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An important aspect of the [[Ketogenic Diet]] is knowing how high your ketone levels are. There are three types of [[Ketones]]; beta-hydroxybutyrate (BOHB) which is measured in the blood, acetoacetate (AcAc) which is typically measured in the urine, and acetone which is typically measured in the breath. * Measuring Acetone in the breath is becoming a good option, and I believe that this is probably the future of ketone measurement. It's an area of rapid development, and it was not available when I performed my [[Ketogenic Experiment]], so I'm still gathering data.* Measuring BOHB is the most accurate, and it's now practical at home using a similar technique to measuring blood glucose, but it's really expensive at several dollars per test. * The easiest and cheapest technique is to measure AcAc in the urine using a test strip. However, this approach is too inaccurate to be useful. =Measuring BOHB Acetone=''Main article: [[Breath Acetone Meters]]'' Acetone can be measured in the blood breath, and there is good evidence<ref name="Anderson2015"/> that there is now practical at home using a similar technique to measuring strong correlation between breath acetone and blood glucoseBOHB ketone levels. In fact, but the evidence indicates that breath acetone is far more expensivea well correlated with even non-ketogenic fat burning, and that it's good evidence of effective weight loss. Measuring [[File:Breath Acetone in the .jpg|center|thumb|400px|The relationship between breath is emerging. Currently, only acetone and blood measurement of BOHB is viable, though urine dipsticks are still required to test for kidney stonesfrom multiple studies. ]]
=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 [http://www.amazon.com/Nova-Blood-Glucose-Monitoring-System/dp/B0050Z48IU Nova Max] and the [http://www.amazon.com/Precision-Blood-Glucose-Monitoring-System/dp/B000N64MZA Precision Xtra]. * The [http://www.amazon.com/Nova-Max-Plus-Ketone-Strips/dp/B006TIEUS0 ketone test strips for Nova Max] are cheaper (around $27 for 10 strips), but less accurate and there tend to be a high number of 'bad' test strips. <jfs id=" B006TIEUS0" noreferb="true"/>. * The [http://www.amazon.com/Precision-Xtra-Blood-Ketone-Strips/dp/B001EL30TM ketone test strips for the Precision Xtra] are far more expensive (around $58 for 10 strips), but better quality. <jfs id=" B00XIBK8HS" noreferb="true"/>. * The best option I've found is to order the Precision Xtra strips from Canada for $20 23 for 10 strips. I've ordered from the [http://www.universaldrugstore.com/medications/ketone Ketone Strips from Universal Drugstore] many times and I've been pleased with their service. It takes a couple of weeks for delivery, and shipping is $7. * You have to draw a drop of blood for this testing, and I'd recommend the [http://www.amazon.com/dp/B002NPCC1A Owen Mumford Advanced Lancing Device] for $9<jfs id=" B002NPCC1A" noreferb="true"/>. It's not much less painful than other lancing devices, but every bit helps. I also use the narrow (33) gauge [http://www.amazon.com/dp/B0000DD8VM BD Ultra-Fine Lancets]<jfs id=" B0000DD8VM" noreferb="true"/>.
=Measuring Acetoacetate (AcAc)=
AcAc is typically measured in the urine using a test strip, such as the [http://www.amazon.com/Multistix-10-100-Test-Strips/dp/B004WNSZGC Multistix] or the cheaper [http://www.amazon.com/Phinex-Parameter-Urinalysis-Reagent-Strips/dp/B0099WTWTA Phinex Multistix equivalent]. These strips which check for 10 different things in addition to AcAc, including trace blood, hydration status and urine acidity. (It's important to test for trace blood in your urine if you're on the ketogenic diet to [[Health Risks of the Ketogenic Diet| detect Kidney Stones early]].) The test strips are cheap, costing around $0.20 each. <jfs id=Measuring Acetone" B00XIKQCJC" noreferb=Acetone can be measured in the breath"true"/>. However, which would overcome many of the problems seen with urine AcAc measurementlevels tend to correspond poorly to blood ketone levels. HoweverDuring [[Ketoadaptation]], there would still I've found urine levels can be some delay between changes in the AcAc level and the 4x higher than blood ketone levels of Acetone, as well as differing but after adaptation the urine levels of AcAc and BOHBtend to drop much lower. HoweverHydration status also greatly affects urine ketone levels, the simplicity and of this approach and possibly the lower cost could be a huge advantage. The first device Ilevels you've come across is re detecting are based on the [http://astoreurine produced since you last emptied your bladder, so they can be quite delayed.amazon.com/ketonix-20/ Ketonix] which is reasonably priced See below for a more detailed look at around $110, but only has a simplistic high/medium/low scale and I've read reports of reproducibility errors (repeated tests giving different valuesthe problems with measuring urine ketones.)
=My Results=
I measured my blood BOHB, urine AcAc (using ([[KetoAnalysis]]), and my blood glucose. The charts below show the relationship between the values, with the regression line in blue and the 95% confidence intervals shaded. As you can see, for my readings there is better correlation between blood glucose and blood BOHB than there is to urine AcAc. I tried adjusting for hydration using the Urine Specific Gravity values from the test strips, but this made little difference to the correlation. Multiple regression of blood glucose and urine AcAc to blood BOHB did improve the model to r<sup>2</sup>=0.73.
<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="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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