The ketone testing technology for the urine, blood, and breath are definitely interesting and a great direction for measuring for the specific level of ketosis.
– Dr. Dominic D’Agostino
Keep carbs low
Eat more fat
Test ketones often
Overdoing protein is bad
At this point in the book, you’ve heard all about what ketones are, why you probably want to increase the amount of them in your body, and what it takes nutritionally to make this happen. But you may be wondering how in the world you are supposed to figure out if you are actually in a state of ketosis. That’s what this chapter is all about, and it will cover some of the old, traditional ways of measuring, the current devices available on the market, and some really cool emerging technologies that could forever change the way we check for ketones in the future.
Before we dive into the latest gizmos and gadgets that technology has to offer for measuring ketones, let’s first identify the three types of ketone bodies that are found inside the body:
- Acetoacetate (AcAc), the primary ketone body in the urine
- Beta-hydroxybutyrate (BHB), the primary ketone body in the blood
- Acetone, the primary ketone body in the breath
For decades, the traditional method for measuring the presence of ketones has been testing acetoacetate levels in the urine. The ketone test strips for urinalysis can be purchased in a bottle of fifty for around $12 to $15. (To double your money’s worth, cut the strips in half lengthwise and just use half of a strip each time.) The strips change color to signify the level of acetoacetate. If you are just starting your pursuit of ketosis, you may see beige (no ketones), pink (some ketones), or purple (a lot of ketones).
Avoid using urine ketone test strips as a measure of keto-adaptation. This is akin to looking for banana peels in your garbage to figure out how many apples are in your refrigerator and how many of those you are eating.
Apart from only measuring ketones eliminated as a waste product, urinary ketone test strips measure only one kind of ketone, acetoacetate, and fail altogether to measure the most critical and predominantly utilized ketone in a healthy state of ketosis: beta-hydroxybutyrate. This is always better and more accurately measured with a blood ketone meter.
– Nora Gedgaudas
Ideally, a state of ketosis is achieved and maintained with finger-stick blood ketone monitoring and by keeping beta-hydroxybutyrate levels at 1 to 3 millimolar per liter. My experience with urine dipsticks for ketones is that, because they are set up to assess for the much higher levels of ketones indicative of diabetic ketoacidosis, they are insufficiently sensitive to be of much assistance to monitor the more subtle levels of physiologic ketosis.
– Dr. William Davis
However, when I contacted these companies, both Abbott and Nova showed zero interest in what I was sharing with them about using their products to test for nutritional ketosis, stating that their focus was on helping diabetics test for ketoacidosis—nothing more. That’s just silly if you ask me, and they’re missing an opportunity to increase their bottom line. But something tells me that if enough people started demanding better access to their product, they’d find a way to make it more readily available at an affordable price. Contact Abbott at (888) 522-5226 and Nova at (800) 681-7390 and let them know you need access to their products to test for nutritional ketosis.
Even though blood ketone monitors are fairly new, the next generation of ketone testing devices is already on the way. One ketone monitor that measures for the presence and amount of acetone in the breath is already available to consumers, and others are in development and show great promise. Breath ketone monitors have been shown to be just as accurate as blood ketone monitors, and since they don’t require strips, they’re much more affordable. Plus, you get good results without the pain of a finger prick.
I’m a fan of breath ketone testing, as it’s less invasive and painful than blood testing. For my personal experiments with ketosis, I used a breath test that detects levels of ketones (acetone) in breath condensate. Breath condensate and blood ketone levels are well correlated, and they’re more reliable and readily detectable than urine ketone levels. Several studies indicate that breath ketones are a reliable measurement for ketosis compared to blood and urine samples.
– Ben Greenfield
In a July 2002 study published in the American Journal of Clinical Nutrition, researchers investigated which is more accurate, testing for ketones in the urine or breath. They found that breath acetone is “as good a predictor of ketosis” as ketones in the urine. Several breath ketone meters are currently in development and not yet available to the general public (most likely we’ll be seeing them by 2015).
As of the writing of this book, only one breath ketone monitor is available commercially to consumers: the Ketonix, a USB-powered device that you can use thousands of times. Created by a forty-nine-year-old Swedish engineer named Michel Lundell, the Ketonix measures the ketones in the user’s breath and responds with a sequence of colored lights that changes depending on the level of ketones detected. Inventing this device was a necessity for Michel when he was diagnosed with epilepsy in 2012.
After having little success in reducing his number of seizures even after doubling the recommended dose of epilepsy medications ten times in one year, Lundell began investigating the ketogenic diet, which has long been considered an excellent treatment option for epilepsy (we’ll examine the evidence for this in chapter 16). He first attempted to measure his ketones using urine strips and then a blood ketone meter. But neither of these options worked for him, so he began to search for alternatives. He came across the idea of measuring acetone in the breath, and when he failed to find any devices for this, he put on his engineering hat and made the very first Ketonix for himself.
Lundell went on to market and sell his device online, making it the first breath ketone monitor to be commercially available, and he has been receiving orders around the world from people with epilepsy, people who are pursuing nutritional ketosis, and even athletes who are measuring their ability to use fat for fuel during sporting events. In June 2014, he was selected as one of only six people from around the world to give a presentation about his invention at the special Shark Tank Competition that was part of the 2014 Epilepsy Pipeline Conference in San Francisco, California.