Before I went on the 2012 Low-Carb Cruise last month, I started reading a book that my low-carb research friends Dr. Jeff Volek and Dr. Steve Phinney had written as a follow-up to their fantastic 2011 release The Art And Science of Low Carbohydrate Living (listen to my interview with Dr. Phinney about this book in Episode 479 of “The Livin’ La Vida Low-Carb Show”). The sequel is called The Art And Science Of Low Carbohydrate Performance and was written specifically to share the latest science behind ketogenic diets for athletes who are keenly interested in optimizing their exercise performance with fat and ketones serving as their body’s primary fuel source once they reach what Dr. Phinney refers to as “keto-adaptation.” But the information these low-carb stalwarts provide in this handy dandy little book goes much deeper than that as you will read about in this blog post.
Most low-carbers have traditionally been using urine ketone sticks under the brand name Ketostix to measure their level of ketones being produced by color (from pink to dark purple) as a result of their low-carb diet. But as I previously shared in this YouTube video, this can be a frustratingly inaccurate way of measuring whether you are producing enough ketones in your blood to see the kind of results you are hoping for on your low-carb lifestyle change. But thanks to the cutting-edge information provided by Volek and Phinney in The Art And Science Of Low Carbohydrate Performance, we now have a new and better way to measure the actual ketones that are in your blood which determines whether you have become keto-adapted and burning fat and ketones for fuel. They refer to getting into this state as “nutritional ketosis” to obviously distinguish it from ketoacidosis which is only an issue for a very small segment of the diabetic population, mostly Type 1’s. Listen to Episode 5 of the “Ask The Low-Carb Experts” podcast with Mark Sisson to learn more about why getting into ketosis plays an important role in maximizing your weight and health efforts when you are livin’ la vida low-carb.
At this point, you’re probably wondering, “Okay, Jimmy, how exactly am I supposed to measure my blood ketone levels?” Great question and I have some good news and bad news for you. The good news is you can get the blood ketone meters and strips just like you can a blood glucometer and blood sugar testing strips. The bad news is it can be very difficult and extremely expensive to find at your local pharmacy. When I went to 8 different stores (Walgreen’s, CVS, Rite Aid, Walmart, Sam’s Club, Publix, Target and a local pharmacy) in the Spartanburg, South Carolina area to inquire about getting a blood ketone meter and testing strips, the looked of bewilderment on their faces said it all. The pharmacist at Walgreen’s said to me, “I don’t think they make anything like that.” When I assured her that they do and that the meter is made by a pretty large company, she said she had never heard of anything like that before. It was a frustrating experience because I was super-excited to start testing my blood ketones at home in pursuit of being in nutritional ketosis.
After failing to have any luck searching for the ever-elusive blood ketone testing device at traditional brick and mortar stores, I then started looking online for a place to purchase a meter and the accompanying testing strips. Looking on Amazon.com I was quickly able to find the Precision Xtra meter at a reasonable price since it also doubles as a blood glucose monitor. But then I got some major sticker shock when I went to purchase the strips–A Box of 10 for for $58! Holy crap, that’s almost $6/strip just to test for blood ketones. Thankfully you only test once daily or that would send anyone not named Donald Trump to the poorhouse in short order. But I knew I wanted to do my next n=1 test attempting to get into and stay into nutritional ketosis and would need probably 100 strips. If I bought 10 boxes of the ones I saw on Amazon, that would have been close to $600! Yikes!
Volek and Phinney admit the testing strips are “relatively expensive” in their book and note that you can probably get them at a good price on eBay for around $1-2 per strip. When I placed a bid for 100 of them there, my original bid was $150 and I thought I would get them at a steal. Nope. Somebody kept outbidding me and I decided that I would stop at $400 which would be $4/strip. I ended up winning the 100 strips so I could begin testing my blood ketones but it cost me the $400. UGH! I’ll share the first 30 days of my results with you in just a moment. But knowing I was going to be writing about this experience of testing your blood ketones and that you my readers would probably want to test your blood ketones as well, I contacted Abbott Laboratories to let them know that they have a whole new market of people who would be interested in using their Precision Xtra devices and testing strips to measure their blood ketone levels. So far, they have limited their marketing to mostly Type 1 diabetics with insulin insufficiency who need to closely monitor their ketone levels if they exceed 10 mmol/L to monitor whether they have reached ketoacidosis. You’ll be happy to hear that Dr. Jeff Volek assured me this “will not happen in a non-diabetic simply restricting carbs.”
After waiting on hold for two hours speaking with six different representatives at Abbott trying to find out how you my readers can get these blood ketone testing strips both readily and at affordable price, they finally said to just go see your doctor and have him prescribe it for you. That wasn’t the answer I was exactly looking for and it’s obvious we’ve got some work left to do to convince them that they are missing out on a chance to expand their business while helping a whole lot of low-carb dieters in the process. Maybe if enough of us contact Customer Support at Abbott Laboratories, they’ll get the message and start making these blood ketone strips more readily available at your local pharmacies. In the meantime, I suppose those of us who are curious will just have to bite the bullet like I did and get them from eBay, Amazon or even overseas.
One of my fellow low-carb bloggers got his strips from an online Canadian pharmacy for about $2/strip. And if you want to get a FREE NovaMax Plus blood glucose/blood ketone meter that comes with 10 blood glucose and 2 blood ketone strips, fill out the brief form here and you’ll get it in about a week. A box of 10 NovaMax Plus testing strips on Amazon.com is a little over $3 each when you add the shipping costs. Yes, all of this is a bit of a hassle and an expense. But as Volek and Phinney share in their book, “Is this (hassle/expense) worth…pricking your finger once per day for a month or two? Based upon our experience working with many people, we think that the answer is ‘yes.'”
On the Low-Carb Cruise I announced to over 250 of my fellow Paleo/low-carbers in attendance that I would be testing this idea of nutritional ketosis for 90 days as my next n=1 experiment upon returning home. Dr. Volek gave an awesome lecture outlining many of the concepts from his The Art And Science Of Low Carbohydrate Performance book, including testing your blood ketones–so I wanted to give it a go for myself. Anyone who has been following my blog knows that it’s no secret that I’ve gained back some of the 180 pounds I had lost in 2004 on the Atkins diet in the years that have followed. And I’ve received my fair share of criticism from those who think I am not worthy of talking about low-carb diets in a positive manner if my weight is higher than they think it should be. Fair enough. Be that as it may, I am like most of the people who read this blog and attempt to do whatever I can to optimize my weight and health with the thoughts and ideas that are shared with me through my podcast guests, other people’s blog posts and the latest books sharing the science behind the healthy low-carb lifestyle. That’s what was appealing to me about attempting to get into nutritional ketosis if I wasn’t there already to see how that might help me in my pursuit of turning my weight around. Before I share my results, let me share briefly what the goal is with testing blood ketones.
In order to be fully keto-adapted and to start burning stored body fat for fuel, ketone levels must be between 0.5 to 3.0 millimolar. There is no added benefit to pushing blood ketones higher than 3.0 millimolar which Volek and Phinney say is “about as high as most people get eating a well-formulated ketogenic diet.” The three primary factors impacting blood ketone production are carbohydrates, protein and exercise. The first one is obvious and requires most people to restrict their carb counts to no more than 50g daily. Some people will probably need a lot less than this while others can possibly be able to consume as much as 100g daily and be in nutritional ketosis. The second one is very likely the problem with most low-carbers who have trouble getting into ketosis. Despite what you hear about low-carb diets being “high-protein,” the reality is protein intake should be moderate or adequate. Why? Because a little more than half of the protein you consume is converted into glucose by the liver (a process known as gluconeogenesis) producing “an anti-ketogenic effect” in the body similar to eating too many carbohydrates. Finally, the third one is exercise which can increase blood ketone levels 0.25-0.50 millimolar immediately afterwards which is an indication that fat-burning has commenced. These ketone levels can “increase sharply during the 1-2 hours after exercise due to increased hepatic delivery of fatty acids and greater rates of fat oxidation,” according to Volek and Phinney. Consuming carbohydrates and the amino acid alanine post-workout will blunt this blood ketone response somewhat which is why they recommend to avoid consuming them.
Here’s a convenient graph from page 91 of The Art And Science Of Low Carbohydrate Performance to help you visualize the “optimal fuel flow for brain and muscles” when attempting to reach nutritional ketosis:
Testing blood ketones is very similar to testing blood glucose, but there are a few subtle differences. The primary one is the amount of blood needed to get a reading on your blood ketone meter. When I first did it I pricked my finger and produced the typical amount of blood I use to test my blood sugar. BIG MISTAKE! As I was watching the blood get sucked up through the strip, it just kinda stuck there as if to say, “Feed me more, feed me more!” I hurriedly started squeezing my finger to produce just a tad more blood to get it to produce a reading. I’d estimate that you probably need 4-5 times more blood (a big drop) to test your blood ketones. It’s no big deal, you just squeeze the finger a little more after zapping it with the lancet. This used to freak me out making blood appear, but I’ve done it so much with my n=1 experiments that it’s no big deal anymore. While a glucometer will give you the blood sugar reading in a few seconds, it takes 10 seconds to get your blood ketone reading. That’s okay, though, because the results are worth the wait.
For my testing, I always checked my blood ketones sometime in the morning after I woke up, usually in a fasted state, and I checked my weight on the scale and blood sugar at the same time. This morning ritual has become a normal part of what I do now for the time being and I’m very comfortable with it. On days that I have an early podcast interview to record, I usually test afterwards while still fasting. So the fun began on May 15, 2012 when I finally took the plunge for myself and measured my first blood ketone reading for the very first time. Needless to say, as a veteran of high-fat, low-carb living for over eight years I was shocked by what I saw: 0.3! Holy cow, that could be one of the reasons why I’m not seeing my weight go down! This is a stark reality check for those of us who just automatically assume we are adequately ketogenic simply because we eat low-carb. Not necessarily for everyone as my dismal starting level of ketones shows. So beginning that day and in the month that has followed, I attempted to get my blood ketones in the proper range as outlined in that graph above and here are my results for Day 1-30 of doing this:
As you can see, within four days I was in nutritional ketosis (Volek and Phinney says it can take as much as two weeks to become fully keto-adapted) and I’ve stayed at 1.2 millimolar and above ever since averaging around 2.0 millimolar daily. While I started at an anemically low level, you’ll notice my blood ketones got as high as 5.0 millimolar at around the two-week mark. I gave blood on Day 2 of this experiment which may or may not have made an impact on the numbers. Honestly, I don’t know why the ketones went that high. And I didn’t “feel” any different with the blood levels of ketones above 3.0. Of course, I’ve been purposeful in eating a diet that is very high in fat to around 80-85% of calories, moderated in protein to about 10-15% of calories and very low-carb minimizing the intake to 1-3% of calories. My #1 goal has been to reach a ketotic state and not consume anything that would knock me out of that. Of course, when my levels reached the 4.0-5.0 range, I felt I had a little bit of wiggle room to have a little something extra if I wanted it. But over the past week or so the blood ketone levels have settled down naturally staying between 1.0 and 2.0 millimolar–right where it needs to be to give me the benefits of ketosis that I’m looking for.
One of the most fascinating aspects of doing this nutritional ketosis experiment is how long I have been able to go between eating meals. While I’ve long heard people talking about doing intermittent fasting for 18-24 hours between meals, this state of keto-adaptation makes doing that a cinch. I’ve not been hungry at all and my wife Christine has had to encourage and remind me to eat. There have been no cravings or hunger at all, I’m thinking much clearer than I have in a while, I’m finally sleeping well again getting 7-9 hours of rest at night, the pimple breakouts on my face have been significantly reduced, my workouts at the gym have been productive with no hypoglycemic “blackout” problems, and in general I just feel better than I have in a long time. It’s incredible how just a very small tweak in my eating has produced such remarkable results like this.
The key for me has been moderating the protein in my diet. Carbs have always been in check and I’ve been eating a good amount of dietary fat. But making sure I don’t eat too much protein is what I think has given me these spectacular results. Even chicken is problematic because it is a lean protein and attempting to offset it with more fat in the form of coconut oil, butter or cheese hasn’t helped. I’m not ready to share my menus or exercise plan with you just yet (but you can probably guess from what I’ve described that it’s high-fat, moderate protein, low-carb without calorie restriction) as I’m still wanting to see where this experiment takes me for the entire 90-day process. Needless to say, everything is looking very good with what I’m doing so far. I will tell you that I’ve drank liberal amounts of water and 2 Tbs Carlson’s liquid fish oil daily along with my regular daily vitamins during this experiment.
At this point I bet you’re curious about what my body weight has done over this same period of time. While I was hopeful that weight loss would happen once I got into nutritional ketosis, it was a pleasant surprise to see this much weight loss in such a short amount of time:
The numbers on that graph can be hard to see, but my weight on May 15, 2012 started at 306.2 pounds. That first week saw a very precipitous drop in weight before a slight increase that led to another steady drop in the second week. You’ll notice in the third week the weight loss just stalled completely out and I think I know why. Christine had spinal surgery on May 30, 2012 and experienced some complications post-op that had her at the emergency room twice in four days after she was discharged. It was quite a stressful time for us with very little sleep and I was picking up a lot of the household duties as well as taking care of feeding and bathing her during this time. Keeping my weight from skyrocketing upward was no doubt a minor miracle with all the cortisol my body was enduring from the stress of that situation. Christine is doing much better now and the cortisol levels were obviously reduced in the fourth week this past week as the weight loss has started going downward again. All in all in the first 30 days of my nutritional ketosis experiment, I’ve lost a total of 20.2 pounds. That’s not too shabby and I’m encouraged that I am on the right path for me with what I’m doing. I know the weight loss will likely slow down from this torrid pace, but shedding 8-12 pounds monthly would put me at a good weight for my 6’3″ body frame in about six months. I’ll continue to document my weight loss during the entire 90 days of my n=1 of nutritional ketosis.
The final health marker I measured during this testing period was my daily fasting blood sugar levels:
Looking at these results, they’re all over the place ranging from as high as 108 to as low as 78. I’m not sure why there are such highs and lows like this, but the average fasting blood glucose looks to be right around 90 which I’m happy with. I’m sure as I continue to keep up with my very high-fat, moderate protein, very low-carb nutritional approach to stay in the proper range of nutritional ketosis, some semblance of normalcy will begin to occur with my fasting blood sugars.
All in all, it’s been an exciting first 30 days of my n=1 examining nutritional ketosis. Definitely pick up a copy of Dr. Jeff Volek and Dr. Steve Phinney’s book The Art And Science Of Low Carbohydrate Performance and learn more about this fascinating concept of measuring your blood ketones. It could be the missing element in your low-carb plan and might explain why, like me, you may feel stuck on your low-carb lifestyle. I’m cautiously optimistic that this is what I need to be doing and I’ll continue to document the results of my 90-day nutritional ketosis experiment. I look forward to sharing Day 31-60 with you in about one month to see if the awesome results I have experienced so far will continue. Feel free to share your thoughts about what I’ve shared today in the comments section below. And if you are already testing your blood ketones, please tell us about how it has gone for you. As always, thank you for reading and for your support of my work!