Thursday, October 18, 2012

One Day on a Ketogenic Diet

Last week in my Nutrition & Metabolism class, we were discussing... well, metabolism, in particular the ketogenic processes in the body. One of the ways our teacher keeps the material fresh is by incorporating surprising real life applications and experiences, sometimes from his work as a clinical dietitian. I think the entire class was surprised to learn that an extreme ketogenic diet is used in some cases to treat severe epilepsy in children. How extreme? Well, a typical 1500 calorie diet would include about 42g fat, 205g carbohydrates, and 75g protein - these are numbers that fall inside the Acceptable Macronutrient Distribution Range.

We were asked to create one day of a diet that contained 1500 calories, 150g fat, 18g carbohydrates, and 20g protein.


Our initial giggly thoughts centered on, you know, "Here's a cup of olive oil. Bottom's up!" But our teacher was quick to bring us back to the human element: "Remember, this is a little kid you've got sitting across from you, and you have to tell him this is what he's going to eat for the next few months or years."

I'm an emotional mess lately, so I got a little weepy thinking about that.

Not surprisingly, without access to a lot of nutrition information, no one was able to come up with a whole day's diet, but a few suggestions were thrown out: egg yolks, bacon, ranch dressing, butter, oil. I managed to look up a few items on my phone and was surprised by their nutrition info when viewed through this lens. Avocados? Not actually high enough in fat for this diet - too much carb and protein! I knew bacon was a good source of fat, but I didn't realize just how much more fat it has than protein. Very useful. And pecans? My friends: they are higher in fat than you imagine. I found the discussion really interesting and decided to finish the activity on my own.

I finally managed to come up with a diet that's at least made of actual food. It's interesting to look at this and realize that, for all its 154g of fat, there just... isn't much food here. And just this one day took me probably an hour to come up with. I kept trying to maintain some normalcy - I started with one slice of bread at breakfast, which turned into half a slice, then a quarter slice, and then it disappeared because an eighth of a slice of bread is way sadder than no bread. It's hard to imagine trying to create a diet based on these restrictions that is tolerable day in, day out for months. I'd almost rather drink my cup of oil and be done with it.

Here's one day on an extreme ketogenic diet:

3.5oz very high fat bacon, all drippings included
1 egg yolk, cooked in bacon fat

1oz shredded green cabbage, tossed in 2tbsp ranch dressing
4oz celery, dipped in 2tbsp ranch dressing

.5oz pecans

2oz spinach, cooked in 2tbsp canola oil

Hot cocoa made with:
2.5oz cream, diluted with water
2tsp cocoa powder
Artificial sweetener to taste

The full day's nutritional analysis is at the top of the post.

Isn't that depressing? Can you imagine being four years old and hearing this is what you'll eat? This little project served as a good reminder of the power we have as dietitians, and the power food has in people's lives, and how very careful we have to be not to abuse either.

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