The keto “flu” is related to our salt intake. If you keep it up, there’s no symptoms of “flu.”
As for used vs. wasted ketones, here’s my take: when we initially embark on our ketogenic diet, our muscles are unused to metabolizing fat, so they have to make do with ketone bodies. Hence, the liver makes an excess, so that the muscles can have some energy. But the muscles prefer fatty acids, even to ketones, so when they eventually finish switching over to full fat metabolism, they refuse the ketones as well as the glucose in the blood, and so the liver can make a smaller amount of ketones. Hence there’s less need for a large amount of ketone bodies to be circulating in the blood.
That would be my guess, anyway. I wonder if there are any experimental data that would confirm this? (There’s an awful lot of stuff on PubMed to wade through; haven’t found anything yet.)
Also relevant to our ketone reading is how hydrated we are, at any given moment. Just remembered that.