Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (21 page)

Although blood ketone testing is considered the gold standard for ketone testing, for reasons we’ll explore later in the chapter, there are some roadblocks that you need to be aware of. Blood ketone monitors can be difficult to find in local stores and pharmacies, and the companies that make them seem uninterested in widening their market beyond type 1 diabetics and the few type 2 diabetics who no longer make insulin and need to test for whether or not they are in ketoacidosis. While the monitors themselves are usually affordable, the strips they require can cost as much as $5 each, making daily testing extremely expensive. My argument to these companies has been that they would do better to make their products cheaper and more widely available because their current, narrow market of consumers is minuscule compared with the number of people (like you and me) who want to test our blood ketones to assess our progress in our health goals. Why wouldn’t these companies want to broaden the appeal of their products by marketing to those desiring to test for nutritional ketosis? That makes good business sense, and you’d think these companies would be all over it.

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.

Using nutritional ketosis to prevent and treat diseases other than epilepsy and obesity is a relatively new concept. So there are currently no large clinical trials in existence. Even most biochemistry textbooks hardly mention ketosis except in reference to starvation and diabetic ketoacidosis.

– Dr. Zeeshan Arain

Look for many more breath ketone meters and associated technologies to be developed in the coming years. According to the July 25, 2013, issue of the
Journal of Breath Research
, Japan’s NTT Docomo is developing a breath ketone reader device and app for smartphones. And a Swedish engineer named Jens Clarholm posted detailed instructions on his JensLabs.com blog for making a homemade breath ketone meter he calls Ketosense (he made one for me to use, and its results are remarkably close to the readings I find on my blood ketone monitor). It would not surprise me if we’ll be able to purchase breath ketone meters in stores by 2016! Now that would be cool.

I’ve said it before, but this point bears repeating: it’s important to remember that when your blood sugar level is in the normal range, the presence of high levels of ketones in the urine, blood, or breath is not at all harmful, no matter how much weeping and gnashing of teeth you may hear from health gurus. Diabetic ketoacidosis, as we’ve already discussed, tends to occur mostly in type 1 diabetics who cannot produce insulin and some type 2 diabetics who are insulin-dependent, and only when blood sugar levels are in excess of 240 mg/dl and blood ketone readings well in excess of 10 millimolar per liter. For everyone else who can make even a little bit of insulin, there is no danger in seeing higher levels of ketones. But since it can be difficult to produce ketones without deliberate effort, being able to test and see where you stand can be reassuring as you pursue ketosis.

Let’s list the pros and cons of each method for measuring ketones.

Urine testing

PROS

• It’s the least expensive method for testing ketone levels.
  
• The test is completely painless, since you just pee on a stick.
  
• There is a clear color change within fifteen seconds when ketones are present.
  
• If you have ketones in the urine, then you are definitely in ketosis.
  

CONS

• It only measures the ketone body in the urine (acetoacetate).
  
• Once you become keto-adapted, ketones in the urine may disappear.
  
• Long-term ketosis cannot be measured using this testing method.
  
• If you do not have ketones in the urine, you still might be in ketosis.
  

Everybody likes urine ketone testing because the strips are readily available in stores, cheap, and easy to use, and they produce a color change if you are in a state of ketosis. But this mode of ketone testing is fool’s gold for people who have become fully keto-adapted after a few weeks of low-carb, moderate-protein, high-fat eating and are now burning fat for fuel efficiently. After a period of transition as you shift from a sugar-burner to a fat-burner, ketones may stop spilling over into the urine, giving you the false test result that you are out of ketosis. What has actually happened is that your ketones are now showing up in the blood and you’re experiencing the long-awaited benefits of nutritional ketosis. Thus, solely relying on urine ketone strips to see if you are in ketosis after successfully making the switch is futile. The bottom line is they are just not a reliable means for tracking your ketone production beyond the initial period of adaptation.

Blood testing

PROS

• It’s the most precise
  measurement for detecting ketones (beta-hydroxybutyrate).
  
• There’s no ambiguity about the results with a clear digital
  display.
  
• It tests for the most prevalent ketone your body is using for
  fuel.
  

CONS

• The testing strips are more expensive ($2 to $6 per strip).
  
• Blood ketone testing supplies are hard to find in stores, so you may have to purchase them over the Internet.
  
• The test requires a painful finger prick for a blood sample.
  

If you’re not used to pricking your finger to test your blood, then blood ketone testing will likely be intimidating at first. But once you get over this mental roadblock and start testing your blood often, there’s a certain confidence and assurance that comes from knowing your blood ketone levels. The blood ketone monitors (especially the Precision Xtra) give an incredibly accurate digital measurement of your level of ketone production. In the next chapter I’ll share my experience testing blood ketones at least twice daily for an entire year to give you an idea of what to expect. But this is arguably the very best method right now for knowing how well you are doing on your ketogenic diet, and it’s worth every penny it costs to test.

Breath testing

PROS

• It’s an easy testing method that you can do practically anywhere.
  
• It’s the only way to measure ketones (acetone) in the breath, which correlate well to the level of beta-hydroxybutyrate in the blood.
  
• Unlike blood ketone testing, there’s no painful finger prick.
  

CONS

• These devices are not yet as commercially available as the other ketone tests.
  
• Different meters have different ways of showing results, and currently there’s no standard for correlating breath ketones to blood ketones.
  
• Not everyone may be able to or want to blow into a device for the ten to thirty seconds required.
  

I had the privilege of personally using some of the new breath ketone devices in the midst of writing this book, and so far they’re very promising. There are still some obstacles to overcome for breath ketone testing, such as the fact that the devices use different ways of displaying results and there’s no exact, apples-to-apples comparison to the results you would get from a blood ketone monitor. But if the companies developing breath ketone meters can smooth out these problems, then this could be one of the biggest breakthroughs not just in ketone testing but in health in general. Ketones play a vital role in many chronic health issues, and having an easy-to-use, pain-free device for determining how well you are producing them would be invaluable.