At the bottom is an addendum to this article (originally published May 28th).
Also, Jimmy Moore, of Livin’ La Vida Low Carb, has posted his very interesting report of the first 30 days of his trial of using blood ketone testing and I’m sure interest is going to rise quickly.
Testing Blood Ketones to Monitor Nutritional Ketosis
A number of people who follow a low-carb lifestyle have become interested in testing blood ketone levels. The reason for this is that the amount of ketones that show up on urine testing tends to drop over time as your body adapts to burning ketones for fuel. This makes following your urine ketone level (urine dip sticks for ketones) of limited value.
If you are eating low carb, you may be surprised to find that your level of blood ketones is much less that you expect. The old “people are so different” game. This matters if being in ketosis would be helpful to you personally for your fat burning and your appetite/satiety balance. If your health is fine without dropping your carbs (actually total carbs plus some limit on protein) down far enough for ketosis, then going this extra mile isn’t something that you necessarily need to do to thrive.
It also matters if you are wanting to be in ketosis for some of its other known or proposed medical benefits (such as seizure control) or its benefits in athletic performance.
If you ketones are not in the range that you’d like, the first things to think of are (1) are you having more carbs than you thought and (2) should you cut back a bit on protein, though keeping in mind that adequate protein is essential?
If that’s not the answer, perhaps your liver is just pumping out too much glucose. This happens when the liver becomes “insulin resistant”. Yes, your liver can become insulin resistant just like your muscles can. This effect is noticed most in the mornings. If you are not yet diabetic or heading into pre-diabetes, this may be happening without necessarily showing up as a notable rise in blood sugar (glucose) level if you still have enough insulin effect to clear the glucose from the blood.
If you are eating low carb, you also will have more ketones with greater activity or exercise levels. There are also medications and medical conditions that could be a factor. This area of science has not received enough research attention to say that we understand it very well, yet.
If you consume a significant amount of medium chain triglycerides (MCT), such as tablespoon amounts of coconut oil, you will have some ketones in your blood that are produced directly from those medium chain triglycerides that you have just eaten, whether you are truly “in a ketogenic state” or not. This is too much to explain properly in this post, so I’ll write on this topic another day.
If you are at all interested in doing this yourself, you will need to put some time and effort into learning about this topic. You would need to thoroughly understand the safe and effective use of low carb dieting and the ins and outs of nutritional ketosis.
If you are considering low-carb eating for yourself, especially at the level of going into ketosis, you must discuss this first with your doctor as (1) there may be reasons for you that this might be a bad idea or a bad idea at this particular time, (2) you may need some testing before and during and (3) you may be on medications that could have very dangerous and potentially lethal effects if the medications are not or cannot be adjusted or changed before and during the transition. You may need frequent medical follow-up in the first days and weeks for adjustment of medications and medication dosages. This is an interesting problem, when you think about it. Your health may improve so quickly that you could actually be killed by the medications you take because those medications are to help you with problems you no longer have.
The book to read that is most informative about nutritional ketosis is The Art and Science of Low Carbohydrate Performance by Jeff S. Volek, PhD, RD and Stephen D. Phinney, MD, PhD. The price is more than reasonable ($8.95 on amazon and no I have absolutely no commercial ties or links). (Update: now available in Kindle format for $5.99)
One of the speakers at the Nutrition and Metabolism Society meeting in 2011 was Dr. Adam Hartman, who is an expert in the use of ketogenic for the control of epilepsy in children. He made an interesting comment on the timing of testing for ketones. When eating the typical mixture of foods that people normally consume in our society (a mix of proteins, carbohydrates and fats), ketones are highest in the morning. This makes sense because the least flow of carbohydrates in from the digestive tract is overnight, so the body burns some fat in the night. When eating a ketogenic diet, on the other hand, the most exposure to carbohydrates is overnight especially towards morning as the liver produces glucose to keep your brain fueled and to prepare you for getting up. Therefore, if you are eating a very ketogenic diet, the blood ketones go up during the day as you burn more fat for fuel.
Regarding testing blood ketones, the following refers to the blood ketone test strips for the Abbott Precision Xtra (Medisense). These come in a box of 10 strips.
Please note that the shelf life of these strips is not long (I don’t know the details) so please be aware of this before ordering a large number of testing strips or before buying from a source you don’t have confidence in. An expiry date will be on each box and a lot number.
For people in Canada, the first place to turn to is your local pharmacy. I bought mine at London Drugs (a major chain) over the counter for $20.00 per box of 10 strips. I checked their on-line ordering site, and they do not offer these strips for on-line sale. I didn’t shop around to compare price, so I am not advocating London Drugs over any other store.
People in the US face prices for these testing strips that can be quite high and also people in smaller towns may have difficulty getting testing strips locally. I did some looking around on-line.
Also, of course I can’t vouch for any company on-line or not. You have to look into any company or on-line seller and make a decision for yourself.
I am just reporting what I have found on-line. I have no idea whether these are good companies (or even real companies) or not. Exercise caution.
A significant factor in cost could be the shipping fees, so you might want to take that into consideration, not just the price per box.
Well.ca offers at this link a box for $24.29 USD ($2.43 per test strip)
CanadaDrugs.com lists, at this link
- $32.42 USD (May 28/12) for box of 10 ($3.24 per test strip)
- for 3 boxes or more (30 test strips or more) this drops to $2.49 per test strip
Universal Drug Store offers at this link a box of 10 for $19.99 USD ($2.00 per test strip)
There may be other sites that are as good or better, this is just what I found with about 20 minutes of checking.
I am not advocating that you purchase from any of these sites or that these sites will link you to a reputable business. Buyer beware.
If you come up with something better, please let me know.
UPDATE June 14, 2012
My Abbott Precision Xtra (Medisense) is my new BFF. Turns out I really do need the ketosis (at least for now) to have a reasonable time with appetite and I was not reliably achieving that with my low carb eating. Despite carbs total about 15 g most days (1-2 times a week up to perhaps 25 g) and protein most days about 90 g (some days about 100 g), I was not getting a good level of blood ketones. My fasting ketones were 0.4 mmol/L to 0.6 mmol/L and late afternoon ketones 0.9 mmol/L to 1.1 mmol/L. I have cut back a bit on protein and added some MCT oil. It will be a while to find my best balance, but I feel an effect on appetite with my ketones in the range from about 1.5 mmol/L to 3.2 mmol/L. Above that I feel a bit tired and out of focus.
It will take some time before there is much collective understanding about the hows and the whys of using blood ketone testing for insight into low carb eating and its benefits. People will have to put their heads and their experiences together. Also, we have to avoid jumping to conclusions too soon, based on only a few people’s experiences.
Addendum July 18, 2012
When I originally wrote this post on May 28th and when I composed the update on June 14th, the book “The Art and Science of Low Carbohydrate Performance” was not available in Kindle format. It was released in Kindle format on June 15th. The price is a paltry $5.99 for this excellent book packed with useful insights into low carbohydrate nutrition.
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