Keto Information

The Problem of Measuring Ketones, Ketosis & Specific Food Responses


So, I recently began an experiment to begin fasting and testing certain foods to see what their relative effect would be on my level of ketosis – in order to better understand what foods would better help me stay IN ketosis vs those that might cause issues, kick me out or lessen my overall state of ketosis.  In order to assist the keto community in this regard, I was posting my results on my InstaGram account for all to see, so they could benefit from my “guinea pig” status.

Unfortunately, I have, through the results of the early stages of my testing and a quite a bit of additional research, determined that I am not going to be able to test each of these foods and truly determine their effect on my state of ketosis individually, primarily because there are a number of variables that I was unaware of at the start of this process, and that I can’t easily control in order to know if my data is accurate or not.

Moreover, the more I’m learning (after, literally, hours of reading, studying and doing breath and blood testing recently), the more I’m not so sure we’re doing ourselves any favors with all of this heavy focus on “the numbers”.

First, allow me to explain, what I am seeing as some fundamental truths about ketone energy and fat metabolism that are not understood by most “ketoers” and, quite frankly, I did not have a solid enough grasp on previously:

Blood Ketone (BHB) Levels Measure “What’s In the Tank”

So, here’s part of the problem.  A blood ketone meter is considered by many to be the most reliable way to measure an individual’s overall state of ketosis, by measuring what level of BHB (beta-hydroxybutryate) you have in your blood. Since this measurement is generally considered the most accurate and precise way of measuring ketones, it’s considered the “gold standard”.  However, the problem is, we often don’t really question just WHAT we’re testing and what that information is truly telling us.

You see, the level of BHB in your blood is only a measure of what your body is keeping “in the tank”, so to speak … ie. “at the ready”.  It’s available to be used as an energy source, but it is not currently in use. Now, that’s not ENTIRELY accurate, since your brain can actually use BHB directly as energy.  But, no other muscles, organs or body tissues can.  So, it makes sense to assume that some of that BHB production is actually intentionally directed for use by the brain.

Nevertheless, in order for anything other than the brain (central nervous system) to utilize BHB for energy, it must first be converted back into acetoacetate.  In other words, removed from BHB storage for active use as an energy source.

BHB is basically a “blood storage” version of ketone (fat based) energy.  When the body is in a state of ketosis and produces more acetoacetate than it currently needs for energy, it will be converted to BHB.  So, another way to look at it is, the level of BHB being measured in your blood at any given moment is a measure of what level of ketone energy your body is PRODUCING minus the level of ketone energy your body is USING.

The EXACT SAME Readings w/ Completely Different Ketogenic States

Take a moment to think about that for a moment.  That means, if your body is PRODUCING a high level of ketone energy, but at the moment that you test your blood or just prior to your blood testing your body is/was also USING a high level of ketone energy (acetoacetate), your actual BLOOD ketone readings (BHB) could read fairly low.

But, if you didn’t know any better, that might imply a relatively low state of ketosis when in fact, you could be deep into ketosis, but simply using the vast majority of the ketones currently being produced for immediate energy (so you’re body is not converting the acetoacetate to BHB for storage).  An example might be when you’re in deep ketosis but just finished a long and grueling workout.

My Own Personal Experience With This

Just this morning I did a short but taxing kettlebell workout (btw – that’s NOT me in the picture at left :).  Prior to the workout my BHB level was 2.4 mmol/L, which is considered fairly deep ketosis (although not nearly as deep as it can be when fully fasting).  However, after my workout my reading was an entire point lower at 1.4 and continued to drop even further to 1.1, which is still a “good” number, but certainly at the lower end of ketosis.

I had not eaten anything that could have negatively effected my ketone production.  But, my body had been USING alot of ketones during that workout.  Therefore, alot of the stored BHB ketone bodies were likely converted back to acetoacetate for energy usage AND the ketones that my body was currently producing were NOT being converted to BHB, but were being left as acetoacetate to be used immediately.

A Completely Different Scenario But Possibly Similar Readings

Likewise, you could potentially receive the EXACT SAME READING from a blood ketone meter if your body was producing a low level of ketone bodies (maybe early stages of ketosis), but your body was also USING a low level of ketone energy (low activity state and/or not keto adapted yet, so you’re not USING your ketones effectively yet).

A blood ketone meter ONLY measures the level of BHB in your blood at any given moment, which is simply a measure of how much fat based energy your body has produced but is not currently using.  How much you have left in the tank and ready to utilize for energy.

Breath Ketone (Acetone) Levels Measure What’s Being Used

Since a cheap breathalyzer or expensive breath ketone meter like a Ketonix unit is measuring breath acetone only, we again have to take a step back and evaluate what that means.  Where does the acetone come from?  What are we ACTUALLY measuring?  It’s not just a measure of our level of ketosis.  There’s more to it than that.

Acetone is produced when acetoacetate is actively being used for energy.  As the acetoacetate flows through your bloodstream on it’s way to various muscles, organs and tissues, some of it spontaneously degrades to form acetone.  Since acetone is a very light molecule and it’s chemical structure has no strong affinity for the water present in our blood, it will easily vaporize, which allows it to pass into the lungs and escape as we exhale.  Some can also escape through our skin.

So, technically, measuring acetone in our breath is not actually a measure of how much ketone energy your body is USING, but, rather, how much ketone energy your body is “losing” as some of the acetoacetate in your blood spontaneously degrades into acetone.

However, since the ratio of total acetoacetate to “degraded acetoacetate” (acetone) in your blood is generally consistent, measuring the level of acetone in your breath is a fairly accurate way of estimating just how much acetoacetate is being produced and NOT converted to BHB for storage.  In other words, how much ketone energy is being produced for immediate use at that moment.

Breathalyzers Inconsistent – Ketonix Very Expensive & Hard to Use

So, based on the above, it might seem that testing breath acetone might be the best way of measuring how much your body is requesting ketones for energy, how much your body is producing ketones for energy AND how much of the ketones being produced are being actually USED for energy (not being converted to BHB).

Unfortunately, my own testing with the inexpensive breathalyzers indicates that they can be fairly frustrating and offer a short useful life.  First, they will frustrate people who are new to keto because they won’t even register until a person has some relatively high breath acetone levels.  And, since breath acetone only shows up when your body is actively using the ketones it is producing (instead of storing them as BHB), a person could be producing plenty of ketones and still not show much breath acetone.

Using a cheap breathalyzer, these low levels of breath acetone might not even register, giving the user absolutely no feedback about their state of ketosis.  What’s worse, you don’t always know when the sensor starts going bad, which will then start throwing erroneous and widely fluctuating values (as happened to me during this experiment).  That’s not helpful.  It’s just discouraging.

As for the Ketonix, I don’t own one, but, from everything I’ve read, they WILL read lower level acetone, they are fairly “accurate” and probably relatively precise, but, the information they offer seems to be a little less than detailed without connecting to a computer.  Also, they can be very cumbersome to use and the Windows software they require can be a bit finicky.  So, when you could spend as much as $200 to $300 for one, it just doesn’t make much sense for most people.

Free Fatty Acids for Energy – Another Level of Confusion

To make matters even more complicated, most people don’t realize that a large portion of your body can actually directly process free fatty acids for energy.  They do not require the liver mitochondria to first convert those fatty acids to ketones.  So, even if your BHB readings or even your breath acetone readings happened to be on the low side, you might still be getting plenty of energy from free fatty acids from dietary intake or the release of body fat stores.

Your brain can’t utilize free fatty acids for energy, because they cannot pass the blood/brain barrier.  This is actually one of the greatest reasons for ketone production.  Ketones CAN pass through that barrier, so, if your brain can’t get enough glucose for energy, it can tap into those ketones.

Free Fatty Acids Converted to Glucose

And, if that weren’t complicated enough, some of your free fatty acids are actually converted to glucose via gluconeogenesis, because there are some cells in your body that CANNOT use ketones or free fatty acids for energy (for instance, I believe, red blood cells).  So, not all of your free fatty acids are being shuttled through the fat metabolism process, which is probably not critically important except to realize, even when you are ingesting NO carbs, your body is still pumping glucose into the bloodstream, because your body still needs some glucose for those cells that cannot use fats for energy.

Of course, protein can also be converted to glucose via the same mechanism, which is why you’ll often hear recommendations to be careful of how much protein you ingest, so you don’t produce an overabundance of glucose.  However, the more I research this topic, the more I suspect that this issue may be more of a non-issue.  At least I’m not convinced you actually have to keep your protein consumption nearly as low as many would suggest in order to avoid kicking yourself out of ketosis.

Another Issue With Trying to Test Specific Food Responses

Getting back to “The Experiment” and why it is ultimately not going to be possible, we have yet another issue that I’m not sure how to easily overcome.  As it turns out, often, the effects that a food may have on your state of ketosis can actually take as much as 24 hours to fully reflect in your ketone measurements.  Thus, the only way to truly test the effect of any particular food on ketosis would be to eat nothing but that food, during a single meal, in a 24 hour period.  This is, sort of, what I initially wanted to do.

However, you’d also have to test that food multiple times and at different total calorie amounts, in order to make sure it wasn’t simply the calories themselves that caused the issue.  Maybe if you’d only eaten 100 calories of it, there would have been no response, but, at 200 calories, the body responded to it, thinking you were bringing it OUT of starvation mode (since you’re “fasting”).

Thus, each food could take multiple days to adequately test and really know the true results.

Non-Food Related Ketone Fluctuations

You’d also have the issue of normal fluctuations in ketone readings throughout the day that have NOTHING to do with food intake.  If anyone were to take blood or breath ketone readings from morning until night, they would see vast fluctuations in those numbers because the body goes through different “phases” throughout the day, even if you’re not ingesting any food at all.  Add in the fluctuations that could be caused by various foods eaten throughout the day and you have a recipe for mass confusion.

Lastly, although doing such a test for various foods would likely ONLY be possible from a fasted state, if at all (to avoid any additional variables), you have the additional issue of the rapid changes in ketone levels due simply to the “starvation mode” that you’re placing your body in.  In a zero calorie intake situation, your ketone levels will quickly climb over the first 5 days or so, topping out in the 4mmol/L range.  Then, from there, they might still climb higher to around 5 or 6, but not generally much higher than that.

So, for the first 5 days of the fast, you really couldn’t attempt any food testing at all, since your numbers would naturally be climbing so much, it would throw off all your numbers.  For instance, what if it were true that “Food A” naturally causes a decline in ketone levels of about a 1/2 point within 12 hours from the point of ingestion?  On day 3 of your fast, you’re at a blood ketone reading of 2mmol/L.

You then eat “Food A” and, 12 hours later blood testing shows your BHB ketone reading is 2.5mmol/L.  How are you to interpret that?  Are you going to think that “Food A” actually causes a rise in ketones?  How do you know for certain how far your ketone numbers would have risen if you had not eaten the food, so that you could at least infer the “drop” in ketones caused by your food ingestion?  You see the issue?

At best, you’d have to wait till you had gotten to day 6 or 7 of the fast (when your ketone levels begin to level out at about 5mmol/L) before you could even begin the test.  And then, once you start, it might take 2 or 3 days to test each food you want to test.  It would be tough to get through too many foods without having a seriously extended fast, which most people aren’t going to do.

For instance, I don’t think I’ve got enough body fat left to safely fast beyond about 7 to maybe 10 days from now.  Thus, I’d barely get started with food testing before I’d have to quit.  And, even then, as a result of all of the other variables that I’ve mentioned in this post, I still couldn’t really guarantee that the “information” gained would actually be of any use.  It might just be a red herring posing as useful information, which is really worse than no information at all.

So, What Should You Do With That Mess?

Realistically, you don’t necessarily need to know all that to properly “do” keto.  But, understanding some of the shortcomings of trying to “measure” everything or to try and understand every nuance of adhering to a ketogenic diet could easily drive you crazy.  More importantly, spending all of your time trying to measure everything can often give you “false” information and cause you to make poor choices based on assumptions about the “data” (trust me, I know this all too well).

So, I think what’s important here is to focus on results.  Are you achieving the results you want, and are you being realistic about the results you’re looking for and how quickly you can attain them?  Let’s face it, keto and fasting can be POWERFUL tools to help you lose weight, detoxify your body, get your diabetes under control and to address numerous other physical/medical ailments.  That being said, it’s not quite a “miracle”, even though there are many who would refer to it that way, since it’s the ONLY thing that’s ever worked for them, and it worked better than they might ever have dreamed.

That being said, if you expect to lose 45 pounds your first week, it’s not going to happen.  If you expect that you won’t run into ANY issues or difficulties along the way, you’re likely to be surprised.  There are alot of things about keto that make it easier to be successful with than other “diets”.  However, that doesn’t mean it’s always sunshine and roses.  There are times when it can be difficult.  There are times that things don’t LOOK like they are moving in the direction we want and we get discouraged.

Weight loss “stalls” can occur, and it can take a little time to work out why (or, maybe there is no specific reason why, we just have to be patient and wait for the stall to come to an end).  We can end up having symptoms of certain deficiencies that frustrate us until we get our supplementation right.  In certain instances, especially before we’re keto adapted, we can feel less energized than we expect we should.

All I’m saying is, first and foremost we need to be patient, realistic and willing to learn, adjust and assist each other in being successful (because there are ALOT of forces out there trying to stop us – sometimes those we’d like to be most supportive, but they just don’t understand what we’re doing).  Don’t give up, don’t give in and do everything you can to bring as many people with you as you close in on success with your own goals.

Remember, If It’s All About Weight Loss, Don’t Forget the Insulin Response

Keep in mind, the main reason that keto is so amazing for weight loss is because lowering your carb intake and increasing your fat intake will, necessarily, lower your insulin production.  Since insulin is the hormone that regulates whether body fat stores can be released for energy, until you get those insulin levels down, you’ll never really be able to lose any significant weight.  So, in the end, if it’s about weight loss, it’s all about insulin.

Of course, you can reduce your insulin levels without doing keto.  You can do it by simply cutting your calories significantly below your daily caloric needs.  However, if you’re not shifting your body over to ketogenesis you will be constantly hungry, because fat will still not be your body’s primary fuel source.  It will still be prioritizing glucose for energy.  Therefore, it will be BEGGING for carbs.

That makes it really tough to keep your  calorie counts down.  It’s a constant struggle to not eat more carbs.  But, if the foods you ARE eating prioritize fat and strictly minimize the carbs, you will force your body to move into ketogenesis, at which point, if you’re overweight, there’s no reason for your body to be clamoring for ANY calories at all.  It has all the energy it needs built right in.

More importantly, you need to realize your body WANTS to off-load the extra weight.  However, when you’re in a constant state of carb intake, it can’t because it has to keep flooding the bloodstream with insulin to manage the glucose, which, in turn, turns off any possibility of releasing body fat for energy.

So, once you drop into keto, your body is HAPPY to use body fat for energy.  You won’t really be hungry.  Now, that’s not to say you might not still crave certain foods or feel like eating at certain times.  But, that’s all about habit.  It has nothing to do with hunger – even though, sometimes, it might FEEL like hunger.

At the end of the day, if you’re doing keto for weight loss (or at least partly for weight loss), then everything you do is basically to get your insulin levels low enough that your body can begin releasing body fat for energy.  Once you do that, losing weight will be as easy as … “NO pie” 🙂

So How DO I Do Keto “Properly”?

To some degree, that’s an individual decision and there IS some flexibility involved here as keto might look a little different from one person to another, depending upon their goals and what issues they are trying to address.  Of course, there have to at least be some rough guidelines, otherewise, what really IS keto?  So, the following are my thoughts:

Don’t Track Every Calorie for the Rest of Your Life

Seriously, don’t spend hours and hours tracking everything to the nth degree until the end of time.  In the beginning, when you first start out with keto, it is valuable to be looking at labels, getting an idea of what the calories and macros look like for certain foods, popping that information into some sort of tracking software or app and keeping some meal totals and daily totals of your calories and macros for awhile.  But, once you’ve done it for awhile and have gotten comfortable with your keto walk, it’s really not necessary.

There ARE a Few Benefits to Tracking Initially, Though

The initial tracking serves a few purposes, from my perspective.  Number one, it helps to get you in the mode of actually THINKING about what you eat before you shove it in your mouth.  “What’s in this? Should I be eating it?” This will be helpful moving forward, even if you decide not to stay strict keto once you’ve attained whatever goal you’re shooting for.  No matter what lifestyle diet you end up on, it pays to keep an eye on just how “healthy” your diet is and actually think about it.

Number two, this sort of tracking starts giving you a good general idea of the calories and macros of certain “basic” keto foods that you can go back to again and again.  You’ll know what foods are pretty much “perfect keto” for you and which foods might be “riding the edge” and might need some supplemental fat to round them out.

Lastly, you’ll also begin to learn just what level of carbs is too much for you to maintain ketosis, so that you know what to stay under.  It’s a bit different for everyone.  20 grams?  50 grams?  100 grams? How much can YOU eat each day and still move toward your goals?  Ultimately, carbs are not evil.  We’ve just allowed them to dominate our diets for too long, and many of us are paying the price.  Initial tracking helps give you an idea of how much is too much for YOU.

Work YOUR Plan, Not Someone Else’s

What degree of ketosis YOU need can be a bit different than what someone else needs.  If you need to lose 100 pounds, and you really want to see results quickly, then you’re going to want to maintain a deeper state of ketosis than someone who’s got 20 pounds to lose and isn’t necessarily in a huge hurry.  That person can probably pop in and out of ketosis for 3 or 4 months and lose the weight, but you’re going to need to be a bit more strict to attain your goals.

Similarly, someone who is using keto to address a brain energy issue will likely need to maintain a deep state of ketosis in order to make sure their brain is receiving significant and consistent ketone energy.  Alternatively, someone who is only using keto for weight loss can afford to have days when they might not be fully ketogenic.

So, again, you have to individualize your plan based on what YOU want.  Are you going to have heavy workout days?  Don’t be afraid to get some extra protein on those days.  Is it likely you’re going to need a cheat day here or there?  Plan it out a little.  Be sure they are not too frequent and consider doing an extended intermittent fast the day after in order to jump start your way back into ketosis.

Don’t Chase Higher Ketone Numbers

As I said, there will be some people doing keto for whom those higher BHB or breath acetone readings will be critical because they are trying to treat a medical problem that only high ketone levels will treat.  But, for the rest of us, you don’t have to be DEEP in ketosis in order to reap most of the benefits of ketosis.  And, sometimes chasing those higher ketone numbers can actually end up costing us money and even cause us to make some unhealthy choices to reach those goals.

For most people, the ketones should not be the goal.  They are a means to an end.  In fact, to some degree, they are almost a SIDE EFFECT of the process that leads to the end result we’re looking for.  Ultimately, what we want is for our body to release stored body fat as fatty acids.  In order to do that, we need lower insulin levels.  To achieve that we need lower carb levels.

Once we do this, there is a cascade of events that occur, and, to some degree, the ketones are actually a BY-PRODUCT of that process.  When those fatty acids are released into the blood stream, some of them end up rolling through the liver to be converted into energy there, and the ketones are a by-product of that bio-chemical process.  It just so happens (well, I believe God designed it that way) that those ketones are ALSO a valuable source of energy.

So, the by-product of the energy reaction with fatty acids is itself another source of additional energy for the body and brain.  That’s pretty awesome.  But, just remember, the ketones aren’t actually the major source of energy once you reach ketosis.  The fatty acids are.  Ketones are just a side benefit, and they serve a critical role in supplying the brain with energy because you’re severely limiting the brain’s only other energy source: glucose.

It’s not about the numbers.  Testing your ketone readings every hour is not going to be helpful.  It’s not even going to really give you very accurate ACTIONABLE data.  Most of the actions that you will choose to take as a result of blood or breath ketone measurements will be erroneous.  You’ll THINK you’re doing the right thing, but, likely, you won’t be.

Use Results, Not Calculus to Establish Your Plan

It shouldn’t require “mathrobatics” to figure out what your keto diet should look like.  Honestly, just pay attention to your results.  If you’re new to keto, work really hard to keep your carbs under 20 grams per day, and if you can get about equal amounts of fat and protein (in grams) or slightly higher on your fat, you’ll be good.  Try to steer clear of artificial sweeteners or even zero calorie “natural” sweeteners like stevia and erythritol for the first week.

During that first week, watch the first few days to see if you’re losing water weight.  Are you going to the bathroom alot?  Are you losing what seems like a ton of weight (maybe five pounds or more in the first 2-4 days)?  Do you FEEL any different?  Even if you wouldn’t describe the feeling as “good”, is it different?  In the beginning, as your body gets used to using fat for energy, there’s going to be a transition period.

You may experience some odd symptoms like headaches (your brain saying, “hey, where’s my glucose”) and such.  Don’t let that stop you or bother you.  It’s normal.  More importantly, it means you ARE actually transitioning into ketogenesis.  If you are NOT seeing any of these symptoms (massive weight loss, frequent urination, strange, possibly flu-like symptoms) then, chances are you’re consuming too much carbohydrate.

Realistically, if you simply keep your carbohydrates really low, even if you don’t consume a ton of fat, your body will STILL have to prioritize fat for energy, because there won’t be enough carbs to sustain you.  It will simply tap almost entirely into body fat for that energy, rather than a combination of body fat and dietary fat.  So, the number one most important thing is to keep the carbs way down.

From that point forward, it’s all about results.  Once you see that you are experiencing the symptoms of ketogenesis, you’ll start to feel brain fog lift, you’ll have good amounts of energy (and much more STABLE amounts of energy because you won’t be on the carb roller-coaster).  Weight loss will continue, but the rate will be somewhat determined by how many calories you’re consuming (there won’t be massive water weight loss anymore).

Even on keto, if you’re getting enough calories in your diet to fully sustain your daily activity, you won’t really lose any weight.  You still have to be in a calorie deficit in order to lose weight.  It’s just much easier to do so when your insulin levels are really low, which they will be on keto.

So, don’t let calories and macros run your life.  It’s not worth it.  It’s too stressful.  Keep the carbs down.  Keep the calories down.  Try to eat roughly equal amounts of fat and protein (or maybe just a bit more fat), but don’t worry about eating tons of “fat bombs” and bulletproof coffee and such to keep your fat levels high.  It’s actually not that important unless you have really low body fat.  Then, if you want to stay keto, you really DO need tons of fat in your diet, but most of  us are not there yet.

What If the Results Taper Off?

Honestly, this will happen from time to time.  Sometimes it’s just a temporary “stall” that will generally release on it’s own.  Be patient.  If you’re pretty sure you’re still “getting it right”, just be patient.  Of course, if you’ve gone a full week and you don’t “feel” like you’re in ketosis and/or you’re not losing any more weight, then it may be time to take a deeper look to see what might be “off”.

Check for hidden carbs.  Maybe a new type of food you’ve started eating recently that you THOUGHT was low carb, but maybe it’s not.  Take a look at low/no calorie sweeteners you’re using.  Have you increased the amount your using?  Did you switch types or brands?  Maybe the brand you switched to has some added ingredients that are supplying carbs.  Maybe you’re body is not responding the same to a new TYPE of sweetener.

Were you exercising before and now you’re not?  If so, maybe the exercise was allowing you to eat a bit higher carb content than you can if you’re not regularly exercising.  As a result, since you’re not quickly burning off those extra carbs, they are stalling your ketosis.  Take another look.

Maybe you’re simply getting too many calories.  When you’re not actually counting calories, sometimes you can fall into a pattern of overeating, just because the food tastes so good.  Seriously.  Although I’ll admit there are times when something full of carbs catches my attention, generally speaking, I LOVE keto food.  I really enjoy it.  So, out of sheer enjoyment, you can overeat on keto.  So, if you’re in a stall and you don’t see any other issues, chances are you’re eating too many calories.

Intermittent fasting can be a great help in this area.  If you confine your eating window to just 4 to 6 hours each day, it becomes REALLY hard to overeat.  Imagine trying to cram 2500 calories into a 4 hour window?  It can be done, but you’d be eating way more than would be comfortable.  So, if you only eat 4 hours per day.  Maybe two meals spaced 4 hours apart, you’ll likely be getting fewer calories than your body needs, so you’ll be burning body fat.  Simple as that.  I.F. can REALLY simplify things.

This Was a HUGE Post, But Maybe I Missed Something

If there is something you feel like I haven’t covered here that you’d like me to, let me know in the comments below.  If enough people indicate that they are interested in the same information, and it seems relevant to this article, I’ll update it.  Promise.

And, of course, if you are more knowledgeable about the ketogenic diet than I am and have information to contribute or corrections to the above, I’d love to hear what you have to say as well.

Let me know.