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KetoCalculator: A web-based calculator for the ketogenic diet

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  • Ketogenic Therapies, LLC
Article

KetoCalculator: A web-based calculator for the ketogenic diet

Abstract and Figures

The classic ketogenic diet (KD) is a mathematically calculated diet with specific daily goals of fat, protein, and carbohydrate. Precise quantities of foods are then derived from these values which result in meal plans for the individual patient. The algebraic algorithm to determine a single meal requires approximately 35 calculations. This process is time consuming given that each individual requires many meals for variety and satisfaction. Computer applications can process multiple calculations in seconds. In 1997, a program was designed by this author with LifeTime Computing, a computer software company. This program was rebuilt into digital format in 2002, given the title KetoCalculator, and made available to registered dietitians on the World Wide Web (Zupec-Kania, 2002).
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Epilepsia, 49(Suppl. 8):14–16, 2008
doi: 10.1111/j.1528-1167.2008.01824.x
SUPPLEMENT - KETOGENIC DIET AND TREATMENTS
KetoCalculator: A web-based calculator
for the ketogenic diet
Beth Zupec-Kania
The Charlie Foundation, Ketogenic Diet Seminars, Santa Monica, California, U.S.A.
SUMMARY
The classic ketogenic diet (KD) is a mathemati-
cally calculated diet with specific daily goals of fat,
protein, and carbohydrate. Precise quantities of
foods are then derived from these values which re-
sult in meal plans for the individual patient. The
algebraic algorithm to determine a single meal
requires approximately 35 calculations. This pro-
cess is time consuming given that each individual
requires many meals for variety and satisfaction.
Computer applications can process multiple calcu-
lations in seconds. In 1997, a program was designed
by this author with LifeTime Computing, a com-
puter software company. This program was rebuilt
into digital format in 2002, given the title KetoCal-
culator, and made available to registered dietitians
on the World Wide Web (Zupec-Kania, 2002).
KEY WORDS: Ketogenic diet calculator, Calcula-
tions.
KetoCalculator (KC) is a tool for calculating multiple
components of the ketogenic diet (KD) including meals,
formulas, nutrition supplements, fluids and the carbohy-
drate content of medications. The program also functions
as a database to store and archive calculations for fu-
ture reference. The advantage of using a web-based pro-
gram over software products is that changes can be made
in the master database and are available to the user in-
stantly; periodic updates are not required. The master
database is regularly updated with current food and product
data.
PROGRAM STEPS
The program is designed to simulate the manual calcu-
lation of the diet and is organized in a step-by-step fashion.
Initial entry of demographic data includes the name, date
of birth, desired weight for length, and gender of the indi-
vidual to facilitate creation of the diet.
The first calculation step in the KC is the estimation
of energy requirements. The recommended dietary al-
lowances (RDA) (Food and Nutrition Board, 1989) may be
used as a baseline value from which 80–90% is calculated.
The KC program automatically computes a guiding range
Address correspondence to Beth Zupec-Kania, R.D., C.D., Con-
sutant, 1325 Victoria Circle S., Elm Grove, WI 53122, U.S.A. E-mail:
ketogenicseminars@wi.rr.com
Wiley Periodicals, Inc.
C
2008 International League Against Epilepsy
of 75–85% of the RDA allowing an additional 5–10% of
calories set aside for ketogenic snacks. Clinical judgment
is required to determine the final calorie goal. This deter-
mination considers the individual’s activity level, weight,
and previous energy intake. Additional calories for a keto-
genic snack may be created later in a separate feature of
the program.
The second step is determination of the individual’s pro-
tein requirement; this is automatically calculated from es-
tablished RDA tables using the previously entered weight
and age.
The third step is determination of the ketogenic ratio,
which is the relationship between grams of fat to the com-
bined grams of protein and carbohydrate. In a 4:1 ratio,
there are 4 g of fat for every gram of protein and carbo-
hydrate combined. The ratio impacts the degree of keto-
sis and can be manipulated during therapy to alter ketosis.
Historically, a 4:1 ratio is prescribed for young children.
Lower ratios such as 3:1 may be used for older children
to allow for higher protein needs. More liberal ratios could
be prescribed such as 2:1 or 1:1 for individuals who are
overly ketotic or unable to consume the high-fat content
of the higher ratios. The Modified Atkins Diet and Low
Glycemic Index Treatment are approximately 1:1 and may
also be calculated using this program. Once the user has
selected a desired ratio, KC will automatically determine
the protein, fat, and carbohydrate contents. The user may
view these calculations and further adjust protein and car-
bohydrate content if desired.
14
15
KetoCalculator
Figure 1.
KetoCalculator calculation of a sin-
gle meal
Epilepsia C
ILAE
The final step is the formulation of the ketogenic meals.
The total daily amount of fat, protein, and carbohydrate
is divided equally into the number of meals that is de-
termined to be necessary for the individual. The user
may select from a list of typical KD meals. The KC
will subsequently create the selected meals to meet the
diet prescription. Each meal should then be reviewed
by the dietitian and adjusted for accuracy. The meals
may be easily modified to meet individual preferences by
adding additional food items or altering the quantities of
foods. The final mathematically balanced meals are used
interchangeably.
Classification of foods into food categories allows
greater variety. The classic KD uses a standard group of
fruit (10% and 15%), and two groups of vegetables (group
A and group B). This allows the caregiver to create a
variety of meal options from one meal calculation. For
example, Figure 1 reveals the calculation of a meal con-
taining chicken, group A vegetables, cream, and butter. A
variety of vegetables from the group A list may be inter-
changed such as broccoli, spinach, or a salad with multiple
vegetables.
During the course of therapy, the KD may require ad-
justment in calories or ratio. The user will create a new
diet prescription. The KC will save previously calculated
meals and allow the user to readjust these to the new diet
prescription.
Liquid formulas may also be calculated using the KC.
Several options to automatically create standard formulas
from commercial products are available in the program.
These formulations may also be modified by adding or ad-
justing ingredients, such as increasing the water content or
adding specific oils.
In addition to the meal and snack calculations, the KC
also assists in the selection of nutrition supplements. Goals
for individual intake are automatically extracted from RDA
tables based on the individual’s age (National Research
Council, 2002). The user may select from a group of prod-
ucts such as multivitamins and calcium supplements and
compare the sum of micronutrients from these products to
goals. The carbohydrate content is also displayed and tal-
lied to reveal the total contribution of carbohydrate from
the chosen supplements.
A separate feature within the program calculates the
carbohydrate content of medications based on a direc-
tory of 250 commonly used prescription and nonpre-
scription medications. The user is also able to enter
new medications into the program to be included in this
evaluation.
The KD should be accompanied by sufficient fluid to
maintain adequate hydration. The KC will calculate main-
tenance fluid volume for the individual based on weight
using the Holiday-Segar Method. This volume serves as a
guide for basic hydration needs. A guide may be created in
this feature to organize fluids and meals into a daily sched-
ule to assist the individual in diet management. This guide
is also helpful for establishing a schedule for enteral for-
mula feedings.
ADDITIONAL FEATURES
The user may add additional foods, medications, and
supplements into their program. There are two support
features for assisting users in the use of the program. A
Frequently Asked Questions section is linked to provide
guidance. There is also a Help Line which allows the
user to submit a question and receive a response within
24 hours.
Currently there are several hundred KC users world-
wide. The program is free to registered dietitians. The
dietitian may provide a password to the caregiver to ac-
cess the meal and snack calculation features. This feature
also includes digital notification to the dietitian when a
caregiver creates new meals and snacks or adjusts existing
ones.
Epilepsia,49(Suppl. 8):14–16, 2008
doi: 10.1111/j.1528-1167.2008.01824.x
16
B. Zupec-Kania
This web-based application is stored on a secured server
and requires a login and password to enter. The data en-
try and beta testing for the program was provided by Beth
Zupec-Kania.
ACKNOWLEDGMENT
I confirm that I have read the Journal’s position on issues involved
in ethical publication and affirm that this report is consistent with those
guidelines.
Disclosure: The author is a paid consultant to The Charlie Foundation and
to Children’s Hospital of Wisconsin (Milwaukee, WI), and has received
an educational grant from Nutricia North America for development and
maintenance of KetoCalculator.
REFERENCES
National Research Council, National Academies of Sciences. (2002)
Dietary reference intakes for individuals, vitamins, minerals, trace
minerals, fiber, essential fatty acids. National Academies Press,
Washington, DC.
Subcommittee on the Tenth Edition of the RDAs Food and Nutrition
Board, Commission on Life Sciences National Research Council.
(1989) Recommended dietary allowances. 10th ed. pp 24–30.
Zupec-Kania BA. (2002) KetoCalculator: web-based program for calcu-
lating the ketogenic diet. https://www.ketocalculator.com. Accessed
September 25, 2008.
Epilepsia,49(Suppl. 8):14–16, 2008
doi: 10.1111/j.1528-1167.2008.01824.x
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Migraine is the third most common condition worldwide and is responsible for a major clinical and economic burden. The current pilot trial investigated whether ketogenic diet therapy (KDT) is superior to an evidence-informed healthy “anti-headache” dietary pattern (AHD) in improving migraine frequency, severity and duration. A 12-week randomised controlled crossover trial consisting of the two dietary intervention periods was undertaken. Eligible participants were those with a history of migraines and who had regularly experienced episodes of moderate or mildly intense headache in the previous 4 weeks. Migraine frequency, duration and severity were assessed via self-report in the Migraine Buddy© app. Participants were asked to measure urinary ketones and side effects throughout the KDT. Twenty-six participants were enrolled, and 16 participants completed all sessions. Eleven participants completed a symptom checklist; all reported side-effects during KDT, with the most frequently reported side effect being fatigue (n = 11). All completers experienced migraine during AHD, with 14/16 experiencing migraine during KDT. Differences in migraine frequency, severity or duration between dietary intervention groups were not statistically significant. However, a clinically important trend toward lower migraine duration on KDT was noted. Further research in this area is warranted, with strategies to lower participant burden and promote adherence and retention.
... Dressler ve ark. (35) (37) . Böbrek taşı KD alan çocukların %2-6'sında görülürken, 6 yıldan uzun süre kullanıldığında %25'lere kadar çıkabilir. ...
... KD'i optimal koşuıllarda uygulamak için KD eğitimi almak ve software programı kullanarak gıdaların bileşiminin incelenmesi önemlidir. KD'in uygulanması için Keto Calculator gibi bir bilgisayar programının kullanılması olasıdır ve hem zamandan tasarruf sağlar hem de hataları önler (27) . Çocuğa bakan kişiye diyetin hesaplanması ve gıdaların tüketimiyle ilgili bilgi vermesi açısından iyi eğitimli bir diyetisyenin olması önemlidir. ...
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Ketogenic diet is a non-pharmacologic treatment developed to be effective in childhoodresistant epilepsy. It is also the first-line treatment for many of these metabolic diseases such as deficiency of glucose transporter 1. Growth and laboratory values need to be closely monitored. For this reason, pediatricians interested in these children should also have adequate knowledge of the diet. The mechanism of the seizure-controlling effect of ketogenic diet is still actively being investigated, but many theories have been proposed. In December 2006, the Charli Association organized a panel with a commission of 26 pediatric epileptologists and dietitians from 9 countries experienced in the use of ketogenic diet. This group has developed a consensus on the clinical management of KD. In this article, the mechanism of neuroprotective action of KD, clinical indications and contraindications will be discussed. Patient selection consists of phases of counseling and evaluation before use of KD, selection of the type of KD, its administration, supplementations, follow-up and management of side effects. The combined effort of the pediatric neurologist, pediatrician and dietician during the monitoring of the child receiving KD is essential in the recognition, protection and elimination of the success of the KD treatment and its possible side effects. In this review, general pediatricians will be able to provide advice to the child’s family and caregivers by increasing the skills they need to know about the care of children using KD.
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Introduction: patients who follow a ketogenic diet for the control of epileptic seizures must carry out a strict control of carbohydrates from the foods they eat and the medicines they are prescribed. In the initiation of a ketogenic diet and when a doctor prescribes a new medication, it is necessary to select the most appropriate pharmaceutical form so that the supply of excipients in the form of carbohydrates from the drugs is minimized. Objectives: the goal of the present paper was to compile a list of carbohydrate and caloric contents in antiepileptic drugs commonly used in pediatric neurology. Methods: in each medication included in the list, the content of excipients considered carbohydrates and derivatives that could influence the patient's ketosis was reviewed. The caloric content from carbohydrates and polyols in each medication was calculated. Results: the table provides the total carbohydrate and caloric content for antiepileptic medications in pediatric patients consuming the ketogenic diet. Conclusions: this table is intended to be a useful tool to help clinicians select a pharmaceutical form that is less likely to affect the ketogenic diet. Additionally, knowing the carbohydrate content of a new medication will allow adjustment of the diet to maintain ketosis.
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Кетогенная диета (КД) - это низкоуглеводная диета с высоким содержанием жиров и умеренным содержанием белков с включением витаминных комплексов, микро-, макроэлементов, особенно, кальция в сочетании с витамином D. У здорового человека при традиционном взвешенном питании углеводы, поступающие с пищей, перерабатываются в глюкозу, которая обеспечивает энергетическое питание и функционирование ЦНС. Посредством КД в рационе присутствует малое количество углеводов, поэтому печень компенсаторно, стремясь обеспечить организм энергетическим питанием, начинает интенсивно преобразовывать жир в жирные кислоты, затем в кетоновые тела - ацетоацетат, b-оксибутират, ацетон (кетогенез) в качестве альтернативы глюкозе. В результате, формируется состояние кетоза - повышенного уровня кетоновых тел в крови - и затем их утилизация в митохондриях периферических тканей и ЦНС (кетолизис). Одновременно происходит глубокое перепрограммирование метаболических процессов с терапевтическими (при эпилепсии и многих нейродегенеративных заболеваниях), или негативными последствиями при дефектах метаболизма жиров, функции печени и почек. КД изначально применялась (часто, с высоким терапевтическим эффектом) для лечения эпилептиформных состояний, вызванных дефектами энергетического метаболизма, у детей; затем у взрослых - ее облегченные модификации посредством умеренного повышения в рационе углеводов, белков, среднецепочечных жирных кислот. КД предусматривает (в соответствии с ростом и возрастом) достаточное количество калорий для поддержания нормальной массы тела, необходимое количество белков и минимальное количество углеводов для роста, регенерации организма. КД-терапия успешно используется при дефекте транспорта глюкозы (транспортера GLUT-1) в ЦНС, дефиците пируватдегидрогеназы; оказывает положительное действие при ожирении, диабете 2-го типа, болезнях Паркинсона и Альцгеймера, боковом амиотрофическом склерозе, рассеянном склерозе, инсультах, травмах и злокачествеенных опухолях головного мозга. Классическая КД противопоказана при нарушениях кетогенеза и кетолизиса, нарушениях функции печени и почек, недостаточности карнитин-пальмитоилтрансферазы I (транспортера жирных кислот в митохондрии), но ее модификации эффективны при некоторых дефектах обмена жиров. Ketogenic diet (KD) is a low carbohydrate diet that contains high amounts of fats and moderate amounts of proteins and includes vitamins, micro- and macroelements (particularly, calcium in combination with vitamin D). In a healthy human on traditional balanced diet, carbohydrates from food are being converted to glucose that provides energy for the central nervous system (CNS). KD contains little carbohydrates, therefore liver, to provide organism with energy, compensatory converts fat into fatty acids and then into ketone bodies acetoacetate, b-hydroxybutyrate, acetone as an alternative to glucose (ketogenesis). This results in ketosis - increased levels of ketone bodies in blood followed by their utilization in mitochondria of peripheral tissues and CNS (ketolysis). Simultaneously, a deep reprogramming of metabolic processes occurs resulting in therapeutic (in epilepsy and many neurodegenerative diseases) or negative (when fat metabolism defects or liver and kidney insufficiency are present) consequences. KD was initially used (frequently with therapeutic benefit) for the treatment of epileptiform conditions caused by defects in energy metabolism in children and later in adults (using lightened modifications with modestly increased levels of carbohydrates, proteins and medium-chain fatty acids). KD provides sufficient number of calories (matching patient’s height and age) to maintain normal body weight, necessary amount of protein and minimal amount of carbohydrates for organism growth and regeneration. KD is used successfully in patients with CNS glucose transport defects (GLUT-1), pyruvate dehydrogenase deficit, it provides benefits in obesity, type 2 diabetes, Parkinson’s and Alzheimer’s disease, lateral amyotrophic sclerosis, multiple sclerosis, stroke, traumas and brain malignancies, Classic KD is contraindicated in ketogenesis and ketolysis defects, liver insufficiency, kidney insufficiency, carnitine palmitoyltransferase I (mitochondrial fatty acid transporter) deficiency but its modifications are effective in some fat metabolism defects.
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The ketogenic diet is a multidisciplinary therapy that requires the dedicated support of physicians, nurses, dietitians, and social workers. A registered dietitian with pediatric experience is vital to the success of a ketogenic diet program, for this person is responsible for calculating, initiating, and fine-tuning the ketogenic diet. The dietitian must assure that nutritional needs are met during the course of diet therapy. The dietitian’s responsibilities include communicating medical concerns to medical team members and communicating regularly with the caregiver of the individual on the ketogenic diet. It is the responsibility of the epileptologist or neurologist and the nurse clinician to provide medical supervision of the ketogenic diet.
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Background: The Ketogenic Diet (KD) is an effective, alternative treatment for refractory epilepsy. This high fat, low protein and carbohydrate diet mimics the metabolic and hormonal changes that are associated with fasting. Aims: To maximize the effectiveness of the KD, each meal is precisely planned, calculated, and weighed to within 0.1 gram for the average three-year duration of treatment. Managing the KD is time-consuming and may deter caretakers and patients from pursuing or continuing this treatment. Thus, we investigated methods of planning KD faster and making the process more portable through mobile applications. Methods: Nutritional data was gathered from the United States Department of Agriculture (USDA) Nutrient Database. User selected foods are converted into linear equations with n variables and three constraints: prescribed fat content, prescribed protein content, and prescribed carbohydrate content. Techniques are applied to derive the solutions to the underdetermined system depending on the number of foods chosen. Results: The method was implemented on an iOS device and tested with varieties of foods and different number of foods selected. With each case, the application's constructed meal plan was within 95% precision of the KD requirements. Conclusion: In this study, we attempt to reduce the time needed to calculate a meal by automating the computation of the KD via a linear algebra model. We improve upon previous KD calculators by offering optimal suggestions and incorporating the USDA database. We believe this mobile application will help make the KD and other dietary treatment preparations less time consuming and more convenient.
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Available pharmacologic treatments for seizures are limited in their efficacy. For a patient with seizures, pharmacologic treatment with available anticonvulsant medications leads to seizure control in <70% of patients. Surgical resection can lead to control in a select subset of patients but still leaves a significant number of patients with uncontrolled seizures. The ketogenic diet and related diets have proven to be useful in pharmacoresistant childhood epilepsy.
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Ketogenic diet therapies involve a collaborative healthcare team and therefore are typically offered in tertiary care centers. Centers that utilize these therapies with frequency gain valuable experience and become skilled in their practice. This chapter is a summary from the presentations of 5 practitioners including a nurse, pharmacist, and 3 dietitians who shared their expertise during the clinical session of the 2012 International Symposium.
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The ketogenic diet (KD) is an effective nonpharmacological treatment used as an alternative not only for children but also for adults in the management of refractory epilepsy. Recently, modifications of the original KD, such as the Atkins diet and a low-glycemic-index diet, have been developed. The availability of these types of diets suggests that the KD could be offered earlier in the management of refractory epilepsy. Nevertheless, these diets may not be as effective as the KD. The KD is the treatment of choice for two distinct disorders of brain energy metabolism: glucose transporter protein (GLUT-1) deficiency syndrome and pyruvate dehydrogenase deficiency (PDHD) syndrome. The KD is absolutely contraindicated in primary carnitine deficiency, carnitine palmitoyltransferase I or II deficiency, carnitine translocase deficiency, β-oxidation defects (long-chain acyl dehydrogenase deficiency, medium-chain acyl dehydrogenase deficiency, short-chain acyl dehydrogenase deficiency, long-chain 3-hydroxyacyl-coA deficiency, medium-chain 3-hydroxyacyl-coA deficiency), pyruvate carboxylase deficiency, and porphyria. The diet may also be beneficial for seizure control in specific epileptic syndromes such as epilepsy with myoclonic-astatic seizures, West syndrome, Lennox-Gastaut syndrome, and Dravet syndrome. After stopping the KD, seizures recur in a few patients with cerebral lesions and electroencephalogram abnormalities; however, long-term health implications should be investigated.
KetoCalculator: web-based program for calculating the ketogenic diet. https://www.ketocalculator.com
  • Ba Zupec-Kania
Zupec-Kania BA. (2002) KetoCalculator: web-based program for calculating the ketogenic diet. https://www.ketocalculator.com. Accessed September 25, 2008.
Dietary reference intakes for individuals, vitamins, minerals, trace minerals, fiber, essential fatty acids
National Research Council, National Academies of Sciences. (2002) Dietary reference intakes for individuals, vitamins, minerals, trace minerals, fiber, essential fatty acids. National Academies Press, Washington, DC.