Ketone queries

CherryAA

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@sock Fiddler -
In reply to your blog question - I thought I would post on the public forum, so others can learn/ correct/ contribute as appropriate .

a bit more research for you to get your head around - dreadfully oversimplified by me

There are three ways to measure ketones and three types of ketones.
I think about this in three stages ( which may be utterly wrong but makes sense to me )
a) peeing out the excess in urine ( like blood sugar problem ) because the body cannot yet process fats effectively but it is starting to make a lot of use of fats , you are calorie deficient overall so fat isn't going into your fat stores anymore and you are peeing out the stuff you put in that it can't yet use because its not yet fully fat adapted.
b) increasing the level of ketones in your blood because the body is now switching properly to fat burning - the ketones could be exogenous ( because you ate a lot of fat) or endogenous ( because you are retrieving it from your fat store )- you don't know which. So now you have much more circulating ketone bodies in your system which you can measure through blood ketones .
c) breathing out ketones because you have processed the fats in your blood and now you are expelling the waste products i.e. you are really using the actual FAT in your system and the exhaust pipe is switched on.

You may well be doing b) and c) at earlier stages in the process, just that the ketone measures you are using can't actually tell you that until you get to c)

Effectively you can measure these stages as you embark on the journey.
a) the first and cheapest is ketostix which measures it in urine.
https://www.amazon.co.uk/Bayer-Keto...=UTF8&qid=1501238842&sr=8-2&keywords=ketostix

These work well at first because you pee out ketones when first adapting to a keto diet and the sticks tend to tend a deeper shade the more into ketosis you are which is very satisfying,

Once you have been fat adapted for while they no longer work so well. By way of example I just did the test this minute and had a pale pink shade at the very first level of ketosis - so I know I am in ketosis but it doesn't look like its working very well. When I did this test 6 months ago after a more calorific diet than I have eaten this week I was well up the colour chart range. As far as I understand it the reason is that once your body is properly running on fat it, it either uses it within the body or expels it through the breath and it no longer feels the need to pee the excess out ( A bit like blood sugars where you get a lot of sugar in urine) .

b) The second stage is Blood Ketones - these effectively show how well your body is adapted to running on fat - the same test at the same moment for me currently shows blood ketones at 1.7 mmol, i.e. well in the nutritional ketosis range - this shows that my body is utilising ketones efficiently as opposed to carbs - which it should be because my total carbs over the last 6 days is only 130g.

The way to think about this is that blood ketones show how well your body is running on fat - you can induce exogenous ( external) ketones by for example eating MCT oil this doesn't actually help you lose weight it just means you are now burning the fat you are introducing to your diet and over time your urine ketones will still go down, you will still be " fat adapted " but you won't actually lose weight. You will only lose weight is your body is burning more ketones than are being consumed ( just like carbs in fact ). So it is perfectly possible to maintain or increase weight and be in ketosis - as many athletes are , you just have to eat enough fats and proteins.

You can buy a blood ketone meter from Amazon for £25, and the 25 sticks for about £20 . so this is rather an expensive process. the good news being that actually once in ketosis there is no real need to check again for a while unless you know you relaxed your diet. There is a tendency to want to check a lot though so that gets expensive at nearly £ 1 per strip.

There is a school of thought that the more fat adapaed you are, the harder it is to get high readings on the blood ketone meters - so a truly fat adapted individual may well have very low blood sugar AND very low blood ketones - meaning that his body is running supremely efficiently using very little energy overall.

c) The third stage is through measuring breath ketones.

Breath ketones show how will your body is actually burning the fat in your blood stream as the product of that process is expelled in breathe as waste , measured in parts per million and called BrAce

Research has been done that tries to correlate blood and breath ketones which shows that whilst there is a connection its not that obvious - which suggests that many people can eat low enough carbs to get into ketosis, but too much fat to get into endogenous ( i.e internally generated ketosis ) from burning your own fat.

https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

Often people chase getting into ketosis by consuming the relevant products which you see being marketed all the time - e.g. raspberry ketones and MCT Oil , or by adding bullet proof coffee- so they are happy that they are achieving a high level of blood ketosis . They are not necessarily actually losing weight - I think this is what I have been doing for the last six months that my weight has been on a plateau. I think you will only lose weight by adding these products if the resulting feelings of satiety reduce your desire for other foods by more calories more than eating the coffee etc consumed ( which I have found to be true for the bullet proof coffee) . Other may have different views.

For me the real goal for weight loss is not ketosis per se, its increasing the amount of internal fat you are using and that can be measured through breath- a Ketonix machine.

https://www.ketonix.com/index.php?o...category&layout=blog&id=29&Itemid=433&lang=en

Research studies have been done that correlate the extent of expelled ketones called BrAce and measured in parts per million and the rate of weight loss

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/

"
The amount of caloric restriction has the next greatest impact on BrAce. Fasting, the extreme form of caloric restriction, can elevate BrAce, up to 170 ppm over the course of weeks, more than macronutrient changes in adults (Figure (Figure1).1). However, fasting is not a sustainable lifestyle whereas a HFLC diet can be a lifestyle that leads to long term elevated acetone levels.

Less extreme than fasting is moderate caloric restriction which allows some food intake and appears to cause modest changes in breath acetone. Breath acetone levels rise as stored fat is metabolized to make up the difference between basal energy requirements and caloric intake. Using caloric restriction, multiple studies have shown a correlation between fat loss and increases in breath acetone 8, 24, 25, 27, 29. Specifically, individuals that maintain a breath acetone of 2 ppm should realize a fat loss rate of at least 114‐227 g week−1, based on the scientific literature 8, 27, 29. On the high end, BrAce could reach 8 ppm which could correspond to a fat loss of 1,200 g week−1 8.



As you know I have been trying to " fast" or at least keep to a very low calorie, very low carb diet whilst still exercising this week. My 6 day calorie deficiency compared to requirement has been about 1800 per day as a result and I have lost 4.6 kg as a result ( mainly water weight I know). My BrAce currently is 9ppm slightly higher than the 1.2 kg per week fat loss above., though nowhere near the 170 ppm achievable through actual fasting for a long time)

Ketonix is not cheap to buy ( I have the red one 189 usd ) however the advantage is that once purchased there are no ongoing expenses and you can test anytime of day.

I hope the above make ketone measurement a bit more understandable and i look forward to finding ut more about it myself from others more knowledgeable than me.
 
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SockFiddler

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Gosh, @CherryAA thank you so much for taking the time to write this.

It seems that, by eating only when I'm hungry and then only until sated, my body is naturally dropping its carb and protein intakes, which is awesome and surprising given my life-long food habits. However, I recognise that I still have some work to do on my psychology before I'm able to consider taking any further steps.

Ketosis, fasting and a VERY low carb diet are all possibilities - I'm not averse to trying anything for a while. But first I have to get my mind ready for it, and that can really only be done by considering my (changing) relationship with food, my goals and by learning more about these processes so that they make inherent sense to me and, therefore, make it easier to understand my goals.

I really admire you. I've been following your blog with much interest, but now I see the amount of effort and thought that goes into it and I'm a little bit in awe. That's not a prohibitive thing, though - 6 months ago, I'd have been in awe of what I've managed to achieve already in my first 6 weeks as a diagnosed diabetic.

It's all about the mindset. And yours is rock solid.

<3
 

CherryAA

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Gosh, @CherryAA thank you so much for taking the time to write this.

It seems that, by eating only when I'm hungry and then only until sated, my body is naturally dropping its carb and protein intakes, which is awesome and surprising given my life-long food habits. However, I recognise that I still have some work to do on my psychology before I'm able to consider taking any further steps.

Ketosis, fasting and a VERY low carb diet are all possibilities - I'm not averse to trying anything for a while. But first I have to get my mind ready for it, and that can really only be done by considering my (changing) relationship with food, my goals and by learning more about these processes so that they make inherent sense to me and, therefore, make it easier to understand my goals.

I really admire you. I've been following your blog with much interest, but now I see the amount of effort and thought that goes into it and I'm a little bit in awe. That's not a prohibitive thing, though - 6 months ago, I'd have been in awe of what I've managed to achieve already in my first 6 weeks as a diagnosed diabetic.

It's all about the mindset. And yours is rock solid.

<3

Would that it were " rock solid" if it were I would be thin by now :) but thanks - what is clear to me though, is that for many of us - getting rid of the sugar addiction is the real key and once you have achieved that - all of the other stuff becomes possible because you are no longer plagued by a hug desire to eat at every possible moment .The thing that you characterise as Psychological is to my mind a by product of, a very hard to get rid of, assumption that your weigh gain and lack of willpower regarding food is a symptom of your mental state . I have found the most liberating part of all this has been realising that actually that's not psychological at all, its physiological and as the damage done from the previous intake of rubbish foods starts to go away, so will the things you can achieve through diet start to expand and the idea of ketosis, fasting, very low carb will start to seem like natural developments of an already healthy path rather than something so far away its beyond comprehension. I look back on myself 12 months ago and I am an utterly different person as regards my own personal health than I was then The only thing I really changed was getting the processed foods and sugar out of my life.
 
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SockFiddler

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@bulkbiker I can read that article - thank you so much. Understanding it is a different bag of cats..!

What are your thoughts (anyone's) on the dual blood meters you can get that test both BG and blood ketones (BK I guess?). I assume they still have to operate within a given margin of error, so are they worth the consideration or do the strips make them prohibitively expensive?

I ask purely because my diabetes paraphernalia is already taking over a little bit and I can't imagine adding yet more stuff to it (though I tend to buy in bulk, so I have 3 months of test strips for 2 meters and 3 months of little sterile wipes to store, too).

This is all incredibly interesting. I'm so grateful for your input. I'll digest what you've written (see what I did there?!) and likely come back with a hundred annoying questions :)
 

CherryAA

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Hi @SockFiddler

If you want a more reasonably priced way to test breath ketones this may help

https://www.ketogenicforums.com/t/t...a-ketonix-using-a-cheap-breathalyzer/9450/294

Its quite long.. I think you should be able to see it without being a member..

Let me know if you can't

yet anther thing for me to buy and compare delivery Tuesday for a tenner. I would moan to myself that I should haev asked here before buying, but I know me, I'm a scker for gadgets so it wouldn't have stopped me getting the ketonix and comparing - more fool me !
 

CherryAA

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@bulkbiker I can read that article - thank you so much. Understanding it is a different bag of cats..!

What are your thoughts (anyone's) on the dual blood meters you can get that test both BG and blood ketones (BK I guess?). I assume they still have to operate within a given margin of error, so are they worth the consideration or do the strips make them prohibitively expensive?

I ask purely because my diabetes paraphernalia is already taking over a little bit and I can't imagine adding yet more stuff to it (though I tend to buy in bulk, so I have 3 months of test strips for 2 meters and 3 months of little sterile wipes to store, too).

This is all incredibly interesting. I'm so grateful for your input. I'll digest what you've written (see what I did there?!) and likely come back with a hundred annoying questions :)

My personal view would be to go for whatever is the cheapest you are comfortable with for blood sugars as you will probably test them way more than your ketones.
 

SockFiddler

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I finally found this thread!

a) peeing out the excess in urine ( like blood sugar problem ) because the body cannot yet process fats effectively but it is starting to make a lot of use of fats , you are calorie deficient overall so fat isn't going into your fat stores anymore and you are peeing out the stuff you put in that it can't yet use because its not yet fully fat adapted.

I bought the Ketostix and they arrived yesterday. Today I peed on one. It went purple. I peed on another - it also went purple.

Properly, deeply purple, but I couldn't understand why and I've been flicking about on this site to try to understand how I could possibly be in ketosis already - I just couldn't find this thread for the longest time!

However, happily, I've now reread what you wrote, Cherry, and understand it better. I'm starting to enter ketosis; my body has realised that there's not much carbs and far less protein than before but, holy macaroni, look at all that fat! It's starting to change over, but it'll still be mostly what I'm eating instead of what I'm carrying.

Good luck to the next doctor who wants to tip my pee: glucose, protein and ketones all present and correct at the moment.

I should market the stuff as an energy drink.
 

CherryAA

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yet anther thing for me to buy and compare delivery Tuesday for a tenner. I would moan to myself that I should haev asked here before buying, but I know me, I'm a scker for gadgets so it wouldn't have stopped me getting the ketonix and comparing - more fool me !

Well I now have a cheap breathalyser and it is true it does register a reading if I am in ketosis. I does seem to be a fairly blunt instrument though recording 0.1 or 02 no matter what the ketonix readings ( up to 30 pm !)
 

LittleGreyCat

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Interesting thread, but I am not fully convinced that it is a progressive 1->2->3 process.

From my not so comprehensive reading I think that Ketostix are a blunt instrument and just measure the ketones that your body is throwing away.

Some people may settle into ketosis and their body may balance their blood ketone level to nicely match their ketone consumption so the Ketostix show little or no ketones when there are loads in the blood.

I also thought that the breath analysis was broadly comparable to the blood test (no false positives) but bloody expensive for the accurate kit.

I do note that the breathalyser approach assumes that you are throwing ketones away in your breath, which seems similar to the Ketostix approach at the other end, but it may be that once you have ketones in your blood some are naturally passed through the blood/air barrier in your lungs along with CO2 and stuff.

In my case I am pretty sure that I have been in ketosis since at least January and testing with Ketostix still shows a dark pink between 1.5 and 4 mmol/L so I am throwing away a lot of ketones.

One key part may be the storage of surplus fats from the blood stream. According to a quick search Insulin is the major factor in the storage of fats.

A random link http://science.howstuffworks.com/life/cellular-microscopic/fat-cell2.htm (no guarantee this is accurate) says:

Insulin
When you eat a candy bar or a meal, the presence of glucose, amino acids or fatty acids in the intestine stimulates the pancreas to secrete a hormone called insulin. Insulin acts on many cells in your body, especially those in the liver, muscle and fat tissue. Insulin tells the cells to do the following:

  • Absorb glucose, fatty acids and amino acids
  • Stop breaking down glucose, fatty acids and amino acids; glycogen into glucose; fats into fatty acids and glycerol; and proteins into amino acids
  • Start building glycogen from glucose; fats (triglycerides) from glycerol and fatty acids; and proteins from amino acids
The activity of lipoprotein lipases depends upon the levels of insulin in the body. If insulin is high, then the lipases are highly active; if insulin is low, the lipases are inactive.

The fatty acids are then absorbed from the blood into fat cells, muscle cells and liver cells. In these cells, under stimulation by insulin, fatty acids are made into fat molecules and stored as fat droplets.

It is also possible for fat cells to take up glucose and amino acids, which have been absorbed into the bloodstream after a meal, and convert those into fat molecules. The conversion of carbohydrates or protein into fat is 10 times less efficient than simply storing fat in a fat cell, but the body can do it. If you have 100 extra calories in fat (about 11 grams) floating in your bloodstream, fat cells can store it using only 2.5 calories of energy. On the other hand, if you have 100 extra calories in glucose (about 25 grams) floating in your bloodstream, it takes 23 calories of energy to convert the glucose into fat and then store it. Given a choice, a fat cell will grab the fat and store it rather than the carbohydrates because fat is so much easier to store.

If this is even mainly true it suggests that if your body has insulin resistance then it may fail to keep your blood fat level down in the same way that it fails to keep your BG level down.

Which would be an interesting take on high cholesterol and triglycerides when on LCHF.

I have wondered about this for some time; is there a complaint "fatabetes" which is similar to diabetes but is poor control of blood fat levels?

It would be just my luck if my blood fat control is as broken as my blood glucose control.

I am managing my blood glucose by not eating carbohydrates.

If I can't eat fat either, and too much protein screws your body up, then where do I go for my calories?
 

SockFiddler

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It's real;y interesting. And the truth is, reading everything I've read, I shouldn't be in ketosis at all - I'm still hovering around (and often just over) 50g carbs / day and I'm not limiting my protein intake at all - that ranges between 75 and 100+ g/day. My overall calories intake is around 2,000 / day (mostly fats), so perhaps it's not ketosis, per se, but all that fat coming out?

But, then again, why would I be processing it into ketones instead of just letting it pass through my gut?

I remain sceptical that I could be in ketosis with those numbers. Admittedly, compared to what I was eating 2 months ago, it's a drastic change in my diet, but it's not the low intake of carbs and protein that, fairly universally, you seem to need to get into keto in the first place.

Confusing!
 

Alison Campbell

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Are you still taking Empagliflozon?

Could it be the low carb diet plus medication flushing the glucose out of your system causing you to burn fat and produce ketones?

Dependent on dose this class of medication can flush out around upto 22-44% of carb intake in women so perhaps your body is getting a lot less carbs than you think?

I maybe getting it all wrong and they could be unfairly blaming the patient but found hints of this information in the following:

http://care.diabetesjournals.org/content/38/9/1638

https://www.endocrineweb.com/news/d...-about-diabetic-ketoacidosis-sglt2-inhibitors
 

SockFiddler

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Oooh, that's a good point there, @Alison Campbell - I am still on the GlucoPee (and still at a fairly hefty 25mg dose) and while I was aware that would account for glucose being present, I hadn't considered that it would also leave a deficit in the glucose it gets out of my blood.

I know the medication has a significantly increased risk of causing KDA (I'm watchful of symptoms but feel pretty good, all in all), it's my understanding that KDA and ketosis are slightly different processes that shouldn't be confused?

Though I'm probably also getting it wrong!

Thanks for the articles, too - I'll have a read now <3
 
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bulkbiker

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It's real;y interesting. And the truth is, reading everything I've read, I shouldn't be in ketosis at all - I'm still hovering around (and often just over) 50g carbs / day and I'm not limiting my protein intake at all - that ranges between 75 and 100+ g/day. My overall calories intake is around 2,000 / day (mostly fats), so perhaps it's not ketosis, per se, but all that fat coming out?

But, then again, why would I be processing it into ketones instead of just letting it pass through my gut?

I remain sceptical that I could be in ketosis with those numbers. Admittedly, compared to what I was eating 2 months ago, it's a drastic change in my diet, but it's not the low intake of carbs and protein that, fairly universally, you seem to need to get into keto in the first place.

Confusing!

I think that the 20g of carbs is the level where almost everyone can get into ketosis. You may well be one of the lucky ones who can eat more carbs and still get there.. I know I can't .. Friday my ketones were only 0.2 (blood level) as I'd had a few too many carbs in the preceding days avg 25g.. due to yoghurt.
 

SockFiddler

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https://www.endocrineweb.com/news/d...-about-diabetic-ketoacidosis-sglt2-inhibitors

Gosh, had I read that article 2 months ago, I would have been terrified to try LCHF- or my meds. The truth is, since that article was written, there has been enough evidence linking SGLT2 inhibitors to DKA to form more than a causal link and the drug's own website lists DKA as a serious potential complication (though it doesn't mention LCHF at all). Interestingly, the second article links incidents of DKA among people who take these drugs to high carb diets (which makes more intuitive sense).

More interesting, perhaps for T1s, is to note that the second article is making a case for use in T1D's, for which it's currently not licensed - precisely because of DKA.
 

Alison Campbell

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I think you are right about DKA as a seperate process hence my comment that they could be "blaming the patient".

I think the more interesting information is about flushing out upto 44% of your carb intake, due to medication, could explain why you are fat burning and producing ketones at a higher carb and protein intake than some.

I definately did not mean to cause alarm. Just a possible explanation, as you seemed to be skeptical about being in ketosis.
 
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SockFiddler

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Oh, @Alison Campbell - no alarm! <3 Was just saying that reading that article alone would have terrified me without the endless question answering, information, advice, support and patience of everyone who's put up with me and my too-steep learning curve on these boards.

I know better now!
 
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ringi

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The big risk is that you can be in DKA while on "GlucoPee" and have BG levels that are below what doctors and A&E nurses expect to see when someone is in DKA. Hence the DKA can go untreated for some time. If you have the other signs of DKA then it needs a "blood gas test" to confirm if you are in DKA.

A "blood gas test" can only be done at hospitals, as the blood needs to be put in the machine within minutes of it being taken, hence it is one of the time when going direct to A&E is the best option even if your GP is open.

Also it is very important to drink lots of water as dehydration is a big risk factor for DKA, and "GlucoPee" does what is says on the tin.....
 
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letstalk1

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Thank you for this Cherry , and looking forward to more of your perfect way of explaining things.
When I plateau , I add 5-10 carbs a day for 2-3 days then right back to my usual and many times I have started losing again.
 

letstalk1

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Gosh, @CherryAA thank you so much for taking the time to write this.

It seems that, by eating only when I'm hungry and then only until sated, my body is naturally dropping its carb and protein intakes, which is awesome and surprising given my life-long food habits. However, I recognise that I still have some work to do on my psychology before I'm able to consider taking any further steps.

Ketosis, fasting and a VERY low carb diet are all possibilities - I'm not averse to trying anything for a while. But first I have to get my mind ready for it, and that can really only be done by considering my (changing) relationship with food, my goals and by learning more about these processes so that they make inherent sense to me and, therefore, make it easier to understand my goals.

I really admire you. I've been following your blog with much interest, but now I see the amount of effort and thought that goes into it and I'm a little bit in awe. That's not a prohibitive thing, though - 6 months ago, I'd have been in awe of what I've managed to achieve already in my first 6 weeks as a diagnosed diabetic.

It's all about the mindset. And yours is rock solid.

<3
Yup , totally about mindset and if mine isnt there I dont stick to my guns right , plus there is always something more to learn I am so glad I am always interested in all of this.