Blood Ketone Levels?

I'm curious if anyone following Dr. Bernstein's way of eating have ever done a random check of their blood keytone levels.

I follow a low carb plan, but generally find myself between 75-100g of carbs per day.
(Yes, this is over double what Dr. Bernstein recommends - but I stay within the bg targets that I set for myself.)

I've recently read The Art and Science of Low Carbohydrate Living by Stephen Phinney & Jeff Volek.
In that they discuss about nutritional ketosis, and any diet with <50g of carbs/day should put you there. They defined a range of blood keytone levels between 0.5 and 5.0 mmol for those in nutritional ketosis A random test of my own blood keytone levels was 0.2 mmol - short of the range that they identifed. They also had a statement about lc/hf diets, and differentiated about he long term effects those w.o.e that put an individual into nutritional ketosis and those that don't - implying that those that did not wouldn't have the same long term benefits. At the very least, this has caused me to start to rethink where I'm at...
I'm reminded of Mr. Miyagi in Karate Kid:

Walk on road, hm? Walk left side, safe. Walk right side, safe.
Walk middle, sooner or later get squish just like grape.

I'm wondering if the same holds true for lc/hf way's of eating.
I'm curious if others have tested their keytone levels, and where they fall...

I have never tested my blood ketone levels, but I did partake in the Atkins diet a few years ago, where I ate nothing but protein and fat (it didn't work out for me, and I'm on a more sensible low-card diet now, where I eat about 5-10g carbs/meal).

The Atkins Diet was really excited about ketones, and wanted you to test your urine ketones constantly. I bought the little ketone strips, but never once did I get a result that showed ketones in my urine. Mind you, I was only on the diet for a couple of weeks before I lost it and ate a bowl of pasta.

I have a bottle of ketostix right there in my bathroom, right next to a bottle of glucostix. I used to test for ketones to monitor compliance to my diet. I never had very high ketones, generally marginal or trace. And I don't think I will have high ketones, it just doesn't make sense for my body to generate large amounts of ketones, just to pee them out. The only exception is after exercise when I could turn the strip dark very easily.

I never seem to make +k

Sounds similar to me.

I rarely test (for keytones), and when I do it is mostly out of curiosity.
Aside from rare cases, I usually show "trace" or "small".
In part I believe that this is driven by my level of hydration.
(I typically drink at least 96 fl oz a day, often more.)

It was also my impression that it wasn't unusual for urine keytone levels to stay low once you are keto-adapted...
so there isn't a direct mapping from urine keytone levels to blood keytone levels.

(I typically drink at least 96 fl oz a day, often more.)

I think I drink that much coffee a day. =^)

I'm in the same boat, testing keytones maybe bi-monthly for curiosity sake. I end up with trace to none sometimes.

I'm curious about this as well (and a few other questions I'm going to tag on!).

1: How do you determine that you have keto-adapted? Since the high-fat/low-carb diet is really only healthy if keto-adapted, it seems important to know.

2: What happens metabolically if you over-carb for a single meal? A week straight? How fast does your body return to glucose as a primary fuel? Does it just use insulin to store the glucose as triglycerides? IF it does, do those triglycerides then become available fuel? Would that impact liver function?

3: If urine tests for ketones aren't showing much of note, do you use blood tests? What ranges do you deem acceptable/problematic?

I have adapted to a pretty low carb life these days, and am thinking of taking the leap to try to go ketogenic, but want to make sure I understand it. I've read through
The Art and Science of Low Carbohydrate Living which was a great book, and have Dr. Bernstein's on the way, so there may be many more answers in there. If so I apologize!

My pump reports that I currently average 46g of carbs per day which is probably slightly under-calculating as I'll snack on nuts between meals and not bolus for it. Last A1c was 5.3. SO I figure I am close enough to make it a fairly easy transition. Just want to do it right!

Hope I'm not redirecting your thread, Knightshade. I think my questions are likely ones you may have as well, so it seemed better to tag it on here than start another thread.

Edit: I did just watch the interview with him that is posted in this thread, which did discuss some of #2 above. He noted that breaking from the diet "for a weekend" could result in a week or more of re-adaptation. It wasn't specified the impact of the metabolic shift though.

I wonder how that would change insulin needs (both basal and bolus).

You are right on track for the information that I am looking for…
I get 6 month follow up lab results tomorrow…

I don’t know if it will answer questions, or simply create new ones.

I saw that interview as well.
I also listened to a podcast with Mark Sisson who argued against that interpretation of the data...

At this point, I'm not sure who is correct....
In part, that is where my question stemmed from.

Where is the dividing line between being keto-adapted vs glucose-adapted?
Is it a line, or are there shades of grey as you approach it?

My personal impressions are that there are shades of grey between 50g of carbs per day and 100g of carbs/day

My understanding, from Stephan Phinney's perspective as a low-carb athlete anyway, is that you need to be in ketosis to get the full benefit of a low-carb diet. In order to do this, you have to drop your carb intake to the point where you are storing extremely small amounts of muscle and liver glycogen.

I imagine that the amount of carbs required to induce ketosis probably varies. Stephen Phinney strongly advises against even the smallest deviation from the amount of carbs that put you into ketosis.

Phinney does have some experiemtal evidence from animal models as support. For humans, it's a mix, but, from what I can see, the strongest results seem to depend on how much you engage in endurance activities. This makes complete sense to me.

Second this thought process. Exercise, even in small amounts really goes after the glucose stores you have and once depleted the Bernstein process seems to really kick in (fat for carbs, etc.).

The problem I find is that days when I am ketogenic my insulin requirements plummet and control becomes rather difficult to the point that I end up eatting more carbs to correct for LBS.

I think that this is one of those phrases that I've been having difficulties with: "full benefit of a low-carb diet"

Is there an itemized list of what this entails?

Perhaps with that, we could judge at what levels those benefits became apparent.

So far, I've been able to accomplish everything that I wanted a low carb diet to accomplish by hovering at the 100g of net carbs/day....
The mindset above implies that there are other benefits to be realized with further restriction....

More efficient use of fat and, apparently, an increased aerobic capacity along with, what Phinney claims, is more efficient glycogen use (I'm skeptical on this point).

Ketosis, basically, turns you into a fat burning machine.

I imagine that there is some gradient to these effects according to how many carbs you are taking in. In ketosis, however, these are maximized because your body doesn't really have a choice.

If your carb level puts you where you want to be otherwise then, yeah, why bother?

To add to that, the prolonged digestion of LC/HF makes for smaller fluctuations in postprandial BGs.

The link in Chris' post did not work here's a working one in case anyone is interested. I find Phinney very informative on low carb, he really knows his stuff.

Testing for ketosis with keto strips is often ineffective because they test for a type of keytone that your body does not produce much of when you are keytone adapted. They are really designed to test for DKA which apparently results in your body producing a different keytone.

Crap! My link had extra characters appended to it. Wish the post was editable. I wonder if there are forum mods who could manage that.

Thanks for the corrected link, BadMoon!

As for the Ketone strips...I think you are spot on there from what I've read so far. They may tell you if you are in trouble for DKA, which is worth checking for I think if you are shifting diets, but not helpful to determine ketoadaption.

I'm still hunting for info/evidence of whether the adaptation is a continuum, or binary (on/off). If a continuum, then there could be all kinds of "happy mediums" for staying low carb, but perhaps not VERY low carb (say 60-75g/day) with increased fat, but not full out 65%. The hunt for info continues!

I think there's enough circumstancial evidence, at least, to suggest that being in ketosis, or rather being out of ketosis, requires a threshold level of carb intake. You have to dig pretty deep into your glycogen reserves and give your cells little choice but to burn fat, building up ketones as a result.

I think Phinney would argue, pretty strongly, that to get the most out of your athletic performance, staying in ketosis is an absolute requirement. By extension, given that he argues strongly against even snacking on carbs to maintain exercise output, I think he would also argue that there isn't much of a continuum when it comes to ketoadaptation.

I think the question is, do you need to be keto-adapted to reach your own personal goals for maintaing your BG control, or levels of exercise, or whatever else you are low-carbing for?

From what I've read here and from some discussions with posters here, it looks like the answer to that is no, there are all kinds of happy mediums when it comes to everybody's level of low-carbing.

I think that this is one of the areas that I'm having difficulty grasping....

If I were to trust the online calculators, I have the following caloric needs:
Basal Metabolic Rate (BMR): 1661 Calories
Total Daily Energy Expenditure (TDEE): 2800 Calories

If in a given day I consume:
100g Carbs: 400 Calories
150g Protein: 600 Calories
200g Fat: 1800 Calories

Wouldn't this imply that I need to be able to metabolize fats just to meet my BMR needs, let alone the cycling that I do?

Does being keto-adapted have a meaning beyond the face value of being able to utilize ketone bodies as a form of energy?
I guess that I'm having trouble finding any backed reference that it is a binary (on/off) at a level of <50g of carbs/day. The fact that I show keytones in my blood (granted at a lesser level) seems to imply that they are being created and available for use....

I believe Phinney says that the cutoff is around 70 grams of carbs, and that below that your body becomes more efficient at utilizing ketones. He says this has implications for athletic performance in endurance events. Everyone has the ability to utilize ketones, most will go into ketosis overnight or during longer periods between meals.