Foods by Ratio

Continued good news: Nora is down to a 1.25:1 ratio today and still seizure free. We are in the home stretch!

Just a word about the “ratio” for newcomers to the ketogenic diet. Remember that the ratio is the amount of fat per amount of net carbs+protein in a food (and remember to first get net carbs by subtracting fiber from total carbs; fiber is good!).

Example: In 100 g of macadamia nuts, there are approximately 80 g fat, 6 g net carb and 8 g protein. The math:

80 g fat /(6 g net carb + 8 g protein ) = 80 g/14 g = 5.7
Thus, there are about 5.7 g fat for every 1 gram of net carbs + protein in macadamia nuts. They have a ratio of about 5.7:1.

The ratio is a “magic number” in the ketogenic diet, with higher fat telling your body to use fat as an energy source by turning fat into ketone bodies for fuel. The traditional form of the diet uses a 4:1 ratio. Nora’s highest ratio was 3.5:1 for 2 years. Since April we have moved it down by 0.25 increment steps (so 3.25:1, 3:1, 2.75:1, etc.) every 3 weeks.

As we have moved down the ratio step by step, I’ve realized that I have a way of thinking about keto foods by ratio when I am building a meal. In the beginning of the diet, the big challenge is to think low-carb. Then you add in the fat needed to get the ratio. But after doing this for so long and having a broader range of known low-carb foods, I’ve started thinking about foods by their ratio instead of their carb content alone. That helps us create keto meals that use naturally high-ratio foods, rather than taking big doses of fat on the side, and that gets much easier as we move down on the ratio.

The spreadsheet that we made to calculate meals shows us the ratio of each food that we are using, so as we changed ratios over the last 6 months I realized how much I was using that knowledge about the ratios. I hope that explaining it and giving some examples can be a guide to others.

At very high ratios, there are very few foods that are above the keto-standard 4:1 ratio on their own. Fat sources are critical to boost the ratio of any meal. All-fat foods that are served to achieve a high ratio are: heavy cream, butter, oil (Nora takes fish oil, others use lightly flavored oils like canola), and coconut oil for its ketone-availability.

Low-carb foods that Nora eats regularly but have very little fat: berries, red pepper, carrots, popcorn, apples, low-carb tortilla (Mission Carb Balance), sliced turkey or ham. We have to serve enough fat, either through the all-fat options or higher ratio foods in order to meet her fat needs at her current ratio.

Here is a table of regularly-used whole foods organized by their ratio, amounts given per gram of food served. Each color indicates a different ratio range:

Red = greater than 4:1
Orange = between 3:1 and 4:1
Green = between 2:1 and 3:1
Blue = between 1:1 and 2:1
Purple = Less than 1:1, but not insignificant fat content

Screen Shot 2014-11-01 at 11.55.30 AM

If you start by thinking about your child’s ratio, you can see the foods that are above and below that ratio. Higher-ratio foods can support or increase the ratio when paired with lower-ratio foods. At the traditional ketogenic diet ratio of 4:1, macadamia nuts and kalamata olives are superstars, with avocado not far behind. But even though you can’t make a 4:1 meal without fat supplementation (actually you could, but it would be a lot of macadamia nuts!), you can choose higher-ratio foods in order to put less fat on the side.

If you move down the ratio to 3:1, you get a few more of those helpful foods. We looked at all of the cream cheese options at our grocery stores and use a brand called Primrose, which has a higher fat content than some other brands.

It’s interesting that there are not many whole foods in the 2:1 to 3:1 range (green) that we use regularly. Sour cream was the only other one in my master list, but Nora doesn’t like it. Some brands of cream cheese fall into this ratio too. Many of the baked goods I make are in the 2:1 ratio because you can mix fats, nuts, eggs, etc., to end up with a 2:1 ratio item.

When we went below 2:1 on Nora’s wean schedule, I realized that there were a lot more foods on either side of her ratio and it got me thinking about foods by their ratios. Now that we are at 1.25:1, Green & Black’s 85% dark chocolate is above her ratio! We can put dark chocolate on berries, maybe with some nuts on the side, and have a perfectly delicious at-ratio snack without a side of cream.

After our next step down in 3 more weeks, Nora will be at 1:1 which is considered the Modified Atkins Diet (MAD) and we can start estimating meals. Knowing which foods are above the 1:1 line, and which are just below the 1:1 line, will help us make combinations of food that keep her meals around 1:1 without all of the calculating and weighing.

This list also shows some interesting contrasts. Just look at the nuts. Macadamia nuts are a stand out by any measure. It is amazing that they stay solid when warm! Walnuts are also excellent. But almonds are pretty far down on the list as a ketogenic diet food. They are not bad, but if I were going to give nuts to Nora I would choose a higher-fat nut that does not require fat supplementation (if possible). Peanut butter is also fairly low ratio, although we would normally think of it as a creamy high-fat food. We have always supplemented it with fat by mixing it with butter. Almond butter is actually a better keto-choice because it is lower carb and higher ratio.

Cheeses are interesting too. Cream cheese has always been the keto diet food of choice. But cheddar (and Monterey jack, which has the same ratio as cheddar), beats out whole milk mozzarella. Both beat out string cheese, which was one thing that was hard to take away from Nora at the beginning, and is not going to be a go-to food even after moving to MAD because it is well below 1:1 ratio. Nora also loves cottage cheese, but it is very low ratio. She enjoys cottage cheese swimming in cream, like cottage cheese soup! It is easier to add fat to cottage cheese than string cheese.

Proteins are the same story. Eggs, pork and beef are higher in fat than chicken and fish, as we all probably know. But even in the chicken category, chicken thigh is 0.42:1 ratio and chicken breast (not listed above), is only 0.12:1 ratio. And chicken thigh is cheaper and tastier, an all round better choice.

There are a few fun discoveries on the list. I love that edamame has both protein and fat. It’s a fun veggie that works on the keto diet or MAD with other fatty foods. Traditional full-fat Greek yogurt is at-ratio right now for Nora! She has it for breakfast every morning, topped with a few berries and some of her granola (the current recipe I made is 2:1 and balances out the berries). The Flackers that she enjoys are now above-ratio too. But even if your child is on a higher ratio, they are a cracker that fits well with the diet and can be topped with a high-ratio food like cream cheese and butter.

No matter where the ratio lands in a diet therapy, you can make meals more palatable by serving some high-ratio whole foods and not putting so much fat on the side. It gets easier at lower ratios when you have a larger selection of foods that are naturally above a 1:1 ratio. These are natural, healthy foods for any body and even better for anyone on a diet therapy for epilepsy or other medical reason.

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This entry was posted in Essentials, Nora's History, Tips and Tricks by Christy Anderson Brekken. Bookmark the permalink.

About Christy Anderson Brekken

In no particular order... Instructor and Researcher, Department of Applied Economics, Oregon State University. Educational background: University of MN Law School, 2005. MS in Ag and Resource Economics, Oregon State University, 2011. Teaches: Agricultural Law, Environmental Law. Mother: brilliant 9 year old boy; brilliant 6 year old girl with benign myoclonic epilepsy on a modified ketogenic diet therapy. Married to: Ted Brekken, OSU Department of Electrical Engineering. Ride: Xtra-cycle Edgerunner with kid seat; 400-pound cargo capacity. Grew up: Devils Lake, ND. Lived in: Minneapolis/St. Paul, MN, Pohang, South Korea, Trondheim, Norway, Corvallis, OR. Interests: Cooking, knitting, eating, yoga, laughing, hiking, traveling, staying sane.

9 thoughts on “Foods by Ratio

  1. Thank you so much for posting this! I have found tremendous relief from Bipolar disorder/celiac/anorexia through a 4:1 ketogenic diet (I hypothesize that I developed severe anorexia in subconscious effort to control bipolar symptoms, which are very seizure like; some psychiatrists believe bipolar and schizophrenia are seizure disorders. They respond to the same meds, so stands to reason that similar diet might help too). It’s turned my lights on, and I’m starting to write about it and to gather resources to share with others.
    I was looking for good info on ratios, and this is clear and thorough and beautifully done. I’ll definitely link when it comes time to write about.
    Thanks again,

    • Ela, we are so happy to hear that the keto diet helped you too–the more we learn about the benefits of the keto diet, the more I’m amazed and I’m sure it would be helpful for so many people. Glad this was useful!


  2. I am math challenged so excuse this question, but if I have a keto diet recipe of 2 to 1 or 3 to 1 but need it to be 4 to 1, how do increase ingredients? So to go to 4 to 1 from 2 to 1, do I just double the fat but keep the part one carb and protein the same?

    Thank you!

    • Hi Sabrina, you have it right. If you had a food with 2 parts fat and 1 part carb+protein, you just double the fat and you are at 4 parts fat to 1 part carb+protein. If you are making a recipe, you should think about whether the recipe can incorporate that much fat. Like if you are baking, it has to be able to absorb and hold the extra fat. Or if you are putting more oil or cream into a sauce, make sure that you are scooping up and serving all of the extra fat.

      You can also increase the ratio of a food like cottage cheese by just adding more cream in the same manner. If 100 g of cottage cheese has 4 g carb and 10 g protein then you need (4+10)x4 = 14×2 = 28 g of fat. If it only has 5 g of fat in it naturally, you need to add 23 more grams of fat from heavy cream or something else.

      Hope that helps!

  3. I am diabetic and trying to retrain my body to use fat for fuel instead of the glucose. I am having trouble with weight loss with this diet. I don’t quite understand the process. Can you give me a little more information? On how this works? Should I get a scale? Thank you!

    • Hi Patricia. We are not medical professionals and did not use the diet for diabetic control or weight loss, so I don’t feel like I can provide any general advice. I would recommend meeting with a dietician for your particular circumstances. If you are counting carbs, a scale is very helpful. There are kitchen scales that will meet your needs, some with built-in nutrition information so that when you weigh a food and put in the code for that food, it shows you the carbs, protein, and fat breakdown. When we started, we found one at our local kitchen store, and I’m sure there are many to choose from online.

      Good luck.

  4. Your table of foods by ratio is really helpful and I’m surprised that I don’t see that presentation elsewhere? Do you know of similar resources with ratios for additional foods that you could point me to?

    • Hi Michel, I don’t know of any other lists like this. When we started the diet, we began with MAD and went to the full keto diet while calculating the ratio of meals, then when Nora weaned off the diet we did the reverse (which is the point that this post was written). So we already had ratios in our head and were working with it to learn how to estimate for MAD.

      I’m glad that you found it helpful! Maybe more web searching will turn up something else like it!

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