Are my ketone levels abnormal/too high?

(Sitanshu) #1

I have been on a ketogenic diet for about 6 weeks and recently purchased a blood ketone tester. Upon using it for the first couple of days, i found my ketone levels to be abnormally high.

My diet - My diet over the last 6 weeks has been fairly decent… I do not consume any grain based or sweet based food, and most of those net carbs comes from non-starchy vegetables. My total carbs are between 50-70grams on a daily basis, with net carbs around 30-40 grams. I haven’t had any cheat days, however, I have taken a fair amount of protein. Generally my macro distribution is Fat (65-70%) : Protein (15-25%) : Carbs (8-12%).
I also use IF with a 16:8 timeline, and do a 36 hour fast once a week.

Workout: Since all gyms are closed in my area, I haven’t been doing much training. However, I have been jogging 3 times a week for 5k and been doing some home strength training (push ups, belgian squats etc) a couple of times a week.

Results: My results have been very positive in terms of fat loss. I have an impedance body composition monitor and my fat loss has been excellent. I have lost over 4% body fat, while maintaining my muscle mass. I also feel pretty good and very energetic all the time. I have certainly lost a couple of inches on my waist. Also, I didn’t really go through any severe form of keto flu in the beginning.

Ketone measurement: Last week I bought a blood ketone monitor and started to measure my blood glucose and ketone. I was expecting them to be decent, but they turned out to be too high.

My numbers on non-fast days are
Morning (fasted for 10-12 hours) - Ketones 1.4 - 2.4 mmol and glucose in late 70s mg/dl
Pre sleep (fasted for 3-4 hours) - Ketones 1.8 - 2.8 mmol and glucose in late 60s mg/dl

My numbers on fast days (fasting greater than 16 hours are)
Night (fasted 24 hours) - 5.9 mmol with blood glucose of 52 mg/dl
Morning (fasted 36 hours) - 5.6 mmol with blood glucose of 55 mg/dl

So, I had a few concerns

  1. Is it clear that I am not in a fat-adapted? I understood that once someone starts to get fat adapted,the ketone numbers will start to drop down. With my numbers, am I fat adapted yet? I do not have any hunger pangs on fasting days and I am always very energetic.

  2. Are my ketone and blood glucose levels close to dangerous on fasting days? I was thinking of going on a longer fast of about 3 days (for autophagy reasons), but I do not want to enter ketoacidosis.

  3. Do I need to increase my protein intake to avoid ketoacidosis?

Appreciate your response.

(Michael - When reality fails to meet expectations, the problem is not reality.) #2

You’re eating too many carbs. Cut the carbs to sub-20 grams (net) per day, and the lower the better. At the beginning it is very important to remain in ketosis consistently. The more consistently you remain in ketosis the sooner you’ll be fat adapted. Also, calculate macros by grams, not percentages.

#3

All your numbers are in a typical range for what you’re doing. Don’t become obsessed with ketone testing unless you’re trying to work on an actual medical issue that’s been proven to be better with high levels.

Unless you’re planning on becoming a Type 1 Diabetic AND somehow quadrupling your ketones levels, that’s not gonna happen!

(Ben ) #4

I’m jealous of your numbers. The last time I got numbers like that was in January. Therapeutic Ketosis !!!

(Bunny) #5

Usually when I fast for a long time (many days) my ketones actually decrease to 2.0 to 3.0.

Could be not enough insulin? But it could also be you are taking your blood samples when the ketones are fluctuating going from extremely high to extremely low (noisy time) and if you take Vitamin C supplements or have high hemocrit (the ratio of the volume of red blood cells to the total volume of blood) blood serum levels it will give you false highs on ketones?

OMG I do apologize, I thought you were talking about ketones, your talking about blood glucose, sorry my bad…lol

(Bacon is a many-splendoured thing) #6

Ketoacidosis is not even a concern until your serum β-hydroxybutyrate rises above 10 mg/dL, and even then, you probably won’t see symptoms until you reach somewhere around 20. As long as your body is producing any insulin at all, diabetic ketoacidosis is extremely unlikely. There is a phenomenon called “euglycaemic ketoacidosis,” which can happen to pregnant or lactating women who attempt to fast. If you are not a woman, not fasting, or fasting but neither pregnant nor giving milk, then you have no need to worry about euglycaemic ketoacidosis.

Your carbohydrate intake is on the high side, but you are probably doing fine, given the level of serum β-hydroxybutyrate you report. You could cut your carb intake further if you wanted to, but it hardly seems necessary. You may indeed see a bit of a drop in the serum β-hydroxybutyrate (or you may not), as you reach fat-adaptation, it’s a very individual thing.

Our serum insulin drops quite quickly after we cut our carbohydrate intake, and it has to, because the liver needs to make glucose and ketone bodies to feed our cells, if we’re not taking in glucose in the form of carbohydrate. For the first six to eight weeks (longer for some people), the muscles sort of limp along, making do with ketone bodies, until they make the necessary chemical shifts to start metabolising fatty acids. This is what we mean by fat-adaptation. At that point, the muscles do fabulously on fatty acids and actively refuse to take in ketones or glucose (so as to spare them for the tissues that need them). People generally notice a drop in performance during the adaptation phase, then their performance returns, and they sometimes find it even exceeding their pre-keto levels.

Once fat-adapted, you should see a large increase in your endurance, because the body can maintain only a small amount of glucose circulating in the bloodstream, but even a lean athlete has a vastly larger supply of energy in the form of fatty acids (a fat-adapted athlete is therefore essentially “bonk-proof”). Explosive power takes longer to return, but eventually there is no difference between sugar-adapted and fat-adapted athletes. The only cells in the body that must have glucose are the red blood corpuscles (erythrocytes) and possibly parts of the brain (the brain’s need for glucose used to be part of the standard wisdom, but some scientists are now calling it into question). The body’s need for glucose is so small that the liver can quite easily manufacture enough out of amino acids, a process called gluconeogenesis, and this process starts up as soon as serum insulin drops low enough to permit it (insulin drops considerably once the body no longer needs it to force excess glucose out of the bloodstream). A related process, called ketogenesis, also starts in the liver. (Ketogenesis is the manufacture of ketone bodies out of fatty acids. Ketone bodies are to fatty acids as charcoal is to wood.)

Both gluconeogenesis and ketogenesis are stimulated by the hormone glucagon and inhibited by the hormone insulin. The insulin/glucagon ratio determines whether the metabolic milieu is fatty acid metabolism or glucose metabolism. A low ratio, which results from low or non-existent carbohydrate intake, stimulates fatty acid metabolism, and a high ratio, which results from excessive carbohydrate intake, stimulates glucose metabolism in order to defend the body from the effects of hyperglycaemia. Hyperglycaemia and hyperinsulinaemia both can do considerable damage to the body, and they are the underlying reasons for all the metabolic diseases: diabetes, dental caries, gout, obesity, hypertension, atherosclerosis, Alzheimer’s disease, certain cancers, etc. Fortunately, much (though not all) of this damage can be reversed once carbohydrate intake drops sufficiently.

In sum, your ketone levels are fine, so don’t worry. The actual level of circulating β-hydroxybutyrate in the blood is only a marker, in any case. It only indicates that there are ketone bodies being produced in excess of requirement. There is no known way to measure the actual ketone production and consumption that is going on. However, if your carbohydrate intake is very low and you are still alive, then it is a foregone conclusion that you must be in ketosis, regardless of what your meter is telling you.

(Sitanshu) #7

Thanks,that was a very helpful link.

I am pretty much staying in ketosis constantly, with very high ketone levels. So I doubt I need to reduce my carbs or protein. I was just wondering whether there was a correlation between not being fat adapted and have too high ketone levels.

(Sitanshu) #8

wow! Thanks for such an excellent explanation. I am certainly a lot more relaxed.

I did panic a little last night (hadn’t read this useful post and the others written above), and tried to reduce my ketone levels by having a 60% cocoa dark chocolate. Unfortunately it kicked me out ketosis and I was 0.2 mmol before bed. Luckily after getting up this morning, my ketone levels were back to 2.5 mmol.

Of course, I wont make that mistake again, now that I know my ketone levels are not dangerous. Hopefully they go back down again soon, and I enter fat adaptation soon.

Thanks, once again for your very useful response.