Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.
There exists great debate on how to quantify the macronutrient ratios and percentages for a traditional ketogenic diet. Despite numerous opinions, the common and ultimate objective is to develop a diet that is sustainable in achieving the desired outcome (i.e., a state of ketosis). As such, while it is suggested that 65–80% of the total calories come from fat, and 15–30% from protein, these numbers will be optimized according to every individual’s unique metabolic needs. For example, an individual who is trying to achieve a state of ketosis might have a different ratio of macronutrient requirements than someone who is using a ketogenic diet to improve their body composition. Once the body begins to use fat as its primary fuel source, metabolic “keto-adaptation” characterized by increased production of ketones takes place. It is important to note that there is no “optimal” level of ketosis, nor is there a standard macronutrient profile to achieve a ketogenic state, because factors such as activity level, body composition, and desired health and performance outcomes will influence these variables. Although individualized, Ketogenic.com currently offers a Keto Calculator that can help provide you with a starting point on your macronutrients.
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