Ketones readings

#1

I tried going keto earlier this year (mid May) and reduced carbs to below 50 and sugar below 20, I was also asked to start metformin for pre-diabetes avoidance, my results came in at 6.4. With this adjustment I dropped from 286 to 284 within a week (usually happens when I reduce carbs and sugar) metformin hasn’t really done much as far as massive weight loss, even the glucose readings were in the usual ranges when I start eating better… I also had no side effects of metformin (1 in am 1 in pm, 500mg ER each).

Then, on June 23 I woke up and jumped into the keto 3 day fat/water fast. 130+ oz of water, approx 720 calories for the day where 90% are from fat, and approx 5g total carbs.

I like to take my readings first thing in the am, after using the restroom, before eating or drinking anything

Day 0 - was at 282 lbs, 98 glucose, keytone strips were defective but urine strips showed no ketones

Day 1 - 277 lbs, 98 glucose, no keytones

Day 2, 276, 82 glucose, keytones detected (skipped metformin for the day because I was low 80)

Day 3, 274, 90 glucose, ketomojo read .9 on Keytones and started adding back calories (mostly fat)

Day 4, 276.5, 90 glucose, ketomojo shows 1.2

Resumed keto eating since then - since starting my bf has dropped from 30% to 28.7%

Now for the obervarion In the AM, I’ve seen urine strips show moderate ketosis but ketomojo shows anywhere from 0.9 to 1.2. I’ve been traveling since the 5th so I’m likely not drinking enough water, and also consuming not enough calories, I am however keeping carbs to below 10, sugars more like less than 5g.

My ketomojo reading in the am is 0.6 - +2 hours after a meal it may be 0.9 or even 1. (On this trip) the only time I’ve seen it at 1.9 was during the first week right after the 4 day fasting…

  1. What are normal keto diet, fasting AM readings? I’ve read that it should be low?
  2. I was concerned that metformin isn’t working - but then I read that muscles will generate sugar on keto mode… I knew about the liver (which is what metformin stops) … is the muscles generating sugar a real thing? With almost no sugar I’m still reading 90 on fasting
  3. If I have a bulletproof coffee (30g coconut oil + 25g protein powder) at 9:30 (after a workout) - when should I take my next reading?
  4. How much time should I place between this and lunch?
  5. I try to end dinner by 4 or 5 pm, 6 at the last so that I can take advantage of IF
  6. Trying to get on some schedule so I can monitor my results… and stay in ketosis.

Thanks!

(Adam Foard) #2

I’ll try to give you my take on your questions by number. Full disclosure, I’m not T2D, so I don’t have a lot of experience with metormin and such.

  1. 0.5 to 3.0 is the typical nutritional ketosis range. For extended fasting this may go a little higher. If you’re over 0.5 keep calm and keto on.

  2. Muscles and the liver store glycogen, but muscles don’t release any glucose. That is 100% liver via gluconeogenesis. 90 is a good fasting blood glucose reading, your liver will make what you need. This sounds spot on to me.

  3. Protein and insulin have a complicated relationship. I have seen some data that says protein powders can be insulinogenic. If you’re a pro athlete protein powder might be good for your training. For us regular dudes just getting 1-1.5g/kg of lean body mass is more than enough. We will get the most benefit from the increased growth hormone secreted in keto/EF. Protein manufacturers are good at marketing to make everyone think they need their powder to lift weights.

Unless you’re monitoring your blood glucose for adjusting medications, checking once a day should be more than enough unless you’re doing some N=1 experimentation.

4-6. Eat when you’re hungry. If you’re traveling and have to plan meals; plan to eat when you would normally be hungry. You’ve done a 4 day fast so late/skipped meals really shouldn’t be an issue.

Late/skipped meals aren’t going to negatively affect your keto. If your getting around 70-100g of protein/day from real food (that’s about a 9oz/255g of steak) and fat to setiety you’ll be fine. Maybe get a multivitamin and extra salt. Otherwise just listen to your stomach (hard for me too).

#3

Thanks! T2D is an entirely diff ball game, I fall in the ever so growing “pre” T2D and the metformin is largely to “clinically” avoid becoming T2D… ofxoursd, diet and exercise can do the same but majority don’t and that’s where the medication does it’s work.

Water with electrolytes on a higher fat diet really helps stop any hunger/hangry issues - it becomes hard to get more than 1300 or so calories in…

Another bit I’m often wondering about is how much caloroes should I be consuming given that I’m at 28% bf. I’m comfortable with eating about 1500 calories, that’s 1000 less than the recommended calculation for weight loss on keto, based on current weight - so at 100g of protein, id focus on 100g-150g fat. (Which puts be back at 1500 ish) -

(Adam Foard) #4

Even the best models of the human metabolism are shots in the dark. They are mathematical approximations based on large data sets, and don’t really work for any given individual. Your metabolism adapts to your environment, and no model will capture all that.

We do know that eating keto, and having long periods of time without eating helps lower insulin which helps with blood sugar regulation and weight loss etc. Etc.

To increase metabolism we also know this:

  • If you eat more, your metabolism increases.
  • If you’re fat adapted, and you have enough body fat to support your daily expenditure (or you fat fast), your metabolism increases

I personally try to focus on the following:

  • eat enough protein, but not too much
  • avoid enough carbs to stay keto
  • eat until I’m full when I do eat
  • get regular long periods of not eating in my life

I try to have a feast/fast cycle and not worry about calories.

#5

I’ve never been diagnosed as pre-diabetic, so my numbers may not be applicable to you, but the concept would be the same for anyone. Tracking ketones is interesting, and somewhat useful for learning how your body works and identifying patterns. But ketones are idiosyncratic, and since they can’t be compared across individuals, there are no established standards/normal levels. Blood glucose yields much more actionable information.

When I started this journey 9 months ago, one of my goals was to reduce my insulin resistance. This is easily determined by measuring BG prior to a meal and 2 hours postprandial. The meal will raise BG, which triggers insulin release, which brings BG back down. People with a healthy metabolism will have a reading pretty close to their baseline within 2-3 hours of consuming a meal. Those of us with insulin resistance will have a BG that is still high many hours later.

Here’s what has worked for me. I use fasting extensively. I don’t track food intake, I track the impact food has on my body. On feeding days I eat whatever I want, but I don’t eat again until my body has “processed” it. I’ve defined this as having a morning BG < 85. Once above that threshold, I fast until BG < 70. The amount of time this takes varies from 1-2 days if it was LC up to 3-5 days if it was high carb.

I like data, so I track a lot of variables that I find interesting. But distilled down to its essence, all I really need is a glucometer.

(Vivienne Clampitt) #6

Interesting protocol, not one I have read about before. But it does make sense.
I like the idea of using blood glucose readings as a way of deciding whther to fast and how long to fast for. How long have you been following this protocol for?

Does anyone else do this?

#7

This protocol arose when I grew tired of block fasting that I dubbed One Meal A Week. Over 6 months, I lost a lot of weight but still didn’t have the insulin sensitivity I desired. I needed a new regime. It didn’t seem optimal to adhere to an arbitrary feed-fast cycle. Eating based on an individualized approach seemed more logical. I’ve been doing this for 3 or 4 months. I expect over time, as my insulin sensitivity improves, my fasting intervals will decrease.

I believe that @KCKeto is doing a similar protocol. Perhaps she will see this thread and chime in.

(Beth) #8

Hi… I also use this approach and it’s been much more effective for me, as well as much simpler.
I am a 49 year old female diagnosed in the last year with T2D and IR, and 35 pounds to lose. I started keto almost a year ago, and while I felt much better, my experience is that keto manages the symptoms well, but I didn’t see my T2D and IR reverse until I added fasting.
I read about @4dml’s OMAW approach in a thread here and it made sense to me, so I started in May. I’ve lost 23.5 pounds in 10 weeks and my BG and ketones stay pretty stable.
I started fasting 4 to 7 days before a refeed meal. To track I only use a scale, BG and ketone strips with a Precision Xtra monitor.
Now that I am about ten pounds from my goal weight, it’s harder to fast as long so I usually have a refeed meal at 48 to 96 hours. I don’t eat until my BG is 70 or below, like @4dml, AND only if I am hungry.
For example, I had a meal last night at 48 hours fasted and this morning my BG is 71, because I ate really low insulinogenic foods (bacon, pesto, tuna, mayo, walnuts, almonds), but I still feel full.
Even if I eat carbs at a refeed (chocolate and cherries a couple weeks ago) my BG only rises to 98 or 99, which is a big improvement from the 110 to 130 range.
This has greatly simplified my keto. I don’t track macros or portions or anything but BG, ketones and weight. I eat when BG is 70 or below AND I’m hungry. I eat whatever I want, but I almost always keep it to healthy, low insulinogenic keto foods. According to my weight tracking app I am still losing about two pounds a week.
@Zxed I had better results when I dropped to two meals a day (more time for insulin to drop between meals) but if it makes you too hungry you may have to wait until you are fully fat adapted. Give it time and keep reading everything you can get your hands on: this site, Dr. Jason Fung’s books (especially The Diabetes Code), etc. You will figure out what works for you.

(Adam Foard) #9

@KCKeto and @4dml How/From where did you develop your block fasting protocol? I tried a quick search and didn’t turn up anything on the forums. I’m not T2D or pre-D, but I have no doubt I have some level of IR. This protocol seems much more empirically driven than the blind fasting I’ve been doing for a few days every few weeks.

#10

A few years ago an odd trick a pcp told me on how to tell if someone was headed to pre-d/d was by looking at the skin under armpits/chest area, IR will show as darker skin there.

I also saw a formula (need to find it) that took glucose + keto numbers…

I should clarify - my issue is not getting hungry, it’s the opposite. After I have my bulletproof + protein, I can go without eating the whole day as long as I’m drinking water… i think I’ll try this for a week and for lunch I’ll have real food (steak, fish, chicken, etc). Hitting a total of 1300 for the day.

#11

I haven’t seen either protocol (OMAW or eating based on BG) anywhere online. I came up with on my own. And I am not a doctor, so YMMV.

(Adam Foard) #12

I think your protocol deserves its own thread, and maybe a Wiki…

(Beth) #13

I stumbled on one of @4dml’s posts in a thread and then searched all her posts to make sure I understood the approach. Adjust as necessary and the immediate feedback makes that possible and more effective. It’s been great to both simplify and speed up the process. I don’t understand why more people haven’t tried it.
The next phase will be adding muscle while maintaining. Maybe with more data it will merit it’s own something. If you try it, let us know your results!

#14

Here it is


GKI - glucose keytone index.

You can look at results to see what happens when GKI < 1. The method explains how it’s calculated. (Pretty simple)

(Glucose/18)/keytone

Getting to below 1 isn’t easy, it requires glucose to be in 70’s and keytone to be 4+… for humans maybe the range needs to be <5

Also - @KCKeto it wasn’t until day 4 of water/fat fasting where my glucose dropped to 78 reading… since family was traveling, it didn’t seem smart to keep taking metformin and not eating while they weren’t around.

Once I return from this trip, I’ll be back to daily 18 hour fasts with 1300 calorie target, specific feeding time and measuring time so I can update this thread with an answe.

#15

Here’s a less technical explanation of the GKI:
https://www.headsuphealth.com/blog/features/tracking-glucose-ketone-index/

The only time my GKI < 1 is during a block fast. If my experience is any indication, fasting BG will decline fairly quickly (within a few weeks) after establishing a fasting regime.

I try to maintain a GKI < 3 at least 20 days of the month. This allows me to eat with some degree of regularity but usually not more than 3 or 4 days in a row. Those who are metabolically healthy can have more frequent eating intervals. My dad can maintain a GKI = 3 eating a OMAD schedule.

Please do. We’d love to hear your experiences.

(Beth) #16

I have only tracked my GKI for the last 35 days. In that time it was below 1 for 27 days; it was between 1 and 2.2 the other 8 days. My goal right now is to keep it below 1 for at least 20 days out of the month for therapeutic reasons. I am the only person in my immediate family who has not been diagnosed with cancer or liver disease, and the only woman who has not been diagnosed with a reproductive cancer, so I am trying to reduce my risk.

(Vivienne Clampitt) #17

Interesting thread! I have only been Keto for just over 3 months now and find longer fasts difficult particularly on a weekly basis. This week doing alternate day fasting and at the moment doing well. But the past two times I have followed this protocol I have been so hungry afterwards I couldn’t manage a repeat for a few weeks.
That’s beside the point though, during the three months the only time my blood readings have come down significantly have been during those alternate day fasts or during a week of fairly strict Keto whilst on a cycling holiday and cycling in the region of 60-70 km a day ( my lowest readings for a long long time). So I have to fast or exercise every day, with Keto as my diet regime. I am considering giving your protocol a try . How did you decide what bs level was the point at which you ate?

(Vivienne Clampitt) #18

Why also a GKI less than 1 ? I understand the maths, but what dies GKI mean? What if the readings are higher than one?
Is there an article I can read up on on this topic? Thanks

#19

This is very interesting! I’ve seen you talk about this before but it makes more sense now for whatever reason. One question, when do you check your BG? Do you check it at routine times of day, or when you’re hungry and wondering if it’s time for a refeed?

I’m also wondering if as your IR has been resolving, have you had to shift these numbers downward in response to your BG range coming down? @KCKeto, would love to hear your experience with this as well.

(Beth) #20

If you scroll up in this thread, @4dml posted a link to an article from headsuphealth about GKI. It explains how different GKI numbers can help with different conditions. I am trying to keep mine at therapeutic levels to address cancer on the advice of my doctor. I am high risk.