POLL! Plus an attempt so explain a few things about ketosis

#1

How do you view ketone levels: good, bad, or indifferent?

  • Don’t care as long as I’m losing fat.
  • Higher than minimal ketone levels make me feel better.
  • Minimal ketosis is optimal, extra ketones are a bad sign.
  • I stress out over getting a good level and don’t know what it should be.

0 voters

And now a few things I’ve been meaning to post about in some type of logical stream of thought… Protein, glucose, ketones and insulin: context matters.

First, a couple of graphs from Ketofest. The first one is from a presentation by Dr. Phinney, who is the source of the phrase “nutritional ketosis” set at a threshold of 0.5 mmol. He is also involved in Virta Health, which treats diabetics using a ketogenic diet. So, what level are these patients maintaining to get the benfits of the program?

HALLBERG - VIRTA DATA

20190724_075439
20190724_075439.jpg774×689 118 KB

Not very high, right? Incredible health and weight loss benefits associated with minimal ketone levels. No need to chase ketones unless you find additional subjective benefits at higher levels. The amount of protein they are eating is based on these recommendations: https://blog.virtahealth.com/how-much-protein-on-keto/

This is where context becomes important. From Richard’s Ketofest '19 presentation we have a comparison of insulin release in response to protein and/or glucose in T2D subjects vs. healthy ones.

HEALTHY:

Screenshot_2019-07-21-12-21-05
Screenshot_2019-07-21-12-21-05.png895×796 238 KB

T2 DIABETICS
Screenshot_2019-07-21-12-25-21-1
Screenshot_2019-07-21-12-25-21-1.jpg1221×836 200 KB

Note: we typically hear that protein requires approximately 1/2 of the insulin of glucose. This is a rule of thumb from studying T1D where they look at how much insulin is needed to “cover” the increase in glucose due to protein. (A minute here for us to ponder why they are producing glucose in reponse to food without insulin to start the ball rolling. :thinking:) What it does not tell us is how much insulin an individual with functional beta cells in their pancreas produces in response to protein.
Now, you might be thinking “Hey, that’s not in the context of ketosis!” and you’d be correct. So let’s assume an Ideal Bikman Ratio of 1:3, where insulin and glucagon remain at a constant ratio in ketogenic subjects. If you’re not familiar with this context, see Dr. Bikman https://youtu.be/z3fO5aTD6JU and Amber O’Hearn http://www.ketotic.org/2012/08/if-you-eat-excess-protein-does-it-turn.html.

So healthy ketogenic subjects have no issues maintaining constant, or near-constant, blood glucose levels by eating protein without carbs. That doesn’t mean glucose isn’t produced, just that there is a balance between insulin and glucagon to keep blood glucose steady. They don’t simply neutralize each other. (There is a hormone that neutralizes both insulin and glucagon, called somatostatin, but I’m not going that deep down the rabbit hole.) Physiologically, insulin levels are the dominant force on whether or not free fatty acids (FFA) are released from healthy adipose tissue. If you have insulin resistance, some percentage of your fat cells are leaking FFA and do not respond to insulin, thus diminishing its effect there. T1D have no control over FFA levels without injecting insulin, and produce excess glucose and ketones because of it, even when fasting.
Glucagon, on the other hand, is the primary signal to your liver to produce more glucose by whatever means are available to it, thus keeping blood glucose from going too low in the presence of increased insulin. It doesn’t have the ability to overcome the effect of insulin on adipocytes at physiological levels. T2D are likely to have an impaired level of glucagon. Much like insulin, this can be hyperglucagonemia (too much glucose production) or glucagon resistance (too little glucose production).

Let’s look at what one person’s disturbed I:G ratio looks like from Dave Feldman’s n=many research: https://youtu.be/Z8TtApNYQfE?list=WL&t=465

CHART3
IGhigh

I’ll do the math for you… that’s a ratio bordering on 1:4 along with a high amount of basal glucagon and insulin. This is a fasted test. What happens when that person eats protein? I’d love to see some data, as far as I know there isn’t any in that context.

Focus on the big picture
When I check my ketones via blood test, it only reads low
(Tom Seest) #2

Excellent write up…

(Central Florida Bob ) #3

As usual, what I really think is somewhere between the answers listed, but I went for as close an answer as I could.

#4

Yeah, I can’t think of all the possible answers but you can vote for more than one option. And it’s anonymous.

Feel free to elaborate if you like… but I want to know context. :wink:

(Central Florida Bob ) #5

Well, the third answer. “Minimal Ketosis is optimal, extra ketones are a bad sign” is what I answered, but I’m agreeing with the first half.

I don’t think higher ketones are a bad sign. I know there’s a school of thought that says if we were using them efficiently we’d be burning them off as they’re produced and ketones would never climb, but I don’t think humans get 100% efficient. Too much variability. Look at how many people are saying they still secrete urinary ketones despite the “common wisdom” that people stop doing that after several months.

It seems to me that Phinney’s and Virta’s work shows that levels don’t seem to matter above some relatively low threshold. I think I’ve heard Dr. Phinney say he used to define nutritional ketosis as 0.5 mmol/L but now he thinks it could be somewhat lower. By that chart it looks like 0.4 is good number and it might conceivably be lower. (And we could be seeing some of that trend to producing lower blood ketones the longer someone has been adapted to being in ketosis).

If someone says they feel better with higher ketones, I can’t dispute that, I just never noticed it in myself.

#6

I suspect the feeling better mentally and/or emotionally is a reaction to correcting a problem with glucose metabolism in the brain. As insulin resistance is linked to Alzheimer’s, this makes total sense given my age and family history. But there’s also an effect of eliminating foods without regard to level of ketosis. Carnivore gives us great examples of that.

(Central Florida Bob ) #7

I could also see it being placebo effect. We think ketones should be higher and feel “I done good” when we see it. I see that in myself sometimes. Sure, there are ways to minimize that, but it’s up to the individual.

#8

True. It’s better to maybe start with how you feel, then check levels. I know if mine go up above 2.5 or so, I can get a little too hyper or euphoric. I also feel like total :poop: if I eat something with sneaky carbs, like at a restaurant. And different proteins make me feel different, though I think some of that is a result of amino acids that alter neurotransmitters directly. I’m especially sensitive to typtophan and taurine and wanting to sleep afterwards.

(less is more, more or less) #9

Thanks, @carolT for this thoughtful post.

Compared with many members here, I’ve been most cavalier about my ketone levels as well as the commonly suggested targets for protein maximum daily consumption, since that has been the signal from Dr. Westman to me to follow, and it’s worked well for me. I’d guess my moderate-to-high activity level (for a first-world citizen) has me consuming my ketones and leaving few free-floaters to measure if I understand this correctly.

(Scott) #10

Should have added a category “I have never measured for Ketones and don’t feel guilty about it”

(KCKO, KCFO) #11

Thanks for this posting Carol.

I really agree with the first part of the option I chose, I don’t think higher ketones are bad, it just shows you made more than you needed recently. As long as I get .4/.5 or higher, I am a very happy camper. I have even fallen out of ketosis from time to time, but I seem to get back to it fairly easily, like a nice big plate of bacon and eggs will usually take care of it. And I often feel full of energy just at .4mml/l.

What is interesting to me if according to my breathalyzer, I rarely got over 1.0 mml/l while losing my weight. While fasting I would sit around .6/.7, otherwise I was usually around .5 pretty consistently. I lost 45 lbs. in 10 months, not fast but I am female, 68 that year, postmenopausal, had never lost that much so consistently per month before, and I had NEVER tried fasting either. And I keep it off, I stay in the lower range except for extended fasting days. Works for me.

(Bob M) #12

I also think you have to factor in time in ketosis. When I first started testing about 4 years ago, I could get quite high ketones on my Precision Xtra. Now, 4 years later, the only time I get anywhere near those levels is if I fast multiple days. That first graph, for instance, could show multiple things, such as a slightly higher carb content or the body getting used to ketosis and therefore you read less.

The other issue is that if you’ve been in or near ketosis for 5.5+ years, like me, it’s hard to tell if higher ketones make you feel better, especially when you no longer generate them.

I’ve personally gone from testing everything all the time to testing never. I like to test when the tests provide some quantifiable result, but every time I try to test say higher fat (or higher protein) on ketones, I might get a result one day/time indicating they go up (or down), but then another day/time, they do the opposite. So, I don’t test anymore and just keep my carbs low, eat a lot of meat-only (typically higher protein) meals, etc.

Even though I’m technically “overweight” (no longer “obese”!), I think I’m in the metabolically healthy area. I’ve eaten massive amounts of protein per single meals and my CGM (when I had one) never showed a blood sugar rise that I could see.

(Cristian Lopez) #13

I talked about this in a another topic, Glucagon would go down and insulin would conversely go up.

(Michael - When reality fails to meet expectations, the problem is not reality.) #14

The only option that comes close is “Don’t care as long as I’m losing fat”. But I’m not and do not want to, so I didn’t vote. I think another option might be: Don’t care as long as I’m burning fat. I would check that one.

Anyhow, this is fairly long, but very pertinent:

#15

In the ketogenic context, the insulin - glucagon ratio should remain the same, at least that’s the current hypothesis as proposed by Dr. Bikman in the video linked above. Anything that tips that ratio one way or the other would change blood glucose levels. Now, if you add some carbs to the protein, then we mofht see all kinds of interesting net reactions.

P.S.
I don’t think there’s a right or a wrong answer, more like it’s another thing where individual reactions come into play.

#16

Yes, I missed a lot of options. I should have also included ‘don’t care, fixed my metabolism/disease’ but I couldn’t add more options after ther first 5 minutes.

(Susan) #17

I chose the first option, because I just follow the rules but I have nothing I keep track with, so no idea what mine are. I know I am obeying all the Keto rules and losing weight, and fasting a lot, and do 20:4 IF daily, and don’t cheat, so all good.

#18

Interesting metric to gauge by - until we get that home RER meter. :wink:

But, I’m not so sure “excess energy” is a great way to make the point. Do we care about excess LDL to traffic fat? Excess glucose in the context of PIR? Ketones are an indicator of ketosis, yes. I mean, that’s kind of the definition of ketosis. But they’re more than just a coincidental byproduct - they’re a signalling molecule and an energy substrate, much like amino acids. Except ketones can be stored for quick ATP energy demand needs instead of having to be broken down and converted first.

#19

I have noticed a direct correlation to weight gain and ketone levels. After 15 months, when my blood glucose is low, my blood ketones are high and my weight is stable or goes down. When the ketones drop, my weight immediately starts to go up. It does not appear that the amount I am able to measure has decreased due to my length of time on keto.

Maybe I started too late (66) and my insulin resistance is just too ingrained, but when I let my guard down, the weight finds me. This is why I feel better when they are higher than minimal levels.

(Michael - When reality fails to meet expectations, the problem is not reality.) #20

I think maybe the ‘excess energy’ issue is simply that fuel, any fuel, in sufficient quantities over sufficient time is corrosive and toxic. One of the regulating functions of insulin is to get unused fuel out of the blood and prevent stored fuel getting in.