fat

[simpleazon-image align="right" asin="B000V3IV3O" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/317R0BJJLuL._SL160_.jpg" width="160"]Folk on the ketogenic diet usually test their ketogenic status using Ketostix.  You wee on them and (hopefully) they go pink to purple.

However, they are significantly less than accurate!

Firstly, as you head towards “nutritional ketosis” two substances are produced that are found in the urine: acetoacetate and beta-hydroxybutyrate.  It is the latter, beta-hydroxybutyrate that we are interested in, but, as Phinney and Volek say:

the strips that test for ketones in the urine detect the presence of acetoacetate, not beta-hydroxybutyrate

They go on:

In the kidney, this process of keto-adaptation is also complex. Over time, urine ketone excretion drops off … This decline in urine ketones happens over the same time-course that renal uric acid clearance returns to normal  and thus may represent an adaptation in kidney organic acid metabolism in response to sustained carbohydrate restriction.

[simpleazon-image align="right" asin="B005CVV2AE" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/515TE8b8jLL._SL160_.jpg" width="106"]So we are not only measuring the wrong thing (acetoacetate vs beta-hydroxybutyrate), but over time acetoacetate excretion drops off (which is why so many people in ketogenic forums and Facebook groups keep asking why they are “no longer in ketosis” (as measured by the Ketostix) when they are being good and sticking to the diet.  Phinney and Volek conclude:

These temporal changes in how the kidneys handle ketones make urine ketone testing a rather uncertain if not undependable way of monitoring dietary response/adherence. Testing serum for beta-hydroxybutyrate is much more accurate but requires drawing blood, and it is expensive because it is not a routine test that doctors normally order.

From [simpleazon-link asin="B005CVV2AE" locale="uk"]The Art and Science of Low Carbohydrate Living[/simpleazon-link]

Well, there’s something they didn’t know when they wrote that: you can now do serum testing (testing the level of beta-hydroxybutyrate in your blood) at home with a simple meter that is similar to a blood glucose meter.

I have recently found a brand-new meter, an upgrade from the Precision Xtra, which is called the Freestyle Optium.  I got mine for free!  Further down this post, I will tell you how (although it may only be possible in the UK).  So what follows between the rules is how it was until recently, and how it may still be outside the UK.

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There are a couple of meters you can use, and they have been tested and compared by Jimmy Moore in his n=1 reports on his own progress with nutritional ketosis.  One of the meters comes out badly in his review: you have to remember that these meters were not intended for the likes of us, who are trying to achieve nutritional ketosis, as defined by Phinney and Volek.

They are designed for Type 1 diabetics who are trying to avoid keto-acidosis (more of this further down this blog post).  Which is why one of the meters just says “LO” for low measurements: that’s good enough (and good news) for someone who is Type 1.

Jimmy comes out in favour of [simpleazon-link asin="B0000537OO" locale="uk"]Precision Xtra Meter[/simpleazon-link], because it is capable of the levels of accuracy that we need.

However, especially if you live outside the USA (like, in the UK, as I do for a significant part of the year) the cost of the test strips for  the Precision Xtra is a serious expense.  In Amazon UK this pack is £66 plus £2 delivery for 10 (yes, that’s right, TEN!) strips. [simpleazon-image align="left" asin="B001EL30TM" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/21xRxYm7hhL._SL160_.jpg" width="160"]

That comes to £6.80 every time you do a test.  I suspect you won’t test all that often!  The meter from Amazon.co.uk is £25.48, including delivery.

If you are in the USA, the cheapest place I have found to get a Precision Xtra is MedExSupply.com, where, at the time of writing (August 10, 2013), it was $18.00.  The best source of test strips is Universal Drugstore in Canada, where they come out at $2.00 a strip (plus $7.00 shipping).  UDS need a prescription from your physician:here’s the e-mail they sent me describing what they need: Universal Drugstore e-mail.

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However, that’s the bad news.  Here’s the good news: I just got a brand-new, latest model meter for free, and 10 β-ketone test strips for £16.99.  (Actually, I bought three boxes and paid extra for express delivery.)  That comes out to $2.55 a test.

Optium in hand

Abbott Freestyle Optium

I had got so frustrated with my research that I Googled Abbott (the makers of the Precision Xtra) and discovered that they have a company in the UK, Abbott Diabetes Care.  I called them and asked them about the Precision Xtra and they said that there’s a new model, the Freestyle Optium, and would I like them to send me one for free.  I said yes, and two days later it arrived.  It is a very cool little machine!

It measures both blood glucose and blood ketones (FreeStyle Optium β Ketone test strips for self-testing your blood ketones).

After quite a bit of Googling I found by far the cheapest source of these test strip on eBay: Freestyle Optium Beta B-Ketone Test Strips Pack Size 10.

If you want one too, call Abbott Diabetes Care in the UK on 0500 467 466 (it’s even a free phone number).

If you find information about this for other countries, let me know and I’ll add it here.  And when my test strips arrive next Tuesday, I’ll let you know how I get on.

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See also:

Ketogenic What is a Ketogenic Diet, in a nutshell?
Ketogenic A Guide to Ketosis
Ketogenic What is the Ketogenic Diet Good For?
Ketogenic Tips for Starting and Restarting Ketosis
Ketogenic On Ketogenic Diets
Ketogenic How to Use the Keto Calculator
Ketogenic Ketone Testing
Ketogenic A one-page intro to Ketogenic Diets, to hand to medical sceptics
Ketogenic 203 Comments on Mark Maunder’s “Basic Ketogenic Diet”

I have been following up some Internet research for a good friend of mine who has followed the “Radical Nutrition Programme” of LFFO, has lost close on 60lbs and looks FABULOUS, but still has some problems.

Some of those are in the mind, and we’re working on that together, but this person also has all the symptoms of Metabolic Syndrome:

  • Can’t shift the weight around the middle, even though the BMI says you’re at a good weight
  • High Blood sugar that medication has difficulty shifting (insulin resistance)
  • High Blood Pressure (hypertension)
  • High Cholesterol

[simpleazon-image align="left" asin="1468161776" locale="us" height="160" src="http://ecx.images-amazon.com/images/I/41ZUxuOCjLL._SL160_.jpg" width="107"]There are other symptoms, but this is enough.  Susan found an article in “The Week” that was a summary of a longer article in the Daily Telegraph, called “The Bitter Truth About Sugar“.  It’s not a long article but it certainly inspired me to Google the scientist behind the article, Professor Robert Lustig of UCSF.  His video on You Tube (below) has had 2.25 million hits and makes compelling viewing: I just watched it in one go.  He argues that sugar is as toxic as ethanol (alcohol).  The table above summarises the argument: I still think it’s worth watching the video.

At times it gets a bit technical when he delves into the biochemistry, but he’s entertaining and keeps us with him, but if you’ve ever worried about your weight, you owe it to yourself to find the times to watch one of these videos.

Nobody chooses to be obese,” says Lustig. “Nobody. Especially not children. This is a global pandemic. D’you think, all of a sudden, everybody in the world became gluttons and sloths at the same time? Get with the programme!

Read the article and if it catches your attention, and either watch the short version of the video (26 minutes)

httpv://www.youtube.com/watch?v=14ZIKOQkTiM

… or the long version (89 minutes)

httpv://www.youtube.com/watch?v=dBnniua6-oM

This isn’t just scare stuff: he suggests what we can do to help ourselves:

Lifestyle Intervention

  1. Get rid of all sugared liquids–only water and milk
  2. Eat your carbohydrate with fibre
  3. Wait 20 minutes for second portions
  4. Buy your “screen time” minute-for-minute with physical activity.

Also, get some exercise: not because you’ll burn the calories (it takes a LOT of exercise to burn a Big Mac!), but because:

Why is exercise important in obesity?

  1. Because it improves skeletal muscle insulin sensitivity
  2. Becasue it reduces stress and resultant cortisol release
  3. Because it makes the TCA cycle (the basic process that digests food and produces energy) run faster, detoxifies fructose, and improves hepatic insulin sensitivity.

Also, he’s heavy on making sure that you have plenty of fibre in your diet:

Why Is Fibre Important in Obesity?

“When God Made the Poison,
He packaged it with the antidote”

Fructose is a poison, but wherever it appears in nature, it’s packaged with way more fibre.

Fibre:

  1. Reduces the rate of intestinal carbohydrate absorption, reducing insulin response (Fat or Fart)
  2. Increases speed of transit of intestinal contents, raising PYY 3-36 and thus induces satiety signal sooner
  3. Inhibits absorption of some free fatty acids to the colon, which are metabolized by colonic bacteria to short-chain fatty acids, which suppress insulin

So, here’s the summary of the message:

  • Fructose consumption has increased in the last 30 years, coinciding with the obesity epidemic
  • A calorie is not a calorie (fructose is not glucose)
  • You are not what you eat, you are what you do with what you eat
  • Fructose metabolism in the liver leads to Metabolic Syndrome
  • Consuming fructose interferes with obesity intervention
  • Fructose is a chronic liver toxin: it’s alcohol without the buzz.

Here’s an excellent infographic from an article (The Amazing Similarities Between this Toxic Sugar and Alcohol) on Mercola’s website with a wealth of info:
fructose overload infographic

Discover the fructose content of common foods, beverages, sauces, and even sugar substitutes in our infographic “Fructose Overload.” Use the embed code to share it on your website.

fructose overload infographic

Discover the fructose content of common foods, beverages, sauces, and even sugar substitutes in our infographic “Fructose Overload.”

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