Fat Adapted and Still Excreting Ketones in Urine: Survey 🔎

[Karim_Wassef]

Ketones and glucose levels are not linear responses to fixed variables. They’re adaptive nonlinear and use history to keep us alive. So while the pattern isn’t clear, it’s a real system and very dynamic.

Instead of thinking of it like a machine with input and output, consider your metabolic system like a guardian AI (or angel) that is trying to plan and predict your future needs while optimizing (minimizing) waste. Maybe instead of artificial intelligence (AI), I’ll call it biological intelligence (BI).

When you measure, you think you’re looking at a reaction to what you did. Your body is way ahead of that… it’s looking at what you’ve done, what you’re likely to do next, what you did yesterday and a week ago around this time. It tracks your food intake (or not), nutrients, macros, enzymes, amino acids… it tracks your activity base needs and likely expenditures. It’s literally a massive parallel GPU supercomputer that is working to keep you conscious and alive and collecting massive data to make intelligent choices.

It’s why I can run at 33 blood glucose while fasting without crashing. My BI has figured out how to give me what I need and sometimes that means 9 blood ketones and sometimes it’s 0.5

And as soon as I’ve locked on to the pattern, it’s already learned more new stuff and adapted again… it’s just WOW

[Regina]

27% has got to be some kind of record, I’m sure

Yeah, I’m quite the talker! Today - pee strip positive, BK 0.8.

[amwassil]

I apologize for this being somewhat verbose, I wanted to summarize the past 3 days since my dental procedure apparently affected my ketosis similarly to alcohol (per @carolT linked below). In my case, though, the anesthesia appears to have take 48 hours to get removed completely, and then the better part of another 24 hours for my ketosis to return to normal again. If anyone else has had a similar experience please post in the other topic linked below. Thanks.

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)…
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.

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!

…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.

From here: Dentist local anesthetic affect on ketosis 🔎

Within an hour of completion of the dental procedure, my BrAce dropped lower than my normal range and stayed at the lower range for the next 48 hours - Jun 1 at 2 pm. It has gone up again to my normal range, but I had to give it some help by eating raw ginger last night before going to bed and eating some coconut oil today at work.

And as of this morning, BrAce appears to back to normal again.

Dentist local anesthetic affect on ketosis

If it was Lidocaine (most common) it could be an adrenal cortisol response to the epinepherine…

And the liver has to metabolize Lidocaine as a toxin, so that might give your ketones a hit much like alcohol.

I just tested urine again, Jun 02::2:30 pm and matched 1.5 mmol/L.

[amwassil]

To @Karim_Wassef @PaulL @Shortstuff @Screenack @ctviggen

Reminder that:

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.”

…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.

Also, not trying to determine why or why not, or whether there is any correlation to other ketones. Questions for another day.

[atomicspacebunny]

Beware of getting caught up in the numbers game. It is irrelevant how much of our ketone bodies get wasted in breath or urine, or how much are circulating in our blood, what is important is that our liver is producing them and organs that need them are using them (brain, especially). We tell people to expect reduced excretion of ketone bodies simply to stop them panicking unduly when the number drops, as it quite often does, with fat-adaptation.

Wanted to follow up on what Paul is saying, looking at the information cited below, would it not stand to reason that your going to be making more BHB from ketones and thus not really see them on a keto urine strip or on a ketone breathalyzer after three or four years of doing a ketogenic lifestyle; but only see very small trace amounts of ketones; if the liver (is not damaged?) is efficiently converting ketones into BHB; then you would be seeing very small trace amounts of ketones in the 0. something region or range with a ketone blood meter?

My spin on this is, if you have been doing the ketogenic lifestyle for many many years and your still seeing HIGH ketones on a breathalyzer, urine sticks or ketone blood meter when inactive and in a rested state then something might be WRONG?

Possibilities:

1. …your not really doing a ketogenic diet long-term in other words switching back and forth between low and high carb for extended periods of time?

2. …something your eating or taking is inhibiting your long-term ketogenic BHB conversion metabolism in the liver? (i.e. actual and realistic long-term ketogenic fat adaption)

3. …ketoacidosis?

4. …impaired hepatic function; damaged liver or liver disease?

5. …your fasting extensively EF?

Notes:

[1] ”…A healthy liver minimises the acetone lost via the lungs by converting most of the acetoacetate it produces to a more stable substance, called beta-hydroxybutyrate or BHB. And this is where those euphoric feelings could come from. …” Professor Andrew Brown, School of Biotechnology and Bio-molecular Sciences, UNSW

[2] “…Urine strips are generally useless because you can have higher amounts of acetoacetate in your urine because of dehydration or nitrogen overload as well but it doesn’t really tell you much about how well you’re using ketones for energy. …” …More

[3] The three main ketones your body makes from fatty acids are:

• Beta-hydroxybutyrate (BHB) . This is the most abundant, making up to 78% of total ketones in the blood[*].
• Acetoacetate (AcAc). It makes up around 20% of ketones in the blood.
• Acetone The least abundant, making about 2% of ketones in the blood. It’s not used for energy.

Both BHB and acetone are derived from acetoacetate(AcAc), however, BHB is the main ketone used for energy because it’s extremely stable and abundant, while acetone is lost through respiration and sweat.

Your body makes two types of BHB[*][*]:

• D-BHB: This is the one your cells use for efficient energy and its produced in high amounts. It’s responsible for the anti-aging effects of total BHB.
• L-BHB: This one is produced in lower quantities and can’t be used for energy as efficiently as D-BHB. It’s more helpful in the synthesis of fatty acids. …” …More

[jeanbar]

Here are my ketone levels taken Jun 1.

Time on keto - 1 year
Strips - Dark red between 80-160 range.
Blood - 3.9 mmol/L

Have been keto for a year and have tested positive for ketones the entire time. I test with the strips every morning and they are usually dark red. I tested my blood ketones frequently for a few months with averages in the mid 3s to 4s. Lows occasionally drop into the 2s and rise into the 5s. The lows correspond mostly with my ‘cheat’ days, but I have not noticed any changes over time.

I reached my current weight of 112 lbs (from 163) in Jan and have since stayed within a couple of lbs (more or less). My ketone levels in maintenance are measuring pretty much what they did during weight loss.

[Rusthallbint]

I’ve been keto for over 2 years - never not been in ketosis (tested by blood - usually between 1.5-3mmol). Tested urine out of curiosity recently and ketone in urine corresponds accurately with ketones in blood. I have no idea what’s going on??

[carolT]

4 posts were split to a new topic: Studies using ketone salts and esters

[marklifestyle]

I will test high during a longer fast. Once my BHB goes above 3.0mmol and BRace goes past 75 PPM I will definitely piss out ketones. I have maintained that this was an effective measure of showing how the body is preparing for the ultimate energy emergency by producing excess ketones BUT ridding the body of them quickly if the need for them was not apparent, thus preventing any type of ketoacidosis issue.

I have nothing but n=1 to back that up.

[amwassil]

I just tested urine again Jun03::1:30pm at 1.5 mmol/L. Same as yesterday’s reading at about this same time. I had previous taken a BrAce sample about 10 minutes earlier of 11.4 ppm. This is the day’s BrAce low point so far, falling slowly since the day’s peak at 05:25 of 21.8 ppm. I’ve spent the morning fairly inactively and the slowly falling BrAce concentrations are typical, although still within my normal 10-20 ppm range. I expect the concentration to rise during the afternoon and evening while I’m at work expending lots more energy. I will also be swishing a few spoonfuls of coconut oil.

[RedThain]

I don’t believe it because you get a zero reading on the pee strips it’s because one can get widely varying results from no color to purple and not really telling you anything that important. Mostly depending on hydration level. I can tel you the highest blood reading I got I’m the beginning was 1.8 and I no I was tracking all I ate and the pee strips barely turned any color the darkest of which was a light pink. My better half when she tried keto for 2 months had blood readings in the 2+ regularly. So the strips are just unreliable at best. The best thing to do is to track what you eat and as long as your under your carb threshold your in ketosis and burning fat. How well is up to you and your diet.

Also checkout the FASTER study by Volek. Many of the long term fat adapted athletes were showing blood
reading below the .5 range and still were burning the most fat.

[Janie]

First data point from me since I finally picked up some pee sticks.

20 hours fasted on a (hopefully) multi-day fast this week.

Pee stick - between Small and Moderate (15-40)

BG: 75
BK: 1.9

[amwassil]

A reminder to @RedThain and any others who either haven’t bothered to read the OP or have forgotten what we’re doing with this survey, allow me to reiterate:

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.

We are testing whether or not this specific claim is true. That’s all. We are NOT testing whether or not the urine test sticks are reliable and/or accurate. In addition, I’ve asked those who do blood tests and/or BrAce tests to do those tests in proximity to their urine tests and give us some additional data. This is possibly to note anything interesting that might warrant further examination. We are NOT testing whether or not urine test sticks give data that corresponds to data obtained by other test methods.

I think it is clear by the responses so far, that we have pretty much refuted the claim. Other issues introduced by various posters may become the bases of additional surveys and/or experiments. For one, I would like to know what factors cause some fat adapted individuals to dump acetoacetate and/or the other ketones in urine and others apparently not. For two, I would like to know what factors control the amount of ketones dumped in urine and/or why and how excess ketones are synthesized only to end up dumped. For three, I would like to know if excess ketone dumping actually does diminish over time, albeit far longer than anyone so far has reported. In other words, if the refuted claim actually IS true, but only after many years of fat adaptation.

[Janie]

Another data point:

Pee strips - solid Moderate 40
BK: 3.6

Fasted 32 hours when data was collected.

This is in line with what I’ve seen on previous fasts - ketones gradually rise over time and my blood and pee strips are rising this time also.

It makes sense to me - I am only consuming water and coffee so the energy to drive my body must come from my own fat stores. Burning that fat produces ketones as a side effect and it shows up on pee sticks and blood tests.

Why wouldn’t it? At least in a fasted state like I am now.

Since we are testing the theory of colorless pee sticks after fat-adaptation I would like a scientific explanation on how my body could be fueling itself from its own fat stores since I am consuming practically no calories, no carbs, no protein and no fat (for the purists who count macros in coffee) and NOT be spilling excess ketones into my urine.

According to the theory my body should be ONLY burning enough fat so than none are wasted in my urine and only show up in my blood? Or am I understanding the theory wrong?

[Janie]

I should add my background info to this data thread:

Been eating keto since Dec 2017, so 17 months. Lost 35 lbs and have maintained it for a year. Been fat-adapted since around 2 months. Fast anywhere from 36-100 hours on a regular basis. I am 60 years old and post-menopausal.

[Dennis]

Been doing LCHF off and on for about 16 years. Been pretty strict keto for the past 15 months, the last 9 of which, I’ve tested for BHB with Keto Mojo at least a few times per week. I have always shown color changes with the urine sticks, except when I knew that I wasn’t in ketosis. I know they’re not accurate, but for me they continue to give a reliable yes/no answer. Like many others have written here, the longer I’m fat adapted the less frequently I see high blood BHB levels like I used to.

[Janie]

I only get trace when I am eating normal keto but fasting multiple days is a whole nuther animal. 40 hours in and cruising today with little to no hunger.

[amwassil]

I only get trace when I am eating normal keto but fasting multiple days is a whole nuther animal. 40 hours in and cruising today with little to no hunger.

LOL. You’re like a child throwing food out the car window as the family cruises to the summer cottage! Your β-hydroxybutyrate looks like a big overflowing picnic basket. In other words: ketone abundance. My bet: if you had the means to measure it you’d have substantial BrAce as well (guess: 20-40 ppm).

[Janie]

Probably! I usually hit blood ketones between 6 and 7 by day 3 of fasting and BG in the 50-60’s.

It’s been a fun experiment - haven’t measured urine ketones in several months and not at all when fasting since I have a Keto Mojo. I never bought any more pee sticks when they ran out.

I picked up a box of 50 for $11 and next to it was a box of 100 on sale for $12. As tempting as it was… I passed on it because they would expire before I ever used them up. If I’d known a newbie starting keto I totally would have grabbed the box of 100 and given most away.

[carolT]

I only get trace when I am eating normal keto but fasting multiple days is a whole nuther animal.

I have similar experience but no data besides blood ketones. TMI: I can just smell the difference in urine and breath.