Ketone Test Strips - Up then down

#1

It’s been a week. So far so good. I’m getting mentally used to eating so much fat and am also happy to be able to stop eating when satiated. I upped my electrolytes and survived the Keto Flu. I’m back to working out and am feeling good. Energy levels are good.

I bought ReliOn Ketone Test Strips (urinalysis) and was showing an increase in the presence of ketones for the first 4 days. Trace (5 mg/dl) to Small to Moderate (40 mg/dl). I am now moving back down to small/trace the last couple of days. I consistently test first thing in the morning every day so I don’t think it’s a change in hydration issue. Is it possible that I am getting fat adjusted already (!?!) and my body is just using the ketones instead is spilling them? I’ve kept my net carbs under 20g for a week, ranging from 11.5-15.2g. I measure all of my food so I’m confident in my carb counts. My fat counts have ranged pretty dramatically based on how hungry I happened to be on a specific day.

I guess I just need some reassurance that I’m not royally messing this up. Or maybe I am and need to be guided in the right direction.

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(You've tried everything else; why not try bacon?) #2

At only a week into the diet, it is not likely, though it is certainly a possibility. Keto-adaptation (fat-adaptation) generally takes six to eight weeks, but there are people who manage it in less time, and some for whom it takes longer. You may be one of the lucky ones.

It is true that the liver makes an abundance of ketone bodies at first, and then does a better job of matching production to demand, once the skeletal muscles become fat-adapted. Also, the kidneys independently get better at filtering ketone bodies out of the urine and back into the blood stream.

What is considered the most accurate measure of ketone production is serum β-hydroxybutyrate (one of the three ketone bodies produced in the liver), which technically should be above 0.5 mmol/dL for nutritional ketosis.

The test strips were designed to give Type I diabetics an early warning that they might not be handling their insulin correctly and are therefore at risk for diabetic ketoacidosis. For that purpose, they don’t need to be all that accurate, just accurate enough to show that ketones are being spilled into the urine at a rate that is of concern. (If you are becoming ketoacidotic, you want enough warning to get to the hospital before symptoms become manifest. And if your pancreas is producing any insulin at all, then diabetic ketoacidosis is not a concern.)

But no home measurement device is all that accurate. One of the best tests for ketosis I have read about was posted by a wag on these forums: You know you are in ketosis when (1) you are eating less than 20 g of carbohydrate a day, and (2) you are still breathing in and out.

Lastly, if you are eating a ketogenic diet for the sake of fat loss, no one has ever demonstrated a correlation between ketone levels and rate of fat loss. If you are eating a ketogenic diet for metabolic health, it is possible for that to improve without high levels of ketones. If you want a high ketone level for the sake of brain cognition or some other brain problem, then it might be worthwhile to take a ketone ester supplement.

P.S.—For any newcomer reading this thread, it is easy to avoid the keto “flu” by slightly increasing salt intake and drinking to thirst. A cup or two of bone broth a day will prevent the keto “flu.”

#3

Thank you, @PaulL for all of the info!

I am, indeed, starting keto for fat loss (and intend to continue the lifestyle for all of the other benefits) so I’m relieved to read this. I was worried that I was falling out of ketosis before I was even fully there.

#4

This should probably be on page 1 of the many “how to do keto” websites and blogs.

#5

While I 100% agree with this, Paul, there’s a critical piece missing which I think is the primary source of people’s questions and anxiety on this topic, and that’s the time factor… “You know you are in ketosis when (1) you have been eating fewer than 20g of carbohydrate a day for ____ days, and (2) you are still breathing in and out.”

I’m not sure there’s a good answer to the blank above, since the answer varies widely and is very much N=1, but I think the missing time element is what gets people tripped up - i.e., how long must I have been eating this way to “be in ketosis.”

(Bob M) #6

If you want the “most accurate” ketone monitor, it’s likely blood ketones. But I use “most accurate” with some caution, as they really aren’t that accurate, and are hard to use to test anything. But they tend to have fewer poor readings than do urine versions, which are highly susceptible to things like how much water you’re drinking.

(You've tried everything else; why not try bacon?) #7

. . . for 36-48 hours . . . (approximately)

It doesn’t take long for us to deplete our stores of glucose and glycogen, thus triggering a low insulin to glucagon ratio, and ketogenesis and gluconeogenesis in the liver.

Fat-adaptation takes much longer in most people.

(Joey) #8

I recall reading that we have about 1 teaspoon of glucose circulating in our bloodstream. That’s enough to power us (primarily our brain/heart) for around 4 hours or so. If this is correct, your body starts producing glucose via gluconeogenesis pretty quickly … certainly while you are asleep, with a “dawn effect” surge to help energize you enough to wake up and hunt for coffee. :wink:

“Ketosis” - on some level - is happening nearly all the time (except perhaps immediately after ingesting a lot of sugar/carbs due to insulin spike which suppresses this process).

If you’re not feeling hungry/hangry after a day without eating carbs you are certainly in ketosis… how adapted your mitochondria have become to maximally utilizing ketones for production of energy is what takes weeks.

Everyone: Please correct me if I’m wrong.

Pee strips are primarily for peeing on. If that’s enjoyable, go for it. Newspaper is still cheaper.

#9

:skull_and_crossbones::skull_and_crossbones::skull_and_crossbones:
Ok. You made my day.

#10

Exactly! Our livers don’t hold much at all, I never understood why people think it takes so long to deplete it, and the muscles don’t give thiers back and don’t count against you until you use it up. Especially the people who can’t go from breakfast to lunch without the hangry setting in, pretty good gauge there.

#11

I bought some pee sticks out of curiosity simply because they were the cheapest method possible to measure. At the time I wasn’t sure if I was going to go full keto or just a moderate LCHF but I thought it might be interesting to measure levels either way.

They showed me hovering around the 4 or 5 mmol/L after the first week into the second, bar one day where they read 8. After that, it was 1.5 or lower.

I don’t care to measure any more because I know all is well regardless. Still watching my intake of everything, feeling great and doing well :slight_smile:

(You've tried everything else; why not try bacon?) #12

Or alternatively, when one is highly insulin-resistant, in which case the elevated insulin resulting from anything more than a strictly limited amount of carbohydrate is likely to be enough to inhibit ketosis and gluconeogenesis, and to last longer than the insulin response to the same amount of carbohydrate in an insulin-sensitive person.

Bingo! You took the words right out of my mouth!

(You've tried everything else; why not try bacon?) #13

I’d be interested to know what the difference is, in terms of ketone levels. In my book, any diet low enough in carbohydrate to get someone into ketosis is a ketogenic diet—for that person, at least—regardless of the actual amount of carbohydrate, and even if it’s above the 20 g/day we recommend here.

One’s actual carbohydrate threshold depends on one’s degree of insulin resistance, or so I understand. Gary Taubes cites a paper by Ralph DeFronzo et al., in which they measured the threshold level of insulin at just under 25 μU/mL. The more insulin-sensitive one is, the more carbohydrate one can eat before driving insulin above the threshold and us into fat-storing mode; the more insulin-resistant, the lower the carbohydrate limit required to keep insulin below the threshold and us in ketosis.

#14

Indeed. I’ve no idea where I started out in terms of insulin. Never been one for sugary foods or much in the way of overly processed crap, but I did eat a lot of bread (home baked) and drank like a fish.

But it’s honestly near impossible to make me go to the docs when there’s something horribly wrong with me, so getting a bunch of tests ‘just to see’ is about as likely as pigs flying.

Shame really, it would be genuinely interesting to see where I started and where I’ll end up. But that’s me; a stubborn fool.