What are Ketones (in urine) and Ketones Are They Dangerous?
An alternative source of energy has attracted the attention of many nutritionists and scientists in recent years.
I am not talking about carbohydrates, fats or proteins, but about another source of energy. We call them ketones or ketone bodies. For your body, however, ketones are nothing new.
Our heart and brain cells use ketones (in part) as fuel. These cells prefer to use ketones instead of blood glucose (blood sugar).
After days of fasting or following a ketogenic diet, the production of ketones increases and other cells such as your muscles and brain cells also begin to use them for energy.
This is the primary goal of the ketogenic diet.
To know if you are actually in ketosis you will have to measure the number of ketones in the blood or urine.
As a result, ketose sticks and ketosis strips are popular tools used by many people to measure ketones.
But how do they work exactly? And are they accurate for measuring ketones? You learn that after reading this article.
What you will discover further in this article:
- What exactly are ketones
- How you can measure ketones with ketosis sticks and ketosis strips
- The most accurate method to measure ketone levels in your body
- The most common symptoms of ketosis
- Several health benefits are in ketosis
- The liberating answer to the question of whether ketones are dangerous
- And much, much more …
What are ketones?
A quick search in Google yields dozens of results that refer to ketones.
Ketones and ketone bodies are used interchangeably in many articles, but they are not exactly the same. So let me start at the beginning so that it becomes clear what ketones can mean for your body.
Most people extract most of their daily fuel from glucose. Your body needs the energy in glucose to function. Glucose is obtained by the body by eating carbohydrates.
Glucose is the primary source of energy for our body. This is because it can be broken down to energy much faster than any other energy source (protein or fat).
However, the use of glucose as fuel has a number of negative effects.
What we gain from speed, we lose efficiency …
During the process of sugar incineration, more free radicals and molecules (called reactive oxygen species) are released.
These are harmful substances that can cause cell damage. Less energy is also created than when we use ketones and fat as fuel.
Ketones are an alternative fuel that body can use for energy. Ketones are produced by the breakdown of fat.
There are three types of ketones (also called ketone bodies):
- Beta-hydroxybutyric acid
- Acetone (an organic compound that results from the breakdown of acetoacetate)
The first thing to remember is that these ketones meet the energy needs of our body in the same way as glucose.
Often we hear that carbohydrates are essential for energy, they are not. Our body can also meet its energy needs through fat.
However, unlike glucose, ketone bodies do not affect blood sugar levels or insulin levels.
Ketones are a more efficient energy source that inhibits the production of free radicals and reactive oxygen species. This leads to numerous benefits, especially for the brain cells that use ketones instead of sugar as fuel.
Several studies on people with different types of cognitive problems (such as Parkinson’s disease or epilepsy) confirm that the use of ketones as fuel can greatly improve brain function (source, source).
Your body is put into ketosis when it is minimally supplied with glucose and therefore has to turn to another source of energy for primary fuel.
However, the body can use both carbohydrates and fats for fuel (source). When the intake of carbohydrates is very low, the body switches to fat burning for energy.
If this happens for several days, then your body is in a state of ketosis.
When glucose is not readily available, fat is broken down by the liver into glycerol and fatty acid molecules. The fatty acid is continued to be broken down in a process that we call ketogenesis. During this process, acetoacetate is the first ketone body that is produced.
Acetoacetate is then converted to beta-hydroxybutyric acid (BHB) or acetone. Acetone is the least common ketone body, but it can be made in larger quantities when you first start the ketogenic diet.
As your cells adapt to the limitation of carbohydrates, BHB becomes the most common ketone body and your brain cells and muscle cells use it as their primary fuel.
In ketogenic condition, ketones can provide up to 50% of your basal energy requirement and up to 70% of the energy needs of your brain (source).
A strict low-carbohydrate diet limits the glucose available to your body, forcing your body to burn fat. This can lead to ketosis.
It is important to note that not all low-carbohydrate diets create a ketogenic state. It depends on how much carbohydrate you consume daily.
If you eat up to 20-30 carbohydrates per day, you usually end up in a ketogenic state within a week.
While you eat fewer carbohydrates, your insulin level decreases (source). This ensures that your body releases fatty acids. These fatty acids are brought to your liver, where they are oxidized (broken down).
In summary: Oxidized fatty acids are converted into molecules called ketones. Your body and brain can use ketones for energy.
Measuring ketones in the urine
So you want to get your body in a state of ketosis, causing the body to burn fat for fuel.
In that case, it is important to measure ketones in your blood. Only by measuring ketones you can find out whether you have reached the ketosis state.
While we are in ketosis, the concentration of ketones in the blood rises. Ketones are a by-product of the breakdown of fats. The measurement of ketones can, therefore, indicate whether our body is in a ketogenic state.
For this reason, ketose sticks and ketosis strips are becoming increasingly popular.
For people who want to know if they are in ketosis, ketose sticks are a cheap and easy way to detect the concentration of ketones.
They are also known as ketosis strips and work through urine analysis to determine the concentration of acetoacetate in the urine.
You probably already forgot what acetoacetate is.
Acetoacetate is one of the two most important ketone bodies and it is present in the urine. We can test it by using ketose sticks or strips.
Beta-hydroxybutyric acid is made from acetoacetate and is the second most important ketone body. This ketone body appears in our blood and a blood meter can tell us something about the concentration. More about this.
Acetone is also a ketone body, although not as common as acetoacetate and beta-hydroxybutyrate. The breakdown of acetoacetate produces acetone and it is present in our breath.
How do ketosis strips work?
Ketose sticks, or ketose strips, work quite simply:
- Collect some urine in a clean container (urine container).
- Take a thin strip in the hand with the spongy test area at the end.
- Keep the tip of the strip in the urine for a few seconds.
- Remove the strip from the urine.
- Wait 15 seconds for the strip to change color.
- Compare the color of the ketosis strip with the color chart to test whether you are in ketosis.
Below is a video of someone who shows it:
Knowing how to read the color strip is important.
Below you can see an example of a ketosis color chart:
The color on the left means that no ketones are present in the urine and the pink colors indicate a mild to moderate concentration of ketones.
The darker the color, the stronger the concentration of ketones in the urine.
State of ketosis Ketone level (mmol / L) Ketone level (mg / dl)
Very light 0,1 – 0,5
1 – 5
light 0.6 – 1.5 6 – 15
Average 1.6 – 4.0 16 – 40
Strong 4.1 + 41 +
You probably think that you should have the darkest color to be in ketosis.
But for a healthy person with a bit of overweight, very high ketone values are not necessary at all. Higher ketone values are not necessarily better. For the average person, light to moderate ketosis is fine.
Because even a light color already shows that your body is able to burn fat as primary fuel.
In short, striving for a random color on the color chart is not the right approach. Listen to your body and see how you feel!
Disadvantages of testing for ketones in the urine
The biggest objection I have to ketosis sticks is that they are not as accurate as you would initially think.
There may be certain circumstances in which measuring ketones in the urine produces inaccurate results.
# 1: Ketones in the urine give no indication of what happens in the body
Only the ketones that remain unused by the body are excreted via the urine (source). In other words, urine sticks only show the concentration of excessive ketones that our body could not use.
So suppose that the level of ketones in the urine is very low, this does not mean that the level in our blood is too low. It does not mean that we are not in ketosis.
# 2: Body needs time to adapt to ketones
Your body needs time to adapt to the ketogenic state. You may have heard of the ‘keto flu’. This refers to the often uncomfortable period in which the body begins to adjust to use fat for fuel instead of glucose.
In other words, when someone starts a ketogenic diet for the first time, the body will not yet use ketones efficiently (source). Therefore, a higher concentration of ketones will also be present in the urine in the initial phase.
Over time and as your body adjusts more to the burning of body fat as fuel, it should be more skilled in burning ketones for energy. As soon as this happens, the concentration of ketones that we excrete through the urine will also decrease.
This can be very confusing, because your body is increasingly in a ketogenic state, while the ketose sticks indicate that the ketone level in the urine is very low.
For these reasons, I find the blood meter a more reliable method to measure whether you are actually in ketosis.
Let’s take a look at the most reliable method.
Blood counters are much more accurate than ketone tests with urine strips. However, this accuracy does have a higher price.
How does the blood ketone meter work?
- First of all, you must place a strip in the blood meter.
- After this you prick your finger with a sterile needle to draw some blood. This only needs to be a drop of blood, just as it is the case with a blood glucose test.
- Place the drop of blood on the ketone strip and check the results.
This method is fairly simple and also provides a reliable indication of whether your body is capable of ketosis.
Although a breath measurement does not offer the same accuracy as a blood ketone meter, breath analysis has some positive points that I do not want to remember.
The purchase of the breath-meter is indeed more expensive than the ketone strips, but it is a one-time purchase.
Unlike the other two methods, you can use the breath meter as often as you like.
It is also easy to use and requires no urine or blood. If you are afraid of blood, a ketone breath measurement offers a solution.
How does the ketone meter work through breathing?
It works incredibly simple:
- All you have to do is switch on the equipment and breathe in for about fifteen seconds.
- Then wait a few seconds and check the results.
The breath meter is probably somewhere in the middle when it comes to accuracy.
Symptoms that you are in ketosis
In addition to measuring ketones using ketose sticks and ketosis strips, there is another way to find out whether you have reached the state of ketosis.
Before you can see the effects of ketosis, you can experience some symptoms. This would make you think in the first place that ketosis does not work for you, but this is a natural reaction and these symptoms are only temporary as your body adjusts to ketosis.
What should you pay attention to?
Some symptoms are mild in nature while others can cause serious health problems.
Let me mention the main signs of ketosis:
- Fatigue (short term)
- Cramp in the legs
- Constipation (constipation)
- Weight loss (mainly fluid in the first week)
- Decreased appetite
- Bad breath
- Increased concentration of ketones in the blood
Important: the above symptoms are no guarantee that your body is actually in ketosis. For this it is necessary to test the amount of ketones in your blood. But if your body switches, these symptoms will undoubtedly appear.
Some people have to eat fewer carbohydrates than others to get into ketosis, while others see an increased concentration of ketones within a few days. Every body is different and therefore our bodies will react differently to a keto diet.
There are many benefits of ketosis. To get into ketosis an increased concentration of ketones is necessary.
Once your body is in ketosis, different positive effects can occur. These health benefits go far beyond just weight loss.
The benefits of a keto diet are similar to those of other low-carbohydrate diets, but it is more potent than a normal low-carbohydrate diet.
Important benefits of ketosis are:
# 1: Weight loss
Changing your body into a fat-burning machine naturally influences your weight. Fat burning increases enormously, while insulin (the fat storage hormone) decreases strongly.
This creates ideal conditions in which you can lose weight without suffering from hunger. Several studies have shown that extreme low-carbohydrate and keto diets ensure effective weight loss (source, source).
# 2: Reduced appetite
Ketosis helps you regain control over your appetite. When your body is completely switched to fat burning, it has constant access to stored energy, which reduces the hunger feeling drastically.
# 3: Constant energy
During the adaptation period you may experience fatigue symptoms because the body adjusts to fat burning instead of sugar burn.
Once in state of ketosis you can experience an increase in energy. This is because in ketosis the brain hardly needs any carbohydrates.
You no longer suffer from sugar peaks (which are followed by significant decreases). The brains are now fed by ketones, which serve as a constant energy supply.
# 4: Suppresses epileptic seizures
The keto diet is a proven and effective medical therapy for epileptic patents that has been used since the 20th century.
Ketosis is mainly used in children who suffer from epileptic seizures.
Following a keto diet in epilepsy can mean that fewer or no anti-epileptics (medicines) have to be taken, while they are still free from seizures.
# 5: Can reverse type 2 diabetes
Believe it or not, type 2 patients with diabetes can reverse their illness with adjustments to their diet.
A keto diet can normalize blood sugar levels and works well for reversing type 2 diabetes.
This has been proven in several studies in which the ketosis diet helped a majority of the diabetes type 2 patients reverse the disease (source).
Research shows that as many as 94% of patients could stop taking insulin after having followed an extremely low-carbohydrate diet. They also lost 12% of their body weight in the same year.
It is perfectly logical since ketosis lowers blood sugar levels and insulin levels.
# 6: improvements in health markers
Health markers can say something about the risk of cardiovascular disease.
Deteriorated health markers are associated with various health complaints called the ‘metabolic syndrome‘.
There are several studies showing that extreme low-carbohydrate diets (leading to ketosis) help to improve cholesterol profile (HDL, triglycerides), blood sugar levels, blood pressure and insulin levels (source, source)
Are ketones dangerous?
You sometimes read that ketones can be dangerous to health. This has to do with various reasons.
The first reason is simply because the word ‘ketosis‘ is often confused with the word ‘ketoacidosis‘.
Let me be immediately clear about this: ketoacidosis is a condition in which you do not want to be. Ketoacidosis is usually associated with type 1 diabetes and is therefore also called diabetic ketoacidosis (DKA).
This happens when diabetes patients do not receive enough insulin. At that moment the body enters a state that is equivalent to starvation.
Curiously, this can also happen if patients have sufficient glucose in their blood. They are then unable to convert it.
The body then tries to adapt to survive and begins with the production of ketones. Hereby the goal is that the body uses ketones for energy. But the problem is that patients still can not produce insulin.
Ketosis is regulated by insulin. This prevents your body from exaggerating with the production of ketones. In ketoacidosis the insulin is not to indicate that the body stops producing ketones.
Together with a high blood sugar level this can ensure that the pH value of the blood is out of balance. When the pH of the blood becomes too low, the blood becomes dangerously acidic.
Hence the name keto acid (acid) ose. The reason for this is the fact that ketones themselves are acidic. This acidic condition can cause a series of dangerous symptoms.
Ketoacidosis can eventually lead to a comatose state and even death.
Another reason why people think ketones are dangerous is because they believe that our brains could not function without carbohydrates.
But the vast majority of our brains do NOT require glucose as fuel!
Some brain cells use glucose, which is not a problem (more about that).
In fact, this happens automatically when people have a shortage of food.
“But Tommy, what about those cells that still depend on glucose?”
In principle, this does not have to be a problem. I will not go into details too much, but during ketosis your body is involved in a process called gluconeogenesis.
Thanks to this process, a little glucose can still be produced that your brain cells need to function.
The third reason why some people think ketosis is dangerous is simply because of the presence of a larger concentration of ketones in the body.
Ketoacidosis is characterized by an extremely high concentration of ketones, much more than what is observed with ketosis.
But ketones are not just “bad”. Your body produces them because they are useful. Ketosis is not the same as ketoacidosis.
Because ketosis leads to the production of ketones, this does not automatically mean that you are in a state of ketoacidosis. Ketosis is a separate, safe and stable metabolic state!
Although ketosis is generally safe and healthy, you can experience some side effects that are not so pleasant. Side effects such as cramps in the legs, bad breath and digestive problems are not uncommon. They are described as the ‘keto flu’.
However, these effects are usually temporary and should disappear within a few days or weeks. Changes in diet and lifestyle can also help to minimize these complaints.
Some people feel great during ketosis and experience a lot of health benefits, while others feel better on a normal low-carbohydrate diet.
In summary: Are ketones dangerous? No not for healthy people. Because ketones in themselves do NOT result in ketoacidosis. The production of ketones (which affects your body in ketosis) has different health benefits.
And if you still have doubts about deleting almost all carbohydrates from your diet to achieve a state of ketosis, then you can always try a fanatical low carbohydrate diet (50-100 grams of carbohydrates a day) that is not ketogenic and also many health benefits.
Did you know that research shows that 1 in 3 just gains from a diet instead of losing weight? (source)
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