Targets for Ketosis using BioSense

[Naposghost]

I recently purchased a BioSense breath keytone measurement device which I have to say is very much preferable to a finger stick. I have some questions.

What is the target ACE range I should shoot for to be inline with Bredesen recommended ketosis state?
What if I also want to lose weight? Would the ACE target be higher?
How often should I test during the day?

Thanks!

[Julie G]

Thanks for posting this! Of course, it depends upon your goals, but in general Dr. Bredesen recommends an AM fasting goal of 0.5 BHB or higher (which is comparable to 4 ACEs or higher) rising up up to 4 BHB or 32 ACEs at some point during the day. Most people do fine getting to 1-1.5 BHB or 8-12 ACEs at some point during the day; whereas others with greater deficits may need higher levels.

I’ve learned that with BHB, I can get a good sense of my state of ketosis with one test right before I break my fast. That’s when I typically get my highest reading. Whereas with ACEs, I recommend testing at least 3 times per day, preferably 5. First thing in the AM, before meals, and before bed. You want a minimum daily score of 100.

I’m eager to hear of your experience. I ran a 3 week trial with Biosense, concurrently checking BHB. I learned that In general my my BHB tends to be higher than my ACEs, but one day (with pretty strenuous exercise) my ACEs went up really high for me- up to 26. Let us know what you think of it!

[Naposghost]

Julie,
Thanks so much! I had no idea I should measure throughout the day so will start that. I have been getting 4-5 ACE fasting in the AM so, good to know that's where it should be. I'll add 4-5 additional measure points during the day and before bed. THANKS again. More to report later. - Rene

[Linda]

I know Dr. Bredesen used to say to stay in nutritional ketosis with a level from .5 - 1.5. I see that he is now saying to be above 1.0. I've been on a Keto diet for over a year now, and I usually test my blood after a 14 - 16 hour fast, right before my first meal of the day. I am usually in a lower level of nutritional ketosis with readings between .5 - .9. As I've been reading more, I started testing often to see how different meals are affecting my levels. I have been surprised and I am now totally confused!! I am no longer in nutritional ketosis after I eat, even if the meal is high in fat and low in protein and carbs. (i.e. a small piece of salmon with butter sauce and a kale salad with lots of olive oil.) My readings consistently drop to .2 - .4 and remain there for the rest of the afternoon. I usually keep my daily carbs below 50, and often below 20. I had been obliviously happy before I decided to experiment and test more often. I know that being in ketosis is best for brain health, so I need to figure this out. Do you need to stay in ketosis above 1.0 throughout the day in order to reap the full benefits, or is it still beneficial for your health/ brain if you cycle in and out of ketosis? Also, could being underweight and having a low BMI (17.9) be a cause of getting kicked out of ketosis after eating? Unfortunately, I really do struggle with ways to eat healthy, stay in ketosis, and gain weight because so many of the healthy high calorie foods give me severe migraines. Avocados, bananas, nuts, nut butters, and hard cheeses all give me severe migraines. I do take DAO enzymes for histamine issues and I've been adding tablespoons of olive oil to my smoothies. You are all so smart and kind! Does anyone have any suggestions for me? I need to gain weight AND get my ketone levels higher, without getting migraines. Thanks so much!!! (I'm ApoE 3/4)

[Julie G]

I know Dr. Bredesen used to say to stay in nutritional ketosis with a level from .5 - 1.5. I see that he is now saying to be above 1.0.

I think his advice remains pretty such the same. He would like us to be at or above 0.5 first thing in the AM, then get to 1-1.5 at some point in the day. For me this is typically right before I break my fast. When providing a range, he doesn't want to frighten people who get higher levels while also acknowledging that some, with more advances stages of cognitive decline, may need higher levels to help fuel their brains.

I am usually in a lower level of nutritional ketosis with readings between .5 - .9. As I've been reading more, I started testing often to see how different meals are affecting my levels. I have been surprised and I am now totally confused!! I am no longer in nutritional ketosis after I eat, even if the meal is high in fat and low in protein and carbs. (i.e. a small piece of salmon with butter sauce and a kale salad with lots of olive oil.) My readings consistently drop to .2 - .4 and remain there for the rest of the afternoon. I usually keep my daily carbs below 50, and often below 20.

Your "lower level" may be just fine. It sounds like you're almost reaching his goals. I think it's normal to kick out of ketosis after eating. How are your general glycemic markers; fasting glucose, insulin, hbA1c?

[Linda]

Thanks so much, Julie! I have a doctor's appointment in 2 weeks and I'm hoping to see an improvement from last year's results! My homocysteine was still high last year at 8.1, but down from 12.1 the previous year. My hbA1c was still too high at 5.5, but it was down from 5.7. My doctor expressed a real concern last year for my high cholesterol level, so I'm hoping she doesn't try to push me to take meds. (I won't.) My total cholesterol was 268. LDL was 161. HDL was 95, and my triglycerides were 58. I guess things have been improving, but ever SO SLOWLY. Thanks again for your response!

[Tincup]

I have a doctor's appointment in 2 weeks and I'm hoping to see an improvement from last year's results! My homocysteine was still high last year at 8.1, but down from 12.1 the previous year. My hbA1c was still too high at 5.5, but it was down from 5.7. My doctor expressed a real concern last year for my high cholesterol level, so I'm hoping she doesn't try to push me to take meds. (I won't.) My total cholesterol was 268. LDL was 161. HDL was 95, and my triglycerides were 58. I guess things have been improving, but ever SO SLOWLY.

Linda,

Your Tg/HDL ratio is 58/95 or 0.6. This is somewhat discordant with your HbA1C of 5.5. The average glucose association for A1C is based on an assumption of the life of your red blood cells. Someone who has longer lived RBC's will have a higher A1C. The low Tg's and high HDL's are indicative of lower blood sugar. It would be interesting for you to test your finger stick glucose over the day & see how well it matches with the A1C.

[Linda]

Thanks so much, Tincup. Unfortunately, I'm struggling to understand what this means. Is my ratio of .6 where it should be? Are you saying that you would assume that my HbA1C would have been lower than 5.5? I wonder what could have caused this discrepancy. Is there something else I need to be aware of? I check my ketones more often than my glucose level, but I will definitely be more on top of it.

Thanks again for this information!!

[Tincup]

Unfortunately, I'm struggling to understand what this means. Is my ratio of .6 where it should be? Are you saying that you would assume that my HbA1C would have been lower than 5.5? I wonder what could have caused this discrepancy. Is there something else I need to be aware of? I check my ketones more often than my glucose level, but I will definitely be more on top of it.

Your Tg/HDL ratio of 0.6 is quite good. The Tg/HDL ratio is a proxy for insulin resistance (or lack thereof). What I'm saying is that A1C is an imperfect measure of average glucose. Your average glucose may actually be lower than a 5.5 would indicate. If you put 5.5 in a calculator, the correlation is an average glucose of 111 mg/dL. See this.

[Linda]

Thanks so much for clarifying this for me. I truly appreciate it!!