How do I know if I'm "in" ketosis?
deansdad101
Posts: 644 Member
It's a question that is asked by virtually all "newbies" to LCHF/NK (and many "old timers" as well). Given the recent spate of threads on the topic, perhaps it would be worthwhile to consolidate the various opinions and specifics in one place - so here goes:
As most know, I'm firmly in the ketostyx are basically useless, and the "only" real way to know for sure is by measuring blood ketones - "camp".
Most also "know" that opinions vary widely as to IF it even "matters" (that one know for sure).
Why not simply rely on the "typical" responses (keto flu, "average" time to adapt, 20 carbs, purple styx readings, etc) or actual weight loss results?
For many, that's "good enough" - for others, not.
We can (and should) debate both the "science" and the psychological as each "side" has compelling reasons and only by being well informed on the various points of view can one make an intelligent choice for themselves.
As the (self-appointed) captain of "team meter" I'd request that those currently measuring blood ketones not only report their experiences but also comment on the different meters, cost and availability, and whether or not they would do it again if they had a chance at a "do over".
The information would be invaluable for those considering the option.
Much of my information came about as a result of the work of Phinney and Volek and the subsequent ramblings of Jimmy Moore and I'd encourage those interested to look to those sites for the details. Meanwhile, I'm indebted to them for their efforts and feel confident that passing along the results of their work isn't something they would have a problem with.
In the US there are basically two (now three) meters that measure both (ketones and glucose) and each has advantages and disadvantages (both functionally and cost wise).
The FreeStyle Precision Xtra (Abbott Labs) is arguably the "gold standard" (and my personal preference), BUT it too has some "negatives" - not the least of which is total cost of ownership.
The second major player is the NovaMax Plus, typically less expensive initially (and ongoing), BUT with a couple of "issues" that may or may not be important to any given individual user.
First, it does not provide a digital reading for measurements <0.5mmol (the level at which one "enters" KA) but rather displays "Lo". For those "approaching" NK it's "all or nothing" until you hit 0.5 thus providing no feedback on progress. For those actually adapted though (>0.5) it's irrelevant.
Next, "uploading" data (to your PC) requires a proprietary "dongle" (extra) and just a PITA (IMO) in this day and age when they could have just used a standard USB connection.
The third "entry" in the US market is the WallyWorld version of the Precision Xtra.
In fact, it is "exactly" the same unit (from everything I've read and seen) as the Xtra (uses the same strips or wally brand) - just a different color, different box, and name. It's the ReliON Ultima (be careful as there are a number of ReliON "versions" and ONLY the Ultima will work.
From time to time, BOTH the Precision and the NovaMax offer "free" meters (either outright "free" or free with purchase of strips), ReliON does not (at least to date) but initial purchase is relatively cheap, $15-20 usd.
Glucose test strips are cheap (15-30 cents/each), readily available, but NOT interchangeable. You MUST use the same brand (it's the old Gillette plan, cheap razor, buy our blades for those of us old enough to remember razors that didn't plug in).
Ketone test strips are another story and the primary reason many people reject the concept of blood ketone testing - it isn't "cheap" there is simply no two ways about it.
Depending on where and when you get them strips can range from ~$2/ea to $5 or $6 and, as with the glucose strips you are "stuck" with whichever meter you have.
As a general rule, the ReliON strips (glucose) are the least expensive, Nova next, and Xtra the most costly. (Remember though that ReliON strips will work in the Xtra.
For the most part (changes almost daily) the Nova system has the lowest "total cost of ownership" but that will depend on the number of tests one actually conducts. They have (today) a "free meter with purchase of strips" offer and one can purchase the "starter" system for ~$40 but it's VERY basic and will require purchase of additional test strips.
The ReliON + 10 Ketone Test Strips (amazon) will run about $60 total (strips are $4/ea).
The Precision Xtra at retail is the most expensive but currently there is a promotion for a "free" meter and strips are available at ~$2/ea (but who knows how long that will last?) so as of right now, it's not only the "best" meter, but also the "best deal" - at least IMO.
Whether it's "worth it" or not is a decision only YOU can make for yourself.
Final entry in the debate is the recently introduced Ketonix Breath Meter.
It has a LOT of advantages, but as is almost always the case, disadvantages as well.
Primary advantage is cost ($100-$130 depending on model) but that's the final/total cost (no strips, lancets, etc).
Primary disadvantage is that (like the styx) it does NOT provide an actual "digital" readout of the level of ketones (and it's measuring breath, not blood). The "results" are "relative" - two levels higher than yesterday or three lower e.g., but there is (at least to date) no way to correlate the "green + 6 blips" reading to actual blood mmol levels.
Sorry for the length and wordiness but there really is just no way to reduce (most) things that actually "matter" to a 30 second soundbite.
Thanks for reading and PLEASE add your thoughts, comments, personal experiences, and questions.
As most know, I'm firmly in the ketostyx are basically useless, and the "only" real way to know for sure is by measuring blood ketones - "camp".
Most also "know" that opinions vary widely as to IF it even "matters" (that one know for sure).
Why not simply rely on the "typical" responses (keto flu, "average" time to adapt, 20 carbs, purple styx readings, etc) or actual weight loss results?
For many, that's "good enough" - for others, not.
We can (and should) debate both the "science" and the psychological as each "side" has compelling reasons and only by being well informed on the various points of view can one make an intelligent choice for themselves.
As the (self-appointed) captain of "team meter" I'd request that those currently measuring blood ketones not only report their experiences but also comment on the different meters, cost and availability, and whether or not they would do it again if they had a chance at a "do over".
The information would be invaluable for those considering the option.
Much of my information came about as a result of the work of Phinney and Volek and the subsequent ramblings of Jimmy Moore and I'd encourage those interested to look to those sites for the details. Meanwhile, I'm indebted to them for their efforts and feel confident that passing along the results of their work isn't something they would have a problem with.
In the US there are basically two (now three) meters that measure both (ketones and glucose) and each has advantages and disadvantages (both functionally and cost wise).
The FreeStyle Precision Xtra (Abbott Labs) is arguably the "gold standard" (and my personal preference), BUT it too has some "negatives" - not the least of which is total cost of ownership.
The second major player is the NovaMax Plus, typically less expensive initially (and ongoing), BUT with a couple of "issues" that may or may not be important to any given individual user.
First, it does not provide a digital reading for measurements <0.5mmol (the level at which one "enters" KA) but rather displays "Lo". For those "approaching" NK it's "all or nothing" until you hit 0.5 thus providing no feedback on progress. For those actually adapted though (>0.5) it's irrelevant.
Next, "uploading" data (to your PC) requires a proprietary "dongle" (extra) and just a PITA (IMO) in this day and age when they could have just used a standard USB connection.
The third "entry" in the US market is the WallyWorld version of the Precision Xtra.
In fact, it is "exactly" the same unit (from everything I've read and seen) as the Xtra (uses the same strips or wally brand) - just a different color, different box, and name. It's the ReliON Ultima (be careful as there are a number of ReliON "versions" and ONLY the Ultima will work.
From time to time, BOTH the Precision and the NovaMax offer "free" meters (either outright "free" or free with purchase of strips), ReliON does not (at least to date) but initial purchase is relatively cheap, $15-20 usd.
Glucose test strips are cheap (15-30 cents/each), readily available, but NOT interchangeable. You MUST use the same brand (it's the old Gillette plan, cheap razor, buy our blades for those of us old enough to remember razors that didn't plug in).
Ketone test strips are another story and the primary reason many people reject the concept of blood ketone testing - it isn't "cheap" there is simply no two ways about it.
Depending on where and when you get them strips can range from ~$2/ea to $5 or $6 and, as with the glucose strips you are "stuck" with whichever meter you have.
As a general rule, the ReliON strips (glucose) are the least expensive, Nova next, and Xtra the most costly. (Remember though that ReliON strips will work in the Xtra.
For the most part (changes almost daily) the Nova system has the lowest "total cost of ownership" but that will depend on the number of tests one actually conducts. They have (today) a "free meter with purchase of strips" offer and one can purchase the "starter" system for ~$40 but it's VERY basic and will require purchase of additional test strips.
The ReliON + 10 Ketone Test Strips (amazon) will run about $60 total (strips are $4/ea).
The Precision Xtra at retail is the most expensive but currently there is a promotion for a "free" meter and strips are available at ~$2/ea (but who knows how long that will last?) so as of right now, it's not only the "best" meter, but also the "best deal" - at least IMO.
Whether it's "worth it" or not is a decision only YOU can make for yourself.
Final entry in the debate is the recently introduced Ketonix Breath Meter.
It has a LOT of advantages, but as is almost always the case, disadvantages as well.
Primary advantage is cost ($100-$130 depending on model) but that's the final/total cost (no strips, lancets, etc).
Primary disadvantage is that (like the styx) it does NOT provide an actual "digital" readout of the level of ketones (and it's measuring breath, not blood). The "results" are "relative" - two levels higher than yesterday or three lower e.g., but there is (at least to date) no way to correlate the "green + 6 blips" reading to actual blood mmol levels.
Sorry for the length and wordiness but there really is just no way to reduce (most) things that actually "matter" to a 30 second soundbite.
Thanks for reading and PLEASE add your thoughts, comments, personal experiences, and questions.
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Replies
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I low carbed for many months before even knowing what ketones were. I never really realized how the quantity of fat kept me full longer. I had no problems losing.
Really, and this is probably not good, but honestly the only time being in ketosis matters for ME is if there is a cheat or an unforseen event that might be worthwhile to me to eat more calories and carbs than I would otherwise. If I know Im full blown there, Im much less likely to eat those treats and calories. The payback for that cheat comes the next few days when I think about food more or feel more hungry. I do use the urine test strips mostly out of curiousity and how dark the strip will get (even though that can vary and I've heard it doesn't matter as long as you're in ketosis)
I also "know" when I've had my coffee with coconut oil and cream in the morning on my way to work and I don't even think about food until mid afternoon.
I did receive the free meter but I have yet to buy test strips.
This may all change once I get closer and closer to my goal, but as of right now with what I want to lose...this is how I feel about knowing if Im in ketosis.0 -
Mel;I low carbed for many months before even knowing what ketones were. I never really realized how the quantity of fat kept me full longer. I had no problems losing.
Really, and this is probably not good, but honestly the only time being in ketosis matters for ME is if there is a cheat or an unforseen event that might be worthwhile to me to eat more calories and carbs than I would otherwise. If I know Im full blown there, Im much less likely to eat those treats and calories. The payback for that cheat comes the next few days when I think about food more or feel more hungry. I do use the urine test strips mostly out of curiousity and how dark the strip will get (even though that can vary and I've heard it doesn't matter as long as you're in ketosis)
I also "know" when I've had my coffee with coconut oil and cream in the morning on my way to work and I don't even think about food until mid afternoon.
I did receive the free meter but I have yet to buy test strips.
This may all change once I get closer and closer to my goal, but as of right now with what I want to lose...this is how I feel about knowing if Im in ketosis.
My "guess" is that your experience(s) is/are probably pretty typical of the majority of folks here.
That's not a "good" or "bad" thing - it's just to say that it "is".
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I am usually a gadget freak and I used the unavailability of gadgets as an excuse for a while. I don't have access to them here and I go back home only 1 month out of the year. Buying online is complicated.
when I finally decided to give it a go I had one sign that was obvious and it is really all I need. My urine smells indecent and the stream turns filmy looking (I had read about this and no idea what it meant until I saw it and smelt it ). I know I am in ketosis. The degree of ketosis and the count haven't really mattered as much as knowing I am in ketosis.
no gadgets needed then. I will save the money and spend it on butter.
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urine smells and looks different when in ketosis? could someone please explain what it's supposed to smell like?0
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I find the smell fades...that or you get used to it, but it smells like nail polish remover to me.0
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SLJ;sljohnson1207 wrote: »I find the smell fades...that or you get used to it, but it smells like nail polish remover to me.
One of the reasons that I place so little faith in the "tell tale" symptoms that people tend to rely on to "confirm" that they are/are not "adapted" is that there is so much individual variation and subjectivity (among other reasons<G>).
Neither my wife nor I (both >6 mos in) have ever experienced any of the "I know I'm "in" because....." symptoms (metal mouth, bad breath, urine signs, etc).
We did (both) have a touch of the k-flu symptoms 1st week or so but very mild and chalked it up to the diet change (way too soon to be an indication of adaptation).
I don't question that some (many?) people DO experience them, or that they honestly believe that purple styx or stinky urine is "proof" - I'm sure they do.
But "believing" isn't "knowing".
My concern is for those who have been led to believe that the subjective indicators are "good enough" but may find themselves right on the edge of actual NK where a small dietary change might propel them forward to actually be "in" (>0.5-1) and reap the benefits they were missing by being "close" but not but not quite there.
I know (think?) we agree (from your prior posts) on the virtues of blood measurements and by responding to your post here I'm not challenging your position but rather using your example (re the smell) to emphasize the point that "subjective" is just that (subjective) AND also subject to change, rendering it basically useless as "confirmation".
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well, in my own experience (which is not vast), my body odor gets very ammonia like. this is my third time doing this (i know, i know) and it seems fairly reliable, at least for me.0
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deansdad101 wrote: »
SLJ;sljohnson1207 wrote: »I find the smell fades...that or you get used to it, but it smells like nail polish remover to me.
One of the reasons that I place so little faith in the "tell tale" symptoms that people tend to rely on to "confirm" that they are/are not "adapted" is that there is so much individual variation and subjectivity (among other reasons<G>).
Neither my wife nor I (both >6 mos in) have ever experienced any of the "I know I'm "in" because....." symptoms (metal mouth, bad breath, urine signs, etc).
We did (both) have a touch of the k-flu symptoms 1st week or so but very mild and chalked it up to the diet change (way too soon to be an indication of adaptation).
I don't question that some (many?) people DO experience them, or that they honestly believe that purple styx or stinky urine is "proof" - I'm sure they do.
But "believing" isn't "knowing".
My concern is for those who have been led to believe that the subjective indicators are "good enough" but may find themselves right on the edge of actual NK where a small dietary change might propel them forward to actually be "in" (>0.5-1) and reap the benefits they were missing by being "close" but not but not quite there.
I know (think?) we agree (from your prior posts) on the virtues of blood measurements and by responding to your post here I'm not challenging your position but rather using your example (re the smell) to emphasize the point that "subjective" is just that (subjective) AND also subject to change, rendering it basically useless as "confirmation".
Yes, we agree. And I also agree that's it's subjective. The urine smell thing doesn't seem universal to LCHF dieters, just as my macro percentages that have yielded great weight loss probably won't work for every LCHFer. It's truly not a one size fits all. Some people don't even get keto flu at all when dropping carbs so drastically.
I do notice smelly urine when entering ketosis, and I do notice a different body odor when I sweat. It's noticeable by my husband as well. However, I don't think the urine smell stays once adapted. I think it fades...at least in my experience. And in my experience the smell is like nail polish remover. Someone else may have a different experience, or not experience that at all.
As stated before, the only way to know for sure if one is in ketosis and at the optimal range, is blood testing for bohb. However, not everyone wants to know for sure, and is okay with some "signs", and the biggest sign they want is weight loss, usually.
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I've haven't felt the need to test. When I first started this lifestyle, I ate @20-30 grams net carbs. I did go through the flu and stinky pee phase. I now eat 10 or less total carbs daily. If I'm not in ketosis now, then I never will be.
Regardless, I am losing weight, I have more energy, and I feel great. I partly don't care if I'm in ketosis - only that what I'm doing is working well for me.0 -
had no idea there were blood testing available for ketones. I have the bad breath not so much stinky urine (That I've cared to try and smell
) But I did get the 'flu' symptoms this week, but that might also be due to the cold weather...
I might check out how much they are in my area!0 -
Mar;had no idea there were blood testing available for ketones. I have the bad breath not so much stinky urine (That I've cared to try and smell ) But I did get the 'flu' symptoms this week, but that might also be due to the cold weather...
I might check out how much they are in my area!
Check out the first post most of the detail on availability etc is there.
Your profile shows GA so I'm pretty sure you have a WallyWorld nearby or if not Bentonville, AR should be less than a day's drive <bg>
Anyway, Precision Xtra is free from Abbott website, Nova is free (sort of) you have to buy strips so I think it's $40, or ReliOn is <$20 at Walmart (but you need to buy strips).
Xtra is my choice and delivery on the free one is pretty quick (~1 week).
Order that one then go to WM and pick up a box of 50 glucose strips and a box of lancets (the little "needles"). Total should be about $25.
That will get you started and you can learn the tricks doing blood glucose tests (which are also very important to know as you'll see). Big reason is the glucose test strips are 35 or 40 cents each - the ketone strips $2 - $6 each (so you REALLY don't want to waste them.
Once you really "know" you are fat adapted (instead of just "guessing" with the styx or your breath) and comfortable with glucose testing, you can tell with a very high degree of certainty that you are staying in the 0.5-3.0 mmol range with just the glucose (40 cent) test and only a once a week (or so) ketone strip to validate. So the cost/strip isn't that big of a deal.
Ketone strips in the drug store will be $5-6 but you can get them on line for $2-3 so that's the way to go. You can also get the glucose strips cheaper online so no more trips to Bentonville (unless you're going anyway of course <s>.
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