如何使用改良后的阿特金斯饮食法？.doc

How Do I Use the Modified Atkins Diet?如何使用改良后的阿特金斯饮食法？So far weve talked about the history of the modified Atkins diet (MAD) and future directions, as well as what the diet basically is. In this chapter, well give you the “MAD:101,” which is what we do when we counsel our families. Lastly, well talk about fine-tuning the MAD and switching from the MAD to the ketogenic diet.到目前为止，我们已经谈到改良后的阿特金斯饮食法（以下简称MAD）的历史及其未来发展方向，以及上述饮食基于什么。在本章中，我们会为你解读“MAD：101”，与家人讨论时，我们该做什么。最后，我们将谈论微调MAD及从MAD饮食转换至生酮饮食。The Basics Of The First Month第一个月的基础In general, this is meant to be simple. If its not, somethings wrong!Before starting the MAD (or any diet), make sure your child doesnt have a reason not to start a diet-your neurologist will know. Also, get a baseline fasting set of blood work, including a CBC,SMA20(CMP),and fasting lipid profile. Appendix F lists many of these labs.一般情况下，是很简单的。如果不是，就是有什么地方错了！开始MAD饮食（或任何其它饮食）之前，确保您的孩子没有理由不开始规定饮食您的神经科专门医师学家会知道。此外，获得一个空腹血液基线，包括CBC、SMA20(CMP)、空腹血脂谱。附录F列出许多可做上述医学测试的实验室。We start by telling families that carbohydrates need to be reduced to 10 grams per day (20 grams for adults ). We start adolescents at 10 grams per day , but if its too hard after 1 week, well go up to 15. For the MAD , it doesnt matter which carbohydrates you use, although 99% of out patients naturally choose the lower glycemic index carbohydrates because you get “ more bang for your buck” in terms of carbohydrates. It is also important not to go lower than 10 grams per day: There will be no additional benefit, and it will just make the diet tougher. Food records show that most parents are already within 5 grams of 10 grams/day of carbohydrate when we cheek - you will do a good job!我们会先告诉家长必须减少碳水化合物摄入量至每天10克(成人为20克)。我们开始为青少年每天限制在10克,但是如果一周之后太难坚持,我们将升到15克。对于MAD饮食来说,摄入什么碳水化合物都没有太大关系,尽管超过99%的病患自然选择较低的glycemic指数的碳水化合物,因为你需要从碳水化合物中“more bang for your buck ”。同样重要的是不要去低于10克/天:它除使得饮食疗法更持久之外没有额外的好处。食品记录显示,当我们检查时大多数父母可以做到碳水化合物510克/天,你将做得很好！ Carbohydrate-counting guides are important to show you the contents of most foods out there. In our opinion, the best one is the Calorie King paperback, which is updated each year, includes restaurants, and is about $10 (www.calorieK). There are also carbohydrate-content lists of common foods available on the Internet. We list some basic foods from the Atkins books in Appendix C. After a while , youll get familiar with the contents of most foods your child likes, and you wont need to refer to this book often. 碳水化合物计算指南是向你显示大部分食物的相关内容。在我们看来，最好的是一本平装的Calorie King（卡路里之王），它每年出一个新版本,包括餐厅，大约十美元（www.calorieK）。在互联网上也有普通食物的碳水化合物含量清单。我们在阿特金斯饮食书的附录C中列出一些基本食物的含量。一段时间之后你将熟悉大多数你的孩子喜欢食物的含量，你就不用经常参考书本了。 Second, it is important to remember that this a high fat diet. We will often tell families that foods should “shine” from the flash of a photograph if you take one! The meals should look similar to those on the ketogenid diet. In fact, we give recipes of ketogenic diet foods. KetoCalculator can be used; just calculate a 2:1 ratio to be safe, and double check the number of carbohydrates per day. However,this is usually not needed as meals are flexible and calories are not restricted. Eat typical ketogenic diet foods such as heavy whipping cream, oils, butter, mayonnise, and soft cheese. On the MAD, these foods are not only ad lib in regards to amounts, but encouraged. 其次，重要的是要记住，这是一个高脂肪的饮食。我们会经常告诉家长：如果你把用闪光灯为该饮食拍照，这些食品可能会“闪光”！饭菜应类似于ketogenid饮食。事实上，我们给的是生酮饮食的处方。 KetoCalculator可以使用，只要计算以2:1的比例，是安全的，并认真检查每天摄入的碳水化合物数量。然而，这通常不需要膳食是灵活的和热量不受限制。多吃典型的生酮饮食的食物，如：多脂奶油、油、黄油、mayonnise，软奶酪。在MAD，这些食品不仅没有限制，而且受到鼓励。Calories are ad lib. However, just like on the ketogenic diet, we try not to make children gain significant weight. Hunger should not be an issue - if you child is hungry for breakfast, give more eggs! If they are hungry for lunch, give more tuna or hamburger. Just dont forget the fat, which can be very satisfying, so its probably better to give more butter and oils. Protein is also ad lib, so good sources like meats, fish, and soy can be given as much as your child wants (but again, dont give them at the expense of fats). Fluids are not only ad lib, but we push them. To date we have not seen a kidney stone in a child on the MAD, and that may be due to the extra fluids or less urinary calcium or acid. Drinks such as diet sodas and flavored waters (e.g.,Fruit2O, Aquafina Flavor Splash, Powerade Zero, Nestle Pure Life Natureal Fruit Flavored Water, Dasani Natural Flavored Water, O Clear Water) are great and really help. Artificial sweeteners are fine. Extra fluids may make the urine seem less ketotic (due to more fluid), but thats okay. 卡路里是随意摄入的。然而，就像生酮饮食一样，我们尽量不要让孩子们获得显著的重量。饥饿不应该是一个问题如果你的孩子早餐时饿了，给他更多的蛋！如果他们午餐时饿了，让他吃更多的金枪（吞拿）鱼或汉堡包。只是不要忘记脂肪，这可以是非常令人满意的，所以可能更好的是摄入更多的黄油和油。蛋白质也是随意摄入的，良好蛋白质来源如肉类，鱼类，大豆，可以给你的孩子想吃多少就吃多少（但再次提醒，不让他们被脂肪损害）。流质不仅是随意的，而且我们还加以推荐。到目前为止，我们还没有看到一个使用MAD的孩子有肾结石，这可能是由于额外的液体或更低的尿钙或酸。饮用食用苏打和加味水饮料（例如：Fruit2O, Aquafina Flavor Splash, Powerade Zero, Nestle Pure Life Natureal Fruit Flavored Water, Dasani Natural Flavored Water, O Clear Water）是很好的而且很有帮助。人工甜味剂也很好。多余的液体可能使尿液中少酮（由于更流畅），不过没关系。For the first month, check urine ketones as you would on the ketogenic diet using ketostix. During the first month, they will likely be large. You might even see over-ketosis (see Chapter7). However,in some children they can be lower (e.g.,moderate) or fluctuate. In our experience the larger the ketones the first month the better, so give lots of fat if the ketones seem to be dropping. Check them twice a week, and record them on a monthly calendar, along with seizures. In addition,we recommend checking your childs weight weekly.当生酮饮食的第一个月，使用尿中酮体检查剂（ketostix）检查尿酮。第一个月期间，尿酮将有可能大。你甚至可能看到过酮（见第七章）。然而，在一些孩子可以较低（例如中度）或波动。根据我们的经验，酮第一个月大会更好，如果酮似乎下降给很多的脂肪。每周检查他们两次，并和发作一起记录在日历上。此外，我们建议每周检查孩子的体重。Start a low-carbohydrate multivitamin and calcium. Any tablet form in fine, as well as the sugar-free chewables (e.g.,Bugs Bunny or Scooby Doo). This is as important as it is on the ketogenic diet. We do not use other supplements such as carnitine, selenium,or Polycitra K, unlike the ketogenic diet in which we often do.开始低碳水化合物、多种维生素和钙。总之，最后无任何片剂就象无糖咀嚼片（如宾尼兔或史酷比）。这是与生酮饮食一样重要。我们不使用其它补充剂，如肉碱、硒、或Polycitra K，不像生酮饮食中我们经常做得那样。During the first month, we have a “tough love”approach. We do not reduce medications, but similar to the ketogenic diet, we switch to carb-free preparations. We also stick to 10 grams per day (20 grams for adults). One of our studies surprisingly found that 10 grams per day (for a child) was better than 20 grams per day for the first 3 months (we didnt test formally switching earlier at 1 month). Try to avoid carbohydrate-free store products the first month, such as those made by Atkins and other companies. In general, they are fine, but only after the first month. Lets see what the MAD can do by itself without any other changes.在第一个月期间，我们有个“坚持的爱”的做法。我们不减少药物，但减少生酮饮食，为切换到无碳水化合物的准备工作。我们还坚持10克/天（成人20克/天）。我们的研究中一个惊人的发现是：在前3个月，每天10克（一个孩子）比每天20克要好（我们没有测试正式开始1个月的情况）。尽量避免第一个月时碳水化合物转化及存储，例如Atkins和其它公司的产品，在一般情况下，他们都很好，但只有第一个月之后。让我们来看看没有其它的变化，MAD自身能做什么。THE INTERNET IS YOUR FRIEND网络是你的朋友We give families lots of recipes and ideas. However,most of the information we get is from the internet. Recipes are available at and . We also list some recipes in Chapter 23 and ideas of what meal plans may look like in Appendix E. It is sometimes easier to tell families what they cant eat (e.g.,cookies,pasta,rice) than what they can. In this way,ideas for foods and recipes can be critical.我们给家长大量的食谱和想法。然而，我们得到的信息大部分是源于互联网。食谱可由 和得到。我们也在第23章列出了一些食谱，和在附录E列出了膳食计划。上述方法告诉家长孩子能吃的东西比列举他们不能吃的东西（例如饼干、面食、米饭）更容易。这样，食品和食谱的想法可以是至关重要的。Another trick we use is to tell families to go shopping before actually starting the MAD. We often counsel families on Fridays and tell them to fill out a 3-day food record from Friday-Sunday of foods their child is eating already. This gives our dietitians a chance to see what the childs normal intake (especially calories)is,but it also gives the family the weekend to hit the store and shop. Bring your child and let them be part of the shopping.我们使用的另一个技巧是告诉家人在真正开始MAD前去购物。我们经常建议家庭在周五购买，并告诉他们记录孩子周五至周日三天的摄入食物记录。这给我们的营养师有机会知道孩子的正常摄入量是什么（尤其是卡路里），但它也带给家庭周末去商店的麻烦。带上你的孩子，让他成为购物的一分子。Ketocal: A Boost To The MADKetocal: 促进 MADIn 2010, we published results from a study in which we tested our theory that a higher fat version of the MAD would work better. By using KetoCal as a supplement, parents were able to raise the average ketogenic diet ratio of the MAD from 1:1 (historically) to 1.8:1. This Improved the chances of the MAD working to a remarkable 80%(from about 50% without KetoCal). Although certainly giving more natural fat (or MCT oil) might achieve the same goal, we have found that KetoCal is a potentially easy and palatable way sneak in the extra fat.我们提出高脂肪的MAD会更有效的理论，并于2010年公布了一项研究结果。通过使用KetoCal作为补充，家长使用MAD的比例从1:1（历史）平均能够提高到1.8:1。这个使得MAD显着地提高到80（约50没有使用KetoCal）。当然更多的自然脂肪（或MCT油）可能也会达到同样的目标，我们发现KetoCal的一个潜在用途是使多余的脂肪更容易入口和更美味。The other part of this study was to see if this was only important for the first month. This also was true. As shown in other studies, after 1 month you can lighten up the restrictions of any diet, and the Ketocal could be stopped. About 1 in 5 children had slight worsening of seizures, but this is typical for anyone on the diet after the first month. Of course, if your child loves the KetoCal, it can be continued.研究的另一部分是：看似开始第一个月是唯一至关重要的。这也是真实的。其他一些研究表明：1个月后可以减轻任何饮食限制，并且可停用Ketocal。约5个中有1个儿童有轻微的癫痫发作恶化，但是这是典型的对上述饮食一个月后的反应。当然，如果你的孩子爱KetoCal，可以继续使用。In the study,children were giver a case (6 cans) of KetoCal 4:1 powder. This can be purchased from the company and costs about $150. We told families to get in 60 grams per day, which is 2/3 of a cup of the powder. It can be used as a milkshake (mixing with either water or Fruit2O) or the powder can be use to cook with (recipes at ). The milkshake is made by mixing 2/3 of a cup of KetoCal with 8 ounces (240 ML) of water to make a 10-ounce shake, which is about 400 calories. Many families reported to us that the milkshakes taste better cold (made the night before) and flavored with either Fruit2O as the liquid source, carbohydrate-free flavorings (e.g., Bickford, Starbucks), or sugar-free Jell-O. The times to drink it were also up to the family - most children drank the snakes all at once, either for lunch or as an afternoon snack. The carbohydrates in KetoCal given this way do not need to be counted toward the daily limit.这项研究中，给予孩子们6罐KetoCal4:1粉。这可以从该公司购买，约为150美元。我们告诉家长每天给予孩子60克，这是一杯粉的2/3。它可以作为奶昔使用（与水或Fruit2O混合）或烹饪（食谱见 ）。奶昔是由2 /3杯KetoCal和8盎司（240毫升）水混合至摇动至10盎司，约400卡路里。许多家长向我们反馈奶昔冷的味道更好（前一天晚上做好），要么加些诸如Fruit2O的液体、无碳水化合的调味（如：Bickford, Starbucks）、无糖Jell-O。家长决定喝的时间大多数孩子马上就喝完，无论是作为午餐或下午茶。将限定的碳水化合物混在KetoCal中摄入，这样就不需要每日计算碳水化合物是否超出限制。KetoCal also comes in a pre-made liquid from now, in small cartons (“tetrapaks”) that look like juice boxes. The premade packs were not tested in our study,but there is no reason to think they wont work as well. We would suggest one pack per day,which is pretty close to 400 calories.KetoCal也可以预先制作成液体，倒入小纸箱（“利乐包装”）让它看起来像果汁盒。在我们的研究没有测试预制包，但没有理由认为这个无效。我们建议每天一包，非常接近400卡路里。After the first month,if your child doesnt like the KetoCal (or its too expensive), it definitely can be stopped without losing seizure control. The decision at this point is up to you.一个月后，如果你的孩子不喜欢KetoCal（或它太贵），它肯定可以停止，而且不会使癫痫发作失去控制。在这一点上的决定权在你。Reading The Food Labels阅读食物标签Food labels are critical for any processed or prepared foods. Remember that the carbohydrate content highlighted on the front of the packaging for many low-carb products can be somewhat misleading, as not only fiber but sugar alcohols are excluded (see later for more on this). Look for the total carbohydrate amount and subtract only fiber. This is the final amount for that product. Remember portions can be your friend,too: If a candy bar has 10 grams of carbohydrate in it,you can have your child only eat half for 5 grams.食品标签是任何加工或料理食品的关键。请记住，很多低碳水化合物产品的包装外标识的碳水化合物含量可能会有点误导，不仅纤维，还包括糖醇被排除在外（下面会提及）。总碳水化合物量只减去纤维就该产品的碳水化合物量。记住可以成为你的益友的这点：如果一块糖含碳水化合物10克，你的孩子只能吃一半。Month Two: Time to lighten up!Now that you and your child have succeeded in making it to the end of the first month, things can be made less strict if the diet is helping. We do recommend making one change at a time, similar to the ketogenic diet. Each week things can be changed, very carefully, if desired.现在你和你的孩子已经成功坚持了一个月，如果饮食有帮助，可以不那么严格限制了。类似生酮饮食，我们建议每次做一点改变。如果需要的话，每个星期东西可以很小心地改变。The first change that is possible is to increase carbohydrates. Go up by 5 grams of carbohydrate / day each month if desired (e.g.,to 15 grams/day for month 2 and 20 grams /day for month 3). For most children, we will not go higher than 20 grams / day and adults to 30 grams / day. Surprisingly, most children are doing well at 10 grams/day, and this switch is not usually the first one to be made.第一个变化是可以增加碳水化合物。如果需要的话，一个月每天增加5克碳水化合物（例如第2个月15克/天和第3个月20克/天）。对于大多数孩子来说，不超过20克/天，成人不超过30克/天。令人惊讶的是，大多数孩子能于10克/天做得很好，这通常不是第一个月达成的。The second change is to stop the KetoCal. As this will lower the ratio slightly by itself, compensate by giving more fat if possible. This is a change to the MAD, so if you plan to stop the KetoCal (as all families did in our study), count this as a change and do not increase carbs, for example, at the same time.第二个变化是停止KetoCal。由于这将略降低本身含量，如果可能的话，补偿更多的脂肪。这是MAD的一个变化，所以如果你打算停止KetoCal（就如我们研究中的所有家长所做的），这会改变份量并不增加碳水化合物，例如同一时间内。A third possible change is to reduce medications. We are all in favor of giving this a shot, just do it slowly and leave the MAD unchanged if youre going to do this. If seizures worsen,consider increasing the medically indicated.第三个可能的变化是减少药物。我们都赞成这是一个冲击，如果你要做到这一点，只要缓慢地进行而坚持MAD不要改变。如果病情变坏，考虑增加医疗。A fourth and final change is to start using low carbohydrate products. Remember to read the food labels as discussed earlier. At this point we dont count fiber toward the carbohydrate limit, but we do count sugar alcohols (e.g., xylitol, maltitol), which can be in many candy bars and low-carb baking mixes. Another way to think of it is fiber is free. If you choose to use these products, and many of our families do,just try one new one per week to make sure it doesnt make seizures worse. Some favorites include the Atkins candy bars, shitake mushroom noodles, low-carb chocolate milk, and baking mixes. Just the Cheese snacks are also a great and crunchy snack.第四个即最后的变化是开始使用低碳水化合物食品。记得阅读前面论述过的食品标签。在这一点上，纤维不计入碳水化合物限制，但我们将可能在许多糖果和低碳水化合物烘焙中混合的糖、醇（如木糖醇，麦芽糖醇）等合并计算。另一种想法认为需要避免摄入纤维。如果选择使用这些食物，学习很多家长的做法：每周只尝试一种新的，以确保它不会使病情恶化。一些最受欢迎的食品包括：阿特金斯糖果，香菇面条，低糖的巧克力牛奶，和烘焙混合物。只是Cheese小吃也是一个美味和松脆的小吃。You can also now be less strict about checking ketones. Our studies have shown that it is natural and normal on the MAD to have large ketosis in the fir month but moderate (or trace) ketosis by the sixth month. In most of these children, they were doing great, or even better. Keep track on the seizure calendar and show your neurologist. We recommend once weekly ketones on the MAD after the first month.检查酮也可以较以前少一些。我们的研究表明，在MAD首月高酮是自然和正常的，但第六个月时酮将是中等（或微量）。大多数儿童做得很好，甚至更好。继续跟踪记录在日历上，并交给神经科医生看。我们建议第一个月后，每周验一次酮。Long-term use and monitoring长期使用与监测After 1 month (or definitely by 3 months) you should be touching base with your neurologist and dietitian. By this point, you should have a good sense if the MAD is helping. If it is, then we recommend filling out a new 3-day food record (now that you child is on the MAD) and rechecking the labs you did before starting the MAD. These results should be compared, especially the total cholesterol and triglycerides. If they are too high, then adjustments to the types of fat may need to be made. Your child should also be seen by the dietitian to check his / her weight and height and answer your questions. Although side effects appear to be less frequent with the MAD compared to the ketogenic diet, they still can occur and need to be looked out for.一个月后（或干脆3个月之后），你应该与你的神经科医师和营养师联络。此时若MAD有帮助，你应该得到一个好的判断。如果是的话，那么我们建议您填写一个新的3天食品记录（现在你的孩子使用MAD），而且还应再次使用MAD开始时的实验室复查。这些结果将进行比较，尤其是总胆固醇和甘油三酯。如果它们过高，则可能需要调整过去的脂肪类型。你的孩子也应知道，营养师来检查他/她的身高和体重，并回答提问。虽然与生酮饮食相比，MAD出现副作用要低，但仍然可能发生，并且需要警惕。Fine-tuning the MAD微调MADUnlike the ketogenic diet, there are fewer specific changes that a dietitian can make to the MAD if things are either not going well from the start, or seizure control is lost. This can definitely be a disadvantage to the MAD, but there are some changes that can be made that we have found helpful. Of course, the ultimate fine-tuning change us to switch to the ketogenic diet, but that is not usually necessary. More details on that switch are in the next section.与生酮饮食不同，MAD具体的变化较少，如果不是一开始就不太好或癫痫失去了控制，营养师也可以制定。这肯定是MAD的一个劣势，我们也已找到有用的办法将带来一些改变。当然，最终的微调是切换为生酮饮食，但通常没有必要。该转换的更多细节将在下一节讨论。Usually the first thing we do is look at the seizure calendar and see if ketones are high and also if they correlate to seizure control. If there is a correlation and ketones are low, well look at a 3-day food record and make sure enough fat is being given. We might also add extra fat sources such as MCT oil or KetoCal (assuming the latter has been stopped after the first month by the parent). Carnitine has also been helpful for some of our patients. One of the most common mistakes made by parents is to make the MAD a high-protein rather than a high-fat diet.通常我们做的第一件事是看发作日历和了解如果酮高且与控制癫痫是否有关。如果酮低且有相关性，我们将看3天的食物记录，并确定是否确保足够的脂肪摄入。我们还可能添加额外的脂肪摄入，如MCT油或KetoCal（假设已第一个月后被家长停止服用）。肉碱也对我们的一些患者有用。家长最常见的错误之一，是使MAD成了高蛋白质饮食，而不是高脂肪饮食。Secondly, well double check the 3-day food record to look at calories. Some children may be eating much less t