Understanding Low Ketone Level Readings

What does it mean if your strips show ketones, or if they don’t?

Your starter kit includes ketone urine strips. This article will help you understand why your urine strip results may not tell the whole story, and what that means for your Revero health journey. 

Brief Ketones Review

First, let’s briefly review what ketones are, and the different ketones that your liver produces. On a ketogenic diet, the liver produces three main ketones: beta-hydroxybutyrate (BHB), acetoacetate (AcAc), and acetone. 

• BHB is the most abundant and is primarily used by the body for energy. 
• AcAc can be converted into BHB or used directly as fuel. 
• Acetone, a byproduct of AcAc, is mostly excreted through breath, giving it a distinctive odor. 

To monitor ketosis, BHB is often measured via blood tests, AcAc through urine strips, and acetone using breath meters. Each ketone indicates different aspects of ketosis, helping individuals on a low-carb diet manage their metabolic state effectively.

Measuring Ketones in Urine

In the early stages of a ketogenic diet, the body excretes excess acetoacetate in the urine, making these strips useful for confirming initial ketosis. However, as you become keto-adapted, your body becomes more efficient at using ketones for energy, particularly converting acetoacetate into beta-hydroxybutyrate (BHB). 

As a result, less acetoacetate is excreted in the urine, leading to lower readings on the strips. This can give the false impression that you're not in ketosis, even though your blood ketone levels, especially BHB, remain elevated. For this reason, keto strips are better for indicating ketosis when you’re first becoming keto-adapted. After your body is efficiently burning fat and ketones for fuel, ketone strips aren’t a reliable indicator of ketosis. 

Excess Ketones: Diabetic Ketoacidosis

Ketone strips can be useful for detecting ketoacidosis, especially in diabetic patients on medications and a low-carb diet. Diabetic ketoacidosis (DKA) is a serious condition where ketone levels become dangerously high due to a lack of insulin, causing high blood glucose and acid buildup. Ketone strips, which measure acetoacetate in urine, can detect elevated ketone levels that might signal the onset of DKA. 

However, it's important to note that ketoacidosis is not common when a low-carb diet is followed with proper medical supervision. If you experience symptoms of DKA, alert your Revero coach and provider as this may require urgent medical attention and a referral to urgent care or ER. These are the symptoms of ketoacidosis:

• High blood sugar levels (typically over 250 mg/dL)
• Excessive thirst and frequent urination
• Nausea and vomiting
• Abdominal pain
• Shortness of breath or rapid breathing
• Fruity-scented breath (due to elevated acetone levels)
• Fatigue and weakness
• Confusion or difficulty concentrating
• Dry or flushed skin
• Muscle aches or stiffness

No Urine Ketones Isn’t a Problem

If you find that urine strips no longer show ketones after you've been on a ketogenic diet for a while, don't be discouraged. This doesn't mean the diet isn't working; in fact, it's a sign that your body has become keto-adapted and is efficiently using the ketones for energy rather than excreting them. 

Your body is now better at converting and utilizing these ketones, particularly beta-hydroxybutyrate (BHB), to fuel your cells. This is a positive indicator that the diet is doing exactly what it's supposed to—helping your body run on fat and ketones instead of carbohydrates.

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