The Ketogenic Ratio Explained

If your child’s physician has recommended a ketogenic diet for epilepsy management, you likely have many questions, which may have led you to this post. As you collect information online and educate yourself on the topic, you may come across the term “ketogenic ratio” and wonder what it means. I’ll try to clear things up in today’s post.

Photo by Lurie Children’s Hospital

The classical ketogenic diet for epilepsy is designed according to a ratio. This ratio, often referred to as the “ketogenic ratio”, represents the amount of fat in the diet, in comparison to the amount of protein plus carbohydrate. If you are a visual person like me, this infographic to the right, which was created by the awesome keto team at Lurie’s Children’s Hospital, will help explain the concept better.

If the last paragraph didn’t trigger long-forgotten memories of middle-school math class, the remaining paragraphs surely will. Don’t worry if math is not your thing- the fundamentals will come back to you quickly. Many keto parents will tell you that managing their child’s ketogenic diet revealed math and cooking skills they never knew they had! Also, keep in mind that the ketogenic dietitian who you work with will very carefully design and calculate your child’s diet, helping you to manage it at every step along the way, so you are by no means on your own.

The most commonly used ketogenic ratios are 4:1 and 3:1. A 4:1 ketogenic ratio describes a ketogenic diet that is made of 4 grams of fat for every 1 gram of protein plus carbohydrate. In other words, for every 5 grams of food consumed, there are 4 grams of fat and 1 gram of protein and/or carbohydrate. Therefore, a 4:1 ketogenic diet contains 80% fat (4÷5=80%) and 20% protein plus carbohydrate (1÷5=20%). Likewise, a 3:1 ketogenic diet contains 75% fat (3÷4=75%) and 25% protein plus carbohydrate (1÷4=25%).

Notice that the ketogenic ratio compares the amount of fat, protein, and carbohydrates in grams, a measure of weight. This is because the diet is calculated in grams, since foods are measured by weight using a gram scale.

If you compared fat, protein and carbohydrates according to the number of calories provided from each (rather than the number of grams of each), the ratio would be a little different because fat provides more calories per gram than protein and carbohydrates do. Each gram of fat provides the body with 9 calories, while each gram of protein or carbohydrate provides the body with 4 calories.

For example, let’s say that you need to consume 360 calories. To provide 360 calories from protein and/or carbohydrate (which both provide 4 calories per gram), you would need to eat 90 grams of protein and/or carbohydrate (360÷4=90). However, to get the same amount of calories from fat, you would need to eat just 40 grams of fat (360÷9=40). Fat provides the same number of calories with much less mass because it is more calorically dense than protein and carbohydrates.  For this reason, ketogenic meals tend to look smaller than standard meals, even when they provide the exact same amount of calories.

If a child is on a 4:1 ketogenic ratio, 90% of the calories in their diet comes from fat. Did I lose you there? This part confused me
at first because I thought “how can it be both 80% fat and 90% fat?”. The answer is that it is 80% fat if you are measuring by weight and 90% fat if you are measuring by calories.  Remember that a 4:1 ketogenic ratio represents 4 grams of fat for every 1 gram of carbohydrate plus protein. Four grams of fat (which provides 9 calories per gram) provides a total of 36 calories (4 x 9 = 36). One gram of protein or carbohydrate (which provides 4 calories per gram) provides a total of 4 calories (1 x 4 = 4). The ratio of calories from fat to calories from protein plus carbohydrate is 36:4. This means that for every 40 calories consumed, 36 come from fat and 4 come from protein and/or carbohydrate. Thus, 90% of the calories comes from fat (36÷40=90%), and 10% comes from protein and carbohydrate (4÷40=10%). On a 3:1 ketogenic diet, about 87% of the calories comes from fat, and 13% comes from protein plus carbohydrate. For comparison’s sake, a typical American diet contains about 35% of calories from fat and about 65% from protein and carbohydrate.

3-1typical

I hope that this post helped to explain the ketogenic ratio and the basic design of the ketogenic diet, but if you have any questions or need anything clarified, please comment and we’ll do our best to help!

Mallory

For more information on the medical ketogenic diet for epilepsy, visit http://ketogenicdietforepilepsy.com/.

Parent Guest Blog: Tips for Making the Ketogenic Diet Fun

We are delighted to welcome our very first guest blogger to KetoConnect. Dana is a mother of two adorable little girls, one of whom is on the ketogenic diet. We want to thank Dana for sharing her family’s keto story and for these wonderful tips for making the ketogenic diet fun for kids.

 

5 Tips for Making the Ketogenic Diet Fun

Two years ago, my daughter’s doctor recommended that we put her on the ketogenic diet as a way to help curb her uncontrolled seizures. As a busy mother of two, I felt overwhelmed at the possibility that I might have to add yet another thing to the laundry list of items that had consumed my life up to that point. I was scared that I would not be able to follow the diet as strictly as it required. I was worried that I would not have time to devote to it. Most of all, I was questioning whether it would work for my daughter.

Then we took the leap and put her on it. Within days, we noticed improvements in her behavior and her seizure control. She was having status seizures every 6 weeks, and was not yet potty trained (at nearly 4). After starting the diet, she was fully potty trained within a week and went 6 months without seizing. She also seemed happier. Now, she tends to seize only when overheated or very sick.

It took about 6 months before I started creating my own recipes. I eventually made it my mission to make her food that other kids would want. My goal is to cook meals that my daughter will not only like, but that she will be proud to eat. Here are my top 5 ways of making the ketogenic diet fun:

  1. Listen to your child– if they are able to verbalize what they want, then try to make it work. – One day my daughter said she wanted carrots and cucumbers. Up to that point, I had not yet created a recipe that included these items. I knew she liked hot dogs, so I made her a meal that included hot dogs, cream, oil, and a side of carrots and cucumbers.
  2. Keep their favorites handy – sometimes they want to eat the same meal all the time. –Back to the carrots and cucumbers. One day, I asked my daughter what she wanted for breakfast. Her response, “sausage, carrots and cucumbers.” I asked her again for lunch. Again, “sausage, carrots and cucumbers.” I think you know where I am going with this. Needless to say, I always keep hot dogs, sausage (each nitrate-free and filler-free), carrots, and cucumbers in the fridge.donut
  3. Be creative – you do not always have to follow recipes word-for-word. – I like to make my daughter the pizza from the keto cookbook, but I do not always like having to whip egg whites, so I bought several shapes of silicone molds. I simply add unwhipped egg whites to the mix and make her “pizza bread” or “pizza bagels”. It actually takes less time. – Another time, she asked for a donut. I did not have a recipe for donuts, but I had a recipe for pancakes. So I poured pancake batter into a donut mold, and voilà, she had a keto donut that she loved!
  4. Make them feel awesome – “Geez, I wish I could eat princess food.” – The fact of the matter is that, as parents we feel guilty about many things that are out of our control. We do not realize how food-based our culture is until we are presented with huge limitations. I was afraid that I would be depriving my daughter. No more Happy Meals. No more cookies and ice cream. She would be forced princess cupcakesto eat food that looked unappetizing and tasted bad. That does not have to be the case. It does not take that much more time to make their food look delicious. Keto-friendly food coloring and flavoring can make something simple look and smell divine. – For my daughter’s 5th Birthday, she wanted to have a Barbie cake. Well, I did some research and reached out to my keto-related support groups. I made it happen. Not only did I make her a Barbie “cupcake” but I also made her friends cakes that looked identical to hers.
  5. Not all accidents are bad – the frozen Ketocal story. – Sometimes my daughter loves a Ketocal shake and sometimes she does not. We use the Ketocal shakes a lot when we travel or when we do not have time to cook. We were visiting my mother and had to leave to attend an event. My mother thought she would just stick a Ketocal drink into the freezer to chill it. Well, she forgot about it until my daughter mentioned she was hungry. My mother pulled a very frozen Ketocal out and panicked. Then she thought, “Why don’t I serve it as ice cream?” And it was a huge hit. My daughter asks for it to this day. “I want my ice cream.”

So in the end, my suggestion to parents who are new to the diet is to take a deep breath. It can be overwhelming and daunting, but if the diet works, there are more benefits than drawbacks. It does not have to be expensive or overly time-consuming. You just have to focus on what your child is interested in at the time. Eventually you will find your groove.

-Dana

Top Five Kitchen Essentials for the Ketogenic Diet Chef

When a child goes on the ketogenic diet, his mom and dad become experts of many trades.  After a few months, parents will be math whizzes (measuring food to the tenth of a gram), they’ll learn to spot hidden carbs a mile away, and most impressively, they’ll become absolute magicians in the kitchen. Keto cooks quickly learn that there are some kitchen supplies that you simply can’t live without.

Although we’re not nearly as skilled as some keto parents we know, we do spend quite a bit of time creating and testing new KetoCal recipes, so we’ve come across some tools that we’ve found to be especially helpful. Below is our list of the top 5 kitchen essentials for the ketogenic diet chef.

1. Silicone spatulas:

Silicone spatulas, especially the mini ones, are perhaps our most cherished keto cooking utensils. They work great for getting every last drop out of a dish (which is critical in keto cooking).

2. Parchment paper:

We find that parchment paper is a must for the ketogenic baker. Use it to line baking pans and cookie sheets so that foods don’t stick to the pan. Another perk is that it saves time cleaning up! Note that parchment paper and wax paper are not the same thing- Parchment paper is oven-safe and wax paper is not (Yes, we learned that the hard way!).

3. Silicone bakeware:

Silicone bakeware is awesome for cooking keto recipes because it a) makes it super easy to remove food from the pan, b) keeps food from sticking to the pan and c) keeps all of the oil in the finished product. If you allow the food to cool before removing from the pan, the excess oil will absorb back into the food so you don’t have to worry about losing some of the fat.

4. Mini prep bowls (lots of them):

When preparing keto meals, you need small bowls to weigh each ingredient before combining them. Stocking up on mini prep bowlswill save you time because you won’t have to wash bowls in between weighing multiple ingredients.

5. Mini whisks:

We find these most helpful for recipes involving eggs. Usually the recipe will call for a given amount of eggs, raw, and well-mixed. To prepare this,  you crack an egg into a mini prep bowl (see above), mix it well, then measure the amount that you need for the recipe. The regular size whisk doesn’t fit into the mini bowl and we find that a fork just doesn’t mix quite as evenly. The mini whisk works great for this!

You can usually find these kitchen tools in kitchen supply stores or online department stores.

Keto parent chefs- Which kitchen tools can’t you live without? Please share your top 5 in the comment section below!

Mallory & Ellen