Ketogenic Ratio

The Ketogenic Ratio is the ratio of the weight of fat to carbohydrate and protein in the Ketogenic Diet. So a daily diet that included 200g fat, 10g carbohydrate, and 40g protein would have a Ketogenic Ratio 4:1. While this is a simple concept, there are many factors that make it a little trickier than it appears.

• A Ketogenic Diet not only specifies the Ketogenic Ratio, but it typically also specifies the maximum amount of carbohydrate, as carbohydrate is far more anti-ketogenic than protein.
• The Ketogenic Ratio assumes that the total calorie intake matches the ideal intake for age and weight.
  • If fewer calories are taken for weight loss, then the burned body fat needs to be included in the ratio. For example, assume an adult that needs 2,000 calories. If they only consume 100g fat, 10g carbohydrate and 40g protein, the diet provides 1,100 Calories and they burn 900 Calories of body fat (100g). That is a true Ketogenic Ratio of (100+100) to (10+40) or 4:1.
  • It's less clear what happens if more calories are required for exercise. My personal experience suggests extra exercise does not allow for a proportionately greater carbohydrate or protein intake.
• The carbohydrate intake is measured as Net Carbohydrates, which ignores carbohydrates that are Fiber. (See below for sugar alcohols.)
• Monounsaturated and polyunsaturated fats tend to produce more Ketones than saturated fat. However, it has been noted that high levels of Omega-6 oil cause Nausea and digestive problems, so Omega-3 and monounsaturated fats may be better.
• MCT raises Ketone levels directly, even without carbohydrate restriction.
• The timing of food intake can impact ketone levels. Taking a disproportionate amount of the carbohydrates (or even protein) in a meal can rapidly lower ketone levels.
• Those with little or no body fat, especially children, may run out of available fat and start to burn muscle, which will drop ketone levels.
• There are a number of unexpected sources of carbohydrate that can reduce Ketone levels:
  • Carbohydrate can be absorbed via the skin from suntan lotion (sunscreen), lipstick or soap.
  • Toothpaste contains carbohydrate, so it's important not to swallow any while during routine brushing. It may be necessary to rinse with water to wash out any residual toothpaste.
  • Processed foods can contain up to 0.9g carbohydrate per serving while declaring "0g carbohydrate" and other rounding errors can occur. If in doubt stop taking all processed foods to troubleshoot unexpectedly low ketone levels.
  • Medications can contain carbohydrate, especially liquid formulas given to children.
  • IV medication sometimes contains glucose (this is mostly an issue for children being treated for epilepsy with the ketogenic diet).

1 Calculating Macronutrients

calculating how much fat, carbohydrate, and protein is not straightforward. Let's assume you want to do a classic 4:1 ratio ketogenic diet, and restrict your carbohydrate intake to 20 g. If your daily calorie expenditure is 2,000 calories, then the calculation looks like this:

Assume Ratio = 4:1 (grams), 9:1 (calories)
Assume Calories = 2,000
Assume Carbs = 20 grams, 80 calories
Fat Allowance = 90% of 2,000 = 1,800 calories, 200 grams
Protein + Carbs = 10% of 2,000 = 200 calories, 40 grams
Protein = 200 – 80 calories, 120 calories, 30 grams

Using that formula, we can estimate the grams of protein allowed for different calorie requirements and different carbohydrate intakes. Note that the number of calories is an estimate of how many calories you burn, not your calorie intake. If you take in less calories from fat than you burn, your body will burn body fat (after early Ketoadaptation) to make up the difference.

Calories	20g carbs	25g carbs	30g carbs	35g carbs	40g carbs	45g carbs	50g carbs
1,600	35g	34g	33g	31g	30g	29g	28g
1,700	38g	36g	35g	34g	33g	31g	30g
1,800	40g	39g	38g	36g	35g	34g	33g
1,900	43g	41g	40g	39g	38g	36g	35g
2,000	45g	44g	43g	41g	40g	39g	38g
2,100	48g	46g	45g	44g	43g	41g	40g
2,200	50g	49g	48g	46g	45g	44g	43g

2 Sugar Alcohols

Sugar alcohols are generally modified forms of sugar that are harder to digest than regular sugar, therefore they have far fewer calories. On a ketogenic diet, it appears that different sugar alcohols need to be treated differently. I would ignore grams of Erythritol and Lactitol, count half the grams of Xylitol, and all the grams of Maltitol and Sorbitol.

• Erythritol can be ignored as it's not metabolized at all. (It's absorbed but excreted intact.)
• Lactitol has no impact on blood glucose and only a slight rise in insulin, so it can be mostly ignored.
• Xylitol seems to have some impact on blood glucose, about half that of fructose (glycemic index of 7).
• Maltitol raises blood glucose in larger amounts. 50g of Maltitol raised blood glucose by 75% as much as pure glucose, but 10g had no detectable effect.
• Sorbitol raises the blood glucose, peaking at about 25% as high as with sucrose (table sugar), but insulin response may be similar.

3 See Also

• The classifications and types of Low Carbohydrate Diet.
• An introduction to the Ketogenic Diet.
• My experiences with ultrarunning on the Ketogenic Diet
  • How the Ketogenic Diet can be used for the treatment and management of disease.
    • Using the Ketogenic Diets to mitigate and treat Epilepsy
    • How Ketogenic Diets might help with Cancer
    • A look at the possible mechanisms of action of the Ketogenic Diet
  • Health Risks of the Ketogenic Diet
    • Health Checks for the Ketogenic Diet
    • Supplements for the Ketogenic Diet
  • The time frame and changes that occur with Ketoadaptation
  • What are Ketones
    • How to measure Ketones
    • What ketone levels to aim for
  • The pros and cons of the Ketogenic Diet for athletes
    • The Science of Ketogenic Exercise
  • The Types of Ketogenic Diet
    • The "traditional" Ketogenic Diet based on the Ketogenic Ratio
      • The ways the Ketogenic Ratio can be calculated
        • The different definitions of Net Carbohydrates
    • Low Glycemic Index Treatment
    • MCT Diet
      • MCT
    • Modified Atkins Diet (M.A.D.)
• My Ketogenic Recipes
• Non-Ketogenic Low Carbohydrate Diets