The ketogenic diet, commonly known as the keto diet, is characterized by its low-carbohydrate, high-fat, and moderate-protein composition. This dietary approach offers several health benefits, including weight loss, improved blood sugar control, and potential longevity. A primary objective for individuals adhering to the keto diet is to achieve ketosis, a metabolic state where the body primarily utilizes fat for energy instead of carbohydrates. Keto strips are often used to determine whether the diet needs adjusting to reach and maintain ketosis.
What is Ketosis?
Under normal circumstances, when following a standard high-carbohydrate diet, the body relies on glucose derived from carbohydrates as its primary energy source. However, when carbohydrate intake is restricted, such as during a keto diet, the body seeks alternative fuel sources. It does this by breaking down stored fat into fatty acids and ketones. These ketones then serve as a replacement for glucose, providing the majority of the brain's energy needs and inducing a state of dietary ketosis.
Being in dietary ketosis leads to increased ketone levels, which can be detected in breath, urine, and blood.
How Keto Strips Work
Keto strips are a convenient and cost-effective method for determining if you're in ketosis. Originally designed for individuals with type 1 diabetes to assess the risk of diabetic ketoacidosis, these strips are now widely used by those following a ketogenic diet. They can be purchased over-the-counter at pharmacies, supermarkets, and online retailers. Keto strips typically expire within three to six months after opening, so it's essential to consider how frequently you intend to use them.
To ensure consistent results, it's recommended to test your urine ketones at the same time each day, such as in the morning or several hours after your last meal.
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The process of using keto strips involves the following steps:
- Wash your hands thoroughly.
- Collect a urine sample in a small, clean container.
- Immerse the absorbent end of the strip into the urine sample for a few seconds.
- Remove the strip and wait for the time specified on the package for the color to change.
- Compare the color of the strip to the color chart provided on the packaging.
- Dispose of the urine and strip appropriately before washing your hands again.
The color of the strip corresponds to the concentration of ketones in your urine, ranging from no ketones to high concentrations. A darker color indicates higher ketone levels.
Alternatives to Urine Keto Strips
While urine strips are a useful tool, particularly in the initial stages of adopting a keto diet, they may not provide the most accurate long-term assessment of ketosis.
Blood Ketone Meters
Blood ketone meters offer a more reliable and accurate way to measure ketone levels in the body. Originally developed for individuals with type 1 diabetes, these meters have gained popularity among those following a ketogenic diet seeking a more precise measurement of ketosis.
Blood strips can typically be found wherever urine strips are sold. However, a meter is required to read the blood strips. Many blood glucose readers are compatible with blood keto strips, even though the glucose strips themselves are different. Blood strips are generally more expensive than urine strips, costing around $1 per strip, but they have a longer shelf life of 12-18 months.
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To use a blood ketone meter:
- Wash your hands.
- Load the lancet with the needle, following the provided instructions.
- Insert a blood ketone strip into the ketone meter.
- Use the lancet to prick your finger and draw a small drop of blood.
- Allow the strip to come into contact with the blood drop and check the results.
- Dispose of the strip and lancet as directed.
A blood ketone level between 0.5 and 3 mmol/L is generally considered a preferable range for dietary ketosis.
Breath Meters
Measuring ketosis can also be done using a handheld device called a breath meter or analyzer. Like urine testing, breath testing is affordable, though it has the disadvantage of being less accurate.
Lab Testing
Lab testing is the most expensive and highly accurate way to measure ketones in your serum or plasma (from your venous blood sample). As a keto dieter, this ketone monitoring method isn’t practical because you can’t go to a lab or doctor’s office every day.
Interpreting Keto Strip Results
Urine strips are most useful during the initial weeks of a keto diet, when the body is still learning to efficiently utilize ketones for energy. During this period, excess ketones are excreted in the urine. However, as the body adapts to using ketones for fuel, it becomes more efficient at producing and utilizing them, resulting in fewer ketones being excreted. Therefore, after several months of following a ketogenic diet, urine strips may indicate only trace amounts of ketones, which can be misleading.
Read also: Decoding Ketone Results
If you've been following a ketogenic diet for an extended period and desire a more accurate assessment of your ketone levels, blood keto strips are a better option. However, the higher cost and the need for finger pricking should be taken into account.
Achieving Ketosis Through Diet
For healthy individuals, it typically takes several days of following a keto diet to enter ketosis, and a few more weeks to become fully keto-adapted.
A keto diet emphasizes high fat intake, moderate protein consumption, and very low carbohydrate intake. The recommended macronutrient ratio is 65-90% of calories from fat, 10-30% from protein, and less than 5% from carbohydrates.
For comparison, the 2020-2025 Dietary Guidelines for Americans recommends that people get:
- 20-35% of calories from fat
- 10-35% of calories from protein
- 45-65% of calories from carbohydrates
Generally, consuming less than 50 grams of carbs per day will induce ketosis. However, individual responses may vary, with some individuals requiring lower carbohydrate intake.
Addressing the Gray Keto Strip Phenomenon
One of the confusing aspects of using keto strips is the potential for them to turn gray. While there's no definitive explanation for this phenomenon, it's often attributed to the expiration of the strips or exposure to heat and moisture.
Keto strips typically have a shelf life of six months after opening. Using expired strips can lead to inaccurate readings. It is recommended to write the date of opening on the container to keep track of the expiration date.
To preserve the integrity of the strips, store them in a cool, dry place, away from direct heat and moisture.
What to Do When Keto Strips Don't Change Color or Turn Gray
If a keto strip doesn't change color or turns gray, it may not be detecting ketones in the urine properly. In such cases, it's advisable to purchase a new box of keto strips.
If you have diabetes and are experiencing symptoms of diabetic ketoacidosis (DKA), contact your doctor immediately, regardless of the keto strip reading.
Dehydration can also affect the accuracy of keto strip readings. Ensure adequate hydration before testing.
Are Keto Strips Accurate?
Keto strips measure the excess ketones excreted by the body, not the actual ketone levels in the blood. Therefore, they provide an overview of ketone concentration but may not be as precise as blood ketone measurements.
Keto Strips and Diabetic Ketoacidosis (DKA)
It is very important to know that urine test strips degrade over time. Ketone levels can indicate if you are at risk of diabetic ketoacidosis.
At-home urine test strips will change color to show the level of ketones in urine.
- Negative or trace: Considered normal for people with type 1 diabetes.
- Small: Closely monitor your ketones. If you are experiencing illness, call your diabetes care team and follow the plan you have in place for treating ketones.
- Moderate: Indicates risk of diabetic ketoacidosis. Call your diabetes care team right away and follow the plan you have in place for treating ketones.
- Large: Considered a medical emergency.
Blood ketone meters provide a number to indicate ketone levels.
- Less than 0.6 mmol/L: Considered normal for people with type 1 diabetes.
- 0.6 to 1.5 mmol/L: Closely monitor your ketones. If you are experiencing illness, call your diabetes care team and follow the plan you have in place for treating ketones.
- 1.5 to 3.0 mmol/L: Indicates risk of diabetic ketoacidosis. Call your diabetes care team right away and follow the plan you have in place for treating ketones.
- More than 3.0 mmol/L: Considered a medical emergency.
If testing shows you have elevated ketones in urine or blood, follow the plan you and your diabetes care team have in place for treating ketones.
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