Changes

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. The easiest and cheapest technique is to measure AcAc in the urine using a test strip. However, this approach is too inaccurate to give more than a vague idea of your ketone levelsbe useful. Measuring BOHB in the blood is now practical at home using a similar technique to measuring blood glucose, but is far more expensive. Measuring Acetone in the breath is still under development and is not widely availableemerging. Currently , only blood measurement of BOHB seems is viable, though urine dipsticks are still required to test for kidney stones. =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 viablea high number of 'bad' test strips. * 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. * The best option I've found is to order the Precision Xtra strips from Canada for $20 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. 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].

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 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]].) * This approach is The test strips are cheap, with the strips costing around $0.20 each. * Unfortunately=Measuring Acetone=Acetone can be measured in the breath, which would overcome many of the problems seen with urine AcAc measurement. However, there would still be some delay between changes in the AcAc level and the levels of Acetone, as well as differing levels of AcAc and BOHB. However, the simplicity of this approach and possibly the lower cost could be a huge advantage. The first device I've come across is the [http://astore.amazon.com/ketonix-20/ Ketonix]] which is reasonably priced at around $110, but only has a simplistic high/medium/low scale and I've read reports of reproducibility errors (repeated tests giving different values.) =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 r²=0.73.{| class="wikitable" |- valign="top"|[[File:BLK2UKL.jpg|none|thumb|x400px|My blood BOHB against my urine AcAc levels. r² is 0.43, p < 0.001.]]|[[File:BLK2GLU.jpg|none|thumb|x400px|My blood BOHB against my blood glucose levels. r² is 0.68, p < 0.001]]|}=Problems with Measuring Urine Ketones=In the past the only viable method of measuring Ketones was to use a Urine dipstick, but this is too inaccurate to be useful. * Urine dipsticks require you to match the color of the test strip against reference patches, so it is not particularly precise. Using image analysis ([[KetoAnalysis]]) can help somewhat. (The test strips use a nitroprusside reagent which changes color from pink to maroon. The addition of hydrogen peroxide does not improve the ability of the urine tests to detect BOHB<ref name="SmithManini2008"/>.)