The ketogenic diet team are proud of their patient centred approach to care and are always happy to trial new products and recipes. This helps them to provide individualised diet plans tailored to the patients’ needs. So why not take this one step further by going fully onto the ketogenic diet?
All 4 dietitians (Vicki, Candy, Leah and Lucy) made the decision to spend 2 weeks on diet and then the wonderful assistants (Lydia and Ellena) also joined in, this was very impressive as they were new into the role.
Preparation
The first step of the challenge was telling the rest of the dietetic team – to stop us from backing out!
Each dietitian made their own plan and mainly used the modified ketogenic diet, both Candy and Lucy also used some MCT products to boost their ketones. Carbohydrate intake averaged at 10-15g daily, with fat between 150-160g. The team used ketone meters to measure their blood ketones and blood sugars twice daily for the duration of the trial.
The team commenced the diet more quickly than they would usually recommend to families, halving their carbohydrate intake on day 1, and going into the full ketogenic diet on day 2.
What went well?
The whole team found the WhatsApp group an invaluable tool in keeping morale up and sharing recipes and ideas. Leah said ‘It was great to share the experience with colleagues and talk about the highs and lows. It would have been much harder to do without that support and encouragement’. It highlighted to the whole team the importance of support for the amazing families who have children on the ketogenic diet, and how important the family days and online forums are.
The whole team enjoyed trying different recipes, Lucy particularly enjoyed using K.Flo in her overnight oats recipe from the Vitaflo website. All of the dietitians were able to be creative with different ingredients, particularly Candy who was able to prepare multiple attractive dishes whilst also cooking for her family! Lydia and Ellena both felt it was a useful experience to help then to develop recipes for keto patients, and to see the products used in practice.
Lucy and Leah started having an iced coffee using the K.Flo vanilla milk, and this was a real high point of the day to keep energy (and fat) up! The team also used some low carbohydrate bread options to try to trial the products that their families would use, although tended to stick with more whole foods.
What was difficult?
The whole team found the lack of spontaneity difficult – when hungry it was not possible to reach for a snack without doing some calculations first. This really showed that preparation was very important.
When weaning onto the diet Vicki experienced multiple hypos, and she said ‘I noticed that I felt shaky and unwell with glucose levels at 2.6-2.9mmol/L, so I do think we need to counsel families about how they may feel and how to manage this.’ However she did note that once blood glucose was stable above 3mmol/L she had good energy levels and was even able to commute to work on her bike as normal!
Getting enough fat in was tough for the whole team, and Lucy felt that rather than trying to put it all into her main meal, it was easier to instead split it over 2 courses (such as having fruit and cream or a K.Yo pot for pudding). Both assistants Lydia and Ellena reported feeling some hunger, but that this could possibly have been due to not hitting their fat target in the day.
Lucy and Vicki both felt that their meals were becoming repetitive and if the diet were to be repeated they would meal plan to prevent this happening. However, as time went on the ketogenic team did feel they could be more adventurous with their recipes – favourites listed below.
As the team were testing ketones and blood sugars twice daily this introduced some healthy competition but it could feel demoralising when ketones came back as low after being very strict! Candy found this frustrating but then introduced some MCT to good effect, Lucy also did the same and had some K.Quik before bed to boost her ketones. All of the team managed to get into ketosis for a period of time, although Vicki achieved the highest ketones of the week at over 4mmol/L!
What surprised you?
The team were all surprised by how they felt when weaning off the diet, Vicki had a bumpy time with hypoglycaemia for the first couple of days. She felt this showed her how important it is to take the ‘slow and steady’ approach when weaning patients who have been on the diet for much longer than 2 weeks.
The team were all surprised about how steady their energy levels were once they achieved ketosis, the ketogenic dietitians are quite active and were able to keep up with their usual cycling, running and climbing whilst on the diet.
Lucy was pleased to be able to take the K.Flo milk to a local coffee shop for an iced coffee! She also attended a festival while on the diet, and was pleased to have been able to bring in her own drinks and snacks to stay in ketosis throughout. She hopes to share with families how their children can still be included in usual activities (maybe with a bit of extra forward planning).
Learning points:
- A lot of planning is required, particularly whilst getting used to things so it is very important to remind families of this prior to starting on the diet.
- Have some low carbohydrate snacks available that are easy to grab when hungry. •
- Weaning off the diet gently is so important to prevent blood sugars dropping and spiking making you feel unwell.
- Support from each other is so important – we will be encouraging families to use family day opportunities for support and to make use of online forums.
- It can be demoralising when ketones are low despite sticking strictly to the plan – a lot of reassurance is needed as this is a process and can take time.
- Using sharper flavours like citrus, pickles and rhubarb can help to cut through the fat and provide different flavours.
- Make sure to stay hydrated, and use carbohydrate allowance for vegetables to keep fibre up!
- Keto families are amazing!
Favourite recipes
- Spicy scrambled tofu with cauliflower rice
- Mushroom and spinach curry
- Steak vegetables and creamy mushroom sauce
- Fajitas with lettuce wraps
- Mozzarrella stuffed chicken breast with creamy pesto sauce
- Steak cooked in garlic butter with asparagus
- Cheese and mushroom omelette
K.Flo/K.Quik/K.Yo are foods for medical purposes and must be used under medical supervision. K.Flo/K.Quik/K.Yo are for the dietary management of epilepsy in the ketogenic diet, Glut1 deficiency syndrome and other conditions requiring a ketogenic diet. K.Flo/K.Quik/K.Yo are suitable from 3 years onwards.
Speak to your healthcare professional for further information including the suitability of the ketogenic diet and recipes.
