Ketogenic Brownies

Ketogenic brownies for the last day at Pediatrics Neurology posting! For some kids with epilepsy the ketogenic diet is used as a treatment option – many of them achieving greater than 50% reduction in seizures. For seizure control it is actually a medical supervised option that may even require a short inpatient stay to titrate initially.

The way it works is likely multifactorial, but the general idea is based on the theory that ketone bodies created in the liver from long and medium-chain fatty acids are directly anticonvulsant when crossing the blood-brain barrier. Many studies (mostly from the International Ketogenic Diet Study Group) have found that after six months, 60% of children started on the ketogenic diet had a greater than 50 percent seizure reduction, and 30 percent have greater than 90 percent seizure reduction. Kids must control their carbohydrates, but are allowed have very high fat and moderate protein in this diet. They can even supplement with MCT oils to increase the direct conversion of ketones.

Quite incredible! At KKH there is a ketogenic diet clinic – where kids get put on a Modified Ketogenic diet that may be more friendly to follow, or the classical KD typically in the 4:1 ratio. I’ll always remember a kid whose a huge fan of croquettes and Mayo – in a way she was already on the Keto diet, before her official KD diet initiation. Her cute mom even brought in recipe books at the Dietician consult. In general these kids can still get to enjoy dishes such as horfun or soup noodles, as long as it is made with substitutions like Shirataki (konjac) noodles. Of course, this diet has its challenges. It should only be initiated by a proper specialist and clinical monitoring, including inpatient hospital stay. There was a child in the wards with epilepsy on the Ketogenic diet, whose medications was restricted to pill or IV only, as syrup medications contained too much carbohydrates. The team had to crush up the tablet to serve his medication.

For fun, here are the nutritional contents of these brownies and how it relates to Ketogenic diet: 1 serving 167 kcal / 2g net carb / 0g sugar / 16g fat / 5g protein. For kids I found this kind of cute!
Update 20 Feb 2022: Made these again and this time I used 170g powdered Erythritol (the original called for 200g). I also replaced half of the butter with vegetable oil. Texture was better but it was too sweet! Better to stick with the reduced sugar at 150g.
Ketogenic Mint Chocolate Brownies
makes 12 medium brownies
Ingredients

Ketogenic Chocolate Cake adapted from TPH Keto Desserts

80g unsweetened Dutch-processed cocoa powder
150g powdered erythritol
1/2 tsp
115g unsalted butter
110g eggs (around 2 large)
1 tsp vanilla
70 g almond or other nut flour

To make Ketogenic Brownies:

Preheat the oven to 180C/350F. Grease 8″ square baking pan.

In a large bowl, melt together the cocoa, sweeteners, salt, and butter over low heat until very warm not hot (around 30 seconds).

Let the cocoa mixture cool down a bit, then whisk in the eggs, and vanilla.

Sift in the almond flour, and mix together thoroughly until fully incorporated.

Bake for 20-25 minutes, or until the edges are firm, but the center is still soft. Cool fully before frosting or slicing, you can even freeze the frosted brownies for about 30 minutes for clean slicing.

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