When on a ketogenic diet, it is a problem if ketones are going up to 5 to 6 millimoles per liter?

When on a ketogenic diet, it is a problem if ketones are going up to 5 to 6 millimoles per liter?


When on a ketogenic diet, it is a problem
if ketones are going up to 5 to 6 millimoles per liter? Tiana Tallant says, “A friend of mine has
been on a ketogenic diet for the last three weeks. Initially, her ketone levels were 2 to 3 millimoles
per liter, but the last few days, they’ve been up to around 5 to 6 millimoles per liter. Her macros are 80 grams of protein, 20 grams
of net carbs, 130 grams of fat. What could make ketones this high? Are there any concerns for them being at this
level?” Those are the normal fasting levels of ketones
at a normal long-term fast. I don’t know. Actually, this was in one of the previous
AMAs. I forget who it was. I don’t want to misstate the person’s name. One of the popular ketogenic advocates was
saying that if the ketones are getting above 3, then it’s from not eating enough protein. I don’t really see it that way. I think that protein will suppress ketogenesis,
and so will carbs. Five to 6 millimoles per liter is what you
see in therapeutic ketogenic diets. I think the real question is what is this
doing to our health? I don’t see any obvious threat to our health
on the basis of the ketones alone. I think you have to judge that against is
she experiencing any health problems or is she feeling better? I think those would be the primary things. In terms of how you could bring the ketones
down, more carbs or more protein are going to bring them down. Between the two of those, probably protein
would be the most important thing to increase as a means of protection against lean mass
loss and as a means of keeping neurotransmitters and all the other things that you do with
protein healthy. But you could raise the carbs a little bit
too. Because remember that your carb demand even
on a ketogenic diet is definitely not down to 20 grams of carbs. That’s not even feeding your brain on the
ketogenic diet. If you have room to increase carbs, then I
think would be great to get the carbs up to at least 30 and then maybe use protein going
up to supply the rest of that. Then also pay attention to micronutrients. Do a dietary analysis. If there are certain nutrients that this person
is not really getting in that more vegetables would help those micronutrients, then increase
the vegetables and the carbs along with them for that purpose. But just on macros alone, I would say go up
at least 10 grams on the carbs and go up to, if you can get there, a gram of protein per
pound of body weight on the protein, and that will bring the ketones down. Thanks, Tiana, for your question.

Comments

(6 Comments)

  • James Kantor

    Can you share in a video, why you like ketogenic diet of lower carb diets. Ie 70-100 grams of carbs a day.

  • Michael Sparks

    The researcher you're thinking of is Steve Phinney. I don't know offhand in which video he talks about it in the most depth, but here's one where he at least mentions it: https://youtu.be/2KYYnEAYCGk?t=100

  • Lynne Cobb

    Most experts agree, your brain is quite happy to run on ketones. I think red blood cells are the only things that can't use ketones, they must have glucose. Your liver can produce all the glucose you need in a demand driven system

  • Patrick Ryan

    Her cells are obviously using the ketones way too slowly therefore causing them to back up in the blood to these high levels.. Why?

    She's not eating enough carbs. "Ketones burn in a carbohydrate flame in the cells" after all.. Just eat more carbs, especially in the evenings.. Don't worry about knocking yourself out of ketosis every evening because you'll be back in ketosis the next morning anyway.

  • Joe Simone

    Its adaptation, long term, ketones will start to be utilized more efficiently. I've seen this testing month 1 vs. Year 1 and so on.

  • mattmoo1007

    Pretty good advice. I've been keto for about 5 years and I've noticed an improvement with just a little bit more carbs or a higher amount protein per pound of body weight. Often you'll hear those in the keto community (the hardcore) stressing that you don't need any carbs, and while this may be true, some people, like me, seem to do a little better with just a little bit more than 20 grams. 40 grams works for me and I still maintain ketones in the .8 to 2 range almost every day. And in a paradoxical response, my blood sugar is often slightly better with 40 grams of carbs vs 20 grams or near zero.

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