Practical aspects of Roberta's diet  




Nutritional imbalances rarely manifest themselves in only one deficiency. For us, fine-tuning is a process of translating the ketogenic ratio into wholesome foods, specific supplements, and digestive aids. We have modified the ketogenic diet to suit a fast metaboliser (who needs way more calories) who gets too acidic (and even stress plays a role in that) and whose blood sugar swings are well controlled with low carbohydrate veggies (alkaline, as well) of low glycaemic index.

Variety in the diet

I am appalled at the misinformation about the diet and adults. Many professionals say the diet doesn't work on adults, but the truth is that very few adults have ever been put on the diet. And if their experience resembles mine and Roberta's, those few probably never got very far with it. The diet controls Roberta's fits and her chronic anxiety has vanished. She has a diagnosis of autism spectrum, and we're seeing overall behavioural improvements that are truly spectacular

I have heard Roberta's former neurologist say "the diet is so unhealthy". Roberta has a normal omelette (eggs and cream) for breakfast. She has a whopping tasty salad of mixed greens and low carbohydrate veggies with mayonnaise and a protein allowance of meat/fish/cheese/soy hotdog/tofu for lunch/dinner. A cream soup might be worked into the menu or a frozen cream dessert.  She loves the meals. French triple cream cheeses! Hollandaise sauce! What's not to love? She's very disciplined about avoiding outside stuff because she knows the diet is replacing the drugs, and she's feeling and acting like a new person, and saying so in no uncertain terms.  

The following suggestions reflect my own observations - almost thirty years of grappling with the conundrum of how to feed Roberta.

Roberta gets the right amount of protein of high biological value. And she gets roughage and excellent micro-nutrients from fresh vegetables (mostly raw, including various sprouts) and eggs.

For the purposes of the diet on a day-to-day basis, natural good quality foods are preferable to processed supplements. Omega-6 fatty acids occur very sparingly in nature, but a person eating a wide variety of nuts and green vegetables will be well protected from deficiency. The sardine meal that Roberta eats is adapted from an old family favourite that dates back to my student days in the South of France. A supper that culminated in the consumption of my virginity, began with Salade Tunisienne. I can't duplicate the rich quality of french food as it was in the 1950s, nor can I replicate the recipe (I've omitted the tomatoes and spicy peppers). But Roberta, who is possessed of a respectable palate, gives thumbs up every time to:

A base of mixed, fresh salad greens and cucumber dressed in extra virgin olive oil, pieces of black kalamari or provencal olives, a little chopped onion, chives and basil; small pieces of sardine and/or small pieces of anchovy; the whole topped with a sunny-side up (sprinkle paprika for flavour and potassium on the white of the egg) . She'll polish off a small cup of shaved ice to rinse her mouth. Then iced cream for dessert.

Mono-meals cannot sustain health over time, let alone promote CNS healing and repair. To conform to standard protocol, here's a list of diet suggestions:

Eggs and protein

Eggs are the most biologically available protein. Millie Kelly said it too: use real eggs, not eggbeaters and other processed products of lesser biological value. If you can get eggs from hens that are free-range and not fed antibiotics etc, you're really nourishing a child. Kraft Cream cheese, in comparison, is a rather mediocre nutritional product.

Menu variation number one could be: 40g whole egg 40g 36% cream 19g macadamia nuts (Mauna Loa in bottle) 62g mixed salad veggies (fresh, organic and/or locally grown if possible): mixes of water cress, arugala, radish, daikon, cabbage, cucumber, green and red peppers, endive, fresh herbs, all salad greens etc. 10g pecans, dry roasted, 15g Udo's oil - this blend contains flaxseed oil (omega-3s as in fish), MCT oil, GLA (as in evening primrose oil) and others.

If you hard boil the egg, it can be crumbled into the salad. Add a bit of paprika to the egg, if you like (good trace minerals). Use high quality natural salt with trace minerals and iodine. Pepper, if he likes it. Chop the nuts up with the salad to make it interesting. If he won't eat it, then crumble up a small amount of his favourite cheese - and you may be on your way to (a) damnation as a heretic (b) salvation because he'll eat it, and it's a really nutritious meal! Numbers (without cheese!): ratio: 3.1, calories 558, protein 8.9, fat 54.2, carbohydrate 8.8.

If you use tofu puffs (hinoiche) instead of eggs, the numbers are: 559, 9.4, 54.1 and 8.6 (ratio 3.0). Discuss the foods with him - their nutritional content. Discuss great chefs (who are usually men, treated like gods in France, and paid a lot) Keep that boy happy and healthy and he'll shake the monkey from his back. Bon appetit to us all.

To reduce the acidity of the eggs, use egg whites only. If this is a breakfast meal, use coconut milk and ground almonds instead of orange juice. You'll get more food this way. Orange juice is alkaline, as are virtually all fruits and vegetables, but I believe it's wise to choose foods that are low on the glycaemic index scale. Surely one of the benefits of the ketogenic diet is to keep metabolic processes slow and even and steady, with insulin and glucagon in balance at all times.

The biochemist Barry Sears ("The Zone" and "Mastering the Zone") would say the above is a better choice for promoting good eicosanoids (prostaglandins that engender health and well-being). The biochemist Dr Patricia Kane, who has worked a good deal with autistic and brain injured individuals, would say the fats are better balanced. You might whip up the egg white and cream as an omelette. Serve with cooked zucchini mashed with butter and oil and topped with ground almonds (grind in a coffee grinder). Older children don't have to have the nuts ground up. If you are comfortable with some ‘free lettuce’, you can make a cold salad of lettuce and grated raw zucchini squash as a variant (with butter and sesame oil and almonds all blended together as a dressing).

Cream and butter

Roberta now fills up on as much heavy cream as she wants; has butter with some raw veggies like chilled radishes/cucumber; moderate snacks of fresh nuts (macadamia, pecan, pignola, walnuts, filberts etc - seeds (especially sesame and flax), home made mayo (variety of oils including some MCT oil). Low carbohydrate veggies can be made into delicious cream soups as well, with or without protein, which could be fish or tofu or egg; add fresh herbs; a natural salt with abundant listed trace minerals; small daily seasonings of fresh pepper, ginger; cayenne; turmeric; garlic; paprika etc. etc. Many of these traditional fresh seasonings have valuable nutritional properties.

I wouldn't worry about unpasteurised milk - it's almost impossible to find in any case!

High fat milk: the artificial ‘cream’ from Pacific Foods of Oregon is a forbidden food if you fear aspartame (also contained in Bugs Bunny vitamins). Reported reactions to aspartame, which contains small amounts of methanol (wood alcohol), include fits and migraine headaches. An even more compelling reason not to use artificial cream, however, and certainly never as the principal source of fat in the ketogenic diet, is that nothing is known about use of unsaturated fat (in this case, canola oil) as the primary fat in the diet. Traditionally, the diet has been implemented using saturated fat from heavy cream

By the way, the cream we use is not at all like super market creams. We're fortunate to have a Fresh Fields/Whole Foods Market that stocks The Organic Cow brand from Vermont. The label reads: calories per serving (15ml) 50; calories from fat 50, carbohydrate 0; pure cream, pure fat. It is thick. It is yellow (which means the cows have been eating fresh grass).

The ketogenic diet has been proven using saturated fat or MCT oil. I'd never substitute the Oregon ‘cream’ product, which gets its fat from canola oil. I'd definitely give goat's cream a shot if I could get my hands on some! Evening primrose oil and cod liver oil; or Udo's oil; or Omega Nutrition's sesame oil; grape seed oil; Omega Nutrition's coconut butter are all offered in moderation. Offer your child different choices and he'll choose what is needed. Roberta is doing so well. No sign of the old 'wall-to-wall' complex partial fits that earned her an autistic label.

Personally, I wouldn't stop using butter and cream on the ketogenic diet. Dr Kane uses the following ‘butter’ which she calls ‘better butter’: one half stick of pure high quality (organic if possible) butter (allow to soften at room temperature first) blended with one cup of Omega Nutrition sesame oil and 6 tablespoons of Omega Nutrition coconut butter. (I think I've figured out her reasoning: sesamin inhibits an enzyme that converts certain fatty acids to arachidonic acid). MCT oil is a standard ketogenic diet oil and the fat from which it is derived, coconut milk, could also be used. Remember that the ketogenic diet can be implemented using a wide variety of nutritious foods. Notice that Dr Kane's recommendations can be incorporated into any ketogenic diet program.

If there is an allergy to dairy products, then use coconut milk. By all means make your own from fresh coconuts. Use good quality ghee, preferably your own making A small amount of MCT oil is good for quick energy (it gets metabolised faster). Also, try a small amount of sesame oil (pure; cold pressed).

How about coconut milk with tofu and sesame tahini? Or better yet, blend in fresh whole sesame seeds. Use a variety of nut butters. Dr Kane uses sesame a good deal. She would definitely not approve of the trans fats in margarine.

We make our own keto-tahini with MCT oil (pure, no additives, no orange flavour etc) and fresh sesame seeds blended together. Apart from heavy cream and ghee, we've given up all other oils. French culture - which I love with all my heart - has taught me that the 'restauration' of a meal begins with relaxation and good humour. Roberta won't have our lentils this evening, but she'll have pumpkins for decoration, an organic chicken leg with a sauce of clarified butter and fresh, home-grown oregano, grated raw zucchini squash, a smidgen of carrot, a little grated ginger, broccoli sprouts (I used to sprout all my own sprouts in little containers, but don't do that any more since we have excellent local markets), radish, cucumber, keto-tahini, and heavy cream over shaved ice for dessert. Sparkling Perrier to drink, and Celestial Seasonings Sleepy Time tea as a "digestif". Sante, Sharon, and health to your son.

For breakfast I would try ground almonds with coconut milk (with lightly cooked finely chopped egg whites). This will give a more alkaline start to the day. I subscribe to the notion that our western diet is too acidic. One of the strengths of vegan diets is its alkalinity. (Fruits and vegetables are alkaline). Following this line of thinking, I would limit protein foods to the following: egg whites; tofu; fish (a couple of times a week using a fatty fish like salmon once or tuna a couple of times); occasional chicken. But remember that protein foods are acid.

Other fats

Dr Kane's ‘better butter’ recipe is pure fat, no carbohydrates, no protein. If you use sesame seeds instead of sesame oil, their composition is: per 100g: 563 calories, 18.6 protein, 49.1 fat, 21.6 carbohydrate. Seeds and nuts pack a lot of relevant nutrition for fit patients: excellent minerals and vitamins as well as very interesting fatty acids. Dr Kane generally recommends sesame seeds and sesame oil and also Viobin wheat germ oil. Her treatment of individuals, however, is specific depending upon test results. Dr Kane does not recommend McDonald's fare because of the trans fats in the hydrogenated and partially hydrogenated fats that they use. Nor is frying a healthy practice. It's better to cook meat and fish without added oil. Pure fats and oils contain no carbohydrates at all. If heavy whipping cream is pure it contains no carbohydrates. The consensus I'm finding is that unsaturated fats may be inclined to speed up the brain; whereas saturated fats, particularly cream and butter, have a sedating effect. A half-meal of ketogenic egg nog before bedtime makes a lot of sense to me! Bon appetit from the fat guru.

Sardines are high in omega-3 fatty acids (linolenic acid), not omega-6 (linoleic acid). How smart Marika is to want a sardine meal! Maybe a quarter or a half capsule of evening primrose oil (omega-6) could be added to it for balance.

If you want to use a fish oil supplement, Dr Kane prescribed Max DHA (molecular distilled omega-3 fish oil, 50% DHA and 20% evening primrose oil. This is from Jarrow Formulas.

The goodness of nuts
The fact that Christopher loves macadamia nuts is good news! Christopher is wonderfully intelligent, and he is telling you eloquently and passionately (because his very life depends upon this communication): "I am mal-nourished and hopelessly out of balance. I need nutritious vegetable matter high in essential fatty acids." Give him the freshest nuts you can find. Crack them fresh out of their shells. Feed him what he wants from these key foods: Fresh coconut, sesame seeds, pumpkin seeds, all fresh seeds (introduce as much variety as possible because different foods contain different micro-nutrients; all nuts (fresh and unprocessed) almonds, brazil nuts, pecans, pine nuts etc. A diet of nuts and seeds (be careful that the pieces are not too big in case he might choke) and fruit ( with a low glycaemic index) with egg white and tofu for concentrated protein, seems ideal for Christopher. If the concentrated protein is a problem, forget about it in the short term. There are protein powders made from soy that could be made into a ‘shake’ with cream or baked into ‘pancakes’, but I wouldn't worry about that for the moment. If he's eating a wide variety of nuts and seeds his protein needs will certainly be ok for now. Every meal should contain a wide variety of seeds, nuts, sprouts like alfalfa, mung bean etc (if he'll accept sprouts), fruit (with low glycaemic index) and cream. With or without a few grams of MCT oil. With or without a few grams of Udo's oil. Feel your way into the right number of calories for him; then the right ratio. Shape the diet based on his response. You can't measure what's going on within the cells of the body. You can observe whether Christopher is better or worse. I don't believe you have to be meticulous to the tenth of a gram: weighing is necessary simply because you have to know what you are doing, but I believe there is a fairly broad ketogenic zone for each individual. I believe that the point of the ketogenic diet is that the body makes ketones that penetrate the cells of the brain and CNS thereby repairing damage that was sustained due to one, or a combination of, the following: vaccine induced demyelinisation; nutritional deficiency (exogenous or endogenous); toxic assault from environmental pollutants and heavy metals. I believe that the composition of the ketone bodies - on a subtle level that might be hard to analyse chemically - depends upon what is being ingested. An inadequate diet means inadequate ketones. The macro composition of the cell membrane is saturated fat, amply supplied by pure cream - the tried and true staple of the ketogenic diet. But micro-amounts of essential fatty acids are required to produce the cell's energy. For this reason, the macadamia nut is a god-send on this diet. The bottom line brooks no exception: to function properly the body has to be in nutritional balance. And, of course, all of the above must be predicated upon (a) electrolyte balance (b) capability of assimilating and digesting food and eliminating waste. I believe that natural food sources are better and safer than processed oils and supplements such as Udo's oil or evening primrose oil. You might want to be very conservative in using such oils; and, indeed, any oils at all. Why not try a tiny taste to see what Christopher thinks? Christopher is the ultimate expert. Christopher can be verbal when he gets out of this quagmire he's in, but in the meantime you must communicate with him on his terms - whole body terms. Food is your big love connection. Milk it for all it's worth. Seduce him with the foods. He will tell you he wants.

For snacks I would use celery, cucumber or zucchini squash ‘boats’ with a filling of ground nuts/seeds/butter/chopped egg white or tofu I'd use a wide variety of greens with home-made dressing of oil, herbs and spices. Ginger is alkaline. We make ginger infusions quite often. We drink only mineral water and herbal infusions.

The values I use for sesame seeds (whole) per 100g. are: 563 calories, 18.6 protein, 10.0 fat; 21.6 carbohydrate. Almonds also are incredibly good. They're alkaline and naturally sweet, so good to grind up an incorporate into a cream. The French repertoire contains a paste called amande - almonds are pounded with a little water and butter, then passed through a sieve. Almonds are 598 calories, 18.6 protein, 54.2 fat, 19.5 carbohydrate (per 100g.) I really like oils in their natural state ( ie: before processing) in fresh, organic nuts. The fibre content is so beneficial. The more food is processed, the more its biologic value is diminished.


Bill Milner wrote that bananas are on the diet. Of course! The diet is a set of numbers and ratios. It can be implemented with anything that satisfies the numbers. For example, jello is often included in the ketogenic diet protein calculation. But gelatine is not a complete protein, so we're wasting some of our precious food allotment every time we serve jello. We need to know that the body cannot use incomplete protein. If all the essential amino acids are not present at the same time, the protein ‘count’ is a misleading number. Not all protein is created equal. There was a post from a paediatric dietician. She pointed out that eggs are the optimal protein source for human beings (ie: they supply the most biologically available complete protein). How terrible to read a post to the effect that egg was being avoided because the Freeman/Kelly book warns against frequent use of eggnog! Traditionally, eggnog is made with raw egg hence, particularly on the part of professionals, there's an understandable reluctance to run the risk of salmonella infection. But the ketogenic mix of eggs and cream makes an omelette which is nutritionally far superior to a breakfast of bacon and cream cheese.

Bananas may be great for Uncle Bill's nutritionally correct daiquiris, but why use a high carbohydrate food? Is there actually anyone who does this? It seems to me I've seen posts about using cereals, as well? There is such a small carbohydrate ration on the ketogenic diet that surely we have to make the most of it with the bulkiest low carbohydrate veggies - salads of mixed greens, zucchini, cucumber, celery, green peppers etc. As for potassium, bananas yield 370mg of potassium per 100g edible portion. Pecans are even higher, however, with 392mg., and macadamias yield 368mg. Even beef and pork are not so far behind with 338 mg and 361mg. respectively, and lettuce contains 264mg. Top of the class again, a true ‘ketogenic’ natural, surely easy to mash up for little kids, is the Amazing Avocado! There's a whopping 634mg of potassium in 100g of raw California avocado, and 488mg in the Florida avocado. If we're obliged to restrict the diets of growing children, the least we can do is make every gram count, and then some!

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(update 1.3: 18 July 2002)
(issue : 26 March 1998)