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This poster was presented at the 9th Global Symposium on Ketogenic Therapies in September 2025. If you are a practitioner interested in any of the themes or ideas, please feel free to contact me here. 

The Ketogenic Algorithmic Challenge: Rethinking Ratio Use in Clinical Practice and Research

This poster essentially presents three ideas.

• Ones that I reflected on and explored during my doctorate of professional practice journey.

What is the Ketogenic Algorithmic Challenge?

• It is one thing to know WHAT we do.

• It is another to deeply reflect on the WHY.

• I took a deep dive into the nature of ketogenic ratios SKR and TKR.

  • Reflecting on what they mean in practice and problem solving.

• Particularly the influence of the Protein : Carbohydrate ratio part.

• Ultimately defined this as the Ketogenic Algorithmic Challenge.

  • What is the fundamental problem we are trying to solve

  • How do we get patients into their individual Optimal Clinical Response to keto.

  • I got it down to “The sum of n three-value-ingreidnet-ratios must balance to the target ratio prescription within a range where symptom relief is achieved while maintaining the integrity of the recipe or meal.”

What is the history of ratios?

• I wanted to know when SKRs started to be used.

• How they are used, ie labels or targets.

• And what are the current emergent methodologies dietitians are using in practice as keto continues to evolve and branch beyond epilepsy.

Why should we discuss a standardised labelling protocol?

• I’m not the first person to consider that ketogenic labelling is imprecise.

  • When literature includes quantifiably obesigenic diets identified as ketogenic, something is wrong…

• I’ve proposed a flexible but consistent labelling protocol.

  • For practice and research.

• This is independent of KD, practice or delivery method.

Why is this important to my practice?

• In our service we use this protocol.

• We can see at a glance the ratio, macros, and portions.

• Improved communication with the Neurologists.

• Shapes how we think in initiation, weaning, problem solving and fine tuning.