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  • Writer's pictureTracy Insalaco

Keto As Medical Necessity (Not A Fad)

Updated: Mar 15, 2022

Pet peeves. We all have them, don’t we?

Leaving grocery carts in the parking spots — twitch.

People who are chronically late — twitch.

Someone talking over me or asking a question when I’m not even done with my sentence — twitch.

Someone saying “me too!” when I tell them my son is on a Ketogenic diet — BIG twitch.

This is a major reason why this site uses the full word “KETOGENIC,” in order to distinguish itself from the hair-flip “Ket-O!”

First, I’ll say that I am grateful for the keto trend in that it offers some support on the benefits of high fat diets and even inspiration towards ideas on how to get creative in feeding my son. However, my eyes glaze over a bit when people assume our journey is the same as their “Keto” journey. Why? Because, the truth is most “Keto” trending adults are actually doing more of a Modified Atkins diet. They limit their carbs and eat more fat. Then they prick their finger to check ketone levels and get really excited when it’s a 1.5.

Well, AJ lives between a 4 and 7 on the ketone scale. How 'bout them avocados?

Second, I’m not mad, and I don't want to be disrespectful. I fully acknowledge that most people simply have zero awareness of the classic, medically prescribed Ketogenic diet, which is why I feel the need to gently educate those I talk to. I now say my son is on a strict ketogenic diet where everything he eats has to be in ratio, with every calorie accounted for. This usually minimizes the comparison comments.

I also want to acknowledge that my experience thus far has solely been with the Ketogenic Diet, yet there are families administering a medically prescribed diet in the form of Modified Atkins. This is not in the same category as keto-fad, given the limitations and requirements are more strict and require medical supervision.


I went from breastfeeding my baby, to plunging syringes of olive oil in his mouth (with a few drops of breast milk mixed in). He started the diet at the classic ratio, which is 4 parts fat to 1 part carbohydrate/protein COMBINATION. It is extremely important that he eats everything in ratio (which means every crumb, every drop must go in his mouth), because if the ratio slips and he drops out of ketosis not only is it a challenge to get back in, but now we’ve cut off the fuel to his brain. Seizures or increased developmental delays could ensue. If the opposite happens, and his ketones shift too high, his body becomes very acidic, risking sickness, kidney stones, etc. It is also critical that he be monitored by professionals.

Although, low to no sugar is a great benefit of the ketogenic diet, this is not an ideally healthy lifestyle. He can’t eat as much as he wants on these high fat ratios or he would quickly become obese! So we have to count and limit his calories. For example, today AJ is eating at a 2.25:1 ratio with a total of 1160 calories a day broken down into 320 cal per meal (3 x day), with 200 cal of snacks.

Here is a picture of one meal (pesto, zucchini, chicken, parmesan, tomato, oil)

It doesn’t look like much, but it is sufficient.

One good thing, also, is that the high fat content allows for this meal to be more filling than it would be otherwise.

Another differentiation from the fad diet is that we cannot simply grab a "keto" product fresh off the shelf, open it and eat it. Even those products still need to be filtered through the Ketogenic Diet Calculator in order to be properly incorporated into Eating by Ratio.

The same challenges exists when going out to eat at a restaurant. Buttery shrimp might seem like a no-brainer, but in reality I need to know the weight of that shrimp, how many grams of butter are on that piece, and also any additional spices/sauces.

Currently, as far as I am aware, there is no easily portable system for calculating ketogenic medical necessity meals..... AHEM.....


If anyone has the desire and expertise to build an app that would use your phone as a seriously accurate gram scale, as well as mimic the calculating ability of the already-existing "KDC" -- LET'S TALK! :)

Okay, I've rambled on enough about this...

I do hope the differences between the two are a bit clearer and will perhaps lead to a little less twitching in my life.

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