Spilling ketones

(Chelsey) #1

This is my 13th day on the ketogenic diet. I bought ketone test strips to test my urine. I’ve been testing a few times a day and been in the low range. This morning I’ve tested twice and it says “Large” and correlates with the “8 mmol/L” color on the test strips. I’ve been “high fat, moderate whole foods carbs” for months, if not longer. I’m not diabetic but have a glucometer to test for blood sugar spikes to know what foods to avoid. My blood sugars have been 60-90s consistently. Is there any concern about spilling too many ketones? Educate me please!!

Keto sticks as indication for when to start fasting?
Ketone Test Strips
#2

Just due to the nature of the presence of the 3 different versions of circulating ketones, some will always spill over to the urine. how detectable they are will depend on your hydration level more than anything else. So no there is no concern, which is good because you can’t do anything about it anyway. If you are producing ketones, some will show up in the urine:period. if you are hyper hydrated you won’t see many, if you are dehydrated you will see dark purple. Exercise tends to reduce the amount of ketones in the urine, in my experience. There is a falsehood that circulates that your body “learns” to use ketones more effectively thus “spilling less” into the urine but that’s not technically correct. Although the use of ketones by different tissues can be up regulated (made more efficient depending on demand) there will always be some in the urine if you are producing them at all.

(ketohealthclub) #3

I’d love to read the data explaining that. Do you have any links? I’ve definitely read the opposite: that over time your body wastes fewer ketones, which renders the ketostix pretty useless after a few weeks.

(Guardian of the bacon) #4

The only risk of producing too many ketones is if you are a Type 1 diabetic producing NO insulin.
Insulin acts as a braking mechanism keeping ketones in check.

#5

your body never “wastes” any source of energy. as a byproduct of fat metabolism, when levels rise in the blood stream tissues that can readily accept ketones for fuel (mostly the brain and heart0 will be up regulated to burn them. skeletal muscle prefers fatty acids to ketones (technically, although they are biochemically interchangeable at one point).

2 of the 3 types of Ketones (acetoacetate and BHB) appear in urine. the strips only test for acetoacetate. the third kind is expelled in breath (acetone).

As far as a link goes, I don’t know what to say. This is just biochemical physiology. the kidneys filter the blood and produce urine. Whatever is in your blood ends up in your urine (or a metabolized for of it does). Glucose, ketones, liver byproducts, etc.

(Richard Morris) #6

We primarily make aceto-acetate (AcAc) and then that is either spontaneously converted into the volatile Acetone or reduced by beta-hydroxybutyrate dehydrogenase in all our cells into the much more stable beta-hydroxybutyrate (B-OHB). But the cells in our liver and kidneys that are making so much acetoacetate that that they are spilling mostly AcAc into circulation and don’t have the luxury of time to idly convert them into BOHB.

That is why when you first enter ketosis you can measure ample AcAc in urine using pee strips. They are designed to detect keto acidotic levels in type 1 diabetics - not nutritional levels in ketogenic dieters.

One of the keto-adaptations that happens after a few weeks of adaptation is that our cells upregulate monocarboxylate transporters (MCTs) becoming better able to transport ketones and fats into our cells and out of them. Our muscle cells with their more efficient MCTs hoover up all the AcAc and convert it into BOHB and send it back into circulation.

So your body does learn to transport ketones more efficiently across cell walls and that allows all the cells of the body to participate in converting AcAc into the more stable BOHB. This is why after a few weeks AcAc drops off.

#7

It drops off but never disappears. I have been in ketosis for years and always pee dark purple unless I hyper hydrate. I agree they cannot be used to “monitor” nutritional ketosis but if you are in (or were in) nutritional ketosis they will be present in the urine. How detectable they are is simply based on how concentrated the urine is, not on how efficiently you are using them. The sensitivity of the strip, in theory could be raised so high to detect micro traces. this of course would not be useful.

Testing blood will always be the gold standard, but its not financially feasible for all. if you consistently test your urine you could can get an idea of whats going on. pee strip positive in morning and evening? you’re doing it right. pee strip always negative? you might be doing something wrong, but you can’t say for sure. there is no false positive on the pee strips, unless you came out of ketosis in the last few hours.

(ketohealthclub) #8

WI’m sorry but I’m still not seeing anything different than I’ve learned in the past. 1) ketostix measure unused (“wasted”) ketones 2) we become more efficient in using ketones over time.

Without a “show me the science” link rather than a “this is common sense” comment, there’s nothing new here. I’m all for refuting existing info, but there should be documentation somewhere showing the studies that indicate previous research is incorrect. What Richard says is the more in-depth version of what I’ve read.

#9

This is the good stuff here. :bacon: :richard:

(Keto Krazy) #10

“if you consistently test your urine you could can get an idea of whats going on. pee strip positive in morning and evening? you’re doing it right. pee strip always negative? you might be doing something wrong”

I have found what you are saying to be mostly true for me as well. Two and a half years in ketosis and I still spill ketones on the stick in pretty close correlation with my blood ketones. However, I am not sure it’s really hydration related? What I have noticed for myself, is that if my ketones aren’t at least 1.0 mmol or higher, the strips are less likely to register.

(Kathy L) #11

Doc Nally says in his experience with thousands of patients, most people cannot rely on the pee stick after a couple of months ( the level of ketones excreted drop off) but SOME people continue to show positive on them…

(Keto Krazy) #12

I tend to keep in the higher range of nutritional ketosis, and it sounds like @Jason_v may as well? I think most people may hang out in the lower end of ketosis. That could be part of the equation.

I do think that it is pretty pointless to worry about anyway as long as you are having results. Unless you are just a nerd like I am and like to self-experiment. :wink:

(Kathy L) #13

Keto Talk discusses this issue in Podcast #6 - (posted 1/24/16) around the 16 minute mark, if you’d like to hear what Dr. Adam Nally. (can I include a link here? http://ketotalk.com/2016/01/6-vegetables-dairy-testing-for-ketosis/)

(Alex Peralta) #14

If after a couple of months of seeing urine test results then nothing even though carbs and protein intake is good, could one assume the body might have become fat adapted?

(David) #15

It is well known that after a while that after adaptation the level of urinary ketones drops dramatically. This is normal (from what I understand) and can cause confusion amongst some people.

I think I heard it on a Prof Noakes podcast.

(Lisa Stevens) #16

Definitely confused on this subject. I’m at least 7 months in and still see ketones on pee strips when I use them.

(Ken) #17

Don’t feel confused. After 17 years I still see them. Remember, ketosis is a secondary energy process of lipolysis. The majority of your energy is coming from fatty acids. The thing about strips is that when they test positive they confirm you’re in lipolysis, so you know you’re secreting glucagon and therefore burning fat.

#18

the pee sticks are influenced more by your level of hydration more than anything else. while its true that your body “learns” or upregulates its ability to consume ketones in the blood, you are never completely clearing them from your urine. your body doesn’t wait until all the ketones are 'almost gone" before dumping more into the blood stream. as long as your are metabolizing fat (your own or dietary) in the absence of dietary carbohydrates you will be creating ketones as a by product of beta oxidation of lipids and that energy will be put into the blood stream. obviously they will be cleared by tissue that can use them but not down to zero. any overall increase in the excretion of water will “hide” them from the pee sticks, but not your blood or breath.

#19

I use a blood meter, far more accurate and less prone to hydration issues. In fact I thought I had to be in ketosis based on my diet and high level of exercise (triathlon) but nope. Blood meter set me straight and told me the truth.