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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 Acetone=''Main article: [[Breath Acetone Meters]]'' Acetone levels correlate well with body fat loss<ref name="Kundu-1993"/>, but are also elevated by the [[Ketogenic Diet]]<ref name="Kalapos-2003"/>, [[MCT]] <ref name="Freund-1966"/> intake, and exercise<ref name="SasakiIshikawa2011"/> even in the absence of weight loss. One study found that a 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 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"/>. This makes it useful for monitoring the progression of a ketogenic diet, as well as for measuring weight loss. The formula below was developed based on 12 adults consuming Ketogenic meals over a short period<ref name="Musa-Veloso-2002"/>: For Breath Acetone (BrAce) in mmol/L: BOHB = 0.11 * BrAce^0.47 - 0.18Note 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 now practical 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 home using a similar technique to measuring four, seven, and 10 hours, representing the rise in blood ketones and an hour after each of the meals. The blood glucoseAcAc levels rise at four hours and 10 hours, but the pattern is far not quite so distinctive. By comparison, breath acetone responds more expensivesmoothly, 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. Measuring ]]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 emergingexchanged 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. Currently* A full breath, breathing in deeply and fully exhaling will result in ~85% of maximum acetone concentration but only blood measurement at the end of the breath. * Breathing in and out of BOHB a bag for six breaths results in the maximum acetone concentration and the best repeatability. Of course, this is viable, though urine dipsticks are still required to test the most uncomfortable method. * Breath holding for kidney stonesover 60 seconds has no impact on breath acetone concentration.

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. Another option is [https://www.ebay.com Ebay] and search for "Abbott Freestyle Optium ketone", which are from Australia and cost nearer $1/strip. * 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"/>.

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.)