Semi Urgent Question About Ketosis

[AdamJames]

Sorry about the title, not sure how to 'place' it; just I could do with making a decision before I go to be in about an hour.

I've only been doing LCHF for 4 days, and just had a surprising reading from urinating on a Ketostix strip. The colour is a firm match to 8 mmol/l. I also know from experience of mild ketosis that I seem to get a higher reading throughout the night every time I pee, so I'd expect this to get higher overnight.

The recommended level for 'nutritional ketosis' seems to be 4 or less. Also there's only one darker colour to go on my strips, and I'm worried that to reach it would be a bad thing, especially if overnight while sleeping.

I know people aren't encouraged to offer medical advice, I'm really just looking for other people who have done LCHF to let me know what kinds of levels they have had and what they've noticed as a result. I'll eat some carbs if this seems too high.

Thank you.

 

[leahkian]

You need to phone 111 asap as 8 is way to high and could still be rising, have you been drinking plenty of water and have you been sick if the answer is yes to both you need to get to a & e quick so they can get the keytones under control

 

[Resurgam]

The level of ketones is not all that significant if your blood glucose levels are low.
If you drink a couple of glasses of water now the colour should reduce, but it just means that at the time the urine left the kidneys, fat was being burnt for energy.
The combination of high glucose high ketones is an indication of serious metabolic problems, but on their own a high concentration of ketones usually indicates being a bit dehydrated - at the start of LC eating you do lose more water and electrolytes than normal.
Remember that most things to do with nutrition are dictated by people who regard low carbing as close to devil worship - at least that has been my experience, so their ideas might be skewed to higher intake of carbs as being desirable.

 

[BrianTheElder]

Hi @AdamJames
Ketostix are pretty unreliable. You don't say if you're T2, but if you are and you are trying to achieve nutritional ketosis, then the figure of 8 would be very high. A range from 1 to 5 would be expected. Also, of course , it depends on what meds you're on and whether a hypo or ketoacidosis are likely.
So, more info required, please.

 

[AdamJames]

You need to phone 111 asap as 8 is way to high and could still be rising, have you been drinking plenty of water and have you been sick if the answer is yes to both you need to get to a & e quick so they can get the keytones under control

I've been drinking to thirst, not ensuring I've had 3 litres. That could be part of it. I'll see what's happening in an hour after I've drunk some water.

Thank you.

The level of ketones is not all that significant if your blood glucose levels are low.
If you drink a couple of glasses of water now the colour should reduce, but it just means that at the time the urine left the kidneys, fat was being burnt for energy.
The combination of high glucose high ketones is an indication of serious metabolic problems, but on their own a high concentration of ketones usually indicates being a bit dehydrated - at the start of LC eating you do lose more water and electrolytes than normal.
Remember that most things to do with nutrition are dictated by people who regard low carbing as close to devil worship - at least that has been my experience, so their ideas might be skewed to higher intake of carbs as being desirable.

I expected about 7 mmol/l and have just got a 7.3, so it's not being caused by sky high sugar levels. Thanks for the idea of checking bg.

I'll force some water down and check again in 30 mins then an hour.

Thank you.

Hi @AdamJames
Ketostix are pretty unreliable. You don't say if you're T2, but if you are and you are trying to achieve nutritional ketosis, then the figure of 8 would be very high. A range from 1 to 5 would be expected. Also, of course , it depends on what meds you're on and whether a hypo or ketoacidosis are likely.
So, more info required, please.

Yes, T2 and going for nutritional ketosis. Re Ketostix being unreliable, that's reminded me I have another type of strip that measures various things. I'll see if that agrees.

In the same way that bg can go up when ill, can ketones? I have been having a sore throat today.

Thank you.

 

[Resurgam]

People on the Atkins list doing Induction - that is the first two seeks of the diet seem to survive high levels of ketones - but they are not, for the most part, diabetic.

 

[AdamJames]

My other sort of testing strips agree, they are a definite 8 and possibly a bit beyond.

Just had some water. Will have some more, finish having a shave(!), have yet more water then check again.

Thank you.

 

[AdamJames]

People on the Atkins list doing Induction - that is the first two seeks of the diet seem to survive high levels of ketones - but they are not, for the most part, diabetic.

Reassuring nevertheless.

I think a sensible plan is to try to lower it to less than 4 using water then carbs if need be. I'll stay awake until I can do that, don't fancy going to sleep in this state. If I can't resolve it I'll go to hospital just in case.

Thank you very much for you assistance, everyone!

 

[AdamJames]

Technical question: Is the carb RATIO what's important, rather than the absolute carb amount? I.e. if I'd had 20g of carbs on a 1,800 calorie day, would you expect a very different ketone level if I'd had 20g carbs on a 3,000 calorie day, i.e. more fat and protein?

 

[Resurgam]

I have never tested for ketones and I've been eating low carb whenever I could get away with it since the early 1970s. I suspect it has been masking the symptoms of diabetes for some considerable time. I stopped counting calories (and I burnt the book in the garden) when I realized that when doing Atkins I seemed to be consuming negative amounts of calories.
With your blood glucose being under 7.5 - which is, I think the top of the absolutely normal range I don't think that any level of ketones is going to set off alarm bells - I mean - how are they going to treat it?
Ketoacidosis in type ones and insulin dependent type twos shows high glucose high ketones and they get fluids and insulin - not really appropriate in your case.

 

[AdamJames]

Now at 4 mmol/l, possibly a bit less. Resolved just with a lot of water and peeing a few times to flush things through. I'll check what's happening every time I get up tonight for a pee!

I feel a bit of a drama queen now, but then again I'd never have realised that water levels could have such a quick and noticeable effect, so really glad I asked for advice. I'd probably have spent all night eating carbs which would be bad for other reasons!

I've been writing down what I eat today, but haven't worked out the macros. I'm pretty sure it's been a high calorie day as I'm trying to maintain weight, not lose it, and I've realised how peskily good this LCHF thing is at making you lose weight, so been upping the calories each day!

So the very low carb to fat ratio, combined with only drinking to satisfy thirst, are probably what I need to be more careful of in future.

Thank you everyone for your advice.

 

[ziggy_w]

Hi @AdamJames,

I am attaching a graphic with this post that translates urine ketones into blood ketones. You will see that a level of 3+ on ketostix translates into 1.8 mmol to 5.2 mmol blood ketones. This equates to something between after exercise ketosis and starvation ketosis -- but this is still a far cry from ketoacidosis.

As @Resurgam has said many initially experience high urine ketones when starting on a low carb diet -- this usually gets better after a while when your body has gotten used to using ketones for energy.

If you are concerned, you might also try having some protein (meat for example). This causes an insulin response, which will tell your body to stop producing ketones. So, it works similar to carbs, but doesn't raise your blood sugars as much.

 

[AdamJames]

Hi @AdamJames,

I am attaching a graphic with this post that translates urine ketones into blood ketones. You will see that a level of 3+ on ketostix translates into 1.8 mmol to 5.2 mmol blood ketones. This equates to something between after exercise ketosis and starvation ketosis -- but this is still a far cry from ketoacidosis.

As @Resurgam has said many initially experience high urine ketones when starting on a low carb diet -- this usually gets better after a while when your body has gotten used to using ketones for energy.

If you are concerned, you might also try having some protein (meat for example). This causes an insulin response, which will tell your body to stop producing ketones. So, it works similar to carbs, but doesn't raise your blood sugars as much.




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View attachment 24768

Thanks for that, and the tip about eating meat!

I found it seemed to get lower throughout the night, every time I got up for a pee and drank some water.

Re blood glucose, I'm finding it harder to get low morning readings since I started LCHF. Went to sleep at approximately 7.5 and woke up the same, i.e. to within my meter's accuracy nothing much changed.

Then again I'm now certain I'm coming down with something. Had a sore throat yesterday, it's worse now and feeling like poo, so there are too many factors to be drawing any conclusions after just 4 days of LCHF. I'm really hoping for lower morning glucose levels eventually.

 

[Daibell]

Only usually a problem if your blood sugar is high as well. If your bs is near normal then it's probably just ketosis and not keto-acidosis. Just keep an eye on the bs.

 

[ziggy_w]

Hi @AdamJames,

It's good to hear that your ketones came down after drinking lots of water -- though it probably didn't make for a very relaxing night.

What were your fasting blood sugars before embarking on low-carb eating? Have they increased a lot? It might well be that your coming down with a bug explains the rise. You probably have to get over the cold/flu first before you can judge the impact of your new way of eating on your blood sugar levels. I really feel for you with this cold -- they make you feel miserable.

 

[BrianTheElder]

Technical question: Is the carb RATIO what's important, rather than the absolute carb amount? I.e. if I'd had 20g of carbs on a 1,800 calorie day, would you expect a very different ketone level if I'd had 20g carbs on a 3,000 calorie day, i.e. more fat and protein?

I believe it's the absolute amount that's important. Once your body senses there are spare carbs around, it will switch from lipolysis to glycolysis. Also, if you eat more than moderate amounts of protein, your liver will produce glucose via gluconeogenesis. It is quite difficult to stay in a ketogenic state and you have to be strict with your carb and protein control. Of course, if you eat lots of fat, that is lots of calories, so you will put on weight. Moderation (or less) in all things!

 

[AdamJames]

Hi @AdamJames,

It's good to hear that your ketones came down after drinking lots of water -- though it probably didn't make for a very relaxing night.

What were your fasting blood sugars before embarking on low-carb eating? Have they increased a lot? It might well be that your coming down with a bug explains the rise. You probably have to get over the cold/flu first before you can judge the impact of your new way of eating on your blood sugar levels. I really feel for you with this cold -- they make you feel miserable.

The morning fasting bgs varied before. If I'd exercised in the evening before and eaten sensibly, I could get as low as 4.5. Doing the same exercise at the same time in the evening on LCHF, so far I haven't been able to get it below 6. If I just "eat what I want and don't exercise" on LCHF it seems I can expect about 7 at the moment.

Early days, lots more to explore!

 

[AdamJames]

I believe it's the absolute amount that's important. Once your body senses there are spare carbs around, it will switch from lipolysis to glycolysis. Also, if you eat more than moderate amounts of protein, your liver will produce glucose via gluconeogenesis. It is quite difficult to stay in a ketogenic state and you have to be strict with your carb and protein control. Of course, if you eat lots of fat, that is lots of calories, so you will put on weight. Moderation (or less) in all things!

I've been writing down what I've eaten since I started, but not yet worked out the calories, carbs, protien and fat per day. I might get a shock when I do that. I'm going to be working out a diet plan with ratio targets to aim for, thank you.

I'm weighing myself every morning and so far it seems if I eat all I want on LCHF, I can maintain weight! That's probably because I have a fair bit of weight to maintain!

 

[Brunneria]

Are you familiar with the differences between nutritional ketosis (happens in the presence of 'normal' blood glucose and insulin levels) and ketoacidosis (happens in the presence of high blood glucose, and the absence of insulin, happens to T1s and T2s on insulin if they don't have enough injected insulin)?

Basically, if your own body is producing enough insulin to keep your blood glucose at reasonable levels then it is almost certainly nutritional ketosis.

There are rare and notable exceptions to this for Type 2s (aren't there always exceptions?) but these involve certain classes of stronger T2 drugs, and if you are on them, then the info leaflet inside the packet will give you all the information you need.

Another factor that may be in play is that if you are new to ketosis, then the body has to 'learn' how to use the ketones as fuel. After all, it has been running on glucose for most of your life, and now you are asking it to switch to another fuel. During the transition, ketones are dumped out of the body via the urine, whereas a few days later, the ketones get used as fuel and don't appear so much in the urine. This is one of the reasons why ketones in urine are considered a fairly inaccurate gauge of ketosis, because the longer you stay in ketosis, and the better your body adapts, the less your ketones will show on a dipstick.

It is perfectly normal for people (everyone, not just diabetics) to slip into ketosis at night, and then slip out of it when they have breakfast, so ketones are often higher at night.

 

[AdamJames]

Are you familiar with the differences between nutritional ketosis (happens in the presence of 'normal' blood glucose and insulin levels) and ketoacidosis (happens in the presence of high blood glucose, and the absence of insulin, happens to T1s and T2s on insulin if they don't have enough injected insulin)?

Basically, if your own body is producing enough insulin to keep your blood glucose at reasonable levels then it is almost certainly nutritional ketosis.

There are rare and notable exceptions to this for Type 2s (aren't there always exceptions?) but these involve certain classes of stronger T2 drugs, and if you are on them, then the info leaflet inside the packet will give you all the information you need.

Another factor that may be in play is that if you are new to ketosis, then the body has to 'learn' how to use the ketones as fuel. After all, it has been running on glucose for most of your life, and now you are asking it to switch to another fuel. During the transition, ketones are dumped out of the body via the urine, whereas a few days later, the ketones get used as fuel and don't appear so much in the urine. This is one of the reasons why ketones in urine are considered a fairly inaccurate gauge of ketosis, because the longer you stay in ketosis, and the better your body adapts, the less your ketones will show on a dipstick.

It is perfectly normal for people (everyone, not just diabetics) to slip into ketosis at night, and then slip out of it when they have breakfast, so ketones are often higher at night.

Thanks for all that info!

One thing I was aware of was ketoacidosis, and I sort of presumed it couldn't be that because I'd had hardly any carbs, but Resurgam made me realise it would be a good idea to check my blood glucose anyway, and the result was very reassuring.

I'm going to stick at this for at least 2 weeks to give it a fair chance, probably longer now that I realise I am coming down with a bug. Feeling great on LCHF in spite of that. If I can get to the point where I wake up with bgs less than 6 then I'll definitely feel comfortable sticking to it long-term.

Based on the last few months, I have a feeling that calorie deficit, regardless of the macro ratios, has a big impact on helping get my morning bgs low, and I'm not aiming for calorie deficit at the moment, so that's another reason why I may not be getting great bgs.