The season that brings us Hanukah, Christmas, and Kwanzaa is filled with festivities, celebrations, and the traditional exchange of sweets. But the holidays can be a challenge for those on the ketogenic diet.

Many of us are tempted by rich foods and even richer desserts. Most of us will succumb to calorie-laden cakes and pies by telling ourselves: “It’s the holiday and I’ll diet after the New Year.” But those with specific restrictions on the ketogenic diet are not able to indulge because sweets can be harmful and lead to seizure breakthroughs for some.

Used as a method for managing seizures, the high-fat, low-carbohydrate ketogenic diet incorporates whipping cream, butter, and vegetable fats into the menus. However, these must be monitored by a physician and all food must be carefully prepared and weighed on a gram scale. Though the modified Atkins diet is less restrictive, the typical holiday foods can still be very problematic.

Carbohydrate-rich foods found at the holidays are virtually eliminated from the ketogenic diet. If a child consumes even a small amount, it could upset the metabolic balance that the diet creates and cause a seizure.

The Holiday Challenge

Just as birthdays and Halloween can be difficult for children on the ketogenic diet, Hanukah, Christmas and Kwanzaa are an even greater challenge because they span more than a single day. It seems as if the entire month of December is a swirl of candy canes, chocolates, cakes, cookies, and pies.

The best advice is to have a child bring their own low-carb treats to holiday parties at friends’ houses, and make sure gatherings at relative's homes have plenty of ketogenic diet friendly foods,” according to Eric Kossoff, MD, Pediatric Epileptologist, Johns Hopkins Hospital. “We also recommend parents leave holiday cookies and cakes given to them as gifts at the workplace to avoid tempting their children at home.

Dr. Kossoff, who writes a monthly feature about the Ketogenic diet for epilepsy.com added: "Similar to other holidays, parents should try hard to make treats and presents small toys or gifts, rather than cookies or chocolates."

According to Beth Zupec-Kania, RD, CD, Ketogenic Diet Coordinator, Children's Hospital of Wisconsin, “Fortunately for young children – despite the strictness of the diet – they seem to adapt. But teenagers often find it difficult to follow. New research is exploring the use of more liberal low-carbohydrate-diets for older children and adults,” she said.

Beth is also associated with The Charlie Foundation, which was established in 1994 to raise awareness about the ketogenic diet as a treatment for childhood epilepsy. The Foundation's role is to facilitate investigation, educate professionals, and inform families about the current status of the ketogenic diet (www.charliefoundation.org).

Beth encourages menu plans that can be shared by the entire family. Whatever holiday or festive occasions celebrate in the upcoming month, the dinners suggested here are healthy, and supportive of a child with epilepsy.

Bon Appetit!

Here are three suggestions for holiday meals that incorporate a ketogenic diet menu:

A Hanukah Menu

• Zucchini Leek Soup
• Peppered Beef Brisket
• Carrot (or shredded cauliflower) Latkes
• Chocolate candy (see below) made into coins (gelt)

A Christmas Menu

• Smoked Ham
• Spinach Soufflé
• Baked Onions with Sour Cream
• Crème Brulee

Kwanzaa Menu

• Roast Beef
• Tomato Avocado Soup
• Buttered Winter Squash

Recipes

Dr. Kossoff asked several patients and the Matthew’s Friends ketogenic support group for holiday recipes that are ketogenic or Atkins friendly. Here are some recipes (with photos) to share!

Keto Chocolate Candy
50 kcals, 4:1 (provided by Beth Zupec-Kania)

Ingredients:

• 2.0 gm Hershey's Cocoa (unsweetened cocoa for baking)
• 6.0 gm Butter
• Liquid Saccharine sweetener

Instructions:

• Soften butter at room temperature.
• With the back of a metal spoon, mix cocoa powder into butter.
• Stir in 10 drops of liquid saccharine sweetener.
• Use a spatula to form the mixture into 1 or 2 mounds onto waxed paper.
• Freeze until firm.
• Serve cold to maintain firmness.

Yield:
Makes one serving that may be shaped in a candy mold.

Fairly Low-Carb Coconut Carob Chip Cookies
(From Colorado)

Ingredients:

• 1 c. butter
• 1 c. xylitol
• 1 egg
• 1 TBSP heavy whipping cream
• 1/2 tsp sea salt
• 1/2 tsp baking soda
• 1 tsp vanilla
• 1 c. almond flour
• 1 c. whole wheat flour
• 1 c. unsweetened shredded coconut
• 1 c. unsweetened carob chips

Instructions:

Mix together until cookie dough textures
Drop by spoonfuls onto a Teflon cookie sheet
Bake at 375 degrees for 10-11 minutes

Pumpkin Pecan Cheesecake
(reproduced from Atkins for Life™)
10 grams of carbohydrates

Crust:

• 1 1/2 cups pecans, finely chopped
• 1 tbs Splenda
• 1/2 tsp ground cinnamon
• 2 tbs unsalted butter, melted
• 1 large egg white

Filling:

• 3 (8-ounce) packages cream cheese, softened
• 2/3 cup Splenda
• 1 cup heavy cream
• 1 (15-ounce) can pumpkin puree
• 1 tsp vanilla extract
• 1 tsp pumpkin pie spice
• 3 large eggs

Instructions:

For Crust: Heat oven 350 degrees. Combine pecans, Splenda and cinnamon in a food processor. Process until finely ground. Toss with butter and egg white; press onto bottom of a 9-inch pan, rounding up to cover the pan seam. Bake until golden and set, 8 - 10 minutes. Cool completely on wire rack.

For filling: Reduce oven to 325 degrees. Combine cream cheese, Splenda and cream in a large bowl. Beat until smooth with an electric mixer at medium speed. Add pumpkin puree, vanilla and pumpkin pie spice, mixing to combine. Beat in eggs, one at a time, just until combined.

Pour batter over crust. Bake until just set, 45 - 50 minutes. Turn off oven and let stand for 10 minutes; transfer to wire rack and cool completely. Cover and refrigerate until chilled, 4 hours or over night.

Classical Christmas Muffins
(from England)

Ingredients:

• Ground Almonds (you could use a mix of Ground Almonds and Ketocal)
• Egg
• Butter
• Sweetener
• Sugar Free Flavoring – i.e. vanilla essence
• Cranberries
• Small pinch of mixed spice

Instructions:

Whisk all ingredients together, EXCEPT THE CRANBERRIES. Put your mix in the case then the put the weighed out cranberries on top and bake in a moderate oven as you would a normal sponge cake, until firm to the touch.

Tips:

1. Using a mix of ground almonds and Ketocal gives an extra lightness to the mix and if you use the Vanilla Ketocal – also helps give a lovely flavor.
2. If you have a lot of egg in the mix, which is making the cake more like a batter mixture, then you could replace some of the egg with a protein powder (your dietitian can recommend this).
3. If you have a lot of butter in the mixture, then reduce the amount you put in the mix and then cut the muffin in half after it is cooked and spread the rest of the butter in the muffin. You could even sweeten/color the butter and put it on top like a form of icing – similar to a cup cake.
4. When you have cooked your muffins allow them to cool in the tin, as any fat that may have come out of the muffin will soak back in. Parents have also lined their tins with tin foil to make sure none of the fat is soaked up by paper cases as well.

Santa’s Sleigh and a Chocolate Yule Log!
(from England)

Adapted from the Muffin Recipe

Adapt the above Muffin Recipe – take out the mixed spice and cranberries and add in some cocoa powder – that will dress up your cake!!! This is a favorite at Christmas time with one of our kids – it is the same chocolate cake recipe he has all year – but when it is transformed into Santa’s Sleigh – somehow it just tastes a whole lot better and it is especially for him!

Cook it in a Swiss roll tin lined with baking parchment. When cooked, take it out and let it cool slightly and then roll it using a fresh piece of baking parchment and let it cool completely.

Weigh the whole thing and then divide into your number of meals so that each piece weighs the same.

Christmas Cookies
(from England)

Ingredients:

• Ground Almonds (or mix of ground almonds and ketocal)
• Coconut oil or butter (using butter will make them more crumbly)
• Egg
• Desiccated coconut
• Pinch of mixed spice

Instructions:

Mix all the ingredients together until they are well combined. Divide into the number of cookies you want, put them onto baking parchment on a baking tray and bake for 10 minutes at about 180°C.

Some of the fat WILL seep out. Don't worry. Leave them on the baking parchment to cool and move them gently back and forth to absorb the fat back in.

When they are completely cool, wrap in small squares of foil and freeze in sealed freezer bag. You can have different flavors if you want to use other sugar free flavorings and essences. For example, you can calculate in some cocoa powder and also use come orange essence for a ‘chocolate orange’ cookie!

ENJOY! And please share your recipes with us, so that we can share them with others!

Rita Watson, 11/28/2006 and updated on 12/06/07

Edited by Steven C. Schachter, MD