The ketogenic diet has been demonstrated to have a wide variety of benefits spanning multiple populations including the treatment of epilepsy, type-2 diabetes, neurological disorders, weight loss, endurance performance and even certain types of cancer treatments (1-5). The hallmark of a well-formulated ketogenic diet is a rise of ketone bodies which happens following a prolonged period of carbohydrate or caloric restriction (i.e, fasting). Ketone bodies are produced in the liver as an alternative fuel source to carbohydrates and measuring ketones is a way to determine the degree of ketosis someone is in.
The two primary methods for measuring ketones are via blood and breath testing. There are a number of consumer devices on the market to support either method. Having a central location to track ketone values can help you fine tune your approach on the ketogenic diet. The Heads Up Health web app is designed specifically to help you track ketones alongside all of your other vital health data. You can start your free 30-day trial (no credit card required) using the button below. Or, read on to learn more about the difference between blood and breath ketone testing.
Why Measuring Ketones Matters
Being able to frequently and accurately measure the level of ketosis can be important for those following the ketogenic diet for clinical purposes as well as for overall health and performance. Due to individual variability in response to different types of food, having frequent feedback will aid individuals towards improving their understanding of how their body responds while increasing motivation and adherence.
This need has led researchers and practitioners to be on the look-out for fast and accurate methods to assess ketone levels. Traditionally, ketone levels have been assessed via urine strips and while this method may be easiest, it is not the most practical. This method measures the excretion of ketones and wasn’t intended for people following a ketogenic diet; rather it was intended for those suffering from conditions such as diabetic ketoacidosis. This is because urine strips test for unused acetoacetate rather than the main ketone that our body does use, B-hydroxybutyrate.
In the ketogenic space, measuring the blood B-hydroxybutyrate concentration is the standard protocol. While this method has been shown to be more accurate than urine tests, these blood assessments may be troublesome for children and elderly, and could become expensive (requires a constant supply of blood strips), and not as practical outside of a clinical setting.
Recently, researchers have identified breath acetone assessments as a practical and accurate method to determine level of ketosis (6).
What is Breath Acetone?
When following a ketogenic diet, acetyl-CoA is produced in the liver from the breakdown of fat and is used to produce acetoacetate, one of three ketone bodies. From there, acetoacetate can be converted to the other two “ketone bodies”, b-hydroxybutyrate and acetone. While b-hydroxybutyrate is tested via blood meters, acetone actually diffuses into the lungs and can be measured by testing exhaled breath (7)! Acetone is a byproduct of fat metabolism and is present in the breath of all humans but in different concentrations.
In healthy individuals, resting acetone levels may range from 0.5 to 2.0 ppm. Individuals following the ketogenic diet can see levels of acetone up to 40 ppm. Individuals undergoing a prolonged fast may see elevated levels up to 170 ppm. Lastly, uncontrolled diabetes and subsequent ketoacidosis may lead to acetone levels of 1250 ppm (8).
It is also interesting to note that as acetone is a byproduct of fat metabolism, it can also be used to measure the rate of fat loss (9).
More specific for those following a ketogenic diet, to date, six studies have compared breath acetone levels with blood b-hydroxybutyrate levels and have found a strong correlation (R2= 0.77) (8). One study in particular directly compared blood, breath, and urine samples of 12 healthy individuals undergoing an experimental protocol designed to induce a state of ketosis. The results demonstrated that plasma acetoacetate was best predicted by breath acetone (6). Therefore, it appears that breath acetone assessments are a fast and accurate way to test for the degree of ketosis.
Tracking progress with Heads Up Health
The Heads Up Health web app is designed specifically to help you track your progress on the ketogenic diet. Powerful dashboards, charts and other tools help you use data to customize and fine tune the ketogenic diet for your own body. More specifically:
- Connect the LEVL breath ketone analyzer and instantly sync your readings. Learn more.
- Connect the Ketonix breath ketone analyzer and instantly sync your readings. Learn more.
- Easily track Keto-Mojo readings on your Heads Up dashboard. Learn more.
- Track ketones from other blood meters. Learn more.
Create your own personal dashboard with the metrics that matter most to you!
Blood vs. Breath Ketones
Wrapping it up: Measuring Ketones (Blood VS. Breath)
While blood assessments are a great way to measure ketosis, breath acetone assessments also appear to be a fast and accurate measure to determine the degree of ketosis. This is not to say that blood assessments should lose any of their value as they are still extremely valuable and should be taken in conjunction with breath assessments. However, the major benefit to breath assessments is the practicality of breath ketone levels as it can be assessed frequently with no invasive procedures helping individuals maximize their ketogenic diets!
Heads Up Health lets you track all types of ketone measurements – urine, breath and blood – so you can choose the method that works best for your lifestyle and budget. Additionally, the LEVL and Ketonix breath ketone meters can be electronically linked to your Heads Up Health account so readings will be synchronized automatically and can be tracked alongside all of your other vital health data. Start your free 30-day trial today!
1.) Neal, E. G., Chaffe, H., Schwartz, R. H., Lawson, M. S., Edwards, N., Fitzsimmons, G., … & Cross, J. H. (2008). The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. The Lancet Neurology, 7(6), 500-506.
2.) Westman, E. C., Yancy, W. S., Mavropoulos, J. C., Marquart, M., & McDuffie, J. R. (2008). The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & metabolism, 5(1), 36.
3.) Gasior, M., Rogawski, M. A., & Hartman, A. L. (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17(5-6), 431.
4.) Johnstone, A. M., Horgan, G. W., Murison, S. D., Bremner, D. M., & Lobley, G. E. (2008). Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum–. The American journal of clinical nutrition, 87(1), 44-55.
5.) Zhou, W., Mukherjee, P., Kiebish, M. A., Markis, W. T., Mantis, J. G., & Seyfried, T. N. (2007). The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer. Nutrition & metabolism, 4(1), 5.
6.) Musa-Veloso, K., Likhodii, S. S., & Cunnane, S. C. (2002). Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. The American journal of clinical nutrition, 76(1), 65-70.
7.) Kalapos, M. P. (2003). On the mammalian acetone metabolism: from chemistry to clinical implications. Biochimica et Biophysica Acta (BBA)-General Subjects, 1621(2), 122-139.
8.) Anderson, J. C. (2015). Measuring breath acetone for monitoring fat loss. Obesity, 23(12), 2327-2334.
9.) Freund, G. (1965). The calorie deficiency hypothesis of ketogenesis tested in man. Metabolism-Clinical and Experimental, 14(9), 985-990.
In this post we will explore the high fat diet and how you can start testing if for yourself. We propose that rather than focusing on “reducing fat” and “cutting calories,” you should consider a focus on eating foods that promote stable blood sugar.
Healthy and stable blood sugar holds the key to weight loss, hormonal health, better sleep, stable energy, lower blood pressure and more. As it turns out, a diet that supports stable blood sugar tends be higher in healthy fat and lower in carbohydrates.
Heads Up Health gives you the tools to change your diet and track the results for yourself, regardless of which diet you are on. You can get started for free using the button below. Or read on to find out how you can transform your health through a high-fat diet and better blood sugar management.
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High Fat Diets – Getting Started
Step 1: Re-program the way you think about weight loss
Making the switch from a low-fat diet to a high-fat diet may seem counterintuitive for many people. For decades we’ve been told to eat “low fat” and that in order to lose weight, we should cut back on calories.
As it turns out, the whole notion that dietary fat leads to high cholesterol and that high cholesterol causes heart disease was based on research that has now been disproved. We had it wrong. Rates of heart disease, obesity, cancer and diabetes have INCREASED as we’ve removed healthy fats from our diets and replaced them with calories from refined carbs, sugar, grains and processed foods.
When consumed, these processed foods (bread, cereal, pasta, fruit juice, grains, soda etc.) cause huge spikes in our blood sugar. When blood sugar spikes, the pancreas secretes insulin to help shuttle the circulating glucose into our fat cells. Insulin is a hormone that tells the body to store fat rather than to burn it as fuel.
Blood sugar testing before and after meals
By switching to a diet that keeps blood sugar low, we reduce insulin secretion and reduce the amount of fat being stored by the body. Replace refined carbs, grains, sugars and processed foods with sources of healthy fats such as avocado, salmon, butter, olive and coconut oils, nuts, seeds, and grass-fed meats. We provide some recommended reading on finding an optimal diet in the appendix.
Key takeaway: Shift your thinking from “low fat” and “calorie restriction” to instead focus on “low blood sugar” and “minimizing insulin secretion”. You can eat healthy, high calorie, high fat meals that keeps you feeing full and keeps blood sugar low.
Key takeaway: Eating healthy fat does not make you fat. Food that jacks up your blood sugar makes you fat. Healthy fats provide a slow, stable calorie burn and do not spike blood sugar.
Step 2: Exercise
Diet alone is rarely enough to reach a state of optimal health. We still need to exercise. Our bodies have evolved to be physically active. Sweat is your friend! Develop an exercise plan that works for you. Ideally one that focuses on plenty of walking (10,000 steps per day), strength training 3 times per week and sessions of higher intensity cardio at a level that is safe for you.
Our bodies were designed to move! Tracking steps can help…
Step 3: Measure-Measure-Measure
Don’t take our word on any of this stuff, try it yourself and collect the data!
3a. Measure your macronutrients: Download myFitnessPal and start logging everything you eat. myFitnessPal will show you exactly what percentage of your calories are coming from fat. vs. carbs. vs. protein (see image below). Slowly move your macronutrient breakdown to the point where you are getting 50-60% (or more) of your daily calories from healthy fats. Keep protein at about 20% and the remainder from complex carbohydrates (vegetables, sweet potato, yam).
Track your macronutrients with myFitnessPal
3b. Measure your blood sugar: Purchase a glucometer and start logging your blood sugar. We recommend checking your fasting blood sugar in the morning and also measuring your blood sugar one hour, two hours and three hours after each meal.
Blood sugar testing
Experiment: Test your blood sugar one hour after eating pizza, a burger/fries or your favorite comfort food. Compare to results an hour after eating a hearty serving of salmon and steamed vegetables loaded with butter. You should see a much lower reading from the high-fat/low carb meal. Tailor you food intake to meals like this which keep blood sugar low.
For a quick tutorial on how to track blood sugar in Heads Up Health, see this video.
3c. Track your weight and your body fat percentage: There are scales on the market for under $50 that can measure both weight and body fat (see appendix for recommendations). Log this data in Heads Up over the course of your experiment.
Experiment: Cut out bread, pasta, sugar, soda and as many processed foods as you can for one month. Get at least 10,000 steps per day. Track your data in Heads Up Health. Do it!
Step 4: Work with a professional who can guide you on your journey
Many conventional doctors are still preaching the low fat dogma and will counsel you against moving to a diet higher in healthy fats. Seek out an alternate practitioner who can give you another perspective and come to your own conclusions on what you think will work best for you.
Primaldocs.com is a great source for finding a health practitioner who can help you on your journey. You can also contact Heads Up Health’s own Functional Medicine advisor, Dr. Justin Marchegiani, who can guide you on making the changes to your diet.
Somewhere along the line we got it wrong. We thought dietary fat was bad and we removed it from our diet. We replaced fat with sugar, grains, refined carbohydrates and processed foods but this made the situation worse. Now our blood sugar is getting jacked up after every meal and it’s making us fat and sick.
Our key takeaways:
- Reduce or eliminate breads, pastas, grains, sugar, processed foods and refined carbohydrates. Start slow and work at your own pace to phase these foods out of your diet.
- Replace the calories that were coming from these foods with calories from healthy fats. Obtain the rest of your calories from good quality protein, vegetables and modest amounts of low-sugar fruit.
- Exercise. If nothing else, strap on a FitBit and get 10,000 – 15,000 steps per day. Ideally add in strength and cardio training.
- Measure your results in Heads Up Health. The data will guide you.
- Find a skilled practitioner to help you on your journey.
New research has shown us that healthy fats are good for us. They keep blood sugar low and provide a steady source of energy throughout the day. You can make the switch and Heads Up Health will give you the tools to measure it yourself. Sign up now and get started or contact us if you have any questions!
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- A great way to get started with a high-fat, low-carb, low inflammation diet is Dave Asprey’s Bulletproof Diet:
- For additional reading, look into diets based on a paleolithic template
- Glucose tracking:
- Traditional glucometer: Any glucometer should work fine. We recommend the Precision Xtra.
- Wireless: For a wireless model that can integrate with Heads Up Health, we recommend the iHealth BG5 model.
- Body composition:
- Traditional body fat scale: The Tanita BF679W is accurate and very affordable.
- Wireless models: The FitBit Aria or the Withings WS50 can both wirelessly sync with your Heads Up account.