Measuring ketones with Precision Xtra meter

Yesterday I met with my endocrinologist (I'm type 2 diabetic), Since starting a keto diet a month ago I've lost 15lbs, my glucose levels have ALL been in the normal range (85-129), my A1c dropped almost a full point (6.6) since my last visit AND I've stopped taking glimpiride. My cholesterol also dropped and every measure is in the perfect range.

My doctor was pleased with the results but he is very against the keto diet. He claimed it is dangerous and damage could occur to my kidneys, heart and brain if ketones are elevated long term. He recommended a change to a standard low calorie diet with a minimum of 60 carbs preferrably 100/day and around 1500 total calories.

I told him I'm going to continue on keto until I reach my weight goals (5'11" and 215lbs now, I'd like to get down to 190lbs) then start adding carbs and calories to see if I can maintain my weight and glucose levels.

To learn more about keto I've ordered Dr. Mercola's book - Fat for Fuel. I've also ordered a Precision Xtra ketone meter and strips.

My questions are:

  1. What do you think of my doctors reaction to keto and his recommendation?

  2. What ketone levels on the meter are considered high and potentially harmful?


  • @steel_horses

    Congratulations on your improved health!

    I personally am not familiar with all the research behind a keto diet, thus it's important to speak with someone knowledgeable of this condition (such as @Frank) . Historically, keto diets have been used in medical nutrition therapy for the management of epileptic seizures, but have evolved to become a weight loss trend. With any dietary pattern, it's difficult to evaluate it's long-term safety until data is available on a large enough group of people.

    Susan Macfarlane, MScA, RD
    Registered Dietitian Nutritionist
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  • @steel_horses I agree with @Susan_RD_101 on the long term studies and the efficacy of a ketogenic diet long term is not known. But, the Inuit (Eskimo) and other cultures have done very well on them. Not everyone reacts the same and there is no one size fits all approach to nutrition. I think your rationale and road map moving forward is prudent and will tell you if it is good for you long term. Right now your diabetes seems to be a big issue and keto has it on the run! Read Mercola's book, it is an easy read and puts keto in laymen's terms. It will also give you a lot of research and studies you can refer to and share with your doctor about long term use.

    High ketones have not been "officially" defined, so we don't really know. The fear out there is that you will get into ketoacidosis and that can be life threatening. Ketoacidosis gets confused with ketosis, they are two completely different things.
    Ketoacidosis is high ketones AND high glucose levels. That really can only occur with type 1 diabetics because they produce no insulin and can't deal with glucose, thus it runs high. If they are on a keto diet, they can get both high and that is not good! Being in ketosis is producing ketones and using them for energy, with normal glucose. If you don't have type 1 diabetes and produce insulin, you should not run into ketoacidosis.

    What is high glucose then? High glucose levels are not known either, as is relates to ketoacidosis. The American Diabetes Association can give you little guidance, and they say "Many experts advise to check your urine for ketones when your blood glucose is more than 240 mg/dl".

    So what are high ketones? Again, that has not been determined, but general consensus is that you have to get up into the 10, 15 20 mmol range. Most of my clients and those I know doing keto are 1-3, some get up into the 6-7 range but that is because they are taking ketone supplements and/or they hit those numbers in conjunction with fasting. Volek and D'Agostino (2 of the biggest researchers in keto) state that ketosis is 1-3 mmol of ketones in the blood via a blood tester. And yes, the Precision Xtra is the meter they use.

    Hope that all helps! Long winded, but it is important to know it all.

    Best regards,
    Frank Alvarez
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  • Thanks for the responses! I found this ketosis "zone" chart

    Nutritional ketosis optimal zone is 0.5 to 3.5 According to Dr's Volek and Phinney, Authors of The Art and Science of Low Carbohydrate Living.

    I did my first ketone test today and it was 2.6 right in the optimal zone so I must be doing keto right!!!

    So far 45 days in and am 18.6 lbs down and glucose readings are all under 120 now.

  • @steel_horses perfect! That is Volek's chart and shows what I was writing about.

    Best regards,
    Frank Alvarez
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  • edited October 2017

    Hi @steel_horses

    I also am a type 2 diabetic (diagnosed in 2011). Over the years I have studied and learned a lot both from books/videos and also from trying different diets and the effects on my diabetes.

    From a diabetic view point, our bodies cannot handle carbs. I have been doing a low carb/higher fat type diet for several years now with very good results. My doctor at one point wanted me to start on a statin for my Cholesterol (My total cholesterol was 200 but because of a bad family history of heart issues he thought it was a good idea). After doing some research on the negative effects of statins I went began faithfully exercising and also watching my carbs much more closely. I spent a few weeks studying everything about cholesterol and decided to do the opposite of what is recommended (which means I did Keto). I also decided to pay for a specialized cholesterol test after 4 months of the diet to show my doctor (I believe its called the NMR Lipoprofile test) that much more accurately measures risk indicators, size of LDL, etc. The result is everything on my test came back better than average (better than most non-diabetics)! Don't be afraid of doing Keto ... you will find (as you are already finding) that your diabetes will greatly improve as will your other tests.

    Lately I have been doing Keto with IF (intermittent fasting as taught by Jason Fung). This just means that I am going longer between my last meal in the evening, till my first meal the next day. This allows the insulin level to fall (which stays too high in most type 2 diabetics if their beta cells are not burned out) and allows my body to burn/use up the glucose from the day before and begin burning fat. In just a week of doing it my bG is staying in the high 70's/low 80's during the fasting time, and my diastolic blood pressure is staying in the low 70's. (I may have to cut back on my blood pressure medicine which is a good thing).

    If I tried to follow the diet your doctor is suggesting (which is probably similar to the ADA diet with 120+ grams of carbs daily) I would never be able to control my bG's. I highly recommend you watch some videos on youtube by Jason Fung.

    As a diabetic you have 2 choices on how you deal with your diabetes:

    1. The way most diabetics deal with it is to continue eating too many carbs and gradually increasing meds over the years until they get to the point they go blind, lose a foot, etc. The meds only deal with the bG's which is just a symptom.
      1. Other's like myself deal with what is causing the high blood glucose - too much carbs and also the problem of the effects of too much insulin (too much insulin caused by lack of insulin sensitivity). If you deal with the cause not the symptom, then you will control your diabetes, it doesn't have to progress and become worse.
  • Thanks for the very informative and encouraging reply. I watched Dr Fung's video "The two big lies of type 2 diabetes" a couple days ago. It's simply amazing how t2 diabetes can be reversed with just diet. We're living proof. 7 weeks in for me and my bg levels are perfectly normal day after day. I'm down 19lbs now and just dropped another diabetes med (2 down), keeping jardiance and metformin until I meet with my endo doc. I almost don't even want to see them anymore, they're just going to criticize the keto diet and give me the same BS advice I've gotten all these years. "It's progressive,, normal to get worse, you are maxed out on meds so we need to start you on insulin". It's almost malpractice the way we've been treated, maybe even criminal how these docs just blindy follow the ADA's treatment regime. They've turned us into healthcare "junkies" needing their increasingly expensive services and lining big pharma's pockets all the way to our graves.

    Enough ranting :) I've got a question on keto diets - maybe you or Frank or anyone else could answer - how often do you come off the diet? I keep coming across comments that you should break the diet every so often to "resensitive" your body.

    I'm also very interested in starting intermittant fasting (18/6) but am just beginning to learn the how to's. A similar question - how long do you keep it going and are breaks a good thing?

    If you haven't seen Dr. Sarah Hallberg's Tedx talk on Reversing Type 2 diabetes I highly recommend it,

    Thanks again for the replies.

  • @steel_horses Cycling can be good for your ability to go in and out of ketosis. Some anecdotal evidence is showing that going in and out makes you go in and out more efficiently. I see this in myself, I can cycle out pretty hard and get back in ketosis in a day. Fasting really does it for me (about 24 hours). It is also a psychological break too. I just went in and out all late summer with watermelon and corn hitting here in Wisconsin. I love it, it has a tone a good nutrients, so I enjoy it for a bit. It is past now and I am back in ketosis. Remember to enjoy the journey.

    Best regards,
    Frank Alvarez
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