Measuring ketones in urine
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Keto Diet Ketones in Urine

Urine is mostly composed of water and minerals. A normal sample of urine will contain minerals and high amounts of potassium, nitrogen, and phosphorus.

However, if you’re closely following the ketogenic diet to lose weight and improve health, you may be able to test for the presence of ketones in your blood.

One way to measure the quantity of ketone levels produced in the body is with urine test strips.

The Basics of Ketosis (and the underlying metabolic effects)

Keto Diet Ketones in Urine

Simply put, ketosis is triggered by a low-carbohydrate diet, which reduces the amount of glucose in your blood. This, in turn, causes the body to burn fat for energy instead of relying on carbs. Experts agree ketosis can be achieved by prolonged exercise and a low-carbohydrate diet.

During this state, the body produces more acetoacetate and beta-hydroxybutyrate compounds from fatty acids. The body releases fatty acids when blood sugar is sufficiently low. Once the ketones are released in the body, they can be circulated to other muscles so they can be used to generate energy.

Figuring out if you’re in a state of ketosis is not as simple. But a quick urine test can indicate the presence of ketones in the body.

Keto Diet Urine Ketones: Why Can we Measure Ketones in the Blood?

Impact of ketones in the keto diet

Ketones, like many minerals and nutrients, are present in the blood. The blood will eventually pass through the body’s filtration system – the kidney. Smaller molecules are discarded through urine while others are recirculated in the body.

This reabsorption process is important because it prevents the wastage of energy. Your body can’t use ketones for energy if they’re flushed out of the system.

The kidney reabsorbs ketones at lower concentrations. However, once the levels of ketones in the blood begin to rise, the unusable ketones are then disposed of by urine. This is why we can measure the presence of ketones in urine.

Why is the higher level of ketones important? Because they indicate whether your body is burning more fat – which is the end goal for many people.

Pro tip: It is possible to trigger a state of ketosis with the help of exogenous ketone supplements. However, urine testing isn’t the best way to test for ketosis achieved with the help of ketone supplements.

Who Should Use the Urine Test?

Ketones in urine

Urine testing can be used by anyone. However, it is particularly useful for individuals following the ketogenic diet. In fact, urine test strips are highly reliable for keto-dieters, but there are a few exceptions worth mentioning.

Urine test strips are only reliable during the first phase of ketosis.

Keto adaptation can skew readings and give misleading results. People trying to lose weight could use urine test strips to get an idea about their ketosis level and use that to plan their next course of action.

However, individuals diagnosed with type I diabetes are recommended to measure ketone in the urine – very frequently. Doing so helps them efficiently manage the disease and prevent severe complications.

This is because patients with type I diabetes often suffer from diabetic ketoacidosis (DKA). This is a state where the body produces a large amount of ketones in the blood, creating a state of net acidity. The presence of ketones in the urine in individuals with type I diabetes can be an indicator of DKA.

Keto Diet Ketones in Urine: Why DKA is Bad News It is important to distinguish the term ‘ketosis’ and ‘diabetic ketoacidosis’. They are very similar due to the presence of high ketones in the blood. However, their effects are polar opposites.

Ketosis triggered by nutrition and dieting is beneficial. In fact, it is the end goal for anyone closely following a ketogenic diet (or those taking ketone supplements exogenously).

It’s important to understand the metabolic science behind ketosis. When beta-hydroxybutyrate levels spike above 0.5mM, the body is said to be in a state of ketosis. Most individuals can have high levels of ketones, as much as 8 mM. The levels don’t seem to rise beyond this threshold because the body’s feedback mechanisms will regulate the production of ketone.

A growing body of evidence suggests that ketosis has numerous health benefits, perhaps because it activates certain survival pathways in organisms. In fact, one animal study of mice found that ketogenic diets are associated with longevity.

More importantly, ketones are an efficient fuel source for the body and yield health benefits such as better glucose control, mental clarity, better athletic performance, health conditions, and weight loss.

Then you have the polar opposite of ketosis – diabetic ketoacidosis (DKA). It is a medical emergency with the potential for fatal outcomes. It occurs because of low levels of insulin (which is often the case with individuals struggling with type I diabetes). Entering this state may require immediate medical attention.

This leads to an inability to circulate blood glucose into the body’s tissues for energy. It can significantly increase the presence of blood sugar levels, which can lead to electrolyte imbalances.

The low insulin continues to signal the liver to start producing more ketones in the body. In normal conditions, insulin can inhibit this signal. However, high levels of ketones, to the tune of 20mM or more, can cause the pH of the blood to decrease. This makes the blood dangerously acidic. If this condition is not treated, it can lead to coma or even death.

Some of the symptoms of DKA include excessive thirst, nausea, abdominal pain, heart palpitations, bad breath, and heavy breathing.

This is why urine testing for ketones for individuals with type I diabetics is extremely important. Medical doctors advise these individuals to measure their ketone levels frequently to manage their symptoms. In fact, the American Diabetes Association (ADA) recommends testing for ketones if your blood glucose is higher than 300mg/dl, you feel sick, tired, nauseated, have bad or fruity-smelling breath, or dry mouth.

These are all signs of DKA. Individuals diagnosed with type II diabetes are also advised to measure their ketone levels with urine testing strips.

How to Test for Urinary Ketones

Testing for ketones in urine

There are many methods of measuring ketones such as AcAc, acetone, and BHB. For example, a blood test can be used to measure the presence of BHB. Breath testing meters can be used to test the presence of acetone.

A urine ketosis test is used to measure the presence of AcAc. Unfortunately, urinary ketones do not indicate the levels of BHB in the blood.

Urine strip kits are available over the counter at most supermarkets and pharmacies. You can also place an order online. They are relatively inexpensive and each package contains several hundred strips. The strips may expire within six months after opening, so make sure you plan on how to use them.

It helps to check your ketone levels daily at a specific time. For the purpose of comparisons, measure your ketone levels in the morning or a few hours after your last meal.

Here’s how you can measure urine ketone levels.

To get a reading, fill a small container with a urine sample. Dip the absorptive end of the strip into the urine sample for a few seconds and then remove. After a few seconds, compare the strip with the color chart on the container. Next, dispose of the urine and strip appropriately before washing your hands.

The color coding on the urine strips may vary based on the brand you’re using. In most cases, the darker the color, the higher your ketone levels.

Pro tip: You should allow up to 15 seconds for the color to change. If you wait too long, however, you may get an inaccurate result.

Best Time to Conduct a Urine Test

Studies suggest that urine testing is most reliable when the test is conducted in the early morning or a few hours after dinner. Regardless of the time you pick for testing, it is important to stick to a schedule for consistent results.

Pros of Urine Ketone Testing

Urine testing is very cost-efficient and you can buy a pack of 100 test strips for under $10. Moreover, urine test strips are relatively easy to read and display results on the strip.

It is easy to purchase, testing is quick, and can be done at any time. Urine ketone testing isn’t invasive and doesn’t require any blood samples. It is less expensive than their alternatives.

Cons of Urine Ketone Testing

Urine ketone testing does not provide precise results. If you are the kind of person who likes to collect raw numbers, urine testing may not be suitable for you. Urine testing only provides an idea of a range of numbers. It can be highly subjective.

It also depends on various factors that could skew the reading and mislead you. For instance, your level of hydration is a big indicator of accuracy. If you’re overhydrated, the ketone presence in your body may be low, and vice versa.

Certain medications can also throw off the results.

Measuring ketosis via the urine testing method

Moreover, if you’re using exogenous ketone supplements, it would be hard to measure the state of ketosis using urine samples.
Exogenous ketone will result in high ketone levels that are equivalent to several weeks of ketogenic dieting. Huge increases in blood ketone levels will not be detected in a urine test. Remember, nutritional ketosis is easier to measure.

It is also shown urinary ketones do not correlate with blood BHB at higher blood ketone levels.

To maintain the accuracy of results, use the following tips:

  • The urine testing strips should be stored in a cool, dry place with the lid tightly closed
  • Keep the strips away from moisture and heat because they can alter the chemical composition of the strips and lead to inaccurate results.
  • Don’t store the strips in the refrigerator and keep them away from sunlight and heat.
  • Urine testing is only accurate for nutritional ketosis.

Make sure your levels of hydration are within normal levels because this could also affect the test results. This is why we recommend early morning testing.

Finally, try not to touch the test strips. If you follow the tips mentioned above, you will see consistent results. For more information on how to follow a ketone diet, make sure to read this blog.

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