Using a Ketone Meter to do a Ketogenic Diet

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Using a Ketone Meter to do a Ketogenic Diet


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Old 06-29-2012, 12:50   #1
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Default Using a Ketone Meter to do a Ketogenic Diet

I thought I would start a new thread for discussing using a ketone meter to aid your ketogenic diet efforts. I had previously shared Jimmy Moore's success but I wanted something where any members who are trying this tactic can share their progress and tips.

Ketone Meters
At the moment there are only 2 ketone meters: Precision Xtra and Nova Max Plus. As usual the price of the strips should probably dictate which one you buy. If you are willing to wait, sometimes you can request a free meter directly from the manufacturer (nova max plus).

Ketone Strips
There's no getting around it, they are much more expensive than blood glucose strips. Here are some average prices and places to find them:
  • Amazon: $5-$6 per strip for Precision Xtra, $3-4 per strip for Nova Max Plus
  • Ebay: $4-$6 per strip. Usually only cheaper when sold in bulk
  • Online Canadian Pharmacies: $2-$4 per strip. Make sure to select an accredited pharmacy! Most should not require a prescription since it is "over the counter".

The Basics
Here is my understanding of how to go about this based on my reading of two books by Drs. Steve Phinney and Jeff Volek: The Art and Science of Low Carbohydrate Living and Performance.
  • If you are already trying a low-carb or ketogenic diet (and think you may be in ketosis), you may want to try keeping your diet the same until you get your strips so that you get a baseline. Maybe you already have good ketone levels.
  • Start your ketogenic diet. There are tons of threads on this forum about it (search for smorgan's posts or ketogenic). Here's the short version:
    • Restrict carbohydrates to < 50g a day. You most likely will need to be lower, use your meter to guide you.
    • Get adequate protein for your size and activity (0.7 1.5g per lb lean body mass) - but keep it on the low-end if you are having trouble getting high enough ketones. Too much can prevent ketosis. Here are some threads on protein, and some calculators.
    • All your remaining energy is coming from healthy fats. Prefer saturated and monounsaturated fats like animal fats (meat, eggs, dairy), coconut oil, olive oil, avocados, etc.
    • Stay hydrated!
    • You may need to supplement with sodium (2 cubes of bouillon), magnesium (400mg mag citrate), potassium or zinc. See the chapter on Mineral Management for details.
  • A health goal range for ketones is .5 - 3 millimolar. If you go higher than that, please be careful and check your blood sugar too. If you already have your blood sugar under control, DKA should not be a concern but if you have ketones AND high blood sugar, get thee to a doctor.
  • Since strips are expensive, figure out a testing plan. I and others have gone with testing fasting ketones since or most people, ketones are lowest in the morning (fasted) and rise through the day. My plan is to test 1x a day until I've hit my goal range. Once I'm in ketosis for a week, I will test less often, maybe 1x a week to make sure I'm staying there.
  • It may take up to 2 weeks to get your ketones into the desired range. How long really depends on many factors such as: previous diet, glycogen stores, blood sugar control, medications and identifying your personal carb/protein/fat ratios.

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Last edited by Daytona; 06-29-2012 at 12:53.
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Old 06-29-2012, 13:17   #2
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I had previously been following a LCHF diet but was not restricting protein very much. On Tuesday I started aiming for a ketogenic ratio, with < 20g of carbs, 90g of protein and a minimum 140g of fats.

I am going for a slight calorie deficit though it may not be necessary. If I am hungry, I eat a snack high in fat (e.g. chocolate pudding or coconut oil chocolates) and am not limiting calories. It's just that if I don't put limits on myself I tend to mindlessly eat even when not hungry...

Day 1:
0.4 ketones
I'm listing ratios from the previous day
35 carbs, 80 protein, 137 fat, 1.68 KR

Day 2:
0.3 ketones, down 1.2 lbs
24 carbs, 79 protein, 161 fat, 2.1 KR

Day 3:
0.4 ketones, down 1.2 lbs
28 carbs, 97 protein, 157 fat, 1.85 KR

Day 4:
0.9 ketones, down 2 lbs
25 carb, 82 protein, 164 fat, 2.08 KR

KR = Ketogenic Ratio = (Fat*0.9 + Protein*0.46)/(Carbs*1+Fat*0.1+Protein*0.58)

I'm very excited about this. I LOVE having feedback on my ketones. Just like knowing your BG helps you keep it in check, I feel the same goes for this. Also I have been stalled at the same weight (with tons more to go) for a year. So to lose any weight makes me want to cry.

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Old 06-29-2012, 14:05   #3
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I do LC/HF and am at my desired weight range. I assume I am in Ketosis at 20-30 carbs a day but I never do test. I really wonder if it is necessary to test ketones if you are getting desired results. I pay enough for diabetes supplies without adding more costs.

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Old 06-29-2012, 14:15   #4
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I'd expect the initial feedback -- to get into ketosis range -- would be important.

For someone like me, who does a lot of protein-burning, it would help ... but I am a bit loath to spend the $$$ involved, I admit!

Thanks for the comprehensive post, Daytona! I may use it to experiment again, in a few mos.

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Old 06-29-2012, 14:42   #5
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Agreed, if you are getting results on your current diet this isn't necessary. However if you have been stalled out (which I have) then this may help.

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Old 06-29-2012, 16:07   #6
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Daytona, I hope I'm not hijacking your thread, but I thought this might be a good place to ask this sort of question for others who might be wondering.

Do you think it matters how we allocate our protein in terms of weight loss? More in the morning, less at night, even across our meals? The reason I ask is that the calculator on your website said I need about 70 grams of protein per day. I ate about 30 grams this morning, which is much more than usual for me. So, nearly half my daily goal. (Fat grams ~60 and carbohydrates <2 grams.) Is front loading all this protein a problem, a good idea, neutral? It's okay if you're not sure! I have absolutely no idea.

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Old 06-29-2012, 16:27   #7
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Quote:
Originally Posted by Miss_Blue View Post
Daytona, I hope I'm not hijacking your thread, but I thought this might be a good place to ask this sort of question for others who might be wondering.

Do you think it matters how we allocate our protein in terms of weight loss? More in the morning, less at night, even across our meals? The reason I ask is that the calculator on your website said I need about 70 grams of protein per day. I ate about 30 grams this morning, which is much more than usual for me. So, nearly half my daily goal. (Fat grams ~60 and carbohydrates <2 grams.) Is front loading all this protein a problem, a good idea, neutral? It's okay if you're not sure! I have absolutely no idea.
I don't believe there is a hard and fast answer and it really depends on your body. With protein you are juggling 3 concerns: maintaining bone, muscle and organs; not spiking your BG and not consuming so much that it stop you from being in ketosis.

As far as lean body mass, I have heard (but can't find) of a study that showed that women would maintain muscle mass as long as they consumed adequate protein regardless of how it was distributed across meals. But that study didn't include diabetics.

From everything that I have heard on this forum (jwags and foxl come to mind), many of us have trouble with spikes when we don't limit how much protein we have in a sitting. The best way to figure out your limit is to use your BG meter. I found that my personal max is 30g so I try to split it evenly between breakfast, lunch and dinner. When testing this I found that since I eat fatty meats, the protein spike occurs much later than 2 hours, closer to 4.

I don't know of any data showing that protein timing has an effect on ketotis. But I would not be surprised that eating 90g at dinner would have a huge anti-ketogenic effect.

My recommendation would be to try to split it evenly across snacks and meals and always eat your protein with fat. I like the idea of hitting a ketogenic ratio not just for the day but for each meal. It's okay to get a snack that's all fat, but I would avoid having an all carb or lean protein meal without fat to counterbalance it.

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Old 06-29-2012, 16:38   #8
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The protein question is an individual thing. I know I cannot eat a lot of protein in the morning otherwise my bgs spike. I was drinking LC whey shakes but had to cut the whey portion because of spiking. But I am very insulin resistant even though I am rather thin. I have to admit my muscle mass is probably not what it should be. Most of my muscles were destroyed by 15 months on statins. But I am slowly rebuilding them with exercise. I have to keep protein to no more than 3 -4 grams per meal, mostly lunch and dinner. Most of the calculators say I need around 70, but I am lucky to get 50 most days.

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Old 06-29-2012, 18:25   #9
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I ordered strips from Canada yesterday. They were $2 each - yikes! - but hopefully once I get more information I'll be able to back off these as I have with glucose ones. I'll post results once they arrive (couple of weeks - hard to wait!) - but will stay steady with current diet so I can see where my body has been.

I use the urine strips occasionally to check in and confirm ketosis (excess always shows up, color at least moderate range if not higher) - so this will be interesting. But based on your carbs and blood ketones, methinks I'm not doing as well as I thought.

I want/need to lose weight badly, but am not willing to stay hungry to do it. If this works I'll kiss a porcupine. Seeing your weight loss is so encouraging - you must be ecstatic!

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Old 06-29-2012, 18:38   #10
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Quote:
Originally Posted by moon View Post
But based on your carbs and blood ketones, methinks I'm not doing as well as I thought.

I want/need to lose weight badly, but am not willing to stay hungry to do it. If this works I'll kiss a porcupine. Seeing your weight loss is so encouraging - you must be ecstatic!
I'm looking forward to reading your results! I wasn't surprised that my ketones weren't very high, everything I have read from smorgan about ketogenic diets confirmed that I ate too much protein.

It's almost a good thing to have it confirmed that you aren't ketogenic because then you have obvious changes to make and a method of measuring success. Nothing is more frusting than doing everything you can think of and not seeing results. Having a meter to look at and actions to take based on the value made me feel empowered.

Oh goodness, to lose some weight again brought tears to my eyes! I'm praying that it continues, I don't care how quickly, just as long as it's moving in the right direction. But even if I don't lose weight I have been very happy on the new diet. I am much less hungry, eating more calories than before and now I'm starting to crave fat instead of carbs which I'm free to indulge.

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