how to measure ketonesKeto is unique compared to other diets because there is an objective marker that tells you if you’re on the right track. With an easy at-home test, you can confirm that you are, in fact, in a state of ketosis.

Regular readers probably know I’m not a big data tracker. My energy, sleep, workout performance, stamina, and enjoyment of life tell me almost everything I need to know about how well I’m doing. Nevertheless, I get that some people love to play the self-quantification game. In some medical situations, measuring ketones is advisable, even necessary, as well. I’m not a total curmudgeon about it. Heck, I’ve been known to check in on my blood glucose and ketones from time to time.

If you’re thinking about testing, you should become familiar with the three different methods. Each has its own pros and cons. You’ll want to pick the option that’s right for you.


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What Exactly Are You Measuring?

Let’s back up and do a quick refresher on ketogenic diets. These are any diets where carbohydrate intake is restricted below about 50 grams of total carbs per day. When you restrict carbs, you are really restricting how much glucose the body has to meet its energy needs. Without much glucose coming in, the body needs an alternative fuel source, especially for the brain, which doesn’t run well on fat. That fuel source is ketones.

The liver produces ketones from fatty acids when insulin levels are low and liver glycogen (stored glucose) becomes depleted. This happens when you follow a very-low-carb diet, fast, or engage in sustained exercise.

When your liver is producing measurable amounts of ketones, you are said to be in ketosis. This is not to be confused with ketoacidosis, a potentially fatal medical emergency. Keto diets don’t lead to ketoacidosis because the body has a safeguard that prevents ketone levels from becoming dangerously high: insulin. When ketones rise, the pancreas releases insulin, which in turn hinders the release of fatty acids from stored body fat. Fewer fatty acids in the bloodstream mean less substrate (material) for the liver to turn into ketones.

This feedback mechanism keeps ketone levels in safe ranges unless your body can’t produce insulin. Individuals with type 1 diabetes and very advanced type 2 diabetes are at risk for developing ketoacidosis for this reason. Diabetics often monitor their ketones to make sure they are within safe ranges.

For the rest of us, measuring ketones is just a way of checking whether or not we are actually in a state of ketosis. We might want to know that for a number of reasons, discussed later.

Meet The Ketones

In ketogenesis, fatty acids are metabolized in the liver to create ketone bodies. The primary ketone body is acetoacetate (AcAc), which can convert into beta-hydroxybutyrate (BHB). AcAc also spontaneously breaks down into a third ketone body, acetone.

The body primarily uses AcAc and BHB for energy. Although acetone can be converted into pyruvate, it’s generally considered a waste product.

How to Test Ketones at Home

There are three ways to test your ketones at home:

  1. Urine test strips, which measure AcAc
  2. Blood tests, which measure BHB
  3. Breath tests, which measure acetone

Urine Ketone Test Strips

How it works:

You can purchase urine ketone test strips online or in many pharmacies. They are cheap, costing only pennies per strip. Don’t confuse them with urine pH strips.

Simply collect your urine in a sample cup or pee directly on the strip. After a set time—usually 15 seconds, but some strips take longer—the end of the strip will change color. Compare the color on the strip to the key on the package to get your ketosis level. Rather than giving you an exact readout, the color tells you if your urine does not register any AcAc, or if it shows low, medium, or high levels.

It’s straightforward but not foolproof. For one, if you let the strip sit for too long before you interpret the results, the test can be inaccurate. Urine strips also tend to overestimate the amount of AcAc present and can give false positives.https://pubmed.ncbi.nlm.nih.gov/12081817/’>2 Results can be affected by how well hydrated you are, too.

Although urine tests are shown to correlate decently well with blood and breath tests in diabeticshttps://pubmed.ncbi.nlm.nih.gov/12081817/‘>4 AcAc in the urine is considered “spillover.” When you first start a keto diet, your cells aren’t great at utilizing ketones, so some get excreted. You’re measuring ketones the liver made but the body can’t use. As you become more keto-adapted, there should be less spillover.

Most keto dieters do find that their urine ketones decline over time. That’s a good thing, indicating less waste; but it also means the urine tests become less useful. It’s very common for experienced keto dieters to have low or no measurable ketones in their urine despite having plenty in their bloodstreams.

Pros:

  • Least expensive method of testing
  • Does not require blood—no finger pricks

Cons:

  • Least accurate, especially after keto-adaptation period
  • Affected by how well hydrated you are
  • Does not tell you exact ketone levels

Blood Tests for Ketones

How it works:

Blood tests measure the level of BHB in the bloodstream. This is considered the gold standard in ketone testing. They require an initial investment in a meter, plus ongoing purchases of test strips. You also need a lancing device and sterile lancets to prick your finger and draw a droplet of blood. If you’re planning on testing several times a day, it can get expensive fast, not to mention your sore fingertips.

The two most popular meters in the U.S. are the Keto Mojo(™) and Precision Xtra. Both also measure blood glucose, but you need separate test strips. The Precision Xtra meter runs around $25 depending on where you purchase it. Ketone test strips cost about $1.20 each, and glucose test strips about $0.65.

You can get a Keto Mojo starter kit on the company’s website that includes the meter, lancing device, 10 lancets, 10 ketone test strips, 10 glucose test strips, and a travel case for $59.99. Additional ketone test strips cost $49.50 for a 50-pack. Glucose test strips are $14.99 for a 50-pack. They also offer a Bluetooth connector for $9.95 that allows you to upload your test results to an app.

Understanding blood test results:

Your meter will give you a reading of 0 or “Lo” if you aren’t in ketosis. On a typical keto diet, you might be anywhere from 0.3 to around 2.0 mmol (millimole). Fasting and exercise can each drive BHB up to 4.0 mmol or higher. Ketoacidosis occurs above 10 mmol.

In The Art and Science of Low Carbohydrate Living, renowned researchers Jeff Volek and Stephen Phinney proposed that ketosis begins at 0.5 mmol. The designated 1.0 to 2.5 mmol as the “optimal ketone zone.” Don’t get too hung up on these numbers, though. Some individuals produce high levels of ketones on a normal keto diet, while others barely register any unless they fast or use exogenous ketones (which contain BHB). I have friends who have been strictly keto for years and consistently hover around 0.3 or 0.4 mmol. We don’t really understand why these individual differences exist. I’ve offered some hypotheses, but it’s still a bit of a mystery.

Anyway, higher numbers don’t mean that you’re doing better than the next person. In certain medical situations, such as for seizure control, high BHB levels are desirable. For the average person doing keto for weight loss or general wellness, there’s no evidence that it makes a big difference. More recently, Phinney and Volek have started to talk about the “effective therapeutic range”—where you can expect to reap benefits from being in ketosis—as being anywhere between 0.5 and 4.0 mmol.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/‘>6

Breath acetone does reliably correlate with blood BHB. Multiple studies also show that acetone readings are correlated with weight loss when participants follow a calorie-restricted diet.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097355/‘>8 Blood tests were otherwise fairly steady throughout the day, with a modest decline in the afternoon. Urine tests showed higher ketones as the day progressed, also with a small mid-afternoon dip. The highest levels occurred before bed, at 10 p.m.

Do You Need to Test?

No, but there are some reasons you might want to.

As I said up top, those using a ketogenic diet therapeutically might need to track ketone levels. For certain conditions like epilepsy, patients might aim for ketone levels of 4.0 mmol or higher.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367849/’>10 A blood BHB measurement is required to calculate GKI.

You might want to track your ketones if you’re running an n=1 experiment. Maybe you want to see what happens when you eat more protein or carbs, or you’re gauging your reactions to certain foods.https://pubmed.ncbi.nlm.nih.gov/15111494/‘>1 You don’t have to do zero fat, just don’t pile it on. Cooking with fat shouldn’t be a problem.

Carb Timing

I’ve said before that I think carb timing is relatively low on the hierarchy of things to care about. It’s not as important as what you’re eating or how much. I think it’s also less important than your macros—getting sufficient protein and experimenting with different levels of carb intake.

That said, if you want to experiment with carb timing, go for it. You won’t get a lot of guidance about how to do it, though, at least not from empirical research. I can’t find any studies that systematically vary carb intake, morning versus evening, among people eating anything like a Primal or paleo diet.

The good news, though, is that there isn’t an obviously wrong way to do this. Carb timing is unlikely to be the factor that makes or breaks your health, fitness, or longevity goals. Still, it might move the needle, so let’s get into it.

Rationales for Eating Carbs in the Morning

Insulin Sensitivity is Higher in the Morning

In my estimation, the best argument in favor of eating most of your carbs in the morning is that that’s when you’re most insulin sensitive. It makes sense to eat your carbs at the time your body is best equipped to handle them.

Eating a greater proportion of your carbs in the morning also seems to promote insulin sensitivity.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341154/‘>3

For what it’s worth, this is also why proponents of chrononutrition advocate for eating more of your total calories in the morning. Doing so, they argue, takes advantage of the natural peak in insulin sensitivity and acts as a zeitgeber to entrain your circadian rhythm.

And yes, I usually skip breakfast myself. I also eat a fairly low-carb, and therefore low-insulin-producing, diet. I’m metabolically healthy. My sleep is top notch. I’m not worried about my glucose tolerance nor my circadian rhythm. Both are in tiptop shape. For me, skipping breakfast feels natural, and I like extending my overnight fast. Since it seems to have no ill effects, I’m sticking with that schedule for now, but I’m open to change.

To “Sleep Low” for Fitness Gains

This one is really about avoiding carbs in the evening more than eating them in the morning per se. Here’s how it works: In the afternoon or evening, do a high-intensity workout to deplete glycogen stores. Do not eat carbohydrates after. In the morning, do a low-intensity session, such as a light jog, then eat breakfast with a balance of carbs, fat, and protein.

The purpose of sleeping low is to force your body to upregulate fat metabolism. Researchers have studied this protocol among elite male triathletes. They compared men who ate carbohydrates spread across three meals to men who ate all their carbs at breakfast and lunch and then “slept low.” Both groups ate the same total amount of carbs and did the same workouts.

In one report, after three weeks of this training, the group that slept low scored significantly better on a test of muscular efficiency. They also performed better on a surpamaximal test—basically pedal until you (almost) puke—and a 10k run in simulated race conditions.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5188410/‘>5

Reasons to Eat Most of Your Carbs in the Evening

Carbs Affect Sleep

Carbohydrates increase tryptophan production. Tryptophan is a precursor of serotonin, which in turn converts to melatonin. Still with me?

Thus, the theory goes, eating carbs at night will boost melatonin production and, hence, promote sleep. It makes sense, and you can certainly try it, but there’s no concrete evidence it actually works. According to the one tiny study that has examined this effect, your best bet is to eat some high-glycemic carbs four hours before bedtime.https://pubmed.ncbi.nlm.nih.gov/20849868/‘>7 and college students who were or were not stressed before eatinghttps://academic.oup.com/jcem/article/87/8/3984/2847416‘>9

What does this mean? It is true that if you’re hoping to extend an overnight fast and promote fat burning, then eating a high-carb breakfast that raises insulin will be counter to that goal. If you’re specifically worried that it will tank your cortisol, though, it may not be the case.

However, there is also tremendous variability in individuals’ cortisol responses. Certain people may indeed do better avoiding carbs in the morning. Some practitioners advise individuals with adrenal issues and cortisol dysregulation to eat most of their carbs in the evening instead of the morning.

For Weight Loss?

A lot of people tout this benefit, but there is no real evidence to back it up. There are a couple poorly done studies, and one that showed that participants who ate carbs at dinner instead of lunch lost more weight than those who did the opposite. However, that was because they lost lean tissue in addition to fat.https://pubmed.ncbi.nlm.nih.gov/9435517/‘>11

After exercise, when glycogen stores have been depleted, muscle cells become more insulin sensitive.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019055/‘>13 This only applies if you’ve actually depleted your muscle glycogen, though. A nice long walk, 30-minute bike ride at an aerobic heart rate, or microworkout won’t do it.

What If You’re Trying to Build Muscle?

As a pre-workout, consuming a small amount of carbohydrate, 25 to 30 grams, may be beneficial. You don’t need to worry about having full glycogen tanks, though.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928613/‘>15

Should You Eat Carbs Separately from Fat?

This is another one of those beliefs that makes sense on paper but doesn’t quite bear out in practice. The idea here is that when you eat carbs and fat together, the carbs raise insulin, which unlocks fat cells, which allows the fat you just ate to be easily shoved inside. In other words, carbs + fat = weight gain.

It can work like that, but it doesn’t have to. This is a much bigger concern if you are eating an excess of calories. If you’re consuming more energy than your body actually needs, and you’re potentiating the fat storage process, then yeah, you’ll end up storing body fat.

If you’re not consuming more energy than you need, you don’t need to worry. For example, in one study, two groups of patients ate a hypocaloric diet where carbs and fat were eaten either separately or together for six weeks. Both groups lost similar amounts of body fat and showed comparable reductions in plasma glucose and triglycerides. , alzheimer’s disease, ancestors, ancestral health, ancestry, animal fats, animal-source foods, animal-sourced foods, bacon, bestselling author, brain, Brain Health, burn fat, clinial practice, cognitive function, colon health, dementia, dha, diet, diet and nutrition, dietary diversity, dietary propaganda, digestive process, digestive tract, eat real food, emf, emf pollution, Episodes, fake meat, fancis pottenger, fasting, fat burning, fat burning man, Fat-Burning Tips, fat-soluble nutrients, fatigue, Featured, fiber, financial interests, fish oil, game changers, generation, genetic heritage, Genetics, government interests, grass-fed liver, Health, health conferences, health under attack, heritage, how to burn fat, hunter gathere ancestry, Hunter-Gatherer, immune health, immune system robust immune system, indigenous tribes, intermittent fasting, internal wildlife, international bestseller, internet, Interviews, invisible threats, keto, ketogenic, ketosis, liver, living with wild wolves, Longevity, mainstream narrative, microbiome, moderation, muscle meats, national defense authorization act, News, nora, nora gedgaudas, nose to tail, Nutrition, omnivores, optimize health, Paleo, phytochemicals, podcast, Podcasts, political landscape, pottenger's cats, Primal, primal body, primal body primal mind, primal fat burner, primal mind, primalgenic, primalgenics, pro vitamin a, propagandize, protocol, radiation, rethinking fatigue, self-empowered, superfood, Supplements, tangible threats, the fat burning man, The Wild Diet, threats, Thyroid, thyroid issues, top health podcast, vegan, vegan documentary, vegan propaganda, videos, vitamin d, vitamin d3, who, wild diet, wild fish, wild superfoods, wild wolves, wisdom, wolves, world health organization

Are you sick of dietary propaganda? Me too. This week’s guest has been wiping the floor with ridiculous, government-mandated, top-down nutrition recommendations for decades now.

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keto cancer

If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these as long as they keep coming in. Thank you for reading!

Folks, I have been grateful for every story that has come my way over the years. It’s an incredible privilege being on the receiving end of your reflections and evolutions, and they are why I’ve kept at it all these years—knowing the message and information have made a difference in people’s lives. I appreciate every single one. This success story comes from Registered Dietician, Primal Health Coach, and cancer survivor Martha Tettenborn. She takes us through her journey from learning to advise a low-fat, high-carb lifestyle to beating cancer using Primal principles. Enjoy! —Mark

It has become my passion to share the power of nutritional interventions for improving health overall, but especially in the treatment of cancer. I have come to this from personal experience…

I studied at University in the early 1980’s to become a dietitian, because I had an overwhelming interest in nutrition and wanted to be in a helping profession. At that time, the cholesterol and saturated fat theory of heart disease and overall health was considered cutting edge science and we were fully indoctrinated into the low-fat approach to almost all health issues. The only exception was using a high calorie, high protein approach to under-nutrition (such as with failure-to-thrive or cancer patients), and in that situation, we recommended using sugar or honey, butter or cream, and other added fats and simple carbs to increase the caloric density of foods.

I have been a Registered Dietitian for over 30 years, basing my practice for most of that time on the standard paradigm of low fat foods, heavily carb-based meals, fruits and vegetables, lower fat meats. Personally, our family spent many years eating no red meats, using turkey “bacon,” ground chicken and other processed foods, but avoiding beef and pork – and feeling virtuous while doing that.

Professionally, I have spent the last 20 years working in geriatrics, contracting my services to long term care facilities. I care for many residents with the end stage consequences of the Standard American (and Canadian) Diet – diabetes, strokes and of course, dementia, both vascular and Alzheimer’s. It is rare that a resident has simple osteoarthritis or other simple wearing out of old age. Most of them are younger and slowly dying for years with the chronic “diseases of civilization.”

About 10 years ago, I started down the path of alternative nutrition, starting with Seth Robert’s ideas, called the Shangri La Diet, using flavourless oil shots to impact on appetite control in the brain. I was successful in losing about 18 lbs that had been quite stubborn prior to that time. Shortly after that, I found Mark’s Daily Apple and the concept of the Primal Diet, eating an Ancestral pattern that suited our physiology. It resonated so strongly with me that this was correct, although it went against all of my training. The strength of the science won me over; however, I spent hours on the MDA forums, reading scientific discussions, success stories, recipe and meal planning ideas and journals from the MDA community.

About 3 years ago, I decided that I wanted to take my interest in low-carb, high-fat (LCHF) and start up a private practice. In order to update my knowledge, I completed the Primal Health Coach certification – an excellently presented and in-depth course. As an RD and member of a Registered Health Profession, with a regulatory college, I had to establish a private practice that met with the regulatory guidelines of my
profession, so I started Primal RD in July 2017. Because of my counter-conventional approach, I have had no support from local doctors and getting my practice going in my small Ontario community has been slow.


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Last summer, I discovered the presence of a large ovarian cyst in my abdomen and had it surgically removed in late September. The cyst was a simple fluid-filled balloon, but huge, holding 1.5 litres of fluid (over 50 oz – 6 cups!). Despite nobody expecting it, it turned out to be Stage 1 high grade serous carcinoma – ovarian cancer. It had been intentionally ruptured to make laparoscopic removal possible, so that was considered a “spill” and a second surgery for hysterectomy and chemotherapy were highly recommended.

I was 58 years old and in stellar health prior to this diagnosis. In fact, a great deal of my self-identity was wrapped up in being “super-healthy” and this sudden change to “cancer patient” was a huge crisis for me. However, as a naturally optimistic and curious person, I headed down the rabbit hole of research to determine what I could do for myself to impact on my health journey and return myself to my formerly stellar good health.

What I discovered was startling. That cancer is no longer considered by some to be a genetic disease, but rather a disease of disordered metabolism. That this information was first discovered and described by Otto Warburg in the 1920’s, for which he received a Nobel Prize. That this scientific information was then lost by virtue of it being of German origin, and the Germans lost the Second World War. And that this critical understanding of the metabolic nature of cancer has only been brought back to light in the past 10 years through the work of dedicated researchers who are working outside of the medical establishment.

Cancer, although it is thought of as a genetic disease, and that it is thought of as many different diseases, has one almost universal underlying common characteristic. Almost all cancers have damaged and malfunctioning mitochondria, the fuel-processing organelles that create the energy for all cellular life. Instead, they produce energy by the ancient process of fermentation in the cytoplasm of the cell, an inefficient process that is entirely dependent on glucose or glutamine for substrate. Cancer cells have no ability to burn fatty acids or ketone bodies. That’s their Achilles heel.

keto cancer

By using a ketogenic diet throughout my chemotherapy, I was able to deprive any remaining cancer cells from having access to elevated circulating insulin or glucose. And by producing ketones through the diet and through fasting for 72 hours each chemo administration, I was able to starve the cancer cells of their preferred fuel, while putting my body further into ketosis, thus supplying my healthy cells with adequate fuel. My healthy cells down-regulated their metabolism in response to the fasting, going into “stealth mode” and escaping notice by the chemo drugs (essentially poisons aimed at fast-metabolizing cells). This turned out to be powerfully protective in preventing most side effects. I had no nausea, emesis (vomiting0, gastrointestinal damage, nerve damage, tingling or neuropathy, no joint or muscle pains. I did experience hair loss and bone marrow suppression, the 2nd week effects of the chemo, but these were moderate, not requiring any additional medication. Overall, I sailed through chemo with a few “low energy” days, but mostly it was life as normal, just with no hair. This was decidedly NOT the expected course for this type of chemo.

A friend said to me when I was starting down the cancer path that it appeared that everything in my life to this point (becoming a low carb dietitian, the PHC certification, and my passion for researching health) had prepared me for this day – that I would be the “Keto Cancer Dietitian.” The idea stuck, and a passion for sharing what I had learned about how powerful nutrition can be in the cancer journey was born.

As I went through chemo, I started blogging about my experiences and my journey so that others could read my story and gain hope and understand the power that we each have to impact on our own health, even in the face of daunting obstacles like a cancer diagnosis. I write about my experiences at my website, Powerful Beyond Measure, at www.marthatettenborn.com.

I feel very blessed for so many reasons. Firstly, that I had found the low carb Primal way of eating and had a solid basis of good health prior to starting this cancer journey. Secondly, that I had the knowledge and skills to research the metabolic nature of cancer and implement specific nutritional interventions (namely ketogenic diet and therapeutic fasting) for impacting on the chemotherapy experience. And thirdly, that I am now able to share that knowledge with others so that we can change the cancer and cancer treatment experience for the better. I was not a helpless “victim” of cancer and I was not fighting a war against my cancer. I was an empowered and effective partner in my own healthcare, positively impacting my response to conventional treatment.

That’s what I wish to share with others.

Mark has been so generous to share his knowledge with the goal of changing lives and that’s what I hope to do as well, from the perspective of a Registered Dietitian, a Primal Health Coach, a lifelong “healthy eater” and a cancer survivor thriver. I’m just at the beginning of that journey.

Martha Tettenborn, RD
Owen Sound, Ontario, Canada

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why am I getting low ketone readingsEven after publishing several books and hundreds of  articles that draw upon the science of ketosis and low-carb living, I keep researching, thinking, revisiting, and discussing the underpinnings of ketosis. My writing partner, Brad Kearns, and I maintain a running dialogue on all things keto. The latest conversation revolved around two very common questions or “problems” that keep coming up in the ketogenic community: why am I getting low ketone readings?

It’s a fair question. Why do some people on a keto diet register high ketones while others eating the same way register low numbers?

I won’t offer definitive answers fit to etch into stone. I will offer my exploration of the research, some educated speculation, and actionable advice you can ruminate on. And by all means get back to me with your take on the questions and my explorations, please. Dialogue is essential to understanding.

What Level of Ketones Indicates Ketosis?

The generally accepted range that indicates ketosis is 0.5-3 mmol/L. I hesitate to define a prescriptive range, though, because so many factors affect readings – what you ate for your most recent meal, how long ago you exercised, and even the instrument you used to test can affect readings.

Why do some people on ketogenic diets produce low ketone readings when they test?

There are several potential explanations for low ketone readings. Some are hypotheses, some are based on your individual biology. A few possible explanations for low ketone readings include:

  • You have developed fat-burning efficiency
  • Keto-adapted people may be able to burn free fatty acids
  • Genetic predisposition to low ketones
  • Recent exercise
  • Total caloric intake
  • Use of exogenous ketones

Let’s dig deeper.

You have developed fat-burning efficiency

One theory is that some keto-adapted people are so efficient at producing and burning ketones that they don’t leave any extra to spill into the urine and breath. They make only as many as they can use and their cells gobble up almost every ketone they produce. Under this argument, low ketone numbers on a ketogenic diet are a reliable sign of full ketone adaptation.

This sounds plausible, but I haven’t seen any empirical evidence that it’s the case.

Keto-adapted People May Be Able to Burn Free Fatty Acids in the Bloodstream

Another theory is that the keto-adapted have built so much fat-burning metabolic machinery in their muscles that they can burn free fatty acids directly and don’t require much additional fuel from ketones. They make enough ketones to fuel the brain, since our brain can’t run on fatty acids directly, but your muscles no longer require as many. Many people who have been in long term ketosis can get by quite nicely on 20-30 net grams of carbs a day and might only show .4 or .7 millimolar ketones on a blood test, but they have plenty of energy from burning free fatty acids and maintain muscle mass on relatively fewer calories than when they were dependent on carbs.

The evidence is inconclusive, but a few indications point to increased ability to extract energy directly from fat as a possibility.

Keto pioneers Stephen Phinney and Jeff Volek found that keto dieters blew higher readings early on in the diet when they were still burning ketones in the muscle. As they grew adapted to free fatty acids as a source of fuel and produced ketones primarily for the brain, ketone levels dropped. It was totally normal. If anything, they were more fat- and keto-adapted at lower ketone readings.

Consider the energy requirements of the brain. Whether it’s running on glucose (most of the population) or mostly on ketones, the brain is a steady state organ that never spikes energy demand. It’s a slow-burn 24/7 at nearly the same output whether you are sleeping, exercising hard, or concentrating hard. While the brain has a substantial caloric requirement (at roughly 2% of our body weight, it uses 20% of our resting metabolic rate), you don’t need a ton of glucose or ketones at any one time to power your brain gracefully all day long. That’s why people can “get away” with lower ketone production and still reap the benefits we expect from eating this way.

Genetic Predisposition to Low Ketones

There’s almost certainly a genetic component to ketone production, too. Take the Inuit, who were rarely in ketosis despite traditionally eating a very low-carb diet.1 It takes several days of deep fasting for them to produce measurable ketones. Yet, they are adept at burning free fatty acids, almost as if they “skip” keto-adaptation and proceed directly to burning fat. Other variants that affect ketone production have yet to be discovered, but they’re out there.

Recent Exercise or Otherwise Increased Energy Demand

If you test your ketones before and after you exercise, you may be surprised to find that your numbers are quite different after you’ve worked out. Remember, ketones are an energy source, not a stamp of accomplishment. Ketones are consumed when there is an energy demand in your body. It doesn’t mean you messed up your diet. Quite the opposite  – it simply means your body used the energy source available at the time. Once ketone bodies are in low supply, your body will burn fat to make more, and that’s a win.

Why do Some People on Long-term Keto Diets Still Get High Ketone Readings?

A few of the previous theories assume that you develop an increased ability to burn fat after you have been in ketosis for a while. But there are people who, after being in ketosis for a long period of time, still get high ketone readings when they test. What gives?

Total caloric intake is a factor in ketone levels

A major factor not often mentioned in whether someone on a keto diet registers high or low ketones is overall calorie intake. How much food are you eating?

Ketones are generated when the amount of dietary fat available to be burned exceeds the supply of oxaloacetate (provided by protein or carbohydrates). It’s not that the body thinks, “This woman needs some ketones, stat.” It’s more like, “I’ve got too much acetyl-COA from all this fat, and I can’t find any oxaloacetate. Time to ask for ketones!”  If you’re the type to use keto to justify chugging olive oil, you’ll generate lots of ketones simply because your fat intake is outpacing the supply of oxaloacetate. Keto athletes eating tons of calories will probably produce more ketones simply because they’re eating so much fat.

If you’ve attained “caloric efficiency” and are eating fewer calories overall, you’ll generate fewer ketones but still experience all of the benefits of being in ketosis.

Use of exogenous ketones result in high ketone readings

Another factor is the use of exogenous ketones. Realistically, you could take your ketone readings, then take keto salts or keto esters, then take your readings again and see a bump. That is what they’re for.

Don’t Get Caught Up in the Numbers

Above all else, focus on how you feel.

  • Can you go without a meal and maintain steady, even energy and concentration?
  • Are you losing body fat, or are you happy with your body composition?
  • Are you thinking more clearly?
  • Has the keto flu come and gone?
  • Are aerobic activities easier than ever?

If you’re experiencing the benefits of ketosis, there’s no need to fret over some numbers on a device. The numbers can’t negate your real world experience.

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how to get back into ketosisA little planning and motivation will help you start a low-carb, keto, or Primal lifestyle, and under normal circumstances, keeping your carbs on the low side is easy. But let’s not create the illusion that it is easy all the time. From time to time, you may get stressed and eat mindlessly. Or, your aunt drops off her blue-ribbon cake that you’ve loved since you were in preschool, and you give in, just this once. Or, you had a jam-packed day and all you can muster to make for dinner is that package of gluten-free noodles in the back of your pantry. The next thing you know, you’ve eaten enough carbs for a week, and you wonder how you’ll get back into ketosis after a carb binge.

The short answer is, yes you will recover from a carb binge. Yes, you will get back into ketosis. As far as how long it will take to get back into ketosis – that depends on numerous factors, that we’ll dive into here. The important thing to remember is, you did not obliterate your goals with one misstep. Especially after you’ve spent some amount of time in ketosis, your body will allow for fluctuations in carb consumption here and there. That’s called metabolic flexibility, which we’ll go into shortly.


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Can You Have a Cheat Day on Keto or a Primal Diet?

Admittedly, I’m not a fan of calling them “cheat days,” for a few reasons:

  • “Cheating” implies that you did something wrong and should feel guilty about it.
  • Earmarking “cheat days” sends the message that you can eat whatever you want that day with abandon. You’d be surprised how much you can backpedal on your goals in a 24-hour period.

I prefer to frame higher carb meals or snacks as carb cycling or carb refeeding, which is an intentional higher carb meal to enhance your results; or, frame them as treats, which are planned. That way, the extra carbs are enjoyable, planned in advance, and come with limitations so you don’t go overboard. And, there’s no guilt involved.

So, can you have high-carb days on keto? If you are in ketosis and have a sudden surge in sugar or carbs, your body will burn glucose instead of producing ketones. In order to get back into ketosis, you have to use up the glucose you just consumed, and the glycogen your body just stored.

The concern is whether the transition back into ketosis will be as difficult as you remember from those first days cutting carbs. If you have been in and out of ketosis for a while, you may slip back into ketosis fairly easily because you’ve developed metabolic flexibility. If you’re just starting, you may go through some of the discomfort of transitioning between fueling with sugar vs. fueling with ketones. Your body “remembers” though, and most likely, it will not last as long or be as severe. This article contains some things you can do if you experience “low-carb flu.”

What Happens to Your Body After a Carb Binge?

So, you decided to give in. First, don’t beat yourself up. It happens. What does your metabolism do with the surge of insulin and carbs? Even a few quick forkfuls can shift you from small doses of quality carbs wisely spread throughout the day to possibly 100 or more grams of pure sugar in one sitting. It’s likely you’ll experience some effects, but you can get past it.

First off, the good news. There’s no carb police coming to take away your keto card. Nor is there any other permanent fate awaiting you. You’ll go about your day a live, generally functional human being. There is no truly long-term risk elevation for that matter. Nonetheless, you’ll likely experience a fair amount of regret for cheating on keto.

  1. Your Pancreas Kicks Into Overdrive. Within a few minutes, your pancreas starts pumping out a flood of insulin to try to sop up all the excess glucose that’s suddenly rushing through your bloodstream. Remember, while glucose is muscle fuel when it’s in the muscles, it’s toxic sludge when it stays in your bloodstream. Your body knows that and does everything it can to get it out of there. Perhaps you’re feeling flushed, a little high, spastic, anxious, or nauseous depending on how much you ate, how big you are, what your normal carb load is, and how acutely you tend to “feel” the effects of sugar and other substances. Ironically, if you were insulin resistant, you might not even notice these sensations.
  2. Excess glucose converts into body fat. The gush of insulin now creates a see-saw effect. If your glycogen stores have room, some of the sugar goes into muscles. If there’s no more room, the excess goes into fat cells, where it is stored as fat. In reaction to this quasi-emergency that your brain perceives as a life-threatening stress, the body steps up its efforts to achieve homeostasis by releasing both epinephrine (adrenaline) and cortisol from your adrenals. Your heart starts racing, and you’re starting to feel uncomfortable, maybe even sweating. And we’re still likely within the first hour after you finished off that cake!
  3. Sugar crash. After a bit more time passes, burnout settles in? That’s called a sugar crash – when all the glucose is gone from the bloodstream and you start to feel sluggish, off-kilter, like the internal circuits are all fried after sparking in a heap of now smoldering wires.
  4. Your immune system slows down. The havoc that sugar rush set off – the swing of glucose and insulin, the cortisol and adrenaline – they’ve sent your immune system into a tailspin. Researchhttp://jcem.endojournals.org/cgi/content/abstract/85/8/2970?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=85&firstpage=2970&resourcetype=HWCIT‘>2 on the body. Your blood even thickens as a response to the stressors. A hefty dose of sugar can compromise the immune system

carb cycling carb refeeds for women

One of the more common questions we get in the Keto Reset Facebook community is, “How do I break through a weight-loss plateau?”

Stalls are frustrating. You’re cruising along on your Primal or Primal + keto diet, and then wham—you hit a wall. It’s all a totally normal and expected part of the weight loss process. Weight loss is never linear. There are always downs, ups, and flat spots.

In fact, if you’ve been losing weight for a while, and then you stall out for a week or two, I wouldn’t even consider that a plateau necessarily. Your body might keep losing weight on its own if you give it time and don’t stress about it. Still, I get it, you’re eager to kick-start the weight loss again.

One strategy that gets tossed around is trying a carb refeed or “carb up.” Carb refeeds are touted as plateau busters and also, more generally, as a strategy to support weight loss. In today’s post, I’ll explain the logic behind this idea and explain why it might be effective, especially for women following a generally low-carb approach.

 

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What Is a Carb Refeed?

Let’s get some terminology out of the way. Strategically adding carbs to a low-carb diet is variously called a “carb refeed,” “carb up,” or “carb cycle.” These terms don’t have standardized definitions. In general, carb cycling usually refers to eating low carb for a certain number of days, then higher carb for a certain number of days, and repeating.

“Carb refeed” and “carb up” can mean the same thing, or they can mean adding carbs more intuitively when you feel like you need them.

Carb cycling strategies have long been used to promote leanness, especially by physique and other athletes trying to achieve low body fat percentages. In this context, carb cycling involves specific protocols, usually 5-6 days of very low carb eating combined with 1-2 days of higher carb eating. They may include exercise and fasting regimens, too.

The carb cycling protocols used for getting super lean aren’t the same as what we’ll be talking about for general weight loss and breaking out of a stall. For one thing, they usually involve more carbs than you probably need. We’ll get to that later. Also, although some of the mechanisms are probably the same, they focus specifically on depleting and refilling glycogen stores. For our purposes, that’s not so important.

How Do Carb Refeeds Work?

First let me say that the evidence for carb cycling strategies, especially with regard to weight loss and plateaus, is mostly anecdotal. There is pretty good data to support the pieces, but the whole picture has not been rigorously tested.

So what do we think is happening? There are a few (not mutually exclusive) hypotheses here:

  • Carb refeeds work by boosting leptin
  • Carb refeeds work by relieving the stress of dieting
  • Dieting is hard, and carb refeeds help us stick to them

Carb Refeeds Work by Boosting Leptin

Leptin is sometimes called the “satiation hormone,” but it’s probably more accurate to think of it as a starvation sensor.1 Its main role is to tell the brain whether we have sufficient energy on board, either in fat cells, which secrete leptin, or because we have recently eaten (especially carbs).

It’s well established that leptin levels drop both when we lose body fat and when we eat in a caloric deficit2 for even a short period. Remember, from an evolutionary perspective, weight loss signals that we are in a time of food insecurity and stress. Low leptin signals to the hypothalamus that we might be facing an energy shortage. In turn, the hypothalamus kicks on the processes collectively known as adaptive thermogenesis,3 or energy conservation. These include down-regulating thyroid activity and slowing metabolic rate, decreasing energy expenditure, and increasing hunger and appetite.

Premenopausal women’s bodies are especially sensitive to anything that sets off the “Danger! Starvation possible!” alarms. (Postmenopausal women are generally more resilient.) Leptin is a key player in that system. It is also involved in the regulation of insulin sensitivity and glucose metabolism, the female reproductive and immune systems, and skeletal and cardiovascular health. Basically, leptin is really important if we want to feel good and achieve optimal hormonal balance.

Leptin levels rise in response to eating carbohydrates specifically.4 Thus, one rationale behind carb refeeds is that by boosting leptin, we can reset the system. Basically, it tells the brain, “Hey, it’s cool, we have food around. It’s safe to let go of some of this body fat.”

Carb Refeeds Work by Relieving the Stress of Dieting

A related hypothesis is that dieting is physiologically stressful on the body. After periods of energy restriction, we see a decrease in thyroid hormones and an increase in cortisol (which may be related to falling leptin). These are part of the adaptive response that aims to restore energy balance. Carb refeeds alleviate the stress of being in a constant state of energy restriction.

Dieting Is Hard, and Carb Refeeds Help Us Stick to Them

One of the main reasons dieting hard is because of hormonal changes (ahem, leptin5) that increase hunger and appetite. Besides feeling unpleasant, this leads many dieters to eat more than they realize, undermining fat loss. Multiple studies also suggest that low leptin levels increase reward-seeking behavior. Basically, food becomes more appealing and harder to resist.

Low leptin is also related to depression6, anxiety, and perceived stress, all of which can make it harder to stick to your diet goals.

For all these reasons, periodically boosting your leptin via carb refeeds should make dieting feel less challenging. Beyond that, there’s also the psychological factor of knowing that you don’t have to strictly adhere to a diet indefinitely. Although it might seem counterintuitive, research confirms 78that giving yourself planned breaks can help relive the doldrums of dieting and actually increase your adherence in the long term.

Who Should and Should Not Consider Incorporating Carb Refeeds

There’s no evidence that carb refeeds are necessary or optimal if weight loss is your goal. Like so many things, this is going to be an n=1 situation. They might help, hurt, or be neutral depending on the individual.

First and foremost, if it ain’t broke, don’t fix it. If your current diet is working just fine, you feel great, and you’re losing weight, you don’t need carb refeeds. (By the way, if you’re impatient because you’re losing slowly, I haven’t seen any evidence that they will speed up weight loss.)

Likewise, they generally aren’t recommended for people who still carry a significant amount of body fat. There’s no real guidance as to what constitutes “significant amount,” unfortunately. As a rule, though, leaner individuals are more likely to benefit from the hit of leptin because they have less adipose tissue to produce it on a day-to-day basis.

DO: Reasons to experiment with carb refeeds include:

  • You’re experiencing a weight loss plateau. This means several weeks of no change in weight or body measurements despite nothing else changing. This isn’t a guaranteed strategy, of course. There are lots of reasons weight loss can stall, not all of them related to leptin or diet adherence. It’s certainly worth a try, though.
  • You’ve been low-carb and/or calorie restricted for a while, and you’re experiencing other signs of hormone dysregulation. These include menstrual irregularity and sleep9 disruptions, among others. Depending on how severe your symptoms, you might need more than the occasional carb refeed. For mild symptoms, an occasional refeed might help.
  • You’re sick of dieting. Mixing it up with carb refeeds (which are not the same as “cheat days”) can relieve the dieting fatigue.

DON’T: Other instances when carb refeeds are not advised are:

  • For people who are using low-carb or keto therapeutically, such as for epilepsy or Parkinson’s, unless advised by their health care practitioners.
  • For people who are extremely insulin resistant.

How to Implement Carb Refeeds

No matter what strategy you use, you want to refeed with nutrient-dense, Primal-aligned foods. We’re talking sweet potatoes, potatoes, beets, baked goods made with almond or coconut flour if you want, in-season fruit, quinoa, maybe legumes if they work for you. If you want to eat some rice (sushi!), no judgement here.

Primal carb refeeds aren’t just an excuse to “cheat” (a term that I hate). You’ll see carb cycling protocols that allow, even advocate, eating copious amounts of junk food (another term I don’t love) on refeed days. Since our goal here is metabolic health and hormone balance, stick to the same Primal foods that support those goals, just with more carbs.

How Many Carbs Should I Add?

If you look at the literature on carb cycling, you’ll find various opinions. Depending on who you ask, it can be upwards of 300+ grams per day. Again, though, these come mostly from protocols aimed at physique and other athletes, and these high carb recommendations are for men who are already quite lean. It’s not clear how they apply to the average woman looking to kickstart their weight loss.

As usual, it’s also hard to find research on people who follow a low-carb Primal or paleo approach. In this oft-cited study,10 for example, the control diet was a mainly liquid diet supplemented with orange juice, yogurt, and cream that came in at an average of 224 grams of carbs per day. In the carb overfeeding condition, which was shown to boost leptin, the average daily carb intake was 394 grams—way more than the average Primal eater probably consumes.

In the absence of solid research-based recommendations, you’ll have to experiment. A good place to start is bumping up to twice your normal daily intake by adding nutrient-dense carbs to one or two of your meals, and increasing as necessary. If you want to be scientific about it, log your food and also keep track of metrics like weight, sleep, and energy. Play around with the frequency of carb-ups, as well as the amount of carb you add, and see what works best.

Should You Increase Carbs, Calories, or Both?

Technically, carb refeeds don’t have to involve more calories. Some protocols state that you should reduce fat on carb-up days so that your total caloric intake stays the same. Others specifically recommend adding carbs and increasing calories by a fixed amount.

Unfortunately, we don’t have enough studies to break down the separate effects of carbs and calories here. In theory, both should signal to the body that energy is available, but carb intake uniquely boosts leptin. Once again, experiment to see what works for you. To start, I’d recommend allowing your calories to increase on refeed days. You might dial back your fat a little, but I wouldn’t overthink it, especially if you’re already low-carb or keto. Adding 50 or 75 grams of carbs is 200 to 300 calories. That might be less than your typical caloric deficit. Even if you add more, it’s unlikely to negatively effect weight loss if we’re talking occasional refeeds.

I know that many dieters are afraid to increase their calories for fear of “undoing” their progress. That fear seems to be unfounded. Multiple studies confirm that intermittent dieting—mixing periods of caloric restriction with eating around your maintenance calories—is no worse11 for losing weight than continuous calorie restriction. It may even be advantageous12 for weight loss, and fat loss specifically.

How Often Should I Refeed?

In terms of how often to refeed, you have some options:

  • Add in carbs whenever you plateau
  • Carb cycling on a schedule
  • Carb cycling around your menstrual cycle
  • Eating carbs intuitively

Add in Carbs Whenever You Plateau

If you’re actively trying to lose weight, one option is to wait until you hit a plateau—at least a couple weeks when the scale stops moving—then add a day or two of higher-carb Primal meals to see if that moves the needle.

Carb Cycling on a Schedule

As I said up top, some carb cycling strategies involve fixed periods of lower- and higher-carb eating. Often this looks like eating low-carb during the week and then doing one or two higher-carb days on the weekend. This is more convenience than science though. There’s no reason you can’t do 9/1 or 12/2 or any other pattern that works for you. You don’t even need to take a whole day. Some people just do one high-carb meal per week and feel great.

Obviously this strategy is more of a lifestyle than an acute tool for breaking through a weight-loss plateau. This is for people who don’t do well with continuous dieting or who find it easier to stick to their goals when they have planned deviations. It is akin to the idea of a cyclical ketogenic diet, although you don’t have to be keto to use carb cycling.

Carb Cycling Around Your Menstrual Cycle

Another carb cycling strategy is timing carbs strategically around your menstrual cycle.

This strategy isn’t specifically geared at weight loss but rather supporting the whole hormonal system, but it potentially allows you to kill two birds with one stone. There are different approaches here, but a common one is increasing carbs 4 to 5 days post-ovulation (around days 19 and 20 of your cycle) and on the first couple days of your period. These are times when your leptin levels naturally dip, so you could possibly benefit from the boost. Some women prefer instead to add carbs around ovulation, days 13 to 15. Again, see what works be for you.

Eating Carbs Intuitively

Finally, you can wait until your body starts calling out for carbs and respond appropriately. In my opinion, intuitive eating is one of the goals of a Primal diet and lifestyle. When we improve hormone balance and tap into how good it feels to nourish ourselves with nutrient-dense foods, we should be able to trust when our inner voice says, “Hey, I could use some starchy vegetables here!”

Eating carbs intuitively isn’t the same responding to sugar cravings or eating something off plan just because it “sounds good.” I think we can all recognize the difference between listening to our bodies and eating purely for pleasure. (You’re more than welcome to do that too, but it’s not what we’re talking about here.)

Intuitive carb refeeds are probably going to work best for people who have been on the Primal train for a while and who generally feel pretty in tune with their bodies. Women who are dealing with chronic health issues or hormone imbalances might need something more structured.

Note that this is a different question than carb timing, which Mark covered recently. Carb timing is about when to eat your carbs during the day.

Don’t Be Afraid to Experiment

I’m a big fan of experimenting with your diet. There is so much bioindividuality, it’s impossible to find a one-size-fits-all approach. The best strategy for you is the one that hits that sweet spot where you to feel your best and also enjoy how you eat.

Moreover, I’m going to go out on a limb and say if you’ve been low-carb for so long that you’re afraid to consider eating even nutrient-dense, Primal-aligned carb-y foods like sweet potatoes, you should challenge yourself to try a carb refeed and see what happens. I’m not talking about people who know they feel better eating very-low-carb and simply don’t have the desire to switch it up. I’m talking about people who have a mental block around the very idea of carbs. We don’t want people to get “stuck” in a low-carb paradigm to the point where they feel unable to enjoy otherwise nutritious foods just because they have more carbs than, say, broccoli.

Finally, although their are good reasons to try carb refeeds if your current low-carb diet isn’t working the way you want, it’s only one of many things you might try. In particular, if you haven’t also gotten your sleep and stress in order, make those priorities as well. Carb refeeds can only do so much if you don’t have a solid foundation of healthy habits in place.

Tell us: Have you had success implementing a carb cycling approach? What works for you? What are your favorite foods to use to increase carb intake?

Related posts from Mark’s Daily Apple

Does Carb Cycling Work? It Depends.

Dear Mark: Should I Increase Carb Intake for Weight Loss?

Carb Refeeding and Weight Loss

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