Kicked Out of Ketosis? The Dirty Little Secret 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. Out of all of the issues that you can have with a low-carb lifestyle, understanding ketone testing strips is one of the biggies.


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 a low-carb diet. Even those who are using a blood meter often go by the rumors circulating around the web instead of listening to Dr. Phinney for themselves.

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.


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

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 result in muscle insulin resistance. This resistance to the presence of insulin allows those ketones 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."

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 dirty little secrets about ketone testing strips that you probably won't hear in a low-carb forum.

[Some of the links in this post are affiliate links. I might receive a small commission if you purchase something by using one of those links.]


Pinterest Image: Boy Kicking a Ball Out of the Court



What Can Ketone Testing Strips Tell You?


The only thing that urine ketone test 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.

THAT'S IT!
  • 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 tell you is:

IF you are in ketoacidosis (Type 1 diabetic) and 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?


Many low-carb dieters believe that the ketone testing strips are an easy way to fine-tune your low-carb diet. They 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.

Shrimp with Spaghetti
Low-carb dieters like to test low-carb pasta,
but you must test 5 hours after you eat it
or the test won't be accurate.

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, these dieters assume they've been kicked out of ketosis. 

Because of these false beliefs, many low-carb foods are eliminated and the experience shared 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.

If you don't know what's really going on, how the ketone testing strips work, you might be tempted to banish those low-carb foods from your own diet, as well. 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 low-carb 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. It 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 until the excess ketones get used.

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. 

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) were how Dr. Atkins experimented 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 type of sticks Dr. Atkins used are not the same type of 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.


Large Green Salad with a Couple of Cherry Tomatoes
Are you carefully measuring how much salad you're eating?
Lazy Keto can result in stalled weight loss.

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 glutamate..

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.


Comments

  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?
    Diego

    ReplyDelete
    Replies
    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.

      Delete
    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 this...today 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 anything....my 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!

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    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.

      Delete
  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

    ReplyDelete
    Replies
    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.

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

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  4. Your website is awesome thank you!

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

      Delete
  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)

    ReplyDelete
    Replies
    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.

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  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.

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    Replies
    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.

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

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