Not understanding my very low ketone ratings

(Dave) #1

Heya, I’m really hoping someone might be able to help with my ketone blood ratings which I’m quite concerned about. To start off I’ve been eating keto for over 12 months and know the diet well. It was never for weight loss but for all the benefits that come from the nutritional ketosis range (generally 1.5-3 reading). I’ve used ketostix before and they have always come back as a dark reading. I know how inaccurate they can be though and have not used one for maybe 3 months now.

I finally bought a Freestyle blood ketone monitor and was mortified to see how low they were. Here in Australia the strips are very cheap compared to USA so the cost is nothing for me to worry about.

This week I’ve been paying extra attention to diet and have been averaging at 120g protein / 220g fat / 30g carbs per day. I remember I was having around 40g carbs per day when getting dark ketostix ratings. One month ago I started intermittent fasting and now only eat 3 meals between 1pm-9pm if this might have any affect?

Here is a run down of my most recent results:

YESTERDAY
7am - Wake up - Ketone 0.1
1pm - After 16 hour fast - Glucose 76 Ketone 0.6
3pm - 2 hours after 1st meal - Glucose 76 Ketone 0.3
5pm - 20 minutes post heavy weights - Glucose 70 Ketone 0.3
10pm - 1 hour after last meal - Glucose 88 Ketone 0.5

TODAY
1pm - After 16 hour fast - Glucose 76 Ketone 0.4 (just tested now)

Does anyone know why my readings could be so low? From yesterday, I can’t understand how it could be 0.1 lower after not eating for 16 hours.

Any help would be amazing! :slight_smile:

Low Blood Ketones despite strict keto
#2
  1. Ketone levels in the morning tend to be lower due to cortisol/dawn phenomenon.
  2. Ketone levels after eating or exercising tend to be lower.
  3. Assuming you’re fat-adapted after having been keto for 12 months, the consensus and science is that your ketone levels are lower because (a) your body is more efficient at making them (i.e., not too many or more than necessary); and (b) your body is more efficient at using them, so there’s less free ketones in your blood.

Translation: as long as you’re keeping your carbs low enough (into ketogenic levels), I wouldn’t worry about it and would KCKO.

Here’s a thread that you may find helpful. Specifically, see @richard’s experiences with his ranges.

(Dave) #3

Thanks so much and this was helpful. Knowing my ratios and that I am also quite athletic, I would be fat adapted and that would explain a lot.

If we take a look at graphs for example on https://ketosummit.com/optimal-ketone-levels-for-ketogenic-diet which suggests

Weight Loss - above 0.5
Improved Athletic Performance - above 0.5
Improved Mental Performance - 1.5.-5
Therapeutic - 3-6

So does becoming fat adapted and now having lower ketones essentially mean we are no longer able to gain these benefits from having a higher reading? (eg mental performance, if we are to believe its in the 1.5-3 range)

(Sjur Gjøstein Karevoll) #4

You don’t get the benefits of ketones from how much is in your blood, but from how much you’re using. Those levels you cited are also not particularly scientific, they’re more just ballpark numbers. If you want to improve some specific aspect of your life then measure that aspect. If it’s mental performance then find a way to measure that. Don’t worry about ketone levels just because someone said there’s a correlation.

The ketogenic diets that have become popular and that almost all of us follow also aren’t guaranteed to get everyone into ketosis, certainly not all the time. Diets that guarantee you get into deep ketosis all the time are incredibly restrictive and therefore hard to follow and with great potential for deficiency. They are only advisable for people who have some life-affecting condition that requires them to be in deep ketosis all the time, like epilepsy.

#5

its extremely disingenuous to suggest they are “only advisable for life affecting conditions”. many people choose to be in deep ketosis for health and lifestyle reasons. there are no demonstrated downsides as long as its a well formulated ketogenic diet.

(Sjur Gjøstein Karevoll) #6

The well formulated ketogenic diets, modified ketogenic diet, modified Atkins, whatever you want to call them, don’t guarantee you stay in deep ketosis to the degree that a classic ketogenic diet does, and the classic ketogenic diets have been scientifically proven to have some downsides.

Look at for example the 4:1 diet, which is 4g fast for every 1g carbs and protein combined. At a daily intake of 2000kcal this would mean 200g fat and only 50g carbs and protein combined, which even if you eat zero carbs would be on the extreme low end of protein for a sustainable diet. This extreme macronutrient ratio also makes the diet very restrictive and unpalatable.

This isn’t saying you can’t eat a well formulated ketogenic diet and stay in ketosis all the time, just that it’s a little less reliable, and you’re not going to be quite as deep as the extreme diet. For most people they’re not going to have any benefit from those extra ketones anyway.

(Dave) #7

If anyone is interested I decided to do a 3 day fast just to see how high my ketones would go… turns out not high at all haha

24 Hrs - Glucose 3.9 Ketones 0.9
48 Hrs - Glucose 3.9 Ketones 1.6
72 Hrs - Glucose 3.5 Ketones 2.3

(Justin Durgin) #8

Hello. I’ve recently been dealing with something similar. My blood Ketone meter has been giving me readings as low as .2 mmol/L. The highest I’ve been able to get in the last week is .4. I’ve been ketogenic for 5 months, with only one or two days with carbs over a hundred grams. For the most part less than 30, and those mostly incidental from nuts and eggs. I work out every morning from 4 a.m. to 6 a.m., running and lifting, so I am thinking that my increased activity and exercise make my body extremely efficient at using the ketones? I’m not really sure. I wanted to test it, so I purchased some exogenous ketones. I have tried taking them pre work out in the morning, and tested my ketones after a workout. I have attempted post-workout, at midday, before/after dinner, and test an hour and two hours later, just to see if I can flood my body with ketones and get a really high reading. No dice. The highest I’ve gotten is .4. the only thing I can think of is that my body uses ketones extremely well, and when they are available I do not waste them. There is nothing in my diet that would cause me to fall out of ketosis. And aside from Bulletproof Coffee at 3:30 in the morning, I typically only eat once a day at around 6 p.m. So I fast generally 22 or so hours a day I’ve been trying to find some information on the forums about this, but I have yet to find and extremely well-trained person comment on having very low Ketone levels, aside from what I’ve read on this post of course.

#9

more info than you probably want but it has value if you can get through it

(keep in mind they are “selling” the idea that you can super micro manage nutrients to make it “optimal”)

(Corie Ridgway) #10

I’m in the exact same boat. Trying to figure it out. I’ve been testing my blood ketone levels n it’s all i can do to get to 0.4. If i work out, even just walking for an hour, its taking me completely out of ketosis. Is it possible my body produces too much cortisol?? Or that my intermittent fasting is causing my body to stress? I don’t feel like that, but cortisol is the only thing I’ve been able to find that might be the culprit. I was at high ketone levels since starting keto in late March, early April, until i had an allergic reaction and broke out in hives. Doctor put me on prednisone for a month… which i know would have raised my cortisol. Ive been off the steroids for over a month, still haven’t been able to get back into ketosis, over a 0.2 or 0.4. Not sure how long the steroids would affect me.

(Roy D Rushing Jr ) #11

My blood ketone levels do a similar thing. They start out at around 0.2 mmol/l, peak between 12:00-1:00PM at around 1.0 mmol/l, and then inexplicably begin to fall back down to 0.3-0.4 mmol/l in the afternoon. I fast until dinner every day, so that pattern has always confused me. I would expect that my ketone levels would rise as I got farther and farther away from my last meal, but instead they describe a daily arc. I might consider changing my diet to see if that does anything, but the peak levels are pretty decent, so I’m thinking that there probably isn’t anything wrong there. Still, I like it when things make sense, and while I have the dawn effect to explain my morning ketone levels, I can’t figure out what to make of the afternoon decline. Oh well, I’m eating everything I want and I’m not gaining any weight, so I’m not complaining.

(Marty Kendall) #12

People following a ‘ketogenic diet’ for long tern to see lower BHB levels as they lose weight and their metabolic health improves. This chart is from the Virta study after one year. Ketones initially jumped from 0.17 to 0.54 and then dropped to 0.27 after a year and then 0.27 mmol/L after two years.

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Prerelease Virta 2 year paper is here if you’re interested:

Ketone values on the Nutrient Optimiser Challenge rose temporarily but then reduced as people continued to lose weight.

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Unless you keep adding more dietary fat, it seems that people on a low carb diet with better blood sugar control tend to have lower blood ketones.

(chiria) #13

Hi,

hope this reference is still relevant. I’m experiencing the same issue with @ketoaussie, low blood ketone (around 0.6-0.8). I measure my ketone level 4 hours after I wake up every morning.

Based on the article, it is stated that though the ketone level is low, the athletes still stay in ketosis. I wonder how to know whether or not our body still in ketosis if it is not indicated by the ketone level?

Would love to get some clarity on this, thank you.

(Gregory - You can teach an old dog new tricks.) #14

At the risk of over-simplifying, if you are not getting sufficient carbohydrates to meet your energy needs, you will be in metabolic ketosis .

(Bacon is a many-splendoured thing) #15

Some thoughts you may find comforting:

First of all, 0.6-0.8 is within the range of nutritional ketosis, as defined by Dr. Phinney and Prof. Volek. I’m not clear why you are concerned. A level of 1.0 might be better, possibly, but anything higher than 1.0 won’t confer any benefit that 1.0 won’t confer.

Second, circulating ketones (acetoacetate, acetone, and β-hydroxybutyrate) are the gap between the amount produced by the liver and the amount consumed by the cells. We don’t have an easy way to measure these, so circulating ketones are the stand-in.

Third, the blood metre measures only β-hydroxybutyrate, but not acetoacetate or acetone, which are also used by the body. (For some reason, while all three ketone bodies are found in the blood, the breath, and the urine, we customarily measure only β-hydroxybutyrate in the blood, only acetone in the breath, and only acetoacetate in the urine. When you think about it, this means that are measurements aren’t actually complete.)

Fourth, there is an inherent margin of error in home measurement devices. It can be as large as ±20%. (You’d have to read your metre’s instruction manual to find out what its margin of error is.)

And lastly, what @OldDog said. There is a simple way to determine if you are in ketosis: (a) you are not eating carbohydrate, and (b) you are still breathing in and out.

(Bob M) #16

I rarely agree with Mr. Kendall, but I can agree with him here.

Agree also with everything in @PaulL’s last post.

And if you think 0.6-0.8 is low, I’ll show you low. These are from my home Keto Mojo (right of time) and my work Keto Mojo (right most column):

image
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That’s after 6 years of low carb/keto. I can only get to 0.6-0.8 in the morning if I fast multiple days; sometimes, if I eat a ton of fat the day before, but not always.

(Roberta) #17

“You don’t get the benefits of ketones from how much is in your blood, but from how much you’re using”. I find this statement very interesting and something I have never heard before. Would you have more information…perhaps an article you can direct me to that expands on this? I would love to read more about this. TIA :slight_smile:

(Bacon is a many-splendoured thing) #18

I am guilty of phrasing things that way, and the statement is true, from the point of view of using ketones as fuel for the body. The liver makes ketone bodies (ketogenesis) for the use of cells as an alternative to metabolising glucose. Those organs that can benefit from ketones (particularly the heart muscle and the brain) do so. But there is no direct measurement of ketogenesis or ketolysis that I know of, so we are reduced to measuring what is circulating in the bloodstream. It stands to reason that the liver will produce more ketones than are actually needed, so that we are not caught short, and therefore what is circulating in the blood is that “excess.”

However, there are uses for ketone bodies other than simply metabolising them. Professor Eric Verdin and his team have published several papers in recent years that demonstrate how ketone bodies are also powerful hormones that affect various genes. We hear the most about the principal ketone body, β-hydroxybutyrate, but this signaling role is apparently also played by the other two ketones, acetoacetate and acetone. But I don’t think it has yet been shown how much of the three ketone bodies needs to be circulating in the blood for us to see these signaling benefits.