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Frequently Asked Questions 

How many meals will my child eat on the diet?

The diet is usually divided into 3 or 4 meals a day. If snacks are required then these will be calculated into the meal plan. Each meal is based on a specified amount of fat, protein and carbohydrate, which will be calculated for you by your dietitian who will, in time, teach you to do this for yourself.

What will I need to monitor?

The aim of the diet is to produce ketones that can be used by the brain for energy. Initially you will need to check urinary or blood ketones every morning and evening by a simple urine test or finger-prick blood test. You will be provided with suitable equipment to do this. Once your child is producing stable ketones, you may be able to test blood ketones less frequently. It is normal for ketones to fluctuate throughout the day/night and vary from day to day. Your dietitian will advise you on the range of ketosis suitable for your child.

Be sure to record the number of seizures your child is having each day along with changes in mood, behaviour, alertness, sleep and general health. You may be given a weekly ketone and seizure record sheet to record these events or you can use the photocopiable record sheets found at the end of this section.

Invest in a good quality hot food flask for food on the go. A cold flask for cream shakes/smoothies is also very useful.

What if my child is struggling to make ketones?

Don’t panic. Talk to your dietitian as there will be many different things that can be ‘tweaked’ to get your child into ketosis. In the first month there are often lots of adjustments - this is completely normal.  Please note that it is normal for ketones to fluctuate throughout the day/night and vary from day to day. 

What if my child loses ketosis?

First check that your child has not eaten the wrong foods mistakenly. Make sure that the food portions have been calculated and weighed correctly. Sometimes ketones are lost when a child develops an infection. Don’t worry, stay on the diet and ketones should reappear. If in doubt contact your dietitian. Weight changes and constipation can also affect ketosis. It is important that the diet is not stopped suddenly. If it is to discontinue, it should be done gradually, with the advice of your dietitian.

Can my child have other medication?

Yes, but these will need to be sugar-free and the carbohydrate content will need to be checked. Low-calorie, carbohydrate-free medicines are best. If in doubt ask your pharmacist or paediatrician. As a rule of thumb, tablet formulations tend to be lower in carbohydrate.

Note: sugar-free does not necessarily mean carbohydrate-free. The carbohydrate in medication may need to be calculated into your child’s diet. Therefore let your dietitian know of all medicines your child is taking including homoeopathic medicines, complementary medicines and vitamin supplements.

What if my child refuses to eat?

Don’t panic! As the diet is based on fasting, missing a meal should not have an impact on ketone production. If your child is not eating because they are unwell, contact your GP and inform your dietitian as soon as possible.

What if my child is unwell?

If your child is unwell and not eating, it is important that they receive regular fluids so that dehydration is avoided. Frequent drinks of carbohydrate-free liquids should be used (water, sugar-free squash). If a child is ill for longer than 24 hours, medical advice must be sought. In the case of vomiting and diarrhoea, Dioralyte or an oral rehydration solution may be necessary.

When contacting your GP always let them know that your child is on the ketogenic diet. Any medication that your child receives should be carbohydrate-free, so it is important that your GP and pharmacist are aware of this. Any new medication should be checked with the pharmacist for the carbohydrate content.

You will be given a detailed advice sheet for information on how to manage illness whilst on the ketogenic diet by your dietitian, so please refer to it.

What if my child attends a nursery, school or respite care?

All people looking after your child will need to know about your child’s special diet so that they do not give them any other food or drink. This is very important. Your dietitian will give you an information sheet, “I am on the ketogenic diet”, that can be given out informing them about the diet. The Daisy Garland provide free ‘I Can only Have Food from Home’ button badges. Please email [email protected] to request one.

What if a meal is needed away from home?

It is best to give your child a packed lunch or frozen meal to take to school*, respite care, or other place away from home. This ensures each meal is carefully calculated and weighed out. Your dietitian can give you an emergency milkshake recipe, which can be used to replace one meal. For lunchbox inspiration please refer to The Daisy Garland website recipes page. *Some schools and nurseries may prepare food in line with your child's ketogenic prescription. 

What equipment do I need to get started?

Electronic kitchen scales

These must weigh quantities to the nearest gram and are included in our Daisy Garland Ketogenic Welcome Boxes (see below). Top Tip: Always be sure to have a spare set of batteries in the house as your scales are a very important part of the diet.

Small plastic containers, masking tape or freezer labels and permanent markers

Containers are useful for storing batch meals and when meals are needed away from home. Clearly label food with date, ratio, contents and any ingredients that still need to be added.

Plastic spatulas and soft-tipped baby spoons

These will ensure that all oil or butter is scraped out of the pan and bowl.

Small frying pan

A non-stick pan is recommended.

Silicon cupcake cases, moulds and baking trays

These can be used to make keto muffins, quiches, ice cream and chocolate etc.

Measuring cups and jugs

Make sure these are easy to read.

Daisy Garland Ketogenic Welcome Boxes

The items listed above are invaluable when running the ketogenic diet. Please ask your keto dietitian to contact us 2 weeks prior to starting the diet so we can send you a complimentary Daisy Garland Ketogenic Welcome Box. This includes many of the things you need, plus lots of little extras to get your keto journey off to a positive start. Each box is tailor-made to suit your child’s age and dietary prescription.

What food should I buy to get started?

This list of food items may be useful to buy prior to starting the ketogenic diet. This list will expand as you become more comfortable and adventurous with the recipes.

Fat

• double cream (full-fat, at least 50g fat per 100g)

• mayonnaise (full-fat brands such as Hellmans)

• oil (olive, vegetable, rapeseed, coconut, avocado, sunflower etc.)

• butter (full-fat, at least 80g fat per 100g)

Protein 

• back bacon

• chicken

• extra lean mince

• tuna in brine or spring water

• eggs

• cheese

Carbohydrate

• vegetables, fresh or frozen

• low carbohydrate fruit such as blueberries and raspberries

Pantry Staples

• salt, pepper, mixed herbs, garlic powder, vinegar, Worcestershire sauce

• spices such as curry, cinnamon, nutmeg, turmeric

• cocoa powder e.g. Bournville (not hot chocolate)

• sugar-free jelly

• sugar-free squash

• ground almonds

• vanilla extract i.e. Sainsbury’s Madagascan Vanilla or other carb-free flavourings such as Dr Oetker peppermint extract or almond essence

• sweeteners (Truvia calorie-free or Hermesetas liquid)

Regularly check the nutritional content of food items as they can vary. Double cream, for example, may have a different fat content depending on the time of year.

What fruit and vegetables can be eaten on the diet?

Here is a useful list of some low carbohydrate fruit and vegetables that can be calculated into ketogenic meals.

Fruit 

• apple • apricot • avocado • blackberries 

• blueberries • canteloupe melon • cherries • coconut 

• kiwi • pineapple • raspberries • rhubarb • strawberries 

Vegetables

• asparagus • artichoke • aubergine • beans, green

• beetroot • broccoli • brussels sprouts • cabbage

• carrots • cauliflower • celeriac • celery

• courgette • cucumber • garlic • lettuce

• mushrooms • onion • pepper • pumpkin

• spinach • swede • tomato

What sweeteners and flavourings can be used?

The ketogenic diet is a carbohydrate restricted diet and it is important to avoid the following:

• Aspartame • Lactose • Mannitol • Dextrose

• Maize starch • Polycose • Fructose • Maltitol

• Sorbitol• Glucose • Maltodextrin • Sucrose

• Glycerol • Maltose • Sugar

Diabetic products and low sugar foods may contain the above so it is very important to check with your dietitian if you are unsure.

Low-carb breads and pastas often contain higher levels of carbohydrate and protein than allowed on the ketogenic diet so please check with your dietitian before using them.

Avoid powdered sweeteners such as Canderel as they contain a significant amount of maltodextrin.

Suitable choices are:

• Truvia calorie-free sweetener

• Sweetex

• Hermesetas liquid

• Da Vinci Syrups

• Walden Farms Near Zero Syrups

Suitable keto-friendly sweeteners and syrups, to use in desserts, cakes or biscuits, are readily available online.

What prescribed products can be used on the diet?

The products below can be an important part of the diet but they must be prescribed by your dietitian and GP. Please note not all prescribable products will be suitable for your child’s needs.

Calogen

A blend of mono and polyunsaturated fats with a low amount of saturated fat. This may be used in recipes to replace some of the fat provided by cream. Can be used in cold and warm foods, but do not fry with it or it will separate/split.

FruitiVits

Orange flavoured multivitamin and mineral supplement especially for those on the ketogenic diet. They can be mixed with water or sugar-free squash.

K.Flo

A palatable, nutritionally complete, liquid feed, in a 4:1 ratio of fat to carbohydrate and protein, with fibre, docosahexaenoic acid (DHA) and arachidonic acid (ARA). Suitable from 3 years of age.

K.Quik

A medium chain triglyceride emulsion of fat, which can be used as a milk replacement and in cooking.

Kanso DeliMCT CacaoBar 4.8:1

Ketogenic cacao bar with medium-chain fatty acids. Suitable from 3 years of age.

KetoCal 2.5:1 LQ

A ready to drink liquid that can be enjoyed on the go, as a convenient snack or used as an ingredient in many recipes both sweet and savoury. Available in vanilla flavour.

KetoCal 3:1

This is similar to KetoCal 4:1 but is designed for those requiring a lower ratio and to be used as an infant formula. It is unflavoured.

KetoCal 4:1

This can be used to administer the classical ketogenic diet for children fed via a nasogastric or gastrostomy tube. It can also be used as a supplementary milkshake drink for children on any of the ketogenic diets. It can be used in recipes as a flour replacement. KetoCal contains milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is available as a powder or a ready-to-use liquid (KetoCal LQ) in vanilla and unflavoured varieties. Both the liquid version and powdered version contain fibre.

KetoClassic 3:1 Bar

High-fat, high-fibre bar for use in the classical 3:1 ketogenic diet from 3 years of age.

KetoClassic 3:1 Bisk

High-fat, high-fibre bisk. Suitable from 3 years of age.

KetoClassic 3:1 Bolognese

High-fat, ready prepared meal. Suitable from 3 years of age.

KetoClassic 3:1 Chicken

High-fat, ready prepared meal. Suitable from 3 years of age.

KetoClassic 3:1 Muesli

High-fat, high-fibre muesli. Suitable from 3 years of age.

KetoClassic 3:1 Porridge

High-fat, high-fibre porridge. Suitable from 3 years of age.

KetoClassic 3:1 Savoury

High fat, high-fibre savoury slice. Suitable from 3 years of age.

KetoVie 3:1 Unflavoured

Used for the dietary management of intractable epilepsy and other disorders for individuals who require a ketogenic diet for both oral and tube feeding. Suitable for 1+ years.

KetoVie 4:1 Unflavoured

A nutritionally complete ready-to-use liquid 4:1 ketogenic medical food with no artificial sweeteners or flavourings, 100% partially hydrolyzed whey protein and contains MCT. Suitable for 1+ years.

KetoVie 4:1 Chocolate and Vanilla flavours

A ready to use liquid ketogenic formula that contains a blend of key nutrients. Suitable for 1+ years.

KetoVie Peptide 4:1 (Also available in Plant-Based Protein Vanilla)

An unflavored ready-to-feed ketogenic medical food containing MCT and extensively hydrolyzed whey protein complete with vitamins and minerals. Suitable for 1+ years.

KetoVie Kwik Mix 4:1

Keto-friendly baking mix for pancakes, waffles, quick breads and more.

K.Yo

A unique 3:1 ready-to-eat chocolate or vanilla flavoured complete food. Perfect to eat on its own from the tub, or turn into ice cream by mixing with double cream and freezing. Suitable for 3 years and over.

Liquigen

A medium chain triglyceride (MCT) emulsion of fat used in the MCT diet.

MCT Oil

This can be used in cooking or added to drinks. It is important to introduce this slowly as large intakes can cause vomiting or diarrhoea. MCT oil has a lower flash point than other commercial oils, so heat at a low to medium temperature.

MCTprocal

A neutral-tasting food fortifier and medium chain triglyceride supplement, which can be used in cooking and baking.

Phlexy-Vits

Multivitamin and mineral supplement. Add a small amount of water and mix to a smooth paste before adding to food or water. Alternatively, mix with a small amount of sugar-free squash and dilute with water according to taste.

Protifar

A powdered, unflavoured high-protein supplement made from skimmed milk protein. Added to some sweet or savoury meals where more protein is required. This may be used in the ‘emergency ketogenic milkshake’ recipe, which your dietitian will give you.

Record-keeping and Useful Forms

When starting out on the diet it is essential to keep an accurate record of ketones, height and weight and any tweaks, however small, that you make to the diet. This information will help your dietitian maximise the therapeutic potential of the diet for your child.

We have designed a number of record sheets to help you do this. The information you record will be invaluable when speaking to your dietitian and neurologist.

Printable record sheets included are:

Dietitian Appointments

Seizure Record

Height and Weight Monitoring

Weekly Ketone Monitoring

Diet Tweaks Record

I found it really useful when speaking to our dietitian and neurologist, to have a record of all things diet-related filed together in one handy place - Rebecca.