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You did it! You decided the ketogenic diet is right for you, so you started last week or last month.

(And if you haven’t, it’s not too late. Check out my blog post explaining ketogenic diet 101.)

You’re diligently tracking your macros.

You feel more energized throughout the day. 

You don’t have sugar cravings.

You’ve lost a few pounds.

You enjoy preparing delicious meals with whole foods.

But how can you be sure the diet is working for you? Is there a way for you to check your ketones? What are common causes for keto plateaus in weight loss?

Let’s troubleshoot early and ensure that the ketogenic diet is working for you.

Checking Your Ketone Levels on the Ketogenic Diet

Remember, the ketogenic diet is a low carbohydrate, adequate-protein, high-fat diet. Fats are converted to ketones through ketosis. Ketones are made in your liver and released into your bloodstream. 

Carbohydrates are converted to glucose through a process called glycolysis. On a standard high-carb diet, your body is using this glucose as its main fuel source. 

In order for your body to experience the benefits of a ketogenic diet, you need to be in ketosis. This means your body is burning mainly fat for fuel instead of carbohydrates for fuel. 

But how can you be sure that you’re in ketosis and not glycolysis?

You can check your ketone levels. Your ketone levels will increase when your body’s in ketosis.

There are three ketones that can be measured: 

  • Acetoacetate (AcAc)
  • Beta-hydroxybutyrate (BHB)
  • Acetone

AcAc is the primary ketone body that can convert into BHB and acetone. The body mainly uses AcAc and BHB as energy sources, while acetone is considered a waste product.

Let’s explore how these ketones are measured through your urine, blood, and breath.

  1. Measuring ketone levels through your urine

To measure your ketone levels through urine, you can use ketone urine sticks. Ketone urine sticks are affordable and available online or through your pharmacy. Since you test your urine, these strips are non-invasive making it easy and not painful to check your ketone levels. 

All you need to do is collect your urine in a sample cup, stick the ketone test strip into the liquid, and follow the instructions on the box. Tests are usually completed within 15-30 seconds, and you match the color with the colors on the package to determine your ketosis level.1

Urine ketone sticks measure the primary ketone body AcAc.

However, there are downsides to this test method. 

First, you want to be sure your ketone test strip isn’t submerged in the sample liquid for too long, because you’ll get an inaccurate reading. You may also get a false positive if you’re not hydrated well.

Lastly, ketone sticks work best if you’re just starting the keto diet. When you first start a ketogenic diet, your body can’t use ketones for energy efficiently. So, you excrete most of the AcAc ketones out through your urine – this excess AcAc is known as spill over

Once your body is used to being in ketosis, fewer AcAc ketones will show-up in your urine. This is because your body is now comfortably using AcAc as an energy source. You will have less AcAc spill over in your urine and a large quantity of ketones in your blood, but your urine test will show only a small amount of ketones.  

So while your body is working well in ketosis, your urine is telling a different story and doesn’t think you’re in ketosis.

What’s a more accurate way to measure your ketone levels? Keep reading to find out.

  1. Measuring ketone levels through your blood

For the most accurate way to measure ketones, you can use a blood test.2,3 Blood ketone tests measure the ketone BHB. The AcAc (measured from urine samples) converts into BHB. 

The blood test is invasive and requires a finger prick. It also requires more money per test than the urine ketone sticks. To measure ketone levels through blood, you’ll need:

  • Lancets
  • Blood ketone strips
  • Blood ketone meter (such as Keto Mojo) 

To continue testing blood samples, you’ll need to invest in lancets and test strips after they run out from the initial testing kit. Also, you’ll need to be sure the blood strips don’t expire before use.

Overall, ketone levels are measured accurately through blood no matter which stage of the ketogenic diet you’re in. However, if you prefer a less invasive method, consider measuring ketone levels through your urine.

Another less invasive method is measuring ketone levels through your breath. 

  1. Measuring ketone levels through your breath

While AcAc is measured through urine ketone testing and BHB is measured through blood ketone testing, acetone is measured through breath ketone testing. This is because AcAc can break down into acetone. 

But if ketones travel through your bloodstream, how can they be measured through your breath?

Well, acetone travels through your bloodstream and then diffuses into your lungs. When your body’s in ketosis, you breathe out a larger concentration of acetone than when you’re in glycolysis.

Right now, the most accurate breath ketone meter is by BiosenseⓇ.I recommend this device to my patients. While the device is an investment up front, you won’t need to worry about purchasing disposable testing strips and lancets. The test is also more accurate than urine testing and less invasive than blood testing, and you can test your ketone levels multiple times per day.

All you need to do is take a breath in and breathe out into the device. You’ll need to ensure you’re doing a deeper than normal breath out because BiosenseⓇ requires deep lung samples for accurate measurements. 

The reading you get is a number between 0 and 40.5 ACE is the unit of measurement used and signifies the ratio of acetone in the breath to the amount of ketones in the blood. From BiosenseⓇ’s research, 1 ACEs unit equals 10X the blood ketone equivalent.  So a 5 ACE is equal to a 0.5 blood ketone measurement. 

When Should You Check Your Ketone Levels?

I recommend that you check your ketone levels around the same times every day. I recommend testing first thing in the morning as soon as you wake up, as well as before you eat your meals and before bed.  You can test ketones anytime to experiment on yourself to see how different foods and activities affect your levels.  Of note, for most people ketone levels will decrease for a period of time after exercise. 

If you’re using the BiosenseⓇ device, I recommend that you measure your ketone levels at least three times a day.6 They also have great guidelines on their website, such as not measuring for several hours after drinking alcohol, or within an hour of brushing your teeth or applying lip balm, as ingredients like menthol in those items can affect levels.

So you’re measuring your ketone levels, but what happens if your ketone levels plateau? What if you’re no longer seeing results from the ketogenic diet? Let’s troubleshoot this problem.

What Causes Keto Plateaus and How To Break Them

You started on the ketogenic diet. You lost weight and saw results. You were so happy – it’s working!

But then the number on the scale stopped budging. It can be frustrating, especially if you aren’t at your ideal weight yet.

Don’t worry: Plateaus happen to many people, and they’re normal. It takes time when it comes to weight loss and long term changes. Here are some reasons why you may be experiencing a weight loss plateau.

  1. You’re consuming too many carbohydrates

You need to be aware of the amount of carbs that you’re consuming every day. If you’re consuming too many, your body won’t be in a state of ketosis. Instead, your body will be using the carbs as glucose to fuel everyday processes.

To prevent this from happening, I recommend the Carb Manager: Keto Diet App to my patients. It’s a free app that includes a:

  • Food diary
  • Macronutrient calculator
  • Calorie counter
  • Water tracker
  • Exercise tracker
  • Weight tracker

Many foods contain a large amount of carbs. Sometimes the carbs we eat can add up  throughout the day, and before you know it you’ve consumed too many. Also be wary of healthy foods that are high in carbohydrate content like starchy vegetables, most fruits, and grains. Even too much of a keto friendly food can add up to too many calories or net carbs and affect your results.

Using a keto diet app like Carb Manager can help you stay on track of the foods you’re eating and may break your keto plateau.

  1. You’re not getting enough sleep

The average person requires between seven to nine hours of sleep  per night. When you don’t get enough sleep, your body suffers from sleep deprivation and your weight can be affected.

Poor sleep is linked with hyperphagia (increased appetite). This is due to the hormone leptin. When you have poor sleep quality, there’s an increase in the production of leptin telling your body to consume more foods.  I think we can all relate to having more cravings after a poor night of sleep!

If you want to improve your sleep quality, consider tracking your sleep using a sleep journal. The National Sleep Foundation (NSF) includes a free guide on their website.7 Here are some additional tips on how to get quality sleep that can help break your keto plateau.

  1. You’re too stressed

When you’re stressed, you produce a high level of the hormone cortisol. This can make you more likely to overeat on carbs and sugary foods. Cortisol also increases glucose in your bloodstream which leads to increased insulin.  If this frequently occurs, it can lead to insulin resistance.8   

Your body’s cells will no longer absorb glucose from the bloodstream, which leads to higher glucose levels in the blood. Higher blood glucose levels prevent ketosis from occurring. 

Ideas to reduce stress:

  • Take deep breaths
  • Schedule in a self-care item such as a massage or a nightly epsom salt bath
  • Make time for a daily relaxation practice such as meditation
  • Get enough good quality sleep
  • Get out in nature
  • Increase your daily movement
  • Spend time with friends and family you love

By decreasing your stress levels, you could end your weight loss keto plateau.

Overall, know that there’s a solution to your keto plateau. It all comes down to getting to the root cause of your keto plateau. You could be consuming too many carbs, not getting enough sleep, or feeling extremely stressed. Or there could be additional causes like thyroid or sex hormones, gut health issues, and mindset. If you’re not sure what the root cause of your weight loss plateau is, we can find the problem and give you solutions.

Let’s Make the Ketogenic Diet Work for You

You have 3 options for measuring your ketones! Breathalyzers offer a non-invasive, accurate way of testing your ketone levels. And regularly testing while on the ketogenic diet helps you reap the most benefits.  Testing and tracking typically lead to more success!

While it’s common to see weight loss plateaus through the ketogenic diet, there’s a root cause to them. If you’re not sure what it is, we can determine the root cause through testing. 

If you’d like to see if the ketogenic diet works for you or if you’re experiencing unexplainable keto plateaus, schedule an appointment with us. 

Here’s to your health,

Dr. Emily Parke

References

  1. https://www.marksdailyapple.com/how-to-measure-ketones/
  2. https://journals.sagepub.com/doi/abs/10.1177/088307380001501203
  3. https://www.sciencedirect.com/science/article/pii/S1059131109002143
  4. https://mybiosense.com/
  5. https://mybiosense.com/understanding-the-aces-unit/
  6. https://mybiosense.com/tips/
  7. https://www.sleepfoundation.org/nsf-official-sleep-diary
  8. https://www.marksdailyapple.com/how-stress-can-make-you-fat/
  9. https://pubmed.ncbi.nlm.nih.gov/29225114/
Dr. Emily Parke

Dr. Emily Parke

Dr. Emily Parke, D.O., is a certified functional medicine doctor, board-certified in anesthesiology & pediatric anesthesiology, and trained in medical acupuncture. She’s an experienced speaker in the medical and functional medicine community, and presently gives talks on a wide array of subjects.