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					   KetoGator Connection
 Volume 8 Issue 2                                                                    May 2005
                                                                   can give it a pudding-like
Inside this Issue                                                  consistency that is nice. You can
⇒ Kelly Talks Keto                   Kelly Talks                   use a whip or
                                                                   electric mixer and
⇒ ABC’s of Ketogenic
   Therapy                              Keto                       whip the cream,
                                                                   rather than offering
⇒ Necta-Sweet                                                      it as a drink.
   Saccharin Tablets                                               Adding a small
⇒ KetoGators go to                                                 amount of diet soda to the cream
                                                                   can be fun, too. It tastes like an
   ASPEN                                                           ice cream float, and is sometimes
⇒ Interview with a Keto                                            the easiest way to get kids to
   Patient’s Sister                                                drink the cream. Cream can also
⇒ Keto Therapy Around               Following ketogenic therapy be frozen with a small amount of
                                                                   oil, some calculated Jell-O, and a
   the World                   for long periods of time can be
                               difficult and using creativity in   little diet soda to make a
                               the meals may make it more          popsicle. Just baking the eggnog
                               enjoyable. I have a number of       recipe with sweetener and extract
                               ideas that have been given to me in a water bath at 325 degrees
                               by parents over the years, and I    until firm makes a nice dessert-
   Shands Hospital             thought I would share some of       like meal that can be convenient,
 Ketogenic Therapy them with you.                                  especially when traveling. This
                                    Cream can be used in meals is sometimes easier to get down
            Team               in a number of different ways.      than eggnog, especially when
Pediatric Neurologist:         Try whipping it with sweetener      your child is sick.
                               and extract and then putting it in        Soups are great when your
Paul R. Carney, M.D.                                               child is sick and are an easy way
                               the freezer until it is almost
Registered Dietitian:          frozen. At that time canola oil     to provide some variety. Using a
                               can be whipped into the cream       meat and vegetable recipe, heat
Kelly Winger, R.D.
                                                before it is       the cream with a little water and
Nurse Practitioners:                            refrozen.          add diced meat and vegetables
Debbie Ringdahl, ARNP, M.S.N.                   Approximately 1 (weigh cream, butter, meat and
                                                gram of canola     vegetables before preparing).
Christie Snively, ARNP, M.S.N.                  oil can be mixed Mix the butter into the soup and
Research Coordinator:          into 1½ grams of cream. If you      stir until melted. Use a tiny
                               try to mix in more oil than that it pinch of seasonings for flavor.
Peggy Borum, Ph.D.                                                       Cheese soup or cheese sauce
                               tends to separate out. Using a
                               milkshake mixer to whip the         may be made with a recipe
                               cream with sweetener and extract containing cream, butter and
                                       KetoGator Connection                                                  2
cheese. The sauce can be spread                                             child. This may be helpful

                                            ABC’s of
over meat and vegetables or used                                            information because it might
for dipping, or vegetables and                                              allow you to predict whether he

                                            Ketogenic
meat can be mixed in a thinned                                              or she may have more seizures in
down sauce for cheese soup.                                                 a day and also notify you if diet
                  Weigh all                                                 adjustments need to be made to
                  ingredients first,
                  and then mix               Therapy                        keep your child in ketosis.
                                                                            Ketones are a byproduct of
                  butter and cream                (Part 2 of 3)             ketosis, which generally means
                  together over a                                           that if your child is metabolizing
                  low heat. Add        Jell-O                               fat their ketones will be higher
grated cheese and stir until                                                and they will have more seizure
smooth.                                If your                              control, hence the basis of
     Oil may be mixed with any         child’s                              ketogenic therapy.
sauce or stirred in with               snacks are
mayonnaise or ketchup. Try             lacking some flavor then sugar       Labs
mixing oil into applesauce or          free Jell-O might be a great idea.
tomato juice. Both butter and oil      Beware however, that even            Getting lab work done at clinic is
mix well in scrambled eggs.            though the box says sugar free       a vital component of ketogenic
Frying vegetables can hide some        there is still carbohydrate in the   therapy. Labs tell the clinic staff
of the fat, just be sure that your     Jell-O powder. Consult with          all the things that they cannot see
child gets their full fat allotment    your dietitian on how to             from just
if you fry. Any oil that is not        incorporate the flavoring into a     observing
incorporated into the fried food       tasty snack. One idea is to add      your child
must be added to the rest of the       some to heavy whipping cream         briefly,
meal. Brussel sprouts and              and then freeze. KetoGators have     such as
cabbage                                experimented with this by using      whether they are lacking certain
both sop oil                           Strawberry Jell-O. These tasted      nutrients or getting too much of a
up well.                               like strawberry creamsicles. Of      certain fat. Often the clinic staff
                                       course you have many other           will adjust your child’s
     Remember to use your              flavors to choose from including     supplements and meal
creativity to make this diet more      cherry, lemon, orange, peach and     equivalents based on their labs.
fun. Hide the fat in the food,         wild berry.                          Lab work should be done every
when possible, to make meals                                                time your child comes into clinic
more enjoyable. Create fun             Ketones                              or every six months.
designs with food and spread
food out on the plate to make it       It is important to check your
more appealing. Send in your           child’s ketones daily, especially
ideas for making keto meals            if they have experienced
more fun. We’ll share them with        increased seizures for that day.     Meal equivalents
others.                                By recording your child’s
     In our next installment I will    ketones and seizures in their        Meal equivalents are the
discuss with you the option of         daily diaries the KetoGator team     “recipes” for the ketogenic diet.
making your own meals for your         will be able to see if there is a    It is important not to feed your
child.                                 correlation between low ketones      child a recipe unless it is in the
Kelly Winger RD                        and increased seizures for your
                                  KetoGator Connection                                                 3
meal equivalent form, which is in polyunsaturated fatty acids.         protein. It can be thought of in
why the KetoGator always insists Saturated fats, found in meat,        this simple equation: fat :
you contact your dietitian before butter and whole milk and trans-     carbohydrates + protein. Often
administering any of the recipes fatty acids found in many             your dietitian will try to
we include in the newsletter. All commercially baked goods, can        manipulate the ratio to gain
food needs to be weighed to the    increase LDL cholesterol and        better seizure control. When the
nearest tenth of a gram due to the total cholesterol. If your child    ratio goes up it means that your
specificity of the diet. The       has high cholesterol lab values it  child will receive more fat and
KetoGators are currently           might be helpful to discuss with    less carbohydrates plus protein,
working on a drug database so      your dietitian some oil             which is why it is important to
that eventually your child’s       alternatives.                       make sure your child is receiving
medications can also be added to                                       adequate protein whenever their
their meal equivalents.            Preparation                         diet ratio is changed. A higher
                                                                       ratio can mean more rigidity in
Newsletter                           Being prepared ahead of time      their meals and less room for
                                     can be helpful in many aspects of things like vegetables and fruits.
The KetoGator Connection can         ketogenic therapy. One example
be a valuable resource for           is to make more than one meal at Janeen Alidina
patients and                         a time and to refrigerate them.
their family                         Preparations for clinic can also
members on
the diet.
                                     help to save time. Knowing what
                                     prescriptions need to be refilled  Necta-Sweet
                                                                        Saccharin
Often the newsletter contains        for your child and having their
tips and hints for aspects of the    daily diaries are some examples.
diet, such hiding fat in your        The KetoGator team will always
child’s meals and traveling with be willing to help out with any
ketogenic meals. If you have         preparations that might be
                                                                        Tablets
ideas for articles or would like to helpful to you, such as blank
see something researched and         daily diary sheets and clinic
then written about the KetoGator appointment reminder cards.
Connection please feel free to
contact us at prb@ufl.edu. And       Question
of course, feedback is always
welcome at clinic.                   Going along with preparations, it
                                     might be helpful for you to            NSI Sweeteners’ Necta-
Oil                                  prepare a list of questions and   Sweet tablets are Keto-friendly
                                     concerns to bring to clinic. This artificial sweetener tablets made
Because fat is such a major          can make clinic visits more       from saccharin. Saccharin is an
component of the ketogenic diet efficient and ensure that you          artificial sweetener that may be
oil is often a large part of         have all of your child’s needs    up to 700 times as sweet as
ketogenic meals. It is important     addressed at that time.           sugar.
to note however, that not all oil is Ratio
the same. Olive oil is made up of                                           Necta-Sweet tablets are
primarily monounsaturated fatty Your child’s diet ratio is a ratio available in three sizes: ¼-grain,
acids, while vegetable oil is high of fat to carbohydrates plus        ½-grain, and 1-grain tablets. The
                                                                       “size” of the tablet defines its
                                   KetoGator Connection                                               4
sweetness as described in the      to flavor drinks, milkshakes, or   this data by looking through all
table below. The different sizes   Keto Ice Cream.                    of our previous newsletters and
are available in color-coded                                          cataloging the number and types
bottles making them easy to            The tablets are available at   of articles we have written. For
locate at the grocery store.      local grocery stores, such as       example, we found that there
                                  Publix, or can be ordered online have been 52 articles that have
Tablet      Sweetness Bottle      from websites such as               been written to provide tips and
size                      Cap     “walgreens.com.” A bottle of        hints to our families and there
                          Color   1000 tablets typically costs        have been 47 recipes provided.
¼-grain 1 tsp sugar Red           around $2-$5, depending on the After compiling all of this
½-grain 2 tsp sugar Blue          store and the tablet size.          information together, we used
1-grain 4 tsp sugar Green                                             Microsoft Powerpoint to make
                                  As with any new food product, if the 3 x 5 foot poster. The
Necta-Sweet tablets have no       you are interested in               purpose of the poster was to
nutritive value. Each tablet,     incorporating Necta-Sweet           show others how our Ketogenic
regardless of size, has the       tablets into your child’s           Therapy program tries to
following nutrition facts:        Ketogenic diet, consult with your improve the administration of the
                                  dietitian before doing so.          diet and to help others do the
0 g carbohydrate                  Julie Lawson                        same.
0 g protein                                                                Not only did we learn that
0 g fat                                                               there was a substantial amount of

      The tablets do not contain
                                   KetoGators                         people interested in Ketogenic
                                                                      Therapy, but we also met some
dextrose or maltodextrin,
carbohydrate fillers commonly      go to ASPEN                        of the doctors, nurse
                                                                                        practitioners,
found in other artificial                                                               and dietitians
sweeteners such as granular          Recently in February three                         from all over the
Sweet N’ Low packets, Equal       members of the KetoGator team                         country that had
packets, and Splenda packets.     and Dr. Peggy Borum presented                         their own
The tablets’ lack of carbohydrate a scientific poster at the                            Ketogenic
fillers makes them ideal for      American Society for Parenteral     Therapy programs. We met one
Ketogenic Therapy patients, who and Enteral Nutrition (ASPEN)         nurse practitioner that was
may be sensitive to small         Conference at the Gaylord Palms interested in starting a program
amounts of carbohydrate present Conference Center in Orlando,         at the University of Virginia and
in other artificial sweeteners.   FL. ASPEN is a national group, we also met another dietitian
                                  dedicated to exploring the          who was part of an 80-patient
                                  different ways of providing         program in Canada. After
                                  nutrition. Janeen Alidina, Parin discussing our poster with them,
                                  Chheda, and Pruthu Patel,           we gave them our website
                                  constructed a poster about the      address
                                  KetoGator Connection, its           (http://borum.ifas.ufl.edu) so that
      Necta-Sweet tablets can be  contents over the past eight        they could take advantage of our
used in cooking and baking        years, and its goals on improving Food and Drug Databases, Meal
without losing sweetness. They    the quality of life of our patients Equivalent templates, and all of
dissolve quickly in both hot and and their families. We obtained the issues of the KetoGator
cold beverages and may be used                                        Connection.
                                     KetoGator Connection                                              5
                                     supervision. Now I make both       now I am more confident.
Parin Chheda                         oral feedings and tube feedings.   Also I feel great helping out my
                                                                        parents because I know they get

 Interview                           3. What are some of the steps
                                     you would recommend taking
                                     before making a meal?
                                                                        tired from working all day.

                                                                        7. What do your friends and
   with                                   Firstly, I take out all the
                                     ingredients and the meal recipe
                                                                        family say when they see you
                                                                        making meals?

  Natasha                            sheet. When I start weighing
                                     each individual ingredient, I
                                                                             When my friends or family
                                                                        ask, I tell them I’m making

 Armstrong
                                     always put                         Quade’s special food to help
                                     everything away                    with his seizures.
                                     as soon as I
     Recently at clinic, the         finish weighing                    8. What kind of impact has this
KetoGators had the pleasure of       to save space and                  experience had on your life?
meeting Natasha Armstrong who        make sure I don’t accidentally         It has had a lot of impact on
is the older sister of Quade         add an ingredient again. I also    my life; it makes me learn about
Armstrong, an eight year old         weigh each item in separate        what patients go through while
patient receiving Ketogenic          containers before mixing because   on Ketogenic Therapy.
Therapy. Like many siblings,         sometimes the scale cannot
fourteen year old Natasha helps      weigh greater than 400 grams.   9. In addition to making meals
out her parents with various tasks                                   for Quade, what other
in the household. One of the     4. What are some of the             activities do you do with him?
tasks we were most excited to    challenges you face while                I usually lay on the floor
hear about was Natasha making    making a meal?                      with him and play with toys with
meals and formulas for her            One of my biggest              him. Sometimes I dress him and
younger brother. We had the      challenges is measuring each        do his tube feedings. Also, I
                                                    th
opportunity to conduct a brief   ingredient to a 10 of a gram. I     sometimes watch him for a short
interview with Natasha during    think it is very hard getting the   time while my parents run an
clinic.                          exact amount and it takes a lot of errand.
                                 patience.
1. When did you start making                                         Natasha is currently in her first
meals?                           5. How long does it take you to year at Hamilton County High
    A few months after my little make a meal?                        School. She
brother started the Ketogenic         When I first started it use to has two dogs,
Diet, when I was 13 years old.   take an hour to make a meal but one cat, and
                                 now it takes about 30 minutes.      two fish. Her
2. How did you learn how to                                          dogs’ names are Russell and
make meals?                      6. What is some advice you can Paxton and her cat’s name is
    I first watched my mother    give to other siblings who have Smokey. She spends her free
make the meals and soon I was    brother or sisters on the diet?     time playing ball with her dogs.
making meals by myself while          I would say to them to watch In the future, Natasha hopes to
my mom supervised. Gradually,    you parents and if you think you become an animal
I was able to make meals without can do it, do it. In the beginning conservationist protecting
                                 I was nervous at messing up, but
                                  KetoGator Connection                                                6
various endangered species like    therapy. In Italy, it is difficult   Use of the Ketogenic Diet.
jaguars and cheetahs.              for patients to avoid customary      Epilepsia 46(2): 280-289.
                                   foods like pasta and bread. In
Pruthu Patel                       France, it is necessary for the       Kirsten Madsen
                                   patient to restrain from eating

Ketogenic
                                   pastries, a cultural norm. In
                                   Israel, religious and kosher
                                   reasons prohibit the consumption
                                                                         Fun Summer 
Therapy                            of meat and milk together, so
                                   patients will eat milk with fish,        Meals 
Around the                         but not with meat. Also, if the
                                   patient’s father is a Cohen (of the   A new twist on bacon: 
World                              priest class), he cannot enter a
                                   building where dead bodies
                                   reside, therefore patient initiation         Bacon and
The
ketogenic
                                   must be done at home, not in the           Strawberries
                                   hospital. Ghee is a fat blend
diet has                           used in the diets of patients in
been                               India, while Germans eat a great
gaining                            deal of bratwurst, sauerkraut, and
widespread acceptance since        grape-seed oil. Saudi Arabian
1995, and in the United States     patients have difficulties finding           Oscar Meyer Bacon
there are over 80 centers that     medications that can be used              Heavy Whipping Cream
offer the therapy. Similarly, the with the therapy, since virtually
                                                                                 Big Valley Frozen
treatment’s popularity has been    all antiepileptic drugs and                     Strawberries
increasing worldwide.              vitamins contain carbohydrates.                  Canola Oil
Currently, approximately 40        Lastly, in Asia it is difficult for          Sweet Cream Butter
countries, which mostly reside in patients to give up eating rice
                                                                          McCormick Imitation Vanilla
the United States, Europe, and     and noodles, which are staple                      Extract
Asia, have ketogenic therapy       foods. Cultural differences
programs. There are very few       slightly                              Preparation: Cook bacon and
centers in Africa and Central      affect the diet                       weigh. Spread butter over
America, yet there is a growing    throughout                            bacon. Whip cream gently
interest in the treatment. Each    the world;                            while adding oil. Add all of
country has a differing culture    however                               the vanilla to the cream to add
that slightly changes the way the many factors remain the same           flavor. Serve the cream on the
therapy is viewed and              such as the types of foods used       side or as a frozen treat. Mix
administered.                      and the success rates.                strawberries in with cream or
     In Brazil, patients have           For more information on the      serve on the side.
trouble finding electric scales to status of the ketogenic therapy
weigh foods, MCT oil is very       throughout the world, visit
expensive, and it is customary to http://www.neuro.jhmi.edu/Epile
eat four meals a day. This has an psy/Peds/ketoworldwide.htm.
impact on the ease of              Information for this article was
administration                     taken from: Kossoff, K.,
of the diet                        McGrogan, J., 2005. Worldwide
                                 KetoGator Connection                                                7
                                  Preparation: Cook hotdog and                Sabrina Khouri
      Bacon and                   weigh and then cut into bite-                 Julie Lawson
       Peaches                    sized pieces. Spread butter
                                                                                Ashley Olsen
                                                                                Pruthu Patel
                                  over hotdog. Whip cream                     Benjamin Porras
                                  gently while adding oil. Serve              Sydnor Richkind
Bryan Sweet Hickory Smoked                                                      Brynn Wilson
                                  on the side or as a frozen treat.
           Bacon
                                  Serve applesauce on the side.
   Heavy Whipping Cream
Del Monte Lite Sliced Peaches
                                   Hamburger and
                                                                      Please send any questions or
       Vegetable Oil
                                                                      ideas that you may have to:
     Sweet Cream Butter
McCormick Imitation Vanilla         Sweet Peas                        Peggy R. Borum, PhD
                                                                      409 FSHN
           Extract
                                                                      P. O. Box 110370
                                      Ground Beef Sirloin             University of Florida
Preparation: Cook bacon and          Heavy Whipping Cream             Gainesville, FL 32611-0370
weigh. Spread butter on bacon       Canned Green Sweet Peas           Or e-mail us at prb@ufl.edu
and serve. Drain peaches,                    Butter
weigh and set aside. Whip                Vegetable Oil
cream gently while adding oil.      McCormick Vanilla Extract,        Be sure to check
Add all of the vanilla to the
cream to add flavor. Add
                                            Imitation                 out our new and
                                          Black Pepper
drained peaches to cream and                   Salt                   expanding website!
serve on the side or serve
                                                                      http://borum.ifas.ufl.edu
peaches as a side for bacon.     Preparation: Form meat into a
                                 patty and cook in oil in a
                                 nonstick pan. Sprinkle salt and
                                 pepper on top of the patty.
                                 Spread butter over meat.
Is the Family Having a           Microwave or cook peas on top
Cook‐Out?:                       of the stove. Spread remaining       On the next two pages you
                                 butter over peas and serve next to   will find some activities.
   Hotdog and
                                 hamburger patty. Whip cream
                                 gently while adding remaining
                                                                      Also on the last page is the
                                                                      next installment of the
   Applesauce                    oil and vanilla extract. Serve on
                                 the side or as a frozen treat.       Ketogenic Sibling Series,
                                                                      “What to do, Little Sue.”
  Oscar Mayer Beef Franks
   Heavy Whipping Cream
Mott’s Natural Applesauce (no
        sugar added)                        KetoGator
  Sweet Cream Buttermilk                  Connection Staff:
         Canola Oil
 McCormick Vanilla Extract,                Janeen Alidina
          Imitation                         Laura Chan
                                           Parin Chheda
                                          Keshia Ferguson
                                            Jonathan Ip
          KetoGator Connection           8
Match the baby animal with its mother.
     Color in the blank pictures
KetoGator Connection   9

				
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Description: Ethan Frome Cherry Extract