Ketosis, signs and symptoms, how to trigger ketosis, how to measure ketones?


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What is ketosis?

Ketosis is a process that occurs when the body doesn’t have sufficient carbohydrates to burn for energy. Instead of carbs, the body burns fat and converts it into ketones (ketone bodies), which are used for energy production. This natural metabolic state is ketosis.

Three types of ketones are produced by the breakdown of fatty acids.

  • Acetoacetate: It is formed first while ketosis
  • Acetone: It is formed as a side product of acetoacetate
  • Beta-hydroxybutyric acid: it is produced from acetoacetate

You can get into ketosis by following a very low carb, moderate protein, and high fat ketogenic diet

It helps you to achieve weight loss and clinical treatment goals such as Alzheimer’s, and Parkinson’s disease, epilepsy, etc.

 What is ketoacidosis?

Ketoacidosis is a serious complication of diabetes (mostly type 1 diabetes mellitus). Dangerously high levels of blood sugar and ketones lead to this life-threatening condition. Ketoacidosis also known as diabetic ketoacidosis (DKA). Diabetic ketoacidosis can also take place in people with type 2 diabetes who have little or no insulin production.

The combination of high blood sugar and high levels of ketones makes the blood too much acidic. This too much acidic condition can change the normal functioning of body organs such as your liver and kidneys. It’s a critical condition that requires emergency treatment.


Causes of DKA:

  • Illness (infection)
  • Improper diet
  • Problem with insulin therapy: Inadequate dose of insulin or missed insulin dose


What is the difference between ketosis and ketoacidosis?


Characteristics Ketosis Ketoacidosis
Condition/process Natural A disease condition that has to be treated immediately
Number of ketones Low (between 0.5 and 3 mmol/l) High (greater than 3 mmol/l)
Blood glucose(sugar) level Low High
Causes Diet (low carbs diet) Type 1 diabetes mellitus, illness, or extreme starving
Blood glucose(sugar) level Low High
Time It generally takes 2–4 days DKA can occur very quickly or it may develop in less than 24 hours
Heath benefits  weight loss and clinical treatments such as Alzheimer’s, and Parkinson’s disease, epilepsy, pain and inflammation (rheumatoid), IBS, fatty liver, PCOS, cancer, heart disease, blood sugar level, and acne, etc None
Effects/symptoms Exhaustion, weakness A flushed face

Nausea and vomiting

Stomach pain

Shortness of breath and tachypnea (rapid breathing)

Tachycardia (rapid heart beating)

Hypothermia (low body temperature)

Weakness or fatigue

Mental confusion

Dangers Not dangerous Extremely dangerous can lead to coma and death


How long does it take to get into ketosis?

If someone is doing extreme workouts with a low-calorie intake (keto) he can get into ketosis in a day.

It generally takes 2–4 days to get into ketosis if you eat less than 50 grams of carbs per day.

However, It can also take several days, up to 7 days for most people that follow the keto diet, because it depends on a few factors such as age, physical activity level, metabolism, and carbs, fat, and protein intake.

Producing ketone bodies is just one step towards keto-adaptation. It’s just the beginning, not the end goal. The body needs time to learn how to use this new source of energy efficiently and it may take a few weeks.

How to get into ketosis or how to trigger ketosis?

You can get into ketosis naturally and ketosis can also be triggered by using keto supplements.

All techniques spin around the same plan- lower the blood glucose and increase fat consumption. Here are some most important tips that can help you trigger and increase the level of ketosis:

  • Minimize your daily carb intake:

Many studies recommend eating 20-50 grams (0.7 to 1.76 ounces) of carbohydrates per day.

Each person has a different carb intake limit to attain and maintain ketosis. It depends upon the total number of calories they intake and levels of physical activity per day.

Usually, 5–10% intake of total calories from carbs will produce ketosis

For people with type 2 diabetes: 20–50 grams of carbs per day

For people with epilepsy patient: 7.5-20 grams (2-5%) of carbs per day

  • Increase your healthy fat intake:

Healthy fats include fatty fish, avocado oil, and olive oil. Healthy and high-fat foods are also very low in carbohydrates. Eat more avocado and unrefined oils such as serve each non-fatty meal with a tablespoon of oil or a slice of avocado. This is a good strategy to acquire the required amount of daily healthy fat.

  •  Include coconut product into your diet:

Coconut oil contains fats called medium-chain triglycerides (MCTs) that can help you attain ketosis. MCTs are quickly absorbed and taken straight to the liver. In the liver, MCTs can be used instantly for energy or converted into ketones.

Replace your regular snacks with a piece of copra or a cup of coconut milk. Use coconut milk and coconut oil to prepare keto-friendly meals and drinks.

  •  Integrate keto with intermittent or short fasting:

You can get into ketosis quickly by following this integration.

  • Maintain adequate protein intake:

An adequate protein is required to attain ketosis, but not in excessive amounts.

Getting 20% of your calories from protein makes you feel full for a longer period of time. This helps to avert hunger and to build muscles.

  • Be active and do exercise or physical activity :

The body needs more glucose to perform physical activities and when you exercise or workout, your body depletes stored glycogen. Depletion of glycogen storage normally replenished when you intake carbohydrates, which are broken down into glucose. The extra glucose quickly is stored as glycogen.

If you intake less carb, glycogen stores remain low. Consequently, your liver produces more ketones. These ketones can be used as an alternative fuel source for your muscles

Additionally, being more active can help you quickly get into ketosis.

  • Use keto supplements:

Coconut oil or MCT oil capsules

MCT oil is the most digestible fat. MCT oils are generally made from the fruits of oil palm trees or coconuts. Coconut oil capsules are also supplements that can promote ketosis.

Try exogenous ketone supplements

Exogenous ketones may help increase ketone levels of the body.

Sometimes, people may not be able to produce sufficient ketone bodies. Therefore, they may not enter or stay in a ketosis state. On this occasion, exogenous ketone pills can help to attain good results on the keto diet.

What are the signs or symptoms that tell you you are in ketosis?

There following common sign, symptoms, and side effects at the beginning of ketosis:

  • Keto flu (The flu-like symptoms such as runny nose, headache, fatigue, and other symptoms are brain fog, dizziness, and insomnia)
  • Keto breath (bad breath)
  • Keto crotch (unpleasant smell from your vagina)
  • Keto rash
  • Increased ketones in the urine or breath
  • Frequent urination
  • Low blood sugar
  • Dry mouth and increased thirst
  • Decrease in appetite
  • Short-term fatigue
  • Short-term decreases in performance
  • Improved cognitive performance
  • Increased focus
  • Increased energy
  • Weight loss


How to measure ketones if you are in ketosis?

Ketosis signs and symptoms are the subjective ways that tell whether you are fat-adapted or not.

There are some tests that provide you hard data on your metabolic state. You can also use these tests to measure your body’s ketone production.

Blood ketone test:

The blood test is a gold standard, the most accurate and valid method for measuring ketosis. This test measures the ketone body called beta-hydroxybutyrate (BHB) in your blood.

You can measure your blood ketone levels at the lab, or you can do it yourself at home with a blood ketone meter and test strips.

Blood BHB levels above 0.7 mmol/L tell that you are getting into ketosis.

Blood BHB above 1.0 mmol/L tells that you are in deep nutritional ketosis.

The best blood level of ketones for dietary ketosis is between  0.5 and 3 mmol/L (9 – 54 mcg/dl).

How to perform urine ketone test and how does blood ketone meter work?

  1. Wash your hands and dry them.
  2. Load the lancet with the needle.
  3. Set a blood ketone strip into the ketone meter.
  4. Prick your finger by using the lancet and draw a small drop of blood.
  5. Contact the strip with the drop of blood and examine the results.
  6. After finding the results, discard the strip and lancet.

Urine ketone test:

The urine ketone test is the easiest, convenient, fastest, and cheapest method to figure out the levels of ketones in your urine by using urine strips. The predominant ketone excreted in the urine is acetoacetate.

How to perform urine ketone test?

  1. All you need to do is just pee on the strip, the strip has a certain color.
  2. After peeing on the strip its color will change.
  3. Note the color change that indicates your depth of ketosis.
  4. Find the corresponding ketosis value on the label.
  5. Early morning or after dinner is the best time to measure urinary ketones.

Breath ketone test:

The breath ketone test is a new and convenient method to measure ketone (acetone) in your breath that gives you keto breath. This breath test is performed by using a ketonic/ketonix breath analyzer(a device). Breath acetone is correlated with blood and urinary ketone measurements.

What do ketone test results mean?

  • Ketosis state: more than 0.5 mmol/l
  • Moderate ketosis :1/2-1.5 mmol/l
  • Ideal ketosis: 1.5-3 mmol/l

A ketone level greater than 3.0 mmol/l is abnormally high and can lead to severe health problems. If your ketone level is higher than 3 mmol/l then consult your doctor as soon as possible. Seeking 2 mmol/l is a safe way to avoid ketoacidosis and benefit from an ideal ketone level while following a keto diet.

Ketone levels Benefits and risks
Less than 0.5 mmol/l Negative to low ketone level No influence
0.5 to 1.5 mmol/l Moderate ketone level Nutritional ketosis begins
1.5 to 3 mmol/l Optimal ketone zone Best weight loss results
Greater than 3 mmol/l Abnormally high Risk of ketoacidosis

 What happens if ketone levels abnormally high?

Ketones can make your blood acidic. Acidic blood can cause diabetic ketoacidosis.

Signs and symptoms of ketoacidosis:

  • A flushed face
  • Frequent urination
  • Excessive thirst
  • Dry mouth and skin
  • Nausea and vomiting
  • Stomach pain
  • Shortness of breath and tachypnea (rapid breathing)
  • Tachycardia (rapid heart beating)
  • Hypothermia (low body temperature)
  • Weakness or fatigue
  • Confusion
  • Fruity-scented breath
  • High blood sugar level
  • High urine ketone level

If you have these signs and symptoms contact your doctor and seek emergency care immediately.

The most serious effects of diabetic ketoacidosis include:

  • Swelling in your brain-cerebral edema
  • A loss of consciousness
  • Diabetic coma
  • Kidney failure
  • cardiac arrest
  • Death


  • Intravenous fluid replacement:

To deal with dehydration fluid resuscitation should be with a large volume of normal saline. If the blood glucose falls to below 15mmol/l the fluid should be changed to 5% dextrose or dextrose-saline.

  • Intravenous insulin administration:

Intravenous insulin administration improves their ability to use excess glucose in the blood for energy. Blood glucose levels should be measured every hour and adjust the insulin dose accordingly. When ketones and blood acid levels return to normal then intravenous insulin may no longer be necessary. You would resume your normal insulin therapy regimen.

  • Electrolytes replacement:

Potassium, sodium, chloride, and bicarbonate administration to deal with heart, muscle, and cell functions

How to prevent abnormally high ketone levels?

Careful management of diabetes or low carbs diet plan is the key to preventing high ketone levels.

  • To keep your blood sugar levels healthy and ketone production to a minimum, you need to do the following things:
  • Monitor your blood sugar levels regularly
  • Take insulin according to the doctor’s recommendation or treatment plan
  • Increase the frequency of monitoring blood glucose if you are having symptoms of high or low blood sugar
  • Monitor your urine ketone levels
  • Don’t exercise if your blood sugar levels and ketones are high
  • If your ketone level is high then drink extra water to flush them out of your body and contact your doctor immediately
  • Take a healthful and balanced diet
  • Avoid skipping meals

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