Kicked Out of Ketosis? The Truth about Ketone Testing Strips

Bowl of Fresh Raspberries
What can Ketone Testing Strips
actually reveal to you?

Confused about how ketone testing strips actually work? 

Do you think you've been kicked out of ketosis because they suddenly turned tan? 

Many low-carb dieters have misconceptions about Ketostix and blood ketone levels, so in this post, we are going to clear out some of those myths and misunderstandings. You'll get the truth about testing strips and learn what really causes those high blood ketone levels.

If you hang out at low-carb forums for any length of time, you're bound to hear again and again how someone recently got kicked out of the state of ketosis, and they are looking for a fast way to get back in.

I got kicked out of ketosis,” is one of the most common complaints I hear.

And while that may or may not be true, depending on the situation, there are a lot of misconceptions about the role that ketones and ketone testing strips play in ketosis.

Out of all of the issues that you can have with a low-carb lifestyle, understanding ketone testing strips is one of the biggies.

Even those who are using a blood meter often go by the rumors circulating around the web instead of listening to Dr. Phinney, the creator of the Nutritional Ketosis diet, himself.

For example:

One of the misconceptions I've run into over the years is the idea that ketones are used to fuel the entire body. This is only true at the very beginning of your low-carb diet.

When the body first runs out of glucose, the body runs on protein and ketones, but as carbohydrate restriction continues past those first few days, your body goes through a series of steps, or adaptions, that eventually results in muscle insulin resistance. 

This resistance by muscle to the presence of insulin allows any glucose and the ketones building up in the blood to be saved for the brain.

Once you are fat adapted, the only time your muscles use ketones is during intensive athletics or if your blood ketone level has gone up too high and the body is trying to correct what Dr. Phinney calls: "Ketone Starvation."

Man Hiking
After Induction, the body continues to make adaptions
that save ketones for use by the brain.

If you think that you've been kicked out of ketosis because your sticks have suddenly turned tan, or your blood ketone level isn't as high or as highly consistent as someone else's, listen up. 

Here's the secrets about ketone testing strips that you probably won't hear in a low-carb forum.

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What Can Ketone Testing Strips Tell You?

The only thing that urine ketone testing strips can tell you is if you have acetoacetate ketones spilling over into your urine, the type of ketones that signal a diabetic is in danger of ketoacidosis.

  • They cannot tell you if you are in the state of ketosis.
  • They cannot tell you if you are burning body fat for fuel.
  • They cannot tell you if you overate too many carbs.
  • They cannot tell you if a particular food kicked you out of ketosis.
What they do is measure the relative acetoacetate ketone concentration in your urine at the specific second you tested.

Likewise, blood ketone test strips measure the relative beta-hydroxybutyrate ketone concentration in the bloodstream, the amount of ketones available to the brain that hasn't been used yet. 

While blood ketone strips can tell you if you are in the state of ketosis and whether you're in the Ketone Zone, they cannot tell you:
  • why you are not losing weight
  • if you are burning body fat or dietary fat for fuel
  • if your body can use ketones effectively
  • if you are insulin sensitive or insulin resistant
What these two types of ketone testing strips can tell you is:
  1. IF you are in ketoacidosis (Type 1 diabetic); and
  2. The concentration of beta-hydroxybuterate ketones that have accumulated in the bloodstream. 
Depending on how many ketones are available for the brain, according to Dr. Phinney, you can also determine if you are not eating enough protein.

What Affects Ketone Levels?

You might believe that the ketone testing strips are an easy way to fine-tune your low-carb diet. 

You also might think that since the strips reveal the concentration of ketones in the urine or blood, the food or foods you ate just prior to testing will help you sift out problematic foods.

In other words, foods too high in carbs will cause the urine test strips to immediately give you a negative reading while ketosis-friendly foods will always turn the ketone strips at least pink, or darker. 

When the strips don't change color, you may assume that you've been kicked out of ketosis. 

Shrimp with Spaghetti
If you're going to test how low-carb pasta affects
your blood glucose level, you must test
5 hours after you eat it or the test won't be accurate.

Because of these false beliefs, you might eliminate many low-carb foods and share your experience with others, so other dieters don't make the same mistake and get kicked out of ketosis themselves. 

I see this type of behavior on low-carb forums all the time.

Newbies are particularly susceptible to these types of suggestions, since they haven't been on a low-carb diet long enough to make a reliable judgment about themselves. 

However, those who have been on a ketogenic diet several times before often feel anxious enough to lose weight that they quickly accept these misconceptions without checking out the information for themselves.

What Affects the Amount of Ketones in Your Urine?

There are a lot of things that can affect the amount of ketones spilling over into the urine or accumulating in the blood:
  • How high was your insulin level at the time you tested?
  • Were you under any type of physical, mental, or emotional stress?
  • What time of the day did you test? Best time, or random?
  • How active were you just before you took the test?
  • How long have you been on a low-carb diet?
  • How much protein are you eating?
Urine testing is only accurate for that single moment in time.

The sticks reveal what's going on with acetoacetate ketones at the exact moment you test. 

A minute later, or even an hour later, the results might be different because all the sticks can tell you is that something triggered the body into dumping acetoacetate ketones. It can't tell you what that something was.

Problems With Ketostix and Lipostix Readings

A dark reading on the ketone strips doesn't necessarily mean you are burning fat right then. 

A dark reading is just as likely to be from consuming too many carbs because when insulin goes up after a carb load, acetoacetate ketones will be dumped to clear the way for the glucose coming in. 

This ketone dumping is also the body's backup system for protecting you against ketoacidosis, and that holds true for both urine and blood testing methods for ketones.

If your blood concentration of both types of ketones gets too high, the excess ketones will trigger an insulin release to get the ketones in the blood down to a safe level. Ketone production will slow down or stop until the excess ketones get used or dumped.

Likewise, when you eat or drink something that triggers insulin, the body will dump ketones into the urine to make way for the anticipated glucose.

If you happen to be testing at the moment these ketones are dumped, you can mistakenly assume that what you ate didn't affect you. I've seen this reaction a lot over the years by those who are doing a cyclic low-carb diet. 

The sticks showed ketone spillage during a carb up and didn't turn negative until a couple of days afterward.

A lack of ketone spillage might also convince you that you got kicked out of ketosis, even if that isn't true. 

Ketones aren't discarded in a consistent manner. 

Plus, urine test strips don't register beta-hydroxybutyrate ketones at all. Acetoacetone ketones are only dumped when they build up in the kidneys to a particular level.

In addition, fat adaption causes more acetoacetate ketones to be converted into beta-hydroxybutyrate ketones, the type of ketones the brain uses for fuel, so the body can use fatty acids instead. 

This means the urine testing strips will get lighter and lighter as your diet progresses, until they eventually stop working completely. According to Dr. Phinney, this is common among those who are actually fat adapted.

If nothing triggers the dumping of the acetoacetate ketones you make, because the ketones were used during intensive exercise or they were converted into beta-hydroxybuterate, they can't be tossed.

Why Did Dr. Atkins Introduce Ketostix and Lipostix in His Books?

If the ketone sticks are so unreliable, then why did Dr. Atkins introduce them in his books?

Bowl of Raspberries with Whipped Cream
Ketone test strips enabled Dr. Atkins
to create his revolutionary diet.
The urine ketone testing strips (available at Amazon, Netrition, or your local drug store) are similar to the ketone pills that Dr. Atkins used to experiment on himself when he was creating the methods for his low-carb diet. 

He got the idea from Dr. Bloom, who was doing metabolic ward studies on diabetics to observe the body's reaction to a zero-carb diet. Since this was the first time Dr. Atkins had ever restricted carbs before, the strips allowed him to see what worked and what didn't. 

By using the sticks, he determined the speed at which to return carbohydrate foods to his diet, their effect on him, and how to best determine his personal carbohydrate sensitivity. 

However, the method Dr. Atkins used are not the same sticks available today.

For those brand new to a low-carb lifestyle, the method works very well. You can easily learn how many carbohydrates are too many for your metabolism by using the various ketone-measuring sticks on the market today. 

These sticks can give you a rough estimate of your carbohydrate tolerance, which is generally close enough for success.

What Dr. Atkins didn't anticipate was people wanting to walk away from his low-carb diet, although he did warn people that returning to Atkins Induction too often could backfire on you.

For Atkins, losing weight without hunger and feelings of deprivation were all it took to keep him from returning to his old style of eating, so he didn't realize the urine testing strips would eventually become a problem. 

Their initial purpose was to motivate you and help you discover your critical level of carbohydrate sensitivity.

They were not meant to be used indefinitely.

Once you know your upper limit for carbohydrate consumption, you don't need the urine testing strips any more, so while not perfect, Ketostix and Lipostix were the best way Dr. Atkins knew to show his patients and readers that burning fats for fuel was possible:

The clear premise for Induction is to switch you into a primarily fat-burning metabolism by sharply controlling carb intake. Your LTS [lipolysis testing strips] will help you measure the extent to which you've done so. Later, as you move through the other phases and increase your carbohydrate intake, the strips are no longer needed.” (Dr. Atkins' New Diet Revolution, 2002.)

In addition, Dr, Atkins cautioned his readers to not take the ketone strips too seriously:

Should your LTS not turn pink or purple, despite the fact that you are doing everything correctly, you may still show a decrease in appetite, an improvement in well-being, a loosening of your clothes, and a slow but steady weight loss and reduction in inches. This simply means that you are not producing enough ketones to register on the LTS but enough to burn fat. Remember, the strips are tools; making them change color is not the sole object of the game.” (Dr. Atkins' New Diet Revolution, 2002.)

While the strips can be psychologically supporting by confirming that you are in lipolysis, and therefore burning fats for fuel, you don't have to use the strips to follow the diet. As long as your hunger is under control and you are losing weight and/or inches, you are burning fat.

What to Do if the Ketostix or Lipostix Aren't Turning Pink

If you're at the beginning of your low-carb diet and the ketone testing strips are not turning at least pink, first make sure that you are measuring for ketones at the same time each day.

If so, you might want to next check that you aren't making any of the typical Atkins Induction Diet mistakes. Also, make sure that it's been at least 5 days since you started Induction. You want to give yourself plenty of time to enter into the state of ketosis before you begin tweaking anything.

Strictly measure out your salad and other carbohydrate foods to guarantee that you're eating not more than 20 net carbs per day. Many people overestimate their carbohydrates and calories, so using a diet scale to weigh your foods can help you accurately measure those carbs. 

You also might want to try cutting out tomatoes and onions. Both of these veggies are relatively high on the glycemic index, and Dr. Atkins said they can be problematic for a some people.

If none of those suggestions work to get the ketone testing strips turning pink, as a last resort, he also suggested that you try cutting down on the amount of protein you're eating. 

Recent scientific research shows that excess amino acids are rarely converted by the body to glucose, as was once thought, that conversion is a lengthy and difficult process. What typically happens is that amino acid oxidation goes up. The body can directly burn amino acids for fuel and it can make glucose out of non-essential amino acids, such as glutamine.

In some people, however, protein consumption can trigger a higher-than-average insulin response, and thereby, interfere with ketone production in protein-sensitive individuals. 

If you're prone to secreting too much insulin, the body will dump ketones every time you eat protein, so stop eating protein for snacks and try reducing the amount you're eating to just cover your body's maintenance and repair needs. 

For most people, that's about 0.8 grams of protein per pound of lean body mass or 20 to 25 percent of maintenance calories for your ideal weight.

If you're doing everything correctly, then don't worry about what the ketone testing strips are doing.

Lipolysis heavily suppresses the appetite and cuts back on food obsessions, which can be a much better indicator that you have not been kicked out of ketosis than the ketone strips are.

Vickie Ewell Bio


  1. Not quite understanding what you're saying. Are you saying that Keytones trigger insulin release?
    Are you saying that urine strips showing purple that you may not be in ketosis?
    Hoe does glucose level in blood relate to ketones?

    1. Hi Diego,
      Sorry if I confused you. If too many ketones build up in the bloodstream, those ketones can trigger an insulin release. The ketones that spill over into the urine do not. There are 3 different types of ketones, and the body does different things with each type.

      If the urine strips are showing purple for you, you're most likely new to low carb? People who have done this before, don't generally show purple. They're more likely to turn the sticks lavender or even just pink, which makes it more difficult to determine exactly what's happening when they eat certain things. If the strips turn "any" color other than beige, then you're predominantly burning fats for fuel and most likely in ketosis, but not always.

      There's a small window where eating too many carbs can initially dump ketones into the urine to make room for incoming glucose. The body burns glucose first, rather than fats, so if you eat too many carbs, it dumps the ketones because it can't turn them back into body fat.

      If you test yourself at the moment the body is dumping those ketones, you'll mistakenly believe you're in ketosis when you're not. It's a good idea, when you start returning carbs to your diet or if you ate something that's suspect, to test yourself more than once, or wait a day or two before checking. That will give you a more accurate reading.

      For beginners, the ketone strips will show lighter and lighter shades of lavender as you add more carbs to your diet. That's normal, and gives you a good idea of how many carbs your body can tolerate. For some people, however, the sticks just don't turn any color at all, even if they are in ketosis. That's because the sticks only check for one type of ketone. The ketones that your brain uses are different.

      Ketones are a by-product of fat metabolism. As fatty acids you eat are processed or as body fat is pulled out of your fat cells and processed, ketones are a result of that process.

      Once your glycogen stores are emptied and you're in ketosis, When your blood glucose level drops too low, the body will make the glucose it needs to keep it steady from body fat. Body fat is 10 percent glycerol, which the body can turn into glucose. It can also turn certain amino acids into glucose, if necessary, but it doesn't take that much glucose to keep your blood glucose steady, as long as you're not eating a ton of carbs.

    2. I can answer you too. The first 3 days are the worst, tired, hangry, craving, just feeling miserable, but trudging through. Your sticks may show up pink to purple, especially after a workout. However, let me add day 5 I woke up with energy, starving, drank my Vega shake with greens, ate 2 boiled eggs...and at lunch, 12:00 (5 hours later) I had to remind myself to eat! I am sweating my butt off cleaning my house, with NO cravings or hunger. I used a ketostick and it is faint pink. BUT I am feeling so satisfied I cannot handle it. I am also a horrible hypoglycemic, and on a regular diet of eating blood sugar would loop d-loop all day, causing me jitters and worry. On carb-free (20-30 carbs a day) I am leveled and balanced. Makes me never want to go back to more. I feel great and know something is working, because I never sweat either. Dont worry about the sticks. Do your carbs, get some movement, and watch how your clothes fit! God Luck!

    3. Thanks so much for sharing your experience and insights. The fact that the body uses the ketones for energy and only throws the excess away seems to be a really difficult concept for people to understand.

  2. Hi Vickie, you seem to understand this ketosis stuff quite well so maybe you can help me.
    I'm 51 year old female needing to losr at least 25lbs.
    I have been on a keto diet for almost 4 weeks. My keto strips are purple but I haven't lost a pound!
    I'tracking my macros and calories on my fitness pal and have been spot on.
    Carbs are less then 20g(5-10%), fat at 60-75% protein at 20-30%
    Calories 1200-1500
    Any explanation as to why I'm not losing?
    Frustrated lynn

    1. By keto diet, I'm assuming you mean Nutritional Ketosis? The actual Keto Diet doesn't use percentages. The whole concept of high-fat is misleading.

      Percentages are based on the number of calories you're eating. For that reason, they can be quite misleading, as well. Absolute grams are an easier way to track because for Nutritional Ketosis, part of your fat percentage has to come from your body fat stores. A diet of 75 percent fat is maintenance.

      Some people are able to lose weight on 1200 to 1500 calories, while others cannot. General rule of thumb is to start with 10 times your current body weight, in calories, and then adjust down from there, if needed. What you take away is always fat because it's really the only macro we have to play with.

  3. 50% correct, 50% wrong haha. But nice try.

  4. Your website is awesome thank you!

    1. Thanks. Glad to hear that you find this website awesome! I appreciate you taking the time to share your thoughts.

  5. Hi Vickie. I have been on a strict keto diet (lchf) for a little over 6 weeks. I am losing weight and inches slowly, but I am wondering about my ketone readings. I measure blood and urine ketones once a week when I weigh and measure, just to make sure I'm staying on the right path. I always measure first thing in the morning after a fast. Last week when I measured, my blood ketones were 1.1 (down from 1.7) and my urine ketones were 80. This week, my blood ketones were at 0.8 and my urine ketones are still at 80. It seems that if my blood ketones are low-ish (for ketosis) and my urine ketones are high, that I am dumping the ketones instead of burning them. Is this the case? If so, why? Thank you.

    PS, no history of diabetes, blood sugar measures at around 110-115 at the same time (in the morning, after a fast)

    1. Ketones you can measure in the blood urine ketones are "different" types of ketones. As you adapt to the state of ketosis, the body will convert more of the urine ketones into the type of ketones your brain can use efficiently. Lower blood ketones is perfectly normal if you're only 6 weeks into the lifestyle. It takes 3 to 9 weeks for the body to become efficient at fat burning. Until then, you'll use more ketones for energy. Once you're fat adapted, you'll burn more fat for energy, saving the ketones for the brain. This causes the number of ketones in the brain to go up a bit. However, anything over 0.5 is ketosis, with anything between 1 and 3 being the optimal number. More ketones doesn't mean you'll burn more body fat. Ketones are used by the brain, and fatty acids are used by the muscles.

  6. Hello, thank you for the information. But new I am wondering about my progress. I am on a medically-supervised VLCD and have been since March 23. Macros are roughly 35-40 net carbs per day. I've used the ketosticks since I started and in the last 2 weeks they have been negative. Not even a trace. I'm still doing what I'm supposed to be doing so now am a little concerned that I might not be burning any more to lose weight.

    1. It's perfectly normal for the sticks to stop working. It doesn't mean you're doing anything wrong. It actually means you're doing things right. As you become better at burning fats for fuel, you spill fewer and fewer ketones into the urine, so the sticks are supposed to stop working at some point. The sticks don't measure the ketones the brain uses, so you're doing fine. You want your body to burn fat instead of ketones.

  7. Thank you, Vickie! I really do appreciate the information! Happy Independence Day!

  8. Thank you so much for this information. I've been using the urine test strips since I started the keto diet three months ago, always first thing in the morning. I've averaged low to medium on the strips, but this past week I'm negative. I've been wondering what happened, as I haven't changed my eating. It changed right after I added hot yoga classes to my exercise routine (major sweat-fest!), but it seemed weird that this would cause me to be out of ketosis, so I've been searching for answers. I also still feel great, I'm not getting food cravings. So, if I'm understanding this article correctly, it's actually a good thing? A sign that my body is becoming more fat-adapted? Have you heard of this happening when someone starts something new in their exercise routine? Thanks so much! :)

    1. Yes. Intense exercise that works up a sweat often uses ketones for fuel, since glucose is scarce. There won't be as many in the urine. It's definitely a good thing because you want your body to prefer fat and ketones.

    2. Thank you! You have some really informative articles. Appreciate your information! :)

    3. This information was very helpful. I started the keto path 3 months ago. I've been weight lifting and running 2 miles a day for about a month and every morning, the keto sticks turn darkish pink. However, this past week, i have been negative. My work out has been a little more intense. My wife and kids are on the same path as I do believe this is the most healthy regiment to bolster good health. They test in the morning as well and are darkish pink. We all eat the same meals. What's the best method of testing to ensure my body is burning fat for fuel? Thank you in advance.

    4. If the keto sticks are going negative due to an increase in physical activity, that means you are fat adapted. That's the perfect state to be in as far as low carb goes. It means the body is burning fats for energy 'proficiently,' which is what you want to happen. If you were not fat adapted, the sticks would not have gone negative on you. The most reliable way to test is by using a blood ketone meter, but that will still show a drop in ketones since you're using them.

  9. I'm heading into week 4, I'm down 8.2 lbs and my biggest fat areas are dimpled and squishy. I'm a very well controlled type 2 Diabetic. My A1C Averages out to 6.0 over the last several years with the highest having been 6.1.

    In general, my BG is between 80 and 90 throughout the day, but no matter what I do (until going low carb) my fasting BG has been between 140 and 160 pretty consistently throughout the years.

    Since beginning this WOE my highest reading has been 128 and I'm pretty sure that was mostly related to not getting enough water over the last couple of days (I think that was from a food related illness and nausea). I have hit as low as 104 a couple of days.

    My urine test strips have been pretty consistently in the Medium range. I mostly feel pretty good and definitely less brain foggy.

    I'm 57 and my exercise consists mostly of some form of HIIT though I want to move back into weightlifting soon. The lightest results I've had were after a 3 hr very intense belly dance workshop.

    I assumed that was probably from using more keytones than I was wasting. I pretty consistently have nasty breath and when I use the bathroom my urine is pretty obnoxious too.

    Is that more indicative of waste? Oh also I'm on 1000mg/bid Metformin and I wonder how that factors into becoming fat adapted.

    Mostly I'm under my calorie limit and between 68 and 72% dietary fat. I occasionally eat over 20g of net carbs, but it's pretty consistently under 40g and no more than 25g total if I am over (there have been a couple of times I was closer to 40, but I tend to hover between 22 and 25). Do you think that is good enough to hit the fat adaptation mark or do I need to try to tighten it up further?

    I am considering getting a keytone blood monitor (dual), but do you think it is worthwhile based on the fact that it doesn't measure the stuff the brain uses for fuel? TIA!!!

    1. Hi Irridia,
      Losing 8 pounds your first month is a great achievement! Nice to hear you're being so successful! Some people see better fasting glucose numbers if they eat a small protein snack before going to bed. Exercise definitely uses ketones if it's intense enough, so nothing to worry about. It's my understanding that metformin works by cutting down on gluconeogenesis in the liver, so it won't interfere with becoming fat adapted at all. Your carb intake is fine. The average low carber eats about 35, so you're doing great! I only recommend ketone blood meters for those who have seriously stalled for a long time and haven't been able to figure out why. So, I'd wait, if I were you and just give the diet time to do its work.

  10. Hello, I’ve been on the keto diet for about 3 months. I lost 12 lbs in the first month and felt great. However, I’m now gaining weight. My fat is consistently 75-80% of my calories and protein 20-25 protein and carbs are consistently below 15. My urine test strips are showing no ketones...what could be stalling my wight loss and actually causing a gain??? I’m 51 yrs old and weigh 258, so it’s not like I don’t have fat to burn!

    1. According to Dr. Phinney, 75 to 80% fat is "maintenance," and not for weight loss. To lose weight, you have to eat less fat than your body needs, so it will be forced to pull it out of storage. There is a LOT of confusion within the low-carb community about fat intake. That 75 to 80% figure was originally recommended for endurance athletes. Not dieters.

      The urine strips only show the amount of ketones your body is throwing away. They don't show how many you are using throughout the day.

  11. I've been on a low carb diet now for 6 weeks. I lost 15kg in that time and am now at my goal weight of 88kg. I am now eating my maintainence calories(6000) for those 2 days in only one eating window(maybe 4 hrs) every 2nd day. Yes that is a lot of food! My strips are now showing pretty clear but I am certain that I am 100% fat adapted.

    1. When you move to maintenance, when done correctly, the strips shouldn't show very many ketones. The body should be using them all. If you're only eating every other day, then I can see why you need the high calories. Good job! I love to hear success stories!

  12. so I have been maintaining at 72 to 75 fat macro per day as instructed, but you are saying the fat should be less..much less?

    1. Instructed by WHO? Who told you to eat 75 percent of your calories as fat? The ratio for Atkins is 60 to 65.

  13. Thanks for this article! Glad I came across it as it's answered a lot of questions I've had about the urine strips and blood tests. I've been three weeks strong and definitely noticed a difference in my energy at and after work. I do still struggle with eating too much protein over the fats. I love meat, all types from fish to pork lol!

    Every time I've tested blood, the highest I've seen was .3 and the urine sticks pink/slightly darker which was discouraging until I learned a lot from your article.

    One question though about sucralose. I love me my white can monster energy drinks. They say zero carbs and sugar, but I know sucralose is a sugar. What are your thoughts on consuming sucralose?

    1. Sucralose is fine unless you're sensitive to it. The blood testing strips will be much more accurate after you've become fat adapted, about 6 to 12 weeks in. I've always been a heavy protein eater and it never messed with my own weight losses. Fats is actually how you dial in your calories.

  14. Hello Vickie,
    I think this article is very informative, but I have a problem...well actually my wife has a problem. We both started the keto diet one week ago. Using the urine strips we both had readings in the 1 to 3 area. My wife teaches Zumba and I work out every day in some fashion. My workouts are generally high intensity interval style training as well as jump and power training. Over the course of the week I lost 4 pounds and my wife lost 3 pounds. The problem with both of us, but more with her is that my wife was down about 8lbs on Saturday morning, we played in a volleyball tournament on Saturday as well. So when my wife weighed herself this morning she was down 3.2 lbs on the week, but up almost 5lbs from Saturday. She is now completely distraught and of course has lost he belief in the keto diet. Her ketones in the urine are also negative now and she has barely eaten any carbs what so fact I dont think she has been getting more than 20g a day. A little background might help. My wife is 53, when she was in her very early 20's she was skinny but obsessed with being or staying skinny, she became a cross between anorexic and bolemic, in fact she was once admitted to the hospital for it. My wife teaches zumba 6 times a week for an hour...she has also been a "carbie" for as long as I have known her, so a low/no carb diet is tough for her. This past week she has been picture perfect as far as carbs go and she has lost the weight I mentioned above. What is freaking her out is the fact that she was down 8lbs 2 days ago and she is now up 5( from 2 days ago but still down 3.5 on the week) and her ketones have disappeared. I dont know what to tell her, hoping you can help. I too am down 4 lbs on the week but up 1lb since since Saturday (2 days ago). Do you have any suggestions that I might be able to help her feel better...neither of us understand the diet really well.

    1. The first 5 to 8 pounds lost on keto is just water and glycogen. Not body fat. It takes a full week or so before the body begins to burn fatty acids for fuel, and another 4 to 6 weeks for the body to become proficient in doing that. I generally recommend that folks give the diet a 4 to 6 week trial before deciding if it's sustainable, or not.

      Intense exercise when mixed with low carb does some wacky things. Low carb is using the starvation pathway, so too much exercise or exercise that is too intense "can" cause the body to fight fat loss.

      There's a lot of water retention that happens, which can mask fat loss, as well. In addition, intense exercise burns ketones, since glucose isn't available. When that happens, there are no ketones to throw off into the urine. Your body is using them.

      Gaining weight after exercise is very common. Exercise causes water retention. Plus, the body needs lot of protein (1 to 1.5 grams of protein per pound of lean body mass) and will store water to help with muscle-tear repair.

      If the intensity is too strong, some people don't lose body fat on keto at all because their metabolism tanks. Intense exercise uses glucose and ketones. However, the only way to know if it's simple water retention or stress is to give the diet a little bit of time to work.

      Keto was designed for those with insulin resistance. But it works well for those with eating disorders and excess hunger/cravings as well.

      Past dieting history matters. If your wife is not new to dieting, then body will already have a multitude of defenses against losing weight it can pull out and use. This is the situation I'm in right now. I've been low carb for a few weeks again now and haven't lost a single pound. Sometimes, it's just a waiting game.

      And other times, it's because you're eating too many calories. I think that's what's wrong with my own stalled weight. While low carb sets the body up to burn fat, you have to eat less fat than the body needs or it will not have a reason to go into your fat stores. If you're guys are doing 80 percent fat, that's maintenance.

    2. Thank you for the response. I have convinced my wife(because of your reply and some research from Dr. Phinney) to just stick with it. I have also convinced her to stay away from the scales, or at least limit the scales to once a week. In my case my training intensity is something I have always done, I play a lot of sports and I am too darn competitive to not train like an Olympic hopeful. I am considering adding a few carbs, more like a targeted keto, or maybe cyclical keto. With that said I am actually down 6 pounds from when we started 8 days ago and it definetly looks like I have lost some fat, especially in my face and its working for me. I dont think keto is a long term thing for me, but judging by my results I am inclined to stick with it. Keto really is a trial and error thing. My biggest fear is to lose muscle mass (which can occur rapidly if your body thinks it is starving), so I have a hard time keeping the calories up. I need about 3000 calories a day to maintain, but I don't always feel hungry which makes that a difficult goal to meet. So what I am doing is basically going calorie deficient for 5 days (about 500), and then I eat like a starving hyena for a day, and get the right amount of calories for a day, and then back to a deficit. Just to let you know, I have never been a huge carb eater. Keep up the good work, solid information is hard to find.

    3. I went and looked at a Zumba video, so I could see what your wife is doing, and it looks fine. Not overly intense at all, so I'm thinking that it's just her body being overly protective. It definitely is a trial and error thing. Once you both become fat adapted, it will be easier to tweak things. Phinney is definately the one to listen to.

  15. Very informative! What I don't understand is that I seemed to get kicked out easily by protein (not a whole bunch either). I am a female with 20%bf 135lb and whenever I eat like a beef patty with a couple of slices of bacon, cheese, i have a blood ketone rating of .2 and have cravings. Did keto last year for 7 months, lost muscle and actually gained a few pounds of fat. I always struggled to maintain anything more than .3-.4 in blood ketone levels. Am I just that sensitive to protein/insulin? Normal blood sugar is around 80-85. I just started keto up again about a week ago, and am worried that i won't maintain nutritional ketosis for me to achieve the benefits.

    1. How did you do the second time around? Are you very active? The amount of ketones in the blood doesn't tell the whole story, especially if your blood glucose is in the normal range. 20 percent body fat is pretty low for a female. The body is going to be very protective of its fat stores at that point.

  16. Blow into the device and within 10 seconds your ketone results are ready. ketone breath meter

  17. Hi! very informative article! as i have been depending on those strips a lot. I have been on keto for a little over 3 weeks and lost bout 8.5lbs so far. i had a cheat day due to my best friends baby shower and i got back into "ketosis" according to the strips 1.5 days after cheat. Does that cheat day reset my 3 weeks to make my body fat efficent? i work out 4-6 days a week and its always intense cardio.. usually 4 mile run, elliptical or stair master. i seem to be stuck on the same weight for a week now (actually gained 2 lbs) should i lower my calorie intake? i stay at 1400-1500 cal but with the exercise my calories would be around 900-1200 a day. or should i reduce my fat intake that stays at 70-75% this morning my strip urine was tan, but i was just knocked out of ketosis on Saturday (5 days ago) due to the cheat day.
    190 lbs
    29 years old

    Thank you!

    1. Hi Michelle. Going one week without any weight loss is quite common. You won't lose weight every single week. Plus, a cheat day this early in the game can be interpreted by the body as carbs are available. In that case, the body will start to store water.

      Working out depends on the intensity and whether your body is seeing your workouts and diet as stressful.

      I ran your stats through the keto calculator to see how close you are and I got this:

      1442 calories (20 percent deficit)
      91 grams of protein
      20 net carbs
      111 grams of fat (69 percent)

      Keep in mind that percentages are not a good way to keep track of where you are. Protein given is the least amount that you should eat to maintain muscle mass. It's not a goal.

      Similarly, fat isn't a goal either. 111 grams is the most that you should eat. It's fine to eat less.

      Getting to the point of fat adaption takes awhile for most people. What that looks like is very similar to what you saw in yourself. After a cheat, the body goes right back to fat burning.

    2. Thank you so much for your helpful input! i will try to get more protein in as i was scared to consume too much... (as for the intensity of my workouts) i try to keep my heart rate 170-190 for 30-40 mins that way i know im on burning fat mode. Maybe my body is stressed by there workouts and i should have more rest days.

      Thank you!

    3. You're welcome. Experimenting is key.


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