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Ketosis & Measuring Ketones

Following my recent post about carbohydrates, I've put together what I consider to be the most important facts about ketosis and measuring ketone bodies.

Ketosis vs. Ketoacidosis

Ketosis is a state at which your body produces ketones in the liver, shifting the body's metabolism away from glucose and towards fat utilisation. The presence of ketones in your body, which is indicative of lipolysis, is a definite proof of ketosis. According to Volek and Phinney in their best-selling book "The Art and Science of Low-Carbohydrate Living", nutritional ketosis is defined by serum ketones ranging from 0.5 to 3.0 mM.

The frequently asked question is whether ketosis is dangerous. Ketosis is not only a great weight loss tool, but it has been used for treating diseases such as epilepsy, Alzheimer's or cancer. You can check out my post here to see more about health effects of ketogenic diets with links to relevant research.

While nutritional ketosis is perfectly safe, ketoacidosis is an indicator of serious health problems. Ketoacidosis occurs in serious health conditions such as type 1 and type 2 diabetics and alcoholics and has nothing to do with nutritional ketosis. The level of ketones in ketoacidosis are 3-5 times higher than in ketosis resulting from a ketogenic diet.

Nutritional ketosis occurs when blood ketones are 0.5 to 3.0 mM. This is completely different to urinary ketones, as they may be higher or lower.

4 Ways to Measure Ketones

There are three types of ketone bodies: Acetone, Acetoacetate and Beta-Hydroxybutryate (BHB). Unlike protein intake, where the daily amount is determined by your lean mass weight, the amount of carbs to enter ketosis can be estimated using:

1) Blood ketone meter

It's the most accurate way to measure ketone bodies, beta-bydroxybutryate (BHB, although not technically a ketone body). Blood ketone meters can precisely determine the level of ketones in your blood but they are also pricey. To give you an idea, the meter itself is about $40 and the test strips cost $5 each. If you want to test yourself daily, it will cost you $150 per month plus the cost of the meter. I don't know about you but I'd rather spend it on quality food or a gym membership. On the other hand, if you are on the Restricted Ketogenic Diet and numbers matter to you, a blood ketone meter may be the best and only option you have.

Ketostix (urine test strips) vs. Blood ketone meter

2) Breath testing - "Breathalyzer"

According to Volek and Phinney in The Art and Science of Low-Carbohydrate Living (chapter 13, Ketones - To Measure or Not), a non-invasive and cheap alternative is to measure breath acetone concentration. Acetone is one of the ketone bodies that results from a break down of acetoacetate.

The Ketonix Acetone Breathalyzer is available and offers an easy and inexpensive way to test your breath ketones (acetone). Keep in mind that breath ketones do not always exactly correlate with blood ketones and are affected by several factors (alcohol consumption and water intake). You can find my review of the breathalyzer here.

3) Urine ketone strips

Ketostix, Uriscan and other urine detection strips are not as accurate and may not work for some people. They only show excess ketone bodies excreted via urine (acetoacetate) but tell you nothing about the level of ketones in your bloodstream (BHB) which is most probably higher.

Some people use them to test if they are sensitive to certain foods that may be keto-friendly but still have a negative effect on their weight loss. They are easy to use and fairly cheap. You'll pay about $10 for 50 strips, that's $6 a month if you test yourself daily. If urine detection strips don't work for you, use one of the other two methods.

4) Observation

Listening to your body's signals is another way of finding out whether you are in ketosis. When your body is in ketosis, you may smell of acetone. This could be sensed in your breath, sweat or urine. Some people refer to this as ketogenic "fruity" smelling breath. If you detect any of these signs, you are more than likely in ketosis.

Why are Ketostix Inaccurate?

As mentioned above, although your body may produce ketone bodies which you can measure in your blood stream, Ketostix only show excess ketone bodies excreted via urine. These excess ketones are, in fact, wasted calories. Below are the main reasons for different level of ketone bodies in your blood and urine:

  • Ketostix don't measure all types of ketones produced by your body. Although there are 3 types of ketones (acetone, acetoacetate and beta-hydroxybutyrate), they only measure acetoacetate. Depending on how long you have been in ketosis, your body produces different types and amounts of ketones and you may not be able to detect acetoacetate when keto-adapted. For more details, check out this post at Ketopia.com.

  • As you become keto-adapted (3-4 weeks), you will excrete less ketone bodies via urine. This means that you may show high blood ketones and low or none urine ketones.

  • Also, changes in hydration affect the concentration of ketones. A high water intake may dilute the concentration of ketones in the urine. Because it's important to stay hydrated, you will likely see lower readings.

  • Other reasons (fluctuations that appear after waking up, after eating and post-workout)

More Ketones, More Fat Loss?

Most people believe that in order to lose as much fat as possible, they need to restrict their carbs intake as much as they can. I've already explained the main effects of a low-carb, ketogenic diet.

Currently, it's not clear what the full effect of such carbs restriction is. Some diet authors, including Atkins himself, supported the idea that more ketones equals more weight loss. The reasoning they gave was that ketones are, in fact, calories which are made from the breakdown of fat in the liver. Is that really a valid reason?

Although some fat loss may appear as a result of a potential "metabolic advantage" (more ketones / calories excrete), the most important factor for fat loss is natural appetite control. While urinary ketone excretion means that body fat is being excreted causing fat loss, the effect is minimal: Based on recent studies, the number of calories lost in the urine as ketones is not significant (100 kcal at most).

Anecdotally, higher levels of ketones may actually slow down fat loss. Individuals who maintain lower ketone levels (trace ketones) appear to lose fat more efficiently. Why does that happen? One explanation may be that high levels of ketones in the bloodstream may slightly raise insulin and block the release of free fatty acids from fat cells.

Also, when becoming keto-adapted, some individuals tolerate relatively greater carbohydrate intakes without disrupting ketosis. It's up to you to find your optimal carbs intake. As I've explained above, more ketones won't help you burn significantly more calories - no studies show such effects. As long as you stay in nutritional ketosis (0.5 to 3.0 mM), moderate amounts of carbohydrates can be added to your diet.

If you want to know more about ketone levels and their effect on fat loss, have a look at this post: Do Ketones Matter?

Don't Focus Just on Ketones, See the Big Picture

Recently, I've noticed a growing obsession when it comes to measuring ketones precisely. Although urine detection strips may not be accurate for keto-adapted people, they work for most of those that have just started the ketogenic diet. By the time they become keto-adapted, which takes 3-4 weeks, most of them understand what to eat and what to avoid without any real need to measure the precise level of ketone bodies.

I've been in nutritional ketosis on and off for almost two years and can't really complain about urine strips. I don't personally need to track exact numbers because it won't make a difference to me. When I started, I used Ketostix to find out when I was in ketosis and what my net carbs limit should be. These days, my daily net carbs intake varies from 30 to 60 grams depending on how active I am.

My advice is that you should give Ketostix a try. If you need to keep track of your ketone levels, use a blood ketone meter or the breathalyser. In the end, what really matters is not ketones but the effects of low-carb diets: weight loss and improved health.

More Diet Tips

  • Generally, ketone concentrations are lower in the morning and higher in the evening. Whatever time you pick to measure ketone levels, make sure to keep it consistent. Also, do not measure your ketone levels right after exercise. Ketone levels tend to be lower while your glucose levels higher so you won't get representative numbers.

  • Keep in mind there are daily fluctuations caused by changes in hormone levels. Don't get discouraged!

  • Another aspect that affects the level of ketones is the amount of fat in your diet. Some of you may show higher concentration of ketones after a high-fat meal. Coconut oil contains MCTs that will help you boost ketones.

  • To easily increase your fat intake on a ketogenic diet, try fat bombs - snacks with at least 80% fat content.

  • Ketone levels tend to be higher after extensive aerobic exercise as your body depletes glycogen stores. Exercise may help you get into ketosis faster.

  • ketogenic "fruity" breath is not pleasant for most people. To avoid this, drink a lot of water, mint tea and make sure you eat foods rich in electrolytes. Avoid too many chewing gums and mints, as it may put you out of ketosis; there may be hidden carbs affecting your blood sugar.

  • Increase your electrolyte intake, especially potassium. You are likely going to lose some sodium and potassium when switching to the keto diet.

  • Finally, if you find it hard to lose weight on a ketogenic diet, there may be plenty other reasons than the level of ketone bodies: Not Losing Weight on Low-Carb Ketogenic Diet? Don’t Give Up and Read Further.

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Comments (187)

Hi,
I'm being doing LC about 7 months now and have lost a lot of weight. When I first started my mmol reading were in the optimal range between (1-3 ). This last while my readings have been between 4-5 mmol, wondering why? Does it increase because I've increased carbs? If I limit carbs more will my readings go back into the optimal range? I still have some weight to lose so i want to do whatever it takes to do this. Also, if my readings are at between 4-5 mmol, am I losing any weight at all? Tks so much!

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Hi Sharon, adding carbs would cause a drop in your ketone levels so it's likely something else (eating fewer carbs, using MCT oil, exercise, etc). I don't think you should worry about optimal ketone levels, especially if you're doing well. Here's more about ketones: ketodietapp.com/.../do-ketones-matter

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Hi,
I have one problem and i need help. My blood ketones no matter what i tried are not above 0.4 but in the same time urine strips are dark purple.
My macros are fine, diet is in check, working out 3-4 times a week....
please help

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Hi Fran, have a look at this post, I hope it helps: ketodietapp.com/.../do-ketones-matter

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Is there any information out there concerning the rate at which blood/sugar will decline? I started the keto lifestyle two weeks ago, and my blood/sugars have dropped from 250+ (extremely high) to an average around 125-136(depending on when I take my reading). I know I've experienced some side effects, hypoglycemia (had a little peanut butter to bump my sugars up a tad, took care of that), a couple of days of splitting headaches, lethargy, and am enjoying constipation as we speak. Any information or links to websites would be greatly appreciated.

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Hi Michael, I don't know what the rate is but your blood sugar will decrease if you follow a low-carb diet. Some people experience elevated blood sugar on a low-carb diet but it's usually just a temporary effect during the initial phase and doesn't get to "unhealthy" high levels.
If you experience hypoglycaemia, it's better to avoid intermittent fasting (or any type of fasting) and apart from 2-3 regular meals, try adding 2-3 snacks. Make sure you are getting enough electrolytes (that will help with headaches and lethargy): ketodietapp.com/.../Keto-flu-and-Sufficient-Intake-of-Electrolytes
For constipation, try magnesium citrate (I like Calm - you can try this drink: ketodietapp.com/.../beat-keto-flu-with-homemade-electrolyte-drink) and stay hydrated. In my experience, coconut oil and eating enough non-starchy vegetables can also help with constipation.

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Hi there.  I have changed over for almost 10 days now.  My ketostix show I am anywhere from small to medium amounts.  I got the keto blood metor and while I tested 0.7 a few days ago late morning, I was curious to text today first thing this am.. I am 0.4mmol and just wonder if this is OK and if I will still reap the rewards of ketosis as I am on a strick diet.  I know it there are fluctuations through the day.. but do you need to be 0.5 mmol or higher at any given time to reap benefits.. what happens if you are mostly over 0.5 bit in am under?

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Hi Melissa, yes, if you test your ketone levels, it's better to do it same time of the day. Ketone levels are naturally low and increase during the day (with peak levels in the evening before bed).Plus there are other factors (activity level, diet, time of your last meal before measuring and macronutrient composition, etc). That small difference is likely just a reflection of natural daily fluctuations. You don't actually need to be in ketosis all the time - have a look at this post for more details: ketodietapp.com/.../do-ketones-matter

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Hi, can my period affect ketone production? As in lower it? I have bbeen successful in producing ketones above 3.0 on a LCHF diet for 2 months now however whenever I get my period I fall out of it with reading at around .1
I feel like Im failing at these times but unsure of the reason? I honestly do not eat anything extra than I would normally when achieving ketosis. Thank you.

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Hi Rach, yes, your monthly cycle can indeed affect ketone levels (due to the shift in hormone levels). Have a look at this post (you may not need to aim for high ketone readings): ketodietapp.com/.../do-ketones-matter

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I am a type 1 diabetic. Endo says this is working great for me so far. Reduced insulin in half! Just checked ketones with urine strip. I'm a little dehydrated. They are at a 5.blood sugar is normal. I'm on day 24. Should I be concerned with a reading of 5?

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Hi Carrie, firstly, well done on reducing your insulin! If your test results are fine, there is nothing to worry about. Since you are a type 1 diabetic, make sure you discuss your diet with your doctor and get monitored. Urine test strips are inaccurate and I wouldn't rely on the numbers. If you want to get accurate results, try a blood ketone meter (same as blood glucose meter, just different test strips for monitoring ketones).

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I don't understand what a Keto is

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Hi Kirsten, here's all about keto & how to start: http://ketodietapp.com/Blog/page/Start-Here

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Great website,
I am just beginning keto diet and you supply a wealth of information
Thank you

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Your assertion that ketoacidosis only affects those with diabetes and alcoholism is absolutely false.  There are a number of rare metabolic disorders that can cause ketoacidosis, including glycogen storage disease and ketotic hypoglycemia.  

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Thank you for your insights, I listed the most common cases but I'll remove the "only" from the sentence. The purpose was to distinguish nutritional ketosis from ketoacidosis.

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Thanks for your article and explanations. I slipped into ketosis by lowering my carbs to my comfort zone and increasing animal fats, also to my comfort zone, so at first I did not know I was in ketosis until the signs appeared: headache and cramps, which I took care of right away (salt and water) and have been in ketosis now for 3 weeks very comfortably. I am loosing inches since not much weight to go--more just burning the fat and being full of energy--both mental and physical.
I have a question: I just had a bunch of blood tests (my triglycerides went from 172 to 76 in 3 months! Wow good!) but not sure I understand the urine test. The medical place also took that specifically for ketones--they are guiding me in my ketogenic diet. So the questin is if the 20(1+) that showed in the urine is the 20 I see on my Ketostix? (I see 15 small and 40 moderate so 20 would be in between.) Is that what the lab urine test also shows? And what is the (1+) in that?
I tried to find the explanation on the test result explanations but this is not noted. While I do have the blood testing kit, I have not used it yet since the strips are so pricey but my doctor ordered beta hydroxybutyrate test--I don't yet have that result. I guess it would be good to know some number ranges for the blood test. Do you have any information on that to share?
Thank you,
Angela a Stanton, PhD

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Those are amazing results Angela, well done!I I wouldn't trust the numbers on Ketostix - I would only use them to see how my body reacts to foods and whether I am in Ketosis, and only for the first few weeks. Ketostix will become less accurate as your body gets keto-adapted.
If you really want to track ketone levels, a blood ketone meter is much better (although pricey) for that. After years of following this diet, I only use it occasionally or when I want to "test" the effects of some foods which is always different for individuals.
While Ketostix measure acetoacetate, blood ketone meter measures beta-bydroxybutryate which is what you want to monitor. Keep in mind that BHB levels fluctuate during the day and only home monitoring would be useful.
Here is another way to measure ketone levels (less expensive and fairly accurate): ketodietapp.com/.../how-to-use-the-ketonix-breathalyzer

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Hello,
I wanted to thank you profusely for your site. Two years ago, right before taking a new job in Arizona, several suspicious spots were detected in my liver and kidneys, and one in my lower left lung. In addition, I had a fatty liver. Since both parents had died with cancer, I was told there was a good chance the spots might be cancerous.
I remembered reading online several years earlier about three studies by three different universities on how a ketogenic diet had cured most of the stage four cancer patients who volunteered to participate in the study, so I went looking for ketogenic diet information and found your great site.
I began a ketogenic diet two years ago after I got settled in Arizona, and by the end of the first year, I had dropped 5 dress sizes without really trying. I was able to walk to work and back, a total of two miles per day, and walked about everywhere else in my small town, too, which probably added another several miles per week, but that is all the excercise I was able to get...very busy schedule.
When I went for my yearly physical at the end of that first year of the ketongenic diet, the doctor could find no spots anywhere in my body! I was estatic! I am not saying infinitvely that the diet cured my possible cancer spots, but it sure went a long way to getting me back to good health, and to shrinking my enlarged liver back to health, and who knows if that isn't a cure in cancer in itself, right?
So just wanted to thank you for caring enough to post about this diet. It could have literally saved my life.
Marsha

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Thank you Marsha, I really appreciate that! That's truly amazing, well done!

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Hi! It has been 2 weeks I have been on keto diet. I think I am on 75% fat, 20-25% protein and 5% carbs. I checked my serum ketone on the 7th and 14th day but the tests show its negative. I was assuming by now there will be ketones in my blood. Initially, I lost a few kgs and I think its stagnant now. Does this mean the diet is not working for me?
FYI, I have been on low calorie diet for the past 10 months before starting keto and I have been engaging in intense cardio and weight training for the past 11 months.

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It doesn't mean that it's not working for you. It depends when you measure your ketone levels - they are usually lower in the morning and after a meal. Have a look at this post for more details (too much exercise, low-calorie diets, etc. can all negatively affect weight loss): ketodietapp.com/.../how-to-low-carb-15-common-weight-loss-mistakes

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Hi Martina,
I'am keto adapted and I got MS when do you think I'll feel any increase of my multiple sclerosis?
Thanks.

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Hi Geraldo, I'm not an expert when it comes to MS but have a look at the list of experts here: https://ketodietapp.com/Blog/page/low-carb-experts

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Can you tell me what range in the Ketonix is equivalent to (0.5 to 3.0 mM) as measured in the blood test? I am currently running around 50 with the Ketonix meter and not sure if I am in nutritional ketosis or not.
Thanks

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Hi Jennifer, have a look at my review of the Ketonix Breathalyser: ketodietapp.com/.../how-to-use-the-ketonix-breathalyzer (anything from green to yellow and red - it also depends on the setting).

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Hi,
I just started this on Monday 4/11/2016. I've changed my diet and am eating no more that 30 net grams of carbs 90 grams of protein the rest of my 1400 come from fat. I've been using recipes from rule.me for snacks and food ideas. So far so good. I just got my blood test meter with my keto strips. I tested this evening 4/16/16 around 7 pm and got a .4 reading. My question is, Is that good? Or should it be higher at this point? I plan to test every two weeks and use ketostix in between. I just want to know if I'm on the right track.
Thank you.

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0.4 is quite low for evening numbers (they are usually higher) but I'd give it a few more days. Also, have a look at this post: ketodietapp.com/.../do-ketones-matter

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Hi! I was wondering if there is a way to really know if I am in ketosis without any strips, etc. I live in Argentina and this products are not available. Thanks!

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Yes, it is possible but may be tricky if you are new to the diet. Make sure you stay within the recommended daily carbs and you should be fine.

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Hi Martina,
I'm a type one diabetic wanting to do the keto diet. My question is as a diabetic high blood sugars cause DKA but would having high ketosis make my blood sugars higher or are they unrelated? Thanks!

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Hi Aaron, I don't think that increased ketone levels would increase glucose. However, since you are a diabetic, you will need to get your medication adjusted - talk to your doctor before following the diet.

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Hi I have been on the low carb diet for about two months now, I am 214lbs and have only lost 11lbs since being on the diet. I am getting very discouraged because my ketosticks were showing me levels between the moderate to large ketos levels. I don't understand why I am not losing weight. I am using the Myfitnesspal to track my daily MACROS but I am to the point that I really want to give up! I am not getting the results I was hoping for!

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Hi LaShawn, please, check out this post: ketodietapp.com/.../how-to-low-carb-15-common-weight-loss-mistakes

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I just did my first test with the blood ketone monitor. My read was 3.3. In the chart, that says starvation Ketosis. What can i do to bring it down a little? How will this negatively affect me weight loss? Just fyi- my daily averages are are 65% fat, 25%protein and 10-12%carbs. I eat an average of 1700 calories a day.

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I think that values up to about 3 are fine and even if it's more, you won't need to worry (provided you are not a diabetic). It's just that there are no additional benefits of high ketone levels. Some people have naturally high ketone levels and they also vary depending on how long you've been following the diet. Usually, when you start, your levels will be higher simply because your body doesn't utilise ketone bodies as well as someone who is keto-adapted.

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Hi Martina,
I've been trying to follow the ketogenic diet for two weeks now. i am male, 170lbs and a 175cm tall. my macros are as follows :
fat 167 grams ( 85% )
protein 46 grams ( 15 % )
carbs 22 grams ( 5 % )
this is about 1807 kcal
this morning i used a glucometer ( one that tests for ketones as well ) and test both my blood glucose and ketones.
my blood glucose was 4.3mmol ( which i know is a good reading right? )
but my ketones was way up there at 5.9mmol
What should i do? should i be worried?
thanks,
ben

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Hi Ben, this is indeed an unusually high number, especially for morning - how do your night (before bed) values look like? In case of ketoacidosis, you would also have high blood glucose so I don't think this is the case.

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Hi! I've been doing the keto lifestyle thing for 5 weeks now. My preferred version is intermittent fasting (Bulletproof style) low carb, medium protein, higher fat. So mostly no food between 8pm and 1pm the following day. I do have the butter coffee in the morning around 8am. Total cals most days between 1200 and 1500, and I scrupulously maintain hydration levels. I find it hard to reach the desired levels of cals and if I eat to appetite, only get around 700 total. So I really have to work at it as I am NEVER hungry. Carbs vary but most days less than 50g, completely gluten free. Protein averaging 75 grams. Fat varies, 70-110ish. Not hugely active at the moment but increasing.
I know that urine lipsticks are not accurate, but I use them to track pH and specific gravity, as well as ketones. I test the same time every morning, and find myself at the highest rating on the dipstick (deep red). Yesterday, as an experiment I ate a Nutella cupcake on top of my usual carbs, and this morning had the same urine result (deep red). My goal is weight loss, I have a lot to lose.
My concern is the consistently high levels of urine ketones. Even on a day when I got 70g of carbs. Is this likely to be the result of intermittent fasting? Do you fast yourself and would you recommend it?

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Hi Jacquie, yes, it can also be the result of your fasting. I wouldn't worry about high urine levels. If you want to be sure that there is nothing else going on (e.g. in case of diabetes which you would likely know about), you can use a blood ketone/glucose meter. I do fast every now and then but not for too long. I have a thyroid condition so the only fasting I do is by skipping meals, usually breakfast because I rarely feel hungry in the morning.

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Hi Martina,
Here's my deal: I'm a mother of 4, full-time student & I help my hubby with his business but most of all . . . I LOVE sugar! I didn't even realize how much until I started keto, but I am determined to lose the weight I've gained over the last few years. I'm only 5'2" and weigh 215 but I'm comfortable at 140-150. I only started keto 4 days ago and I've been very careful to stay under 25g of carbs/day. But, I haven't seen any results yet - yesterday I had no reading on the ketostick (but I drank a lot of H20) & today I'm showing trace amounts. I ordered the meter online so hopefully that can help me determine if I'm in ketosis. There is SO much info out there that I feel a little overwhelmed & I would love just 1 or 2 good resources to help me through this. I would really hate to deprive myself of my starbucks mocha for 2 months only to lose 5lbs of H20 weight. My problem is that I'm making sure to count all my carbs (I even add up <1 carbs & count them) but I crave sugar so deeply that I try to find any way to get something sweet into my carb intake (like the Atkins choc bars). Should I be tracking my calories/protein & fat better or just make sure that I stay between 15-25g of carbs? Yesterday I had 3 cheesy eggs & 3pcs of bacon, 4oz low-carb trail mix (my sweet), 3 boiled eggs, then a salad w grilled chix & about 3tbs dressing, plus I had a double espresso with sugar-free syrup & heavy cream. I was hungry during the day but at night I was full (we don't eat supper til about 9pm). I'm hungry now & I've had 2 boiled eggs & coffee (sf syrup). I really want to lose this weight but I don't see any results. What can I do?  

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Hi Rachael, I know there is a lot to learn when you start following a low-carb diet. I can only advice you to go through my blog - also, check out this post: ketodietapp.com/.../how-to-low-carb-15-common-weight-loss-mistakes
I know it's hard but Starbucks Mocha contains loads of sugar - enough to impair your progress. You can make your own mocha without all the sugar - just use raw cacao powder, mix it in coffee, cream or coconut milk and add some stevia or Erythritol.
Once you give up sugar, it takes weeks to get rid of the cravings but you will get there - stay strong! In general, you don't need to count calories but if your weight is stalling for more than 2 weeks, then it may be better to track all macronutrients.
Make sure you get enough protein - that will keep hunger at bay. And don't be afraid to eat veggies - you don't need to be "zero-carb" to lose weight. Eatine little to no carbs can, in fact, have the opposite effect.

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what happened to my comment? Did I lose it?

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Hi Sula, it just takes time to approve & reply to all the comments Smile

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Sorry, my last comment was cut off.  I was wondering if the ketostix would be useful in determining ketone levels in my urine so i can be sure not to have excess levels when i go to the dr.  They look like the same thing dr.s use.  

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Hi Amy, yes, if you use Ketostix for this purpose (to determine urine ketones), they are reliable.

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I have been on and off Keto for the past 6 years with, overall, success.  At my heaviest was 248 and my lowest 179 (as recent as 2 months ago) Clearly Christmas has come and gone and so were the days of 179.  I am now focussed on seeing those numbers (and more) again so I've jumped back on the bandwagon hardcore.  I never monitored Keytones before as I was certain I was in ketosis however this time around, I'm doing everything I've don't in the past, and yet I'm slowly watching the scale creep up.  I'm now at 202 and decided to buy the KetoStix, which thankfully led me here. I have read and understand that they are not as reliable as the blood monitor and may or may not purchase one, depending on the results of the Stix.  I have noticed moreso, many posts, referring to very high readings.  I just wanted to remind the users of the Stix that (after reading the instructions thoroughly) be reminded that firstly, you must time 15 seconds after saturation of the stix whereupon at THAT time the reading should be most accurate.  After that point, the stick will naturally get darker (as is my understanding of the instructions) and the reading less accurate.   So... here I go, 1st attempt tonight.  Wish me luck!  OH...and THANK YOU for reminding me why I started this journey in the first place.  I am grateful for your wealth and depth of information and knowledge! Smile

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Thank you Erika, yes, Ketostix are not reliable and high ketone levels are not needed for weight loss. Have a look at this post - it may be your macros that are causing weight stalling or even weight gain: ketodietapp.com/.../how-to-low-carb-15-common-weight-loss-mistakes

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Hi there, I was on Keto diet before and I tested myself using the urine stick. I felt I was very easy to get into Keto because I didn't consciously restrict myself or plan all my meals (I had in mind what types of food I should be eating and relative amount of net carb of the food, roughly, just didn't want to exhaust myself by doing all the calculation and data input), and the tested level was towards the highest scale. I've cheated before, the level dropped but went back very quickly. I was totally off the Keto diet during December and picked it up again this month. But my level was on 0.5mg/L the whole time even though I didn't cheat at all. I do drink a lot of water but I was drink a lot of water before. I'm having college exams now so during my revision I tend to feel hungry all the time and eat a lot more. But I kept my carb intake low. So I have no idea why the test results showing such a low level. Just wondering if you can identify any mistakes that I'm making. Thanks!

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Hi Mary, you may want to check out this post - high ketone levels are not needed for weight loss (if that's your goal): ketodietapp.com/.../how-to-low-carb-15-common-weight-loss-mistakes

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Hi there! I started the keto diet a week ago. I am currently 67kg (148 pounds) and 166cm (5ft 5 in). I am consuming 20 grams net carbs a day and feel ok mostly - just a bit tired and occasionaly dizzy. I bought keto stics and they show the ketone levels as very high (the highest on the scale). Is this dangerous? Should I add more carbs? Will this change as I become keto adjusted? Thanks!

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Hi Iveta, nutritional ketosis caused by dietary changes is completely safe. The only case when it becomes a problem is when your body gets in ketoacidosis (if you have diabetes and also high blood glucose when having high ketone levels). Also, keep in mind that Ketostix are very inaccurate compared to blood ketone meter readings as they only measure some types of ketones. You will feel tired during the first few weeks as it takes 3-4 weeks to get keto-adapted but once you do, you will feel better and your energy will improve. Until then, make sure you get enough electrolytes: ketodietapp.com/.../quick-guide-to-keto-flu-remedies

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Hi!
Thanks so much for your website and for taking time to answer questions.  I am currently 17 weeks pregnant and have been continuing to follow an lchf style of eating.  I have two concerns: 1) ketones in my urine and causing my doctor to worry.  2) that i may fail the glucose tolerance test because i do not consume many carbs and no sugar (i have read that women who follow a low carb diet while pregnant sometimes fail the glucose tolerance test).  Since i do not think my dr will support a low carb diet and i cannot change drs because of insurance limits, do you have any advice on how i could keep feom setting off any alarms on these tests while still following lchf?  I have heard some suggest to carb up a few days prior to the glucose test.  What about ketostix?  If i tested mybown urine

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Hi Amy, this is a bit of a grey area and some experts advice to follow a low-carb - but not necessarily ketogenic diet - during pregnancy and breastfeeding. Unfortunately, many doctors are not familiar with the ketogenic diet. Here is some information about what you can do before the glucose test: ketodietapp.com/.../Experts-Insight-Is-Very-Low-Carb-Ketogenic-Diet-Healthy (it's for the oral glucose tolerance test if it helps).

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I think when you write "exerted" you mean "excreted", maybe? Ketones are not exerted in one's urine, unless your urine and ketones are working really hard. Ketones are excreted in one's urine.

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Thank you for spotting the typo!!

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The comments in this blog are quite instructive. I just became interested in learning about ketones after getting a test result indicating that my ketone level is 1+ while the standard range is negative. My spouse also tells me these days that I have a dragon breath (her own way of describing ketogenic "fruity" smelling breath, perhaps) indicating probably that I'm in ketosis. In my lay man's understanding of the subject, I still wonder about the overall health implications of ketosis beyond weight loss. Can someone enlighten me more on this?

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Hi Otu, I have listed some health benefits of low-carb eating here: ketodietapp.com/.../Health-Benefits-of-Low-carb-Diets
When it comes to ketosis, other health benefits are: improved energy, improved sport performance in the long term, muscle-sparing effects and also therapeutic effects for people with certain health conditions (epilepsy, Alzheimer's, cancer, etc)

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Hi I am trying to get into ketosis quickly and hear that you can get some ingestible assistants to do this. However this may be still under scientific studies with navy seal divers.
Just wondering if you know anything about these and how to access them if they are available. Thanks - love your work!

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Hi Natasha, if you are referring to "exogenous ketones" aka "ketone esters", here is my view (it's the 8th in my keto terminology post): ketodietapp.com/.../keto-diet-glossary-ketogenic-diet-terminology

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Thank you for the blog!
I have been attempting a Keto diet for the last few months, but struggle because of how much I travel.  I also have the desire to be vegan because of the environmental effects that meat/dairy agriculture have on the planet.  Is this a possibility to have a vegan ketogenic diet? Cheers

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Hi Caroline, some people say you can be vegan but I think it's almost (if not completely) impossible in the long term. I'd think that you should make a choice - either be low-carb / keto or vegan. I'm not convinced that "vegan" is best for the planet either. Hope this helps!
Here are some health-related issues: authoritynutrition.com/.../
And here is more about the effects on our planet: https://www.youtube.com/watch?v=vpTHi7O66pI

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Question. I am 5 weeks into Keto. My blood levels are 1.4-1.7 consistently. First 3 weeks lost 4lbs. Third week gained 1lb. Last week lost 1lb. Why am I not losing when I'm definitely in ketosis???? Help

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Hi Nicole, have a look at this post: ketodietapp.com/.../Not-Losing-Weight-on-Low-Carb-Ketogenic-Diet-Dont-Give-Up-and-Read-Further
Also, here is more about carbs: ketodietapp.com/.../Total-Carbs-or-Net-Carbs-What-Really-Counts (ketone levels are not the main reason people lose weight on a ketogenic diet)
and here is our keto calculator to help you get the right macros: http://ketodietapp.com/Blog/page/KetoDiet-Buddy
Hope this helps!

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I started ketogenic diet four days ago and I have not experienced any side effects such as headaches, dizziness, or fruity breath. I checked my ketone level in the urine today, and it is moderate. I am feeling totally fine as though I made no changes whatsoever. I did lose 2 lbs in these 4 days. So strange, I am eating so much and losing weight at the same time. In addition, I don't feel hungry for long periods of time. After researching on this diet and reading what people say (how terrible they felt at the beginning), I am wondering if there is something wrong with me since I don't feel anything! Am I doing something wrong? Please advise!  

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Not necessarily, some people don't experience keto-flu - my fiancé didn't. Just make sure you get enough electrolytes. Good luck!

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I haven't read all the comments yet but in response to the first one - keytones have a powerful hunger reducing character that is very impotant to most people on a diet. Whether for diet or health, if keytones are available the brain can use them for MOST of its functions. This has a welcome effect of reducing the brain fag so well known by conventional dieters. Majorly important. Where the keytones come from is not so important. The fact that they are working for you IS. With respect to dieting keytones aid the body to shift into fat burning more comfortably - so that you can escape the carbohydrate-insulin cycle. The changeover can be difficult espescially for previous yoyo dieters. Using MCTs or coconut oil, or a keytogenic diet to feed the brain through this difficult withdrawal period makes sense.

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I'd say that low-carb diets in general have this effect (not necessarily ketogenic or ketones). Once you lower your insulin level, you will experience less cravings and feel less hungry. I think that everyone's "ideal" carb level is different and some people do well on a VLCKD. I haven't noticed more benefits with higher ketone levels. In fact, I found it hard to stick with a very low-carb diet (hormone imbalances etc) - I follow a mildly ketogenic diet and it works great for me.

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I am so glad I stumbled upon your Blog!! I have been devouring it all day long. I am an endurance athlete looking for an edge. I am considering adopting this diet. Could you give me some direction as far as athletes and ketogenic diets. I don't want to loose to much weight. I would like to drop a little % of body fat. How can I account for calories lost during long periods of exercise? How would I fuel during exercise without falling out of ketosis? I need a mind shift from 'carb' calories in and out. You are doing great work...so informative!

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Thank you for your kind words Andrea! I think these posts may help: ketodietapp.com/.../tagKetoExercise&title=Keto%20%26%20Exercise
and here is our keto calculator that will help you get the right amount of protein & fat: http://ketodietapp.com/Blog/page/KetoDiet-Buddy

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HELP!  I've been on a low carb plan for several weeks.  I'm eating meat, a few veggies, berries in the morning, cheese, prepping meals, using butter, watching to not eat sugar.  I'm averaging 15 carbs day.  I'm shooting 20 or less.  I have been checking urine and not in keytosis.  Help I need to drop weight for a wedding.  It is October 10 and I need to drop 10 pounds.  I'm allergic to eggs.  Here is sample meal plan
Breakfast: Fat bomb coffee, Turkey sausage, Carb wise yogurt with three strawberries diced up
Snack: Meat and cheese
Lunch: Low carb brocoli cheddar soup homemade, Grilled chicken
Snack: Cottage cheese with two small Roma tomatoes diced
Dinner: 2 fillets Fish, cauliflower mash with gRlic butter, Green beans
Snack (sometimes): 2 fat bombs
Drink gallon of water. I don't work out, but I am very active.  
I don't always get my snacks in, but I am a sweet freak, so I always have my fat bombs in eve.
Help please... What should I cut? I need to move the scale! I tried to give up cheese and all dairy but it isn't doable for me, I crave it and being allergic to eggs I need more options for breakfast.

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Hi Steph, contrary to what you might have heard, there are no additional benefits for weight loss with so little carbs. Here is more about it: ketodietapp.com/.../Total-Carbs-or-Net-Carbs-What-Really-Counts - I think you'd do well on 20-30 g net carbs.
Don't worry about not being ketones if using Ketostix (I explained why in this post). More ketones won't help you lose more weight - it's a myth. I'm not a health professional and won't be able to give you personalised advice but I think you might want to avoid snacking and add more food to your breakfast, lunch and dinner instead. Also, check out your macros: http://ketodietapp.com/Blog/page/KetoDiet-Buddy

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I'm getting ready to start taking Therapeutic Ketones. What are your thoughts about taking these?

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Hi Kyle, I haven't reviewed them yet but once I do, I'll share my thoughts on the blog. My first impression was that most people won't need to use exogenous ketones, only those with special needs for therapeutic purposes. That's just the first impression I got based on what I know.

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Martina I'd like to thank you for everything you do, me and my hubby love your blog! I think it's the best keto resource out there and has helped us tremendously. I've never felt better and my hubby lost over 20 pounds in just 2 months. I really appreciate that you don't just sell whatever keto or health product that is out there and I love your app! You keep everything honest and focused on scientific facts and that's quite rare these days. There are so many "sales people" in keto and paleo that sell all these dodgy products with strong claims and I don't trust them. Thanks again and please keep it real!

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Thank you Emily, I really appreciate that! That's amazing progress! Well done Smile

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Hi Martina, I have read that exercise increases Keytone levels.I have found that after exercise urine strips show absolutely nothing but about an hour postprandial they show up again.  Just curious if perhaps I burn through my excess, therefor nothing shows on the stix?  Love to have your input! By the way I work out in relatively a fasted state. The only thing I consume before the workout is a bulletproof coffee.

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Hi Lola, firstly, most likely you drink more water while exercising and ketostix are very inaccurate, especially when you stay properly hydrated, urinary ketone levels are diluted. It also depends on how long you've been following a keto diet. If you are keto-adapted, you may not be able to measure any urinary ketones. You are also using ketones more effectively in a keto-adapted state - blood ketones are the "fuel", urinary ketones are just an indication that may not always show.

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I've been following the keto plan for 3 weeks now.  I lost a quick 10 lbs in the first week but have stalled for an unknown reason.  I've been reading a lot and have been adjusting my protein intake. What am I doing wrong??
Currently I'm 5'11" , 240lbs, age 51.  I'm tracking my intake with Lose It.
Week 1 intake: F 118g 60%, C 21g 6%, P 99g 26%
Week 2 intake: F 129g 72%, C 18g 4%, P 96g 24%
Week 3 intake: F 122g 73%, C 21g 6%, P 80g 21%
All the carbs come from vegitables, no bread, very light exercise.
I'm confused on the neccessary protien intake and fat intake. Im keeping the carbs on the 20g range.  Should I raise or lower far intake?

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Hi Steve, I think you may not be eating enough fat. Have you checked your macros here? http://ketodietapp.com/Blog/page/KetoDiet-Buddy I would personally always opt for a small calorie deficit ("slow" fat loss in the tool). The tool will also tell you how much protein you should be eating. Hope this helps!

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Hi Martina
I read your blog posts with great interest - a brilliant resource! I have been on keto (20-30 grams carbs) for the past six months and have lost 36 pounds. Still a long way to go mind... I use ketostix and measuring with a blood meter and am in ketosis every day but only later in the day. I am out of ketosis every morning despite reducing protein and carefully counting carbs the previous day. I have tried increasing fats and watching the total calories etc but I weight loss keeps stalling and I don't know why I appear to be not fat burning overnight. I also generally only have one meal plus an evening snack ( generally small piece of cheese or few nuts) per day. Any advice??

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Thank you Patria! It's natural for the ketone levels to fluctuate and they are usually low in the morning and high in the evening. I don't think you should worry about that - you don't need to be in ketosis all the time. I would guess that the weight stalling is related to something else - high levels of ketones don't guarantee weight loss. It sounds like you may not be eating enough - Have you checked your macros? http://ketodietapp.com/Blog/page/KetoDiet-Buddy

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(I tried to eat more lipids but got sick... bleaaahh !! More proteins seems to make things worse.)

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Hello from France where noone (particularly doctors) seems to know anything about LCHF diet!
But... what about constantly high level of ketones (>8mmol) on urinary test ? Even in the morning ? Associated with high sweating and fast heartbeats ? My daily level of nutriments is about 60g prot., 20g net gluc. and 120-140g lip.
I am on levothyrox 100 because of hypothyroidis (Hashimoto) and on keto diet as from 18th of July 2015. I have lost 4.5kg so far (74,4kg from 78,8kg, height 174cm).
Thank you in advance. (sorry for the limited English. You can correct me if necessary.)

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Hi Zoziau, the urinary test is very unreliable when measuring exact values. I personally only use it to get an idea of whether I am in ketosis but not to measure values. Many people see the dark purple levels on their strips (or some see none) but their blood levels are completely different. Even if you measure high ketone levels (but I doubt you would measure 8 or more), if your glucose levels are low, it shouldn't be an issue (ketoacidosis happens when both blood glucose and ketones are high).
I think you may not be getting enough electrolytes - the symptoms sound like potassium deficiency to me but I'm not a health professional and you should check that with your doctor. I experienced similar symptoms when I started following a low-carb diet and wasn't aware of potentially low potassium and magnesium levels.
I think your macros look great - you are not too high / not too low on calories and your protein intake may be fine (make sure it is by using this tool: http://ketodietapp.com/Blog/page/KetoDiet-Buddy). Hope this helps!

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Hi all. I have found this blog rather interesting. I have not been able to get through it all, yet I have seen so great posts and some that are a lot of fumes. As one that has a endomorphbody type that is very active or WAS very active in power lifting and rock climbing I learned that though I have the capacity to hold more fat that either of the other two body types I dont have to store fat. I was in fact very well shaped, fit and trim with a 12% body fat at normal times. I would let it climb to 15% as I was training very hard preparing for competition and then right before I would drop to 8% to achieve a lower weight class. I was well able to achieve a state of Ketosis with out all the ingestion of extreme ingestion of fat,fat bombs and such. Yes you MUST bring in fat or your body will resist letting it go. However to get your intake above above 30% of total cal. even on a 2500 cal intake does not require such extreme measures.To bring it up like I see many people do and preach is BS and is very unhealthy even when it is healthy fats. This is even more true when those fats come from a lot of fatty meat is bing pushed. This is one of the best ways for may to get weight down only to learn their arteries are clogged and just one issue of this philosophy. Also to much or too little will through out of whack hormones. I, as a Endomorph must remain very active no mater how low a cal intake I have even if it is very low carbs intake or I will gain weight in the way of fat. Yet, I have NO problem putting my body into a state of Ketosis with increased exercise causing a rapid drop of weight and then maintaining it.
It was a 9 years ago that I was involved in a very nasty and serious injury that laid me up for approx. a year due to the Ins co refusing to follow the doctors instructions. A serious fall where I broke 9 ribs with a total of 23 breaks and one spot shattered and multiple punctures to the lung. I also had to undergo a surgery to repair ribs that were non-union or would not mend. As a result my weight climbed to 311 and my ideal weight is 180. once I was back in the saddle and working out I went from 311 down to 180 in just under 7 months without any muscle wasting and with out taking in extreme levels of fat. I am at 158lbs lean tissue with a calculated body fat of 13% and 53% total body water. I still hold this weight today.  

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Hi Rob, thank you for your insights. Yes, very active people can get to ketosis without having to restrict carbs to a very low level. Ketosis can be temporarily achieved by calorie deficit / fasting. Yes, people can lose weight in many different ways, not just by following a low-carb diet (calorie restriction, more exercise, etc.). The question is what is the best way and the most sustainable way for most people. I say "most" because no diet plan fits all. Some people still find it more difficult to lose body fat than others.
I agree that calories count even on a low-carb diet. The main reason low-carb diets work is their natural appetite suppressing effect. However, I would disagree that it is unhealthy to go over 30% calories from fat - there are no such studies proving that but there are studies proving the opposite. Also, it's a myth that low-carb eating will cause artery clogging - I have linked to several studies and articles explaining this issue. Neither does a low-carb diet cause our hormone levels to get out of control - there are more factors to consider as it's not as simple. Dr Volek and Dr Phinney have authored 2 books explaining this way of eating and the effects it has on our body.

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I began my keto diet 3 weeks ago and my last doctors appointment showed an 11 lb weight lose. You are right on your suggests and observations associated with the diet. I have hypothyroidism and have been plagued with weight for many years. I have elected to have bariatric surgery, which is scheduled to occur 13 days from this posting so this keto diet was part of the final preparation phase of the process. Thanks for the accurate and informative information you have provided.

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Thank you Linda, I'm glad I can help! Good luck!

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Hi! I just started the keto diet a week ago and the keto sticks show moderately high levels of ketones all the time (8 mmol/L). I've deviated from the diet twice and ate a bunch of chocolate and ice cream (but no gluten), and the sticks still measure 3 mmol/L. I've also been getting dizzy a bit. I'm starting to get alarmed that my levels are so high, maybe I have type 2 diabetes and I have ketoacidicus?

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Hi Jenny, do you use urine keto strips or blood ketone meter? I wouldn't worry about the readings from urine ketone strips as these are not very accurate. Ketoacidosis happens in diabetics but you would also have high blood glucose at the same time. Unless you are a diabetic, it's highly unlikely to be anything like that. Dizziness is also a sign of "keto-flu" (read more here: ketodietapp.com/.../quick-guide-to-keto-flu-remedies) or hypoglycaemia (low blood sugar) - I'd suggest you eat more frequently if that's the case.

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So I just started my keto diet 2 days ago. According to ketostix I'm in ketosis, small amounts detected and moderate at night. They came really fast within the first night on the diet though and did I read correctly that excess ketones are just wasted calories? If that's true should I lower my calorie intake? I'm not hungry except at night before bed. I'm on 1500 calories, 133g fat, 77g protein, and 15 carbs. I feel great and haven't experienced any keto flu, just frequent urination. It's so early I can't tell if I'm losing weight yet but would the high ketone readings suggest I can live off fewer calories?

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Hi Mandy, during the first few weeks of the ketogenic diet, your body will be getting used to ketones for energy but it will take 3-4 weeks to use them effectively. That's why you will see higher readings at the beginning when they are not used as effectively. You shouldn't worry about your calorie intake in this sense - in fact, many people on keto don't need to count calories at all. LCHF diets have an amazing satiety effect and you should naturally eat less. If you feel hungry, it may mean that you are not eating enough protein - make sure you eat the right amount (see KetoDiet Buddy: http://ketodietapp.com/Blog/page/KetoDiet-Buddy). Yes, it's probably too early, give it a 2-3 more weeks and see how it goes. Hope this helps!

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So, I'm stuck. For past 5 weeks been on ketosis diet. Eating 1500 calories, 20-30 net carbs, 79-75 protein and 110-125 Grams of fat. Still not in deep ketosis, or lost any weight. I realized I had carb creep from some vitamins I was taking and probably from a small bite here and there. My blood ketones range averages .3 to 7 after morning bullet.  I then read about far fast and started that 2 days ago.. Eating 96 fat, 17 total carbs and 19 protein. This morning after my coffee of oil and butter my ketones were 1.3, but tonight they dropped to .3.   I thought night time was highest? And shouldn't they be higher after 2 days of fat fast? Going to go 2 more days then increase calories and protein. Just feeling like I can't get into that 1.5 range I need to. Any ideas?? Thank you!!

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Hi Traci,  
Yes, they should be higher on a fat fast BUT it depends on how long you've been following the diet. In your case, it' been 5 weeks and you are likely keto-adapted, therefore you will see less ketones (they are used more effectively for energy).
Another thing that comes in mind is what kind of tracking have you been using - is it reliable enough? Is there any reason you want to get to 1.5 range? You can aim for nutritional ketosis which is from 0.5 mM.
1500 kcal sounds reasonable but you may still want to check your intake: http://ketodietapp.com/Blog/page/KetoDiet-Buddy (don't go for the "quick" option if the calories are too low). Also, here is another post that may help: ketodietapp.com/.../Not-Losing-Weight-on-Low-Carb-Ketogenic-Diet-Dont-Give-Up-and-Read-Further

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Hi Martina.
Thank you for the great blog. Keto diet is not the most straightforward one, and even though I've read most available books on it, I still have to keep twicking my food intake. I started keto on 1st January, along with exercise, and lost 6kg (a stone) so far. I've gone on the very strict version  (cut out dairy, nuts), doing 1400 calories with 83% fat, 5% carbs,13% protein. The diet is pretty much the same (using my fitness pal and fitbit hr to measure my activity levels/calories intake), but on some days  I keep stalling my weight loss, and can't figure out what could be causing it. I'm a bit concerned about my ketones levels as they've always been on a higher side around 4 in the fasted state, 6-6.5 two hour after meals, and can reach slightly above 7 in the evening). I am not diabetic so not sure how to reduce the level of ketones and if I actually need to reduce them... I only eat twice a day, breakfast is my main meal, 90% of all calories, at around 10am and then I have a fat snack at around 4. I am never hungry so I don't think I am in a starvation mode. Any insight would be much appreciated! Thanks, Anna

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Hi Anna, thank you for your kind words! Those are amazing results Anna, well done! Just make sure you're eating enough protein - if you don't, you may be losing muscles. Try my keto calculator to make sure your protein intake is about right: http://ketodietapp.com/Blog/page/KetoDiet-Buddy (as always, I recommend going for the "slow" fat loss). Those are really high ketone levels but they are still within the safe ranges - just make sure your glucose is within the normal ranges. What you do is basically intermittent fasting. If it works for you, it's absolutely fine to eat twice a day with most calories in the first meal. Low-carb eating is all about appetite suppression so you should only eat whenever you feel hungry. Hope this helps!

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Thank you for the prompt reply, Martina Smile. I tried the calculator and it does seem I'm not eating enough protein, though I was doing my original calculations based on my ideal weight (got 5kg of fat (about a stone) to go), hence, my protein intake for my present weight is low, logic behind it being: no need to feed extra protein to my remaining fat.. Smile. I will try having more salmon/red meat as for some reason since I started keto diet I've developed a slight intolerance to milk products, cheese in particular  (which is a pain as I love cheese!) Hopefully, the extra protein will tame the ketone production. People complain of not reaching high ketones level, and I have the opposite Smile. I've just bought your book on Amazon, can't wait to see what else I can munch being keto - fied.. Thank you again for the great blog! All the best, Anna

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That is actually quite common Anna - I limit my dairy consumption to cream in coffee, butter and cheese used as ingredients - no more snacking. I think people overestimate the importance of ketone levels - in fact, there is no proof that more ketones are beneficial if you simply want to lose weight. It's important for cancer management though. That's great Ann, hope you like it! Smile It would be great if you could leave a review on Amazon. Thank you!

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Will do, Martina! Thank you for your help xx

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Sorry typo .......its X1 cup of broth and X1 spinach leaf.

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I'm confused and/or frustrated, I've been doin the keto-diet since Jan 1st trying to data round 20g of carbs per day most recently I have been eating lots of walnuts and macadamia nuts inbetween meals or late at night. I bought a ketone blood monitor. My fasting ketones 1st thing in the morning was 0.4 for bfast I ate x2 scrambled eggs with spinach x3 pieces of bacon and X11 cup of beef broth. Two an a half hours after bfast I re-measured my blood ketones and it decreased to 0.3. I had a snack of celery stick and two pieces of cheese at 1030am then lunch at 12.45pm X1 can tuna in h2O bit of raw kale X11 spinach leaf 1/4 cup spring onions 15ml of a low carb mayo + olive oil + 1/2 an avo x2 hours later my ketones decreased now to 0.2. Came home from work had X1 cup of beef broth handful of raw peanuts then two hours later had dinner x4 chicken tenderloins with a salad bout 40 mins later my blood ketones are still 0.2. Yesterday the highest I measured was 0.5 ?? Why can I not get above this ? Do I need to eat more fat ? I cook with coconut oil and I pour a decent amount of olive oil in my salads plus I have beef broth n bacon?? My weight has been stable the last 3 weeks I don't drink alcohol I don't eat fruit. Or am I having too much fat ? B/c my weight is not shifting. The first two weeks I lost 2.5kg I reckon I look slimmer but the scales don't say that?? What's my next move ? I'm 76.6kg height is 170cm I'm 37 y.o and my goal is a nice set of abs !! Shall I try calc how much fat I'm eating ? Or swap it for MCT's ? Let me know ur thoughts. Cheers!

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Hello Dan,
I'm not an expert and tweaking with keto myself, but it looks to me you eat too much and perhaps too much protein. To compare with my eating pattern: I run early in the morning in a fasted state. I have 250ml coffie+butter as breakfast (sometimes add some bacon wrapped around sheep's cheese) and that's enough to keep me going to lunch. Lunch is a large salad with beef, fish etc. Afternoon snack a few almonds. Dinner is meat, vegetables with butter or cremes. SometimesI have bouillon during the day. I weigh 82kg and am 186cm.
Arhab

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Cheers for a the advice guys....I wasn't sure even if my story made it on the blog as after I wrote it I couldn't find it. I re-read parts of Jeff & Stephen's book plus more on ur app Martina and I changed up what I eat more bfast mainly and reduced the nut intake. I did calculate the ideal macros for me too. Bfast now is broth with animal fat left on plus addition of a little coconut butter, MCT oil & coffee with thickened cream. If I snack in between meals it's now only a piece of cheese or a fat bomb. Lunch is protein plus kale and an avocado plus olive oil and dinner is protein plus salad. Blood ketone levels increased more so and I lost a kg in a week but I wasn't as active last week. So this week if I keep diet the same and increase my activity I should see better results. Cheers
Dan

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I'd personally avoid snacking on nuts and cheese or at least try to avoid this at bed time. Ketone levels always fluctuate and I'd just measure them before bed if I were you (at least 2 hours after your last meal). I wouldn't swap the fat for MCTs because these should only be taken as supplements - more may upset your stomach. I think you may be eating too much - it may be worth trying my keto calculator to find out all your "ideal" macros. You don't need to follow them exactly, it's just to give you an idea (go for the "slow" fat loss to avoid any hunger issues): http://ketodietapp.com/Blog/page/KetoDiet-Buddy

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Again, many thanks for responding. Also you read many people having " ketogenic effects" within days I guess I have to adapt for weeks. I started 1st of January (before that I already removed sugars, breads, pastas etc from my diet for more than a year) with measuring BG and ketones. I learned I had to further cut down proteins (milk) and increase fat intake significantly. I also take MCT oil now. Although my appetite has changed (no more cravings - one or two meals a day only) and my girlfriend complains I have a bad breath, I still don't experience the "euphoric" feeling or brain sharpness that I read about - or perhaps I don't recognize them. Anyhow, it is a very educational journey and the more I read and learn the more I'm impressed with the human body's functioning. I also enjoy the " biohacking".
Arhab

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Yes, the effects come in just a few days (detecting ketones) but it takes weeks and sometimes even months to get fully keto-adapted. The breath will go away in just a few days / weeks as you get keto-adapted. You can try water with lemon juice, ginger or mint tea - all these should help with the "keto-breath" - Give it a few more weeks Smile

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Martina,
I have been doing low carb for about 3 weeks and all is well.  Ketostix indicate small 15mg / 3.75 mmo and am losing weight.  However, I am curious about how much fat (grams or ounces) is being converted to sustain my ketone levels.  Simple question but probably a complex answer given the variables such as age, weight, gender, diet (intake and composition of that intake), and exercise levels.  Does such a calculation / formula exist that would determine a fat conversion level?  While I have lost 7-8 lbs, my fluid levels are OK - I am properly hydrated, I exercise every other day (27 minutes on an elliptical and another 15 on the total gym) it would be nice to determine fat loss more accurately than by using a scale or the notches on my belt :>)  Any suggestions would be appreciated.

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Hi Ernie, I'm afraid I can't give you a straight answer on this. As you said, it depends on many factors. If there was such a formula, I'd let you know but I don't know of anything like that. My impression is that you do way too much of cardio - have you thought of trying strength training and some HIIT instead? Moderate cardio is good for your health but it doesn't help weight loss because it usually makes us more hungry & doesn't help muscle growth like strength training does. You can do some cardio if you like it but be aware that strength training 2-3 times a week may have more benefits in the long term (more muscles mean improved fat loss). Hope this helps!

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Thanks again. Nothing is straightforward Wink. Hard to engineer the best personal diet given all the variables which may impact ketone and BS levels.
Still I'm a bit annoyed that I see such swings in ketone levels (e.g I see days that they go from 0.9 fasting, to 2.4 pre-diner and next morning fasting ketones is 0.3 - while diner was only beef and chorizo sausage and a glass of wine.). Leaving the BS for what they are, is this perhaps related to efficiency of ketones production or use? 0.3 is almost knocking me out of ketosis. Or does wine has such a impact on ketones?
Again, perhaps layman's questions and I apologize for perhaps being unpatient....
Arhab

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That's fine Arhab, these are definitely not layman's questions! Smile My ketone levels are just like yours - changing all the time. It could have been the wine you had. Highest ketones are always measured before bed. For a non-diabetic, your BG level is most likely to be highest in the morning and your ketone levels lowest because the liver produces glucose during the night. Even if your ketone levels get temporally low, don't panic, it won't affect your progress and it's perfectly normal. If I were you I'd avoid alcohol, especially for weight loss. You can have some wine during weight maintenance but it should't become an everyday habit. Hope this helps!

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Hi, sorry to bother with a question. After approx. 3 hours after diner, my ketones drop to approx. 0.4. My fasting ketones are about 1.6 and before diner it's between 1.5-1.7. BS is consistently between 88 and 100. Any idea of why the ketones drop so low after diner?
Thanks, Arhab

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Hi Arhab, if you have any carbs & protein, ketone levels are lower after a meal - this is perfectly normal. Hope this helps!

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Thanks for the quick response. I'm still learning a lot. What I also find a bit weird is that many times my morning fasting BS is higher than my BS after 3-4 hours after diner. E.g. yesterday my pre-diner BS/Ketones was 88.2/1.6, 3hrs after diner 88.2/0.4 and morning fasting was 1.3/5.4.
Has this something to do with glucogeonesis during the night?
Thanks a lot again!
Arhab

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You're welcome! I've pointed my readers out to an article which explains why higher blood glucose levels may appear in low-carb diets. It may look like symptoms of diabetics but it's simply a consequence of reducing insulin response: ketopia.com/.../

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Hi, how to i safely get my Ketones down? The highest level I have recorded is 6.4. I've ranged between im pretty much always over 3 and I check at different times of the day. I feel ok. My weight is constant and I'm able to train. My blood globose levels are low and constant.
Do I need to add more protein and a little more carbs? I'm reluctant as I'm a type 1 diabetic.

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Hi Marc, 6.4 is still within the safe ranges (not ketoacidosis which is also accompanied by high BG) - I have about this level when I'm fasting. However, because you are type 1 diabetic, you must make sure your doctor knows that you have been following the ketogenic diet and make sure you frequently monitor your BG and ketone levels. You may also need an adjustment to you medication - that's why is so important to inform your doctor. If you want to decrease your ketone levels, you can add more healthy carbs (vegetables, nuts, berries) or more protein, especially if you are physically active. You may want to check your "ideal" protein level here: http://ketodietapp.com/Blog/page/KetoDiet-Buddy

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Thank you for such informative information! Smile

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You're welcome Angela! Smile

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Hi, I am 32 years old male. My height is 5'7" and I weight about 197. I been on ketosis for about 4 weeks and my fasted ketone numbers are 2.5 mM and blood glucose level is 90 gm/dl. My concern is that does the blood glucose levels has to be lower than 70 for the best results?

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Hi JP, it depends what you are using the ketogenic diet for. If it's for weight loss, than you BS can be within the normal ranges (90 mg /dL is normal). However, some experts say that when using the ketogenic diet for managing diseases such as cancer, your glucose levels have to be as low as possible.

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Hi, I would like to thank you for the great info you provide at your website!i learned lot of new things like checking ketones by blood! I started the kito diet about 4 weeks ago for 2 reasons.1- to lower blood suger levels and 2-loose weight. I`m very overweight but lost about 1 lb per week. My blood sugar stays between 200-230 . used to be 300 and more when I ate fruits and more carb. I am tired during the days and scared to stay at these high numbers. thank g-d im not hungry. I do 5 minutes of  hiit exercise 2 times a day. Do u have any advice for me,
basically I want to know if being on such a low carb diet
will eventually lower  my blood sugar.

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Hi Miri, I'm glad to hear that your blood sugar has dropped but it's still too high. Make sure you consult this with a dietitian, especially if you take medication. Maybe instead of HIIT (or together), you should try walking 30-60 minutes a day. I know someone who may help you and give personal advice. Have a look at Franziska Spritzler's website - she is an amazing person and a certified low-carb dietitian: http://www.lowcarbdietitian.com/about-me.html Hope this helps!

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Thanks for the article and all of the replies.
I just set up my Precision Xtra tonight and on ketones got a 0.9 reading and 101 on glucose about an hour after eating.
It is simple to use and I will chart my results more at first then more like weekly then monthly. Did find fresh ketone strips on E-bay for $1.50 each. Started out with coconut oil trying to manage arthritis pain which helped but cutting sugar and other carbs to <50 grams a day really helped. So I wound up in nutritional ketosis and love it at age 63. Pain down from 7-8+ to 2-3 on 1-10 scale.

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Hi Gale, I'm so happy to hear that. That sounds like a big relief and I hope your pain will go down to zero!

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Hi there,
This is the most amazing resource!  Thank you for your time, effort, expertise and generosity in sharing your understanding.
I'm working my way through all the information - jumping around all over the place it seems, but that is fine because there is so much to learn. I'm confused about keto sticks and measuring ketones. I've only just started getting a high reading of ketones and have been half heartedly at this for a couple of weeks - seriously for the past week. Does the body then start using ketones and therefore the results displayed on a keto stick appear lighter / non-existent, or does it remain dark whilst in ketosis?  
Hope you're able to clear this up for me,
Kind regards,
Lucy

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Hi Lucy, thank you for your kind words! Yes, as your body gets keto-adapted, it uses ketones more effectively and you'll see lower readings even on the blood ketone meter. When it comes to the urine sticks, their colour (and therefore levels) may change due to several reasons. They don't measure all types of ketones. Also, it depends on your hydration. The more hydrated you are, the lower the reading will be. Hope this helps!

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Thank you so much for your response Martina, your information and generosity in sharing is very much appreciated.

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I LOVED your article - thank you!  I want to make sure I'm on the right path so here's my scoop and wondering if you can help me.  I have been yo yo dieting for the past three years - on and off hcg diet, etc.  I lost weight 17 years ago following Atkins and kept it off for a few years, then ended up becoming severely hypothyroid.  Since then I've always maintained a lower carb diet.  I'm also gluten sensitive so I've cut that out.  I eat no grains and only occasionally have sugar.  Barely any fruits except here and there.  Mainly veggies and protein.  Over the last two months I gained 10 lbs. out of no where.  Tried hcg again and didn't work so began researching and came across ketogenic diet.  I've never been able to get into ketosis since I was first on Atkins years ago and wondered why.  After researching and coming across ketogenic diet, I realize it was too much protein and not enough fat.  I started this journey on Wednesday (today is Sunday), and currently only have a trace amount of ketones appearing in the morning urine.  I have only lost .3 lbs as of yesterday but for me, any weight loss is progress b/c i have not been able to lose any weight through 'regular' diet and exercise in years.  I am consuming coffee in the morning w/ coconut oil and coconut cream (about 1 tbsp. of oil and 2 tbsp. cream).  Trying not to eat until 10 or 11 (intermittent fasting) and then eating dinner later in the day.  When i'm on hcg i eat only 500 calories a day.  Regular dieting anywhere from 800-1000.  On this w/ the added fat i'm at 1000-1200 a day.  Is this the reason why my weight loss is so slow?  Am I eating too many calories?  I'm keeping my fat intake about 70-75%, protein around 20%, and carbs around 5%.  I am getting bad headaches in the evening and when I wake up I'm incredibly hungry (which I find odd since I actually have a higher caloric intake).  I notice when I workout my endurance is better and I'm actually perspiring again!!  I definitely notice a difference in my breath too - especially at night.  Just trying to figure out why my weight loss is so slow.  Am I not giving myself enough time to switch my body into 'fat burning mode' since it's only been 4 days.  I'm 5'3" and currently weigh 117 lbs.  My normal body weight is 107 lbs.  I also supplement w/ potassium, celtic sea salt, vitamin D, Vitamin C, magnesium and a multi vitamin.  In addition, I started taking L-leucine and other amino acids at night to help.  Any advice would be greatly appreciated!!  Also, I am going away in a week and I know I'm going to end up 'slipping' a bit - do I just get right back on the wagon when I get back and will it be very challenging?  Thank you in advance for your help!  I truly hope this is the answer for me to get my body working the way that it's supposed to again and to rebalance my hormones, help w/ my skin, sleep, hair, etc.  

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Hi Tina,
I think your weight loss is slow because you don't eat enough and your body is constantly in a starvation mode. Your weight is actually quite low and I'm not sure whether you need to lose any body fat. I think you may need to add some strength training instead and tone-up your body. This can make a huge difference and you'd look much healthier.
Being hypothyroid always makes things more complicated and it will be more difficult for you to lose weight and keep it off (speaking from my own experience). It's very common for people to go back to a low-calorie diet such as HCG and not lose any weight. Extreme low-calorie dieting may have affected your metabolism and it looks like the HCG diet has contributed to your hypothyroid -  500 kcal is extremely low and has put enormous pressure on your thyroid. You need to add calories if you want to help your body "rebalance".
If you just started following the keto diet and really want to track your ketone levels you'll have to get a blood ketone meter (I own one) or a breathalyser (I haven't tried this one but is supposed to be reasonably accurate). Ketostix is not accurate and you may be in deep ketosis while showing almost no urinary ketones. On the other hand, being in deep ketosis is not necessary for weight loss.
I can't tell whether 1000-1200 kcal is ideal but it looks too low. If you exercise, 1000-1200 kcal is VERY low. I understand you are afraid of adding more calories but you may need to do it. Have you tried using my keto calculator? http://ketodietapp.com/Blog/page/KetoDiet-Buddy I'd definitely not go below 1000 kcal but go to at least 1400-1600 kcal.
Headaches are a sign of keto-flu, have a look at my post here: ketodietapp.com/.../Keto-flu-and-Sufficient-Intake-of-Electrolytes
If I were to eat 1000-1200 kcal, I'd be hungry too. This amount of calories is recommended for the fat fast which only lasts for 3-5 days. As I said, I'd increase my calorie intake if I were you: ketodietapp.com/.../Complete-Guide-to-Fat-Fast
If you slip, don't worry, it happens. Some people actually include "cheat days" and say it helps them break through a plateau. I can't really recommend "cheat days" because they don't work for me. However, if this happens, just try to make healthier options during your trip and get back to eating real food after you return.
Hope this helps!

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A good article but one of your facts is in error. Ketoacidosis only occurs in type 1 diabetics and alcoholics.People with type 2 diabetes can and do go into diabetic ketoacidosis. As per my own experiences and with 5 different doctors.

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Thanks for your insights TJ, yes you are right, it can be a complication in type 2 diabetics too. According to an article published in the BMJ in 2013, Diabetic ketoacidosis: not always due to type 1 diabetes:
"Diabetic ketoacidosis (DKA) is not just the hallmark of absolute insulin deficiency in type 1 diabetes—it is increasingly being seen in people presenting with type 2 diabetes."
Thanks for letting me know, I'll update my post.

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Ive been off and on the low carb diet for about 38 years. I can tell you that those recent so-called studies that say about 100k calories at most lost is ludicrous.(I would hardly call that a metabolic advantage).One of the reasons that low carb dieting has worked for me is that i can eat plenty.There is no way that i could have lost so much weight in such a short period of time at 100k calories per day.That's about 1 lb in 36 days.Give me a break.I probably average 2,500-4,000 low carb calories daily.More ketones don't help a person burn significantly more calories but they don't have to. They can pass unburned right out of a body.I don't need anybody to tell me what does or doesn't work at this point. I know !

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Hi Gary, thank you for your insights. The main reason people lose weight on a low-carb diet is its satiety effect and they way it keeps our blood sugar low, so the "metabolic advantage" is insignificant. I personally can't eat too much without putting on weight even on a low-carb diet but I'm usually not hungry anyway.

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I'd appreciate comments and/or guidance about using ketosis to manage high blood sugar when weight loss is NOT desired.

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Hi Emery, if you don't want to lose weight, just make sure you eat enough fat & protein and stay within your "maintenance level": http://ketodietapp.com/Blog/page/KetoDiet-Buddy

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I can't tell you what a gift this site was today. I was feeling SUPER discouraged as I can't seem to stay in ketosis consistently (according to the ketostix), with silly things like onions and cucumber seeming to bump me out. With the knowledge I've gained in the 2 articles I've read I not only feel more empowered, but more confident in my current results and path.
I got here by searching for an answer to why my ketones were so low (or non-existent) in the morning. Not only did I get the answer I needed there, but a WHOLE bunch of more really useful info. THANK YOU for such valuable content. You've won a fan for life. I can't wait to explore more of what you offer.

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Thank you Zed, I really appreciate that! You just made my day Smile

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I don't see any comments about electrolyte levels!  Glycogen binds with water, so going on a Keto diet, which reduces glycogen levels, causes initial water loss - which can change electrolyte levels through the loss of sodium.  Loss of sodium forces the body to lose potassium (it has to maintain sodium/potassium ratios to quite close tolerances), which is detrimental to cell health.  Volek and Phinney in their book 'The Art and Science of Low Carbohydrate Living' stress the need for adequate sodium intake, particularly if one does significant exercise.  I take about 2 gm/day when I exercise (10k run) by adding a gram of salt to two heaped tsp of beef bouillon to make broth. If my body has too much sodium it will simply get excreted.  Too little sodium leads to headaches, tiredness and nausea. I also eat one avocado every other day to ensure adequate potassium   I strongly recommend anyone doing the diet to read Volek and Phinney's book (not I'm not their publisher nor do I have shares in their publisher!!)

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I totally agree Phil! Their book is a must-read. I have more about electrolytes in my post here: ketodietapp.com/.../Keto-flu-and-Sufficient-Intake-of-Electrolytes

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Hi,
I have a child which is on a ketogenic diet for 7 months, because we are with epilepsy. When the levels of ketones in her blood becomes 6-6.5 (during all the day) the seizures worsen. She is feeling best when the level of her ketones is 4-4.5. What is the reason for the ketones to be high? Does it depend on the food she eat or from the calories? The best level for her is 4-4.5, but it is difficult for us to reach that level. What could I do to reduce the level of ketones in the blood?

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Hi Ivelina, it depends on both. Is she eating enough calories? It also depends on her carbohydrate and protein intake. I'm not a doctor but this level of ketones looks too high. She has basically entered starvation ketosis, as nutritional ketosis is defined up to 3.0 mM. How about her glucose levels? Are they low?
In general, the lower you go with carbs and protein, the higher the ketone levels are. Also, MCTs have the ability to increase ketone levels. Have a look at my calculator here: http://ketodietapp.com/Blog/page/KetoDiet-Buddy
It will help you see if she is eating enough. Make sure you also discuss her diet with a specialised doctor. I wish you both all the best and no seizures!

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Thank You very much for the prompt answer. Her levels of sugar vary from 4-4.5. She is taking 1050 calories daily. We are using the ketocalculator of charliefoundation.
I wish You all the best.

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You're welcome Ivelina! Her glucose levels & calories look normal to me. All the best to you and your daughter!

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Hi, great site for info! I just started keto on Monday and just bought ketostix today. I measured between low and moderate but I don't have any of the stinky breath symptoms. But I am sweating a lot and really thirsty. Do you think I'm in a good ketosis rate after 5 days?

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Thank you Annie! I guess the best way to measure ketone would still be blood ketone meter but if you can measure anything using Ketostix, it means you are in ketosis. The level is not as important but ideally, you should stay in "nutritional ketosis", 0.5 to 3.0 mM.

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Hi this is an old article so not sure if anyone will see this. I started low carb on Monday and from Wednesday onwards I had ketones in my urine, I tested today and now I don't have any. Anyone know if I could still be in ketosis? I haven't been eating anymore carbohydrates than when I was showing ketones in my urine. I'm confused!

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Hi Lindsay, you can still be in ketosis and show no urinary ketones. To be absolutely sure, you can get a blood ketone meter instead but I wouldn't worry. As you get keto-adapted, you will measure less ketones, as your body will use them more effectively. Ketones are just indicators - as long as you see some results (weight loss or other), you're doing great! Smile

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Hi all. I started a keto diet 3-4weeks ago im not getting a high reading on my ketone metre. In the morning its 0.4 and the afternoon 0.9 I want to achieve 1.5 and above. I lower my protein to 120-130g a day from 220g which is low for me. I dont wanna lose to much muscle mass as my lean muscle mass is 90kg im currently at 99kg im trying to lose the stubborn fat for a comp in 10 weeks time

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Have you tried coconut oil? I started having high readings after I included coconut oil + pure MCT oil. It did help me lose some belly fat but I also had to cut the calories a bit. If you use the keto calculator: http://ketodietapp.com/Blog/page/KetoDiet-Buddy, you'll see the min calories you should eat + min protein to prevent muscle loss. You just have to be careful with MCT oil it may be too much for some people. I take 1 tablespoon of MCT oil and use coconut oil for cooking and making fat bombs. I think Martina has some recipes for fat bombs on her blog.

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Hi Paul, I agree with Jenny, try the keto calculator on my blog (KetoDiet Buddy), MCT oil, and don't focus on your ketone levels too much. They will naturally go down as you get keto adapted. You may also want to try carb backloading if you are very active but that depends on what type of exercise you do.

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Martina, I have had too many carbs today due to the fact that its my daughters birthday..ooopps. Anyway, have I ruined all my hard work of the last 5 days and will body be out of ketosis or can I jump back on the wagon tomorrow without doing too much damage?

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Hi Megan, things like that happen and I wouldn't worry too much - it was your daughter's birthday! Once you go back to low-carb, it will take 1-3 days to get back to ketosis and you can again focus on your target. Don't be too harsh on yourself Smile

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Hi Martina,
Thanks for your fantastic work - I have your read your work & have your app & it's been so helpful! I'm a few weeks in & using a blood ketone meter. My levels have been really up and down .4-1.6 at various times of the day. I am mainly interested in mental clarity & sustained energy - hopefully it will become consistent once I'm fully adapted. However, I have noticed that I am often puffy around my eyes since starting keto and my eyelids are only what I can describe as 'crinkly'!! (Lol!)  My body has leaned down nicely & my overall skin luminosity has improved - except for the eyes! I am also more 'swollen' in my face. I'm taking extra mag , sodium & potassium. Have you come across this? Any thoughts?

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Hi Nellie, thank you! And we have been working on yet another big update!
Do you also have dry eyes / dry mouth feeling? How much water do you drink - could it be that you're not getting enough water? What is your net carbs intake - do you have any fluctuations?

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Hi Martina! I have the same puyy eyes issue like Nellie! Do you have any news on this? I started LCHF 5 weeks ago and am as well supplementing mag, sodium an a bit potassium. I think I drink enough water (about 4litres/8pints a day). Any suggestions would be highly appreciated! Thank you, Chrissy

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Hi Chrissy, I don't know what else it could be but it looks like it's related to carb withdrawal. I'd give it a couple more weeks, stay hydrated and take your supplements. I hope it helps!

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Hi and when might your book be available for the sony e reader??
Regards
Dr Neil

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Hi Neil, we have currently no plans to make the book for the sony reader. However, you can download a free kindle reading app (for your desktop computer or tablet). With the kindle reading app, you will be able to get my book for almost any device.

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Hi,
I've been doing keto diet subconsciously for many years as I hate the effects of any kind of sugar. Recently I was on a juice fast and they measured my levels on the third day. It was 3.4 ! Do you think that could be too high and signalling something else? They were talking about levels as high as 6 being good.
Thanks  

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Hi Danny, what you have described looks like "starvation ketosis". The reasons your ketone levels were so high was because you have been fasting. Starvation ketosis is not necessarily bad but I won't stay in such state for too long. I won't personally go on a juice fast because it's usually high in sugar. Also, if you do it for too long, your body will lack most nutrients. Have you tried fat fast? 1-3 days of fat fast is more beneficial, especially for the brain. I include one day of fat fast a week or every 2 weeks. On such day I only eat coconut oil sometimes combined with coconut butter (blended desiccated coconut).

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Hi!
I started on my journey a few weeks ago - was pretty disappointed that I didnt lose weight quickly even though ketostix showed I was in ketosis.  So I purchased a blood ketone meter and started monitoring last Saturday. I was at 0.4.  I decreased my protein intake and upped my fat intake and on Tuesday the level was 2.2.  I have lost 5 lbs since Monday.   This morning my ketone levels were 4.4.  I will measure again tonite after eating all meals for the day but would assume they would be even higher than the 4.4 early morning reads.  I am LOVING the weight drop of a lb or more a day but want to make sure I know what blood ketone level is too high.  And if I hit that point, do I just need to add more protein in my diet to get it down a little?  Right now I am at around 5% carb, 12-15% protein, and 80-83% fat. I eat around 1200-1500 calories per day depending on the meals I make.  I feel fine, a little tired during the day - definitely don't feel like I could do a big workout, but want to make sure I am not doing any damage to myself at the higher ketone levels.  
Thanks for any advice you can give me!

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Hi Cindy - that's great!
Your macros looks perfect (although I don't know your body weight, etc.), the calories sound reasonable, the macros are a good example of how Keto should be done Smile
I wouldn't worry about ketones being "too high" to reach ketoacidosis but you can definitely go a bit lower to stay within nutritional (not starvation) ketosis (up to about 3 mM). You can do that by adding 5-10 grams of net carbs per day or more protein. I can't tell you how much protein, but I'd just add a serving of meat, cheese or some nuts.
I'm not sure how long you've been on keto but you may be tired up to 4 weeks before you get keto-adapted. If you are tired even after that time, add a few more calories and make sure you get enough magnesium, potassium, calcium and vitamin D.  If you eat less than 20 grams of net carbs, you are likely magnesium deficient and may be deficient in some other micronutrients.
Well done - Keto on!

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Hello
Thanks got this useful post .  I'm one week in and measuring high for ketosis with ketostix.  What colour indicates to high ketones and where would be too low?  I need to know where to pitch it do I can stabilise and not produce too much.  All if the info is related to diabetes so the opposite to what I'm looking at.
Many thanks

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Hi Claire, nutritional ketosis is defined as a level when blood ketones are 0.5 to 3.0 mM. This is completely different to urinary ketones, as they may be higher or lower. If you want a perfect control over the level, I suggest you get blood ketone meter. Although some sources say you should aim for "pink", not "purple" ketostix, I often have the very dark (the darkest) reading and have no issues with ketoacidosis. Ketostix are good as "indicators" of whether or not you are in ketosis  (not always) but may not show the actual values. This is because ketones in urine are easily diluted and they only represent "excess" ketones exerted via urine.

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Excellent and easy to understand synthesis of the available info on ketogenic diets. I am 69 and have been in keto-adapted for about 6 months (to realize mental clarity, not weight loss).
I received a free serum ketone meter from Abbot at:
https://www.choosefreestyle.com/
I buy serum ketone test strips from:
universaldrugstore.com
for a bit less than $2.00 a strip. Excellent and reliable service.
One question: Will you be supplying and Android app?
     Thanks, Kerry

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Thank you Kerry! I love the mental clarity keto gives me, so I can fully focus on my work. My health has improved and my goal is to get off meds for my thyroid eventually Smile
We have plans for more platforms in our todo list but I can't tell you when this will happen. We still have a lot of work on our existing apps. For now, I have a kindle book with all the recipes and the guide included, but without the planner.

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Thank you so much for all this info! I've been low-carb for over 1 month and just getting used to it. It was quite hard at the beginning but it's so much easier now. The most difficult for me was to give up fruit but I still have berries once in a while Smile This is the best keto resource I've found. Keep on the great work!

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Thank you so much for all the kind words!! I really appreciate it. Good luck with keto!

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Hi Martina, great blog. Thanks!
As you said, it's not uncommon to see a spontaneous reduction in calorie intake when a patient goes on a ketogenic diet.  I dislike the straw man argument that states there is black magic or violations of Thermodynamic Laws at play here... this diet "fixes" appetite in many patients who have metabolic disorders.
Also agree that the depth of ketosis isn't a major factor determining the rate of fat loss.  You're burning fat regardless of whether beta-hydroxybutyrate is 0.5 mM or 1.5 mM.  At that point it depends on energy balance.
Thanks again,
Bill

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Hi Bill, thank you for your kind words and for your work! I've watched your video with Sam Feltham and just going through your book - really enjoying it!

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Thank you Martina! I started LCHF 2 weeks ago, so I think Ketostix should work for me. My hubby told me I should brush my teeth, so I must be in ketosis :-D I've already lost a few pounds but it's just the beginning! Smile I'm not hungry and eat a lot less. I first found it difficult to eat so much fat but luckily love coconut oil and butter. I follow your blog and got your book and LOVE your recipes, especially the one for fat bombs and keto buns! Do you think you can add more recipes for fat bombs? Thank you!

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Thank you Tessa! I will include more recipes soon and fat bombs are on my "todo" list Smile

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"Another aspect that affects the level of ketones is the amount of fat in your diet. Some of you may show higher concentration of ketones after a high-fat meal. Coconut oil contains MCTs that will help you boost ketones."
But that's counterproductive.  The point of seeing that you're in ketosis is that your body is properly telling your adipose tissue to give up their stores, and that you're using that for fuel.  
Consuming fat in your diet just to get the meter to go higher would be like holding helium balloons when you weigh yourself just to make "your weight" temporarily lower.

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It's not counterproductive. Ketogenic diet = diet high in fat, moderate in protein and low in carbs. Eating fat will help you boost ketones and get the right macronutrient ratio where most calories come from fat. Ketogenic diet is not about starving (unless including IF days every now and then) and you need to eat fat to burn fat. Saying "include coconut oil in your diet" does not mean "overeat fat just to get in ketosis".

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I agree with Martina, coconuy oil + MCTs not only helped me boost ketones but I also lost some belly fat. Before I realized I needed more fat, my weight was stalling for 3 months!

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I've been doing a low carb, hight protein diet for about 6 weeks now. Today I j tried my first ketostrip and it was negative. Any thoughts on why that could be?

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Have you been following a high-protein diet? In that case you may be eating too much protein (find out here: http://ketodietapp.com/Blog/page/KetoDiet-Buddy - I'd usually go for the "slow" fat loss option). The ketogenic diet is a low-carb, high-fat, moderate-protein diet. Also, a blood ketone meter is more accurate than urine ketone strips.

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Martina has neglected to share the other possibility of why Damian's Keto stick is appearing negative after 6 weeks.  It is well established in the "Art and Science of Low Carbohydrate Living" (Phinney, Volek) that when one has become "keto-adjusted" over the course of 4-6 weeks of low carb/high fat and protein living, that the type of keytones secreted in the urine, namely acetoacetic keytones, reduce in concentration. Conversely, beta-hydroxybutyric keytones continue to be produced and can be monitored in blood serum, but are not detectable with strips. Strips can only detect acetoacetic acid.
Please don't mislead the reader into thinking that he's eating too much protein, as both fat and protein are essential to maintaining ketogenic state, as well as decent beta-hydroxybutyric acid levels.
If I were to personally recommend a solution to Damian, I would either go and get a blood serum test, or do it the inexpensive way by kicking oneself out of ketosis for a few days, and then using the keto stix to watch your acetoacetic levels increase over the first couple of weeks through your urine.  Once you've reached the 4-6 week period again, you'll notice the strips having gotten lighter and lighter, which indicates the body nearing the phase of becoming keto-adjusted.

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Thank you for your insights. However, this has already been said above - that's why I didn't list all the possible options. Also, I think that checking whether you are eating the right amount of protein is only beneficial to the reader. It doesn't mean I encourage them to eat less protein but rather "moderate" and appropriate based on their body weight, body fat % and activity level.

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Ketogenic diet is high fat, moderate protein (about 1.5g per kg body weight per day), low carb (20g - 50g per day). Yes too much protein can prevent ketosis (gluconeogenesis), and yes ketones in urine tend to reduce once you are keto adapted, that is why a blood monitor is the most reliable testing method.

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Agreed!

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Hi, I'm on the wahls paleo plus, not predominantly for weight loss, but to try to recover from m.e/cfs. So my diet is very nutrient focused, 6 cups of varied veg, meat and a whole heap of coconut milk and fat, yum. No sugar, no dairy. You seem to know loads about ketosis though and I wondered if you could help me?
If as you adapt you stop showing ketones on the stick how do you know if you knock yourself out of ketosis? I am a week and a half in and have been in ketosis since day 2 - I was probably on the verge prior as had been on similar diet just more meat and veg - mornings often don't show up on stick but will be 11am and then onwards until bed. But I want to try to add in a few more carbs, find my upper limit, if I do that now I risk upsetting things while im adapting properly, but if I do it after four weeks I might not be showing ketones anyway so how will I know where my limit is?
Any practical advice would be so gratefully received. Thank you

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Hi Sula, I don't measure ketones regularly but only if I want to see how certain foods affect me. I keep my carbs at about the same level, mostly round 30 g net carbs, sometimes more - I already know my limit. If you use a blood ketone meter (not Ketostix), you will measure ketones even after you get adapted. My advice would be to add small amounts of carbs (see details here: ketodietapp.com/.../How-Many-Carbs-per-Day-on-Low-Carb-Ketogenic-Diet) , ideally after 3-4 weeks. For the first 3-4 weeks, I would aim for up to 20-25 grams of net carbs per day.

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Hi Martina,
I am a 57yr old FM bodybuilder.  A few years ago I was on the Keto diet and did quite well.  No real problems.  I was able to build quality muscle with moderate body fat (BF).  The one problem I had was that when it came time to cut the Fat I was not able to get my body to get really lean.  Following that my trainer told me that I really needed to have a carb based diet in order to get to the leanness I needed for competition.  I said I would give carbs another go and began upping my carb intake last November.  I don’t have to tell you what happened.  I went from 10% BF to what I am today o 20%BF and feel really sluggish.  I decided to go back to the Keto diet but need some guidance from anyone who has been in my position to first take off about 10lbs of BF while maintaining muscle and then begin to build again.
I began the diet 2 weeks ago and didn’t see any real results the first week.  Had LO AM fasted Ketone levels.  Not registered on my meter.  This week I kept a closer watch on my macros.  I had used a Keto Calculator (not yours) that said my Net Carbs should be 20g, Proteins should be 74g.  That seemed a bit low to me but I tried it. Up to know this is what this week looked like. Although this was my second week I’m calling it my first since I began looking at my macros.
Week  Day  Date  AM Weight  AM Ketones  AM Glucose  PM Ketones  PM Weight
1      153.5  LO    LO  
  Mon  8/1/2016  153  LO    0.5  
  Tue  8/2/2016  152.9  0.1    1.1  
  Wed  8/3/2016  152.4  0.3    1.2  
  Thu  8/4/2016  152  0.5    0.7  
  Fri  8/5/2016  150.7  LO    1.1  153
  Sat  8/6/2016  153  1.7    1.6  
  Sun  8/7/2016  152.5  0.2  109    
My Macros look like this;
  Grams  Calories
Calories    2,822
Fat  283.3  2,550
Saturated  171.5  1,544
Polyunsaturated  8.3  75
Monounsaturated  28.3  255
Carbohydrate  16.7  66
Dietary Fiber  2.2  
Protein  74.2  308
Alcohol  0  0
Then I found your site and your calculator gave me totally different levels.  Today’s macros look more that this
  Grams  Calories
Calories    2,372
Fat  301.8  2,717
Saturated  122.8  1,105
Polyunsaturated  9  81
Monounsaturated  29.5  266
Carbohydrate  13.8  54
Dietary Fiber  2.5  
Protein  116.6  478
Alcohol  0  0
I will give your macros a go this week and see what happens. I normally lift 5-6 days/week (Heavy). Last week not so much due to a respiratory issue that came on.  We think is either Bronchitis or walking pneumonia. Have been on several drugs, not much sleep due to coughing.  Anyway, the coughing has been reduced and my lung capacity increased.  I should be able to resume my normal lifting intensity this week.  This should help raise my Ketone Levels.
I am anxious for my ketones to level off.  Should I be looking for my AM Fasted level to be above 0.5 consistently to know that I am using my fat for fuel?  I’m assuming I should notice a decrease in measurements before I notice a drop in weight on the scale. Correct?
When I begin to really cut body fat, what do you recommend I handle that?  Should I just begin reducing my fat calorie intake?
I know you don't give personalized advice but I'm hoping you or an expert can assist me through this journey.  Looking forward to your response

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Hi Melissa, I've seen this a lot. Trainers recommending carb ups for everyone no matter what their goal is or/and what their workouts are. Unless you do high-intensity exercise, you won't need carb ups, in most cases not even if you are a bodybuilder (more info is here: ketodietapp.com/.../keto-diet-nutrition-and-exercise-carbs)
Yes, those macros you used to follow look too low. In your case I would expect protein to be at least 90 grams or even more. Carbs are always determined by individual needs (this number cannot be calculated) - usually 20-30 g net. Fat is then eaten to satiety or according to your goal (that's what determines how many calories you are eating and whether you are gaining, maintaining or losing).
Yes, if you want to maintain nutritional ketosis, your levels should be between 0.5-3 mM. In my opinion, high ketone levels are not needed and won't have a significant impact on your weight loss/ fat loss (I wrote more about ketone levels here: ketodietapp.com/.../do-ketones-matter). You may be using fat for fuel even if you are not in ketosis. If you follow the right macros and keep your carbs low, not necessarily ketogenic, you can still lose weight. Or you may be in ketosis and not using body fat if you eat too much dietary fat.
Typically, when you start eating low-carb, you will first experience water loss (I think this will be reflected in both your measurements and weight).
Most people on a keto diet just watch their carbs but in some cases, watching both carbs and calories (fat) may be necessary, especially if you aim for a low body fat level. I'm not sure if you should decrease your fat intake but if you follow the recommendations in our calculator, you can adjust the calorie deficit according to your needs (avoid going too low in calories - you should not feel hungry). I hope this helps!

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