For Jewish families trying to follow the dietary restrictions of Passover (which includes avoiding leavened bread and many other foods including corn, rice and flour), sticking with the ketogenic or modified Atkins diet can seem all but impossible. Many of the foods that are traditional during this holiday are very high in high glycemic carbohydrates (e.g. matzoh, potato kugel, charoset (mix of apples, raisins, honey, and nuts)). However, as bread, rice, pasta, and many desserts are not allowed during these 8 days, some families on ketogenic diets may see Passover as a blessing in disguise as these foods are often hidden or removed from the house! There is very little information out there about how to maintain both restrictive diets successfully during this week, but I was able to find and will share with you some helpful tips from patients and from the Internet, many from low-carbohydrate dieting websites.
It certainly is easier to keep to the modified Atkins diet than the full ketogenic diet during this time. Low-carb, Atkins recipes are provided as Internet links at the end of this article which can be adapted for those on the modified Atkins diet (just stick to the carbohydrate count!) and are designed to be used in moderation during Passover. However, even those websites acknowledge that Passover is not easy for people on low carbohydrate diets. Matzoh (one square board) has 24 grams of carbohydrates, matzoh ball has 10 grams/ball, matzoh meal is also high (1/4 cup = 27 grams), and 1 tablespoon of typical charoset has 6 grams of carbohydrates.
Some helpful ideas I’ve heard include using smaller portions of matzoh (e.g. ¼ of a typical board or less) and finding matzoh that is whole grain and thus higher in fiber and digestible carbs. Make matzoh ball soup with only a part of a matzoh ball, or better yet, just eat chicken soup. Make matzoh brie (matzoh and eggs) with more eggs than matzoh. Kugel can be made lower in carbohydrate by using vegetables instead of potato, and I’ve seen recipes incorporating cauliflower, spaghetti squash, spinach, and mushrooms. Charoset can be made without honey or raisins, including relatively more nuts, and using liquid Splenda (see below).
Some traditional Passover meal items are low-carbohydrate by their very nature, including beef brisket, spring vegetables (such as asparagus and spinach), and gefilte fish (2-8 grams of carbohydrates per serving, depending on the product). Equal™, Splenda™, Sweet-N-Low™, and Nutrasweet™, while Kosher, are generally not considered Kosher for Passover as they use powder products to keep it granular, which may be theoretically confused as a leavening agent. Alternatively, you can use any of the 8 flavors of Fruit2O™ (a popular choice on the modified Atkins diet…) to sweeten recipes or try to find liquid artificial sweeteners.
If your child is not on the modified Atkins diet, there may be very little ability to eat matzoh or matzoh-derived products. Beth Zupec-Kania RD, a frequent contributor to epilepsy.com and the Dietitian for The Charlie Foundation, has just added several Kosher for Passover foods such as matzoh, gefilte fish, macaroons, and several other items, predominantly from Manischewitz™ products, into her KetoCalculator™ program (www. ketocalculator.com). If your child is on a less strict version of the ketogenic diet (e.g. ratio 2:1 or lower), there may be some “wiggle room” in the menus to adapt and allow some matzoh. Of course, it may be advisable just to have a small amount of matzoh just during the Seder night meal, but not the rest of Passover week. Check with your physician and dietitian first, of course.
Lastly, of course, Jewish religion dictates that none of these dietary traditions for Passover should be followed if they are deemed unsafe for your health and well-being. You might wish to consult with your Rabbi if you think any of these foods eaten at Passover might be dangerous for seizure control, but feel that you need to eat them. You or your child’s health comes first!
Remember you are not alone; there are lots of good tips out there. Have a wonderful and seizure-free Pesach!