Fat Adapted and Still Excreting Ketones in Urine: Survey 🔎

[amwassil]

So we’ve all heard the reports that the lowly urine keto stix aka ‘pee sticks’ are only useful for the first few months for newbies. Once you’re beginning to fat adapt the wasted ketones, specifically acetoacetate, slowly and steadily decreases in the urine until the test strips show nothing. End of story. Maybe not.

I recently became aware of anecdotal reports by fat adapted or presumably fat adapted individuals also showing colour on the strips months after they should be showing nothing. What’s up with that, eh?

I’ve been in ketosis for 99% of almost the past 2 1/2 years and well enough fat adapted that I’m fully conscious and functional (most of the time ). I’ve had low breath acetone (BrAce) all day, May 30, 2019 (at or below 5ppm), even though I’ve been fairly active, at least active enough to burn some energy. For comparison I would usually be in the range of 10-20ppm. I haven’t eaten much today, so far less than 1200 calories as of 8:30pm (I’ll be eating a bit more, but there’s no way I’m going to make it to my 2700 daily target!). So for all intents I should be burning body fat and producing a solid level of BrAce. But I’m not! Go figure.

So I tested my urine. It was NOT zero! Somewhere between zero and the first colour on the chart, so somewhere between 0 and 0.5 mmol/L, probably closer to 0. Either that or I’m colour blind. So why would I be dumping acetoacetate when my liver is probably synthesizing less than usual amounts of it. Not dumping much, to be sure, but detectable. And what does it mean?

I’d like to get some data by polling forum participants. This is for long-term fat adapted people only, please. No newbies for this. To qualify I’d like you to have been in ketosis for at least 6 months (the longer the better) and fat adapted, as far as you are able to determine.

I’d like you to test your urine once or twice a day for a couple of days and report whether or not there was any colour. It doesn’t matter what colour, any colour other than the tan zero on the chart.

If you also own and use a blood testing device, I would like you to take a blood test for β-hydroxybutyrate immediately after a positive urine test. Report that as well.

If you also own and use a Ketonix breathalyzer, I would like you to take a BrAce sample immediately after a positive urine test. Report that as well. Note: Only Ketonix for this, please. Don’t report data from your cheap breathalyzer™.

Thanks in advance to one and all who participate.

[Shortstuff]

Not tested urine for a few months now but almost always get a positive result still and I’ve been keto for four years.

[Ilana_Rose]

Keto two years, always colour on the keto stick, always dark if I’m being strictly compliant. Usually around the 6 mmol colour.

[PetaMarie]

Over six months and always get some kind of color on the keto stick. Usually mid range.

[JohnH]

I started in Sept 2018, so coming up on 9 months in about a week.

I did Atkins a long time ago and urine testing was part of the process, so I just automatically bought a couple of 50-count tubes and started testing, in about the second week.

Mine are graded in mg/dL as the units. The colors equate to 0, 5, 15, 40, 80, and 160. In the early days, it would almost always hit the second-darkest color, so 80. Sometimes even a little darker, close to the 160.

When it was that high, I usually felt crappy and that would be a signal for me to increase my carb intake. I have always felt best when I stick with the Westman protocol, which includes a mandatory 3 cups of veggies/leafy greens a day.

Over time, I decreased the frequency of my checking, just because there was no need of it. I was feeling fine, losing weight, had steady energy, and was always eating on plan.

I have been losing weight more or less steadily, and am down about 95 pounds now.

The last few times I tested was only out of curiosity based on a forum post talking about how useless they are. They have shown color every single time.

I used my last strip a couple of days ago, again, to test out the “they stop working” theory. It showed 40, moderate.

I am nearly 9 months in. So it is definitely lower than the 80 reading that was more common when I was first testing. But still showing ketones.

I don’t really have any reason to spend $12 for another tube, so that may be my last test.

[Mo1]

10 months - always get colour.

[BenBoy]

Same here. Nine months and always had color. Don’t check much now just using up my supply.

[Regina]

I will start testing again tomorrow. I had stir Frye with questionable sauce last night.

[amwassil]

LOL. So now the truth comes out! Seriously, I don’t think carbs have anything to do with excreting ketones other than what I explained here as a possibility:

How long did it take for you to become fat adapted?

Off hand, I would not expect eating carbs to cause an acetoacetate ‘dump’. Although maybe if you had a substantial acetoacetate concentration in your blood and you introduced a surge of glucose, the acetoacetate might get dumped to reduce the overall energy load. Have you ever done a blood test after a positive urine test? It would be interesting to see the concentration of β-hydroxybutyrate when your urine is positive. I wonder if the β-hydroxybutyrate would get converted back into acetoacetat…

[Regina]

Ok. Will test at my usual high point of 2:30.

[amwassil]

May 31::12:00 Just did a urine test and got colour, a perfect match with 1.5 mmol/L. Took a BrAce sample immediately after and got 3.2 ppm. That’s still quite low, but not as low as it got yesterday!

Now I am wondering. Yesterday between about 11:45 and 13:00 or so I had a dental procedure that involved a goodly amount of anaesthetic into my upper right gums. My BrAce yesterday bottomed out at 1.8 ppm at 14:00. Starting to look suspiciously like the anaesthetic might have something to do with what’s going on here. I’ll have to investigate that.

[Regina]

Ok - I can never tell when I am between colors. I look closer to small than to trace, I think.

BG 91
Ketones 1.0
GKI - 5.06

I’ve eaten out the past couple of days and I think this is why I have less than stellar numbers! So what this tells me is that, over one year in, while the occasional fling won’t knock me out, it will lower my numbers and raise my BG. So this notion that one is either in or out, the numbers don’t matter, does not resonate with me.

[Karim_Wassef]

Breath, urine and blood measure different things. Why wouldn’t you expect some urine ketones in conjunction with the others?

[amwassil]

@Karim_Wassef I’m testing the claim “Urine keto stix are useless after two or three months and don’t show anything. They’re only useful for newbies to show that they’re in ketosis.”

[Regina]

Well am I in between trace and small? That would lime ip with my low blood levels.

[Karim_Wassef]

They’re not very accurate, and if they show nothing, it’s inconclusive. So their usefulness is limited on their own. Very n=1

[Regina]

But they should be adequate enough to warn a diabetic if they are in the danger zone. I’m going to keep posting my results. The trend I have seen so far with my very limited data is that the higher the blood ketones, the darker the strip.

[amwassil]

They’re not very accurate, and if they show nothing, it’s inconclusive. So their usefulness is limited on their own. Very n=1

Granted. But the claim under test is that they are useless once you are fat adapted: ie they will always show nothing. I’m not trying to determine particularly how useful they may or may not be, only whether or not they show ketones in the urine of relatively well adapted individuals. From the anecdotal evidence so far, little as it is, the answer seems to be yes they do. Just how much parlance to place on their accuracy or not is a question for another day.

[Ilana_Rose]

So this notion that one is either in or out, the numbers don’t matter, does not resonate with me.

Me neither. I can eat a Mars bar a day and still show traces, but I’ll also be gaining weight. When I’m not eating Mars bars and am strictly keto my color is always between medium and high. What my ketone value is absolutely matters to my results.

[Janie]

I’m out of pee sticks but will pick some up next week and compare to my Keto Mojo readings.

Does it matter if I am fasting all week?