Hello! I began a paleo diet 2 weeks ago and am seeing steady but slow results. Walking through Walgreens today I stumbled upon a blood glucose monitoring system that also measures ketones in the blood! After doing some online searches, it appears this is a more accurate test than urine (sorry no links...). Only problem is, it's geared towards diabetics so I cannot for the life of me find the reference ranges for ketosis, only ketoacidosis.
This is the ketone guide, as printed for diabetics:
below 0.6 mmol/L - normal
0.6-.5 mmol/L - risky
above 1.5 mmol/L - potentially hazardous
The test I did came up as 3.5 mmol/L. Can anyone help me interpret this for ketosis? Is it just simply the reverse? The higher the better? I don't want to assume anything. Thanks! Looking forward to my new lifestyle!
I'm glad to see somebody here bought a home blood ketone meter! I used to recommend them here and on other forums, but I stopped because nobody ever listened.
My ketone meters are Precision Xtras (I own three). Until recently the Precision Xtra was the only home ketone blood meter on the market. This is the first time I've heard of the Nova Max.
Here's an article I wrote last year about the Precision Xtra:
You mentioned references; there are plenty in that linked article.
I don't think you need to worry about pathological ketoacidosis. It occurs as a result of disease (e.g. diabetes or alcoholism). I can't find any mention in the literature of it happening to healthy people as a result of diet or fasting, no matter how high their ketone levels climb.
If there were any danger of ketoacidosis in healthy people, I would expect to find it mentioned in Epilepsy and The Ketogenic Diet by Strafstrom and Rho. This is the standard medical textbook on keto diets. It has extensive sections on biochemistry and clinical applications. The book doesn't mention ketoacidosis (I searched a PDF version).
If there were any risk of ketoacidosis, another place I'd expect to see it mentioned is a terrific review paper on fasting from 1982 called "Fasting: The History, Pathophysiology, and Complications" by Kerndt et al. This paper reviews 175 earlier papers on fasting and tabulates every medical complication that had ever been reported. It doesn't mention even a single instance of pathological ketoacidosis.
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Like all home meters, when you use the Precision Xtra to measure glucose, it's not very accurate. But when you use it with ketone strips to measure beta-hydroxybutyrate, it's a whole other story. The Xtra's ketone strips are incredibly accurate. The Xtra's ability to measure blood ketones has been evaluated about a half dozen times in peer-reviewed scientific publications, and it has been repeatedly found to be very nearly as accurate as reference lab equipment costing many thousands of dollars. It's an incredible little machine.
Any device of this type is probably more accurate than urine strips because urine strips don't measure the thing we're interested in, which is the concentration of ketones in the blood. Moreover, urine strips don't measure urine ketones accurately, and they have a truncated range ... purple is not a very high level, but that's the highest they go.
Maybe the Nova Max is as accurate as the Precision Xtra. I don't know.
In order to evaluate your 3.5 mmol/L number exactly we'd have to know two things:
What substance does the Nova Max measure? Is it beta-hydroxybutyrate? There are three different ketones; beta-hydroxybutyrate is one of them.
Is it reporting a plasma or whole blood number?
I'll assume your machine measures beta-hydroxybutyrate and reports in terms of plasma. That's how the Precision Xtra works.
3.5 mmol/L is a pretty high number. But to put it into context, I've gotten as high as 7.7 on a clinical ketogenic diet -- in other words, I was getting ninety percent of my calories from fat.
If you're trying to lose weight, I think 3.5 is a fine number. Ketosis of that level and higher often suppresses appetite and you may be able to get yourself into a virtuous circle where your appetite gets so low that you practically stop eating, in which case you'll be in high ketosis, which suppresses appetite... around and around. Nutrient-dense foods like eggs and liver and kale are your friends if that happens.
If you're not trying to lose weight, I'm not sure 3.5 is healthy over the long run. I've been at that level or higher for a year and a half in order to control my migraines, and I don't like it. My gut feeling is that it's not healthy. I'm only doing it because of my headaches.
There's a lot of scientific literature about the effects of long term ketosis on kids, but very little about adults.
I would watch for any of the following warning signs and reduce the level of ketosis if they appear.
You can reduce the level of ketosis by eating a spoonful of rice syrup mixed in water. I do this a few times a week whenever my ketosis feels too high. The doctors who prescribe keto diets for children tell them to use orange juice for this purpose, but I think rice syrup is healthier since it metabolizes to nearly pure glucose.
Lethargy, listlessness, fatigue.
Dry mucus membranes.
Impaired immmune system.
Elevated or irregular heart beat.
A feeling of stress or fight or flight response.
Severe orthostatic hypotension (the feeling that you might faint when you stand up suddenly).
Another thing to consider is that clinical ketogenic diets have been shown to increase the risk of kidney stones by a pretty large factor. Doctors often prescribe huge amounts of potassium citrate to kids on clinical keto diets as a precaution. My urologist told me the best precaution against kidney stones is to drink lots of water so the urine doesn't become concentrated. I don't know if this is an effective precaution against the type of kidney stone associated with ketogenic diets, but I've been following my doctor's advice for the last year and a half and so far it's working, despite my history of kidney stones.
I was actually going to comment on Rob's post, but it ended up being pretty long, so I will answer here.
First, I have to second Rob. I have found the urine strips to be essentially useless, and I am glad he put me on to the Precision Xtra, which I've owned for three weeks. One of the best purchases I've ever made. No more guessing. Guessing is for amateurs.
3.5 mmol/L ß-hydroxybutyrate is most definitely ketosis, but not an immediate danger to someone who is not a diabetic. As I have quickly discovered, the body absolutely hates being in ketosis and will use any and every excuse and opportunity to get out of it, because it is essentially a starvation state. For a diabetic, a level above 1.5 mmol/L may be an indicator of runaway ketoacidosis, and would demand action. For a healthy non-diabetic, the system takes care of that for you.
A ketogenic diet is a sort of "bait and switch": reducing caloric intake so that the body starts reaching for stores, then feeding with fat exclusively, leaves the system no alternative.
This state is very difficult to maintain.
I was able to get myself to a about 3.5 - 3.7 mmol/L, but it was not easy, and pretty soon I started having some of those symptoms Rob listed. For one thing, my blood pressure dropped (hooray) and I started having dizzy spells (boo) when I stood up (orthostatic hypotension). I also felt like I'd been run over by a truck. Maintaining my weight was a herculean struggle. I was never hungry and after two weeks couldn't stand the sight of food (or maybe I should say fat, since that was just about all I was eating by that point).
This makes getting adequate nutrition hard, which is why I would say that for most people, ketosis is probably not something you want to sustain over the longer term. For some people, like Rob, it's the only thing that has worked.
I will definitely say that my mind has never been clearer than while in ketosis. Emily Deans has written about the benefits of ketosis for the brain, and ketogenic diets have been used to treat a variety of neurological conditions, not least being epilepsy.
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