June 26, 2017 by Adapt Your Life

Ketones – Dr. Westman

There’s a lot of talk in the keto community about getting into ketosis and also about ketones, yet many of us still have so many questions – Dr. Westman answers some of the most burning questions, revealing everything you ever wanted to know about them and much more.

What are ketones?

Ketones are energy molecules that the body can use just like glucose molecules. And they pretty much work in the same areas where glucose molecules would have worked if you had been eating lots of carbohydrates before, and glucose was your primary fuel.

We focus on blood glucose a lot, and if you’re eating very little carbohydrates, so that your ketone levels go up a little bit, that’s called nutritional ketosis.

Nutritional ketosis vs. ketoacidosis

A lot of doctors were only taught that ketones were bad because they had not learned about nutritional ketosis, and only learned about diabetic ketoacidosis, which is a serious condition that can happen in people with type one diabetes.

But that’s not what nutritional ketosis is. Nutritional ketosis is a range of ketones in the blood that reflect the ketone and fat burning that occurs when you don’t eat many carbs. 

Different types of ketones

What makes it confusing is that in the past you could only check the urine for ketones, and now you can check the blood and also the breath. So the first thing you need to do with any ketone question is to identify – are we talking about breath ketones, blood ketones, or urine ketones?

Do more ketones mean more weight loss?

With blood ketones – if they’re higher, it doesn’t necessarily equal more weight loss. Weight loss actually comes from the energy balance of eating fewer calories and burning more calories than you’re eating over a period of time.

Ketones really just reflect the fact that you’re burning fat as your primary fuel. So more ketones do not necessarily mean more weight loss. “I’ve seen people with great ketone levels and they’re not losing weight, and if you have this mindset of ‘I’m in nutritional ketosis, I should be losing weight’, it’s going to be frustrating,” admits Dr. Westman.

Do ketone levels go down the longer you stay on the low-carb diet?

This is one of those unstudied conditions and new knowledge is now being developed, so some people will say that their ketones went up, while for some people it went down. There’s going to be a range of what normal ketones are when you’re not eating carbohydrates.

“I’ve seen people stay even with urine ketones for years, and yet the common teaching is that urine ketones aren’t any good,’ says Dr. Westman. Urine ketones can actually be valid to use, although we do think of the blood ketones as the better, more reliable marker. 

How do ketones affect energy levels?

Many people do claim to have energy levels increase in ketosis, so this may be possible but at this stage, it’s mostly anecdotal.

Would exogenous ketones (drinking ketones) be beneficial to a growing type one diabetic child during sports?

We’ll soon know the answer to this with Jeff Volak at Ohio State doing the latest research on elite athletes. It’s not something Dr. Westman has a lot of experience, however it should be fine to experiment to see how things work in your child, and how they feel, as long as you’re measuring everything that you can, especially blood glucose. For a type one diabetic, check out Type One Grit’s Facebook page to ask other children who are possibly using certain ketone products to see what they would tell you.

Is there an optimum ketone level to achieve for weight loss and for health?

There is a conference at the University of South Florida in Tampa that have scientists who are looking at different ketone levels in terms of different disease states for which there may be a certain ketone level that you want to achieve, but for weight loss or general health,  the optimal ketone level is unknown. “A lot of people think the more, the better, well, I’m not so sure,” says Dr. Westman.

Can you be ketone resistant (not efficient at burning ketones)?

In a world of carbohydrate resistance, there’s a possibility that there may be ketone resistance. When you’re adapting to a low-carb, high-fat diet, and turning into a ketone and fat burning machine, there’s a time period where you gain efficiency. We usually think of that as a period of one or two weeks until you can maximally function at general levels.

In the movie, ‘Cereal Killers 2’, they keto-adapted two elite athletes with monitoring, they waited six months before saying that there was no greater improvement in the optimal fat burning. So you don’t want to just change your diet and do some strenuous exercise without waiting a period of time – weeks to perhaps even months. And if you’re really trying to do this, then you’ll probably need to wait a period of months to measure your fat burning to make sure it’s really good.

What ketone level would cause an insulin response?

“I generally don’t think of ketones causing an insulin response directly. That will be an area for new research,” says Dr. Westman.

Can a cyclical ketogenic diet be beneficial?

A cyclical ketogenic diet is an approach that has been used for a while in the bodybuilding world. This basically means eating carbs so that you don’t have ketones for a period of time, and then not eating carbs so you do.

“I don’t know a whole lot about it clinically, because my specific strength is using the ketogenic diet for general health, or for therapeutic views in an unhealthy population. There’s a book by Lyle McDonald called ‘The Ketogenic Diet’ that might be a reference for you,” says Dr. Westman.


There’s a lot of talk in the keto community about getting into ketosis and also about ketones, yet many of us still have so many questions – Dr. Westman answers some of the most burning questions, find out everything you ever wanted to know about ketones – from what they are to whether or not you can be ketone resistant.