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EventsLose weight by achieving higher ketone levels
Before we get started, here’s a short recap of the tips so far: The first and most crucial piece of advice was to choose a low-carb diet. The next were eating when hungry, eating real food, eating only when hungry, measuring progress wisely, being persistent, avoiding fruit, beer and artificial sweeteners, review your medications, stressing less and sleeping more, eating less dairy and nut products, stocking up on vitamins and minerals, using intermittent fasting and finally, exercising smart.
This is number sixteen:
16. Achieve higher ketone levels
Warning: Not recommended for type 1 diabetics, see below.
We’ve now arrived at tip number 16. If you’re still having trouble losing weight, despite following the 15 pieces of advice listed above, it might be a good idea to bring out a controversial option: higher ketone levels. Why is it controversial? For most people, “low” or “higher” ketone levels don’t make a difference for health and weight loss, and in general we do not recommend shooting for a specific ketone level. However, for some people stalling at weight plateaus while on a low carb diet, trying to raise ketone levels may be of benefit.
So how does this work? A quick run-through: The first tip was to eat low carb. This is because a low-carb diet lowers your levels of the fat-storing hormone insulin, allowing your fat deposits to shrink and release their stored energy.1 This tends to cause you to want to consume less calories than you expend – without hunger – and lose weight.2 Several of the tips mentioned above are about fine-tuning your diet to better this effect.
Video course
Do you know exactly how to eat a low-carb and high fat diet (LCHF)? This is required for ketosis. If not the easiest way is watching this high quality 11-minute video course on how to eat LCHF, and the most important things to think about.
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Ketosis
Ketosis is a state at which the body has an extremely high fat-burning rate. Even the brain indirectly runs on fat, via ketone bodies. These are energy molecules in the blood (like blood sugar) which become fuel for our brains after being converted from fat by the liver.
To encourage ketone production, the amount of insulin in your bloodstream must be low. The lower your insulin, the higher your ketone production. And when you have a well-controlled, sufficiently large amount of ketones in your blood, it’s basically proof that your insulin is very low – and therefore, that you’re enjoying the maximum effect of your low-carbohydrate diet.3
Measuring ketones
Today, there are reasonably-priced gadgets available for measuring ketone levels at home. One needle prick of the finger, and in just a few seconds you’ll know your blood ketone level.
Blood ketones are best measured on a fasted stomach in the morning (before breakfast, that is). Here are a few pointers on how to interpret the result:
- Below 0.5 mmol/L is not considered “ketosis”. At this level, you’re likely not in your fat-burning zone.4
- Between 0.5-3.0 mmol/L is nutritional ketosis. This is where you see the beneficial effects on weight and metabolic health. For most people, it won’t matter where in this range you fall
- Around 1.5 – 3 mmol/L is the upper end of nutritional ketosis. If you have hit a weight loss stall without a clear reason, one possible intervention is to increase your ketone levels. Although there is no scientific support for this intervention, rare cases may see benefit.
- Values of over 3 mmol/L aren’t necessary. That is, they will achieve neither better nor worse results than being at the 0.5-3 level. Higher values can also sometimes mean that you’re not getting enough food. For type 1 diabetics, it can be caused by a severe lack of insulin, see below.
Ketones in urine
Ketone levels can also be measured in a more old-fashioned way, with urine test sticks (sold prescription-free in pharmacies or on Amazon). Ketone sticks give less reliable results for several reasons, and the above recommendations can’t be straightforwardly applied to them. They are, however, much cheaper.
My personal experience
Feel free to read my accounts of a two-month personal trial:
- Experiment: Higher ketone levels for weight loss and increased performance
- Four weeks of strict LCHF and ketone monitoring
- Final report: Two months of strict LCHF and ketone monitoring
Although I was quite happy with my weight before these trials, they resulted in a further loss of 4.5kgs (10 pounds) and 7cm (3 inches) around my waist – without additional exercise or even the slightest resemblance of hunger.
How to achieve higher ketone levels
Many who firmly believe they are eating a strict low-carb diet are surprised when they measure their blood ketones. They may be at around only 0.2 or 0.4. Why?
The trick here is to avoid all obvious sourced of carbohydrate (sweets, bread, spaghetti, rice, potatoes), consider time restricted eating, and use fat as a lever for taste and satiety.
Sometimes adding MCT oil to your coffee or tea can help increase your ketone levels which may or may not resolve your stall. It may not be “magic” for everyone, but for some it may just do the trick.
If it doesn’t work
Having higher ketone levels for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet. If this doesn’t result in noticeable weight loss, you can be certain that too many carbs are likely not part of your weight issue and not the obstacle to your weight loss. There are, in fact, other causes of obesity and being overweight. The next three tips in this series might help you.
Also, consider signing up for our Weight loss for good program, free for Diet Doctor members!
Try it
Order a ketone meter online and start measuring. There are a few different models, the most popular one is probably the Precision Xtra ketone meter. Unfortunately these meters are all quite expensive to use, as the test strips can cost about $5 per test.
Here’s a complete package with everything you need to check your blood ketone levels.
More
Learn much more about ketogenic diets here:
A ketogenic diet for beginners
Watch my video interview with Dr. Peter Attia, on a strictly ketogenic low-carbohydrate diet: Very Low Carb Performance
Read all the tips on the How to lose weight page.
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A word of warning
If you have type 1 diabetes, you should not follow the above advice to purposefully increase your ketone levels – it may be risky. If you have ketones in your blood at all, you must be sure that your blood sugar levels are normal. If they are, you’re in normal ketosis – just like the ketosis of healthy people who stick to a strict low carb diet.
High blood sugar levels coupled with high blood ketones, on the other hand, will mean that you have a pathologically low level of insulin – something non-diabetics do not suffer from. This can lead to ketoacidosis – a potentially life-threatening condition. If this happens, you’ll need to inject more insulin; if you’re at all unsure of what to do, contact a medical professional. Coveting really high blood ketones for weight control is not worth the risk for type 1 diabetics.
The Journal of Nutrition 2015: A lower-carbohydrate, higher-fat diet reduces abdominal and intermuscular fat and increases insulin sensitivity in adults at risk of type 2 diabetes [randomized trial; moderate evidence]
Annals of Internal Medicine 2005: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes [non-controlled study; weak evidence] ↩
Journal of the American Dietetic Association 2005: Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet [randomized trial; moderate evidence] ↩
Current Nutrition Reports 2018: Nutritional ketosis for weight management and reversal of metabolic syndrome [overview article; ungraded] ↩
Some controversy exists for this cut off level as few head-to-head trials exist comparing low levels of ketone production. Some studies have shown benefit of a ketogenic diet with ketone levels as low as 0.3mmol/L. ↩
468 comments
The "Net" carbs concept appears to have been invented by the food industry, and does not have a precise definition. However, there is a bit of validity to it so long as you are very careful to understand it; it is very easy to confuse. The time a particular food stays in your body is called the "transit time" of the food. The idea behind the "Net" carb idea is that some of a food's carbs is "bound up in fiber", and does not all hit the body at once. The food industry probably hopes that folks will believe that this means that all of the carbs outside of the "Net" category won't make it into the body in the duration of the transit time.
And that _might_ be true for a few of the carbs in some rare foods. However, as I have probed into it, it became clear that most of the carbs will eventually make it into the body. Virtually all of them for most of the foods/transit times I have investigated. The only effect that the fiber tends to have is to slow them down, and that does tend to be a good thing by itself.
However, consider that they will eventually be used by the body. So if you keep adding more foods that have "net carbs" thinking that the non-net part isn't affecting you, you would be making a mistake. Those carbs will (mostly) get there, and be added to by the carbs coming along behind them (if you see what I am saying). So if you eat 300 grams of carbs in a day, banking on the idea that the labels claim that only 30 grams of them are "net carbs", you would probably find that you wouldn't get into ketosis (would be my guess).
When I said that I went virtually zero carbs (or something like 9 grams per day), I was speaking of total carbs. Most people could probably tolerate more than that. However, it does seem reasonable to try to keep whatever carbs you do consume bound up in fiber as much as possible to spread the impact out over a longer period of time. Perhaps I am wrong, and some of those carbs won't make it out of the fiber in the transit time of the food after all. I don't think there are very many experts putting out good information on that. At least I have not found that information.
I personally walk for my exercise. One mile at the time 6 times a day. That's another "spread the impact" concept application. The burning of calories though some amount of exercise is a good thing, because it tends to "burn off" the carbohydrate "float", if you understand what I mean. There are not only a little bit of carbs in everything, but also your body makes more from time to time. I highly recommend some form of activity if a person can manage it.
In the end, someone really serious about knowing what is going on will need a blood ketone meter such as is linked to on this site. The sticks for it are a bit expensive, but it does really tell you what is going on. That reading will be about as close to the "bottom line" as to whether you are accomplishing what you need. If that reading says 0.3, then for whatever reason you are not in ketosis, pure and simple. Make an adjustment that makes sense, be it cutting more carbs, or walking more.
If it says 4.9 (and yes I did get that reading once)....then you ought to carefully consider if you could use more fiber (which tends to have a few carbs in it that you might then be able to tolerate)....it is best to go by that to answer your own personal question as to "am I getting too many carbs?", or even "are the non-net carbs really affecting me?"
My doctor asked me to stop taking any medication for my diabetic type 2 but to continue the same diet as he says I am able to control my diabetic in that way. Any suggestion or advice. Also he said the urine test I had few weeks ago showed small amount protein this may be due to eating a lot diary products: meat and milk. Also my Uric Acid is high 486 (range is 210-420) due to he says again eating vegetables: mushroom and Spinach and meats in particular. Again any advice these are the food that keep my glucose level within the normal level.
Overall I feel good that my diabetic is under control
Its altso used for those whit gout.
http://en.wikipedia.org/wiki/Potassium_citrate
There have been reported that some that get in to ketosis get an acidic urin, that can be one cause for more kidney stones?
High levels of uric acid in blood is not that much about food as about your kidneys ability to excret it in the urine.
Protein in urine indicate that your kidney have some problems.. I hope your doctor follow it up.
Lipid
Cholesterol 4.88
Triglycerides 1.31
HDL-C 1.23
LDL 3.06
Calcium
Albumin 43
Calcium 2.39
Glucose 5.2
Urea 5.5
Creatinine 111
Calcium Corrected 0 .88
Uric Acid 486
eGFR >60
HBA 1C 6.1
The only problem it indicates is the Uric Acid is high and even though I am a doctor nevertheless I believe it is to do with Diet.
Please any advice on the way forward
As I told you one dont know why some get high uric acids.. its not directly linked to diet.. more to disturbans of the kidneys ability to filter out the uric acid.
Fast weightloss is another cause.
Mayby ketosis have somthing to do whit it too.. one dont know, but ketosis altso interfer whit the kidney.
Drink a lot of water, take some potasium citrate of you find any, make folow ups.. perticaly that about protein in urine.
The lab result for the Urine:
Albumin/Creatinine 3.4 range is 0-2.5 increase of 36%.
Albumin Urine 58 range is 0-20.
I have not taken any glucose control tablets for three months I think as well drinking lots of water I am thinking taking the tablets again to protect my Kidney. Also keep LCHF diet which has responsible for reducing my glucose level to normal. The doctor also prescribed to take "No Uric Allopurinol 100mg" per day to help clear the Uric Acid.
I hope Zepp you agree with these steps
Thanks again for the help
What worked for me was taking Hydrochloric acid supplements and enzymes with food (to make sure food went into my intestines sterilised (this drastically reduced fermenting, irritation and even reflux, contrary to what you'd expect my reflux was caused by not enough acid). Correcting small bowel overgrowth took some time. 2hrs after food I would take magensium carbonate, to alkalise and therefore kill any bugs that didn't get suppressed by the acid supplements. I had to eat very carefully to minimise inflammation and help my intestinal walls heal. Getting rid of all grains was a key thing for me, they were causing constant inflammation, letting larger particles through into my blood stream, leading to food allergies and ultimately to autoimmunity. Stabilising blood sugar was also absolutely vital. In the end I bought a glucometer (like diabetics use) and lanced myself all day long until I worked out my own personal tolerance for carbs and sugar. I also tested my blood ketones and kept eating enough fat that they stayed in the zone suggested above.
I'm not a doctor but I can say, having really suffered with Candida for years, that it's been a hell of a job trying to find balance. I think perhaps for Elaine, looking at addressing any leaky gut issues might help. I also think taking some stress off your immune system could help, then the immune system can take care of the Candida for you. I found among the usual supplements that gymmnemia sylvestre was very useful (apparently it stops yeast from spiralling and migrating as they do when under attack and keeps them as single-celled organisms which can be killed off with anti-funglas), oregano oil, horopito and resveratrol (to actually kill the dastardly things) and molybdenum (for die-off symptoms). I also took a lot of antioxidants, including B12 injections, big vitD does and phase 2 liver support.
But what it took me a long time to realise is that on top of a great kill protocol, you need a replacement one - leaving the work of keeping Candida in check to friendly bugs is the sweet spot. You need to find the bugs, either some really hardcore probiotics, like prescript assist, or ones tailored to what you need (if you've done a stool sample to see what you are missing, or have in overgrowth). I think you need to eat probiotic foods for life. I make my own kefir and am moving towards fermented foods every day as well, and gut healing foods like bone broth. It really is making a difference. I understand feeling in despair about it. My Dad always used to say you've got nothing, if you haven't got your health. I didn't used to understand what he meant when I was younger. Perhaps full keto is not giving Elaine enough food to nourish her good bacteria??? I hope you find the formula that works for you. My advice is broadly, eat to repair your gut barrier, do a Candida kill program, immediately after go all out replacing with good bacteria. Eat to nourish your good bacteria and they will work hard for you. Very best of luck!!!!
Please don't get cranky at me unless you have actually tried it. (not for a cure but for relief of the symptoms). It is relatively cheap so if you haven't tried it yet, at least look into it. There's a lot more info around the web.
Extra carbs is like when I feel like some sweet potato, pumpkin or gravy. Or strawberries with cream. I just add coconut oil to balance it out a bit. For those who can't eat it off a spoon, whip 2 parts coconut oil with 1 part (no sugar added) peanut butter. Try that instead. It does add slight carbs but only have a tablespoon of it a day and you'll be right. It keeps fine in the fridge and is amazing on celery.
I understand what you are saying regarding the danger of ketosis for type 1 diabetics. And I personally have no helpful knowledge regarding that situation. However, if you do speak to medical professionals regarding ketosis (or _near ketosis low carb eating_), and learn something helpful, would you post back and let me and others know?
I am especially interested if anyone vis-a-vie the medical community knows how ketoacidosis develops, and what causes that in type 1 folks.
First, dont go for type2 diabetes diet advices, but go low carb anyhow.. it probably looks like the same for moste people that are sugar driven!
But.. type 1 seldome is insulin resistante.. it means they can use glucose better as fuel.. not that much insulin is needed.. GLUT1 take care of a lot.. whitout help of insulin.. if one only goes low carb!
You still need the same insulin level in your blood as healty persons, it have other purposes then regulate glucose/fat.
As more fat/ketones are used for fuel.. less carbs are needed.. and your glucose levels is more stable.
Its mostly fatoxidation thats importante, and that require low normal stable insulin levels!
And dont event think that highest keton levels is a better case.. not for type 1, healty persons can try that, becuse insulin/glukagon regulate even keton levels, but then one need a healty pancreas at first!
Dr Bernstein is the best expert on LCHF and type 1, he is type 1 him self from his youth!
http://www.diabetes-book.com/
https://www.youtube.com/watch?v=BdxPfxIbKqo
And as I read swedish forums.. i read that many t1 have to strugle a long time befor they get a grip of it.
Becuse, first there have some changes in body and hormones, after a wail its a different situation and they have to learn again how there body do react on food and insulin, and again and again!
If none of these helps the next step is intermittent fasting to restore insulin sensitivity.
And in the best of worlds and if LCHF works like it supose to do, one get very unhungry by eating high fat as part of ones energy demand!
Its when ones apetite get lower one should folow that signaling and eat fewer meals at first.. twice a day is comon for those adapted to use fat as predominant fuel.
Protein is essentiall and should be a the same in your diet.. and you keep the carbs as low as you could/can/like, then it is fat that is that you regulate energy intake with!
Thats what it is about.. but dont do any asumptions befor it happens!
Its when your body use say 500 Kcal of body fat aday betwen meals, then you dont need to eat them, if you not get extra hungry!
Thats the way it supose to work. and thats much about mindshift, other eating patterns, listening to ones apetite signaling!
And on top of that.. it make you an UFO.. some strange person how dont eat what others do and not in the same patterns either!
Take a breath and think about if it mayby could be that those others eating strange food and in a strange pattern??
I think this is good advice about how to eat and why?
http://www.fitintegrity.com/uploads/9/5/1/6/9516119/no_sugar_no_starc...
And its the same condition every day.
And that goes for diabetics to.. to get even more insulin when its alredy high but not enough make one have hyperinsulinemia too.
The right approche is to lower that food that rise blood sugar, then one dont need that much insulin.
And that comes naturaly for healty individuals, but diabetics need to recalculate there insulin demand by injection.
Type one always need to inject insulin.. so they have the same amount as healty individuals in there blood.
https://www.youtube.com/watch?v=FcLoaVNQ3rc
One cause to pancreatitis is hyperinsulinemia!
It make steatosis in pancreas.. and it ends up in pancreatitis and cirrosis.. if one cant lower the hyperinsulinemia!
There are other causes to.. like cancer and such things, those causes is very seldome!
Take a C-petide test!
The thing ketosis do is that one dont need that much insulin.
https://www.youtube.com/watch?v=FcLoaVNQ3rc
its free so doctor don't recommend.
Both are good in combination.. less carbs more fat and the best healtyest and nutrient dens food you can buy!
Dr Bernstein is the best expert on LCHF and type 1, he is type 1 him self from his youth!
http://www.diabetes-book.com/
https://www.youtube.com/watch?v=BdxPfxIbKqo
But then one probably got other problems later?
Soo.. LCHF and paleo is a very good combination.
Or rather.. that what we recomend!
Eating real food, even if its not strict paleo is altso a good advice!
Your post here is, in my humble opinion, spam. People at this community want to gain their health and move away from eating the "unknown". I for one recommend that this sites administrator delete your comment because it is a self serving advertisement and as an advertiser you should pay for inclusion.
Could it not be that eating high amounts of fat on a ketogenic diet simply shows ketones in the urine simply because the person is creating ketones from all the fat they are eating rather than burning their own body fat..?
Thanks,
Yes! :) But in normal cases when you eat LCHF it's hard to "overeat" fat and that will increase your chances to burn body fat.
(If you eat a ketogenic diet, low in carbs and moderate in protein, then the ketones and the fat you burn can come from endogenous or exogenous sources)
/Peter - Team DietDoctor
Demotivation and bad food (constant cravings and hunger) in last 2 months saw a gain of about 4-5 kilo.
All through I kept my exercise schedule at least 3 days/week with a trainer. Few days back in started with sportvasten (it's basically a 10 day program to 'switch' you into ketosis by reducing your intake over 3 days to basically 150 ml of juice 3 times a day for next 3 days and then progressively up in next 4days --all the while working out atleast 30 min everyday at 130-145 heart rate). They provide cal/mag/zinc supplement; multi-vitamin supplement; amino acid supplement and omega-oil.
I will now be trying to keep the switch for as long as I can by regular exercise and low carb diet. I assume my ability to keep the switch will determine the amount that I loose; however I am concerned
1. if there is an optimal period for this regime? 2. Are there any specific precautions I need to make esp regarding the earlier comment about reduced protein.. Would going vegetarian be a good idea?
3. What would be optimal calorie intake be?
I guess I would like to reach 100 kilo (18 kilo weight loss through this process) in 1 year.. Reasonable?
Here are the Simple steps to ketosis and weight loss:
1) adopt intermittent fasting schedule (example is 4 hour eating window, 6 pm to 10 pm), no restriction on quantity of food during 4 hour eating window
2) eat LCHF (low carb high fat) and all REAL FOOD...no pills, powders, bars, crap processed food.
3) stop aggressive aerobic gym activity, it causes harm to joints, body, muscle tissue. Do fun stuff, like biking, hiking, dancing, swimming, etc instead.
With these simple steps, your body will go into ketosis, and you will lose weight....and you will also save money, no longer needing to buy gym membership and supplements (pills, powders, etc)
After 25-30 years of abuse, the body stops telling you when you are hungry and what's the optimal level of exercise (not to mention the physochological need to filling yourself with food) ; that's when external structure helps in getting you started. Completing the sportvasten (working out and controlling food) and seeing benefits of being in ketosis, gives me the confidence to have a healthier lifestyle.
I do think I will move to LCHF diet with regular exercises in the open (just discovered cycling and swimming and liking it a lot; also starting to run but very cautiously so as not to hurt my knees and ankles). Any pointers where I can learn more about how to help myself better would be highly appreciated.
Don't beat yourself up about the discipline issue. Sounds like you do have discipline. When you were eating high carb or low fat diet, your body's insulinogenic response was out of whack, causing elevated hunger and low energy. As you learn the proper way to eat (I.e. Low carb high fat, and intermittent fasting) you reduce the insulinogenic response, which will reduce hunger and increase energy levels. So, that's what I mean by "don't beat yourself up". Your body was doing what it was designed to do (increase hunger in the presence of high carb eating). This was inherited through your ancestor's survival-- where seasonal fruits full of sugar appeared during short periods before long spell of no more fruits in season. So, of course your body wants to "gorge" when sweetness and low fat foods touch your tongue. It's a natural response of your body...not your "undisciplined character". So, give yourself a break...you are a well disciplined person with the right intentions...eat LCHF and do intermittent fasting...and you will see your weight come off and naturally get into shape.
The easiest way to super health is to combine ketosis with breathing retraining and getting double or synergetic benefits http://www.normalbreathing.com/diet-ketosis-benefits.php
I have read a few different articles/blogs all which have different views on the topic. Some say being keto adapted will help prevent altitude sickness, whereas others say the opposite. What are your thoughts?
Going on a trip to Peru, will be hiking the Inca trail. I will be following all of the recommendations regarding acclimatizing prior to the hike, lots of fluids, coca tea, maybe Diamox, etc.
Any experience with high altitude sickness and keto?
Thanks!!!
After being on ketosis for a couple of months , I had a low point yesterday.. I ate lot of bakery sweets... So I've decided to fast today with coffee an come out times and then get back to my fat diet.... I want to know what happens if you interest sugar into your body while on ketosis... Has my body slipped out of ketosis?? WHAT CAN I DO IN SUCH SITUATION??
Hi Vijay!
Yes you are most probably not in ketosis any more. If you go back and eat a LCHF again you will probably be back in ketosis in a week or two. It's not dangerous to go out from ketosis and then back in again.
Thank you for your reply!!! This is very helpful! I was wavering between whether to stop keto or continue while on the trip, in fear that I would increase my chances of high altitude sickness. To be honest, I have never had liver before. I wonder if I can buy it dehydrated to make packing it easier. Hopefully I can find some high fat foods in Peru!
Thanks again, I really appreciate the help!!!