Tuesday, December 29, 2015

LPLD Pie Crust

The holiday season is rough without pie.  But as a fruit-based dessert, I was sure we could find a way to make it possible.

I grew up with my grandma's oil-based pie crust, nice and crisp.  I tried it with coconut oil and it worked great!  If you make a single crust (depending on the pie, you can put the one crust on the top or one on the bottom - who says you have to have two crusts?!?), put no fat into the interior of the pie, and eat an eighth of a pie, it will have approximately 7 grams of fat.  3.5 grams if you and your doctor have agreed your health allows you to consider coconut oil half the amount of fat due to its having a lot of medium chain triglycerides!  Certainly not an everyday food, but no longer on the 'never' list, either!

Grandma's Recipe:

Place 1 cup all-purpose, unbleached flour in a small bowl, add 1/2 teaspoon salt and stir.  In a 1/2 cup measuring cup, place 1/4 cup coconut oil (microwave it if it's solid), then add 2 1/2 tablespoons of cold water to the same measuring cup.  Add the whole measuring cup all at once to the flour/salt mixture, and stir with a fork until just combined.  Roll out dough between 2 pieces of wax paper that are roughly 12"x12" (square) until it makes a rough circle that fills to the edges on each side.  Peel off the top wax layer piece carefully and use the bottom waxed paper to place the crust into place on the pie.  Peel off the last piece of waxed paper carefully.  If you need to prebake the crust before filling it, bake it at 450 degrees for 10-12 minutes or until lightly browned.

Cherry pie with a top crust cut into overlapping stars.  So pretty!

Pie filling recommendations

  • 6 cups thinly sliced granny smith apples, 1 tablespoon lemon juice, 3/4 cup sugar, 2 tablespoons tapioca, 1 teaspoon ground cinnamon, 1/4 teaspoon ground nutmeg (definitely a top crust)
  • 5 cups blueberries with 1/2 cup sugar, a sprinkle of cinnamon,  and 1/4 cup tapioca (bottom crust)
  • 5 cups strawberries with 1/2 cup sugar and 1/4 cup tapioca (bottom crust)
  • Two cans of tart cherries cooked with sugar and cornstarch per the can directions (with a top or bottom crust)
  • 3 cups chopped rhubarb, 1 cup strawberries, 1 cup sugar, 2 Tablespoons tapioca (with a top lattice crust)
What other pies do you wish you could make, or have you made successfully?

Monday, December 28, 2015

RareConnect Community

One of our greatest finds since having this diagnosis is the RareConnect Community for LPLD:


There's a place to write your story, make 'friends' with other people in the community (whether it's others with LPLD or other parents of people with LPLD), and discuss whatever is on your mind, The platform isn't perfect, it's difficult to search for old topics especially.  But it's something I rely on for the latest news on LPLD, and we even have an email pen pal for Monica that is Monica's age!
Two of three have LPLD!

Pasta Primavera

This is a recipe for the summer... maybe I'm already craving all these fresh vegies in this cold, but it will be amazing to eat this again when zucchini is in season again!

3 carrots, cut into thin strips
2 medium zucchini (or one large) cut into thin strips
2 yellow squash, cut into thin strips
1 onion, finely sliced
1 yellow bell pepper, cut into thin strips
1 red bell pepper, cut into thin strips
additional vegetables, as desired, consider a small buternut squash, fennel, or bok choi, also cut into small pieces
1 tablespoon olive oil
salt and pepper to taste
1 tablespoon dry Italian herbs (or a dash of parsley, oregano, and basil)
1 pound whole wheat linguine (our favorite for this recipe, but use whatever noodle you want)
15 cherry tomatoes, cut in half


Preheat oven to 450.  In a large heavy baking sheet or brownie pan, toss all the vegies with oil, salt, pepper, and dry herbs.  Put half the vegies on a separate sheet or brown pan and arrange evenly across the bottoms.  Bake until the carrots are tender and vegies begin to brown, stirring every 10 minutes.  This should take about 20 minutes.

Meanwhile, cook the pasta per the directions on the box.  Drain, reserving 1 cup of the cooking water.

Toss the pasta with the vegies in a large bowl to combine.  Toss with the cherry tomatoes and enough reserved cooking liquid to moisten.  Season with salt and pepper to taste.  Serve immediately.
Yum! End of summer harvest! Ignore the pineapple...

Adapted from this recipe.

Sunday, December 27, 2015

Lettuce Wraps

Similar to those served as an appetizer at a popular Chinese chain restaurant, and a big hit in our family.  We use ground beef, but chopped chicken is excellent as well.

1 tablespoon oil
1 lb ground beef (or two boneless skinless chicken breasts)
8 oz can of water chestnuts, minced
2/3 cup fresh mushrooms
1 small onion, chopped
1 clove minced garlic
1 cup+ of other vegetables, including peppers or zucchini, chopped

2 tablespoons sugar
1/2 cup broth
2 tablespoons soy sauce
2 tablespoons rice wine vinegar
2 tablespoons ketchup
1 tablespoon lemon juice
1/8 teaspoon sesame oil (packs surprising flavor!)
1 tablespoon mustard
2 teaspoons water
1-2 teaspoons garlic and red chile paste (if desired for spiceness)

Stir Fry Sauce:
2 tablespoons soy sauce
2 tablespoons brown sugar
1/2 teaspoon rice wine vinegar

Make dip by combining all ingredients, mix well and refrigerate until ready to serve.

Heat oil in large frying pan or woke, saute meat until cooked through.  Remove meat, allow to cool and mince (if using chicken).  Leave remaining grease in cooling pan.  Prepare stir fry sauce by combining ingredients.  Heat the greasy pan again, on high heat, and add chicken, garlic, onions, water chestnuts, mushrooms, and other vegies.  Add stir fry sauce and heat through, for a few minutes.

Serve filling scooped into whole lettuce leaves, rolled slightly, and dipped into the dip as desired.  It's messy, but delicious!

Adapted from this recipe

Saturday, December 26, 2015

Thoughts on parenting a child with LPLD

How do I teach my child to cope with this in a healthy way?
I want my daughters to understand, for sure, that if they eat too much fat, they will get sick.  They've never had pancreatitis to remind them with memories of severe pain, and I hope they never do.  My daughters, therefore, have to trust me, or maybe experience for themselves the milder stomach pains that some people with LPLD get when their triglycerides are too high.

The stereotype of adults that had childhood chronic disease, whether it's leukemia or diabetes, is that they never grow up.  They have had every detail of their lives managed for them since they were little, since it was necessary to keep them alive, but then as a result they never learn to take care of things by themselves or manage their own illness.  I've talked with parents of kids with severe food allergies and my friends who have childhood, or type I, diabetes to help me to try to prevent this.  

One way that we address helping her be in charge of her own disease is that, as Monica grows up, we expand our discussion of LPLD and what it means.  So, as a toddler, we would say certain foods would 'make her sick' and other foods would 'help her grow big and strong' (and other foods, like candy, are 'treat foods' that do not make her sick, but also don't help her grow big and strong).  As a preschooler, we expanded a little, with foods that she could eat a little of if she ate a good (non fat) meal, like a slice of avocado after a big bowl of non fat pasta.  That was our attempt to teach her balance at that stage.  Admittedly, it is hard to differentiate between a 'reward' for eating a big healthy meal, and a 'natural consequence' for eating low fat meals.  But we're trying!

Now as a kindergartener, we can discuss things a little more, and gradually introduce her to the idea that what matters most in deciding if she can eat something that is high fat, is 1: whether she thinks she can stop herself after just a bite or two, and 2: what fat she's had to eat for the last week, and whether she has special events coming up in the next week at which she might want to eat more fat.
Graham cracker gingerbread houses with nonfat frosting and nonfat candy! The Holidays are a tough time for budgeting fatty foods

What happens as a child with LPL grows up?
Medications don't work for this disease, as they all (at this point in time) work by altering the LPL enzyme; but people with LPLD don't have the LPL enzyme, so the medications don't work!  Surprisingly, individuals with LPLD don't seem to have many problems with heart disease or cholesterol buildup in the heart's blood vessels, which is usually why people with high cholesterol go on medications in the first place!  What good news!  The big lifelong consequences of LPLD seem to depend on pancreatitis; the more times the triglycerides have gotten high enough to cause pancreatitis, the more damage there is to the pancreas.  The pancreas functions in controlling blood sugar levels, and so with lots of damage, an individual can develop type II diabetes (and its own inherent medications, difficulties, and diet changes!).  The pancreas also puts enzymes into the digestive system that help breakdown food, and so with lots of damage, an individual can have chronic digestive symptoms such as bloating and foul smelling diarrhea, called pancreatic insufficiency.  The main goal in controlling LPLD, therefore, is controlling the diet to avoid having pancreatitis.

As a parent, I worry that fat will be set up as something Monica can never have, as something so delicious that she longs for it, the forbidden fruit.  That will set up trouble for when she wants/needs to rebel against us, as her parents.  When Monica is a teenager, we want her to rebel against us by wearing silly clothes, using offensive language, and getting her ears pierced without permission.  We don't want her to have a milkshake and a Big Mac.  That's why we use the phrase '(that food) will make you sick' instead of '(that food) is bad' or something similar.  Her getting to eat a fatty food should never have bearing on her behavior, her sweetness or naughtiness (our children are always inherently 'good,' and never inherently 'bad;' that's what I get for marrying a philosopher :) ).   Getting a spoonful of peanut butter is not a reward for doing chores, but it could be something she gets after eating very low to non fat meals for a while, as a natural consequence rather than a reward.  It's a small difference, but one we hope to emphasize to Monica and prevent her from getting pancreatitis, even as she matures and grows away from us as her parents.
Teresa laughing with her uncle - there are joyful things in life besides food!  But sometimes with LPLD it's hard to remember that.
But it's not fair!
Children with LPLD and their parents, alike, have this thought.  Frequently.  A lot of the solace in our family comes from our Catholic faith, and our (continually growing) understanding and acceptance of why God allows bad things to happen to good people.  We talk with Monica about Heaven, where she won't have LPLD anymore.  We talk about offering up her sacrifices for other people who are suffering (basically, praying that God might take away the suffering of someone else, even just a little bit, if you accept your current suffering without complaint, emulating even just a little Christ's suffering on the cross (this works for parents watching their child suffer, too)).

Monica's food choices have also helped me to realize that everyone in the world has foods that they should be eating in moderation.  It's not just Monica.  Yes, Monica's restrictions are more immediately life-threatening and painful.  Most people will suffer from their poor eating choices with heart attacks and the like years down the line, and Monica faces her consequences sooner.  Which, in a way, is a good thing, that it's easier to eat appropriately when the consequences are so close.  OK, OK, I'm kind of grasping at straws for 'good things' about having LPLD.  But it is true that everyone has foods that they should eat more of, and foods that they should eat less of.  Some people just get to ignore it for longer than Monica does.  Somehow this brings me comfort.  Sometimes.

What about my child's children?
Whether Monica and Teresa's children have LPLD, or are just carriers of it, depends on the genetics of who they marry. Since Monica and Teresa are women with LPLD, they will have particularly rough pregnancies and difficulties breastfeeding, possibly.  But that's a long post for another day.

Merry (low fat) Christmas!

Thursday, December 24, 2015

Wildly Successful Homemade Strawberry Ice Cream

We bought an ice cream maker with dreams of offering alternatives to the sorbets and sherbets offered in the grocery store.  We would make more varieties, healthier, with real fruit and less sugar!!!  But it turns out that low sugar with no fat really... isn't that popular.  So I'm embracing the sugar again, and I hope that in reality it's less than in the grocery store versions - I don't have to see the manufacturer add cup after cup to their batch like I do at home!  And at least it's real fruit, actually picked in season! (And sometimes frozen at home for later use).

Here's the one recipe that has really really gone over well:

Strawberry Ice Cream

3 heaping cups strawberries
1/4 teaspoon salt
1 cup sugar
2 large eggs
2 cups fat free yogurt
1 1/3 dry milk
1/3 cup honey
1 teaspoon vanilla extract

Puree strawberries and salt in your blender or food processor, make sure there's still 2 cups of strawberries.

In a large bowl, beat sugar into the eggs until thick and pale.  Add strawberries, yogurt, dry milk, honey, and vanilla (all the rest of the ingredients).  Allow mixture to cool a few hours in the fridge and then follow the instructions of your ice cream maker.

Goes well with chocolate syrup - it's fat free!  Or make your own!

So it only has a cup of sugar and 1/3 cup of honey... not so bad?  Maybe?  It does have raw eggs, too, so use eggs that you trust are fresh and maybe don't serve it to any in poor health or low immune function.
Still not quite as good as plain old snow...

Thursday, December 17, 2015

How To Work A Milk Separator (and other things I never thought I'd be good at)

I have a small dairy nearby that we buy milk from sometimes, and they have a handy device that you put a sample of milk into, and it tells you the percent of milkfat present in the sample.  Someday soon, I will borrow that device and tell you precise numbers of how much fat different methods remove.  But for now, the small dairy is letting the cows rest for the winter, and so I have no reason to make the drive out just for the little device but no milk... so it will have to wait.

In our efforts to remove fat from the breastmilk we feed our LPLD baby, Teresa, we started with just pouring a few 8 oz bottles into a larger bowl, covering it, and letting it sit overnight in the fridge.  Then in the morning, we used a large flat ladle to scoop off that fat, leaving as much breastmilk behind as possible, and using that 'skimmed' milk to give to our baby while I was at work.  It worked well, and I hope to provide numbers someday as to how well, exactly, it works.

But then our breastmilk separator arrived from the Ukraine.  The more expensive an object is and effort required, the better the product should be, right?  Well, the instructions were mostly unintelligible, so luckily Amazon pointed us in the direction of youtube, and, lo and behold, there are great, simple instructions for use on youtube, my favorite of which is here, produced by none other than Slavic Beauty.  Hmm.  Of course.

My Slavic Beauty!
It has a lot of parts that when you actually look for notches that correspond one to the next, make a lot of sense for how you put it together.  There are a LOT of parts though.  Actually running the milk through takes minutes.  The hardest part of separating milk is definitely the clean up afterward.  Every little part disassembled and put in hot soapy water and rinsed and dried.  Due to the fatty nature of what you are working with, there is still a layer of greasiness that will never entirely go away.  And throughout, I rather feel like I am working with my own liposuctioned fat (thanks, Fight Club).

These little blue cones are the hardest part to clean.

So many blue cones!
 All you really do is warm the milk to close to 100 F (keeping in mind the baby scootching around on the floor has limited patience for not being held), assemble the milk separator, press it tight together to nothing leaks in between, turn on the motor and let it warm up for about a solid 60 seconds, and pour in the milk.  Then carefully catch your product before it escapes, which isn't that hard but I've still messed up on a few times and lost a heartbreaking amount of good milk.
Slavic Beauty in action
There's also a significant amount of milk still in the parts after you shut it down, which I imagine your average dairy farmer doesn't care too much about since he has gallons of the stuff with which to work.  However, for those of us working in ounces instead of gallons, that stuff is precious.  So I spend a lot of time carefully taking the pieces apart and dumping the good stuff into my bowl.  This is the main reason I recommend practicing with goat's milk (or any nonhomogenized, nonhuman milk) first, so that the stakes aren't so high as you are learning where the most milk collects and how to get it into a bowl.

Overall, I'm impressed with how well it works with my small amount of milk.  I run a batch about once a week, maybe 50 ounces at a time.  I am able to control how thick the cream removed is - at first I produced basically butter that I had to scrap every little bit out of the machine, and that wasn't worth that extra effort.  Now I make a thinner cream, that might not get quite as much 'skim' milk in the end, but since I've found a premature baby that I love that I am giving the breastmilk fat to, I know I'm not wasting it!  This whole process would be a lot more heartbreaking if I was somehow wasting the fat from my breastmilk.  I know it's a little weird, but really, sharing breastmilk from a trusted source is safe than formula feeding.  Think of the centuries humans practiced wet nursing!  But my goal with this blog isn't to convince you of the awesomeness of breastmilk.  So we'll leave it at that I am lucky to have a baby that can benefit from my 'waste' milk, and it has made all the difference in my attitude towards this process.  Pumping milk four times a day while at work is hard enough!  Oh, and Teresa continues to have no problems drinking the skimmed milk.  She doesn't protest a difference, and maybe drinks a little more than usual.  She might also poop less than usual, but it's hard to tell what's just her, and what's a result of the skimmed milk.  I'll share her lab results next time we check them!  I'm also concerned about her electrolytes with this thinned milk, so I'll share those, too.

Any thoughts on this process?  I welcome comments!

Monday, December 14, 2015

What my baby and a fancy piece of dairy equipment from the Ukraine have in common...

Fun fact: I'm a lactation consultant.  In addition to being a family physician.  So I care an awful lot about helping other moms to breastfeed.  And as for me breastfeeding my own children... well, there's no doubt about it.

Soon after Monica's diagnosis and really understanding it, I began to think about what we would do if we had another child with LPLD.  At what age would we check our baby's cholesterol levels?  And most of all, once we checked, what would we do if he or she had LPLD?

I feel strongly that if you're not going to CHANGE something after checking a medical test, be it an image or a lab, then you shouldn't check it in the first place.  Knowledge is nice, but at least medically, knowledge without a plan of action is a waste of money and effort.
I can't give this up.  So how can I make breastmilk work for my special little LPLD baby?
After a diagnosis of LPLD, could I continue to breastfeed my baby in good conscience?  Or should I switch to the non-fat formula that is available?  What is the impact of a non-fat diet to a growing infant?  Baby brains need fat to grow!  There's just no research on this.  I wanted to try to breastfeed and feed my baby only human milk.  But I wanted to know if she had LPLD sooner than I did with Monica, to give her the best chance of achieving a healthy diet sooner and never having pancreatitis.  So, with discussion with our geneticist, I developed a plan.  I would check a lipid panel at 6 months.  I wanted to feed regular old breastmilk for at least the first 6 months of life.  Monica had had no symptoms in the first 6 months, so I doubted that, at least with the gene combinations of my husband and I, that the triglyceride levels would rise dangerously in the first 6 months for any of our children.

Obviously, if my baby had already had a case of pancreatitis, I would quit breastfeeding and feed the nonfat formula.  The danger to her life from pancreatitis is too great to mess around with, especially when that little and delicate.  But given that she was still healthy and gaining weight those first few months, we would just do breastmilk and check TG levels at 6 months, as we were starting complementary first foods.  From then on, since I had to work and have my husband feed my pumped breastmilk anyway, I would separate the fat out of my breastmilk from then pumped milk.  I would breastfeed from the source when I was with her, so make sure she got some fat for brain development.  But I hoped that by decreasing her fat intake from my milk in this way, it would decrease her chance of having symptoms of LPLD.  For me and my baby, it's a balance between brain growth and lifelong benefits of breastmilk, and avoiding symptoms, rather than relying on the TG numbers.  Monica, after all, didn't develop symptoms until around 18 months, and even then they were rather minor.  The new baby would have the added benefit of knowledge of her diagnosis, so the complementary foods we would feed her, from the beginning, would be low fat.  Plus, instead of whole milk being added after 1 year of age, we could go right to skim.

I went to a small conference many months back hosted by NORD and asked them about my plan.  Luckily, even the lipid and genetic specialists knew already that the health benefits of breastmilk are huge, especially for a baby who has another serious health problem, like LPLD.  They had never imagined a mom willing to go through the craziness I proposed to breastfeed her baby, but they were interested and supportive of my efforts.

And that is how I came to buy a milk separator.  The kind used by small dairies to get skim milk and cream from their milk.  But I'm not using this on cow or goats milk.  I'm using it... on my own milk.

This. Is. So. Weird.
Without further adieu, I would like to introduce you to the latest member of our family! Shipped right on over from the Ukraine, our milk separator!  Keep posted to learn about our earlier experiences with her!

Friday, December 11, 2015

Big news for our family

Teresa will be 7 months old on Monday.  A month ago, we were dragging our feet to have her lipids checked, especially since she's just so healthy!  She gains weight like none of our other babies ever have!  She's happy and has hardly even had a diaper rash!  She has her first set of sniffles right now, but even they don't clog her nose and make breastfeeding hard for her.

On the one hand, I desperately don't want her to have LPLD.  I want her to chow down on macaroni and cheese when she's had a hard day, eat a big grilled cheese sandwich when it's cold outside, have a stash of good chocolate that she nibbles when she feels like it, and eat big bowls of ice cream.  I want her to never be hospitalized.  I want her to get pregnant and have babies safely and easily and healthily.

But there's a tiny part of my heart that doesn't want Monica to be alone in all this.  She is so attached to Teresa, no one can make Teresa laugh like Monica can.  Wouldn't it be nice for Monica, alone in so many ways with this one-in-a-million disease, to have someone to share her pain with?  If there's a baby who has to have LPLD, wouldn't I want him or her to be in my family, where we know this disease and it's not such a big deal?  Wouldn't it be great for Monica to have not only another sister, but a sister in her illness, who can share trials and recipes and hugs, even when Luke and I are gone?

We knew we were going to test Teresa soon and sometimes I would ask Monica to pray with me that Teresa didn't have it.  Monica was definitely torn on praying for what was best for her sister's health versus wanting a friend in her difficulties.

So when I got the results, when I saw Teresa's triglycerides were >1000, too much to count, I felt so guilty.  So guilty to wish this on my baby with even the tiniest corner of my heart.  So guilty for wanting to have more babies at all with this terrible gene in my blood, even playing the odds of a 1 in 4 chance, was I just being greedy?
The latest patient with LPLD
I'm also reflecting on just how difficult things were when Monica was diagnosed.  Even after the relief of her not having cancer, I remember going to Whole Foods and walking around, looking at the fat content of foods.  There was some relief (ketchup!  pasta!) and a whole lot of worry and disappointment about what she could eat.  At least we don't have to do that for this little baby.  I don't stay awake all night wondering if she will be alive in a year or whether this is a countdown of her last days on earth.  But I'm having a hard time being thankful for that.  My heart will come to peace with this eventually, but for now it is broken for my tiny daughter's sake.

So I should probably change my blog name to Monica and Teresa's Mom.  My two little one-in-a-million children.

Wednesday, December 9, 2015

Dessert ideas!

Especially with a young child, dessert might be the hardest time to have LPLD.  Making sure Monica feels included in a special treat at holidays, family gatherings, and weddings, is almost always a source of stress for me!  So here is a list of our best ideas to make desserts feel special:
  • Fresh fruit with sugar to dip in - by far the easiest for a restaurant or a wedding caterer to pull off, especially when it's a special rare fruit (strawberries!)
  • Apple slices dusted with cinnamon and sugar and DELICIOUS
  • Sherbet or sorbet - be careful, sherbet is sometimes fat free, sometimes not!  Serve with chocolate syrup, sprinkles, cherries, and/or marshmallow fluff
  • Marshmallows!  Roasted over a campfire (s'mores can work with chocolate syrup instead of a bar of chocolate), or assembled with toothpicks into a 'snowman'
  • Apple (or other fruit) 'pie' without the crust (or the crust removed)
  • Fat free brownies (I'm still working on an imitation of Trader Joe's mix that's been discontinued)
  • Angel food cake frosted with fat free whipped cream (or whipped topping), fresh fruit, or sweetened nonfat yogurt
  • Fruit juice popsicles (buy them, make your own in dixie cups; maybe even with fat free yogurt, like a frozen smoothie)
  • Merengue cookies are one guaranteed fat free cookie!
  • Snow cones, either with a fancy snow cone maker or use a blender to crush ice, then cover it in sugary fruity syrup
  • popcorn or kettle corn - easy to make on a stovetop, or airpop some popcorn, melt some honey with cinnamon, and toss the popcorn with the sticky delicious result.  I made about 8 cups of the stuff last night thinking it would be a sweet snack for the week.  Monica and Mary ate it all. in. one. night.  !!

So sick of Frozen, but it makes everything more special these days

What are your reliable dessert options when you need a sweet treat?

Tuesday, December 8, 2015

Snack ideas!

If you have the time and patience to walk through the granola bar and cookie areas of your grocery store and look at the nutrition facts of every box there, there may be a surprising number that is LPLD-safe!  Well, surprising if you're like me and you expect there to be ZERO, ha!  We let Monica have bars that have up to 3 g of fat per serving as snacks at school, since our school says it's too much of a hassle to require every Kindergarten parent that brings in snack to make sure it's Monica-safe AND we don't quite have the time and energy to bring in fresh cut up fruit and vegies every single day for snack AND lunch!  So there's actually a wide variety that she has in her own personal 'snack bag' at school for when the snack provided is too high fat (or the teacher isn't sure if it's too high fat).  Monica's favorites are the ones with chocolate!  But as for day-to-day, we like to stay away from snacks that come in bags and never ever seem to go bad.  Here is a list of our favorite snacks:

(Fat free) yogurt with jelly
(Fat free) yogurt with honey
(Fat free) yogurt with a tiny amount of granola or chopped nuts
Popcorn!  air popped or cooked in a small amount of coconut oil
Popcorn with salt
Popcorn with honey
Popcorn with salt and sugar (I am ALWAYS burning this kettle corn lately, sigh)
Carrots with fat free ranch dip
Kiwis cut in half and peeled
Apples with peanut butter dip
Strawberries, blueberries, blackberries, any berries!
Even better if you pick them yourself!
Frozen peas (crunchy and tastey, have you tried them??)
Peeled oranges
Other sliced fruit, especially with yogurt dip (yogurt, honey, and vanilla extract)
Sliced fruit with peanut butter dip
Edamame (look with frozen vegetables in the store)
Cucumber sticks
Pickles! Lots of varieties, all non fat!
Cherry tomatoes
Sliced tomatoes dusted with a little salt
Pea pods
Sliced bell peppers
Fat free tortillas with lunch meat and nonfat cream cheese, rolled up and held with a toothpick
Cubes of fat free cheese (with grapes and apples to be extra fancy)
Low fat muffins!
Dates (super sweet!)
Honey/jelly sandwich
Honey/banana (or other fruit) sandwich
Jello jigglers! from a mix or from this recipe from Kitchen Stewardship

I was so happy with how these candy corn Jello things turned out!
Bean dip (mashed up canned beans, maybe with a little yogurt to make it more dip-y) with fat free tortillas (add cheese to make little quesadillas!)
Brown rice with pasta sauce
Fruit smoothies with fat free yogurt
Raisins and other dried fruit
Egg white with a few vegies sauteed in

What else do you have to add to this list?

Sunday, December 6, 2015

Self Frosting (Anise) Drops (COOKIES!)

Happy feast of St Nicholas!  In our family, St Nick fills our shoes overnight and also comes and frosts these cookies!  They are simple and a family tradition, and they also happen to be low fat; 15 grams for the whole recipe, which I've had make 7 dozen (very small, bite size) cookies!  Use whatever flavor extract you want; traditionally it's anise, but not everyone likes the licorice-ness, so I've also used plain old vanilla as well as almond.

3 eggs at room temperature
1 cup plus 2 tablespoons sugar
1 3/4 cups all purpose flour
1/2 teaspoon baking powder
1/2 teaspoon salt
1 teaspoon anise extract

In a medium mixing bowl, beat eggs until fluffy.  Add sugar gradually, beating constantly.  Continue to beat 20 minutes more (we find another platform to rest our hand mixer on, cause 20 minutes - wow!).  In a separate small bowl, combine flour with salt and baking powder.  Gradually add flour mixture to egg mixture, mixing the whole time.  Beat another three minutes.  Add extract.  Drop by 1/2 teaspoonfuls onto greased and floured cookies sheets, swirling to form a round cookie (we use stoneware but they are hard to get off prettily, but we don't mind cracked cookies).  Let stand 8 hours, or overnight, to dry.  Bake at 325 F for about 10 minutes or until a creamy golden color on the bottom.  Store in air tight tins.  The 'frosting' forms while they are being baked.

Sweet and simple!  Happy Advent!

Saturday, December 5, 2015

Angel Food Cake Cupcakes

I found this on a package of Angel Food mix and I never want to forget it!  I don't like to make a full batch (30-36!) of cupcakes at a time, since I usually just want one or two for upcoming parties, and frost and freeze the rest.  But if you want to make the whole box, follow the directions on the back of the box (it makes up to 36 cupcakes, refrigerate the batter while the first bunch is waiting if you don't have that many muffin cups to bake with, like me!)

Heat oven to 375 degrees F.  Place paper baking cups in 12 regular sized muffin cups.  Measure out 1 cup of purchased angel food cake mix (write on the box or bag how much you've used and how much there is left!  There are usually 4 cups of mix in a box that usually makes a whole cake).  Beat it in a glass or metal bowl with 1/4 and an extra little splash of water (you want 1/4 cup and 1/16 of a cup of water, for you who want the details), for 30 seconds on low speed, then for 1 minute on medium speed.  Pour into muffin cups so that they are 3/4 full (if at high altitude, fill 2/3 full).  Bake 12-20 min or until golden brown and cracks feel dry.

Frosting... is a whole other blog post.  I have yet to get it quite right!

Thursday, December 3, 2015

My Favorite Homemade Bread

I've always wanted to make all our own bread, and after much trial and error I finally found a recipe that works for our family.  It tastes great, it holds up well enough for sandwiches and toasting, and the girls gobble it up!  What's more, it's 100% whole wheat and I've found a way that works with my bread machine to make a great loaf with really minimal work on my part.  See what you think!


1 1/3 cup water (I use just 1 cup in the summer when it's more humid)
1 tablespoon plain non-fat yogurt
2 tablespoons coconut oil (I zap it in the microwave to pour it out of the jar)
3  tablespoons molasses
3¼ c. whole wheat flour (divided)
2 teaspoons yeast
1 1/2 teaspoons salt

Mix the water, yogurt, oil, molasses, and flour together.  I like to put them in my bread machine's pan in the order and let it do all the work of mixing them together, on a 'dough' setting.  Cover the dough (or close the bread maker lid) and leave it for 12 to 24 hours.  This allows the water to soften the hard whole wheat and the bacteria in the yogurt to start breaking it down, as well.  I like to do this in the morning.

In the evening, after everything's been all mixed together and sitting for a while, put the remaining 1/4 flour on top of the dough and make an indentation in the middle of the flour, like a bowl for the yeast and salt, so that the flour is a barrier between the moisture in the dough, and the yeast and salt.  We want those mixed in at the last minute!

Set the breadmaker timer on a dough setting (again, I know; but this time you are mixing in that yeast and salt and letting it rise appropriately) so that it will be all done whenever you are up in the morning, to get it out and put it into a bread pan to let it rise for an hour, then into the oven for 35 minutes.

We like to use a stoneware bread pan to avoid having to put any extra oil to grease the pan.

Bake it at 350 degrees F for 35 minutes

My recent favorite way of eating it is toasted, with a thick layer of sand plum jelly.  Hurray for Oklahoma!

Adapted from Kitchen Stewardship

I can't help it.  I always take a picture when it comes out prettily!

Wednesday, December 2, 2015

Recipe Index

I want this blog to be user-friendly, so please let me know if you have any ideas to make it more so!  In that vein, I dedicate this post to categorizing all the recipes on the blog.  If you have a favorite low/no fat recipe, please email it to me at rachelklangley(at)gmail(dot)com.

Shrimp, grilled zucchini, sourdough crackers, and cocktail sauce.  Yum!
Rice Pudding (also a dessert...)
Cinnamon Rolls
Huevos Rancheros
Bunny Bread

Main Dishes
Vegetable Lo Mein
Shepherd's Pie
White Chicken Chili (links to the outside; perfect as-is, just use nonfat yogurt (or a nonfat sour cream) instead of sour cream!)
Lettuce Wraps
Roasted Bell Peppers of Awesomeness
Fast chicken tacos

Snack ideas in general
Pumpkin Cookies
Homemade Whole Wheat Bread
Kettle Corn

Fat free happy birthday sprinkles!

Dessert ideas in general
Self Frosting Anise Drops (cookies)
Angel Food Cupcakes
Strawberry Ice Cream
Pie crust (and various pies)
Rice Pudding
Gingerbread cookies - links to an outside recipe that I love just the way it is! We just made these and the dough is just like the classic gingerbread I've always rolled out and made shapes out of!
Chocolate cupcakes

St Nicholas Gingerbread!

Shepherd's Pie

This is a longtime favorite of our family, and my favorite recipe to make double of (as long as we're making it anyway), freeze in a disposable pan, and give away to families with new babies or health difficulties, or who just need a little love.  It's full of vegies and man, Monica ate about half the pan last night by herself!

For the topping:
1 1/2 lb potatoes
salt and pepper to taste

1 tablespoon olive oil
1 cup chopped onion
2 carrots, diced
2 cloves garlic, minced
1 lb ground beef (traditionally shepherd's pie is lamb, but it's great with beef!)
1 teaspoon salt
1/2 teaspoon ground black pepper
2 tablespoons white flour
2 teaspoons tomato paste
1 cup chicken broth
1 tablespoon Worcestershire sauce (we love this stuff, load it on!)
2 teaspoons freshly chopped rosemary leaves
1 teaspoon freshly chopped thyme leaves
1/2 cup fresh or frozen corn
1/2 cup fresh or frozen peas

Cut the potatoes into 1 inch chunks, place in a medium saucepan, cover with water, and boil on high heat, covered.  After they achieve boiling, uncover and decrease heat to maintain a simmer and cook for 10-15 min, or until they are easy to shmoosh.  Then drain them, return them to the pan, and mash with your favorite masher.  Consider whipping them with beaters, as well; we like to do that so that they are real smooth to put on top of the filling.

Preheat the oven to 400.

While the potatoes are cooking, sautee the onions and carrots in preheated olive oil in a 12-inch pan over medium heat.  After they start to look dark, 3-4 min, add the garlic and stir it in.  Add the meat, and salt and pepper and cook for 3 minutes, or until the meat is just about completely browned and cooked.  Sprinkle it all with flour, cook for another minute, then add tomato paste, broth, Worcestershire, rosemary, thyme, and stir it all together.  Bring to a boil, reduce the heat to low, cover and simmer for 10-12 min until it's a little thickened.

Add corn and peas to the meat mixture and spread evenly in a 13 x 9 inch baking pan.  Top with mashed potatoes, starting around the edges to create a seal to prevent the mixture from bubbling up and smooth with a rubber scraper (this is the point I'll wrap up and freeze the extra batch for a friend, writing on the lid how to bake it).  Bake for 25 min or until the potatoes just begin to brown.

~Adapted from Alton Brown's recipe
A potato-y smile for a friend in need!

Tuesday, December 1, 2015

School Lunch Extravaganza!

We are into our second year of packing lunch for Monica every day for school, and have yet to wish we could just pay for hot lunch provided by the school. In part, because its just not an option! My husband volunteered weekly last school year to help prepare and serve lunch for Monica's school, and he was dismayed at what the kids were being served, its unappetizing and unhealthy lack of freshness and variety.  I wonder how often we would buy hot lunch if Monica didn't have LPLD! But just because hot lunch isn't an option, doesn't make packing lunch every day an easy task.

A lot of my inspiration for these ideas has come from Kitchen Stewardship. She has many posts on how to make school lunch healthy and easy, but I found this post the most helpful.

Bran muffin, jelly, sliced apples, almonds, yogurt in a Squooshi!
My #1 tip is: Don't let your child throw anything out! No trips to the trash at all. This is threefold: one, because for the sake of the environment we use all reusable lunch ware and it is so expensive, you do not what anything thrown out by accident! This way, we don't even risk the container being thrown out with the uneaten food. Two, you get to see exactly what your child ate, which is super helpful for estimating their fat intake for the day (and guessing as to whether they can have a slice of avocado on their taco for dinner, that sort of thing.) Three, your kid gets that much more time to eat instead of having to spend time at the crowded trash can with everyone else. I don't know about you, but my five year old cannot be rushed through a healthy meal. She is more likely to starve then to scarf food down, she needs every precious moment!

Yogurt, wrap with jelly and fat free cream cheese, pickles, 'trail mix,' juice!
Our favorite reusable lunch options include: this bento box, these squooshies for yogurt or applesauce, dip containers, and bento type forks and toothpicks to make it more fun, then add a stainless water bottle (sometimes with water kefir instead of water), a few plastic or metal forks, and a cloth napkin. Don't forget silverware!! When you forget those, your kid can spend half their lunch time finding some, and time is crunched as it is.
Muffin, yogurt, almonds, yogurt, half a banana!
When we have the energy, we try to make Monica's lunch extra fun. I guess I figure if your kid can't eat the most fun food, at least make it look awesome sometimes! We use cookie cutters on sandwiches, fun notes, and colorful toothpicks when possible. Though Monica reported that kids are mostly jealous of when she gets popcorn for part of her lunch. Popcorn is whole grain, fun to eat, and very low fat! Winner!!

One thing we embrace for lunches is giving her leftovers. We will often ask Monica at dinnertime, if she seems to be particularly enjoying it, if she would like to eat it for lunch tomorrow as well, and she is frequently enthusiastic! She is fine with not warming it up (my kids prefer their food cold, anyway, sigh) and although I imagine it to be a little weird or embarrassing to have a small casserole full of vegies while your peers are eating hot lunch pizza, Monica loves it and hasn't complained. Try to remember to put it right into the lunch container after dinner to minimize thinking and packaging later. Just one more step to make life easier!

Sometimes we make lunches of just snack type foods, and those are some of Monica's favorites.  I can't say I would be thrilled with a lunch of cherry tomatoes, orange slices, pickles, almonds, fat free cheese cubes, and popcorn, but it hits all my food groups (fruits, vegies, protein, dairy) and Monica gobbles it up.

Kiwi, hard boiled egg, yogurt, noodles with our homemade pasta sauce!
Are these pictures helpful?  Should I provide some more for inspiration for you?

Saturday, November 21, 2015

Pumpkin cookies recipe

Adapted from a variety of recipes online, this was my first successful cookie adaptation that was relatively LPLD safe.  Tell me what you think!

LPLD Pumpkin Cookies
1/4 cup coconut oil (54 grams of fat total, divided by the number of cookies you make, I made 52, so just a little more than a gram per cookie! Plus since there's so many medium chain triglycerides, we count coconut oil to be half the fat that it really is)
2 cups pumpkin puree (canned or pureed yourself)
1 teaspoon almond extract
1 cup granulated sugar
1 cup brown sugar
2 teaspoons powdered egg or 2 egg whites
1/2 teaspoon salt
1 teaspoon baking powder
1 teaspoon baking soda
2 cups whole wheat flour
1 teaspoon ground cinnamon
1/2 teaspoon ground ginger
1/4 teaspoon ground cloves
1/4 teaspoon ground nutmeg

Mix all the wet ingredients (oil, pumpkin, extract, eggs) and sugar together.  Mix all the rest of the ingredients together in a separate bowl.  Stir together into one bowl slowly, combining thoroughly.  Scoop heaping tablespoons onto cookie sheets (either greased, lined with parchment paper, or use stoneware; the latter is our preference).  Bake at 375 degrees for 20 minutes or until just brown around the edges.  Let cool for 5 minutes on the cookie sheet, then transfer to cooling racks.  We like to then 'frost' them by dipping them in powdered sugar, but that is optional.  Makes about 50 cookies.
Monica is good at frosting!

Ingredient Essentials

A Tour Through Our Kitchen

Our kitchen has certainly changed since Monica was diagnosed!  I've always enjoyed some weirder or more complicated aspects of cooking and trying new things in the kitchen.  I remember trying to make after-dinner mints when I was in elementary school and winding up with cookie tray upon cookie tray of mooshy, minty, blue puddles.  Yuck!

The first thing we changed when Monica was diagnosed at around 18 months was her milk.  We gradually switched her from whole milk to skim, a week at a time.  First we started filling her bottles (yep, she was definitely still drinking from bottles at that age) with a quarter of 2% milk, three-quarters of whole, mixed together.  After a week of that, she had a week of half a bottle of 2%, half of whole.  Then a week of a quarter whole, three-quarters 2%.  And so we went from whole to 2% to 1% to skim without much difficulty at all.  It took a long time, but just by this one change we were able to drastically reduce her triglycerides.
We do drink organic milk when we can, but there's nothing wrong with drinking conventional.  With milk, we are a little worried about hormones in the milk affecting our girls.  But if money or groceries ever came down to choosing conventional milk or no milk at all, we would be buying up that milk, no matter what!

The hardest thing for us to do without was cheese.  What I did at first was learn to make my own; we were living in Las Vegas at the time, and I was able to get milk from Trader Joe's that would make a survivable mozzarella.  The hardest part of making milk, in my opinion, is finding milk that will actually turn into cheese instead of, well, mush!  I had many many heartbreaking episodes.  I used recipes and supplies from The Cheese Queen and would make large batches and freeze what we weren't going to use soon.  I made mostly mozzarella and sometimes cheddar.  I rarely ate it myself because it was so precious; we would really only use it on pizza for Monica.  It was crumbly and not particularly flavorful, but it was full of calcium and it melted sufficiently.

Then a miracle occurred.  Look what we found at Whole Foods:
I am still amazed that this exists.  I want to buy stock in their company.  I rarely get to go to Whole Foods anymore, since we live in a much smaller town without one nearby, but when we go to the city or visit family, I literally buy them out of this stuff.  It freezes great.  It's admittedly ridiculously expensive, something like $6.90 for each of these blocks.  But man.  We never let it go bad since we freeze it, and it melts beautifully and Monica loves it.  And, perhaps most importantly, I don't have to deal with the hassle and stress of making (and often failing) at making cheese.  HURRAY!

These are sold at our local hippie shop and I couldn't believe the ingredients.  No, really, I asked the shop owner to call her supplier to confirm (another reason I love this store).  Can you read the ingredients?  I made it extra big to try... just flour and salt!  That's it!  So lovely!  Admittedly, we will often lightly fry these in olive oil as a special treat for those of us without LPL, but being able to serve the same food to everyone in our family feels so good.  My next project might be to try to get good at making these myself at home, since we won't be living in this town forever.  Nothing like having a backup for my first few attempts that might fail right when dinner requires their success!

Sauces are key.  At least for toddlers.  Look at all these vinegars that we have on hand all the time for different flavors!  White wine, balsamic, red wine, and rice; lemon juice can really kick flavor up, too.  My husband has become quite the sauce-maker!

Sometimes a from-scratch dip or sauce is too much to ask for.  Ketchup, barbecue sauce, fat free salad dressings, even pickle relish and sauerkraut all can save the day.

Our girls seem to adore anything with tomato sauce.  We make a giant batch about once a month and freeze some of the jars, but we will use a store bought sauce, instead, in a pinch (canned or glass both work great, check the nutrition facts on jarred sauce though!).  Soy sauce is another key item that Monica will eat as a dip or a sauce.  Molasses is a nice sweetener for my girls because it packs some extra iron for nutrition (apparently girls who don't get enough iron end up having more trouble in school, interesting!).  Maple syrup and honey are handy for turning a regular snack into something special without any fat, in addition to a fat free topping for pancakes and waffles.

There's the honey!  Yum.  Jellies and jams are fat free.  We like to have a jar with a lid poked with holes, filled with a cinnamon/sugar mix for putting on top of toast or snacks that could use a little extra something.  Like sliced apples.  Delicious!

Greek yogurt and fat free cream cheese are for the times when you need a little creaminess, or a creamy dip!  I'll even add these to peanut butter, to make a peanut buttery dip that's lower in fat and higher in calcium.  Win-win!  The yogurt pictured is a container of full fat yogurt that I have filled (see the label on top in marker? ha) with yogurt that I made myself with a perpetual culture that I bought from Cultures for Health almost a year ago.  It's lasted that long!  It might be cheaper to make organic yogurt than to buy organic yogurt, but I'm not positive.  It certainly uses less packaging, and I find it easy and enjoyable.
The blurry cultures that we use the most - sourdough (for our pizza crusts) and Greek yogurt.

Another way to add creaminess to a dessert or sweet recipe; fat free sweetened condensed milk.  Apple sauce is the classic baking substitute for butter; moist baked goods without the fat!

I bought this years ago for a biscuit mix for backpacking, but I'm starting to use it in Monica's baked goods.  One teaspoon is supposed to replace one egg, but I'm finding it's a little too strong at that ratio!  It contributes to the 'gumminess' of baked goods, the 'stick-together-ness,' if you will.

What about desserts?  Angel Food Cake is a staple; I once found a box that listed a recipe for how to make angel food cupcakes that I cut out and will save forever.  Elementary aged kids just HAVE to have cupcakes sometimes, it seems.  I'll top it with an egg-white-and-sugar frosting, or with sliced fruit or a sugary fruit sauce.  We keep a few, pre-frosted, in the freezer for emergency cupcake needs (what, you've never heard of those?  They happen.  Mostly when parents at school don't give us a heads up that they're bringing treats for their kids birthday.  Monica has been the kid in the corner trying to look cheerful sipping water as the kids around her demolish their brightly colored sugary treats one too many times for this mom...).

This is our favorite brownie mix ever, an awesome find at Trader Joe's, that I believe they have discontinued.  The best part was that they had a single serving size recipe that has helped us immensely in tight, last minute, fixes.  Like before Thanksgiving (What?!?  No pie that she can eat?!??) or other kids birthday parties for which I didn't plan ahead.  You mix two tablespoons of the mix with one tablespoon fat free greek yogurt, stir it up real well in a mug, microwave it for a minute, et voila. Add marshmallows or sprinkles for extra gold stars.  Anyway, I'm currently using my last box to compare my experimental mixes with, to try to make something myself from scratch in case I never find it at Trader Joe's ever again.

If you have a sorbet or cupcake that is less-than-exciting (definitely happens with baked goods are this house, often), sprinkles are a great way to save the day.  The bigger granule types can sometimes have small amounts of fat.  The tiny crystal types are basically colored sugar and are totally fat free.  Or put some chocolate syrup on top, also fat free.  Or both!

Dream whip is powdered whipped cream that you can mix up with some fat free milk for a last minute dessert topping.  I know they sell 'fat free' whipped topping at stores, but my general rule is that if I can choose between a food that will go bad, and a food that seems to never go bad, I choose the food that can go bad.  Preservatives?  Real-foodiness?  I'm not sure.  I don't know if I'm supported by science in this, but that frozen whipped topping weirds me out.  Dream whip, less so, but it's still not something we eat on a weekly, or even monthly, basis.  The Jell-O pictured I've had for at least 5 years... but the real gelatin that we use isn't nearly so pretty.  It's off-white and in a giant bag since I use it a lot.  I use recipes from Kitchen Stewardship that consist of just gelatin (from Azure Standard) and juice to make jigglers that the girls love.  Not too much sugar + fun shapes and colors = dessert!

The few other LPLD folks I've ever met swear by these, so I searched far and wide to find them.  They are fat free and have chocolate and marshmallow and are so tasty that even people withOUT LPLD love them.  I buy boxes and boxes whenever we find them.  It is so hard to find chocolate things that Monica can eat (pretty much this, chocolate syrup, chocolate brownies that I've already mentioned... that's it.  LPLD is rough on chocolate-lovers).

For snacks, a fruit leather is perfect for all my girls.  Well, not very filling, but it's something that everyone can have, at least, and can live in my purse forever in case of emergencies.  These are my favorite, sold by Azure Standard.  They are thicker than you would expect any fruit leather could possibly be and are all delicious.  And I can buy them in bulk!

Finally, for the small amount of fat that my lovely LPLDers DO get to eat, how do we make sure it's the best, with lots of fat-soluble vitamins (A, D, E, and K!) and essential fatty acids?  I'm currently figuring out how to make breastmilk work; they make fat free formula for babies, but in my opinion, if your baby hasn't had pancreatitis yet, then the benefits of breastmilk outweighs the scary high triglyceride levels!  I'll keep you posted on how things go with Teresa, our newly diagnosed 6 month old, and the milk separator that I have ordered (from the Ukraine.  Huh.)  Our geneticist recommended that Monica get 1 mL of walnut oil every day when she was first diagnosed.  It is chock full of lots of good things, but how do you get a kid to swallow straight oil?  For about the next two years, I would get an ice cube tray and put 1 mL of walnut oil in each spot, followed by two small spoonfuls of sugar and one small spoonful of cocoa powder.  I would mix each cube spot meticulously, and then Monica would get to eat a scoopful of her very own 'chocolate' every day!  We kept it in the fridge and it worked well, but now I use the walnut oil in muffins for her, and hope it adds up to approximately the right amount of good stuff, even if she doesn't eat a muffin every day.  She is also older now and eats a greater variety of food in general, as opposed to as a toddler, when a day's intake might include three noodles and an apple slice, and that's about it.  A toddler will ALWAYS eat a spoonful of sugary, gritty, oily chocolate, it turns out.

That's maybe the hardest part of raising a child with LPLD; balancing enough fat for brain development without getting close to pancreatitis.  So we do try to make sure she gets some fat every day, and try to make it the best possible fat.  Coconut oil is a great one.  Eggs aren't pictured but we use frequently (5 g of fat each!), both whole and separated for their whites (mom and dad get more cream brulee and home made ice cream with lots of egg yolks, darn!).  We can get free range eggs from our hippy shop that are delicious with bright yolks.  I've rendered my own lard from local grass-raised pork that I sometimes cook with.  Olive oil is the go-to fat for our whole family in cooking and sauteeing.  I try to use grass-fed butter on the rare occasions that Monica gets any.  Finally, a frequent and popular snack is a few (10?) almonds or pecans.

So that's a basic run down of how we take care of Monica in the kitchen.  I hope this helps encourage anyone with a new diagnosis that there really is a TON that you can still eat!  Please comment with what you wish to know more about - how I do something, why I do something.