A New Toy Measuring Blood Ketones

I just got a new toy: a device for measuring blood ketones. This is a far more exact and reliable measurement than testing for urine ketones using cheap dipsticks. Ketosis is of course the state the body is in when eating very low carb. Ketones, made from fat, will then fuel the brain instead of glucose.

So who needs one of these gadgets? Perhaps nobody. Obviously it’s easy to eat LCHF without it. This is for curious nerds (like me) and for those who want definite proof that they are eating so little carbs that insulin levels are low and fat burning is maximized.

A ketone level somewhere between 1.5 – 3 is said to be an optimal level for maximizing weight loss. It means that insulin levels are very low. As you can see my first measurement was 0.2, after a caesar sallad dinner. I’m not surprised as I’ve probably eaten at least 50 grams of carbs a day lately.

I will try it out fasting in the mornings during the coming days. Perhaps I’ll try being really strict with the carbs for a while to see what happens.

Have you tried one of these or are you interested in doing it?

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143 Comments

  1. I would definitely love to give this a try! I love testing! Do you know where these meters are available in Europe (Germany)?

    Cheers and keep doing your great work!

  2. Laura
    Is it the same as Jimmt Moore has recently acquired? I hear the sticks are the relatively expensive bit
    It would be really interesting to measure blood ketone levels. The urine sticks are not very useful for established ketosis when they should no longer be lsot in teh urine but rather actively burnt as fuel and therefore only show up in the blood.
    I think I msut be in ketosis by now as it has become sooo easy to fast and i never feel light headed. ain't that wonderfu?l... EHi doc where did you get yours..Amazon perhaps?
  3. I'd love to give them a trial.
    I've used urine test strips but found even though I was losing weight (definitely fat burning) there was only a faint trace of ketones in urine.
    Unfortunately cost of blood ketone strips in UK is outrageous.
    Cheapest I can find is £25.14 & I'd have to buy 4 packs (40 strips) to avoid excessive £5.75 +VAT = £6.90 p&p charge. But even so would still be £2.50 for each test and as it's just curiosity rather than medical need it's not worth it.
    Reply: #99
  4. Do Ketostix have a spill threshold like Diastix? If so, this could be beneficial. As a LCHF type 1, I like to keep an eye on the suckers.
  5. Catherine
    I found several models online - what model and brand would you recommend?
    Thanks!
  6. Fiona
    My 4 year old son is on the ketogenic diet and I use one of these all the time. We use the Abbott brand. The strips themselves are fairly expensive. You may be interested to know,, he maintains ketone levels of 4 to 5, and has gone as high as 7. 6 is our danger zone for ketoacidosis.
  7. Phocion Timon
    Definitely a cool toy. I've had mine for about two weeks. My ketone levels generally stay between 0.4 and 1.5, which strikes me as a bit odd since I eat zero carbs (discounting the small amounts of carbs in the few vegetables I eat). Maybe I'm eating too much protein?
  8. Phocion,
    That could be it. Try more fat, less protein if you want more ketones.
  9. FrankG
    I do not have one of these meters but in terms of the relative cost and for those who want to stick with the urine Ketostix: you might find it worth testing at different times of the day...

    I agree that ideally (once keto-adapted) there should be few if any "wasted" ketones being flushed away but I still find that where I may show nothing, or just a trace early in the day, later in the afternoon or evening I quite often show higher levels of urine ketones.

    Obviously the urine method is less precise that a blood test but if you are only interested in the fact that you are ketogenic, without necessarily needing to know the precise amount, the Ketostix may still be a cheaper option.

  10. ThatWriterChick
    Where are these available for purchase? Do you need a prescription?
  11. Hmm, I bet my Dr. would would write a script for one of these and my insurance company would pay for it, especially since I am a T1 diabetic! Must check!
  12. Stacy in USA
    ThatWriterChick - In the US you can purchase the device from amazon for about $20. As others have mentioned, the strips (you insert into the machine for each use) are expensive at about $10 per strip. You don't need a prescription.

    Dave, I bet if you have a diagnosis, it would be paid for.

  13. PB
    You can get a free NovaMax Plus here:

    http://www.novacares.com/cwd.php

    And decent price on the strips at this site:

    http://search.americandiabeteswholesale.com/search?keywords=novamax

    I credit Jimmy Moore for the heads up on this. His blog coverage is excellent. I noticed that the blood ketones do not correlate to the urine ketones. It seems that the blood ketones are more accurate.

    After a long day of exercise I hit 3.5 on the blood meter but was only barely moderate on the urine strips.

  14. Peggy Holloway
    This is a bit off subject, but I am desperate for some answers, so I'm posting on my favorite low-carb blogs. I have done this in the past, starting over a year ago and got some suggestions, but after a year, the situation has gotten worse instead of better. My sister was diagnosed as Type II (runs in the family - took the lives of our grandfather and father and all of us have carb intolerance) in 1999 after years of fighting weight issues with low-calorie, low-fat diets. She, my brother, and I all learned about low-carb diets about that time and all pursued low-carb lifestyles. My sister persevered despite reluctance from her physician to use diet to manage her blood sugar. She took Metformin from the start and other the years has been on Januvia. She has declined other medications and refused to take insulin. Her blood sugars have remained above normal and she has tried all sorts of "tweakings" of her low-carb diet. Last summer she went to see Mary Vernon (we live fairly close to her Kansas office) and had no success. The only recommendation Dr. Vernon and her associates made was a low-carb diet and they just couldn't understand that she'd been on a low-carb diet for 12 years! Jane also corresponded with Jackie Edelstein (spelling?) of the Atkins Society who suggested a yeast reducing diet, which Jane religiously followed. Not seeing great results, she, with my encouragement, has tried really upping her fat intake and lowering protein to replicate my ketogenic diet (which is the connection to this topic). Nevertheless, this past year, Jane's fasting blood sugars have risen exponentially, and her readings since attempting to go ketogenic are consistently between 180 and 250. Her last A1C was 10. This is really alarming and we have no idea what she should do. (My partner, who is also having great results from a ketogenic diet, losing 40 pounds in the last few months, is a retired Family Physician, so he has tried to help her since her own doctor is not sympathetic to the idea of treating with diet and avoiding medications. His only idea is to get her off her beta blocker which she claims she can't do without getting rapid heart palpatations and severe migraines.). Her doctor wants her to take Byetta and I'm sure will really start pushing insulin. Any ideas what is going on here? Thoughts about what she might do?
  15. Phocion Timon
    The meter is cheap, I got mine from Amazon. The strips though are indeed expensive, even from Amazon. I found a Canadian outfit that sells them for $2 per strip:

    http://www.universaldrugstore.com/medications/Precision+Xtra+Ketones+...

    The lag time between ordering and receiving is a bit longer but any orders do have to go through customs.

  16. Sietske
    Nice tool, have mine for almost two months now! I was eating LCHF on carbs - protein - fat percentages 4 - 21 - 74. My ketones were only 0,5 to my surprise! Only when I lowered my protein intake to about 10-12% my ketones would go above 2,0. A very interesting new insight. I do so love measuring :-)
  17. Jason
    Doc,

    I have been trying to lose weight on what I thought was a LCHF diet for well over a year now. I hadn't lost ANY weight.

    Once Jimmy Moore started his experiment, I ordered a meter and tested myself. It turns out my liver is really good at gluconogenesis, I guess--if I eat too much protein (anything less fatty than a ribeye with butter), I dip down below 0.5 on the ketone meter.

    I've been eating a lot less protein and I've replaced it with fat as much as I can. I've lost about 15 pounds in the last three months. Finally! More importantly, my blood pressure has dropped further, and is now about 120/70. I haven't yet done a lipid panel or CRP, but my niggling pains are slowly going away.

    (un)Fortunately, I have my wedding coming up, and the parties and preparations and everything have stopped my weight loss for a while.

    Eating too much protein does not make me gain weight, though, so it's like I'm ratcheting down the weight. I can lose five pounds in a week or two by being good, and then go for a couple of weeks having 3-5 glasses of wine per week (ok, 3-5 glasses per party!) or eating too much protein and not gain any weight for those couple of weeks.

    So, the ketone meter has definitely been useful for me. I think gluconogenesis might be the reason why a small % of folks don't lose weight on what they think is LCHF...turns out we should be saying something like: lcHFmp for low carb HIGH FAT moderate protein...and moderate is different for every person, depending on how efficient their liver is at gluconogenesis.

    Of course, you've said that all along, Andreas. It's just that I didn't really understand that what I needed to do was cut my steak in half and save the second half for later--and put butter on both halves to make up for it!

  18. Janknitz
    Peggy Holloway, has your sister been evaluated for LADA (latent autoimmune diabetes in adults)? That condition cannot be treated by diet alone. She needs a comprehensive endocrinological evaluation to rule that out.
  19. tooticky
    Hi Peggy, I feel I'm in no position to answer being a non-medical person - but have you heard of food supplement called Berberine? I've not read much about it in English, but have read a lot of positive comments from non-English sites. It has apparently been used in China for long-long time but only came to Western attention around mid 90s. It's available as a food supplement - I've only managed to find some in the Internet but not from my local store.
    http://en.wikipedia.org/wiki/Berberine

    Again, I have no medical credentials to give any advise - and hopefully someone with more knowledge than myself could comment on using berberine in a situation you described. Hope you find help for your sister.

  20. FrankG
    @Peggy:

    Yes please do rule out LADA.. in which case she would need insulin.

    If your sister was already diagnosed with Type 2, chances are that she may not be able to make a full recovery or even successfully control BGs even with the best LCHF diet.

    By the time we are diagnosed the body has already suffered metabolic damage (possibly over many years or decades) and by some estimates we have lost up to 80% of our insulin producing capacity. Of course each person is different but in my own case I was able to lose significant weight and cut down on medication with LCHF BUT I still use a small amount of long-acting insulin injected each evening.

    I don't expect to ever be 100% back to where I was at 21 years old but I am very much better than I was at diagnosis in 2003 and for the 5 years after when I was still dutifully following the conventional wisdom -- right up until 2008 when I read GCBC

    All that said, Type 2 is described as a chronic progressive disease and although I have no doubt significantly slowed and possibly to some extent even reversed its course; I am realistic that I still have to live with it for the rest of my life. Best I can hope for is that I have delayed the serious complications until I am at least 120 years old ;-)

    I hope you find some answers for your Sister.

  21. Galina L.
    Peggy,
    I saw your comments many times on different LC blogs , I am sorry about your sister condition. I remember seeing somewhere an information that Dr. Bernstein is still practicing and taking long-distance patients he communicates with through faxes and video-calls. May be you can see what kind of information your sis may get from his office. May be they are referring to local docs who practice according to their philosophy. If you managed to get one celebrity like Mary Vernon, you have a knack to get another.

    I am not a doctor, just an engineer education, and people like me often think in the lines "do whatever what is working". I think, it is better for your sis to sort out priorities. She can't hold the insulin avoiding as a higher priority than possible blindness or a kidney damage, isn't it right?. Judging by how harmful the elevated blood sugar is, her priority #1 should be the keeping BS at the reasonable range. If it takes taking some insulin, so be it. Frank G. takes insulin, but at much reduced amounts than before he tried a LC diet. Just imagine a mom whose child has seizures refusing to give him meds because a ketogenic diet supposed to be working, but it is not doing job 100%. I think when personal opinions about health get disconnected with a personal reality it becames a religion. It is difficult to get healthy when strategies are based on pre-formed points of view as opposite to being flexible, trying different things and observing yourself.

  22. FrankG
    @Peggy: just to add that so far as I know both Januvia and Byetta encourage the body to secrete more insulin. Considering that the body may already be struggling with exhausted beta cells, that does not seem like a great idea to me... kind of like trying to mend a broken leg by walking it off. In fact I'd suggest that insulin injection might be a more straightforward solution.. rather than something to be avoided at all costs.

    Of course eat LCHF and minimise the requirement for insulin (otherwise it can be a recipe for weight gain) but insulin may be the simplest solution (less side-effects too).

    All things to discuss with her and her Doctor anyway... I'm just offering my personal experience in hopes it is helpful to her.

  23. moreporkplease
    Hi Andreas:

    To score about 1.5 and up, most people will need to eat 75-88% fat. A good way to guarantee success at this is to start at 85% fat, 12% protein, and 3% carbs. The more satfat the better, too. Coconut oil is esp. helpful as is weight lifting once or twice a week.

    3 or 5 days at this ratio should land you squarely at 1.5 with ease. The meters measure BHB - so note that after several weeks, your body will adjust and the same ratios will lower you to about .75 at the same eating pattern.

    Also women should recognize that the monthly cycle appears to affect ketones even when diet remains the same. They may note very low ketones during their cycle, which slowly increase in the week after, and slowly decrease the week before. For obvious reasons.

    I am currently at 1.4 and eat 85% fat, like Jimmy. This means my protein portions have shrunk to about 2.5-3 oz. per meal. Overeating protein will definitely lower your ketone level. So it's important to determine your minimum protein level and eat exactly that - no more. Jimmy is actually eating a little less, I think.

  24. Galina L.
    I don't think I would pay for ridiculously expensive test-strips. I follow a ketogenic diet in order to manage migraines which are an epilepsy in disguise. I don't think that being in a deep ketosis all the time is a very good idea. For many people, especially middle-aged with existing IR, it will cause an elevated fasting BS, and will also raise a post-meal BS in cases when occasional higher than normal amount of carbs is consumed, which happens with basically all LCarbers from time to time for various reasons, mostly socially.
  25. Brigitta
    I don't think this is just for nerds. It could be a huge help for people with serious metabolic issues. They might not have ever realized they were eating too much protein and not enough fat.
  26. Jonathan Swaringen
    Ketones are produced with exercise. Check out Body By Science for good exercise protocol. I highly recommend The Art and Science of Low Carbohydrate Living/Performance, Body By Science, and The Rosedale diet.

    Also jackkruse.com and his forum are another great blog/forum for great information.

  27. I can see a logic in paying for the strips because people who get the meter are surprised to find they are not in ketosis when they thought they were.

    My weight loss is SO slow that I suspect that's the explanation for me, too, but I don't think I want to pay for the strips right now. I am thinking of upping my fat and lowering the protein, to see what happens with the weight.

  28. moreporkplease said 'A good way to guarantee success at this is to start at 85% fat, 12% protein, and 3% carbs'.

    Please would you mind giving me an example of your typical day's food, as I'm curious to know what form the fat comes in. Do you actually lose weight on that amount of fat or are you maintaining weight?

  29. Jane2
    So indeed Kekwick and Kwasniewski are right: 1:3,5:0,5 for P:F:C
    For repairing your body start with high proteine (about 100-120 g) and high fat for 2 weeks; after that lower your protein intake to normal body weight by lenght above 1m to start loosing weight; after 2-3 month lower again your protein intake to 0,5-0,8 % of the same weight. And that isn't much protein.
  30. Sietske
    @moreporkplease How do you mean 'The meters measure BHB - so note that after several weeks, your body will adjust and the same ratios will lower you to about .75 at the same eating pattern.'? How will the body adjust? I'm measuring above 1.5 for 4 weeks now and my numbers havened dipped yet, not did Jimmy's as I recall correctly. Could you explain what you mean exactly with this sentence, I don't understand how the body will adapt and what it has to do with measuring BHB and what it means for your state of ketosis. Nothing like this was mentioned in The Art and Science of LC Performance or was it?
  31. @Jan You choose the fatty kinds of meat, eggs are also fine. I eat lots of grass-fed butter, full-fat cream cheese and full-fat whipping cream, sour cream, crème fraîche and also coconut oil. A favorite of mine for upping your fat-intake is bulletproof coffee (http://www.bulletproofexec.com/how-to-make-your-coffee-bulletproof-and-your-morning-too/) or any variant thereof. I eat about 2500 kcal a day and lost weight, though I have to admit that I combine it with a 22-hour fast every 4 to 5 days this last month, which is easy once you're keto-adapted. The first month I lost weight, but didn't fast. I must say that I am near my 'healthy' weight (whatever that may be), so I don't have very much weight to loose.
  32. Jonathan Swaringen
    @Sietske Any thoughts on if it would be fine to drink a cup of Bulletproof daily? Too much cortisol? Not sure if I am seriously thinking of drinking one a day anyway at 18 dollars for 1 lb...or whatever it was.

    Too expensive lol. I'd love to have a cheaper option for coffee that I can put coconut oil and my kerrygold in.....but no clue about coffee. The Bulletproof people make it sound like any coffee but their own is horrible....I'd love to hear of possible substitutions that aren't so expensive that will be good for me overall.

  33. @Jonathan That's why I said "any variant thereof" :-P I also can't afford 'real' bulletproof coffee, and besides, I live in the Netherlands. Not sure if he ships here, but that would add to the costs. I choose the best coffee I can find here, biological fair-trade great tasting arabica, and start my days with my own double "creamy butter-me-up" coffee! I've read enough positive articles about coffee in itself to believe it not to be that bad for my health to have a cup or 3 to 5 a day.
  34. Jonathan Swaringen
    @Sietske Didn't notice the any variant thereof part heh :) So what I want to look for is biological fair-trade coffee? I'm guessing that won't be in any Kroger or Walgreen's store. Wonder if Sprouts Farmer's Market might have some.

    Anyone in the United States or Texas in particular know of good places to find good coffee?

  35. I recommend Illy coffee for a variety of reasons. Their quality is second to none, they use technology that can sense and discard bad beans. They also are more than fair to their farmers and while they are not Fair Trade certified they can and do show they go above and beyond in pricing and their treatment of the farmers.

    When you mix illy with some great grassfed butter you can't go wrong!

  36. Jonathan Swaringen
    @Dave I want to be clear that I don't think Bulletproof™ Upgraded™ Coffee - 12 oz. is bad. I just can't afford it.

    I'm assuming Illy coffee is referring to Upgraded? Is Illy the place its from or what? Somewhat confused. I am contemplating trying some even with the high price but will have to make it a once a week thing to afford it....or something.

    Hopefully I can find a source of decent coffee that is cheaper. I realize you get what you pay for but I figure something can be not as good but still be better than nothing. If that sounds confusing...anyway

  37. @Peggy Holloway Increasingly higher blood sugar levels is a sign of increasingly extreme insulin resistance. Just this morning Dr Rosedale posted an EXCELLENT overview of hyperinsulinemia. Go here & read, re-read and then re-re-read & bookmark it. http://goo.gl/Bv8jl
  38. @Jonathan I know you aren't saying Bulletproof is bad. I was offering you an alternative high quality coffee that you could add the butter to should you want to make it Bulletproof. Illy is a brand that is from Italy and it is sold throughout the USA.
  39. Jonathan Swaringen
    @Dave oh...I thought you were using a different name for Upgraded coffee I don't know much about coffee so never heard of Illy. I'll look it up thanks a bunch.

    Should have figured that out....need some coffee :) Maybe wake myself up lol.

  40. @jonathan I think once you see the illy logo you will recognize it!
  41. @Jonathan Swaringen @Sietske, Just find the best coffee you can afford that doesn't impair your brainfunction. Go here, read this from Dave Asprey the butter coffee guy: 3 Steps to Finding the Highest Performance Coffee in Your City http://goo.glZJ5j7
  42. Jonathan Swaringen
    Will do. @Dave Are you Dave Asprey by chance? Just wondering if you were some random Dave or THE DAVE :P Thanks for the tips

    @cancerclasses hmmm that link isn't working for me it won't load

  43. @Jonathan No I am Dave Wendel! Your Welcome!
  44. Jonathan Swaringen
    Heh pretty funny coincidence we were talking about Dave and another Dave comes up woulda been really funny if you were him. Anyway thanks happen to have any recommendations for coffee makers or machines to use? I don't want to spend a bunch...maybe I'll spend more later just want a cheap and easy way to use whatever coffee I buy to make Bulletproof.
  45. @jonathan Mr.Coffee makes great coffee makers and they aren't very expensive but the biggest thing to think about is the pot. Getting an insulated pot is the way to go because it will minimize burning. When coffee sits in glass pots it burns after 1 hours time and ruins the flavor. Insulated pots don't have this problem.

    Let me know if you have other questions!

  46. @cancerclasses Your link about Dave's 3 steps to high performance coffee in your city doesn't seem to work... Can't find anything about it on his site either, only his own expensive bulletproof coffee all over the place!
  47. Jonathan Swaringen
    @Dave What have I gotten into lol...so complicated? So I went to the Illy page and they have whole bean coffee, ground drip coffee, dark roast, medium roast....too many terms. I'm guessing dark roast is stronger.

    For health and longevity what would be best? I'm guessing darker roasts are less processed and stronger...? Also whole bean means to use a normal coffee maker that I'm used to that drips through the coffee I need to grind it myself? Which whole bean coffees are good? Sorry for all the questions happen to have any websites to help me pick what to buy?

    Illy Monoarabica
    I'm guessing this one is a more expensive blend?

  48. @Jonathan Yes if it is whole bean you will need to get a grinder to grind the whole beans. I personally prefer the iLLy Normale (red band) when I have espresso but when I have drip coffee I drink the darker roast which is the (black band).

    Lighter coffee is probably higher in nutrients because it has been roasted less (my guess). The illy Monoarabica is quite good and yes the expense is going to be higher.

    If you don't want to grind your coffee just purchase it already ground or have it ground depending on where you purchase it.

    Dave

  49. Stacy in USA
    Jonathan Swaringen - Whole Foods carries high quality fair trade coffee of many varieties. It's more expensive (around $12 per pound) than Starbucks or Peets but the quality is similar.
  50. moreporkplease
    @Jan:

    I lose weight. I eat 85% fat, 12% protein, 3% carb and 1650 calories. I eat normal food - scramble eggs in butter, put real cream in my coffee, have a pat of butter on my veggies. No heroic effort is required. Eat real food with its natural fat (eat the chicken with the skin, eat the fat at the edge of the pork chop). It's dead easy.

    The problem is most low-carb people are still in a low-fat mind-set and think, "OMG how could add a pat of butter to my 3 oz. of green beans? That's SO MUCH FAT." It's not true. It's just normal eating.

    @Sietske"

    Rather than take up a whole bunch of space here, go read the full text of the many studies on this issue - for example: http://www.ncbi.nlm.nih.gov/pubmed/1637355.

    You'll discover that the body processes ketone bodies using various enzymes in the plasma & the liver. Over time the body becomes more efficient at making the needed enzymes, at burning the ketones, and in uncoupling. Men and women appear to metabolize ketones somewhat differently, and your ketone rate varies according to the time of day naturally, as well as according to your exercise level. It's very complex, and well beyond the brief discussion written for athletes in Volek's book.

    But you don't have to believe me. Get yourself at 2.0 with your diet and then don't change anything for 4 months or so. You'll see for yourself that you become more efficient.If you're a man, you may not see the same variations a woman can because you don't have a period.

    I got the Volek book before Jimmy did and got my meter before he did; also, I've been doing it without a break since early May. Jimmy got sick, travelled, etc. so he's had some interruption.

    I also keep much better records than Jimmy. He's not tracking with the same detail I do - that's not his goal. I'm much more quantified in all aspects - that's just my personality. :)

    The key thing to note is that in Volek's book the people with the most success are the ultramarathoners, the super-athletic who run 100-mile races. These are the people who can eat 50-60 total g carbs and remain above 1.25. So many people seem to be reading Volek and saying "well, I Crossfit every day, so I must be an athlete, so I can eat 60 total g carbs and 140g total protein while staying at 1.25 or above."

    BS. Trust me dudes - or don't. Only Jonas Colting can do this. Note that Volek himself pushes 1/2-ton boulders several times a week, was a competitive weight lifter, and still he has to eat less than 40 total g carb while keeping his protein apparently to about 90g.

    You as average Joe are going to have to dial your protein down to the minimum, and lower your carbs both. Count both protein and carbs. Take them to the minimum and replace with fat. Which is easy, as I said - just eat the chicken skin.

    Once you decide to get to 1.5-2.0, you can easily do it (just eat 1 oz less of protein at each meal) and it's quite normal and enjoyable. But your Atkins-style bacon-fests and paleo-style 2 lbs. of muscle meat a day have to end. Grass-fed or living in the Presidential suite of the Hilton - however its "quality," it doesn't matter if you eat too much of it!

    Reply: #98
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