Ketosis & Measuring Ketones Explained

(Image from google)

By Popular Request

Over the years I have been asked several times to discuss ketones (as in ketone bodies), ketosis, and the measurement of ketones or the level of ketosis. The word “ketone” is commonly misunderstood by the public and often misused by commercial interests. In this article I hope to dispel some myths and correct some mistaken ideas, not only in terms of what ketones are but also how we can measure them in our body and what information each measuring method may reveal.

What Are Ketones?

In the above image, which I copied from an academic article over a year ago (no longer remember which one), you can see that there are three types of ketone bodies. These three types are measurable and are the most understood by today’s science.

The picture should be read by starting in the middle top, where you can see “Fatty Acids” that are converted to Acetyl CoA, which then magically appear as Acetoacetate. This process is complex, and I won’t cover it here. Nevertheless, it took us to the first ketone body: Acetoacetate. To the left and right you can see two other ketone bodies, and arrows indicating the direction of the conversion. So, Acetoacetate can convert to Acetone in one direction (to the right), meaning that Acetone cannot convert back into Acetoacetate. Once it is Acetone, that’s it. And if you look in the other direction (left side), you see 3-B-Hydroxybutyrate (BHB) with a double arrow, meaning that when Acetoacetate converts to BHB, it is possible for BHB to convert back into Acetoacetate. This will become important!

The Three Ketone Bodies

The three ketone bodies: Acetoacetate, BHB, and Acetone participate in very different processes and have distinct roles in our body. Let me detail each in just a few words:

  1. Acetoacetate is the basic ketone body from which the others are created. Acetoacetate is not burned as fuel by our body, and unless it is converted to BHB or Acetone, it is eliminated in the urine. If you use urine keto sticks to measure your level of ketosis, you really aren’t measuring the level of ketosis, but the amount of ketone bodies you didn’t use and urinated out. It is an excellent way to check if a person with advanced type 2 diabetes (T2D) or type 1 diabetes (T1D) is heading toward ketoacidosis.
  2. Acetone, as we mentioned above, is a ketone body created from Acetoacetate in a unidirectional process. Acetone is spontaneously generated (combusts) from Acetoacetate into Acetone when much Acetoacetate is produced but isn’t converted to BHB and is, therefore, not used. Acetone is a gas, and this is well known by those starting the ketogenic diet as “keto breath” that makes one’s room and breath smell like a nail-polish remover factory. Why does some Acetoacetate combust into Acetone? Because ketone bodies are “acids” in the blood and a blood becoming overly acidic leads to ketoacidosis, a state of danger to health. The excess ketone bodies in Acetoacetate must be gotten rid of somehow. Excess ketone bodies are capable of escaping as gases through exhalation, which means that “energy” (ketone bodies represent energy and thus Calories that “could” have been burned) is wasted as gas when we exhale. Therefore, Acetone is a ketone body that doesn’t burn as ketones. Measuring acetone levels by a ketone breath meter tells us how much ketone we didn’t burn.
  3. The third ketone body, BHB, is the topic of most interest, since BHB is the only ketone body that humans burn as fuel. Remember that BHB can revert back to Acetoacetate if there is too much in the blood, and Acetoacetate will be urinated out or some may convert to Acetone and exhaled out. Measuring BHB tells us only how much ketone we have available in the blood to burn but tells us nothing about how much we are actually burning.  

In summary: our body burns BHB as fuel in ketosis but burns neither Acetone nor Acetoacetate. As the body learns to burn BHB in an efficient way (becomes keto adapted), there will be less Acetoacetate and Acetone that one can measure, because more ketones are burned in the form of BHB, except at times when the body switches away from ketosis after eating and sometimes also upon exercise.  

Ketones, Glucose, or Fat?

Our body is a fantastic operating system! It has several switches, signal molecules, and a host of redundancies that make sure the body remains the multicellular organism it is supposed to be. For example, in the pancreas, the originator of insulin, c-peptide, and glucagon, there is an order that is based on the “competition” between insulin and glucagon. Only one can be released at any one time. Insulin is anabolic with the job of “increase”, “grow”, and “store”, whereas glucagon is catabolic with the function of “take apart”, “reduce”, and “use what is stored”. These two systems, anabolic and catabolic, cannot operate at the same time. Which one is turned on depends on the level of blood glucose.

This special switch is like a “set point on a thermostat” for blood glucose levels in the blood. When the blood glucose drops to 80 mg/dL (4.44 mmol/L), this switch turns insulin release off and glucagon release on. This is extremely important, because if your blood glucose measures out at 79 mg/dL (4.39 mmol/L) then under normal circumstance, there is not a chance that your body is burning ketones! No matter which meter measures what: you are not burning ketones but are burning glucose! And the glucose you are burning is produced and stored as needed by your liver, its production and release are initiated by glucagon.

The role of glucagon is to initiate stored glycogen release from the liver as well as initiate ketone production from stored fat, so the moment your blood glucose drops to 80 mg/dL, glucagon is turned on and glycogen is released on the spot! This glycogen had been created from the foods you ate at earlier times and insulin deposited as triglycerides for storage. The creation of glycogen from stored fat is called gluconeogenesis. When glucagon activates glycogen release, the liver separates triglycerides into glycerol caps (these are formulated into glucose and released as glycogen) and unesterified free fatty acids (the “tri” in triglycerides are 3 fatty acid molecules). At the same time ketone production is also initiated by glucagon, which takes a little more time. Therefore, if your blood glucose is 80 mg/dL or lower, you are burning glucose released from stored glycogen instead of ketones.

Factors that can modify this special switch include long-term fasting at the levels of starvation when your glycogen storage is so low that your body is unable to release glycogen. In this case you end up emaciated, your body uses up your muscles to release enough glucose to nourish your blood cells so that oxygen is still carried by your blood to your brain. In T1D and end-stage T2D when there is no insulin (also called T1.5D), ketones will be very high in the blood, but the blood can’t burn ketones because it is an obligate glucose burner, and the ketone level increases to such high levels as to acidify your blood. This leads to ketoacidosis.

By contrast, assume that you are in ketosis, and you know you are because you have not eaten a bite of food for 24 hours (water fast). After 16 hours of fasting ketosis takes over running all body functions on ketones that it can (primarily the brain), while most other organs use free fatty acids created from triglycerides. Glucose use from glycogen is maintained for only the most essential obligate glucose users, such as the red blood cells. (See this also in Cahill, G. F. Starvation in man. N Engl J Med 282, doi:10.1056/nejm197003052821026 (1970) and George F. Cahill, J. Fuel Metabolism in Starvation. Annual Review of Nutrition 26, 1–22, doi: 10.1146/annurev.nutr.26.061505.111258 (2006).)

When you end your fast and take a bite of food, be it protein or carbs, you are “out of ketosis” in that instant even if there is BHB in your blood or Acetone in your breath or Acetoacetate in your urine. Why? Because when you eat anything other than fat, from the first bite and even from just looking at food, smelling food, and even looking at pictures/TV commercials of food initiates your insulin release immediately. This is also referred to as cephalic insulin release. Protein will be synthesized, not just into muscles but also into hormones, neurotransmitters, cells, bone, organelles, etc., and these tasks need insulin. The moment insulin is released, you will fall out of ketosis (stop burning ketones), although the ketones in your blood will not drop to zero. In other words:  

  1. Having ketones after fasting does not mean that one is in ketosis.
  2. Having nearly zero ketones after eating does not mean that one is of out of ketosis.

An important point I need to add here is about protein synthesis. Leucine is the most important branch chain amino acid necessary in a bolus amount for the starting of protein synthesis. However, leucine is a ketogenic amino acid, meaning it works in a ketogenic environment. As a result, our body always maintains a very low level of ketones—usually around 0.3 mmol/L—in order to be able to start protein synthesis. I mention this because while we always have such low-level ketones for this purpose, we are not in ketosis when we synthesize protein. Protein synthesis is an anabolic function and ketosis is catabolic, so the two cannot happen at the same time.  

Measuring ketones right after restarting your food consumption after a fast (I recommend you measure it yourself–giving appropriate time for body functions to reach their destination) will provide the proof for everything I have posited up until now. If you measure BHB in the blood in about 10-15 minutes after you started to eat (anything other than fat), you will see an increase in BHB (or at least it will stay unchanged) because it takes time for ketone production to stop, but with glucose and insulin releasing on the spot, it is glucose you will be burning.

The switch to turning the incoming fresh carbs or excess glucogenic amino acids into stored glycogen for future use also takes time and it is done by insulin. While insulin is active, and anabolic functions are happening, BHB appears to “back up” in the blood because burning ketones is a catabolic function and we cannot have both catabolic and anabolic functions active at the same time. Therefore, BHB will wait for the moment of next use opportunity in the blood or will revert back to Acetoacetate and some Acetone and be urinated or exhaled, respectively, as unused ketones. As a result, if you use a urine or breath meter, the numbers will increase because while the body cannot burn BHB, some of the excess converts to Acetoacetate and some of that can spontaneously generate Acetone. Acetoacetate in urine will also increase but with delay, since it has to pass through the kidneys into the bladder before you can measure it.

Later as your body has digested the food you have eaten and runs out of the quick glucose available in the food if you ate carbs or from the glucogenic amino acids that are used to fuel protein synthesis by burning as glucose, your body will move back into ketosis and burn BHB once more and you will see your BHB dropping really fast. By this time your body is using ketones faster than you can produce them. Thus, if at this point your BHB shows something like 0.2 mmol/L, whereas before you ate it was 1.5 mmol/L, it means you are now burning ketones faster than your liver is able to produce ketones. At the same time Acetone and Acetoacetate will be in short supply because you will be burning BHB and fewer, if any, ketone bodies will be eliminated as waste.

Ketone Measurement

Let’s review the three ways by which we can measure ketone bodies once more, especially because there are very confusing explanations attached to the measuring kits, to help in understanding what means what, and when exactly is a person in or out of ketosis!

The Measuring Equipment:

  1. Ketone urine strips–mentioned earlier–are used to measure Acetoacetate in the urine. Since the body doesn’t burn Acetoacetate as fuel, measuring this ketone body in the urine does not measure how much ketone the body is burning. Rather it measures how much is not being used from what has been made. It does not hint at the amount made, only the amount eliminated (wasted) in urine.
  2. Ketone breath meters: these testers create the biggest confusion in the market, due to the amounts of money invested in various devices, the prevalence of unsubstantiated claims, and the fantastical advertisements, but none of what they suggest is true. Contrary to popular belief, since Acetone is a gaseous form of ketone body converted from Acetoacetate in a one-directional way, its presence represents ketones never used but eliminated as excess from the Acetoacetate pool. Therefore, using a breath meter, one can measure the form of ketone body not used but wasted as gas.
  3. Blood ketone testers: this is the most popular ketone testing method, testing BHB, the form of ketone body we burn. This too is completely misunderstood. We sample BHB in the blood, a place where ketones are not actually used (our red blood cells are obligate glucose users). BHB in the blood is in a superhighway to organs that can use ketones and blood is also the storage place of BHB. As noted earlier, storing too much of a good thing can be dangerous. Too much BHB acidifies the blood, and the amount in the blood must be controlled within a certain pH range. Excess BHB will convert back to Acetoacetate where it will depart in the urine or further converted to Acetone and exhaled as gas. BHB is the only form of ketone body we burn as fuel.

What Do These Measurements Tell Us?

And here is where the trouble starts. As you can see, these three ketone bodies are not interchangeable in what they do and how. Measuring Acetoacetate in the urine tells us absolutely nothing about how well we burn ketones or if we are even in ketosis. It simply tells us that we are eliminating unused ketones.

Similarly, looking at breath meter numbers for ketones doesn’t tell us anything about the amount of ketones we are burning since it too is measuring what we haven’t burned.

On the flip side, eliminating energy (ketone is energy with Calories associated with each ketone molecule) in the form of urine or gas is a great way to get rid of excess energy and some may benefit from this by weight loss, however small.

BHB is the ketone body we measure in our blood but this measurement doesn’t reflect how much of it we are burning either; it shows us how much we have available to be burned.

So then, when it comes to measuring ketosis: how do we know how well we are using ketones or if we are using them at all?

The Essence of Understanding Ketone Measuring

If/when our body burns ketones as fuel very efficiently, the amount of wasted ketone bodies, aka Acetoacetate and Acetone, will be minimal, if any at all. And that’s because we are burning ketones as a fuel in the Krebs Cycle, and the end product, after ATP generation, is water, same as with the burning of any fat—after all, ketone bodies are fats.  

Because ketone bodies are used as fat (ketone bodies are short or medium chain fatty acids), the end-product is always the same as for burning any other fat, such as unesterified fatty acids made from triglycerides, with the notable difference that the brain cannot burn unesterified fatty acids because of their large size (long fatty acid chains cannot cross the blood brain barrier) but can burn ketone bodies (short or medium size fatty acids can cross the blood brain barrier). As a result, the best way to measure how well the person is burning fat is by tests that look at energy metabolism, because fat generates more energy than glucose and this is evident in the case of a well-adapted keto athlete who can outperform glucose-burning athletes.

Short of having a lab at home with all equipment, and doctors to help you run the associated tests, and because we have limited capacity to look at fat-burning in the brain, the best way to measure whether you are burning ketones or not, is by running what I call a 5-hour postprandial Kraft-in-Situ mimic test where you measure blood glucose and use BHB measurements instead of insulin every 30 minutes for 5 hours. Ketone is a great proxy for insulin. If you are interested in how we use this Kraft-in-Situ mimic test, please join my Facebook migraine group where such tests are daily occurrences.

Conclusion

It is not possible to measure how much ketones you are burning. You can only measure how much you have available in your blood to burn or how much you expelled through exhalation or urination without use. High BHB, Acetoacetate, or Acetone levels don’t mean you are in high level of ketosis and low level of any of these doesn’t mean you are out of ketosis!

My personal recommendation: I recommend you use whichever ketone measuring device you want to use but be sure you understand what the number it shows really means!!

Comments are welcome, as always, and are monitored for appropriateness,

Angela

About Angela A Stanton, Ph.D.

Angela A Stanton, PhD, is a Neuroeconomist focusing on chronic pain--migraine in particular--physiology, electrolyte homeostasis, nutrition, and genetics. She lives in Southern California. Her current research is focused on migraine cause, prevention, and treatment without the use of medicine. As a forever migraineur from childhood, her discovery was helped by experimenting on herself. She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic variations of all voltage dependent channels, gates, and pumps (chanelopathy) that modulate electrolyte mineral density and voltage in the brain. In addition, insulin and glucose transporters, and several other variants, such as MTHFR variants of B vitamin methylation process and many others are different in the case of a migraineur from the general population. Migraineurs are glucose sensitive (carbohydrate intolerant) and should avoid eating carbs as much as possible. She is working on her hypothesis that migraine is a metabolic disease. As a result of the success of the first edition of her book and her helping over 5000 migraineurs successfully prevent their migraines world wide, all ages and both genders, and all types of migraines, she published the 2nd (extended) edition of her migraine book "Fighting The Migraine Epidemic: Complete Guide: How To Treat & Prevent Migraines Without Medications". The 2nd edition is the “holy grail” of migraine cause, development, and prevention, incorporating all there is to know. It includes a long section for medical and research professionals. The book is full of academic citations (over 800) to authenticate the statements she makes to make it easy to follow up by those interested and to spark further research interest. It is a "Complete Guide", published on September 29, 2017. Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in Economics with dissertation in neuroscience (culminating in Neuroeconomics) at Claremont Graduate University, fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers, certification in LCHF/ketogenic diet from NN (Nutrition Network), certification in physiology (UPEN via Coursea), Nutrition (Harvard Shool of Public Health) and functional medicine studies. Dr. Stanton is an avid sports fan, currently power weight lifting and kickboxing. For relaxation (yeah.. about a half minute each day), she paints and photographs and loves to spend time with her family of husband of 45 years, 2 sons and their wives, and 2 granddaughters. Follow her on Twitter at: @MigraineBook, LinkedIn at https://www.linkedin.com/in/angelaastantonphd/ and facebook at https://www.facebook.com/DrAngelaAStanton/
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6 Responses to Ketosis & Measuring Ketones Explained

  1. Joro says:

    Hi Angela. Insightful texts in the blog. But I have to admit this one has been pretty confusing to understand. There certainly are a lot of weight lifters that visibly do put on muscle while strictly on keto (Zach Effron is a famous example). If no anabolic process is possible while in ketosis, how does that work?

    I have dabbled on and off trying to do proper keto and right now I have been more strict than usual for about a month, trying to actually keep carbs under 20g. Although admittedly I eat out so often that anything is as good as a guess. I have lost some weight and my hunger and appetite definitely decreased. But anything even vaguely resembling “mind clarity”, “increased productivity” and what have you is completely off the table, leading me to mild disappointment with the process. I still consider it a useful diet (if anything for discipline) and agree with all the sugar-insulin-bashing but giving up fruits and sweet potatoes seems a bit pointless at this point.

    Admittedly, I suffer from pretty terrible burn-out, chronic fatigue, procrastionation, etc. so maybe keto just isn’t enough to cut it. (I originally came to your blog researching side effects of SSRIs that were suggested to me by doctors).

    Liked by 1 person

    • Great questions Joro! Let me explain better what’s happening than in my blog. Zach Effron and all others are always in ketosis except after eating. This is the time when most people get confused because ketones often increase at this time and they think it means they are in ketosis. But it is not possible to build muscles or to synthesize protein in ketosis at all, so for a short time they all come out of ketosis, which goes unknown/unnoticed by them. It is not really important to understand it all, but it is important to understand the differences between catabolic and anabolic processes.

      Ketogenic processes are all catabolic becuase they use stored fat and generate glucose from the glycerol caps of the triglycerides, which are used as energy (not ketones) by most organs, including the heart and muscles too, especially when not working out. Really very few organs use ketones, most importantly the brain, also muscles can though ketones are the choice only after free fatty acids are not available, and the heart uses ketones usually only after a heart attack. So ketosis doesn’t mean the “body” is using ketones for energy but that the brain does and the rest of the organs that normally use fat, burn fat instead of glucose and occasionally burn ketones. Some of our body cannot actually use ketones at all–like while the liver creates ketones, it cannot use them. It can use glucose or free fatty acids. Our red blood cells lack mitochondria, thus can only use glucose. So “being in ketosis” means different things to different people but it certainly doesn’t mean the whole body is in ketosis.

      Building muscles (as well as cells, hormones, etc., collectively termed protein synthesis) can only happen in an anabolic process, and by definition, an anabolic process is not ketogenic–I just explained how ketogenesis is catabolic. It cannot be both. And using anabolic processes means “not using ketones” but “building up” muscles and other tissues, using insulin to “build”. So during the “building up” process the person is not in ketosis. But this time is quite indistinguishable for the person who is properly adapted–referred to as flexible metabolism–and so the person will not feel any different. In fact, one of the best things about ketosis is that one can start working out fasted–emptied glycogen stores force the use of ketones and fat burning by the muscles–which prevent lactic acid buildup, and so no muscle aches after weightlifting. Since I was seriously into weightlifting myself pre-Covid, I worked out fasted each time–even if my workout started at 5 pm! But you can get your money on me being out of ketosis when I ate my steak after the workout for the period of protein synthesis.

      In terms of what is happening to you: you likely have not reached full keto adapted (fat adapted) state and since you are moving back and forth between lower and higher carbs, your brain is unable to switch over. This is why you don’t have the clarity of mind. I am like you and don’t stick with keto in the summer, for example–I believe in more seasonal eating than being strict 24/7 all seasons–and I also noticed that my brain isn’t as sharp in the summer. Ironically I had lots of pretty difficult interviews and so I simply didn’t eat those days at all to get my brain back on ketones. Since I have been doing this for 8+ years, and I do have very flexible metabolism by now, I am back into strong ketosis within one day of not eating, so I am doing fine. Like this interview: https://youtu.be/tDH0udMBPXA was originally a one-shot 2.5-hour long chat with a very sharp MD. PhD, so we were really flying through subjects–he split our chat into 2 sections and I am just sharing section 1. I was in ketosis on this interview and quite sharp as far as my abilities go at my age… I was at a 24-hour fast when we started the interview.

      I understand your thoughts about fruits and sweet potatoes. And if you have no health issues like type 2 diabetes, migraines, seizures, cancer, MS, or similar, you have no reason to force your way into ketosis. Many people go after ketosis as a “desired outcome” but ketosis is a tool and not an outcome. You can use the tool to achieve a goal and can stay there if you wish, or just move back to your comfort zone. If that means eating some fruits and sweet potatoes: these won’t make you sick, provided you eat them in a healthy way: whole fruits with skin and not like smoothies and shakes, and don’t eat sweet potatoes instead of a good serving of meat.

      And if you need some special brain power for anything different, fast 24 hours and you will be fine–provided your body is used to such fasting! I basically fast for 16-20 hours every single day! I eat only two meals a day, though both are very large and very protein heavy.

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      • Joro says:

        Thanks! This is useful information definitely. On my case in particular – I have pretty high results on urine samples at least (granted, this very post explains that this only means ketone generation but not ketone use per se) and apart from being at the mercy of the restaurant cooks I do choose keto only options (egg, meat, fish, dairy, few kinds of nuts, greens and nightshades, which do have some carb content but should be below the threshold). Regardless, I think this clarity of mind, higher energy, etc, might be supported by ketosis, but possibly dependent on many other factors like stress and general well-being. But yes, maybe keto adaptation is still a while ahead, although to be honest if after one month i’m still not at least partly adapted, it’s a bit disheartening.

        I tried fasting before but even with drinking salty water and whatnot I got terrible headaches after going past 16h. In fact it was one of the reasons I tried to do keto beforehand. I will try working out fasted though.

        Finally, while not trying to hijack the thread, since you seem to have a lot of knowledge on brain chemistry and seem to be very anti-SSRI/SNRI (and one can’t help but agree), do you recommend ANY medication at all for fatigue, tension, low-level anxiety, concentrantion and memory difficulties, low motivation and procrastination – generally all the mild burnout symptoms. I’ve come to the conclusion that apart from some “nootropics” style of things like racetams, l-theanin and the likes, it wouldn’t be beneficial or would even be harmful to try any actual psychiatric drugs. Of course I realize comment-style dialogue is not a proper way to diagnose but general opinions are informative enough for me.

        Liked by 1 person

        • Yes, of course, stress and general health have a lot to do with how you feel and also whether you are able to get into ketosis at the level necessary is also dependent on health. For example, you are definitely producing ketones but if you are unable to fast, it suggests that you are metabolically not yet healthy. You are likely having way too much blood glucose variability. Blood glucose dropping as a result of high insulin activity will send your ketones to urine since you cannot use them and will make you hungry at the same time as giving you a headache and maybe even nausea and other symptoms.

          A person like you with these symptoms I recommend to try the carnivore diet. A carnivore diet is all animal products, including dairy, organs, and all creatures in the animal kingdom. When you only eat animal products, and eat to satiety each time, you eat enough protein at each meal to start protein synthesis, which stabilizes blood glucose and insulin and prevents sugar crashes because you end up eating excess protein, which can provide the necessary glucose “on demand” as opposed to when eating carbs, which come in all at once.

          I currently work with over 14K migraineurs on Facebook, and most of them are on the carnivore diet to start with. It provides the fastest metabolic healing. And here I connect to the mental health aspect as well. It is quite clear from thousands of examples by now that mentally challenging condition, be is depression or anxiety or anything else, seems to heal/reverse/remiss/whatever you wanna call it state from the carnivore diet.

          In addition, there is one particular supplement I highly recommend, based on my personal amazing experience as well as many others in my migraine group. Let me tell you a bit of my story: When I was 19 I have a major nervous breakdown, which they said was the result of my B12 tanking to almost zero, so they put me on B12 IVs for several months. I am not recommending B12–read on. At that time I was diagnosed with GAD (general anxiety disorder) and panic attacks. I was basically useless most of my life as a result. I was on all kinds of drugs and finally ended up on Valium–the most hated drug on the planet because it is very addictive. Luckily I don’t have the genetic predisposition to becoming addicted (I really pulled a luck card there!!) and so 48-49 years later, still having been taking the same drug, I started a supplement that’s shortened in name to TTFD B1. Allithiamine and Lipothiamine are the only two original types that are fully able top cross blood brain barrier and are smaller (50 mg each) and Thiamax is a 100 mg most recent type on the market. There are no other B1 types that can do what any of these do.

          I tried all 3 and stuck with Allithiamine, 50 mg capsule. After taking the fist capsule, I got knocked over, as if it were a sleeping pill. I basically slept most of the first day through. Then I switched taking it at night and in a few days it no longer put me to sleep so I moved it to taking it in the morning. What I had–the massive sleepiness–was a paradoxical reaction. Other people have other paradoxical reactions, to trick is to discover if you have one. If yes, then once the symptoms disappear, you want to increase the dose. In my case after 2-3 weeks the sleepiness was completely gone so I increased it to 2 capsules, one in the morning, one at night. I kept on increasing until I no longer get any paradox from increasing it. I was at 8 capsules a day at this point..

          I stayed at this dose for a few months and started to taper back down the same way as titrating up–meaning that if I had a paradox from the reduction, I went back to the larger dose for a week and tried again–so the opposite. I went back down to 1 and ended up with a paradox, so 2 has been my ideal dose now for over a year. And the most amazing outcome? From the first week on I felt this sudden and most amazing calm that I have never felt before. My anxiety and panic attacks just vanished! Boom! All gone. I am almost completely tapered off Valium as well. In fact, I had a small surgery yesterday and they took my blood pressure before it. I was sure it was going to be high becuase.. well… before surgery and no Valium.. and wow!! 118/76!! So no more GAD and panic!! None. Zero. All because of diet change and TTFD B1.

          I recommend you give both a try and see if you also benefit. 🙂

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  2. Gina says:

    Hi!! I love your work about migraines and ketosis! My daughter is 4.5 and her urine analysis came back normal except for ketones which were a 1+. She is not on a keto diet but a clean paleo diet which does include beans, sweet potatoes, bananas, and some fruits here and there. She eats a lot of pumpkin and sunflower seeds daily. Most of her meals contain lots of meat and veggies and she does not eat carbs with each meal – maybe 30-60 grams per day max. She has no carbs really besides that and no added sugar. The urine sample was taken about 1.5 to 2 hours after eating a meal of one chicken sausage and a cup of kale. Is 1+ ketone high abnormal in this case? Her blood glucose was normal around 90 I believe and that was after drinking 1.5 cups of coconut water. Thank you so much and please let me know if I can donate or pay you in some way!

    Liked by 1 person

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