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''Main article: [[Breath Acetone Meters]]''
Acetone can be measured in levels correlate well with body fat loss<ref name="Kundu-1993"/>, but are also elevated by the breath[[Ketogenic Diet]]<ref name="Kalapos-2003"/>, [[MCT]] <ref name="Freund-1966"/> intake, and there is good evidenceexercise<ref name="Anderson2015SasakiIshikawa2011"/> even in the absence of weight loss. One study found that there is a strong correlation between one pound (0.5 Kg) per week fat loss correlated with 1.7 PPM of acetone (67 nmol/L). Each ~40% increase in breath acetone and was an additional ∼0.5 Lb (250g) of weekly fat loss<ref name="Anderson2015"/>.[[File:Acetone Weight Loss.jpg|center|thumb|300px|Breath acetone against average weight loss]]Breath acetone correlates well (though not linearly) with blood (BOHB ) ketone levels<ref name="Anderson2015"/>. In fact, This makes it useful for monitoring the evidence indicates that breath acetone is progression of a well correlated with even non-ketogenic fat burningdiet, and that it's good evidence of effective as well as for measuring weight loss. For Breath Acetone (BrAce) in mmol/L: BOHB = 0.45 * BrAce<sup>0.5</sup> + 0.1Note that the relationship is far from exact (r=0.5 or so.)
[[File:Breath Acetone.jpg|center|thumb|400px|The relationship between breath acetone and blood BOHB from multiple studies.]]
Breath acetone levels can vary dramatically, with healthy individuals on a regular diet having less than 1 PPM (parts per million) to 1,250 PPM in patients suffering from diabetic ketoacidosis<ref name="SulwayMalins1970"/>, which is an extremely dangerous medical condition. The diagram below shows some typical ranges. (As far as I can tell, for acetone, 1 ppm is 39.7 nmon/L.)
[[File:Acetone Levels.jpg|center|thumb|300px| Ranges of breath acetone for different populations.]]
The charts below show the results of 12 people who consumed for ketogenic meals every three hours following an initial 12 hour fast<ref name="Musa-Veloso-2002"/>. You can see a distinct spike in blood BOHB levels at four, seven, and 10 hours, representing the rise in blood ketones and an hour after each of the meals. The blood AcAc levels rise at four hours and 10 hours, but the pattern is not quite so distinctive. By comparison, breath acetone responds more smoothly, and is less responsive to the changes in BOHB and AcAc. This makes sense given that AcAc decomposes spontaneously to acetone with a half-life of about 12 hours<ref name="HayBond1967"/>, though enzyme activity may dramatically speed this up<ref name="O'LearyBaughn1972"/>. Overall, this is a good indication that breath acetone is a viable way of evaluating underlying blood ketone levels.
[[File:Ketones 4 Ketogenic Meals.jpg|center|thumb|400px|The ketone levels in subjects after a 12 hour fast, followed by four ketogenic meals every 3 hours starting at time zero.]]
Breath Acetone may respond more slowly than blood BOHB to a reduction in ketone levels, but I've found no clear research that tracks both together. One study found levels remained steady for an hour after a high protein meal then dropped over the next 5 hours<ref name="Smith-1999"/>.
[[File:Time Acetone Protein.jpg|center|thumb|300px|Breath acetone after a high protein meal following a 12 hour fast.]]
The nearest comparison I could find used a high carbohydrate meal rather than high protein, which would result in a faster rise in blood sugar & insulin compared with high protein. It also used a low carbohydrate diet rather than a fast and is on diabetic patients<ref name="Haimoto-2009"/>. This makes it a poor comparison, but shows that in principle at least, breath acetone may be slower to respond than blood BOHB.
[[File:BOHB_Response.jpg|center|thumb|300px|Change in blood BOHB after a high carb meal (black squares; open squares are low carb meal.]]
==Breathing Patterns And Acetone==
Acetone is exchanged mostly in the airways, not the alveoli (the tiny air sacs of the lungs)<ref name="Anderson-2003"/><ref name="Schrikker-1989"/><ref name="Schrikker-1985"/>, so your breathing pattern will have a big impact on the acetone concentration in your breath<ref name="Anderson-2006"/><ref name="SukulTrefz2014"/>:
* A normal, resting breath (called a tidal breath) will result in only about two thirds the maximum acetone concentration.
* A full breath, breathing in deeply and fully exhaling will result in ~85% of maximum acetone concentration but only at the end of the breath.
* Breathing in and out of a bag for six breaths results in the maximum acetone concentration and the best repeatability. Of course, this is the most uncomfortable method.
* Breath holding for over 60 seconds has no impact on breath acetone concentration.
=Measuring beta-hydroxybutyrate (BOHB)=
BOHB is measured in the blood using a small meter similar to a Blood Glucose Meter. A test strip is placed in the meter and a drop of blood is added. After a few seconds, the meter will indicate the level of Ketones. There are two meters on the market in the US, the Nova Max and the Precision Xtra.
<ref name="Medline">http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm Medline Plus Ketones - urine</ref>
<ref name="sensorhealth.com">http://sensorhealth.com/UrineStripFalsePositive-NegativeCauses.pdf Urine Strip False Positive-Negative Causes</ref>
<ref name="Gilbert-2000"> DL. Gilbert, PL. Pyzik, JM. Freeman, The ketogenic diet: seizure control correlates better with serum beta-hydroxybutyrate than with urine ketones., J Child Neurol, volume 15, issue 12, pages 787-90, Dec 2000, PMID [http://www.ncbi.nlm.nih.gov/pubmed/11198492 11198492]</ref>
<ref name="Galvin-1968"> RD. Galvin, JA. Harris, RE. Johnson, Urinary excretion of beta-hydroxybutyrate and acetoacetate during experimental ketosis., Q J Exp Physiol Cogn Med Sci, volume 53, issue 2, pages 181-93, Apr 1968, PMID [http://www.ncbi.nlm.nih.gov/pubmed/5185570 5185570]</ref>
<ref name="Wildenhoff-1977">KE. Wildenhoff, Tubular reabsorption and urinary excretion of acetoacetate and 3-hydroxybutyrate in normal subjects and juvenile diabetics., Acta Med Scand, volume 201, issue 1-2, pages 63-7, Jan 1977, PMID [http://www.ncbi.nlm.nih.gov/pubmed/835373 835373]</ref>
<ref name="Cahill2006">George F. Cahill, Fuel Metabolism in Starvation, Annual Review of Nutrition, volume 26, issue 1, 2006, pages 1–22, ISSN [http://www.worldcat.org/issn/0199-9885 0199-9885], doi [http://dx.doi.org/10.1146/annurev.nutr.26.061505.111258 10.1146/annurev.nutr.26.061505.111258]</ref>
<ref name="Anderson-2006">JC. Anderson, WJ. Lamm, MP. Hlastala, Measuring airway exchange of endogenous acetone using a single-exhalation breathing maneuver., J Appl Physiol (1985), volume 100, issue 3, pages 880-9, Mar 2006, doi [http://dx.doi.org/10.1152/japplphysiol.00868.2005 10.1152/japplphysiol.00868.2005], PMID [http://www.ncbi.nlm.nih.gov/pubmed/16282431 16282431]</ref>
<ref name="SukulTrefz2014">Pritam Sukul, Phillip Trefz, Jochen K Schubert, Wolfram Miekisch, Immediate effects of breath holding maneuvers onto composition of exhaled breath, Journal of Breath Research, volume 8, issue 3, 2014, pages 037102, ISSN [http://www.worldcat.org/issn/1752-7155 1752-7155], doi [http://dx.doi.org/10.1088/1752-7155/8/3/037102 10.1088/1752-7155/8/3/037102]</ref>
<ref name="Schrikker-1985">AC. Schrikker, WR. de Vries, A. Zwart, SC. Luijendijk, Uptake of highly soluble gases in the epithelium of the conducting airways., Pflugers Arch, volume 405, issue 4, pages 389-94, Dec 1985, PMID [http://www.ncbi.nlm.nih.gov/pubmed/4080516 4080516]</ref>
<ref name="Schrikker-1989">AC. Schrikker, WR. de Vries, A. Zwart, SC. Luijendijk, The excretion of highly soluble gases by the lung in man., Pflugers Arch, volume 415, issue 2, pages 214-9, Nov 1989, PMID [http://www.ncbi.nlm.nih.gov/pubmed/2556686 2556686]</ref>
<ref name="Anderson-2003">JC. Anderson, AL. Babb, MP. Hlastala, Modeling soluble gas exchange in the airways and alveoli., Ann Biomed Eng, volume 31, issue 11, pages 1402-22, Dec 2003, PMID [http://www.ncbi.nlm.nih.gov/pubmed/14758930 14758930]</ref>
<ref name="O'LearyBaughn1972">Marion H. O'Leary, Richard L. Baughn, Acetoacetate decarboxylase. Identification of the rate-determining step in the primary amine catalyzed reaction and in the enzymic reaction, Journal of the American Chemical Society, volume 94, issue 2, 1972, pages 626–630, ISSN [http://www.worldcat.org/issn/0002-7863 0002-7863], doi [http://dx.doi.org/10.1021/ja00757a051 10.1021/ja00757a051]</ref>
<ref name="HayBond1967">RW Hay, MA Bond, Kinetics of the Decarboxylation of Acetoacetic acid, Australian Journal of Chemistry, volume 20, issue 9, 1967, pages 1823, ISSN [http://www.worldcat.org/issn/0004-9425 0004-9425], doi [http://dx.doi.org/10.1071/CH9671823 10.1071/CH9671823]</ref>
<ref name="Musa-Veloso-2002">K. Musa-Veloso, SS. Likhodii, SC. Cunnane, Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals., Am J Clin Nutr, volume 76, issue 1, pages 65-70, Jul 2002, PMID [http://www.ncbi.nlm.nih.gov/pubmed/12081817 12081817]</ref>
<ref name="Haimoto-2009">H. Haimoto, T. Sasakabe, H. Umegaki, K. Wakai, Acute metabolic responses to a high-carbohydrate meal in outpatients with type 2 diabetes treated with a low-carbohydrate diet: a crossover meal tolerance study., Nutr Metab (Lond), volume 6, pages 52, Dec 2009, doi [http://dx.doi.org/10.1186/1743-7075-6-52 10.1186/1743-7075-6-52], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20040075 20040075]</ref>
<ref name="Smith-1999">D. Smith, P. Spanel, S. Davies, Trace gases in breath of healthy volunteers when fasting and after a protein-calorie meal: a preliminary study., J Appl Physiol (1985), volume 87, issue 5, pages 1584-8, Nov 1999, PMID [http://www.ncbi.nlm.nih.gov/pubmed/10562594 10562594]</ref>
<ref name="SulwayMalins1970">M.J. Sulway, J.M. Malins, ACETONE IN DIABETIC KETOACIDOSIS, The Lancet, volume 296, issue 7676, 1970, pages 736–740, ISSN [http://www.worldcat.org/issn/01406736 01406736], doi [http://dx.doi.org/10.1016/S0140-6736(70)90218-7 10.1016/S0140-6736(70)90218-7]</ref>
<ref name="SasakiIshikawa2011">H. Sasaki, S. Ishikawa, H. Ueda, Y. Kimura, Acetone Response during Graded and Prolonged Exercise, volume 0, 2011, pages 119–124, doi [http://dx.doi.org/10.1159/000321951 10.1159/000321951]</ref>
<ref name="Kalapos-2003">MP. Kalapos, On the mammalian acetone metabolism: from chemistry to clinical implications., Biochim Biophys Acta, volume 1621, issue 2, pages 122-39, May 2003, PMID [http://www.ncbi.nlm.nih.gov/pubmed/12726989 12726989]</ref>
<ref name="Freund-1966">G. Freund, RL. Weinsier, Standardized ketosis in man following medium chain triglyceride ingestion., Metabolism, volume 15, issue 11, pages 980-91, Nov 1966, PMID [http://www.ncbi.nlm.nih.gov/pubmed/5922367 5922367]</ref>
<ref name="Kundu-1993">SK. Kundu, JA. Bruzek, R. Nair, AM. Judilla, Breath acetone analyzer: diagnostic tool to monitor dietary fat loss., Clin Chem, volume 39, issue 1, pages 87-92, Jan 1993, PMID [http://www.ncbi.nlm.nih.gov/pubmed/8419065 8419065]</ref>
<ref name="Anderson2015">Joseph C. Anderson, Measuring breath acetone for monitoring fat loss: Review, Obesity, volume 23, issue 12, 2015, pages 2327–2334, ISSN [http://www.worldcat.org/issn/19307381 19307381], doi [http://dx.doi.org/10.1002/oby.21242 10.1002/oby.21242]</ref>
<ref name="Kossoff-2011-2035">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Offset 2035</ref>
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