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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. __NOTOC__* 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-ketogenicthan 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]]. Sugar (See below for sugar alcohols are sometimes ignored and sometimes included, and probably should be at least partly included in the carbohydrate count. )
* 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.
** 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).
=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.
{| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"
! 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
|}
=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<ref name="Noda-1994"/><ref name="WölnerhanssenCajacob2016"/>. (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<ref name="Natah-1997"/>.
* Xylitol seems to have some impact on blood glucose, about half that of fructose (glycemic index of 7)<ref name="WölnerhanssenCajacob2016"/><ref name="Natah-1997"/>.
* Maltitol raises blood glucose in larger amounts<ref name="SecchiPontiroli1986"/>. 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<ref name="Akgün-"/><ref name="Kaspar-1980"/>.
{{KetoSeeAlso}}
=References=
<references>
<ref name="Akgün-">S. Akgün, NH. Ertel, A comparison of carbohydrate metabolism after sucrose, sorbitol, and fructose meals in normal and diabetic subjects., Diabetes Care, volume 3, issue 5, pages 582-5, PMID [http://www.ncbi.nlm.nih.gov/pubmed/7002512 7002512]</ref>
<ref name="Kaspar-1980">L. Kaspar, K. Irsigler, [A comparison of the blood glucose increase and insulin requirement after oral sucrose, fructose and sorbitol alone or in combination (author's transl)]., Wien Klin Wochenschr, volume 92, issue 19, pages 683-7, Oct 1980, PMID [http://www.ncbi.nlm.nih.gov/pubmed/7008368 7008368]</ref>
<ref name="SecchiPontiroli1986">A. Secchi, A. E. Pontiroli, L. Cammelli, A. Bizzi, M. Cini, G. Pozza, Effects of oral administration of maltitol on plasma glucose, plasma sorbitol, and serum insulin levels in man, Klinische Wochenschrift, volume 64, issue 6, 1986, pages 265–269, ISSN [http://www.worldcat.org/issn/0023-2173 0023-2173], doi [http://dx.doi.org/10.1007/BF01711933 10.1007/BF01711933]</ref>
<ref name="Natah-1997">SS. Natah, KR. Hussien, JA. Tuominen, VA. Koivisto, Metabolic response to lactitol and xylitol in healthy men., Am J Clin Nutr, volume 65, issue 4, pages 947-50, Apr 1997, PMID [http://www.ncbi.nlm.nih.gov/pubmed/9094877 9094877]</ref>
<ref name="WölnerhanssenCajacob2016">Bettina K. Wölnerhanssen, Lucian Cajacob, Nino Keller, Alison Doody, Jens F. Rehfeld, Juergen Drewe, Ralph Peterli, Christoph Beglinger, Anne Christin Meyer-Gerspach, Gut hormone secretion, gastric emptying, and glycemic responses to erythritol and xylitol in lean and obese subjects, American Journal of Physiology - Endocrinology And Metabolism, volume 310, issue 11, 2016, pages E1053–E1061, ISSN [http://www.worldcat.org/issn/0193-1849 0193-1849], doi [http://dx.doi.org/10.1152/ajpendo.00037.2016 10.1152/ajpendo.00037.2016]</ref>
<ref name="Noda-1994">K. Noda, K. Nakayama, T. Oku, Serum glucose and insulin levels and erythritol balance after oral administration of erythritol in healthy subjects., Eur J Clin Nutr, volume 48, issue 4, pages 286-92, Apr 1994, PMID [http://www.ncbi.nlm.nih.gov/pubmed/8039489 8039489]</ref>
</references>
