Nutritional evaluation of homemade food prepared with a commercial ketogenic cooking/baking mix : gap between expected and real ketogenic ratio

Ketogenic diet is widely used in children and adults for the treatment of refractory epilepsy and other neuro-metabolic diseases. Its efficacy is strictly affected by the compliance to a rigid controlled dietary plan characterized by very low consumption of cereal-based products. A surrogate of traditional flours has been recently developed, a multi-purpose cooking/baking mix (“ketogenic flour” - KF), with a ketogenic ratio (KR) of 5 (5 gr of lipids :1 gr of carbohydrates + protein) (KetoCuisine - Solace Nutrition, Pawcatuck, CT, USA). Our aim was to clarify if homemade cooked food prepared using KF keeps its expected KR. To this purpose, seven typical Italian gastronomical tradition recipes, salty and sweet, have been prepared with different KR by trained dietitians. After cooking, bromatologic analysis (protein, lipid and carbohydrate contents) were performed using official chemical methods. Final KR has been calculated and compared with the expected one (table below). Expected Measured ∆% KR KR KR Panfocaccia bread 4.5 3.5 -22,2 Taralli 3.0 2.3 -24,2 Taralli with sesame seeds 3.0 2.3 -24,1 Crackers 2.9 2.0 -32,6 Cake filled with noisette and mascarpone cream 3.4 2.6 -23,7 Plumcake with noisette 5.2 4.3 -17,8 Focaccia 4.8 4.2 -13,5 Expected Measured ∆% KR KR KR Panfocaccia bread 4.5 3.5 -22,2 Taralli 3.0 2.3 -24,2 Taralli with sesame seeds 3.0 2.3 -24,1 Crackers 2.9 2.0 -32,6 Cake filled with noisette and mascarpone cream 3.4 2.6 -23,7 Plumcake with noisette 5.2 4.3 -17,8 Focaccia 4.8 4.2 -13,5 Expected Measured ∆% KR KR KR Panfocaccia bread 4.5 3.5 -22,2 Taralli 3.0 2.3 -24,2 Taralli with sesame seeds 3.0 2.3 -24,1 Crackers 2.9 2.0 -32,6 Cake filled with noisette and mascarpone cream 3.4 2.6 -23,7 Plumcake with noisette 5.2 4.3 -17,8 Focaccia 4.8 4.2 -13,5 All recipes presented a measured KR lower than expected, with an average loss of -23±6%. The main reason of this gap was the loss of lipids (-5.9±3.5%) during the cooking phase. This study suggests that homemade food prepared using KF presents a decrease in expected KR. Although KF is an interesting ingredient to prepare ketogenic food similar to cereal-based products, the homemade preparations could result in unexpected reduction of plasma ketone bodies level. Standardized cooking conditions and careful education are required especially in case of domestic preparation.