed to give me a little boost and replenish my energy. I quickly made our dinner, a salad with Viera plant based Sharma kebab pieces, avocado, mixed salad leaves and egg. This was really tasty and satisfying. The warm weather has made salads a great go to, but I need to get my thinking cap on for other meals, salads are naturally low carb and just really easy to throw together after work. My total carbohydrate intake for today was 13g, but i was a little down on my fat, so I will have to try harder with that.On Friday I woke feeling quite shaky and my ketones were 2.6mmol/L. The reason I have felt a bit shaky is because I have moved into ketosis very quickly, normally we encourage families to introduce the diet over a longer period, 7-10 days so they avoid the rapid change in metabolism. As I was feeling a bit shaky and lethargic I had a Fatt ketogenic nut bar, raspberry and almond, it was sticky but tasty and helped to wake me up a bit for the day ahead. I followed this up with some fruit, soya yogurt and cream and a mid morning snack of the delicious Ketoclassic Bar. I planned to have a Greek salad with extra olive oil for lunch and a Keyo for dessert which was a perfect treat after it had been in the freezer, it almost felt like an ice cream. I am used to making my packed lunch, but this requires a bit more thought to make sure the carbohydrates and fats are ok. I also need to think of snacks to avoid dips in energy in the day. My snacks today were cheese chunks and some nuts but I think I will need to look at other options too, to keep things interesting! Dinner was another salad... I really need to get planning meals, but I was late home from work so needed something quick so we could all eat together. I had a salad with tuna mayonnaise, a delicious avocado, a boiled egg and some prawns. I have been a vegetarian for many years, but felt I needed to introduce some fish to my diet to ensure I had a good variety of protein, and also because oily fish is a great source of fat. I needed a cheese free dinner and it was just perfect in the lovely warm weather...My carbohydrate intake today has been 13g but I have been much better with my fat intake.With the weekend ahead I am thinking of what I can bake and prepare for the week ahead. I want to try the MCT procal [Vitaflo] pancakes with Keyo [Vitaflo] and the fab pancake syrup from The Daisy Garland. I also want to make some brownies, fat bombs and experiment with Lo-Dough pizza, Ketosavoury [Ketocare] fish or halloumi fingers. We are also heading to a BBQ on Sunday, but I am sure I can find lots of food with barbecued salmon, halloumi, field mushrooms and I might try some marinated paneer skewers. Normally I would have a glass of wine, I might try a gin and slim line tonic with some lime for a refreshing grown up treat!" Wednesday 9th June "So I started to reduce the carbohydrate in my diet this week in preparation for keto next week, but actually have started full keto today. I have wanted to trial the diet fully for some time, but always seemed to find an excuse. I shouldn’t have really. I might have thought, oh we are quite busy, or works stressful right now, but actually I ask the families I work with to start the diet, and they have to manage it whilst the rest of their lives just carry on, so is there really a good time?? I have wanted to trial the diet, to try all the wonderful recipes, but also to really experience what if feels like for the children (although coming from a non epilepsy baseline) and how it is for the parents planning and cooking the foods and meals. I am including prescribable and non-prescribable products so I can experience how they can be incorporated and their tastes. I will be using the modified ketogenic diet with 15g carbohydrate and 150g fat minimum per day. On Monday I reduced my carbohydrates to 60g per day and encouraged the fat more and this was ok. On Tuesday I reduced to 30g of carbohydrate and that was a little trickier. I started the day with some yoghurt and the Ketocare muesli and needed to add some Truvia as I needed the sweetness, then had a lovely feta salad with tzatziki, olives, peppers, cucumber and a bit of beetroot. I had some strawberries and cream for pudding which was lovely! For our evening meal we tried the bare naked noodles, which were ok, we had them with salmon and broccoli with garlic, soy and sesame oil and sesame seeds. It was very tasty, I'll send a picture. I did have a headache on this day and needed to drink extra water. On Wednesday my ketones were 0.8 mmol/L in the morning and I dropped my carbohydrate to 25g daily. I found my appetite was lower today, less thinking about snacking, but missing my large cup of tea mid morning (I only like cows milk in my tea so have had to skip it today). For lunch I had a lo dough wrap with salad leaves, halloumi and tzatziki which was lovely. I had some Alpro plain yoghurt with cream and strawberries too. I still had to drink a lot but that may also be the heat. For dinner we had a spicy mushroom soft taco with spicy mayo and feta, but instead of the soft taco used a Lo-Dough. Today I woke up feeling very thirsty and my ketones are 2.1 mmol/L. I don’t eat my breakfast until I get to work so I was feeling a little lethargic on the way to work but after my breakfast of a Ketocare Ketoclassic Bar and some Alpro soya yoghurt with double cream I felt much better. For lunch I have had a salad with tuna mayo and avocado which was really satisfying and I feel energised for the rest of the day. I haven’t thought of snacking on high carb foods but I have craved a crunchy apple!" Ketocare, Nutricia and Vitaflo products are available on prescription. Please speak to your ketogenic dietitian for further information. The Daisy Garland can provide one off samples of these products for you to try at the request of your dietitian. Contact [email protected] for more information.