Q & A’s

Helpful Equipment & Essential Groceries

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Starting the diet can be overwhelming, especially with the new products and equipment that you need to start using! Here we’ve put together a helpful shopping list for starting the diet and making it more interesting as you go along.

Helpful kitchen equipment

Digital gram scale: This is your most important ally in the ketogenic diet. It needs to weigh food in at least 1g increments (weighing food up to 0.1g is ideal and guarantees the highest accuracy; however these scales can be very expensive and hard to find, especially in South Africa). Try to buy the scale with the largest weight capacity possible – if you can find a scale with a large capacity, then you can use heavier bowls and cups and life will become much simpler. The same goes for surface area – remember, you will be weighing the food in bowls and cups, so don’t buy a scale that won’t fit these items easily. Battery-operated scales are great as they can be used in any situation (such as power cuts), however, make sure to calibrate your scales regularly to make sure that old batteries are not compromising the accuracy of the readings.

Electronic gram scales are available from most home stores in South Africa, such as Boardmans, @Home, or Home Etc. If you cannot access these, yuppichef.com is a reliable online store with a good selection.

To see more hints on caring for your scale and the correct weight technique, see our post on “The ketogenic diet in the kitchen”.

Spare set of batteries for your scale

Syringes (5mL, 10mL, or 20mL): Syringes will come in handy in many ways. Some recipes may call for a specific volume (mL) of food, not the weight; and syringes are ideal for measuring millilitres exactly. They can also be used to store small volumes of liquid. In addition, no liquid will be left behind in the syringe after measurement. In addition, syringes can be used to give MCT oil to the exact millilitre.

Syringes can be bought from any local pharmacy.

Storage and freezer containers: Preparing and weighing food in advance for freezing and storage is one of the best time-saving method for the ketogenic diet, and for this you will need good quality storage containers that seal properly. Tupperware works well. Get creative with old yoghurt and cottage cheese containers or Ziplock bags!

Try wholesale shops to save money, such as Plasticland or Plastics for Africa.

Food labels: For meals prepared and weighed in advance, it is essential that you label the container with the foodstuff, weight, and meal that it was prepared for.

Cooler box: If your keto kid can’t be at home for a snack or meal time (for example, school, a doctor’s visit, or simply running chores), you will need to pack a snack and/or meal for him. A good quality cooler box or lunch box (with ice packs) will be helpful to keep those meals fresh!

Silicone or rubber spatulas: Weighing food to the gram is only helpful if every gram is then eaten. Silicone spatulas are great for cooking and even eating as they are flexible enough to get food off all curves and corners. In addition, silicone can be used at all temperatures without melting.

Silicone equipment: Silicone moulds, cupcake liners, and baking sheets are excellent for cooking and baking as they are non-stick, do not absorb any fat, can be exposed to heat and can be frozen. You can also get fun shapes which younger children and even fussy eaters will enjoy.

Most home department stores these days stock silicone products, including Mr Price Home, Woolworths, @Home, Home Etc, Clicks, Boardmans and yuppiechef.com.

High quality non-stick pan: If food burns or sticks to the pan during preparation, those are valuable grams of fat and other nutrients lost. Make sure to use a high-quality non-stick pan to prevent this.

Steaming equipment: Steaming is a great way of preparing your protein and vegetables to retain nutrients before adding fat. Choose from a wide variety of electronic steamers, microwave steamers, or a lovely simple silicone or bamboo steamer that you place in a pot on the stove.

Electric beater: Whipping cream is a great way to incorporate it into the diet. Beaters can also be used for beating eggs or mixing other dishes.

Food processor: It is possible to keep the ketogenic diet varied, interesting and delicious, but you will probably need to start using special products at some point, such as almond flour and macadamia nut butter. These may not always be available in your area, and may even have small amounts of carbohydrates added to them. It is very useful to have a high quality food processor to prepare such foods yourself using whole, natural ingredients. Try to get the best one you can afford that has a range of functions.

Blender: A blender can be a useful replacement or addition to a food processor (depending on what kinds of foods you are wanting to prepare, of course!). Blenders are great for making keto smoothies, sauces and soups.

“Fun food” equipment: Just because your little one is on a special diet, doesn’t mean food can’t be fun! Fun equipment is a great way of making meals enjoyable, regardless of the food. Try:
Straws for getting every last drop of milkshake
Ice-cream popsicle moulds (for Ketocal or eggnog in the summer)
Fun food moulds for jellies or fat bombs
Different cookie cutters
Decorated crockery and cutlery
… The possibilities are endless!

Other helpful tools:

Also make sure you always have these items in stock:
Keto and glucose monitor: With a good supply of strips for testing.
Vitamin and mineral supplement: As recommended by your dietitian or doctor.
Carbohydrate-free medication: Have carbohydrate and sugar-free medication available for common problems such as pain and fever. It may be helpful to have a recommended medication for constipation, such as Lactulose, which can be a side effect of the diet.
Carbohydrate-free toothpaste: Check with your regular toothpaste, Mentadent P Granules is a good product.
Helpful foods to have in stock

Almost any food can be calculated into the diet, but here are some helpful ones to have around the house.

Try to make the majority of the diet from whole, unprocessed foods. Many preservatives and food additives contain carbohydrates and will make the diet more difficult. This also reduces preservatives and sodium, which is good for anyone’s health.

Fats:
Woolworths 36% Whipping Cream: A pillar of the diet!
Orley Whip: A dairy-free replacement for cream, this can be used as it has no carbohydrates.
Clover Springbok Unsalted butter: Low in carbs compared to most butters.
A range of healthy oils: Great oils are olive, flaxseed (not to be heated), coconut and canola. See more on our upcoming post on oils.
Hellman’s Real Mayonnaise: Low in carbs compared to most mayonnaises.
Avocado: A great healthy source of fat, but they do contain some protein and carbohydrates so be careful with quantities.

Protein:
Eggs: Another pillar of the diet, can be used in many drinks and dishes to add protein.
Chicken: A lovely lean, uncomplicated protein source.
Lean mince: As strange is it may seem to choose the lean version, this helps to optimize every gram of protein from the mince.
Fresh or frozen fish: Hake is always a winner. Fatty fish like salmon, trout, sardines or mackerel will help get in valuable omega-3 fats for brain development.
John West Light Meat Tuna Chunks in Oil: A convenient protein source with fat, but try to limit it to two to four times a week due to its mercury content.
Woolworths Portuguese Sardines in Oil: Another convenient protein source filled with wonderful healthy omega-3 fatty acids.
Eskort Rindless Back Bacon/Woolworths Wood-Smoked Shoulder: Bacon always adds flavour and fat, but sometimes has carbohydrate added in the curing process. These brands are low in carbs, check the labels of other brands.
Biltong (not droëwors): A quick and easy snack food.
Raw nuts: Fantastic high fat sources of protein and fibre, but they do contain some carbohydrates. Watch out for nuts with added flavourings, as these normally contain even more carbohydrates.
Cheese: A quick and easy high fat protein source. Be careful as some cheeses are quite high in carbs. Some local low carb cheeses include Clover Gouda, Woolworths Cheddar (Mild Flavour or Mature), and Tussers. For those with sophisticated tastes, Woolworths Italian Grana Padano and Woolworths Stilton are also great cheeses!
Cream cheeses: Use plain cream cheese (especially Philadelphia) or flavoured cream cheeses to add fat and protein to meals.

Fruits and vegetables:
All fruit and vegetables can be included, but favour low carb varieties so that you can have more:
Asparagus
Baby marrow
Berries (strawberry, raspberry, blueberries)
Broccoli
Brussel sprouts
Cabbage
Cauliflower
Celery
Cucumber
Grapefruit
Mushroom
Orange
Peach
Spinach
Spring onion
Tangerine Naartjie

Other:
Non-nutritive sweeteners: Saccharin is the best sweetener, with no side effects or bitter after-taste, and it can be heated and used in baking. Try Natreen (pills, granules or liquid), Sweetex, Sweet ‘n Low or Sucryl. You can try xylitol; however, it does have an effect on some people’s blood sugar.
Spices and flavourings: Adding a pinch of these flavours won’t change the ratio of your meals and will make a big taste difference
Sea salt: Ordinary salt may induce seizures. Cape Herb and Spice Company’s Ground Sea Salt is good.
Woolworths Organic Liquid Stock: Powdered stocks often have carbohydrates added to keep them in powdered form, so choose low-sodium liquid stock if you don’t have the time or energy to make your own!
Herbal tea bags: Come in many delicious flavours, from Rooibos and Honey to Lemon and Berry, and can be had freely (hot or iced) with sweetener if desired. Use any brand.
Moir’s flavourings: These are fantastic to add flavour to any drink or dessert, and flavours include vanilla, almond, lemon, maple, hazelnut, orange, chocolate, caramel or coconut.
Sweeto: A sugar-free juice concentrate in kid-friendly flavours like raspberry and crème soda. Try to limit to a few times a week.
Sugar free jelly: Moir’s and Simply Delish are widely available.
Zero” caffeine-free sodas: Tab, Sprite Zero, Fanta Zero are great as treats, try to limit them to a few times a week.
Soda-Stream Slim: A sugar-free carbonated drink.
Nomu Cocoa: A rich low carbohydrate cocoa to add chocolate flavouring to baking and drinks
Lindt 85% Dark Chocolate: As it is so intensely flavoured, small amounts pack a punch in drinks and baking.

Some more products for when you’re comfortable:
Woolworths Full Fat Coconut Milk: Can be added to drinks or desserts, no carbs and a lovely taste.
Almond or flaxseed flour: Useful for low carb baking. Nature’s Choice makes good ones, check your local health store for their products. You can also make your own flours using whole almonds and flaxseeds and a good quality processor.
Shirataki noodles: Noodles with no carbohydrates, although quite expensive. Check your local health store.

Preparing For The Ketogenic Diet

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PREPARING FOR THE KETOGENIC DIET

Welcome to the ketogenic diet! For whatever reason, you’re considering this diet as a treatment for epilepsy (or maybe another illness). Maybe your healthcare team is recommending it to you, maybe a friend told you about it, or maybe you read about it on the internet. This is one of the most intimidating stages – you don’t know what it is, what you’re getting yourself into, or if it’s even an effective treatment option. Here we give you some guidelines on how to prepare for the ketogenic diet.

What to expect from your healthcare team

The most important consideration when initiating the ketogenic diet is that it is done under the strict guidance and monitoring of a healthcare team, preferably including a specialised neurologist and a specialised dietitian.Do not attempt to embark on this diet on your own, as it can be harmful to your child’s health if done incorrectly.

The first thing you need to discuss with your team is whether this diet is right for you and your child. Various studies show that we can expect about 30%-70% of patients to reduce their seizures by 50% on this diet. 10-20% of patients will be seizure-free (Jung & Kim, 2011; Levy et al., 2012).   Nonetheless it is similar to any anti-seizure medication: It comes with its own set of challenges and side effects. Your family will need to decide whether the potential benefits will outweigh the challenges. Make sure your keto team informs you fully of what the diet will entail. Some of the questions you may need to consider are:

  • Why are we interested in the diet?
  • Are we aware of the time, energy and financial input required for successful implementation of the diet? Can we afford to spare the time and money for the diet?
  • Is everyone involved in the child’s care committed to the diet – including family, school and even close friends?
  • What outcome will make the diet worthwhile – what percentage of seizure reduction is desired, what changes in medication do we want, how quickly do we want to see results? If the diet does not work, at what point will we terminate the diet?

If you decide to embark on the diet, the team will do a full assessment of your child, including:

  • Measurement of height and weight
  • Blood workup
  • Medical history
  • Current medical conditions, medications and seizure frequency
  • Activity levels and developmental progress
  • Diet history, including eating patterns, likes and dislikes, and allergies

Once all of this is completed, the appropriate type of diet will be chosen (low GI diet, modified Atkins diet, 3:1 ketogenic diet, 4:1 ketogenic diet or the MCT diet) and a very specific meal plan will be prepared for your child, exactly for his/her requirements. The keto team may also prescribe additional vitamin and mineral supplements that you will need to give your child on this diet.

You will receive full education from your keto team, including how to prepare all your meals, what side effects to look out for and how to deal with them, and how to test your child’s glucose and ketones.

Preparing for the diet at home

First and foremost, make sure that you are educated on the diet before initiation. In addition to the information your keto team will give you, visit recommended websites for more material and to see stories from other families (see helpful links at the end of this post).

Enlist the support of friends, family and your child’s school. Everyone needs to understand how precise the diet needs to be, as a well-meaning relative or teacher allowing your child some sugar could undo weeks of hard work. As a caretaker, you may also need support of your own – find someone who you can rely on to take over in times of need, or join an online support group.

Review the meal plan you have received from your dietitian and compile a grocery list, as well as all the equipment you may need to prepare and store the foods. You can also start a seizure diary ahead of initiation, which can help to identify dietary and non-dietary triggers, as well as help to monitor progress when the diet is started.

If possible, start to prepare your child for the diet. Without trying to start the diet itself, expose your child to keto-friendly foods, such as carbohydrate-free drinks or jellies. Experiment with vegetables, hard cheeses and meats to see which your child likes the most, so that they can be incorporated into the meal plan. Try to gradually reduce foods high in sugar such as sweets, chocolates and cakes. If your child is old enough, you can also start to talk about the diet to prepare him/her for the change. It is important that your child is not forced onto the diet, but that it is explained and he/she agrees to cooperate.

How Soon Will I Know If The Diet Is Working?

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How soon will we know if the diet is working?

The diets effectiveness is seen in varying amounts of time among individuals. It can be immediate, while the diet is being initiated in the hospital, or it may take several months. Remember, seizures are different for all children, some have several daily and others only once every 6 months.

How can my child go on diet if he is allergic or intolerant to dairy products?

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How can my child go on diet if he is allergic or intolerant to dairy products?

The Ketogenic Diet can be planned for children who cannot tolerate milk or milk products; this is true for either oral or gastrostomy fed keto kids. Heavy whip cream does not need to be a component of the diet, it can be replaced with other food sources of carbohydrate, fat and protein and produce the same degree of ketosis. For children fed by a gastrostomy, nasogastric or jejunal feeding tube, RCF (Ross Carbohydrate Free) is recommended. The protein in dairy products, which is the allergen, is replaced by a soya protein in RCF, thus there is no allergic potential, as long as the child is not allergic.

How will we be able to manage birthdays and holidays?

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How will we be able to manage birthdays and holidays?

Most of us are used to celebrating special occasions with friends, family, fun and yes, food. These days can still be special, but they do not need to be food centered for the Ketogenic Kids. Birthday candles can be stuck into Play Dough and placed on a gift or the table. The rest of the family need not suffer through the holidays; however, being sensitive to a keto kids unique diet therapy is warranted.

How will my child feel on this diet?

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How will my child feel on this diet?

Children do seem to respond differently to the different stages of the Ketogenic Diet. A lot of this depends on what the child’s baseline awake state is. Most often, during the fasting your child may feel sleepy, lethargic, and cranky. Then as the diet begins, lethargy may continue as well as nausea and vomiting, this may be due to excessive ketosis, or its the side effects of the change in metabolism from using glucose as a primary energy source to using fats instead. It may also be related to a change in drug levels. In time, children should return to their normal, or close to normal activity level; some keto kids even get more energetic with time. One common, side effect of a high fat diet for everyone is a slower gastric emptying time, thus even though the portions may look smaller, the food will stay in the stomach longer and give a longer feeling of satiety.

What if my child cheats on the diet?

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What if my child “cheats” on the diet?

Cheating, or mistakes happen for various reasons, it can be purposeful by the child, or an incorrect amount of food weighed out and realized retrospectively. Trying to minimize this is important, but being prepared for what might likely occur at least once is equally important. Depending on how big the extra amount of food is / was depends on the treatment. Often times, it is safe just to recognize the mistake and pick up with the regular ketogenic meal plan at the next meal.

Will anti-seizure medications be discontinued after my child goes on the diet

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Will anti-seizure medications be discontinued after my child goes on the diet?

Well, that depends on the individual circumstances. In most patients anti-seizure medications are reduced. If they are on polytherapy, we usually try to eliminate some of the medications, perhaps maintaining just one medication. If they start the diet while on just one medication, we may try to reduce the dosage. If the patient is on a barbiturate, we do routinely decrease the dose when they go on the diet, since the diet seems to raise the barbiturate levels.

If the diet works, how long will my child be on the diet?

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If the diet works, how long will my child be on the diet?

If your child remains seizure-free for 2 years, most neurologists would recommend switching back to a normal diet. This “wean” off the Ketogenic Diet is analogous to weaning anti-seizure medication after a seizure-free interval.

Can the Ketogenic Diet or modified versions of the diet be used in adults?

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Can the Ketogenic Diet or modified versions of the diet be used in adults?

In general, the diet does seem to be effective in adults. Up until a few years ago most studies had been restricted to children and a few adolescents. However there are a lot more studies published with regards to the efficacy of the diet in adults and the results are looking promising.

Can the Ketogenic Diet be used for epilepsy in animals?

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Can the Ketogenic Diet be used for epilepsy in animals?

In animals it is yet undefined. Experimental models using rats have been developed, but the efficacy and side effects of the diet in other animals is not known. We would recommend that people consult their Vet about the diet in pets.

The ketogenic diet in the kitchen: Some practical tips

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The ketogenic diet in the kitchen: Some practical tips

It’s all well and good to have the scientific backing for the ketogenic diet, but when you’re in the kitchen with the bizarre-looking recipes in front of you, things can suddenly feel very daunting indeed. Here we’ve gathered some practical guidelines and tips from experienced families and professionals on preparing ketogenic meals.

Ask for help

Most importantly, remember you are not alone in this diet. If you have any questions, from cooking methods to ingredients, contact your keto dietitian. There are many support forums on the web, and you can even ask your keto team to put you in contact with other patients on the ketogenic diet who can help you with the “nitty-gritty” details of the diet.

Weighing methods

It would be very frustrating to go to all the effort of weighing the exact quantities in the recipes, only to find out that your weighing method was incorrect and the ratio of the meals was wrong all along! Make sure that your scale and technique are accurate so that this doesn’t happen to you.

Look after your scale correctly. Make sure it is clean, undamaged, that the batteries are working and that it is calibrated correctly. Do not store it so that it could be damaged by other appliances and do not store it so that something lies on top of it. If your scale did not come with a calibration weight to check for accuracy, then make your own – find a small but heavy object and record its weight when the scale is new, with new batteries. Use this object every few weeks to check that the scale is still measuring the same weight.

When weighing ingredients, make sure the scale is on a flat, horizontal, hard surface. Ensure that the scale is at zero before adding your ingredient.

For liquid or soft ingredients, try use as few utensils as possible – every time it touches a bowl or spoon, a little bit will be left behind and you might not end up with the correct weight. Therefore, for items like oils, butter and cream, try to weigh the ingredient in the same utensil it will be cooked or served in. If you need to transfer ingredients from one utensil to another, use a rubber spatula that can remove as much of the ingredient as possible. A special note for whipped cream or whipped egg: Whip these ingredients first, and then weigh them out afterwards. Weighing first and then whipping will lose a lot of ingredient in the bowl!

If you are unsure, check with your dietitian about whether the weights in the recipes are for cooked or uncooked foods. This makes a significant difference to the nutritional content of the meal, especially with meats and fish.

Cooking methods

It is easy to assume that all foods should be fried, as it is a high-fat diet. This is not always the case – often, frying foods means that a lot of the fat is left in the pan and will compromise the ratio of the meal. It is safer to cook meals without fat, and then add the fat after the meal is prepared. This ensures that none is lost in the cooking process. Safe methods include:

  • Steaming (preferable to boiling, as few vitamins and minerals are lost)
  • Grilling
  • Baking
  • Roasting
  • Pan-frying in a non-stick pan with non-stick spray

If you do feel that a meal needs to be cooked with fat, then use some of the fat from your recipe. Make sure that you use a non-stick pan, cook at a low heat so it doesn’t burn, and use a rubber spatula to scrape all the leftover fat over the meal.

Flavourings

Flavourings we don’t usually even think about can contain enough carbohydrates to affect ketosis. That doesn’t mean you can never use these flavourings again – simply make sure they are included into your calculation. Some flavourings may be used in moderation without having to calculate them in. Remember: always check with your dietitian first!

These flavourings should be able to be used in moderation without calculating them in. If you would like to use more, they may have to be calculated into the diet:

  • Pure dried herbs and spices, including curry and pepper (a pinch of each)
  • White, cider or red wine vinegar (two or three teaspoons per portion)
  • Tabasco (a few drops)
  • Pure extracts such as vanilla (several drops with each meal/drink)
  • Sugar-free sweeteners (usually can be used to taste, but varies according to the sweetener)

These flavourings will need to be included into your recipe calculations:

  • Tomato sauce/ketchup and tomato paste
  • Mustard
  • Bottled sauces (Barbeque, Monkey Gland, chutney, Worcestershire, HP Brown etc.)
  • Soy sauce
  • Balsamic vinegar
  • Lemon juice
  • Fresh herbs
  • Gravy, stock and soup powders (including stock concentrate)
  • Syrups

Time-saving tips

Cooking and weighing out every ingredient, three to six times a day, can be very time-consuming!

Where possible, use the same food as the family is eating. It is much easier to weigh out the food that is already prepared for the family than to make a separate meal. This also has the major benefit of helping your child not feel left out!

Plan the week’s menu in advance. This way you can prepare for making ingredients or meals in bulk. Making food in bulk can be done in two ways: The first is the assembly line method, where you line up the ingredients and weigh each meal separately. This saves on cooking time and, of course, washing up! The second method can only be used for meals which are blended together, such as egg nog or cheesecake. These meals can be made in one big batch, and then weighed into separate portions. You can determine how much each portion should weigh by adding up the weights of the ingredients for one portion. Depending on the food, these meals can then be frozen or refrigerated.

If some ingredients of a meal don’t freeze well (for example, many fruits and vegetables change texture after freezing), then prepare and weigh the individual portions of the meal that do freeze well. Make sure to label them all clearly so that you know which portion goes with which meal! This will decrease your preparation time on the day.

Meals and foods which tend to freeze well include:

  • Ketogenic biscuits, cookies and cakes (made according to recipe)
  • Ketogenic waffles and pancakes (made according to recipe)
  • Ketogenic breads (made according to recipe)
  • Dishes made with baked egg, e.g. soufflés, quiches
  • Meat, fish, or chicken dishes (cooked or raw)
  • Eggnogs and milkshakes

Some families set aside a week day (e.g. Sunday) and spend a few hours in the kitchen, preparing ingredients and meals for the week in bulk. This may sound time-consuming, but uses much less time than individual preparation (and saves on washing up too!).

Take a look at our list of helpful kitchen utensils and ingredients for more practical help in the kitchen!

How to spot hidden sugar and carbohydrates

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Spotting hidden sugar and carbohydrates
Being hyper-aware of all carbohydrates your child (or you) can be exposed to can feel like a daunting challenge. Carbohydrates can be hidden in not only all sorts of foods, but also in day-to-day household products like medicines and shampoo! For some keto patients these aren’t a concern, but for others these hidden carbohydrates can make the difference between being seizure-free and having a breakthrough fit. Here we offer some tips on how to read labels, what to look out for, and how to avoid hidden carbohydrates.

Reading nutritional information
The first step to take is to check the carbohydrate content of the meal. When doing this, be careful of the following:
-Some labels distinguish between sugar and complex carbohydrates, but remember, total carbohydrates need to be counted on the ketogenic diet, not just the sugar.
-Products from the USA will have a “net carbs” value, which can be used as the total carbohydrate value.
-Fibre does not need to be counted as carbohydrate.
-Label legislation usually allows carbohydrate values to be rounded off to the nearest 1g. -In South Africa, this means that if carbohydrates are less than 0.5g/100g, it may be listed as 0g carbohydrate. This shouldn’t be a concern unless you are worried about breakthrough seizures, or your blood ketones and glucose are deranged. Make sure to check the ingredient list!

Reading the ingredient list
Here are some hidden carbohydrates to look out for on ingredients lists:
-Dextrin
-Maltodextrin
-Dextrose
-Polydextrose
-Glucose
-Lactose
-Sucrose
-Fructose
-Maltose
-Polycose
-Mannitol
-Sorbitol
-Maltitol
-Erythritol**
-Xylitol**
-Isomalt
-Corn syrup/ Corn syrup solids/ High-fructose corn syrup
-Malt syrup
-Cane syrup
-Agave nectar
-Honey
-Invert sugar
-Fruit juice concentrates
**Xylitol and erythritol have been known to be tolerated by some patients on the ketogenic diet. As they are sugar alcohols, however, they can have a small effect on blood glucose and ketosis. Be careful of these ingredients if you have a high ratio diet, if you are starting the diet, or if you are experiencing breakthrough seizures.

Don’t fall into labelling traps
Eating low-carbohydrate, low-sugar foods is very popular, so manufacturers will do their best to advertise their products as such. Be careful of the following:
-“Sugar-free” or “no added sugar” does not necessarily mean the product is free of carbohydrate.
-“Diabetic-friendly” products are not necessarily “keto-friendly”.

Look beyond the grocery cupboard
For some patients, the carbohydrates found in these common household products are enough to cause breakthrough seizures, even those that aren’t ingested! It shouldn’t be necessary to worry about many of these products unless you are experiencing breakthrough seizures or you are struggling to achieve desired blood glucose or ketone levels.

Make sure to check the labels of:
-Pills and medications (it is recommended that you limit your carbohydrate from medication to 100mg a day, so make sure all your doctors and pharmacists are informed. If this is impossible, inform your dietitian so that she can include it in your meal plan)
-Vitamin and mineral supplements
-Medical ointments and talcum powders
-Moisturizers and creams
-Sunscreens
-Insect repellents
-Lip balms
-Toothpastes, mouthwash and other dental treatments (be sure to inform your dentist at any appointments where products may be used)
-Shampoos and conditioners
-Deodorants and perfumes
-Soaps and handwashes
-Shaving creams
There is not yet a list of keto-approved South African products, however the Charlie Foundation website has a list of American products safe to use

References
Regulations Relating to the Labelling and Advertising of Foodstuffs. No. R. 146 of the Foodstuffs, Cosmetics and Disinfectants Act, No. 54 of 1972. 1972. Government gazette. 1 March 2010. Government notice no 32975. Cape Town: Government Printer.