Why You Need To Stop Worrying About The Color Of Your Ketostix

Book cover for The Art And Science of Low Carbohydrate LivingYeah, I know you like to use them, but there are so many misconceptions about what they are telling you, that I need to intervene and make sure you get it.

But before I go there, let me urge you to just buy The Art and Science of Low Carbohydrate Living, and read pages 164-165.  Phinney and Volek have the best description of this that has probably ever been written, and you should really just read it from them. If I could copy these pages verbatim and paste it here, I would.  Seriously, it’s only a few bucks and it’s quite literally the book you want to own if you’re interested in low carb ketogenic diets.

OK, while you wait for your book to arrive, let’s dig in…

What ketostix measure

Photograph of someone using ketostix
A color scale for acetoacetate ketone concentration

First off, we need to understand what ketostix actually measure, and more importantly, what they don’t.  Generally speaking, ketostix measure excess ketones in your urine.  They are considered excess, because they are removed from your serum and shunted to your urine by your kidneys. Their caloric content is thereby wasted.

Of the three types of ketones (acetate, acetoacetate, and beta-hydroxybutyrate) produced by your body, ketostix only measure acetoacetate.  This is extremely important to understand, because it turns out that your body produces different quantities of these different types of ketones depending on how long you’ve been in ketosis.  If you’ve been in ketosis for a while, you’re going to see a reduction in the “intensity” of what you register on your ketostix for two reasons:

  1. A change in the relative volume of the ketones produced/present in your body
  2. A reduction in the volume of ketones in your urine as your kidneys reduce the amount they secrete

Both of these are covered below.

Changes in the types of ketones you produce

When you first start your ketogenic diet and you are not yet fully ketoadapted, your kidneys actively excrete two types of ketones into your urine: beta-hydroxybutyrate (not technically a ketone, but it is generally referred to as one in the literature) and acetoacetate.  These ketones are created in the liver in a roughly equal ratio (Note: Technically, acetoacetate is created by the mitochondria of liver cells, and from this beta-hydroxybutyrate is created and acetate is produced as a side product. (source)).

When you start restricting carbs, Phinney and Volek assert that at first your muscles use both beta-hydroxybutyrate and acetoacetate for fuel, but after awhile, they begin taking the acetoacetate and converting it to beta-hydroxybutyrate, and returning that to your serum. As mentioned before, beta-hydroxybutryrate is not technically a ketone.  It is more of a “ketone reserve. When plasma acetoacetate concentrations begin to decrease, more of it is produced from beta-hydroxybutyrate” (source).

As a result of the continued conversion of acetoacetate to beta-hydroxybutyrate, the serum and urine volume of acetoacetate (the only ketone detected by ketostix) is significantly reduced. Your takeaway point is this: If you stay on your keto diet for long enough, the primary ketone circulating in your serum (and consequentially, present in your urine) is not detected by your ketostix.

Reduction in kidney excretion of ketones

Besides the change in relative volumes of serum ketone types, as you become keto-adapted your kidneys naturally down-regulate the volume of ketones they excrete into your urine.  So even if you still had high-serum acetoacetate (which can be detected by ketostix), you’d still be seeing lighter colors on your ketostix because your kidneys are simply not excreting as much of them into your urine as they were previously.

The precise reason for this downregulation is not described by Phinney and Volek, but they speculate it is to prevent wasting the minimal amount of calories contained in urine ketones. Ultimately suggest that it is the result of kidney adaptation to sustained carbohydrate restriction (164-5) and leave it at that.

Even though we lack the sophisticated understanding of why kidneys downregulate ketone secretion into urine, we know that it happens and we know that the volume of acetoacetate in your serum drops as you become more fully ketoadapted.

So quite literally, after a few weeks into your low carb ketogenic diet, you’ll likely start seeing a change in your ketone levels as measured by ketostix.  This is completely normal and does not mean you are having trouble with your diet.  It doesn’t even suggest that you aren’t in ketosis anymore, because it can’t.  Ketosticks are unable to measure the type of ketone that constitutes the majority present in your blood and urine at this point.

This doesn’t mean you have no way to monitor your ketosis: If you really want to know something important about ketones, you’d measure your serum beta-hydroxybutyrate levels.  This is possible by using a portable device like the Abbot Laboratories Precision Xtra Glucose and Ketone Monitoring System. If you go this route, you’ll also have to buy their very expensive and proprietary Precision Xtra Ketone Test Strips to use with it. And when I say expensive, I’m serious. You’re looking at ~$5.00 each time you test.

So you can spend the money and keep an eye on your ketone levels by measuring serum levels, or you could just not spend money on ketostix and expensive testing gizmos.  As long as you eat 20g of carbs a day (or less), you are pretty much guaranteed to stay in ketosis.

Resources

 

70 Responses to “Why You Need To Stop Worrying About The Color Of Your Ketostix”

  1. Measuring ketones becomes an obsession and I’ve stopped doing it. Most important is eating clean and seeing how my clothes fit, how I feel and if I’m losing weight. At my age and weight that’s all that matters.

    Reply
    • I think I stopped measuring daily at about the 12 month mark, and during the last eight months or so of that, I was being told they were registering light because I was well hydrated.

      If you’re going to use them, might as well understand what they tell you.

      Reply
  2. I have been keto long enough and I train hard, I can pretty much tell when I am getting carb creep. Performance suffers quite obviously…

    This blood ketone testing is obviously ideal but out of my price range.

    I can “feel” when I am doing it right, I just go by that now mostly.

    Regards

    Reply
    • Yeah. I think for most people, testing is not necessary. Still, I know new people get reassurance from it, so I figured it would be best to help them understand what they are actually measuring, and how they can expect those measurements to change over time.

      -Michael

      Reply
  3. I like using them. Regardless of what you say, I think they do matter. If I started eating lots of carbs, I doubt they’d be showing much of anything. I would use the blood measuring ketone device, but as you point out, it’s very expensive – especially the strips – so forget that. I just wonder when the ketosis sticks will lighten up, particularly if one has a significant amount of weight to lose. I’ve been doing the ketogenic diet for over a year, & the sticks still show a varying degree of color, from light pink to almost purple. I’m sure many factors affect the color of the sticks, but I Do like to use them. They keep me on track. I feel like I am doing something. I also do not eat as low as 20 carbs a day. Or I might, perhaps. I don’t measure any of that. I just try my best to eat the foods that a ketosis diet recommends. The Phinney book is way confusing for someone like me. I’m no scientist nor am I trying to be. My diet is not perfect. It’s too much information, even, to take in. So, do things my own way. That’s actually working for me – I AM seeing results, both in weight loss & more energy. Before you are too quick to lecture people to dispense w/the sticks, consider that they can be very helpful, as the color can be very satisfying. Seeing that pink to light purple helps me. It may not be measuring much, but it’s measuring Something. If I ate a regular, high carb diet, the sticks would not turn any color, would they? I just need to know at what point they stop turning a color because of all you write of – and not because of any excessive carb eating on my part. Is it when one approaches a goal weight? After over a year, my sticks still turn colors. I’m happy about that. We are all not Jimmy Moore. We all can’t afford to buy the latest gadgets to measure our ketones. The sticks are extremely inexpensive, another reason I like them. I think your points are valid, too. It’s not either/or for me. I like the sticks & I appreciate your points. This all can be very stressful too. There is So Much info on this diet & ones like it. After a while I just don’t want to get side-tracked w/too much info. Some helps, but at some point I need to back away from all the opinions, views & info on this diet. The best thing I can do is see how the diet affects ME. And so far, it’s working rather nicely. Thanks for reading all this.

    Reply
    • Wow! Thanks for your awesome comment, Zell!

      First off, congratulations on finding a way of eating that is working for you, and helping you attain your desired weight. I think that at the end of the day, that’s the most important thing each of us has to accomplish.

      Second off, if ketostix help you, by all means, keep using them. I used them for a year while eating a diet strictly limited to 20g/carbs a day (or less). While eating at that level pretty much guarantees I’ll stay in ketosis (with some exceptions), they absolutely did help me stay on track. I was measuring 2x day (once in the morning, once in the evening) and it really was a fundamental part of my routine as I transitioned from the Standard American Diet (SAD) to a more healthy way of eating.

      It is not my intent to discourage people from using the ketostix (see Do I Need Ketostix?), but rather to help them understand what they are measuring, what they are not measuring, and how those measurements might change over time. This is something that I didn’t know for a long time, and most of the explanations I got were just plain wrong. While it’s nice to know that ketostix measure acetoacetate (and not acetone or beta-hydroxybutyrate), the important thing for me was to understand that even if I’m doing everything right on my diet, I can still measure very light colors on my ketostix and there are other reasons for this besides “hydration”. I see a lot of people stressing over light colors, and maybe this post will help them understand that they shouldn’t worry over it unless they suspect they are not eating properly.

      And yes, you are correct…if you ate a significant amount of carbohydrate (and continued to do so, your sticks would stop registering ketones (or register trace amounts). And this is kind of at the heart of the post: you can register low levels of ketones on ketostix for two diametrically opposed reasons: you are doing your diet well and have been doing so for a significant amount of time, OR you are doing your diet wrong by eating the wrong foods/cheating and throwing yourself out of ketosis. There is no way to tell what’s actually going on with ketostix.

      While I notice that after a 1.5 years on low carb, my sticks are mostly very light pink (and I assume this is for the reasons described above), I do know that if I ingest MCT oils (in coconut oil, typically) they will turn dark, regardless.

      And for the record, I don’t measure my blood ketones either. While I’d love to be able to record such data, I just can’t justify the budget required for doing so at this point. If this ever changes, I’m sure I’ll write about it.

      Thanks again for your post. I tried to answer your questions, but if I raised more or missed something, please let me know and I’ll respond.

      -Michael

      Reply
  4. Michael,

    Thanks! I think it speaks Volumes about you & your fine blog, that you answered my post in such a Considerate & Helpful manner! (I was afraid that my saying I actually like to use the sticks might be seen as 1. stupid or 2. confrontational – or Both). One thing I’ve noticed is that there are people can get Very Intense about diet issues! You don’t seem to be this way. You’ve answered my questions & I really appreciate this! I think it’s very interesting that eating coconut oil might make the sticks darker. I really Love coconut oil – organic & unrefined. I think I will bump up my consumption of it, as a Ketogenic diet is higher in fat than protein. That’s one thing I’ve learned. (I started out, over a year ago, doing Atkins Induction, but now I’m trying to find high fat foods mainly, such as avocados. Most high fat foods that are acceptable on this diet do also seem to be moderate to high protein). Well, one thing I noticed w/the sticks is that they’ve consistently turned a color for me, from light pink to mid-purple, since I’ve been using them) – except for ONE TIME – last week, in fact. I went out to eat at a special dinner & I ordered the prime rib, but it seemed to be covered in a very sweet sauce (this dinner had been pre-ordered, so I wasn’t able to make a request for no sugar in the sauce). The meat also had some fruit – figs I think – on top it, & I ate one by mistake. The rest of the meal, I was really careful: nothing to drink but water & coffee (w/cream) & no dessert or bread, naturally! Still, the next day – Nothing on the sticks – no color, not even Trace! This NEVER happened to me that NOTHIG would register on the sticks. I did panic, I have to admit. I thought to myself: just that one little slip – sauce w/some sugar & a fig – and that’s enough to throw me out of ketosis? I mean, I’ve ordered ribs from Chinese restaurants, w/o the sauce, but I know even the ribs have Some sugar in them. (I don’t do this a Lot, though). However, the day after my steak meal, the stick registered very dark (I only do the sticks once a day). So, I don’t know – maybe for that one time, recently, where the stick showed nothing, the sauce on that steak might have been much sweeter than I realized. Also – how do you think coffee affects people? I’ve had a tough time of it, switching to decaf, but I did it – but now caf is creeping back in (1/2 caf/1/2 decaf coffee) which I have w/Heavy cream, only. Yet Gary Taubes, who was nice enough to respond to an email of mine, told me that the heavy cream might be problematical for me, which confused me, as Heavy Cream is mostly fat, no? I also stopped all diet soda – but alas, sometimes, I will have a bit of diet soda. Michael, I’m not doing this diet Perfectly. I try to stick to ONLY ketogenic food & I think I’m pretty good to Extremely good at that – but for instance, sometimes I will eat hot dogs or other un-organic meat, due to my budget & my energy level, (as I just want to nuke something, not actually cook). After over a year, my energy, while improved, is still low. I really Like this way of eating, though. I think for me, this is not going to be as easy as it is for others, but I also have to realize that my health has been very compromised to begin with, so I’m sticking w/this diet. Love your blog! Sincerely,
    Zell

    Reply
    • Wow! Zell, you’re making me blush with your compliments. Thanks for sharing such kind words.

      Unfortunately, I can understand the apprehension you expressed that you might be called “stupid” or “confrontational” by questioning something. This is an issue I see a lot of places, and it rather infuriates me. I’m acutely aware of how much I don’t know, and always try to frame my opinions in terms of the science that I have available to me…with the painful realization that I’ve not read everything, nor am I an expert in this domain. Also, science can change: what we think we know today might be changed completely tomorrow. So if you see me being a sanctimonious jerk about anything I say, please call me on it. There’s not a lot of it in the low-carb community, but even a little is far too much.

      Now, moving on…

      From your comment, it sounds like you got the shaft with that steak. That’s unfortunate, but we’ve all been there at one point or another. There’s even a rumor out there that Chili’s coats their steaks in starch before grilling. Apparently it helps it get that appetizing brown/seared look. In your case, it sounds as if the sauce/glaze/and adjunctive fruit were enough to kick you out of ketosis…or were they?

      Here’s where it gets interesting (and understand, all of what follows is total speculation. I haven’t researched this type of scenario, so I’m literally just doing the thought experiment thing): It is entirely possible that you managed to stay in ketosis, but you were no longer producing enough excess ketones to spill over into your urine. Or, perhaps you stopped producing new ketones until you burned off the glucose you ingested + the ketones already in your serum. Or, you could have been knocked out of ketosis entirely. Here’s a case where it’s impossible to tell what happened by measuring your urine ketones alone. A negative reading on the ketostix only says that there are no excess ketones in your urine. You could still have ketones in your serum. Still, the very fact that the change in your ketostix introduces uncertainty as a result of a change in your food consumption may be of value, even if we don’t know if you were knocked out of ketosis or not. The very uncertainty of your readings can be enough reinforcement to be more careful next time. (I actually have a hard time typing “careful”, as I think it’s more important to get back on the horse than it is to beat yourself up for a slip up…but hopefully my bigger point comes through.) The fact that your ketostix read dark purple after a day wouldn’t surprise me either. If you did indeed knock yourself out of ketosis, maybe when you ran out of glucose, you overproduced ketones (especially acetoacetate) until your body returns to that homeostatic state where you were at before you got derailed. Ok, enough speculation on that topic. . . we have other topics to speculate about…

      In regards to your coffee question: It’s actually one I’ve tried to avoid researching too much, because I really like my coffee, and I don’t want to give it up. I mean, I REALLY LIKE IT. Enough that I bought a real espresso machine. Granted, it wasn’t working when I bought it (which explains why I could afford such a luxury in the first place), but I spent a couple of weeks bringing it back to life again…just so that I could upgrade my coffee game at home.

      Where am I going with this? Well, I’ve been drinking coffee heavily for a number of years, and during the 18 months I’ve been living a ketogenic lifestyle, it does’ t appear to have influenced my weight loss. Of course, there’s no way for me to determine this for sure, but I’m down 120lbs…which I’m happy with (even though I still have a long way yet to go). I should note, however, that I drink my coffee black. If I have an espresso, I may sweeten it with some stevia drops. If I have a latte, I’ll steam heavy cream instead of milk.

      It’s that last part where my experience might intersect yours: I have learned that I can’t go overboard with my cream. While it does have less than 1 carb per serving, a serving is only 1 tablespoon…and THAT has 50 calories. Depending on how much cream you put in your coffee (or in my case, I use for my lattes), and how many cups of coffee (or lattes) we have per day, we could be taking in an enormous amount of calories and/or suffering from the deleterious effects of carb-creep. Those foods that read “0 carbs” on the label are typically fractional carbs (some value less than 1). If you are ingesting multiple servings, you can’t just assume that you’re still at zero carbs. Maybe that’s what Gary was getting at in his response, or maybe he was getting at the possibility to drastically over consume calories. Both could probably said to be legitimate concerns. (As an aside, I was glad to see you comment on how nice it was to hear back from Gary. I’ve traded a few emails with him as well, and found him to be extraordinarily nice and giving of his time and knowledge on every occasion.)

      Since you mentioned diet soda, I found that I needed to give it up. My wife was always on my case about it because she thinks it’s a toxic soup, but that notwithstanding, I noticed on a number of occasions that if I stopped drinking Diet Pepsi (my soda of choice), my weight loss would progress. However, if I started drinking again (more than 1 per 1-2 days), my weight loss would slow and/or stall. There are a number of possible explanations for why this is (I’d like to cover some of them some day), but in the end, my wife’s argument that “it’s not real food”, and the fact that it didn’t seem to do good things for my weight loss, settled the matter for me. So, I switched to water. If I need it sweetened, I lightly sweeten it with Mio. Before I discovered Mio, I was using Crystal Light, which wound up stalling me as well. It turns out that variety I was using is cut with maltodextrin. Perhaps this is why it stalled me.

      So I gave up diet soda and Crystal Light, but continue to drink coffee…I’m acutely aware of others who can drink diet soda all day long and suffer no ill effects from it. Same thing with Crystal Light. Some people who give up soda because they found, like I did, that it stalls them will tell people wh drink it that they “should stop because diet soda inhibits weight loss”.

      I think this is clearly the wrong approach to take: people need to find out what works for them. Clearly there are people who can drink 4 liters of diet soda a day and not inhibit their weight loss. And there are also people who appear to suffer by consuming a can or two every 1-2 days. Confronted with this knowledge that different people respond differently to it, the best anyone should be telling you is that when it comes to soda, be aware that it hinders some people, and has no effect on others…and that you are going to have to figure out whether or not it hinders you. When people say, categorically, “it’s fine” or “it will slow your weight loss”, we start to get into trouble.

      Of course, In addition to whether or not it inhibits weight loss, there are obviously a slew of other reasons why we might want to consider removing diet soda from our diet. I’m purposely avoiding that discussion because IMO, it gets back to the “food quality” issues that are not really the focus of your question nor our conversation.

      As far as your comments about trying to make the best food choices possible given your budget, energy levels, etc… I think I’m in the same boat as you there: for this to work, it has to be a practical and sustainable component of your life. I can’t eat grass-fed beef every night. We’d go broke. It’s a treat for us. We try to make the best decisions we can make, day by day, and find a way of living that is sustainable and healthy for us in the long run. If that means you have a hotdog here and there, or cook something in your microwave now and again, so what? I’m certainly not sanctimonious or perfect enough to call you out on something like that. In fact, I think you’re speaking to a profound reality most of us will have to come to terms with: how do we make this work without unlimited budget, unlimited time or energy to prepare ideal foods in the kitchen, etc… I’ll take sustainable-and-healthy over ideal-but-temporary any day.

      Lastly, keep up your good work, Zell! I’m also coming from a position where my health was significantly damaged before starting this way of living. You and I have that in common. No going back! :P

      -Michael

      Reply
      • Götz HEINE

        Michael –
        you appear to know so much about ketosis and the diet related to that it makes me wonder why you still count such archaic currency such as ‘calories’.
        Are you sure you should continue this? Do you still believe a calorie of Stevia and a calorie of fresh fruit or cream have anything in common?
        To tell you the truth, you could drain your coffee with fresh cream and still wouldn’t suffer from obesity ever.
        Get back to the roots and reconsider your own writing and you will soon understand that you got misled when it comes to counting ‘calories’.
        All the best for this journey,
        Götz

        Reply
    • Too much protein can also kick you out of ketosis (you can’t store protein, so if your system has more than it needs, it gets converted into glycogen…) That’s described in phinney & Volek’s book as well.

      Reply
  5. Michael,

    Thanks for your great reply! Lots of info there, but I don’t feel overwhelmed.
    I do feel worried now, about calories, but I’m not going to worry too much. I’m of the opinion that by doing a ketogenic diet, I don’t have to worry about calories. After all, the diet features tons of fat, which is very calorie dense. Still, I will try to be careful w/the cream. I really love cream in my coffee. I can do 1/2 caf/decaf as long as I get my cream, but I don’t need stevia or other sweeteners. However, when I use stevia for sweetening other things, I use sweet leaf stevia; it doesn’t have any maltodextrin or dextrose or anything like that added to it. As for diet soda, you’ve given me a good reason to stay away from it! I’ve been drinking seltzer water, sometimes sweetened w/some stevia. Given all my work, I really hope the calories won’t be such a big deal for me. Cream is such a luxury! I just wish I could have ice cream or find some low carb equivalent (but probably not the stuff I see in store freezers). I will also look into Mio; I’ve never heard of it. Well, Michael, you bring up a great point at the end of your response to me; doing this diet in the real world. In the real world, people might not be able to do the diet as perfectly as they’d like, but I think: as long as they stick to basics reasonably well, they are doing okay. I am a very easily stressed person, a person who constantly worries over things, so your kind response is very appreciated! Thanks for this blog. I’ve been checking it for a while. I’m very happy w/your most recent blog entry disproving Dean Ornish. I read that article of his & it stressed me out greatly; your rebuttal was very helpful! Well: Onward! I will not give up!

    Reply
    • Thanks Zell!

      When I started low carbing, I was bitten by stevia cut with maltodextrin and dextrose. I can’t comprehend why they would create a sucrose alternative and then do that.

      Anyways, always check labels, right? After that experience with the powdered stevia we started with, we switched to SweetLeaf Clear Liquid Stevia as well. Good stuff & lasts a long time! I am, however, a bit disconcerted by the manufacturer’s extended range of flavored stevias…but not sure if it’s for good reason, or I’m projecting personal opinion too much.

      Reply
    • Götz HEINE

      Don’t worry about the cream in your coffee, Zel. In fact it is so helpful when it comes to buffer aggressive ingredients from roasting it.
      After all, when you are on a low or non-carb scheme, cream is a mighty help for your hormonal system to promote your health, did you know that? Not only the HDL-cholesterol and the synthesis of your sex-hormones it ensures, also the fatty acids are a big help for any prolonged physical effort. If you want to read something about that feel free to contact me on my site!
      Best,
      creamdoc

      Reply
  6. PS: I think Gary Taubes urged caution to me re: cream because there is a nominal amount of carbs in cream. Gary Taubes doesn’t seem to care about people counting calories, but I have heard him say (& have read his writings on this) that for people extremely carb sensitive, even green, leafy vegetables can be problematical! Since I don’t drink too much coffee, I think I’m okay, but it just goes to show exactly what you wrote, Michael; we are all so different in terms of what might cause us trouble & what might not. I have concerns of not going off this way of eating, so if cream in my coffee helps me not feel deprived, I’ve got to factor that in, too. There is So Much Junk where I work! It’s really insane. Every day I have to refuse it & I Do, but I don’t want to start to feel deprived, because that’s often the death knell of any diet. Thankfully, my sugar cravings have gone Down, but I know that they could Easily be awakened, so your point about ketosis sticks keeping me on track also applies!

    Reply
  7. Thanks for the info….I was worried that my ketostix rarely shows pink colour, always beige, despite keeping carbs very low (under 20 per day)…..what are your thoughts on exercising, as I have seen a lot of high protein diets not recommend too much exercise…do you think this could be interfering with ketosis somehow?

    Reply
    • mjoneill

      Hi Linda!

      Thanks for commenting! I remember having a completely distorted sense of what my ketostix should be as well. I see many people with the same anxiety (or worse), so I’m glad that you found this helpful.

      In regards to exercising: it’s awesome. It’s truly great for health, and can really shape a body. As far as weight loss goes, it’s really not all that helpful and may actually slow things down (according to some of the research).

      I spent the majority of my life thinking that, really, obesity is the result of laziness and I could get thin if I just exercised hard. It wasn’t until very recently that I actually started reading the research on it. It’s a fascinating domain to look in to, and I highly recommend you do so. I’ll add some links to the bottom of this comment, but the long and short of it is that you use diet to lose weight and look good at the office. Use exercise to look good in the bedroom. :P

      Here are the links:

      Reply
  8. I found your blog while searching for an answer to why my keto stix kept showing a negative result. Awesome writing btw!
    I am fairly new to keto, but the last 2-3 weeks I have been eating less than 20 net carbs pr day, and drink A LOT of water.
    I have also been drinking diet coke and Mio-flavored water – do you think this can affect the keto stix result? After my third day of cutting out everything drinkable but water, I am still getting negative keto stix. Should I just stop worrying and not measure anything with the stix?

    I know that if differs and that some people can tolerate it while others have stalls, but can diet coke/Mio hinder the ketosis-level – or do they hinder weight loss in another way? Can I still lose weight even though I am not showing traces of ketones in my urine?

    Thanks for the answer in advance

    Sienna :)

    Reply
    • mjoneill

      Hi Sienna!

      Sorry for the delay. I was on vacation!

      At any rate, if I were in your shoes, I wouldn’t get too worked up over what the ketostix read. You’re still early into it, and it may take a few more days for you to start seeing anything on your ketostix.

      As far as Mio and diet sodas and other artificially sweetened beverages: it seems like you’re just going to have to experiment. Based on anecdotal reports from the various low carb communities out there, it seems that some people can tolerate artificial sweeteners just fine. Others, it stalls out their weight loss or slows it down.

      For What it’s worth, Andreas Eenfeldt has an interesting N=1 experiment showing what happened to his serum ketones after drinking a Diet Pepsi. It may be worth considering as you consider how to approach artificial sweeteners.

      Can I still lose weight even though I am not showing traces of ketones in my urine?

      Yes. Absolutely. A negative reading on your ketosticks does not mean you won’t, can’t or are not losing weight. So don’t get down if you read negative. Just focus on keeping your carb consumption within the range you are using.

      Reply
  9. My friend and I both recently started eating low carb (atkins type) <20 carbs to lose weight. The strips have been helpful encouragement for us to continue on and interestingly forced him to admit he had a sandwich with bread one day! haha We are debating the sugar issue. Lots of items say that they have <1 sugar or 2, 3, or 4 sugars. Those are obviously less than cupcake icing, but where is the cutoff for staying in a weight loss state while eating lowcarb and frying bacon and eggs every day. I thought it was no sugar at all or it would throw you off but some people say as long as the carbs are 0 to super low, then don't worry about the small amounts of sugar that show up in salad dressing, lunch meat, etc.

    Reply
  10. Heather

    Thanks so much for all this information. I have just started LCHF since Monday this week. Have some Ketostix. The colour of the sticks changed dramatically by Wednesday. No weight loss though. I am 62. I have been overweight all my life to varying degrees. Yo yo dieting all my life. I am fairly typical as am a child of the low fat low calorie mantra era – used weightwatchers slimming world lighter life always been successful losing chunks of weight only to pile it back on again time after time. I wanted to know what the ketone measuring meant so have stumbled across this wonderful site (how clever you are and I cannot thank you enough for posting this information for free). It seems you can be in ketosis and still not lose weight just that your body has moved to ketones to use for energy rather than glucose. I want to continue eating this way as I have a brother with Type 2 Diabetes. Although I have not been to the Doctors for confirmation I believe I am either pre-diabetic or actually got it. My weight is the highest it has ever been 17stone (238 pounds) I am very very typical of everything you read relating to metabolic syndrome. So am going to try and eat the LCHF way. It works. I have a sweet tooth. Having had no sugar at all and minimum carbs for only five days I feel better and so far no cravings. Although I have stood at the fridge door staring at my husbands chocolate. He is slim naturally so although eating and drinking anything he likes. I would say though he does not have a damaging relationship with food it has never been an issue. Whereas I have an awful relationship with food. He will eat to live – I on the other hand live to eat! But I am hoping it is not too late for me. At the moment I am just eating foods from the list of LCHF Diet Doctor’s website and trying to follow what is suggested on this forum and also Linda at About.com. I am going to use this Ketopia site to try to get my head around what and how much I can eat and lose weight. So far I believe whatever I am eating is just keeping the status quo, so suspect I have to at least write down exactly what carbs I am having and at least have a rough idea of type of food and keep an eye on the calories. It is difficult for me when it says have what you want, I am trying to treat this LCHF as being a cure for “food addiction” that food addiction that has cost me my weight spiralling out of control and ultimately my health. Thanks for listening just wanted to let everyone know here how much I for one appreciate all the time you have all taken to post your stories and all the fantastic information – which I find hard to take on board but believe I am just starting out on a road which I hope will result in losing weight, saying goodbye to sugar cravings, and keeping diabetes at bay. Thanks again. H X

    Reply
  11. Peter Augusta

    Thanks, I have been doing the < 20 carbs/day for 30 days now, down 19lbs and feel great! I bought some ketostix strips out of curiosity, every time I check, I get a neutral reading. Not real sure why, but you shed some light on the subject for me. The bottom line is I'm loosing weight and feel much better!
    Thanks

    Reply
    • Congratulations on your weight loss, Peter! That’s fantastic progress!

      Keep us posted on your progress, and stay focused on your success (instead of the neutral readings). :)

      -Michael

      Reply
  12. I know I shouldn’t worry about the stix not changing but they did change 2 times during the first 2 weeks and now negative in week 3. I track every morsel of food I eat and know I am under 5% carbs with around 60% fat and 35% protein.
    Sample Day…
    Meal #1
    2 eggs with 2 egg whites
    4 slices turkey bacon
    2 tbsp cream cheese
    Meal#2
    small protein shake post workout
    Meal#3
    veggie egg white omelette
    1 1/2 TBSP peanut butter
    Meal#4
    string cheese
    2 TBSP cream cheese
    Meal #5
    4 oz protein
    100 grams lettuce
    2 TBSP dressing
    Meal #6
    2 eggs with 2 egg whites
    4 slices turkey bacon
    2 TBSP cream cheese

    Macros around 1850 calories 26 carbs 128 fat 143 protein
    **I am allergic to oil and butter which is why I don’t include that

    Any thoughts?

    Reply
    • Hi Jill!

      Fantastic question. Well, a couple things come to mind:

      First: the best way for you to determine what’s going on is to purchase a blood ketone meter and the corresponding test strips.

      That’s not required, though…not pushing you in that direction. It’s just the fastest way to see what your actual serum ketones are.

      The second thing to consider is this: excess protein will be converted into glucose. Some forms more readily so than others (from what I understand).

      Looking over your macros, one thing I noticed is that 143g of protein could be overshooting the mark a bit.

      Based on the rough estimate of .7g of protein per pound of lean body mass (Phinney and Volek recommend .6-1.0g/lb lean body mass), and your consumption of 143g/protein per day… your lean body mass would be 203lbs (please check my math). Seems high to me.

      Before investing in a blood ketone meter, I’d use a protein calculator and try dialing back your protein a bit. You can continue to use the urine ketone test strips and see if they budge, or you can ignore them altogether and just go by the guidelines and see what your body does.
      http://ketopia.com/the-art-and-science-of-low-carbohydrate-performance-phinney-and-volek/“>The Art and Science of Low Carbohydrate Performance for more information on protein macros and your way of eating. I found it to be very helpful.

      Lastly, it’s possible that everything is fine (but check your protein numbers to be sure) and the reason you’re not seeing anything on the ketostix is because you are ketoadapted and just not producing enough to register on the ketostix (or register with the same intensity). Remember, after some time your body will dial back the number of ketones it produces. . . and this can result in fewer excess ketones in your urine.

      Keep us posted on what you learn!

      -Michael

      Reply
  13. I cut out carbs and sugars since December 2012 and down 70 lbs, however, lately I have been obsessed with the color on the keto stix (testing multiples times a day), especially if my first reading only showed a trace of keytone. Crazy …I know. I too found if I have coconut oil it increases the color of the keto stix. I mainly want to ensure I stay in ketosis. However, I did slip up today…ate a little piece of cake and icing. One slip in 7 months. 
    I truly enjoyed reading everyone’s comments. It has helped me understand keto stix better. Thank you everyone. Hopefully I won’t continue to be so obsessed with the color on the stix. I doubt I stop testing completely at least now, but I won’t be so obsessed with it like I have been.

    Reply
    • Deb,

      No need to apologize. Keep your eye on the prize: you’re already 70lbs down. That’s amazing in and of itself!

      -Michael

      Reply
  14. Kristina

    Hi there,

    I have found this site pretty interesting so far, and I’m wondering if it can help me with some nagging questions.

    First off, I have just started a low carb diet about 2 weeks ago. My daily carbs vary from 8-45. Should I be more consistent or keep it lower in general?

    Secondly, I found that a small wheel of camembert cheese melted, with about a small handful of blueberries, tastes great and is low carbs. I’ve been having one everyday, Is this a bad idea?

    I should note that I’m using the strips twice daily, and they are constantly changing between light pink and neutral. Also, my post weight range is consistently 4lbs less.

    Thanks,
    Tina

    Reply
    • Hi Tina!

      Thanks for the question!

      First off, congratulations on starting a low carb diet! That can be an important milestone for many people.

      As far as your daily carb intake: unfortunately, there’s no universally applicable guideline that is ideal for everyone. Some people report that as long as they stay below 75g/carbohydrate a day, weight loss continues. Others report that if they exceed 20g/carbs a day, they stall. Finding what works for you is key.

      As far as consistency goes: again, I’d let the results be your guide. I tend to try to shoot for a consistent range, but that’s just me. If you’re seeing results doing what you’re doing, and you are comfortable with the results, keep on keeping on!

      As far as your camembert and blueberries go: Can you share the carb counts with us? All things being equal and if it isn’t derailing or slowing your progress, then there’s likely little harm in it.

      As my answers indicate, there’s a great deal of variation in Keto in regards to what works for some people, and what doesn’t work for others. Part of the beauty of the advice of keeping carbs below 20g a day is that it tends to be more universally applicable: if you do this, you’ll be in ketosis. However, not everyone needs to be that strict.

      Hope this helps! Keep up the good work!

      -Michael

      Reply
  15. Hi, I found you site very useful. I’ve started doing keto diet for a number of reasons. Although this is not new to me as I use it when competing (bodybuilding), I am 50 years old (63 kg) and have no energy, huge cravings and hormonal changes, so I though after trying all diets that are out there to give this one a go for a long period. I have noticed that with the years I’ve become more sugar sensitive. My question is regarding the nutrients. I worked them out on a calculator and this is what I came up with 120g protein, 110g fat, 5g carbs. I kept the carbs low because I saw no changes in the first week when they were at 20g. I only want to lose 2kg. I currently do heavy weight training 3 x week for 40 minutes, 2 interval HIT training cardio – 40 minutes and 9 x 30 minutes power walks. This might look a look however I do compete and this is already taking my previous training down by half. I desperately need to get some energy back in my life. I don’t do coffee, sweetners (they affect my blood sugar), dairy etc. I have done another week with the above allowances but still not change. The reason I read your article is because there is no ketones showing on the sticks and I now understand why. Thank you

    Reply
  16. I am confused. Have been on the keto diet for 4 weeks strictly, and today went and bought the ketostix and it didn’t show any traces at all…..zilch!!!
    So are you saying that if one is in ketosis then you will get a change in colour to the pinks instead of remaining beige?? Please help. I am having a hard time getting my head around this :(

    Reply
    • Hi Vlasia!

      Thanks for your comment!

      The first thing to do is, don’t panic! :P

      OK, so here’s the deal… If ketostix are not showing ketones, either of the following could explain it:

      • You are not in ketosis. Perhaps you are still burning glycogen stores? What’s your daily carb intake… Are you 20g/day or less…or are you surfing at a higher number, like 75g/day?
      • You are in ketosis, but you are not producing the type of ketones detected by ketostix in sufficient quantities to register a result.

      Unfortunately, there is no way with ketostix to determine which of the above is at play. If I were in your shoes, I’d rule out carb creep. Measure everything for a few days, and keep your carb intake to less than 20g/day. At that level, you will be in ketosis (after a few days).

      You might also try taking a tablespoon of coconut oil and then measuring (hours later). Many people report that doing this invariably turns their ketostix purple. I’m suggesting it ONLY to test that your batch of ketostix isn’t bad. (You could also try another batch).

      I hope this helps you sort through what’s going on? Remember: When in doubt, Keto on…

      -Michael

      Reply
      • Götz HEINE

        So you are really indicating that ketones are a necessary result from going without carbs?
        Let me tell you that I have completely different findings and results, Michael. And this is not for being conflictive or rude, just for the fact of it.
        There i also quite a large number of athletes, patients and normal people who did my diet and are ketone-free (and stay there, no matter whether they eat carbs, sweets or just protein and fat. I figure the key lies in the kind of fat you use and get used to during the process of getting rid of carb metabolism as the only source of energy. Best, Götz HEINE

        Reply
  17. lynn cooper

    I ahve a couple of questions. When everyone speaks of 20 g of carbs is that net carbs or carbs in general? Also, I have heard that caffeine can held or hinder weight loss. Any comment?

    Thanks so much for your article on ketosis. It helped clear up some things and help me let go of the obsession to check all the time.

    Reply
    • Hi Lynn!

      Thanks for stopping in! These are great questions!

      First off, your question about carbs:

      When everyone speaks of 20 g of carbs is that net carbs or carbs in general?

      That’s net carbs (which means total carb content, minus the fiber).

      I have heard that caffeine can held or hinder weight loss. Any comment?

      And here we get into some trickier territory worthy of a post with citations. Until I have the time for that (or someone else takes up the cause), you’re going to have to take the off the cuff response:

      While caffeine is non-caloric, it may have a role in weight regulation for some people…especially if the hormone/insulin theory of obesity is to be believed. Check out this research to get started: Caffeinated coffee consumption impairs blood glucose homeostasis in response to high and low glycemic index meals in healthy men. In this research, the authors conclude that “The ingestion of [coffee] with either a high or low GI meal significantly impairs acute blood glucose management and insulin sensitivity compared with ingestion of [decaf coffee].”

      With that said, many people report no negative effects of coffee consumption while dieting. Others clearly have issues with it and learn to avoid it.

      For what it’s worth, I work with a gentleman with an insulin pump. One day in the cafe we were making small talk while I was making my coffee. Someone asked him why he doesn’t drink coffee. His response: “I can’t,” he said, lifting up his shirt and revealing the insulin pump attached to his belt. “I’m diabetic. When I drink coffee, my sugar spikes and my insulin pump goes crazy…”

      Yes, he was talking about black coffee unadulterated by cream, sugar, milk, etc…

      Reply
  18. Götz HEINE

    Again Michael,
    this is a very interesting blog for someone who has been working with metabolic switches for more than a decade in Germany. Thank you for your work.
    However, let me again emphasize on the fact that we found out that after a very short time of dieting the way I recommend it there is no traces of ketones detectable in any of my patients, athletes and ‘normal’ people.
    Also, there is no need to stay carb-, let alone sugar-free to maintain a lean and healthy body once you have switched your metabolism to converting fat into energy. Its probably because our systems use the ketones straight away, so they don’t even get into the outer bloodstream, let alone lungs, kidneys and urine.
    Best,

    Götz Heine
    alternative practitioner/naturopath
    Munich, Germany

    Reply
    • Thank you Dr. Heine!

      I appreciate your willingness to be so generous of your time and wisdom on so many of these posts.

      Perhaps you can share with us the details of your dietary protocol and how you’re measuring (or not) ketones in your patients.

      Anything else that would inform the discussion is, of course, welcome.

      -Michael

      Reply
      • Götz HEINE

        Just for healthy people and athletes as a quick shot for the moment, Michael:
        The general recipe is switch to fat burning with a diet consisting of whipped cream (no additives!) for like 7 to 10 days. Exercise daily up to one hour (athletes more of course). Drink plain water or herbal tea, (no black or green, no coffee) as much as you like (min. 1 liter/day).

        Monitor your ketones if you want but is n o t essential as you will smell and taste it anyway until they will be gone ;-). Note that some people need longer to get clear of ketones as a sign that their metabolism isn’t already fully adapted to the art of burning fat, human fat as you find it in cream only.*) Understand that everything else (other fats, let alone oils!) is an extra load to a clean efficient metabolism otherwise you could feed it to your babies as well, couldn’t you?
        Addition: For most people a liver flush with Epsom Salt prior to the diet is helpful to clean intestines and bile.
        *) So you might as well give it another go some months from when you went on the first switch, can’t you?
        Best,
        Götz

        Reply
    • I’m still unclear on this part.

      How are you measuring ketone production, and what is the dietary regimen that results in lack of ketone production.

      Regards,

      Michael

      Reply
  19. Götz HEINE

    Hello Michael,
    first of all please note that in the tems of English speaking countries I’m a naturopath, an alternative practitioner, not a doctor.
    To refer to your question let me confirm that by no means I am a scientist who can afford running extended research on where the remnants of fat metabolism go to.
    Both, urine and serum protocol can be used to measure ketones and will monitor the dieter’s success or during the diet already or afterwards, depending on the person’s initial state of health.*)
    The fact that the better they respond the less ketones can be traced in neither of the tissues named above urges me to claim that they, depending on the way the body got introduced to the art of burning fat (and this is where the diet I have been promoting for more than a decade kicks in) get metabolised to CO2 and H2O.
    Therefore, and in my humble opinion, the Ketogenic Diet is a myth rather than a desirable goal to aim at because ketosis is a metabolic state not worth to go for let alone to stay in. For all those who want to shift away from carb overload it is however a neccessary phase to travel t h r o u g h to improve their state of health.
    *) This is why sometimes endurance athletes and children of families who were used to continuous physical work report that even when they went on the Ketogenic Diet you promote couldn’t trace ketones at all (scroll back to Vlasia’s post on October 24, 2013 at 2:38 ). They might experience a light initial nausea followed by an adaptation free of any symptomes and remain there). All other athletes, ‘workers’ and patients pass through a rough state of overcoming their carb addicition. When on the diet I prescribe a general figure is 2-5 days within the 10 day diet until this ketone-free state is reached.
    Some people who need longer adaptation are better off to stop the diet after 7 days, recover and undertake a second attempt later in order to become ketone-free.
    Understand that the primary source of energy from fat is the c r e a m i n
    m o t h e r ‘s/a mammal’s milk, no oils let alone raw or fried fatty tissue. Therefore and provided it has no other option, our metabolism remembers swiftly and will adapt quite easily to this well-known source of energy. Once re-introduced to the Art of Burning Cream (you may call it ‘fat’ but please accept my strong diapproval for obvious reasons, Michael) it will keep up this virtue for a long, a very long time. Now carbs can be added or cut out – no problem, as our body will notably tell us when it had enough.

    Reply
    • first of all please note that in the tems of English speaking countries I’m a naturopath, an alternative practitioner, not a doctor.

      Yes, I understand that you are not a medical doctor. Still, I referred to you as “doctor” as a courtesy. I think it is clear you are not an MD.

      Both, urine and serum protocol can be used to measure ketones and will monitor the dieter’s success or during the diet already or afterwards, depending on the person’s initial state of health.

      So, your patients who show now ketone production after a week…are you using both approaches to determine this? Or are you just reminding us that these two methods can be used?

      Therefore, and in my humble opinion, the Ketogenic Diet is a myth rather than a desirable goal to aim at because ketosis is a metabolic state not worth to go for let alone to stay in.

      I’m not sure I follow your logic here, but I appreciate you taking the time to share your opinion with us.

      Regards,

      -Michael

      Reply
      • Götz HEINE

        So say ‘Creamdoc’ Michael ;-).
        I used to execute both protocolls long time ago. Urine is quite simple, but like in the U.S. serum screening was hideously expensive. Back in those days I even
        carried around a big photometer to stage race events, training camps a.s.f. to screen Hb, Fe, Chol, Uric Acid and other parameters as they seemed to be of more significance to me.
        In my time off I used to work as a direcotr sports, masseur and race mechanic.
        Ketosis you could detect easily by the smell of your athlete’s breath and sweat, so very soon I skipped this from the list of chemicals to carry around.
        B.t.w., if once you entered a team bus full of athletes coming back from a race you could smell testosterone, adrenaline and ketones, of course.
        As there is no reason to hide anything, no frills, no tricks feel invited to take a free course in Cream Dieting by getting in touch with me via info@biomac.biz , Michael.

        Reply
  20. CJ Thompson

    I can pretty much till by the “smell” of my urine when my body is excreting ketones. I’ve used the sticks in the past but they were just for newbie reassurance. One whiff and I’m good to go these days.

    Reply
  21. Hi Michael
    Thank you for a very interesting blog. I am an amateur cyclist from Ireland I have had the advantage and pleasure of working with Götz Heine during a world cup ultra endurance cycling event (Race around Ireland) Which is 1350 miles in 132 hours. I completed his cream diet and adapted to burning fat within two weeks. Body composition Measurements were taken before and after 6 weeks using bod pod. Body fat had been reduced from 12.5 % to 7.5% and no loss of power. For the first time in my life I lost any interest in carb heavy food. However I was able then at that point to take any food I choose. As an comparative experiment I have also followed a ketogenic diet for six months keeping within 0.5-3 mmol. My conclusion was I lost power during anerobic efforts as measured by SRM. I think that once you have adapted to burning fat as a primary fuel which I did with the cream diet then it just becomes a question of carbohydrate timing.

    Regards
    Jim Doyle

    Reply
  22. Steve Hogg

    G’day Michael,
    thought provoking stuff. As with Jim Doyle, I’ve followed Gotz Heine’s cream diet method out of curiosity. I adapted completely to burning fats after 6 days and lost 7 kg in that time. To make the point about ketosis that I believe Gotz is trying to make, I was in ketosis for 1 day only of the 6 days it took my body to ‘convert’ and subsequently completed a hilly 200 km bike ride with a group of fit cyclists while consuming 2 dried figs only during the 7.5 hour hard ride.

    I’m glad that you are attempting to help people but it is not necessary to stay in ketosis as you have outlined.

    Reply
  23. Götz HEINE

    Spoke to Steve Hogg from Australia the other day. He’s both, a client who also became a friend of mine, Michael.
    He follows your blog and wanted to share his experience with your readers, but for some reason didn’t
    get his reply through to you. So I copied it and paste it here:
    “G’day Michael,
    thought provoking stuff. As with Jim Doyle, I’ve followed Götz Heine’s Cream Diet method out of curiosity. I adapted completely to burning fats after 6 days and lost 7kg in that time. To make that point about ketosis that I believe Götz is trying to make, I was in ketosis for one day only of the 6 days it took my body to ‚convert’ and subsequently completed a hilly 200 km bike ride with a group of fit cyclists while consuming 2 dried figs only during the 7.5 hour hard ride.
    I’m glad that you are attempting to help people but it is not necessary to stay in ketosis as you have outlined.”

    Reply
    • but for some reason didn’t get his reply through to you.

      Indeed!

      As you can imagine, we get a lot of people trying to spam the comments here, manipulate backlinks etc… and it appears that Steve’s comments and yours are now considered spam and getting trapped in the SPAM folder upon submission.

      Regardless, I’d like to see the conversation move from repeating “it is not necessary to stay in ketosis” to a more helpful discussion of the science that informs Mr. Heine’s approach.

      Reply
  24. If man had waited for science to develop the wheel, we’d still walk. If medicine had chosen the right way,
    a simple cold wouldn’t exist any more.
    Cut to the chase, Michael, if babies could choose between mother’s milk and scientifically designed powder what would you consider to be better for them? Science describes nature, however it still far from creating it. In the meantime consider Ketosis as a hurdle in man’s way back to a physiologically clean energy production, nothing more and nothing less. The perfect man breaks down fat as if he’d metabolise carbs. And this is good as he has so much bigger reserves of it stored in his body.
    Give me some time and the German version of how to perform the switch will be brought to the English speaking world.

    Reply
    • Hunter

      Sometimes the morning gives false positive due to pooling of ketones overnight.

      Reply
  25. shirley

    Hi I’ve never have used ketone stix before so just want to know when do you do the test like do I do it first thing in the morning or evening and do you do it before you eat and drink or after to get best results ?
    shielry

    Reply
    • Hunter

      Sometimes the morning gives false positive due to pooling of ketones overnight.

      Reply
  26. Hunter

    Love this article and blog. Can you give me your advice on TOO much protein, and how that can knock you out (because it is turned into glycogen if it cannot be used/stored)? Is this true?

    Reply
  27. Leslie tomlinson

    Please help! I have been below 20 grams for four weeks and not lost a pound. I went down to 500 calories on day and gained a pound. I eat two eggs in the morning, cheese or two bratwurst for lunch, a four by six inch piece of meat for dinner. Diet coke and tea. This is beyond depressing.

    Reply
  28. Hello! something I did not understand ….I was in Paris for 2 weeks, my ketosticks were ALWAYS dark purple …I ate lots of cheese and some chicken and more cheese …;-0 , after these 2 weeks my jeans were so tight and I had put on weight ..;-( I was thinking that as long as your ketosticks were purple you were losing weight ….
    is it that the so much cheese took me over too much protein?? Merci!

    Reply

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