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 {{Skeleton}}Introduction/SummaryThe 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__History of * A Ketogenic Diet not only specifies the Ketogenic Ratio Diet, but it typically also specifies the maximum amount of carbohydrate, as carbohydrate is far more anti-ketogenic than protein. * ConceptThe Ketogenic Ratio assumes that the total calorie intake matches the ideal intake for age and weight. * Original 1920s * 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. * Simplified ratio* 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.) * Other restrictions – calorie intake Monounsaturated and minimum protein intake* Limitations – on calorie restriction body fat will be burned, producing polyunsaturated fats tend to produce more ketones Ketones than predicted by the ratiosaturated fat.  =Other things However, it has been noted that effect ketone high levels=of Omega-6 oil cause [[Nausea]] and digestive problems, so Omega-3 and monounsaturated fats may be better. * The type of fat impacts ketone levels – mono/polyunsaturated higher than saturated, except for [[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.

* 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, so if . If in doubt stop taking all processed foods to troubleshoot unexpectedly low ketone levels.** Medications can contain carbohydrate, especially liquid formulasgiven 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 gramsUsing 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"/>.