By Mary T. Newport M.D.

While it is not necessary to measure ketone levels, many people who make the change to a low carb, ketogenic diet and/or use ketone salts would like to have some positive proof that their ketone levels are, in fact, elevated. When transitioning from a higher carb to a low carb, ketogenic type diet, it can take several days to begin to see an increase in ketone levels and the ketone level may continue to rise for two or three weeks before it levels off. The ketone level can fluctuate somewhat throughout the day and can vary considerably from person to person.

Using ketone salts, such as Prüvit KETO//OS® or KETO//OS Max, as a supplement can give you a jump start on getting into ketosis and increase ketone levels within 30 to 60 minutes of taking the product. Using coconut oil and MCT oil as part of the diet can help increase and sustain ketone levels as well.

There are several ways available to measure ketone levels in urine, blood or by using a breath analyzer.

When blood levels of ketones become elevated, the excess ketones will filter out of the blood into the urine. Urine ketone test strips were originally developed for diabetics to help determine if they are going into diabetic ketoacidosis when the blood sugar is elevated. There are a number of companies that sell urine test strips that change color when ketone levels are elevated – usually the deeper the color, the higher the ketone level. This will not tell you what your actual blood ketone level is but can give you a rough idea of whether you are in ketosis or not. However, one of the drawbacks to using urine test strips is that they only measure the ketone acetoacetate and not beta-hydroxybutyrate, which tends to be much more elevated than acetoacetate during ketosis. Also, Prüvit ketone salts contain beta-hydroxybutyrate. You could have elevated levels of beta-hydroxybutyrate and this might not be detected by the urine test strip. Some of the urine ketone test strips state on the package that they measure acetoacetate and others do not – you might consider contacting the manufacturer directly to find out.

A more direct way to measure beta-hydroxybutyrate is by using a blood glucose/ketone monitor with ketone test strips. These monitors were developed for diabetics and come with a lancet holder that pricks your finger and requires only a small drop of blood. The ketone test strips do not detect the ketone acetoacetate, but rather the form of beta-hydroxybutyrate that is in KETO//OS Max. The test strips may not pick up the alternative form of beta-hydroxybutyrate which is higher in KETO//OS® – so you could have elevated levels of beta-hydroxybutyrate that don’t show up on this test. There are several different companies that make these, readily available online, and can also be ordered through a pharmacy without a prescription.

Whenever I test my own blood ketone level, every couple of weeks or so, I have a second monitor setup to test my blood sugar. I like to do this to keep an eye on my fasting blood sugar. A positive health benefit is that fasting blood sugar tends to trend down when transitioning from a higher carb to a low carb, ketogenic diet and with using ketone salts. The monitors themselves are not very expensive, usually less than $40. At present, ketone test strips cost around $1.50 to $2 each and glucose test strips cost much less than that.

Another way to monitor ketosis is by using a ketone breath analyzer, which measures the ketone called acetone. Acetone becomes elevated and is mostly exhaled when you are in ketosis. Like the ketone urine strips, this will give you a rough estimate of how deeply you are into ketosis. The monitor itself is pricey, currently about $190, but is reusable and you can monitor your level of ketosis as often as you like throughout the day.

The most definitive way, but also the most expensive way, to measure ketone levels is through direct lab testing of blood. Both beta-hydroxybutyrate and acetoacetate can be measured with these techniques. This kind of monitoring would be most useful in ketone research where very precise levels are important. If you are having other lab work done, you could ask your doctor to include a ketone level.

Is ketone level monitoring necessary? Probably not, but it could provide positive reinforcement and encouragement to let you know that you are indeed raising your ketone level and burning fat.