Friday, October 7, 2016

How Do I Know if I am in Ketosis?

How Do I Know if I Am in Ketosis or Not?
Worried About Whether
You're in Ketosis or Not?
How do you know if your body is in ketosis?

I have been getting quite a few emails and comments lately from people who have been asking me exactly that:

“How do I know if I am in ketosis?”

After a bit of discussion back and forth, the conversation usually reveals that:

1) The ketone strips that Dr. Atkins recommended are only turning pink;

and/or

2) They are not losing much weight.

For that reason, many people believe they are not in ketosis. Since both of these ideas show a disconnect between:
  • the purpose of ketosis
  • weight loss
  • and low-carb diets
I went searching through the archives to see what I had already written.

During that search, I found this:



Old post on how to tell if you are in ketosis.

Originally, it was written back in 2012. It contained a bulleted list of symptoms that could help you know if you are in ketosis.

It also explained what you can do to ease the symptoms and make yourself more comfortable while going through the process.

I decided that since so many of you are struggling and don't know if you are in ketosis, I would give the post a major overhaul, so it will accurately reflect what we know today.

[Some of the links in this post are affiliate links. If you choose to purchase something by using one of those links, I may receive a small financial compensation, at no cost to you.]

Why Do Low-Carb Dieters Worry About Being in Ketosis?


The foundation of a low-carb diet is often mistakenly thought to be the state of ketosis because in 1972, that was Dr. Atkins' theory.

He knew that depriving the body of carbohydrates caused the metabolism to switch from burning mostly glucose to burning mostly fats. In fact, it was the scientific literature published in the 60s that gave Dr. Atkins the idea about looking for ketones in the urine.

He didn't just make it up.

Professor Kekwick and Dr. Pawan, British researchers, found a fat-mobilizing substance in the urine once their subjects had been carbohydrate free for 48 hours. They also found ketone bodies.


Dr. Atkins theorized that the presence of ketones was a sign that the body was satisfying its hunger for glucose by burning body fat for fuel. He came to this conclusion because ketones are a by-product of triglyceride break-down. However, they can also be made from dietary fats.

Unlike other weight-loss diets, Dr. Atkins ketone diet was the result of pulling information from scientific research.

For example, the metabolic defect idea originally came from Dr. Pennington, assigned by the DuPont Company to figure out why low-calorie diets were not working for their employees. Dr. Pennington believed that the overweight employees were unable to utilize carbohydrates properly, and as a result, they were in fat-storage mode.

To test his theory, he put 20 staff members on a ketogenic diet of 3,000 calories, which successfully enabled them to lose an average of 22 pounds within three months.

When Dr. Atkins ran into the work of Dr. Walter Lyons, who was looking into the metabolic changes that occur on a very low-carb diet, he decided to try a ketogenic diet for himself. Since he was a physician by trade, he knew about urine test strips used to check for ketoacidosis in Type 1 diabetics.

Through personal experimentation, Dr. Atkins discovered that the color on the sticks tended to coincide with how much carbohydrate he ate. It was the tests he ran on himself that birthed the idea that ketones in the urine was a sign of ketosis for everyone.

After a lot of experimentation, the original Atkins Diet was born. While many of the ideas presented in that first low-carb diet book were a direct result of Dr. Atkins personal experiments with carbohydrates and ketone testing strips, many within the low-carb community took Dr. Atkins' theories to be fact.

Since Dr. Atkins held a strong opinion about the tie between ketone spillage, the state of ketosis, and fat loss, many readers took Dr. Atkins at his word – that ketosis is defined as ketones in the urine – and become seriously worried if they were unable to turn the testing strips pink or didn't lose a ton of body fat within a very short period of time.

What is Ketosis?


There are actually two types of ketone substances that the liver makes:

1) acetoacetate
2) beta-hydroxybutyrate

Beta-hydroxybutyrate is made from acetoacetate. A third ketone substance can spontaneously be broken down from both ketones and is called:

3) acetone (toxic by-product)

All three ketones are involved in the state of ketosis, but they contribute in different ways.

When carbohydrates are first restricted, the liver uses its glycogen stores, the storage form of carbohydrates, to keep your blood glucose level steady. The muscles will use whatever glycogen they have stored to fuel your activities, as well.

With Low Glycogen, Liver Oxidizes Protein for Energy
Body Begins to Oxidize Protein
for Energy After a Couple Days
Once glycogen stores run low in the liver, the body begins to oxidize protein for energy.

This is a normal adaption, and nothing to worry about. If you cut down on the amount of protein you eat during the first couple of weeks, thinking that you'll speed up the body-fat burning process, the body will still burn protein for energy. It will just take that protein from your muscles instead of your diet.

According to the most recent low-carb study, all of the weight you lose during the first week of a low-carb diet comes from:

  • glycogen
  • water
  • muscle tissue
You lose absolutely no body fat at all.

Within a few days, your body will begin to make ketones from either the break-down of triglycerides or fatty acids, but this process takes time to get into full swing. The body will initially be slow in doing this, hoping that carbohydrates will be coming in soon.

As ketones begin to be processed in higher volume, protein oxidation will go down, and the body will begin to fuel itself by using ketones and fats.

This situation is the true state of ketosis.

Ketosis is a metabolic state of adaption. It has nothing to do with the number of ketones that are spilled over into the urine.

As ketosis continues, the body will go through another adaption and start converting almost all acetoacetate ketones into beta-hydroxybutyrate ketones because these ketones are able to move past the blood-brain barrier to fuel the central nervous system and a major portion of the brain.

Acetoacetate has a funny smell that can be detected in the sweat, breath, or urine. Some people claim to smell acetone, which is more fruity. Acetone, a by-product of ketone break-down, is generally taken up by the liver and detoxified. It is then converted into lactate. Acetone is also absorbed by other body cells and converted into pyruvate.

Both lactate and pyruvate can be used to make glucose to feed the parts of the brain that can't use ketones. This is why you don't have to be afraid of eating too much protein. The body has other ways of making glucose, other than meat, that it uses first.

Most people who lower their protein, due to a fear of gluconeogenesis, begin to burn muscle tissue to some extent, generating weight loss, but not necessarily fat loss.

When the rate at which the body synthesizes ketones exceeds the body's ability to use them, the ketones will build up in the bloodstream. When blood concentration reaches .5 mmol/dl accompanied by low insulin levels and normal blood glucose, you are in ketosis.

Additional ketone build up is just excess ketones the brain hasn't used yet. More ketones do not provide a deeper form of ketosis.

This is because the level of ketones in the blood is regulated by insulin and glucagon. These levels will vary due to:
  • diet
  • exercise
  • genetics
  • length of time you've been low carb
The amount of ketones in the urine have nothing to do with the amount of ketones in the blood.

Ketone testing strips normally measure only acetoacetate ketones. They do not detect beta-hydroxybutyrate, even though beta-hydroxybutyrate will be dumped if your blood ketone level gets too high.

How to Tell if You are In Ketosis

If you're just starting a low-carb diet, you might be wondering if the ketone strips are truly necessary. After all, the older versions of the Atkins diet depended on them to tell you if you were in ketosis, or not.

Many dieters still believe that the strips measure the state of ketosis, even though that theory has been proven to be untrue.

What the strips look for is ketoacidosis.

Ketoacidosis is a dangerous condition where the ketone level in the bloodstream of Type 1 diabetics rises too high. When coupled with no insulin, the blood can become acidic.


In those who secrete insulin, this dangerous condition never happens because the presence of insulin keeps the number of ketones in your blood from going too high.

Since the ketone testing strips don't measure ketosis, you don't have to mess around with them if you don't want to. What they measure in low-carb dieters is the excess amount of acetoacetate ketones your body is dumping because it can't use them.

Some people find the sticks helpful for motivation, but there are also many other ways to tell if you are in ketosis.

Signs and Symptoms of Ketosis


While everyone describes the state of ketosis differently, quite a few low-carb dieters experience the same signs and symptoms. If you can't decide whether you're in ketosis, here are a few things to watch for:

Sweet, fruity or metal taste in the mouth – A metal taste in the mouth is often one of the first things that many dieters notice. Everything you eat tastes funny. While the media often describes this symptom as bad breath, by the time others can smell ketones on your breath, your ketone level is quite high. Fruity breath is often seen in Type 1 diabetes, but not so much in low carbers.

Strong smelling urine – This is another symptom that shows up right away, often at the very point where you slip into the alternative metabolic pathway. While it is hard to describe, you'll know the difference when it happens to you.

Reduced appetite – The reduction in appetite is often quite startling and is a major sign that you are in ketosis. Even if you're not tossing excess ketones away in your breath and urine, almost everyone experiences reduced hunger pains. The only exception to this sign is if you're close to your goal weight. The closer you are to maintenance, the more hungry you're going to feel.

However, don't be fooled by this symptom. You do get hungry if the body needs fuel, especially at your regular meal times, but it won't be to the same degree as you experienced hunger before. If dinner is late, for example, you won't have that starving, I got to eat right now or I'm going to die feeling if a meal is delayed.

However, there are a few individuals who DO get hungry eating low carb. If you happen to be one of them, check out our latest article for those still hungry on low carb.

Elimination of food cravings – Another sign that accompanies a drop in appetite is the severe reduction in food cravings. This occurs because the state of ketosis often results in a severe lack of interest in food. I'm talking about the physical craving for food. If you have mental or emotional addictions to the sense of taste, or you have always used food for comfort and stress avoidance, those food issues will still be there.


Dry mouth and/or increased thirst – A low-carb diet is very dehydrating, since it takes lots of water to convert glycogen into glucose, so you might experience a dry mouth or increased thirst after your body sheds the water. Since stuffing water into your fat cells is also common on low-carb diets, this thirsty condition can persist until your water fluctuations calm down and your electrolytes are more balanced. At that time, you can expect a visit from the Whoosh Fairy.

Feelings of well being or euphoria – Some people describe the difference in the way they feel as an upswing in energy. Others feel better because they are eliminating junk foods and steering clear of their food sensitivities, such as wheat. Regulating blood glucose levels can make a huge difference in the way you feel. However, there is a sense of euphoria when in ketosis that can't be explained by making better food choices.

Increased energy – While not everyone experiences increased physical energy, those who can easily break down fats for energy, notice a measurable difference in their energy levels. Their stamina increases, and they have more incentive to get up off the sofa and do something physical. This is not a gradual change. It tends to happen almost overnight.

Mental clarity – Mental clarity differs from person to person, but also seems to be tied to the degree to which you can utilize ketone bodies for mental energy. If mental function is more sluggish on low carb, your brain isn't adapting to the alternative fuel source. Unfortunately, a low-carb diet doesn't work for everyone, so make sure that you evaluate your physical, mental, and emotional performance objectively, once you complete the Induction period.

In addition to the positive or benign symptoms of ketosis listed above, negative symptoms often associated with ketosis include:
  • a lack of energy
  • feeling nauseated
  • feeling shaky
Almost always, these negative symptoms are either a result of an electrolyte imbalance or the body adapting to the drastic reduction in carbohydrates. If blood glucose level has been high for quite some time, when it falls to normal, you can feel shaky and weak. As the body adjusts to normal blood glucose levels, the negative symptoms will dissolve.

If they don't, then you need to see your doctor for a checkup. Eating healthy should never make you feel worse.



What You Can Do About Uncomfortable Symptoms


Not everyone experiences all of the above symptoms. Some people have one or two problems, while others might have several. Some people have none of these symptoms at all. However, they are still in ketosis.

Have One to Two Cups of Chicken Broth a Day
Have Chicken Broth to
Increase Sodium
If you're suffering with the Atkins Flu, Atkins Nutritionals, Inc. recommends that you take a little bit of potassium and make sure that you heavily salt your food as well.

Although sodium can contribute to water retention, if your sodium-to-potassium ratio is out of whack, your body will struggle to balance itself. Having a cup or two of chicken or beef broth every day is also a good idea.

Drinking plenty of water to eliminate excess ketones is important when following a low-carb diet, but the excess trips to the bathroom as your body dumps its glycogen stores will also flush out potassium and sodium. Make sure you eat all of your allowed vegetables, and choose potassium-rich foods like avocado.

If adding potassium and salt doesn't help, you can try cutting down on the amount of protein you're eating and up your fats a little to cover the calories. Some people tend to make more acetone when they are eating too much protein.


Yeast overgrowth can also be problematic in those who used to eat a tremendous amount of sugar. A bit of low-carb yogurt can help if you're experiencing a huge yeast die-off situation.

When nothing else works, try upping your carbohydrates. Consuming less than 20 grams a day isn't magic. If you're not feeling well and your electrolytes are not out of balance, then your body might be trying to tell you that you are losing weight too fast.

Some people have difficulties converting fats into energy. I happen to be one of those. I do not do well on a high-fat diet. Although fat loss is the target, you won't get there if your diet is making you uncomfortable or ill.

Excess ketones are eliminated through your breath, skin, and sweat, as well as your urine, so smelling like weak fingernail polish or acetone is common during the first few weeks. Some people even complain of a problem with increased body odor.

Many find relief by chewing sugar-free gum, but if you try this tip, make sure you check the carbs and count them in your daily total.

One reader told me recently that the brand of sugar-free gum she had been using was 5 grams of carbohydrate per stick. A couple of sticks of gum, at that carb count, would take up half of your day's allowance. Make sure you pick a brand like Trident sugar-free gum (1 carb) that won't blow your carb budget for the day.

When I was in the weight-loss phase, the general recommendation for bad breath was parsley, rather than gum. Increasing your water intake can also help with that nasty taste in your mouth.

These negative symptoms of ketosis are most likely temporary because as your new lifestyle continues, the body will convert more and more acetoacetate into beta-hydroxybutyrate, which doesn't smell funny. The body will also learn how many ketones it takes to fuel your body and daily activities, and the number of ketones made per day will slow down.

Make sure that you're getting enough water.

There is a lot of moisture that comes with high-carb foods. When you restrict carbohydrates, you lose that water. This is one of the reasons why adequate water intake is extremely important.

In addition, many people eat more protein on a low-carb diet than they did before. You'll need extra water to process and digest that protein.

Occasionally, hunger signals can actually be your body telling you that it's thirsty, but the message gets crossed. Likewise, you can feel thirsty when your body actually needs more food.

Since low carb is a lifestyle, rather than a diet, if you don't feel well at 20 net carbs, try eating a bit more. There will be plenty of time later on to cut down on the amount of calories you're taking in once the body adjusts to ketosis.

Are You Having Trouble Getting Into Ketosis?


Most people have no difficulties getting into ketosis, but that honestly isn't true for everyone.


For those with extreme insulin resistance, such as PCOS, it may take longer than the traditional 3 to 5 days to get into that metabolic state. The delay doesn't mean you are doing something wrong. Your body is just taking longer to make the necessary adaptions.

If you're eating 20 net carbs a day, or less, and you haven't cheated, even once, it is very rare to not be in ketosis within a few days. Since the brain cannot survive on fatty acids, when glucose is scarce, you have to go into ketosis or the brain would die.

While some people try to trick the liver into ketosis by upping their medium-chain fatty acids with coconut oil and other healthy fats, the increased fat merely shows you that you are already in ketosis.

If you eat enough dietary fat to fuel your body's needs every day, your liver won't have a reason to use your stored body fat to make ketones. Eating more fat only provides a false sense of security. It does not force your body to go into ketosis. You aren't helping your cause by stressing out over whether you are in that metabolic state.

Fat loss does not depend on being in ketosis at every minute of every day. That's “old-school” low-carb magic that didn't hold up to the science.

Fat loss requires an energy deficit, no matter what diet you're following, so give your low-carb diet time to work and focus on replacing your bad eating habits with healthier choices. If you stick to your plan and relax, you'll be in ketosis before you know it.


Additional Resources:


16 comments:

  1. Thank you for this easy to understand ketosis article. It's a welcome relief from all the heavy science I've been finding.

    ReplyDelete
  2. You're welcome. I try to give people info they can use.

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  3. Hi. need help or advice. I started the atkins for the first 3 weeks lost nearly 1 1/2 stone. On the weekend of the 3rd week, i toatlly messed up, had a curry with all the trimmings. I put on nearly a stone by Monday morning. Since then i have not lost any weight. I have found low carb bread and ground flax seed which is meant to be very very low carb (fibre outweighing carbs)also i think the atifical sweetner may be playing a part in the NO sugar red bull i had with my vodka. I have now started exercising for an hour and a half in the morning before work, but the scales will not go in the direction i need them to. throughout the week i eat, salmon, sea fish steamed, chicken, pork, bacon, beef, lamb with my daily amount of brocoli. any suggestions or email me on nakius(at)google mail (dot)com

    ReplyDelete
  4. Sorry my email was wrong it nakiusgrant (at)googlemail.com

    ReplyDelete
  5. Hi Michaela,

    Is this your first time that you have been on the Atkins diet? Eating a higher carb intake after severely restricting carbs will first replace the glycogen you lost during Induction. That manifests in weight gain. It's not fat, but depending on how many carbohydrates you ate, the weight gain can be as much as 5 or 10 pounds even.

    Once that happens, the body often will begin to stuff water into the fat cells, thinking you are going to do that again soon. It won't shrink fat cells and dissolve them unless it has to. So once you cheat, it becomes a waiting game. You just have to wait it out until the body gives up and drops the water.

    Also keep in mind that low-carb bread and alcohol are not added back into the diet until much later on in the program because they tend to cause people to stall. Low-carb bread is extremely high in wheat protein, and many people are sensitive to wheat but don't know it. Alcohol causes the body to store everything as fat, and puts ketosis on hold, while the body burns the alcohol. So they also could be part of the problem.

    The Atkins Carb Ladder and weekly carb additions is designed to slowly return carbs to the diet. Slow enough that you can watch what your body does with each food you introduce. A lot of people have food sensitivities that they don't know about.

    However, weight loss isn't linear. And it's typical to stall around the 3 to 4 week mark due to the dehydration that the diet initially causes.


    ReplyDelete
  6. Michaela,
    I took notes on what you shared here, so I can do a couple of blog posts on the problems I'm seeing, go more in depth as to what might be causing the stall, or at least explain it more fully, but I somehow missed the fact that you're exercising 1-1/2 hours a day. On top of the things I mentioned in the above comment, that much exercise can also stall you because the water has to store extra water in order to repair muscle tears you get while exercising.

    ReplyDelete
  7. Best thing I have read all day!

    ReplyDelete
  8. I am happy to find this website. So is it necessary to test all the time? or at all? I think I am in ketosis. The strips show me nothing. So I have stopped using them. I have no desire to cheat on this diet especially since I am seeing the scale going down. I only need to lose a few pounds but I love what I have been eating and will continue forever.I feel great and look good for 53.
    I will see if you have on your website somewhere that tells us how much to eat and how to measure.

    Thank you Michele

    ReplyDelete
  9. Hi Michele,
    There is absolutely no need to use the sticks. They only measure 1 type of ketone, which the body starts making less of as you move forward with the diet. I don't measure anything on the sticks either. If you're dropping pounds, then you're doing fine with how much you're eating.

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  10. How much water is too much. I started 4 days ago on a ketosis diet to rid myself of a sugar addiction. I cannot seem to get enough water. I worry I am having too much. I am replenishing my sodium levels to compensate.

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    Replies
    1. The recommendation is to drink in ounces one-half of your current body weight. I never drank that much in the beginning myself because I have vertigo, so I could only drink three 32-ounce cups of water a day. Today, I drink maybe 64 ounces of water, plus 16 to 32 ounces of coffee. Sometimes, I drink more. It just depends on how thirsty I am. Too much would be something like a couple of gallons.

      Delete
  11. I just started the Atkins diet yesterday and today I'm craving sweets, ie cookies, pancakes,. What do you do to rid of cravings? The book said no caffeine during induction period , diet pop ok. What do you recommend for alternative to coffee and diet pepsi

    ReplyDelete
    Replies
    1. Which book are you following?

      The caffeine restriction was originally due to the way it can cause sugar cravings for some people. Atkins.com won't let me copy their latest stance on coffee, but they basically recommend 1 to 2 cups per day, and if you have problems with it then cut it out. As for diet soda, we have Shasta here in our area, so I can get a large variety of flavors that are both caffeine and aspartame free.

      Personally, I've never had problems with caffeine, so I've never restricted it, even on Induction.

      The sugar cravings are a signal that your body is running out of glucose. Most people find eating protein and fat together, such as tuna or chopped cooked chicken with mayonnaise helps with that. It will go away as soon as the body switches into ketosis.

      Delete
  12. I just started the Atkins diet yesterday and today I'm craving sweets, ie cookies, pancakes,. What do you do to rid of cravings? The book said no caffeine during induction period , diet pop ok. What do you recommend for alternative to coffee and diet pepsi

    ReplyDelete
    Replies
    1. Which book says no caffeine? There are several versions of the Atkins Diet. The restriction on caffeine has flipped back and forth, depending on what science was showing at the time the book was published. Currently, there is no restriction on caffeine, but it is highly recommended that you avoid asparatame, if possible.

      I don't though. I do worse on splenda sweetened drinks.

      It's normal for your hunger and cravings to go through the roof for the first couple of days. Eat tons of fat and/or protein; whichever one is more satisfying for you. It will pass when you finally make the switch and go into ketosis.

      That normally takes 3 to 5 days.

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