Blood ketone level clarification

[Emacfarland]

I’m confused about what defines being in nutritional ketosis based on blood levels. The Diet Doctor website says 1.5 is considered ketosis while I’ve heard on Keto Talk from Doc Nally that fit and active people can be in ketosis at levels of .3 or .4 and that higher levels don’t necessarily mean better. So I’m not sure what the heck I’m aiming for! If I get readings below 1.5 am I doing something wrong? I am fit and active and Doc Nally has said this can make blood ketone level readings lower because an active persons body is using the ketones more efficiently. Should I be aiming for higher levels?

[BillJay]

It seems that the longer someone is keto-adapted, the more their body produces just the right amount of ketones and what we measure in the blood is only what’s not actually being used, therefore it seems not only possible, but likely that people are in ketosis even with lower betahydroxybutyrate (BHB) levels - the ketone in the blood that these meters measure.

This is somewhat frustrating for me since I’d like for there to be an objective measurement of being in ketosis, but that seems to be elusive.

Therefore, a better indication is your level of carbs since it is HIGHLY unlikely that anything over 50 carbs is in ketosis and more likely that keeping carbs under 20 grams is a safe bet. Another indication is keeping protein at moderate levels which is 1.0 to 1.5 grams per kilogram of lean body weight.

Once the macro-nutrients are in the proper range, I think that signs of keto-adapation are more poignant and below is a post from Mark Sisson on Dr. Mercola’s site that explains many of the signs of being keto-adapted.

What Does It Mean to Be Fat Adapted?

[richard]

Dr Phinney invented the term so he gets to define it.

In his book “The art and science of low carbohydrate living” he gives the range from 0.5 to 3.0 mmol/l

But recently he mentioned that some of Dr Volek’s very athletic subjects were clearly in ketosis at 0.2 mmol/l.

My personal range is from 0.2 to 0.8 mmol/l, and I have been in ketosis for almost 3 years. Prof Tim Noakes is also normally in the same range 0.2-0.8.

I suspect when we first start we aren’t good at using them so we make too many and use too little so we end up with a lot left in our blood. After we become better adapted we end up in whatever physiological range our bodys feel best ensures our survival. And people who are trained and good fat burners may be able to get away with less because they can make it easily.

When I fast for 3 days and then do 3 hours of exercise my ketones can go as high as 3.5. But I know people who regularly get up to 7.

It’s worth pointing out that Dr Nally has mentioned in his most recent podcast that he eats exogenous ketones 3 times a day. And he sells them.

Personally I wouldn’t be worried. I think you are doing fine.

[Emacfarland]

It is reassuring to know your levels are that "low"after doing this for so long. I definitely experience the signs of being in ketosis even when my levels are around .4 or .5. I know doc Nally has a vested interest in exogenous ketones but he often has some good tidbits for those of us who are lean and not doing keto to reverse disease. I was keto last year for about 13 months then went off for about 6 months because I got too lean and had to regain some weight. Now I’m about 4 months back in and am trying keep my ketones up while trying not to lose too much weight. So I don’t know if there’s a correlation between ketone levels and weight loss…

[jfricke]

Doesn’t adding in more fat enable you to maintain desired weight? I’m far from worrying about maintenance yet but I am curious about the process.

[Emacfarland]

Adding more fat is helpful as well as not fasting for too long. Everyone has to find what works for them long term. It will look different based on your activity level and body composition. Maintenance needs are different than weight loss needs for sure!

[cansel]

Mine were 4.5 today - does this mean I’m not eating enough?

[BillJay]

Mine were 4.5 today - does this mean I’m not eating enough?

If you mean that your blood ketones were 4.5 mmol/L, then it means you’re definitely in nutritional ketosis and I wouldn’t interpret that as not eating enough, but instead as a big step to being fat-adapted.

[cansel]

Ok, great! Thank you

[chris.coote]

Richard,
I’m in the same range myself except when fasting. What I was wondering: Do you actually see the numbers drop below .2 if you get kicked out? I’ve been below net 20 for the last 6 mo, but do occasionally hit up artificial sweeteners and other risky items, and I have never gotten a strip under .2 (mostly .3-.8).

[richard]

It’s been a while since I’ve seen 0 ketones. The strongest sign I’ve been kicked out is that my knee starts hurting. Most of the time I don’t notice it. But when I do, and I have remembered to test I had 0 ketones in my blood.

[lesley3128]

I’m so happy to read this thread
I have bee on keto /Lchf for 40 months have stayed at my perfect weight now for over a year
I purchased a ketonix in the first year and regularly blew high yellows
Now days I’m high greens sometimes yellow
I recently purchased a blood ketone/glucose monitor really just out of interest and am going to plot measurements for a month as well as the ketonix
At 11am thus morn ( fasted ) I blew .7 ketone
I know I’m in ketosis ,I would say I am far strictler than 3 years ago as it is now just a way of life
So I’m thinking my body has become very efficient at ketone production My blood glucose was 4.3
It will be interesting plotting for a month

[richard]

I really don’t agree with this graph’s definition of ‘starvation ketosis’

Yeah I agree it’s contextual (probably to Insulin status).

My physiological range on a ketogenic diet is 0.2 - 0.8 mmol/l. I’m only barely in nutritional ketosis according to that chart. For me to see more than 2.0 I have to fast 3+ days, and to get over 3 I need to additionally exercise for hours.

IMO the only 2 ketone numbers that mean much are >0 and >10.

[akirby83]

Doesn’t adding in more fat enable you to maintain desired weight?

Does it? If your insulin set point is dictating a lower body fat than you would like, wouldn’t your body just burn the additional dietary fat? I have been told that subtracting fat from your diet won’t aid weight loss, so will more fat result in weight maintenance? I don’t know what to believe anymore!

[richard]

Do you actually see the numbers drop below .2 if you get kicked out?

Yup last time I ate more than 20g (and that time I ate 100g - april 2016 at a wedding) it went to 0g. But the biggest signal that I am out of ketosis is all of a sudden my torn meniscus in my left knee became so painful I couldn’t sleep. The other signal is the next 2 days I was hungry all the time and over ate a lot.

[Katharina_McMartin]

I’m still new to keto (5 weeks in) and just did my first keto test with ketostix. Could I really be at 0.8g/l or is it more likely I’m doing or reading it wrong?

[Larrym]

I have been eating strict keto 10 or less carbs per day for about 7 months lost 65 pounds feeling great but it’s good to see what I’m reading here because the longer I do it my blood Ketone level rarely goes above .7 and most of the time is .3-.5 I still am losing weight and doing well but I have personally felt that the numbers in the graph shown above are not necessarily fact for all people that this is a ongoing Science learning all the time and I’m glad to see other people have technically low Ketone levels but they are just fine

[PortaPT]

So i am usually high in ketones…like today my blood ketones were a 4.8 mmol but i too just heard for higher readings perhaps my body is not using them? I am a personal trainer/athlete and put all the pieces of the puzzle together with proper nutrition of my greens, moderate protein (avg 60 grams) and good quality fats. I do not use exogenous ketones. But now im wondering if my body is not efficient in using them? And if thats the case what would i do?? I workout an hour or so per day HIIT style, i no longer overtrain the steady state, i strength train, i do intermittent fasting etc. Any links of info if u know any would be appreciated. I follow Dr. MERCOLA

[Mkellett]

So I am new to using the Percision Xtra for ketone measurement. Here is what I have recorded:

Wednesday night: 1.1
Thursday morning: .3
Thursday afternoon: .8
Thursday evening: 1.2
Friday morning: .4

Does this look normal? I have been loosing some weight but feel like it could be quicker. I can see why folks say they are trying to get their numbers up to the Phinney optimum range. If I get my fat intake up and reduce protein should these numbers increase?

Thanks very much for any input,
Mark

[mikpaq]

test with ketostix. Could I really be at 0.8g/l or is it more likely I’m doing or reading it wrong?

Ketostix are not as accurate as a blood test. I would recommend picking up one of the blood ketone meters and measuring that way.