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Testing for Ketones At Home
NEED TO KNOW CHEAT SHEET:
You can test for ketosis via ketone test strips, breathalyzer assessments, and blood analysis.
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The gold standard measurement is blood analysis.
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Breath testing is convenient and a quality proxy on ketosis, but is not bulletproof.
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Ketone test strips may be the most convenient but are the least reliable.
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Each option has pros and cons depending on a variety of factors.
Eating a lower carbohydrate, higher healthy fat diet, practicing intermittent fasting, consuming MCTs, and supplementing with exogenous ketones are all ways to promote the metabolic state of ketosis in the body.
As we have mentioned before, ketosis has numerous health benefits for your health, performance, physique, quality of life, and longevity. Ketones are not only a source of fuel for your brain and body but also powerful signaling molecules that can alter various enzymatic activities.
You are in ketosis when you reach a specific and healthy level of ketones in your blood.
How do you know if you're in ketosis?
If you have ever been in ketosis or are a seasoned keto veteran, you may already know that you can easily tell when your body is effectively running on ketones, simply by the way you feel. That said, there are only a few ways to objectively know if you have reached that ketone level threshold where you are in full ketosis.
Testing for ketones is quite simple and can be reasonably cost-effective. Testing for ketones can be a fun way to do some n=1 science and experimenting to get instant feedback on your diet and lifestyle habits to figure out what way of eating works for you!
Why Would You Want To Test For Ketones?
At the end of the day, the most important factors of your health regimen are that it is objectively making you healthier, feel better, get in better shape, improve performance, promote longevity, and generally improve your quality of life.
While we don't recommend chasing an exact ketone level over the above qualities, tracking your ketones can be a great way to test your diet, supplementation, and provide accountability.
Achieving Ketosis
By definition, ketosis is a “metabolic state characterized by elevated levels of ketone bodies in the body tissues.” There are four ways you can reach ketosis.
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Low-Carb, Ketogenic, and/or Restricted-Calorie Diet: Ketosis can be achieved by eating a lower carbohydrate, higher healthy fat diet such as but not limited to a ketogenic diet.
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Fasting: A direct way to achieve ketosis is to completely restrict any caloric intake for an extended period of time.
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Exercise: High intensity and/or extended endurance exercise will deplete glycogen stores and promote ketone production.
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Supplements: You can achieve ketosis is by ingesting exogenous ketones supplements and/or ketone precursors like MCTs.
There are a few reasons why measuring and knowing your ketone levels may be beneficial. Benefits of Measuring Ketones:
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Ketone levels can serve as an easy to track biomarker, or GPS, for the effectiveness of your chosen form of lower carbohydrate eating. If you want to know just how well your diet is getting you into ketosis, measuring ketones is the only way to get an exact answer.
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Furthermore, measuring ketones during fasts, after eating certain foods, and before and after training/exercise can help you determine how your body responds to these mentioned lifestyle and diet interventions.
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Testing ketone levels can also help to quantify the effectiveness of exogenous ketones and test how your body responds. This can potentially give you some information on how long it takes for your body to enter ketosis after supplementation, as well as how long this presence of ketones in your metabolism lasts.
Essentially, testing for ketones is a great way to provide you objective data for how you respond to certain diet strategies and/or exogenous ketone supplementation. Measuring ketone levels can serve as validation that you are moving in the right direction.
Again, we do not want you to chase ketone levels over other bigger picture health results. Measuring your ketones can be an effective way to help you stay accountable and motivated by making the diet fun and giving you objective metrics for improvement in the early phases of your lifestyle change.
Ideal Ketone Levels
Ideal ketone levels will not be the same for everyone, just as one specific diet will not be optimal for everyone. For example, a more mild state of ketosis, between .5 - 1mM, may have you feeling your best, while a more advanced state, between 1.5 - 3mM, might make you feel less optimal, and visa-versa. That said, a deeper state is thought to be more ideal for some of the ketone benefits, including fat loss and epigenetic effects (gene signaling).
Knowing where you are on the ketosis level spectrum will allow you to tailor your exercise, nutrition, and supplementation to get the ideal levels you want. In essence, if you have certain health, fitness, or performance goals related to your decision to transition into ketosis, testing ketones can be a great way to track, provide accountability, and potentially customize your health and fitness regimen.
Ketone Testing Methods
Urinalysis
That's right... testing your pee! This is the most common way to measure ketosis because it is economical.
Urinalysis specifically tests the levels of the ketone body, acetoacetate (AcAc). AcAc is produced in the liver from fatty acid oxidation (fat burning). AcAc is most often converted into another ketone molecule known as beta-hydroxybutyrate (BHB), but some will get into the bloodstream before it is converted. However, we do not measure its presence with blood testing.
So how does AcAc end up in your urine? The reality is at higher thresholds of ketone presence, or before our body can fully use all of the ketones we produce, some of these ketone bodies are not reabsorbed by our kidneys. These ketones are subsequently excreted in urine when you pee. Through targeted urinalysis measurement, we can measure the level of AcAc and use it as something of a proxy for how many ketones our body is producing.
Urine Testing Breakdown:
Pros
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Incredibly cost-effective and easy access
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Non-invasive
Cons
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Less accurate and reliable than other methods of testing, like blood testing for BHB
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Once your body adapts to ketosis, accuracy drops even further
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Other factors like time of day, stress, exercise, and hydration levels will impact the results
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Does not effectively measure BHB from keto supplements
Although measuring acetoacetate seems less useful than beta-hydroxybutyrate, there is still some value here. At lower levels of ketosis and generally with those new to entering ketosis, urinary ketones correlate well with blood concentration measurements of the gold standard, BHB. Higher levels of ketosis and those who have been adapted to ketosis for much longer have a bit more nuance with their metabolism and thus measuring ketones in your urine becomes less reliable.
How To:
To test your urine ketones, all you need is ketone test strips available at all major drug stores and grocery stores in the diabetes section of the pharmacy.
To measure, you simply place the test strip in your stream of urine or a urine sample until the testing area is saturated, wait 15 to 20 seconds, and then match the color on your strip to the color palette provided in or on the testing strip container.
You'll have to check your brand’s color code, though dark purple is generally used to indicate the highest level of ketones. Most kits will also have a color that corresponds to a level in which no ketones were detected.
Blood Testing
Blood testing is the gold standard measurement for testing ketone levels. Testing your blood will measure the specific ketone body, beta-hydroxybutyrate (BHB). In a fasted or carb-restricted state, our body breaks down free fatty acids and mobilizes them to the liver. Here, they are turned into acetyl-CoA and then consolidated to form another ketone body-known as the aforementioned acetoacetate (AcAc). AcAc is then chemically consolidated in the liver by its enzymes to produce BHB. At this point, it is then mobilized to travel through our circulation networks. This is why we can measure BHB in the blood.
BHB blood ketone levels represent the most accurate measurement of ketosis because it measures the ketone body found in the most significant supply in the blood. This makes it the preferred method of measuring ketosis because blood levels of ketones accurately represent what our body will quite literally be utilizing. The other methods discussed in this guide measure ketones that are excreted.
Pros
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Most accurate method for testing ketone levels
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Measures BHB-the most abundant and effective ketone body in the blood to capture ketone utilization
Cons
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Less cost-effective, the testing strips can get expensive
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Invasive as it involves finger pricking for blood drawing
Although it is invasive and more involved, BHB measurement is fairly easy once you have the equipment in hand. In total, you'll need to purchase a ketone meter, blood & ketone test strips, an alcohol swab pack, a lancet device, and lancets.
How To:
This method involves using a blood glucose or ketone meter, usually only sold online. Most meters will allow you to test blood ketones or glucose test strips. Once you have the equipment, follow the steps below:
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Plug a lancet into the lancing device and set the desired puncture depth
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Insert a test strip into the device meter
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Sterilize your fingertip with the alcohol swab
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Place the lancing device on your finger and press the puncture button
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Gently squeeze your finger to get a sufficient sized drop of blood
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Touch the strip to the blood sample for absorption
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Wait a few seconds and then analyze
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Video demonstrations of the process are available online
To start, you might consider testing at different times of the day. Certain times of the day, in the fasted state, immediately post-meal, pre & post-training, and more are all viable times of measurement since these are the times your ketones levels will be elevated.
Here is a chart of what you may see when testing your ketone levels:
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Low (0-0.4): Not in ketosis, or leading into ketosis.
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Optimal Zone (0.5-3.0): This is where you should aim to be!
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"Starvation" (3.0-5.0): Most likely is reached during a fasted state.
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Medical (5.0-7.0): Being in this zone may be dangerous and we recommend consulting your healthcare professional.
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(10+): Please seek medical attention!
For consistent and reliable feedback, make sure you are comparing your levels at specific times.
Breath Testing
**Not recommended for exogenous ketone supplementation since exogenous ketones deliver BHB directly to the blood and do not produce acetone. **
Testing your breath for ketones will measure the ketone body, acetone. Acetone is a by-product of the chemical conversion from AcAc to BHB that we discussed earlier.
Acetone produced during this conversion is used as a metabolite for your body's metabolic functions, but a majority is waste, excreted in your breath. When some people get into deep ketosis, their breath begins to smell fruity because of the acetone. This fruity breath has been termed 'keto breath.'
A keto breathalyzer is a testing device that can measure the number of ketones in your breath.
Pros
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Non-invasive
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Potentially more reliable than urinalysis
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Only a one-time purchase of the device is needed
Cons
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Less accurate than blood testing
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It does not test for BHB exogenous ketone supplements
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Still measuring a waste product which does not correlate to higher blood ketone levels
Choosing your Testing Methods
If you have decided you would like to begin measuring your ketones, we understand how overwhelming the different methods may be. Hopefully, we can offer some guidance and comfort knowing that any method you choose will work.
The truth is, choosing your testing methods comes down to personal preference. Here are the questions you need to ask yourself when choosing your methods.
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What are the overall health goals you are trying to achieve with ketosis?
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Where are you on your keto journey?
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How accurate do you want or need to be?
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Are you using exogenous ketone supplements?
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What information about yourself are you wanting to understand by measuring ketones?
Rookies / Weight Loss: If you are new to keto and are looking for weight loss, keto urine strips are a great option for you. Keto urine strips are affordable and can give you a general idea of whether or not you are in ketosis. You can couple keto strips with how you feel and you will be able to determine routines and dietary preferences to feel your best. If you are willing to make a bigger investment, you can certainly utilize a keto breathalyzer as well (although not if you are utilizing exogenous ketone supplements).
Performance Athletes: If you are looking to improve your athletic performance with keto, it may be helpful to get a quantitative measurement to figure out what level of ketosis gives you the most performance advantage. Keto breathalyzers can offer you qualitative data in a way that urine strips cannot (unless you are using exogenous ketone supplements), so if your budget permits, you can start there. However, if you are looking for qualitative and the most accurate data, keto blood testing is the route you will want to go.
Therapeutic: We will always recommend seeking medical help from a practitioner before incorporating ketosis as a therapy for any disease state. However, if you and your practitioner have decided to move forward with ketosis as a therapy, you will want to utilize the most accurate ketone measuring method, blood testing.
Citizen Scientists: If you are one of those curious people who are looking to perform n=1 experiments with your dietary and lifestyle habits, we recommend blood testing because it is the most accurate form of testing and will provide you the most objective measurements.
