-Ketogenic Diet
TEAM EDITOR IN-CHIEF/ BANSARI RAO CO- EDITORS / SONU MISHRA, DR. DVIJ MEHTA WEBSITE / NUTRITIONINSIGHTS.IN CONTRIBUTORS / DR. ANAGHA PALEKAR/ DR. SONAL SHAH/MS. ROSHAN KORE/ HITHA BHANKHARIA/ FAGUN GANDHI/ RUCHITA MAHESHWARI/ HETALI TRIVEDI/ RABIA MISTRY MULLA/ POOJA JAGIASI
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contents 06
PROS & CONS - KETOGENIC DIET By - Dr. Anagha Palekar
12
RESEARCH ARTICLES
14
THE KETO KID PROJECT By - Ms. Roshan Kore
04
KETOGENIC DIET IN EPILEPTIC CHILDREN By - Dr. Sonal Shah
09
KETOGENIC DIET - MYTH BUSTER By - Hitha Bhankharia
17
RECIPES
KETOGENIC DIET IN EPILEPTIC CHILDREN BY- DR. SONAL SHAH MD PEDIATRICS ADDITIONAL PROFESSOR, PEDIATRICS, MP SHAH MEDICAL COLLEGE , JAMNAGAR
Epilepsy is defined as two or more unprovoked seizures 24 hours apart. First unprovoked seizure if it has high chance of recurrence due to certain risk factors like positive birth history, family history, developmental delay etc. is also defined as epilepsy. Epileptic seizures are due to excessive ,synchronous discharges from neurons of the brain. Epilepsy depending on the semiology is classified in mainly two groups. Focal seizures ,which arise from one part of the brain and generalized seizures which arise from both the hemisphere. The seizures can be tonic, clonic,myoclonic, atonic or absence seizure depending on their semiology. Most of the epilepsies are well controlled with one or two drugs. But still there are 30% of patients who develop refractory seizures. Refractory seizures are defined as seizures which do not respond to two
or more appropriately chosen dugs given in right dose and for appropriate duration. So in this scenario there is a need for alternative methods of treatment like surgical management, vagal nerve stimulation, ketogenic diet etc. Ketogenic diet which is high fat, low carbohydrates gives promising results in control of refractory epilepsies like tuberous sclerosis,dravet syndrome, west syndrome, rett syndrome, doose syndrome, GLUT-1 deficiency etc. Exact mechanism how ketogenic diet works in control of refractory epilepsy is not known .Ketogenic diet has fat as the primary fuel for metabolism instead of glucose. Ketogenic diet alters the nature and degree of energy metabolism in the brain, thereby decrease neuronal excitability and dampen epileptiform discharges. Ketgenic diet induces changes in neurotransmitter function , thereby WWW.NUTRITIONINSIGHTS.IN | 04
reduces excitatory neurotransmission, which helps in control of epilepsy. Ketogenic diet is an oldest form of the diet tried in children with epilepsy. It is a high fat, low carbohydrate diet. There are different versions of it like classic KD, modified Atkins diet, low glycemic index diet. But the principle remains the same. Ketogenic diet therapy should be adapted to cultural diversity and patient’s taste and need. Ketogenic diet must be tried in following patients with refractory epilepsy. (1) Patients who have failed to respond to two or three combinations of drugs and develop many side effects. (2) The patients in whom surgery for refractory epilepsy is not possible. Over half of children who go on the diet have at least 50% reduction in number of seizures. Some 10 to 15% children can become seizure free. In some children the dose of antiepileptic medicines can be reduced , so many side effects are avoided. When the diet is started child is admitted in hospital for monitoring. Regular dose of anti epileptic drugs is to be continued. All medications which are in sugar based syrup forms should be changed to tablet forms. Because the diet does not provide all the vitamins and minerals found in balanced diet all vitamins and mineral supplements like calcium, vitamin D .vitamin E, vitamin B complex,selenium should be supplemented. It is safe to continue all antiepileptic drugs while child
is on ketogenic diet except Zonisamide which can cause kidney stones in children who are on ketogenic diet. Child is examined every three months for growth monitoring, compliance, and seizure frequency. To get the maximum benefit the diet should be continued for minimum 2 years. If the seizures are well controlled for 2 years ,the child is gradually weaned off the diet over several months or even longer.Child can have increased frequency of seizures if it is stopped suddenly. Ketogenic diet is not a physiological diet, so can have many side effects like dehydration, hypoglycemia,, lethargy, metabolic acidosis and gastro intestinal symptoms. Most common side effects are weight loss ,high LDL, elevated cholesterol, constipation, diarrhea, vomiting and abdominal pain. It is contraindicated in certain conditions like primary carnitine deficiency, beta oxidation defects etc. For some patients it is very difficult to maintain compliance, sometimes child can have increased frequency of seizure by skipping just one meal. Ketogenic diet is an excellent option for children with pharmaco resistant epilepsy in whom surgical option is not possible. It is particularly effective in patients with tuberous sclerosis, dravet syndrome, west syndrome, lenouxgestaut syndrome, doose syndrome. It is cost effective, not so difficult to follow treatment with less side effects compared to multiple anti epileptic drug combinations.
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PROS & CONS Ketogenic Diet By: Dr. Anagha Palekar (Ph.D , RD, CDE)
Ketogenic diet is one of the most tried and researched diet for a range of clinical disorders. It is an established therapeutic option for treatment of intractable epilepsy. It remains popular to induce rapid weight loss in individuals with obesity and other metabolic disorders. Ketogenic diets consist of high fat, adequate protein and very low carbohydrate diet. It originated in 1921 when Woodyatt and Wilder established that ketones, acetone and betahydroxybutyric acid were observed in healthy individuals with diet containing high proportion of fat and very low proportion of carbohydrates and were effective in treatment of Epilepsy. The classic Ketogenic diet consists of total carbohydrate intake of less than 10-15 gm per day. This diet maintains a fixed ratio of fat to combined carbohydrates and protein to 3:1 or 4:1 amounting to 6% proteins, 4 % carbohydrates and 90% fats. This ratio has been modified in variations of ketogenic diet i.e. Medium chain triglyceride (MCT) ketogenic diet, Modified Atkins diet (MAD) and Low glycemic index treatment (LGIT). The range of recommended carbohydrate intake in ketogenic diets varies from 10-50 gm or 4-10% of total calories (Dhamija et al, 2013). WWW.NUTRITIONINSIGHTS.IN | 06
PROS
BENEFITS OF KETOGENIC DIETS
Uncontrolled epilepsy
Endocrine disorders
Ketogenic diet in Type 2 Diabetes mellitus reduces body weight, blood glucose level, Total and LDL cholesterol, serum triglycerides, reduction in Antidiabetic medications, improved insulin sensitivity (Bolla, Andrea Mario, et al, 2019). In a systematic review with meta-analysis, low carbohydrate ketogenic diets led to greater long-term decline in body weight, diastolic blood pressure and serum triglycerides and increase in HDL and LDL cholesterol in obese subjects (Bueno, N. B., et al, 2013). Weight loss, increase in lean body mass and decrease in body fat with this diet may be attributed to suppression of appetite can be attributed to reduced ghrelin level, increase in peptide YY, directly related to betahydroxy butyric acid, protein specific satiation, increased energy expenditure, increased lipolysis (Kalra, S.,2018). Ketogenic diet has shown to reduce insulin resistance which is the hallmark characteristic of Metabolic syndrome and Polycystic ovarian syndrome (PCOS). Ketogenic diet reduced body weight and normalized the hormonal imbalance (reduction in androgen secretion and improvement in luteinizing hormone/follicle-stimulating hormone ratio).
Neurodegenerative Disorders Emerging data indicates ketogenic diet could be
Multiple hypothesis have been formulated to explain the effectiveness of ketogenic diet in uncontrolled epilepsy. This includes “the pH hypothesis” (ketogenic diet alters the blood pH slightly acidic which may have anticonvulsant effect),“the increased brain energy hypothesis” (ketones generate more ATP than glucose, increased available energy may have anticonvulsant effect), “Fast energy and ketogenic diet hypothesis” (glucose responsible for generating fast energy is required for seizure activity and absence of glucose in ketogenic diet prevents seizure), “the GABA shunt hypothesis” (Ketogenic diet enhances GABAergic inhibition and suppresses the seizure ), “the ketone hypothesis” (the ketone bodies may have anticonvulsant effect) (Nylen, Kirk,2009).
Nonalcoholic fatty liver disease
Watanabe et al (2020) in a review reported favourable impact of ketogenic diet in subjects with NAFLD. Severe reduction in carbohydrates and ketone bodies generation resulted in significant weight loss, decreased insulin level and lipogenesis and increased lipolysis, decreased inflammatory cytokines, oxidative stress, decreased hepatic fat accumulation and reduced fibrosis (Watanabe,2020).
Cancer A review of 30 clinical studies and 57 original studies on impact of
ketogenic diet in cancer reported a slowed tumor growth, prolonged survival rate, reversed cancer cachexia, sensitization of cancer cells to chemo and radiation therapy. Ketogenic diet targets the glucose, amino acid metabolism and mitochondrial metabolism of cancer cells. It modulates angiogenesis, vascularization, tumor environment and regulates gene expression (Weber, D. D.,2020).
beneficial in Parkinson’s, Alzheimer disease, amyotrophic lateral sclerosis and some mitochondriopathies (Paoli, A.,2014).
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EFFECTS OF KETOGENIC DIETS
CONS Long term effect of ketogenic diet in some of the abovementioned clinical conditions are not known. Hence, long term studies to assess the impact of ketogenic diets should be conducted. Ketogenic diet should be started under supervision of a qualified Registered dietitian (RD). It involves crucial steps such as pre assessment investigations, thorough nutrition assessment, planning diet through stages, strict monitoring and regular follow ups. However, many of the individuals do not seek guidance of a dietitian and start this diet with help of social media for quick results. This may lead to complications and poor compliance in long term. Side effects such as fatigue, lethargy, headache, concentration issues, nausea, poor breathing, abdominal pain, trouble sleeping, indigestion, depression can be present during initial dietary transition. Acute short-term adverse events such as constipation, low grade acidosis, hypoglycemia, dehydration, Dyselectronemia may manifest needs constant monitoring and guidance. India is a predominantly carbohydrate eating country with every meal being substantially carbohydrate based (64% of total calories) (Joshi S R, 2014). Hence the drastic shift to severe carbohydrate depletion may affect patient’s compliance in long term.
Ketogenic diet is not a balanced diet i.e. deficient in fiber, potassium, calcium, magnesium, vitamin B6, A(Alharbi, A.,2020). Need strong family and social support as separate foods needs to be prepared and consumed in social circle and gatherings. No one diet suits everyone as every individual has different body type, metabolism, genetic make-up, food preferences vary. Patients with renal, liver failure, risk of diabetes ketoacidosis, at risk of heart disease, pregnant and lactating women. To conclude, our eating habits are significant and crucial part of our lifestyle. Sustainability of the diet is one of the most important factors to yield optimum results. Ketogenic diet may exhibit short term improvement however its long terms effect sustainability is questionable. Hence, maintaining portion size, reducing carbohydrates up to 50%, including whole grains, legumes, fruits, vegetables, maintaining adequate protein intake and including 25% healthy fats (MUFA and omega 3 fatty acid), preventing micronutrient deficiency along with exercise, adequate sleep, behavior modification and consulting a qualified dietitian to achieve this is the ideal strategy towards healthy lifestyle.
References: Dhamija, Radhika & Eckert, Susan & Wirrell, Elaine. (2013). Ketogenic Diet. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. 40. 15867. 10.1017/S0317167100013676. Nylen, Kirk, Sergei Likhodii, and W. McIntyre Burnham. "The ketogenic diet: proposed mechanisms of action." eurotherapeutics 6.2 (2009): 402-405. Bolla, Andrea Mario, et al. "Low-carb and ketogenic diets in type 1 and type 2 diabetes." Nutrients 11.5 (2019): 962. Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(7), 1178-1187. Kalra, S., Rosha, R., & Singla, R. (2018). The Ketogenic Diet: An Onomastic Opportunity to be Helpful. Journal of Social Health and Diabetes, 6(02), 061-062. Watanabe, Mikiko, Rossella Tozzi, Renata Risi, Dario Tuccinardi, Stefania Mariani, Sabrina Basciani, Giovanni Spera, Carla Lubrano, and Lucio Gnessi. "Beneficial effects of the ketogenic diet on nonalcoholic fatty liver disease: A comprehensive review of the literature." Obesity Reviews (2020). Weber, D. D., Aminzadeh-Gohari, S., Tulipan, J., Catalano, L., Feichtinger, R. G., & Kofler, B. (2020). Ketogenic diet in the treatment of cancer–where do we stand?. Molecular metabolism, 33, 102-121. Paoli, A., Bianco, A., Damiani, E., & Bosco, G. (2014). Ketogenic diet in neuromuscular and neurodegenerative diseases. BioMed research international, 2014. Joshi, Shashank R., Anil Bhansali, Sarita Bajaj, Subodh S. Banzal, Mala Dharmalingam, Shachin Gupta, Satinath Mukhopadhyay et al. "Results from a dietary survey in an Indian T2DM population: a STARCH study." BMJ open 4,no. 10 (2014). Alharbi, Amal, and Noorah Saleh Al-Sowayan. "The Effect of Ketogenic-Diet on Health." Food and Nutrition Sciences 11.4 (2020):301-313.
Dr. Anagha Palekar (Ph.D , RD, CDE) Registered Dietitian, B. Y. L. Nair Ch Hospital LEC, Indian Dietetic Association, Mumbai Chapter WWW.NUTRITIONINSIGHTS.IN | 08
BUSTING MYTHS OF KETOGENIC DIET – FAD FOR WEIGHT LOSS
BY - HITHA BHANKHARIA RD/NUTRITIONIST, PHD SCHOLAR, DIABETES EDUCATOR
Ketogenic diet or a keto diet – most commonly known as the diet which is low in carbohydrates, a nutrient considered as the devil for all non – communicable diseases; a diet high in fat and moderate proteins, proteins a nutrient which most of us are deficient and unable to meet our requirements. This diet has been trending over a couple of years now, however, it has existed since the 19th century to cure most disease conditions showing a positive impact, especially in epilepsy or convulsions. So from where did this diet actually gain its popularity for weight loss – rightly from the famous “low carbs” which have shown a great impact on weight loss. How does this diet work – in simple words, when the body does have enough of carbohydrates which convert into glucose to use as the source of energy, it uses fats in the form of ketone bodies to provide energy to the body.
1. 2. 3. 4.
Myth – Low carbohydrate will help me loose weight and still feel fit. Fact – Low carbohydrate diet will lead to hunger, fatigue, irritability, mood swings, constipation, headache etc. Myth – This diet works for everyone. Fact – Studies have shown that this diet works for a short period of time on a certain individuals. Myth – I have seen no side effects while following the diet Fact – Low carbohydrate diet will lead to hunger, fatigue, irritability, mood swings, constipation, headache etc. Myth – – Even though I am taking so much of fat in the diet I don’t see any side effects as fat is used as the source of energy. Fact – High intake of fat in the long run leads to risk of heart disease and other complications in the long run. WWW.NUTRITIONINSIGHTS.IN | 09
RESEARCH
THE EFFECT OF KETOGENICDIET ON HEALTH
created dietary
Sciences, 11, 301-313. doi:10.4236/fns.2020.114022. years,
the
ketogenic
diet
is
the
education
has,
although
for
years,
traditional
illustrated
the
intake
of Ketogenic-Diet on Health. Food and Nutrition
recent
partially
adverse effects of high overall including trans-fat
Alharbi, A. and Al-Sowayan, N. (2020) The Effect
In
debate,
most
popular diet around the world. Therefore, keto diet, short for ketogenic, involves eating a high amount of fat, a moderate amount of protein and very few carbs. This research paper aims to know about the
THE KETOGENIC DIET: PROS AND CONS Blair O'Neill 1, Paolo Raggi 2, Atherosclerosis. 2020 Mar;296:1. doi:10.1016/j.atherosclerosis. 2020.01.005.Epub 2020 Jan 20.
effect of a ketogenic diet on our body, to know
Diets have been at the center of animated debates for
about
decades
the
mechanism
of
the
ketogenic
diet
in
and
many
claims
have
been
made
in
one
treating neurodegenerative disorders and to know
direction or the other by supporters of opposite camps,
about
often with limited evidence. At times emphasis has been
the
mechanism
of
the
ketogenic
diet
in
reducing the weight of our body. Also, the objective was
to
investigate
the
ketogenic
diet
stimulates
put on a single new aspect that the previous diets had overlooked and the new one was to embrace in order to improve weight loss and well-being. Unfortunately, very
ketogenesis which treats certain neurodegenerative few
randomized
clinical
trials
involving
diets
have
disorders. Although this is high fats containing food addressed
the
combined
question
of
weight
loss
and
it is beneficial for our body in certain conditions. It is cardiovascular
also
useful
in
the
conditions
in
which
the
brain
requires a low level of glucose so the brain starts utilizing
ketone
bodies.
As
the
intake
ketogenic
diet
outcomes. requires
The a
recently
rigorous
introduced
limitation
of
carbohydrates while allowing a liberal ingestion of fats
of
(including saturated fats) and has generated a flurry of
carbohydrates is lowered so it is also used to reduce
interest with many taking the pro position and as many
the weight of the body.
taking the cons position. The ketogenic diet causes a rapid
In
this
research,
the
qualitative
methodology
has
been adopted which refers to secondary sources of
and
biomarker
sensible
weight
changes,
such
loss as
along a
with
favourable
reduction
in
serum
hemoglobin A1c in patients with diabetes mellitus type 2.
data. In this project, I used a variety of research that However, it also causes a substantial rise in low density
has also been undertaken by numerous researchers lipoprotein
cholesterol
levels
and
many
physicians
are
including dietitians who tend to support the positive therefore hesitant to endorse it. In view of the popular
benefits of using ketogenic diets to manage losing uptake of the keto diet even among subjects not in need
weight as well as other health problems that could result
from
overweight.
Also,
we
used
a
table
to
of
weight
loss,
there
is
some
preoccupation
with
the
potential long-term consequences of a wide embrace of
show the difference between studies. Finally, it is
this diet by large segments of the population. On the
important to note that the ketogenic-diet has
contrary, numerous lines of evidence show that plant-
WWW.NUTRITIONINSIGHTS.IN | 12
RESEARCH based
diets
oncological
are and
associated
with
cardiovascular
reduction
diseases
in
however, no RCT data are available for MAD and
a
LGIT. This evidence suggests that factors such as
and
prolonged life span. The debate reproduced in this
age,
article
medical
important factors in deciding which diet we should
education program between two cardiologists with
start a patient on. This report intends to summarise
largely
guidelines based on the evidence available.
took
place
differing
effectiveness,
during
a
views
continuous
on
sustainability,
the
and
matter
safety
of
of
epilepsy
type,
lifestyle
and
resources
are
the
ketogenic diet compared to alternative options.
ALTERNATIVE DIETS TO THE CLASSICAL KETO-GENIC DIET-CAN WE BE MORE LIBERAL?
an e v a h Do you rach e s e r / e articl der n u d e h s publi e? you nam
Miranda MJ, Turner Z, Magrath G. Alternative diets to the classical ketogenic diet--can we be more liberal? Epilepsy Res. 2012 Jul;100(3):27885. doi: 10.1016/j.eplepsyres.2012.06.007. Epub 2012 Jul 6. PMID: 22771252.
it t e g n e Th re.. e h d e r featu
The ketogenic diet (KD), a high-fat, adequate protein, low-carbohydrate diet has been used since 1921 for the treatment of severe medically refractory epilepsy. In the past 15 years, the use of the KD has expanded enormously and a huge amount of clinical evidence of its efficacy is available.
The
classical
KD
is
however
restrictive
and
therefore alternative more liberal varieties of the classical KD
have
been
developed
within
the
last
8
years.
The
purpose of this report is to summarise the principles and evidence
of
effectiveness
diets:
Medium
Atkins
diet
Chain
(MAD)
of
the
alternative
Triglyceride
and
low
(MCT)-KD,
glycaemic
index
ketogenic modified treatment
(LGIT), compared to the classical KD.
The
clinical
evidence
to
date
suggests
that
the
Mail Us! Send your articles/ research to us at nutritioninsightsmag @gmail.com
more
liberal versions of the classical KD such as MCT KD, MAD and LGIT have an efficacy close to the classical KD;
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In Conversation with... MS. ROSHAN KORE Dr. Roshan Kore is a Senior Dietitian and HOD Clinical Nutrition and Dietetics Department at SRCC Children's Hospital managed by Narayana Health. She has over 24 years of experience in the field of Clinical Nutrition and Dietetics, with a keen interest in the development sector. "THE KETO KID PROJECT" is an initiative to provide 'Ketogenic Diet' to children with epilepsy. The team includes pediatric neurologists- Dr.Anaita Udwadia Hegde and Dr. Shilpa Kulkarni and 2 other Dietitians.
Q
WHO INITIATED THIS PROJECT?
CURENTLY- On OPD basis no fasting is required. CHO wash out process is followed, in which non CHO foods are introduced for 5 days. Lots of non veg+ soya based diet given depending on patients food habits and requirements. Calculations are done as per age and requirements and a ratio of fats and proteins is deduced. Then the recipes are tailored accordingly.
A team of neurologist and dieticians working at Wadia hospital. Dr. KN Shah, Dr.Shilpa and Dr Anaita Hegde, Dr.Suvarna with Dr.Roshan Kore started this project.
Q
WHAT IS THE AIM OF THE PROJECT?
The aim of the project is to plan ketogenic diets for the needy and the non-affording patients.
Q
WHEN WAS THIS PROJECT STARTED?
The project was started in the year 2008, lead by Dr. Anaita Hegde.
Q
WHAT ARE THE CHARGES FOR A CONSULTATION?
It is a free set up to treat the non affording epileptic patients and a small set amount for affordable epileptic patients.
Q
WHERE WAS IT STARTED?
This project was started at Dr. Hegde's clinic. Now it has been shifted to SRCC hospital, Mahalakshmi and all the patients are treated here.
Q
HOW IS THE ASSESSMENT DONE?
It is started with 4 meals a day. Urine ketone levels are checked through urine keto sticks daily. Where urine sample are collected, the sticks are dipped into the samples and then the strip changes color. This color change is then compared with the reference a colour and the ketone levels are identified. The test is performed 4 WHAT IS THE times in a day. No invasive testing is PROCESS? required. Through the obtained PREVIOUSLY- IPD basis was results fine tuning is done. The Ideafollowed. The patient was admitted is to have urine ketosis 4+++ and kept on fasting for 2 days. When throughout the day so that the urine ketone turned positive then the ketones pass through the blood brain ketogenic feed is introduced as 1/3rd barrier and help to stop seizures. portion of the requirement on day day 1. Slowly 2/3rd portion is BENEFICIARIES TILL introduced on day 2 and full portions DATE on day 3. The patient was counselled More than 200 beneficiaries in the about the diet and then discharged last 10 years. with a follow up plan.
Q
Q
Q
WHAT ARE THE ADVANTAGES OF THIS PROJECT?
Q
REGULAR V/S MODIFIED KETO DIET
Regular ketogeneic diet- in this diet We don’t just look into seizure control all ingredients of the recipes are weighed in grams and then the recipe but also observe behavior and is made. cognitive changes. Drugs make the child lethargic and drowsy. Keto diet Modified ketogenic diet- in this diet CHO containing foods are weighed in not only improves behaviour and cups and non CHO containing foods cognition, but also understanding and motor development of the child. can be given in as much quantitiy as required. There is also some speech Advantages- it is useful for children development noted. who have higher appetite, require Ingredients that are used are available freely in the kitchen so no more feed and require variety. The diet is also more flexible. extra cost is incurred compared to It is usually starts with a strict when drugs are been used. When 4+++ ketosis observed throughout the regular keto diet and then depending day then it is said that diet is helpful on the progress the diet can be shifted to a modified keto diet. and then one can decide to stop or modify it.
Q
HOW CAN ONE GAIN ACCESS TO IT?
Access to this project is managed by Dr. Anaita Hegde and the staff through whom appointments can be booked; right now it is functional only at The SRCC hospital. Charges are minimum depending on patient’s condition.
Q
SHOULD THERE BE MORE SUCH INITIATIVES ?
Yes, definitely there should be more such initiatives taken in the development sector of the society.
Dr Anaita Udwadia-Hegde (Consultant Pediatric Neurology)
Affiliation: Jaslok Hospital and Research Center, Breach Candy Hospital Trust, Bai Jerbai Wadia Hospital for Children, NH SRCC Children’s Hospital Qualifications: MD(Ped) MRCPCH (London) Fellowship in Pediatric Neurology(London) Special Interest: Epilepsy, Disability and Movement Disorder WWW.NUTRITIONINSIGHTS.IN | 15
RECIPES
CAULI-
FLOWER FRIED RICE BY - FAGUN GANDHI REGISTERED DIETITIAN
INGREDIENTS medium-sized head of cauliflower, riced 1 tbsp sesame oil or olive oil 2 garlic cloves,minced 1/2 cup mix vegetables, (green beans and peas) 1 cup crumbled paneer (cottage cheese) or tofu 1/2 cup crumbled paneer (cottage cheese) or tofu 2 tablespoon soya sauce Salt and pepper to taste 2 tablespoon sliced spring (green) onions 2 teaspoon sesame seeds, for garnish (optional)
METHOD How to make cauliflower rice: Separate the cauliflower into florets and stalks. Wash thoroughly. Grate the florets of cauliflower with a grater or a food processor to resemble fine rice. How to make fried rice: In a wok, heat 2 tbsp oil over medium high heat. Sauté the minced garlic till it changes the colour. Then add onions, beans and peas and cook for 3-4 minutes or till half cooked. Add cauliflower rice, crumbled paneer and stir fry for 3-4 minutes, until the cauliflower is slightly crispy on the outside and tender inside. Add soya sauce, salt and ground black pepper, mix well and turn off the heat. Garnish with sliced spring onions and sesame seeds before serving.
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RECIPES
KETO CITRUS BALLS BY - RUCHITA MAHESHWARI HEALTHY MANTRA, FOUNDER & CHIEF NUTRITIONIST INGREDIENTS Cottage cheese – 100 gms White chocolate melted – 100 gms Dark chocolate melted – 200 gms Pistas chopped – as required Pinch of salt Lemon juice – 2-3 drops Lemon zest, grated – 1 tsp
METHOD Starting with the keto balls take a mixing bowl, add 100 gms of cottage cheese add a pinch of salt mash it nicely. After mashing it well time to add white melted chocolate in this mixture and some chopped pistas, mix well. Add 2-3 drops of lemon juice & lemon zest again mix it well. Take a plate, covered with cling film to avoid sticking of chocolate. Now take a small portion and make small balls like lemon size. Place white chocolate balls on the plate. Keep it in the freezer for 10-15 (for firmness) Now roll out balls in between your palms giving nice round shape and again keep it in the freezer for 10 minutes. Now take out the truffle balls from freezer and dip them in melted dark chocolate. Garnish a few truffle balls with chopped pistachios and few with white melted chocolate (with a help of piping bag) this can be optional. Keto citrus balls are ready.
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RECIPES
KETOGENIC AALU WADI BY - HETAL TRIVEDI DIETITIAN & SPORTS NUTRITIONIST
INGREDIENTS 100g Paneer (grated) 30g Mozzarella cheese (grated) 30g Processed Cheese (grated) 4 Aalu leaves Isabgol- 1 tablespoon (15g) Salt- as per taste Turmeric- half a teaspoon Chilli powder- 1 teaspoon Aamchur Powder- 1teaspoon Lemon juice- To sprinkle
METHOD Rinse the leaves, pat them dry and leave out for a some time knead the paneer, cheese, isabgol and the spices into a soft dough. Take two leaves, carefully smear a thin layer of the dough on both. Sprinkle some processed cheese on both. Now place one leaf on another and start folding it from both the sides, vertically. Sprinkle cheese on each of the folding side so the leaves stick to one another. Finally roll it from the tip of the leaves to the top. Repeat step 3 for the other two leaves. Fill 1/3rd of the cooker with water, place a vessel inside it and gently put the rolled bunch in the vessel. Pressure cook it for 4 whistles. Allow the cooker to cool down before opening it. Remove the bunch from the cooker and allow it to further cool down. Finally cut the bunch into slices, sprinkle some lemon juice and pepper powder on it.
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RECIPES
CHOCOLATE CHEESE CAKE BY- RABIA MISTRY MULLA NUTRITIONIST
INGREDIENTS For the Base 120 gms mix of almond flour + coconut flour 50 gms butter 1 tsp of Stevia powder or 6 gms of zerocarb sweetener For the Cheese cake 400 gms cream cheese 400 gms thick dahi 3 eggs 2 tbsp Stevia powder or 18 gms of zero carb sweetener 1 tsp Baking soda 1/4th tsp salt 1 tsp Vanilla essence For the Top Chocolate layer ½ slab 70% Dark Chocolate ½ cup full fat cream
METHOD Pre heat the oven at 180 degree Celsius. Mix together almond flour, coconut flour, Stevia powder and melted butter and pat this mixture flat on a 20 cm round spring form mould and bake for 10 mins or until slightly golden in color. Beat cream cheese until smooth then add the thick curd and mix well till smooth. Add the Stevia powder, baking soda, salt and vanilla essence and mix well. Add 1 egg at a time and keep beating lightly till everything is incorporated. Pour this mixture onto the flour lined mould. Keep the spring form over a water bath and allow it to bake for 1 hour till batter is no more jiggly on shaking. Allow it to cool down completely and then refrigerate for 2 – 3 hours. For the top layer Crush the dark chocolate slab into smaller pieces. Microwave full fat cream for 1 min and pour over the crushed chocolate. Mix well to allow the chocolate to melt completely and make a smooth paste. Now pour over the cheesecake and allow it to set in the refrigerator for 15 – 20 mins. Cut in 8 pieces and serve. Enjoy!
RECIPES
GRILLED CHEESE CHICKEN BY - POOJA JAGIASI MSC. CND, CDE
INGREDIENTS 160 gms Chicken Breast 20gm Zucchini (Cut in slice) 10gm Yellow bell pepper(cut in cubes) 10gm Red bell pepper(cut in cubes) 1 cube Cheese 2tspn Butter Chicken Marination 1tspn black pepper 1tspn Ginger garlic paste Juice of 1/2 lime Salt as per taste
METHOD Clean chicken nicely and give a slit from middle and also from top. In a bowl, mix black pepper,ginger- garlic paste, salt, Lime and prepare marination. Apply on chicken and keep it for 20 minutes. Grate cheese cube and stuff inside chicken. On a medium flame, heat non stick pan. Apply 1 and half tsp. butter add chicken to it. Saute nicely both side till it turns slightly brown. On a non stick pan, apply ½ tsp. butter , then add zucchini and bell pepper stir fir slightly on a medium flame for 2 minutes. Remove in a bowl. Finally, on a plate place chicken piece and on a side zucchini slices with bell pepper cubes on it.
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