Very High Urine Ketones, Very Low Blood Ketones simultaneously

newbies
(Mike D) #1

So I started Keto 2 months ago. Been hitting high levels of Ketones regularly with Urine Strips, between 8.0- 12.0 on average. Super dark urine strips! I have been loosing 2-4 lbs (of fat, not overall weight)per week pretty consistently.

I started using a Blood Ketone meter a week ago. My blood meter is reporting very low ketosis everytime I use it 0.1-0.7, yet I will imidiately check it next to a urin strip and will be peeing 8.0-12.0 ketones…

What is up with this? Why are the blood ketones not registering? I feel like I am in ketosis and the strips confirm this.

When the Urine Strips say I am above 4.0, i get a very unique taste in the back of my throat, like fermented fruit. It happens so regularly I use it as a guage for knowing I am in ketosis and the urine strips consistently back this up…So why is the blood meter reporting low ketones? Does not make any sense!

I have tried 3 different meters, 2 KetoMojo GK+ and one Fora6. All three report low to no ketones, while my KetoMojo urine strips report VERY HIGH ketosis.

Oh, I also take 5mg of prednisone first thing in the morning apon waking everyday. Not sure if this is relevent or not. But I test towards the end of the day after the prednisone is minimal. Measurement is taken every evening 12-14 hours post meal. I eat twice a day, once in the morning and again 12-14 later. I test urine all day and blood directly before evening meal. Total daily calories are about 1,400, I am sedentary.

Can anyone please help me make sense of this??Thanks

(Allie) #2

Because you’re not yet fat adapted most likely, urine readings are not helpful as they only show what you’re peeing out (wasting) due to the body not knowing what do to with them yet.

Don’t worry about the numbers. Just keep carbs below 20g and trust the process.

(Bacon is a many-splendoured thing) #3

First, welcome to the forums!

The fruity taste is acetone, one of the three ketone bodies the liver produces. The other two are acetoacetate and β-hydroxybutyrate. The ketone bodies can all be measured in breath, urine, and blood. But given the practicalities of producing home meters, it is customary to measure acetoacetate in urine, acetone in breath, and β-hydroxybutyrate in blood.

So part of the explanation is that you are measuring two different ketone bodies when you compare a blood measurement to a urine measurement. The existence of a discrepancy is therefore no surprise. There are also the limits of accuracy of each measurement to take into account. A slight inconsistency in the manufacture of the test strips, or a glitch in the calibration of the blood meter, and you can have some divergence.

You don’t mention your carbohydrate intake, but it is pretty definite that if you are eating less than 20 g/day and are still breathing in and out, you are in ketosis. And the feeling in your mouth confirms this.

In general, we advise against chasing ketones, unless you have a medical reason for needing to do so (Alzheimer’s disease, epilepsy, schizophrenia, etc.). If you are eating this way in order to shed excess fat, there is no known correlation between ketone levels and fat loss; just the fact of having insulin low enough to be in ketosis is enough, and the same is true if your motivation is primarily to heal metabolic dysfunction. It is lowering serum glucose and serum insulin that makes the difference.

So I wouldn’t worry, if I were you. Ketones in the breath and urine are being excreted, not used, and ketones in the blood are the ones that have been produced but not yet consumed. To have a large gap between production and consumption is not particularly efficient, and the body gets better at matching the two, over time. Now that you have been eating a ketogenic diet long enough to be fat adapted (which generally takes six to eight weeks), you can expect not to see a great amount of circulating ketones. Your urine level may drop off, too, and if it does, that is no cause for alarm.

(Mike D) #4

Thank you for your response

The purpouse for me going Keto is for me to reverse NA Fatty Liver Disease and possibly to reduce Rheumatoid Arthritis, or send in to remission. Reducing strain on my joints by loosing 50lbs is a secondary goal as well…

My carbs are between 20-35g a day. Still trying to nail down and fine tune the diet, as it is so radically different than what I am use to…Get Keto Flu quite often and feel so bad I will knock myself out of Keto on purpouse just to end the KF. But I am inching myself closer and closer to the 20g goal every week. Slowly but surely I am adapting and the KF is improving a little at a time. Also, was on a high dose of corticosteroids last week and it completely knocked me out of Keto, no matter what I ate.

(Bacon is a many-splendoured thing) #5

Lustig et al. demonstrated that fatty liver disease can be cleared up fairly quickly, simply by avoiding fructose, ethanol, and branched-chain amino acids (they are essential to the diet, but not needed in any quantity, unless we are trying to build muscle). All three of these are handled by the same pathway in the liver, and when it is overwhelmed, this pathway causes what is called de novo lipogenesis, which results in fatty liver.

Fructose, fruit sugar, is one-half of a sucrose molecule (table sugar) and 55% of high-fructose corn syrup. So avoiding anything with sugar in it is going to be an immense help to your liver. Your diet doesn’t actually have to be ketogenic for this.

However, a ketogenic diet is very good for arthritis. Not only does the usual loss o/f fat (a pleasant side effect of this way of eating) help the joints, but lowering serum glucose and serum insulin, by cutting carbohydrate intake, generally clears up the systemic inflammation they cause.

Another source of systemic inflammation is polyunsaturated fatty acids, which is why we strongly advise limiting consumption of industrial seed oils (soybean, cottonseed, canola, cornflower, sunflower, safflower, etc.) and replacing them with sources of mono-unsaturated and saturated fats, such as butter/ghee, bacon grease, lard, and tallow.

The so-called keto “flu” is merely a lack of sodium. Elevated insulin causes the kidneys to excrete sodium more slowly, so the lowering of insulin resulting from cutting carbs allows the kidneys to return to excreting sodium at the normal, faster rate. This means that we have to work a bit harder to keep our sodium intake up, especially since cutting carbs usually entails avoiding processed foods, which are loaded with sodium. The healthiest range of sodium intake has been shown to be 4-6 g/day, which translates to 10-15 g/day of sodium chloride (table salt). This, of course, includes sodium already present in food, so there is no need to go bonkers with salt, just make an effort to be sure to salt your food. The usual symptoms of low sodium, besides keto “flu”, are headaches and constipation. So if you are avoiding all those symptoms, you are getting enough salt.

And yeah, steroids don’t help.

What I find easy about the diet is that I can reduce meals to a meat (possibly with gravy) and salad (with blue cheese dressing) or a vegetable (usually broccoli or cauliflower with cheese sauce, yum!). Dead easy to prepare, and definitely very tasty. I don’t miss glazed doughnuts at all, anymore! :bacon::bacon:

(Joey) #6

@SM0oth_0perator Congratulations on embarking on a path to turn your health around! @PaulL has provided his usual spot-on advice, based on lots of science and an untold number of individual success stories. Stay the course and keep us posted. :vulcan_salute:

(Robin) #7

I never tested anything. I simply kept my carbs at 20g and ate when hungry. I learned not to restrict calories at the same time… that backfires.

Lots of people test. Many do not.
Lots of people weigh themselves daily. Many of us do not. Your body and your clothes are a much better measure of progress. Use a tape measure instead if you really want to know numbers. I never have. Just kept buying smaller clothes, and enjoying the lack of inflammation and lethargy.

The process is simple. And the great news is that lack of carbs leads to lack of cravings. Hang in there. Keep it simple if possible.
You’ve got this…

#8

Make them both primary goals, the weight loss will help with the pain more than the ketones will.

Keto flu is electrolyte imbalance, supplement those in, and you should feel fine.

Don’t concern yourself with ketone readings, they’re useless. Keep the carbs low, and keto will do it’s thing.

(Mike D) #9

So if KetoFlu is electrolyte imbalance, what electrolytes should I supplement with?

I get about 1,500-2,000 mg of sodium per day in food.
Aproximately 500mg of Potassium. Not sure how much magnesium, but it is about 100%dv. I do not take extra calcium, because my blood labs show me running high most of the time. Any advice on how much of and which electrolytes to suplement?

Also, my 12-14 hour fasting blood glucose is coming back between 105-120mg/dl on average. Is this indicative of boarderline pre diabetes? My primary care doctor never mentioned diabetes to me, but did say my cholesterol and triglycerides were high in April.

I also notice my prednisone use has a MASSIVE impact on my blood glucose. Trying to figure out if the high fasting glucose is pre diabetes, or just Corticosteroid interference.

I take my regular 5mg prednisone every morning and glucose spikes. Then 6 hours later seems to start leveling off. Last week I had a corticosteroid injection into my knee and upped my prednisone to 10mg. All week long my glucose was all over the map as well as high, even though I was in a fasting state.

I tend to ignore my overall weight loss and focus more on calculating BF% to get my true numbers. I also noticed, that during the week I was jacked on corticosteroids, I lost a lot more muscle than usual, despite reccomended protein intake.

I also noticed that protein raises my blood glucose pretty reliably, kicking me out of ketosis. I hear differing opinions on this and get the impression this is a very individualistic phenomenon. I am consuming roughly 55g of protein a day and weigh 190 lbs 30% bf (130lbs lean weight). Anyone have any thoughts on this, or can give me a minimum protein amount? The reccomended protein intake online seems excessive, if I followed it I would never stay in Ketosis it seems.

A few people have said, just eat 20g carbs and do not think about anything else. But protein is raising my glucose somewhat high and I can feel it kicking me out of ketosis as well.

I feel I am at a crossroads ATM with my chronic diseases. I get the impression I am standing on the edge of a cliff. If I do nothing I will not live very long, but if I turn my health around now I might live an average life expectancy. Besides RA my immune system is a disordered wreck and causes havoc to organs as well as joints. Fatty Liver is icing on the cake, because given my auto immune disorder propensity, It could easily lead to auto immune Cirrhosis at any moment.

Thanks for the support everybody!

#10

Sodium, Magnesium, Potassium. 1500-2000mg is within the “normal” range for people eating “normally” not enough for somebody eating keto, not reataining them with carbs, plus that has the diuretic effect of eating this way. I’d probably double that sodium, most good electrolyte supplements have 1g in them per serving, the one I use, True Nutrition Electroytes (perfect ripoffi of LMNT, half the price) is that, 60 Magnesium, 200mg Potassium. Plus obviously what you’re getting in with food.

I also notice my prednisone use has a MASSIVE impact on my blood glucose.

Yup! It will. no way to tell them apart until you’re off it.

55g of protein is why you’re losing muscle! The go to amount is 1g/lb of bodyweight. That give you what you need for muscle and gives you wiggle room otherwise.

Don’t worry about “being kicked out of ketosis”, Just keep your carbs where they need to be and it’ll all work for you.

What are your pre and post numbers? and are you still on Prednisone during this? Gluconeogenesis (that’s what does that) is demand driven, not supply driven, that’s proven at this point.

For the fatty liver, NAC! Will bring your numbers down and let your liver start healing itself. Along with the keto obviously.

(Mike D) #11

“For the fatty liver,NAC!”…??? No Alcohol, or means No Added Carbs? Not a Concern?

Yes, I take 5mg prednisone every morning. Been on it for 7 years. My adrenals are atrophied and I no longer make my own cortisone. I have to take 5mg every morning just for basic life functions.

The endocrinologist explained it this way. The average human makes the equivalent of 5mg prednisone naturally throughout the day. With the majority being released upon waking and tapering off throughout the day. If I take 5mg in the morning, it is not a whole lot different than a normal persons hormone cycle…However, anything over 5mg is seen by the body as unnatural excess, or fight or flight response due to a violent threat.

I do my best to stay at 5mg everyday, but occasionally have to take more during auto immune disease flares. I know the drug is bad for Keto, but not much I can do about it. Would take me a decade to get off of it, or occording to the Endo, in some circumstances some peoples adrenals never grow back. I have been on it for 7 years, which works against me, but have been at a very low dose on average, so there is some hope to grow atleast half of my adrenal gland back.

If I can reduce my inflammation with Keto, it may allow me to reduce my prednisone someday to 2.5mg or possibly lower. It is a dangerous drug, but unfortunately still the most powerful weapon we have against immune modulated inflammation of all types. Blessing and curse.

(Bacon is a many-splendoured thing) #12

If you are getting enough salt, magenesium and potassium will more easily stay in balance. You may or may not need to supplement.

Refresh my memory: how long have you been eating a ketogenic diet? Also, what was your last HbA1C?

The prednisone may well be distorting your fasting glucose.

This may be because you are not eating enough fat. Under normal circumstances, protein is not an energy source to the body, because of the high energy cost of metabolising it. If you are not getting enough fat, your glucose may be being made in the liver, because your body needs to get energy from somewhere. A hundred thirty pounds of lean mass is 59.1 kg. By our standard recommendation, you would want 59.1 to 88.65 g of protein, which would come to anywhere from 236.4 g (8.3 oz.) to 354.6 g (12.5 oz.) of meat. And many experts say you could or should go even higher, say 16.8 g (17 oz.) of meat.

The automatic teller machine is a hard place to hang out at, especially one that’s at a crossroads. Give keto a bit more time, but if you don’t see any improvements in another month or so, it may be that a ketogenic diet is not for you, and you should go back to your normal high-carb diet.

#13

Haha, that would be N Aceytl L-Cysteine. Takes a beaten into the ground liver and makes it happy. Its an amino, form of Cysteine that we get anyways from protein. Popular for many years in bodybuilding for liver repair from oral steroids. Lot of good health benefits aside from that as well.

Since your stuck with the Prednisone, probably a good idea. I’ve taken it daily for years.

(Mike D) #14

Oh, I see improvements already. I have lost 15lbs in 6 weeks according to body fat %. Fat is noticably dissapearing around my midsection when I grab it. It is the fastest weightloss I have ever experienced. Results were NEVER a problem.

The initial discussion was, why am I obviously in Ketosis, urinating 8.0-12.0 ketones, but blood monitor is saying I am 0.1-0.7 and not registering anything? I am obviously in Ketosis, rapidly loosing weight, urin strips seem consistent and reliable, but blood meter is acting like it is not even working. Whole thing was confusing to me.

Then the conversation split into other topics of general education.

As far as how long I have been on Keto, that is not a clear answer. This is my first time and am learning along the way. 6 weeks ago I started reducing my carbs and would stop temporarily everytime I got KetoFlu. Have been steadily identifying hidden carbs every week and eliminating them. I am down to about 20-35g per day at this moment.

It was not like overnight I went 100g to 20g. I have been reducing along the way, partially to avoid KetoFlu, partially just because I am finding all these sneaky carbs hiding in things and knocking them out 1 by 1.

(Bacon is a many-splendoured thing) #15

The progress you have made shows that you have lowered your insulin sufficiently, then. The lowered insulin is as important as the production of ketones, since insulin, among its many other functions is a growth hormone stimulating the storage of fat and the inhibition of ketogenesis. Observable ketones are a guarantee that your insulin has dropped low enough to permit the exit of fatty acids from adipose tissue, since both ketogenesis and lipolysis require a serum insulin level lower than 25 μU/mL.

Why you are seeing a discrepancy between your urine strips and your blood ketone meter is something I though I’d already addressed, sorry. In essence, you are measuring two different ketone bodies, acetoacetate in your urine and β-hydroxybutyrate in your blood. That alone is going to result in a discrepancy.

Not only that, but the urine strips were invented to provide Type I diabetics early warning of a potential diabetic ketoacidotic episode, with enough time for the patient to make it to the hospital for treatment before the ketoacidosis gets so bad it causes damage or death. So they aren’t designed to be all that precise, just accurate enough to expose a potential problem before it develops into anything serious. And urinary acetoacetate is cheap and easy to measure, so it makes sense to use it as an early warning system for Type I diabetics.

Moreover, there are three ketone bodies that the liver produces, acetoacetate, acetone, and β-hydroxybutyrate. There is a chemical relationship between the three, but the level of one is not a precise indicator of the levels of the other two. Serum β-hydroxybutyrate is easy to measure, and it is a reasonably good proxy for the other two, but just because it appears to be low doesn’t necessarily mean the other two are. Also, it is common for someone to have low circulating ketones as the liver gets better at matching production to consumption. It is possible to measure urinary β-hydroxybutyrate, but that requires a laboratory. Though I have to say, it would be fascinating to know how your urinary β-hydroxybutyrate compares with your serum β-hydroxybutyrate, not to mention your serum acetoacetate with your urinary acetoacetate, and so forth.

(Doug) #16

The strips are notoriously less reliable than blood tests, to begin with. “High ketones in urine” - this is partially dependent on the amount of water leaving the body. Even if we take the strip test result at face value, if one had consumed substantially more water, for example, and thus increased the volume of water in the urine (for whatever time unit is applicable), then the ketones would show up at a lesser rate.

(Mike D) #17

I noticed that, but my water intake is pretty consistent. I have been drinking 1-1.5 gallons of water per day everyday for about 5 years. I pee about once an hour then drink 8 ounces after I pee. So I am at a steady state of hydration during the day. Only time I am dehydrated is when I first wake up, but I drink 40oz as soon as I wake up. Urine keytones are still very high 12 hours post meal. They have gone as high as 16.0 on a couple of occasions. Yet blood meter came back with a measly 0.8. If anything, the urine strips are more consistent than blood meter from what I am seeing. Urin strips always reflect how I feel and the rapid weight loss says the strips are right. The blood meters from my perspective just seem flat out wrong…

Unless, going by Pauls info. I could be rapidly using β-hydroxybutyrate for energy and my body/kidneys are disproportionately identifying acetoacetate as a waste product for disposal. This is where I wonder if it is the prednisone causing such a large descrepency from the two testing methods. I have no doubt at this point that corticosteroids impact Keto Diets in a huge way. Just how exactly that impact happens I have not entirely figured out yet.

I mean ultumately the Keto diet is working, what I am doing is getting physical results. I just like to understand the science and the data. Also, kinda bummed that the Blood Meters were so expensive, yet seem not to be all that helpful. Especially considering I purchased 3 of them thinking the whole thing was an error of some sort. Should have just stuck with the urine strips in hidsight and stayed below 20g while “trusting the process”, but all the websites push blood monitors as “gold standard”, so am a little dissapointed at the moment.

(Mike D) #18

Paul, is β-hydroxybutyrate the only Ketone that can be used as fuel? Are acetoacetate and acetone just waste ketones that cannot be used by the body?

(Bacon is a many-splendoured thing) #19

That’s a lot of liquid; be careful not to disrupt your electrolytes. The noted physician, researcher, and marathon runner, Dr. Tim Noakes, advises simply drinking to thirst.

No. B-hydroxybutyrate gets most of the attention, but all three of them, being partially metabolised fatty acids, can be fully metabolised to carbon dioxide and water. Acetone and β-hydroxybutyrate are both particularly useful to the brain (ketone bodies can pass the blood-brain barrier, whereas fatty acids cannot), and ketone bodies are particularly useful to the heart muscle when the coronary arteries are occluded, because they take less oxygen to metabolise than fatty acids. (A useful analogy is to think of fatty acids as being like wood, and ketones as being like charcoal, which is partially combusted wood.)

Skeletal muscles, by contrast prefer fatty acids over glucose and ketones, and will actively pass them up in favour of organs and cells (particularly the brain and the red blood corpuscles) that need or can use them.

The three ketone bodies have also been shown to have epigenetic (gene-signaling) effects. For example, elevated insulin activates a gene complex that shuts off the body’s endogenous defences against oxidative stress, thus making it necessary to consume such exogenous anti-oxidants as Vitamin C. By contrast, β-hydroxybutyrate turns off that same gene complex, thus restoring the body’s endogenous defences and eliminating the need for exogenous anti-oxidants. Acetone also has documented epigenetic effects, involving the brain in some way (sorry, I didn’t keep a link to the paper, so I am foggy on the details).

(Fun fact: in chemist’s terms, only acetoacetate and acetone are actual ketones; β-hydroxybutyrate is not, technically speaking. So the term “ketone bodies” was coined to cover all three chemicals.)

(Mike D) #20

Ahh ok, this article made sense of it for me. Since I am early in Keto actoacetate is the primary ketone being made, so that is why my urine tests are high.

It takes a while for the liver to build enough enzymes, to convert acetoacetate to β-hydroxybutyrate. Which is a later adaptation. The β-hydroxybutyrate is the primary fuel source and acetoacetate is the precurser.

So it makes sense now, my body is producing high acetoacetate, hense the rapid weight loss, but my body is not good at converting the acetoacetate to β-hydroxybutyrate yet, so I have not switched over to efficiently using the ketones as fuel. Just basicaly pissing out the acetoacetate and breathing out fruity acetone from my mouth.

Seems I am not Keto adapted for energy USE yet. Just creating a lot of precursers so far.