Ketones are chemicals made in your liver, usually as a metabolic response to being in dietary ketosis.
That means you make ketones when you don’t have enough stored glucose (or sugar) to turn into energy. When your body senses that you need an alternative to sugar, it transforms fat into ketones.
You might think that you have to be on a ketogenic diet or be in a state of ketosis to have ketones in your bloodstream. But you have ketones in you quite often.
In fact, you might have ketones in your blood right now[*].
So, what’s the deal with ketones? What are they? And why would you want more of them?
Read on for a full overview of ketones and their role as the primary energy source once you’re in ketosis.
Ketones, also known as “ketone bodies,” are byproducts of the body breaking down fat for energy. This only happens when your carbohydrate intake is low, and your body switches into a state of ketosis[*].
Here’s how it works:
- When you go super low-carb, fast for a prolonged period, or exercise heavily, your body eventually burns through glucose (aka, blood sugar) and glycogen stores (aka, stored sugars).
- Once you run out of glucose, your body starts to look for an alternative source of fuel. In the case of the ketogenic diet — it’s mostly fat.
- At this point, your body will start to break down dietary fat and body fat for fuel — a process known as beta-oxidation. Your body can use fatty acids for fuel, plus other compounds called ketones, which are formed in your liver.
- People following a ketogenic diet specifically reduce their carbohydrate intake for this reason: to create ketones for energy.
Many people use the benefits of ketosis — less reliance on carbs and more burning of fat — to possibly help lower blood pressure, reduce cravings, improve cholesterol, increase weight loss, improve energy, and more[*][*][*].
Ketones are an alternative source of fuel for your body. Although you may not be as familiar with them as glucose, they are perfectly safe compounds that you can use for energy.
When you produce ketone bodies, any excess ketones that your body can’t utilize will be eliminated through your breath or urine.
The only time that ketones can become an issue is if you have Type 1 or Type 2 Diabetes, and a lack of insulin causes a buildup of ketones and glucose in your blood. This condition is referred to as ketoacidosis and is touched on in-depth later in this article.
So, what else do you need to know? To start, there are technically three types of ketone bodies:
- Acetoacetate (AcAc)
- Beta-hydroxybutyric acid (BHB)
Both acetoacetate and beta-hydroxybutyrate are responsible for transporting energy from the liver to other tissues in your body[*].
During the process of ketogenesis, which is when ketone bodies are formed from the breakdown of fatty acids, acetoacetate is the first ketone that’s created.
Beta-hydroxybutyrate is then formed from acetoacetate. (It should be noted that BHB is not technically a ketone due to its chemical structure, but it’s considered a ketone because of its relation to the other metabolites and its function in your body.)
Acetone, which is the simplest and least-used ketone body, is created spontaneously as a side product of acetoacetate[*].
If acetone is not needed for energy, it will break down and be removed from the body as waste through the breath or urine. Acetone is the cause of a characteristic fruity smell on the breath when someone is in ketosis or ketoacidosis.
For thousands of generations, humans have relied on ketones for energy when glucose isn’t available.
For example, our ancestors likely experienced frequent periods when food wasn’t immediately available, whether because of food preparation or availability. And still today, our bodies are amazing at adapting to the burning of ketone bodies for fuel.
Other functional benefits of ketones can include:
- An increase in mental performance — because ketones readily cross the blood-brain barrier to provide your brain with quick and efficient fuel[*][*].
- Physical energy — once you’re not relying on glucose for fuel, your body will become more effective at burning fat during exercise. This means more fat burning and steady energy once you’re in ketosis[*][*].
There are three different methods for testing your ketone levels — blood, breath, and urine. Of all three methods, blood ketones are the most accurate because they represent what you’re body is currently working with.
Urine testing is only helpful in the beginning stages of keto-adaptation when your body is still learning how to use the ketones you’re creating. During this time, a good portion of the ketones you produce will get filtered out through your urine. This can give you insight into whether or not your body is producing ketones. However, over time, your body will become more adapted, and the number of ketones lost in your urine will decrease.
Breath testing is a valid way to test and is much less invasive than blood testing, but it may be less accurate.
Either way, knowing your ketone levels is a good way to determine if your diet and lifestyle changes are working.
There are several ways to test your body for ketones. You can get the tests done in a lab, but there are quicker and more affordable alternatives.
Your ketone levels can be anywhere from zero to 3 or higher., and they are measured in millimoles per liter (mmol/L). Below are the general ranges, but just keep in mind that test results can vary, depending on your diet, activity level, and how long you’ve been in ketosis.
- Negative ketone level: less than 0.6 mmol
- Low to moderate ketone level: between 0.6 to 1.5 mmol
- High ketone level: 1.6 to 3.0 mmol
- Very high ketone level: greater than 3.0 mmol
Now that the levels are defined, let’s go over the different methods for testing and the pros and cons of each:
Method: You pee on a urine strip, which indicates the level of ketones by color.
Pros: You can buy the strips at most pharmacies or online for a very low cost. This is an affordable and easy option for someone new to the ketogenic diet.
Cons: Urine test strips aren’t as reliable the longer you’ve been in ketosis. This is often because the longer a person is in ketosis, the more efficient the body becomes at using ketones (especially acetoacetate) for energy. It’s therefore possible that the test can indicate a lower level of ketosis than you’re actually in. Also, the urine ketone readings can be affected by other factors, including the level of electrolytes in the body or how hydrated you are.
Method: With a blood glucose meter, you use a lancet pen to press onto your fingertip and draw a small blood sample. The blood applied on a test strip monitors blood ketone levels through the meter.
Pros: This is a very accurate method of ketone monitoring since few factors alter the results.
Cons: It can be expensive, especially if you test frequently. Cost is often $5-10 per strip!
Note: The ketone BHB is transported through the blood, so this is the best way to monitor your levels of that specific ketone.
Method: You use a Ketonix breath meter to test the amount of acetone present on your breath.
Pros: It’s affordable after purchasing the meter. Once you buy it, you can use it continuously without extra expense.
Cons: It’s not the most reliable testing method, so it’s best used in conjunction with other methods.
Ketones and Diet
When it comes down to the right level of nutritional ketosis and ketones in the body, a proper ketogenic diet is key. For most people, that means eating between 20-50 grams of carbs per day. How much of each macronutrient (including carbs) you need to consume will vary, so you need to use a keto calculator like this one to figure out your exact macro needs.
To do this means cutting back on, or completely eliminating, most carb sources in your diet, including:
- Whole and processed grains
- Candies and baked goods
- Fruit juices and sugary soft drinks
- Refined sugars
- Starches like potatoes, bread, and pasta
- Beans and legumes
Besides cutting back on carbs, a ketone-centric diet also involves eating moderate amounts of protein and, most importantly, high amounts of fats to rev up your fat burning.
For those who are just beginning a ketogenic diet, there are possible short-term side effects that you might experience within the first week or so. This is due to the shift that happens in your metabolism, which can throw some other processes in your body off.
One of the main culprits for the symptoms of keto-adaptation is water and electrolyte loss. When your body shifts into fat-burning mode, you end up losing a lot of water, and electrolytes along with it[*].
Symptoms can vary greatly depending on the person, and some people might not have any at all.
Temporary effects of ketosis might include:
- Feeling weak
- Feeling “foggy” mentally
- Mild fatigue or irritability
- Flu-like symptoms
Thankfully, side effects are temporary and alleviated quickly since the body adapts to the change in dietary fuel source over time.
Those with both Type 1 diabetes and Type 2 diabetes need to be aware of diabetic ketoacidosis (DKA), which turns the blood acidic if ketones build up and reach a very high, dangerous level.
This is especially important for people with Type 1 diabetes, as DKA is typically the result of low insulin levels, or missed insulin injections[*].
DKA can be life-threatening, so if you’re diabetic, you should never start this diet without medical supervision. This can happen with diabetics who are hurt, sick, or not intaking enough fluids.
It’s also crucial to know that DKA is different from nutritional ketosis, which is safe on a healthy, nutritious ketogenic diet. For most people, there should be no concern about ketone production, as ketones are either used or eliminated from the body and are part of a healthy weight loss and fat burning process.
Ketones can have a very beneficial role in many aspects of life, including overall health, weight loss, energy efficiency, and maintaining a wholesome ketogenic diet.
Understanding the details about ketones and how they fit within the scope of ketosis and a low-carb diet is key for success in all of these areas combined.