Ketosis

ketosis3

One of the most frequently asked questions by people encountering a Zero Carb diet for the first time, especially if they come from a low carb, ketogenic diet background, is…

Do I need to be concerned about or measure my level of ketones?

I think one of the main reasons this happens is because the descriptive label most often applied to this way of eating is Zero Carb, rather than Zero Plant Foods, All-Meat, or Carnivore (labels which are actually far more descriptively accurate). Additionally, this way of eating probably attracts more people from the low carb community than from any other dietary background. The question comes up often enough that I felt it might be helpful to collect some of the best responses offered by long term Zero Carb practitioners and put them into one place for easy reference.

Basically, as you will see from the quotes below, there is no need to measure blood, breath, or urine ketone levels while eating an All-Meat diet in order to experience the benefits that this way of eating offers.

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Rose Nunez Smith:

I’ve been ZC nearly six years. A couple years ago I got scared about cancer (I’m adopted and discovered a long list of direct maternal relatives who died of cancer), so I bought a blood ketone meter, what with all the exciting research starting to happen around ketosis and cancer. When I’d been VLC eight years ago, I turned the ketostix purple consistently, so I figured I’d get a pretty good reading on a blood meter.

I couldn’t get above trace. My diet for years had been meat, egg yolks, butter and lard for cooking, water, coffee. That’s it. I began cutting meat and adding more butter. The number nudged up. I cut out beef entirely, eating chicken, pork and fish, and added coconut oil to my coffee. A little more nudge. I skipped breakfast and lunch and ate one small meal at night, smothered in butter. Finally, a reading over 1.0. I was elated. It had taken about fifteen days to get there. On day 20, I realized I felt awful. That feeling kept going for about another week, so I started to log my food into NutritionData.

I was eating 800 calories a day! I had no idea I was eating that little, just to get a reading on the damn meter. I went from a healthy ZC diet to 800 calories a day for a stupid number. That little adventure cost me a lot, too–I had a rebound effect for a long time afterwards, and didn’t fully recover my ZC zen until a few months ago, but that’s another story.

When I first read a few years ago that the Inuit didn’t register ketones, I didn’t believe it. They MUST have been in ketosis with all that fat and no carbohydrates in their diet. Now I think there’s a strong possibility that long-term keto-adaptation can lead some (many? most?) people to not “spill” ketones, even in their blood.

I don’t show more than trace ketones on the blood meter, and I’ve been ZC for nearly six years. As mentioned above, I have to drop to near-starvation levels to go above 1.0. Several long term folks have reported similar experiences. It’s an open question whether ‘being in ketosis’ is really the same as ‘showing ketones.’ Perhaps it’s possible that the longer you’re in ketosis, the more efficiently you use ketones, and – consequently – there’s less to measure, even in the blood.

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Dr. Paul Mabry:

Just because you get a low number on a fingerstick ketone reading doesn’t mean you’re not in ketosis. The liver maybe supplying them the same way modern car plants are supplied parts using the “just in time system”. It’s the most efficient and cost effective. The get just enough parts every day keep the assembly line going. In the same way your liver may be sending “just enough” ketones to the cells of the body to fuel them with no build up in levels in the blood. This is common for folks in long term ketosis.

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Kelly Williams Hogan:

I have never used a Ketone stick and never plan to. I have no idea if I have ever been in ketosis, nor do I care. All I know is that I have lost 130 pounds, feel amazing, regained my fertility, have plenty of energy, and lead a happy and fulfilling life by eating high-fat meats and avoiding all carbs.

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Charles Washington:

Those of us who have been on Zero Carb for a long time generally do not devote much attention to ketosis. If you eat meat and drink water, you’re going to be where you need to be both health-wise and weight-wise. Turning the Keto-Stix purple does NOT guarantee weight loss. After a while on Zero Carb, we don’t turn those strips dark colors anymore, nor can you detect it in our breath because our body learns to use the ketones efficiently and stops spilling them into the urine and breath. There might, however, be detectible ketones in the blood.

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Ash Simmonds:

In the same way that sobriety is an obligate side effect of not consuming alcohol, ketosis is an obligate side effect of not consuming carbs. I tested my ketone levels hundreds of times throughout 2014 just for fun, and my readings were consistently between 1.4 – 1.9. Higher ketone levels are only a goal for those with severe brain or central nervous system malfunctions – like epilepsy or Alzheimer’s Disease – where running on ketones is the best or only option to reduce complications or mitigate disease progression. The rest of us can safely ignore ketone levels because, when you are not consuming any carbs, you will always be state of mild ketosis.

[Ash Simmonds is the creator of the High Steaks | Meat is Life website dedicated to sharing information on low carb eating and the author of Principia Ketogenica, the most complete collection of low carb research available in a single volume.]

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Margot McGraw:

After 3 years of low carb and checking those sticks every day for ketones, I lost 50 pounds. I went to Zero Carb and lost the last 30. I stopped worrying about my level of ketones and I never peed on a stick again. After 18 months of zero carb, I had a complete blood panel and urinalysis done. After a 12 hour fast, the lab detected ZERO ketones in my urine. Ketones DO NOT MATTER to the success of a Zero Carb diet. Monitoring and measuring them is a waste of time, money, and mental energy. During the years I was eating low carb, and then very low carb, my Keto-Stix were sometimes purple, but I never lost an ounce in the last year of eating very low carb in spite of being “in ketosis.”. In fact, I actually gained 10 pounds! I lost those last 30 pounds with Zero Carb and never thought about ketones again.

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When I (Esmee) first found the Zero Carb community myself, I was very curious about the ketone issue. So, a nice man from the community who had been eating a Zero Carb diet for about 6 months volunteered to test his blood and breath ketone levels for me.

Kevin Fenderson:

I have one keto blood strip left, from back when I tested regularly. I just ate a fairly protein heavy meal 45 minutes ago. It was a NY Strip steak (probably about 10-12 oz), topped with a burger (~ 8 oz) and two fried eggs. It’s probably around 130-140 gms of protein in a single sitting. Also, it’s likely the only time I’ll eat today. I will wait until about 5 pm, about 1.5 hours after eating it, and test my blood ketones at that moment.

Okay… at 5 pm, my blood ketones measure 0.7 indicating a low level of ketosis. The Ketonix Sport breath ketone meter gives me 6 green blinks, indicating a low level of ketosis. So, I am below the “target” range for those who want to get to an optimal level. My diet, as I have said, is pretty consistent from day to day, thus I suspect that this reading is pretty indicative of what I would get any other time. But it fell right where it was falling when I first switched to meat and was still measuring on a regular basis (between 0.5 and 1.0).

These days, I don’t test my blood ketones at all. I don’t test my breath ones either (I have the meter as well). When I transitioned to just meat, I slowly started to worry less and less about actually being in ketosis or not. When I was testing, at the start, I found myself to usually be between 0.5 and 1.0 on the blood meter. So, the low end.

After I moved over to a Zero Carb diet, I put away all my expensive ketone testing gear. It was just collecting dust. I don’t even want to think about all the money that I spent on ketone test devices and blood strips. It was easily several hundred dollars. And, it didn’t actually mean anything in the end. It is nice to not have anything to track or worry about now (except possibly over-cooking my steak).

Instead, I am now focused on how I feel, rather than on my level of ketosis. If I was to discover that eating meat until satiety was negatively impacting me being in ketosis, then I would just have to say that ketosis was a less than optimal state of being for me.

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The Inuit Ketosis Controversy

Regarding Rose’s comment above about whether or not the Inuit were in Ketosis, these excerpts from Lierre Keith’s excellent book The Vegetarian Myth may explain this phenomenon…

The diet consists of “whale, caribou, musk ox, Arctic hare, rock ptarmigan, walrus, seal, polar bear, seagulls, geese, duck, auks, and fish, all often (but not always) eaten raw and fermented.” They also ate liberally of salmon and roe. Organ meats of large land mammals were also consumed raw…

The raw components of these fats are critical. The metabolism of cooked fats results in by-products called ketone bodies. An elevated number of ketone bodies in blood and urine is a state called Ketosis… Ketosis is a perfectly natural state. We evolved to store fat when we had plenty [of food], and burn fat when food was slim…

But what is more interesting is that studies of indigenous people eating essentially nothing but protein and fat “showed no Ketosis. These native people completely metabolized the fats in their… high fat diet because many of the fats were raw. This is not surprising since lipase [an enzyme for fat digestion] is found in concentrated amounts in raw! natural fats.”

~These excerpts are taken from pages 190-191.

…..

In conclusion, it doesn’t seem to matter if we register ketones in our blood, breath, and urine or not while eating a Zero Carb diet because the beneficial effects of eating this way appear to be independent of ketone levels. However, it is probable that many – though not all – who follow a Zero Carb diet would likely register low levels of ketones in their blood if tested. But the cost of testing blood ketone levels on a regular basis is prohibitively expensive, and absolute ketone levels have not been observed to make any difference to the outcomes of the individuals following this dietary path.

44 thoughts on “Ketosis”

  1. I was beginning to think it was just me!

    After the first 2 weeks of starting Nutritional Ketosis I was in the “zone” – blood ketone scores of over 2.4. Since then I can’t get sores of over 0.2 !!

    Ive been on this nutritional journey for the last 5 months, not to lose weight but as an experiment for my intense training loads for an event that I’ve got coming up. previously my training programs relied heavily on carbs and gel shots, but I’d still come up short.

    So far my Nutritional Ketosis journey has definitely been a very good decision!
    I can back up heavy training days no problem! I can’t even remember the last time I suffered from severe DOMS !!

    I’m relieved after reading this article!

    Thanks 🙂

    PS. You can follow my journey for the 2015 Fairfax Police & Firefighter Games on instagram – @KetoFirefighter

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  2. I went low Carb for a few weeks, 20 grams of carbs per day. When I checked my ketone levels it was 5.3, wich really scared me. I upped my intake to 30 grams and now my ketone level is 3.7. I know 10 is ketoacidosis, so I was thinking if I get a reading of 6 or higher I will stop. I went to the doctor to check and I don’t have diabetes. I guess that my body just does not efficiently use ketones yet, but such high readings do scare me. Now I really want to try Zerocarb for a month, at what ketone level do you think I need to stop?

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    • If you are not a diabetic, then you will not experience negative effects from ketones in your body. It is not the ketones that are the problem for diabetics, but the acidosis they are experiencing. The ketones are present, but not the cause of their issue. Nutritional ketosis and keto-acidosis are two entirely different phenomena. People with epilepsy, that are put on very high fat ketogenic diets, often register ketones in the 5-7 range with only beneficial effects for their brains. You might find this article on keto-adaption helpful: http://www.ketotic.org/2012/05/keto-adaptation-what-it-is-and-how-to.html

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  4. Hi Esmee! I’ve really enjoyed reading your blog. I too don’t show ketones on the stick and this morning I was at 0.1 on my NovaMax ketone meter. LOL.

    I have spent way too much time and money fretting over ketones for most of my adult life.

    Sometime last December, I got to thinking that VLC was not working for me because of my overactive insulin response to even thinking about food. Sheesh!

    In February I got serious and moved closer to ZC. I’ve lost about 20 pounds of fat according to my DEXA, but only lost about 10 pounds on the scale.

    I am super excited! I’m getting stronger everyday. I’ve also started weight training regularly.

    This week, I broke up with heavy cream and coffee. It’s sad, but I’ll get through it. It’s just meat, animal fat and water now.

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  5. Hi Esmee! I’m curious about the effect of an all meat diet on glucose levels for those with insulin sensitivity. I normally register ketones in the 3s but glucose is usually above 90 fasted which is keeping me from adapting. I have an ungodly amount of food sensitivities which I’m sure affect my glucose numbers. Would love to move away from plants as I find I naturally crave just bone broth and meat…but what about gluconeogenesis?

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  6. Remember, ketosis occurs around 75-20-5. Even if your carbs are zero, if your protein intake is above 20% give or take, then the liver will simply metabolize protein for energy and you will not be in ketosis, (like your Eskimos) thus you will have nil/very low reading on your measuring device.
    As one poster noted, he/she could only get the needle to budge when they were on a total fast and that was very uncomfortable for them. NASA has done small studies on this for long term space flights. Keto diets and total fasts(supplemented of course with vitamins etc.) were found to work but had the following drawbacks 1) the astronauts were not about to give up their carbs 2) getting rid of keytones in the air might be a long term problem, and 3) a slight lowering of cognitive brain function.
    To me this is a fascinating topic, but one that needs empirical studies not just random anecdotal evidence. The problem with a clinical trial is who would pay for it? And who would participate? How would you double blind a ketogenic diet?

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    • The amount of fat and protein a person can eat and still remain in ketosis is actually different for different people and on a zero carb diet, most people can eat more protein because they are not ingesting carbohydrates. We have one person in our group who eats 45% protein and 55% fat and she is still in ketosis. I personally feel better on about 70% fat, and I know others who feel better on 80-85% fat. If a person is a type 2 diabetic starting this diet, they usually have eat less protein to start out with, but as their metabolism heals, they can often increase the amount. Thanks for your input and I really need to re-write this page!

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  7. Hi,

    Is it possible that not showing the ketones in this diet is because of too much protein compared to ketogenic diet where the protein is moderate?

    Thanks

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  8. Hi there. Is it possible to eat Zero Carb and still keep a low protein profile? I am allergic to basically all fruit, many salad stuffs and low carb vegetables make for a miserable, bad smelling meal.

    I’ll eat any meat you give me, but do you have any tips for keeping the fat percentage higher than the protein? Cooking in butter or ghee, making buttery ‘sauces’, for e.g.? Great website!

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  9. Hi Esmee, Very cool site, I found your site last weekend and quite moved by your story, What a journey! I have a question I want to get your advice. I transformed from a plant base most raw diet to HFLC about 1year and half, I only eat meat, bone soup and green vegi,but I gained 30lb! its a lot, since I was slim before. By checking my blood glucose, I found after meal, mostly between 90-110,but after 4hours, it dropped to 60- 80, sometimes even 57. I read your post regarding bone broth, made me think my diet, since I almost ate beef broth every day two meals. Now I move to Zero carb, beef and water only for 30 days. today is my third day, I checked my blood glucose about 4.5 hours after breakfast, it was 67, half hour later, 84, then I ate dinner, one hour later, 68, two hours 87. maybe the meter is not very accurate, but what do you think my readings? I also seeing your interviews with people, when they eat ground beef raw, is it safe? anything need to do before I take them out from the store package?
    Thanks for your time,
    Jessica

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    • Jessica – I am really surprised that you have gained 30 lbs. However, I think that a raw vegan diet is deficient in a lot of things and when those of us who have followed such a diet for a long time start eating animal foods again, our bodies are so happy to get what they have been starving for that they hold on to as much of it as they can. At least that is one possibility. I also think that eating a raw vegan carb-based diet can lead to high insulin levels. It would be very interesting to know what your fasting blood insulin level is, but that test has to be done through a lab. The glutamine in bone broth definitely can be easily converted into glucose, and so that might be working against you. I think your idea of doing only beef and water for 30 days is a good one. Do you have any idea how many grams of protein and fat you have been eating per day? Often people tend to think they need to eat a lot more fat than they really do and this can get translated into body fat, especially if your insulin is on the high side. Also, please tell me how tall you are.

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      • Thanks Esmee for your quick reply! I have checked my glucose fasting at Dec-2015 5.2mmol/L, and Oct-2016 at 5.3mmol/L, my triglycerides was 0.52 and Cholesterol is at High risk 6.97 mmol/L, HDL 2.86,LDL 3.87. I was very puzzled at HFLC diet for me, my blood glucose just could not contain within 40 range(for low to high), which swing is bad for me. My weight is really bother me, relatives look at me, say you are the example that eat fat grow fat. My height is 160cm was 120lb and doing endurance running, hiking, before but now at 150lb. And I am Asian, which my ancestor certainly does not eat a lot of meat. I looked through your articles, is trying to figure out how much protein and fat ratio should I take at this stage. I am eating maui ribs now which is a thin cut, and has a lot of fat in it.
        Thank you so much for your time and I am looking forward to hear from you!
        Jessica

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        • Your total cholesterol is not really that high. Your HDL is phenomenally good and your triglycerides are also excellent. Based on your HDL/Trig ratio, I believe most of your LDL cholesterol would be the large fluffy kind (measured by a special particle test) which is what you want. So, I don’t see anything amiss in your lipid profile.

          Your weight, however, has me a bit baffled. Based on your height, you need a minimum of 90 gm of protein per day which is equivalent to 15 oz of meat (lean portion). This is the very least you should eat to support your lean body mass (muscles, bones, etc.). We generally recommend starting with a 1:1 ratio of fat to protein, and to eat this ratio to satiety as often as you feel hungry. In the US, meats that naturally contain this ratio of fat to protein are 80/20 ground beef (if all fat that cooks out of it is also consumed), chuck roast, New York Strip Loin, and Ribeye. We recommend this for people who are just getting started and need to go through adaptation and get past all the initial carb cravings. Once you have done this, and see how your body is responding to this ratio, then playing with fat to protein ratios can be done. It would really be helpful for me to know exactly how much fat and protein you have been eating on average each day. I really cannot suggest adjustments without knowing what you have already been doing.

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          • thanks Esmee, I am buying a scale to measure my meat, maybe I should not add any fat on beef even if the part is a bit lean. I will play with the ratio, and see how that works. in my case, could I eat bone marrow?
            Jessica

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  10. Is it possible to do ZC and not reach ketosis? I’m going on my 2nd week and am now just starting to feel the withdrawal from sugar, but not losing any weight. Following the height and weight requirements. Does it take longer to start losing the weight?

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  11. Hunters like the Inuit were forced into cycles of feasting and fasting (shouldn’t zero carb include fasting periods? Dr. Fung thinks so.). My Ketonix usually registers low levels of nutritional ketosis (50+-5), but when I did a 4 day fast the level jumped to 80+. I have metastatic prostate cancer (good news is that the last 2 PET scans showed sites smaller and/or less active) so I periodically need a 70+ level (says Ketonix inventor). The fasting induces autophagy (cleans out damaged parts inside cells) and apoptosis (programmed cell suicide of damaged cells, like cancer cells); i.e., a natural “cleanse”. Eating anything stops autophagy cold. Dr. Seyfried recommends 1-2 one-week fasts per year to prevent cancer, and many more for those with cancer. For those already in nutritional ketosis, the fasts can be shortened by 2 days. There is also some evidence that the ketones themselves negatively impact cancer cells.

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  13. With regards to the excerpt about inuit and other indigenous people not being in ketosis because the fat they ate was raw…
    I eat nothing but raw beef fat and raw meat and am consistently in nutritional ketosis (anywhere from 0.8 to 8+ mmol). I get 85 to 95% of calories from fat and have been eating up to 4500 calories per day the last couple of months (very active job).

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  14. I’ve never heard of the all meat diet, just found you while doing research for keto diet drinks. I’ve just started a more plant based diet… wow, this really runs counter to that. I’ll have to read more to see what your testimonials pages say… this is a big change from where I am… thanks for your perspective!

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    • Many who have found this way of eating were former plant-based eaters. I was a vegan/vegetarian for 25 years. It made me very, very sick unfortunately and I will probably never be right because of that stupid choice.

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      • My own stupidity in that area “only” lasted 10 years (I was a vegetarian for seven years and then a vegan for three) but I regret each and every one of them. Especially the vegan diet thoroughly screwed up my health. I have meanwhile been able to reverse most of the issues but some are not so easy to remedy …

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  15. Pingback: Eat Meat. Drink Water? Do Tell! | EAT ME - I'm your friend!!!!

  16. I wanted to try the all meat diet, looks promising, but unfortunately I have B6 toxicity, and each time I eat too much meat (even if I feel it helps me a lot with other gut and sleep issues), so I don’t know what to do now, most meat is high in B6 I don’t seem to find a solution all meat low B6, what would you suggest ? thanks

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    • You should not be able to get B6 toxicity just from eating food unless you have some in born error of metabolism that does not allow you to eliminate it properly. It’s a water-soluble vitamin. I guess you would just need to monitor your levels. Do you experience negative symptoms from your high B6 levels?

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      • Thanks Esmée for your kind reply and great website. My levels were 127 (B6) which is above the recommended max level here (which is around 110 if memory is ok, and is already higher then in other countries). It seems that when eating just meat, I feel energic, but maybe too much 🙂 My muscles, especially shoulders become tense and painful, close to fibromyalgia symptoms, tinnitus and anxiety increases (I suffer from tinnitus since 17 years + allergy, some eczema, sleep apnea and digestive issues depending on what I eat) but it goes away as soon as I lower my meat/protein intake. But the same happens when I use B6 supplements (which I don’t use since a long time anymore). I have read somewhere that some people don’t eliminate B6 very well, so maybe that’s my issue too. Really sad, because I saw a few great improvements in my energy, and also eczema and digestion and sleep apnea. Is there a way to eliminate B6 better ? thanks again and keep up the great work!

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          • Never heard of that kind of doctors but I’ll check it out, thanks! It seems that B6 toxicity is something most doctors ignore and is relatively new, but is actually a problem a lot of people aren’t even aware off and think they have something else, but I’m going to do a few more tests. Something I heard from a french naturopathe is that supplementing with glycine is interesting to remove the excess of methionine from eating lots of meat. But I don’t seem to find info on B6.

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