Ketones too high?

(Bellsky) #1

I’m female, 70 years old. I’ve been on keto for a couple of months and my blood ketone levels are consistently over 5 mml. They’ve gone as high as 7. My blood glucose has been in the 90s. I’m recovering from chronic fatigue caused by Lyme disease, which apparently causes significant damage to the mitochondria. I’m wondering if I have an impaired ability to utilize ketones and whether I should attempt to lower them. I do feel better overall on keto, especially mentally, but I’m already at the low end of my weight range (5’8”, 118 pounds). Exercise is still difficult because I get exhausted easily. Any ideas?

(BuckRimfire) #2

5 mM is supposedly typical in starvation ketosis after not eating for the better part of a week. If you are getting that level while eating every day, you seem to be an overachiever in ketosis. I have no idea what to make of that.

Ketoacidosis is considered to begin at levels above 10 mM, so if you’re not approaching that level, I assume you’re safe. I am NOT a physician, just a dumb molecular biologist you met on the internet, so don’t take my opinion as valuable in any way!

Just to be clear: are you diabetic? What method are you using to test ketones?

It would be interesting to see your fasting insulin and insulin 30 minutes and two hours after a glucose challenge. I have no idea if your doctor can order those tests without you having to pay for them, but you could easily do them independently at Questhealth.com or something like that. Taking three insulin tests in one day would be $300 at Quest. I assume they will let you schedule three in a day, but I don’t know that for certain.

(Bellsky) #3

Thanks for your reply. I’m not diabetic, but I was pre diabetic a while back. I did keto back then and haven’t had a problem since. My last insulin test result was 6, but that was years ago. I’m sure my doc could order it again; not sure insurance will cover it. I suspect that my body is not utilizing the ketones properly. I’ve had moderate chronic fatigue for several years due to post treatment Lyme disease syndrome, which also caused gastrointestinal and neurological issues. Keto has really helped with everything except the gastrointestinal problems, so I don’t want to stop. Definitely I’m not in keto acidosis. I plan to expand my diet to include more fiber, if my gut will allow that.

(You've tried everything else; why not try bacon?) #4

Welcome to the forums!

And the answer to your question is no. Ketones are easier to digest, because they are already partially metabolised, so it requires less oxygen to digest them, and the levels you are showing are perfectly safe.

Now for the background, which you can skip, if you are not interested:

A diet too rich in carbohydrate can damage mitochondria, and it takes a while to restore them to health after embarking on a keto diet. However, once past that initial adaptation phase, which generally lasts six to eight weeks, we are fine. You, having been “on keto for a couple of months” are probably now out of the adaptation phase.

Diabetic ketoacidosis is a state in which serum glucose is very high, and serum β-hydroxybutyrate rises above 10 mmol/L. You do not meet those criteria, and the symptoms of ketoacidosis do not manifest themselves until serum β-hydroxybutyrate reaches at least 20 mmol/L.

There is also “euglycaemic ketoacidosis,” which is caused by taking certain specific drugs, or when pregnant or breast-feeding women on a ketogenic diet attempt to fast (the keto diet is fine; it’s the fasting that causes the potential problem, since women were not intended to fast while under such a heavy metabolic load). If you are pregnant or nursing (not likely, eh?), you can easily avoid euglycaemic ketoacidosis by not fasting; if you are taking one of the drugs that cause it, your doctor should have told you.

A factor in all this is how you are measuring ketones: urine sticks are notoriously unreliable for exact measurements, since they are designed to warn Type I diabetics that they might be entering ketoacidosis and should get to treatment before they have real problems. Breath meters are better, but they have their problems. The most reliable measure is serum β-hydroxybutyrate, especially as measured in the lab, since home meters have their limitations.

As far as the Lyme disease is concerned, a cousin of mine, a nurse, had a bad case of it and has done a lot of research. It turns out that Borrelia burgdorferi can encapsulate itself and lie dormant in the system for a long time. It can emerge later to wreak more havoc. My cousin takes nattokinase and serrapeptase, two enzymes that have been shown to break down the encapsulation and kill the bacterium.

Before I came down with Lyme disease myself, I already had chronic fatigue, and a keto diet went a long way to restoring me to normality. I, too, experienced a return of the fatigue, but it has slowly gone away over the subsequent years, though I still have lingering neuropathy in my fingers and toes. I switched to a carnivore diet during the active disease, because my sister, also a nurse, came across evidence that a carnivore diet can help with the neurological damage of the Lyme bacterium. Given my level of recovery, I have stayed carnivore since.

(KM) #5

How many calories are you typically ingesting per day? A significant calorie deficit / micronutrient deficit can leave you feeling more tired. While some people find they ironically struggle to lose weight when eating too little, others of us definitely see a drop in both weight and energy when we undereat. Can you boost your overall fat and protein consumption a bit, possibly with a bit of targeted nutrition supplementation, and see if that perks you up?

(Bob M) #6

5-7 mmol/l of blood ketones is pretty high. I think the highest I ever saw was 4.7 after fasting 4.5 days. But I also didn’t start testing ketones until I was around 3 years into the diet, back when the strips were $5 each, but less than $4/each if you went onto Ebay.

You might not be able to use ketones that efficiently right now, which is one guess I have. For people who are trying to address mental issues like depression, bipolar, etc., a lot of folks recommend higher ketones. But it is individual.

Exercise being hard and being near your lower weight range are more troubling. You could try something like adding smarties (or some other small amount of carbs) around exercise to see what happens. It might take a while to transition, and I’m assuming that since you have higher ketones, your body doesn’t use them as well as they could. For instance, I have low ketones (about 0.3mmol/l in the mornings, rarely get above 1.0 mmol/l), but I’ve exercised hundreds or thousands of times in the last 11+ years, and I think I’m highly efficient in using ketones now. I assume at some point, you’ll do the same.

For doing keto while being thin, many of us (including me) don’t have that problem. :wink: If there’s something you really like to eat that’s keto, maybe eat a lot of it. For instance, I stopped eating nuts and bacon, because I could eat so much of those. If there is something you feel you can eat while maintaining weight, that’s a good thing.

(Bellsky) #7

Thanks. I haven’t been tracking my calories, but I think they’ve been too low. My gut reacts badly to some foods and I’m often just not hungry. But I’ve been experimenting with reintroducing dairy and that seems to be helping. Starting keto, I think I was a bit militant about it but now I’m relaxing a bit and enjoying my food more. I’m going to start adding some fiber in slowly to see if my gut will tolerate it.

(Bellsky) #8

Thanks! I agree that I’m not utilizing ketones well, but I am doing better on keto than I was before. Compared to half a year ago, I’m doing great. I love how much calmer and more focused my brain is. Depression, anxiety and ADHD symptoms have faded tremendously.

It can take a long time to heal from Lyme and I guess I was hoping keto would be a magic bullet. But Lyme isn’t a metabolic disease, it’s an infection that can affect multiple systems. I’ve been able to reduce my bacterial load considerably and that has helped a lot. But I still need to be patient.

Funny you should mention finding something you really like to eat and sticking with it. Tonight my meal was salami (a French variety), Brie, tzatziki and a few slices of homegrown tomato. Best meal I’ve had in a long time! I could definitely stick with that. I’m going to try incorporating some fiber into my fat bombs slowly. My gut hasn’t tolerated fiber well. So this is definitely an N=1 experiment.

#9

It seems tracking just a typical day could be useful. If you eat too little, we have found a problem (I am an experienced enough programmer to know it’s the height of naivety to think we have found THE problem, more may be lurking!) and that may be the main one, not your inability to utilize ketones well.
It doesn’t matter if you are hungry or if you have an appetite, your body needs nutrients so you should eat. It’s good to find food you can eat much if that’s a problem for you. It may be food you really like or may be food you can’t get satiated easily but can eat a lot of. Best if these conditions meet.

We all get different things from keto (I got basically nothing except fat adaptation but I was already a long term low-carber and my original keto wasn’t ideal for me, it turned out). I don’t get much energy on any diet, there must be something else wrong, there are so many factors involved that (and I suspect it’s just genetics or something. I am a healthy type but much energy, I will never have. or not easily).

Why do you want to add fiber? Especially if your body seems not to like it? You must have some reason for it but I didn’t find it in this topic (I didn’t read every word but searched for fiber.)

(KM) #10

Just on the fiber thing, there are quite a few discussions here if you use the search feature. While some people cannot function without fiber, others seem to feel much better without it, and then again many of us don’t seem particularly sensitive one way or the other. It may not be a goal you need.

(You've tried everything else; why not try bacon?) #11

Good that you’re experimenting.

We have forum members who experienced opposite results. Some feel that they must have fibre to be okay, whereas others feel that fibre is deadly to their intestines. Most of us, of course, can take or leave fibre. Once you figure out where on the spectrum you are, you will know how best to proceed.

(I see @kib1 said essentially the same thing, lol!)

(Joey) #12

If you’re interested taking in a deeper dive into fiber…
Here’s Dr. Zoe Harcombe on “What About Fiber?”
A true classic. I’ve always enjoyed watching it again.

#13

Oh, thanks. I rarely watch nutrition videos as they are very often too long and somewhat boring (and I know what I really must already, of course more knowledge is nice) but I liked this one :smiley:
One can just eat plain fiber, by the way. Not alone, that’s not hedonistic but I use fibers in baking sometimes. Usually not as it dilutes the flavor but sometimes it’s no big deal. Once I made some flaxseed/psyllium husk (never get this word right for the first time, I mean psyllium but now I know that phyllium is a word too, it’s a genus of leaf insects!) buns and ate them all, that was one of my highest-fiber day in my life.
I am so glad my body doesn’t care about fiber intake. I probably got enough on vegetarian keto but on a meaty diet, it would be way too restrictive for my liking.