The year is coming to an end and we are all starting to prepare for 2018. In order to kick off the New Year we wanted to ask one of the true experts about some things to help those following a ketogenic diet get through the winter and holiday season. Bobbie Barron is the ketogenic dietitian at the Johns Hopkins Adult Epilepsy Diet Center. She has worked with hundreds of adults beginning and maintaining the ketogenic diet, especially the Modified Atkins Diet. Thanks to Bobbie for sharing some of her wealth of knowledge with us!

We asked our Facebook followers to provide us with some questions so let’s start with some of these questions…

Have you had many patients transition from keto to MAD. If so, is it difficult for them? What are the difficulties with transition?

Our Adult Epilepsy Diet Center was started to help transition the keto kids to the Modified Atkins Diet (MAD) and an adult neurologist once they turned 18. Just like when starting the ketogenic diet, some families have an easier time starting MAD than others. Change is not always easy, but can be totally worth it in the long run. MAD is designed to be a more liberal ketogenic diet, so no need to take a scale with you. Carb counting and portion estimation make eating out much easier. There are no set calorie levels or patient specific menus on MAD, so you can eat more freely. This can be intimidating for families that are used to the structure of a ketogenic diet. Your MAD dietitian can help you lower your ratio gradually and will find other ways to help you transition comfortably.

I am having seizures since starting cancer treatments. Also, I have calcium deficiency and I am anemic. Taking an iron supplement makes me sick. What can I do?

Definitely reach out to your treatment team (which should include a Registered Dietitian Nutritionist) regarding your calcium deficiency and anemia. They will know best how to evaluate and treat you. Keep in mind that good sources of calcium on MAD are canned salmon with the bones, cheese, collards and turnip greens, unsweetened fortified milk substitutes (like almond and coconut milks) and almonds.

Meat, poultry, and fish are great sources of readily absorbable iron. You can increase the absorption of iron from plant foods by adding broccoli or red pepper as a source of vitamin C.

You can also look for iron glycinate on the supplement label; it is generally well tolerated. However, I urge you to have a full workup regarding your anemia if you haven’t already.

Some additional questions from others following the diet:

It’s starting to get cold where I live, are there soups, chili, or stews I can have on MAD?

Definitely! My favorite thing about winter is the hot chow! If buying store-bought soups or at a chain restaurant, look for the carb count on the food label. Make soups at home if you are able. You can’t go wrong with broccoli cheddar, bean-free chili, or a homemade cream of chicken. Start by cooking your aromatics – garlic, celery, carrots, onion (light on the last two or eliminate entirely) in a large scoop of butter, coconut oil, or lard. Add in a carb-free store bought or homemade broth. Add another low carb veg like broccoli, leafy cooking greens, mushrooms, or cabbage. Next add your meat. Cook and then finish it with off with an additional serving of fat from avocado, heavy cream, or more butter.

Are there some MAD friendly appetizers I can take to a party and serve my friends?

My favorite MAD dish to bring to parties is the Keto Sausage Balls found on www.ketosizeme.com. Other good options are shrimp cocktail served with a spicy mayo, buffalo chicken dip, spiced nuts, and veggies with a high fat dip.

 What is a good kitchen gadget to gift someone following a Modified/ketogenic diet?

There are fun kitchen gadgets that are useful for MAD at every price point.

Under $100: An Instant Pot- It is the best way to get dinner on the table, fast! It is an electric pressure cooker with many other features. I like to make pulled pork and serve it with broccoli slaw sautéed in lots of butter. Find it here.

Under $50: A more reasonable gift is a vegetable spiralizer which you can use to make zoodles or zucchini noodles, a great MAD pasta substitute. Find it here.

Stocking stuffer: A great stocking stuffer is an avocado saver. There are many brands in the marketplace. It may only have one purpose and take up valuable kitchen space, but it will be worth it to the avocado fanatics! You know that friend! Find it here.

For adults (21+) following a MAD diet, is there a cocktail they can enjoy at a holiday party?

Choose a liquor-based drink like vodka and soda water with a splash of lemon/lime or rum and diet coke. A MAD friendly eggnog can be made with eggs, cream, spices, and rum. Avoid liqueurs which are made with sugar; think Malibu rum, Bailey’s, Kahlua, Amaretto, etc. I generally recommend avoiding beer, but wine is very reasonable at 4g net carbs per 5 oz. pour!

I love mashed potatoes, what can I use to substitute?

Well, cauliflower, of course! Buy fresh or frozen (which is much more affordable), cook, and blend or mash up with butter, cream, garlic, and parmesan cheese. Delish! I’ve been serving this to my family for 5 years and everyone loves it!

What should I do if I slip up and cheat on my diet?

Though I never recommend a planned “cheat” day or meal, I know temptations are out there and that accidents happens. The best thing is to be prepared in order to avoid temptations in the first place! Bring a MAD friendly dish to parties and check in with the host about the menu. When eating out, browse the menu in advance, make a selection, and stick to it. Consider eating extra low carb during the day if you plan to go to a party to account for unknown carbs.

• If you have accidentally eaten over your carb limit, it may also be beneficial to eat extra fat. You may not see an immediate increase in ketones, but get back on the diet as soon as possible.
• If you are in fact “planning” on cheating (which I never advise), do so in moderation (a bite of cake), not excessively (a whole cake).
• Take any seizure precautions that you normally would if you expect an increase in seizures: have rescue medication on hand, no driving, no swimming alone, and stay well rested.