optimal ketone and blood sugar levels for ketosis
- Reducing the amount of refined non-fibre carbohydrate in your diet will stabilise your blood sugar and promote ketosis.
- Elevated blood sugar levels are associated with a reduction in risk of many modern metabolic diseases (e.g. diabetes, heart disease, stroke, cancer, Parkinson’s and Alzheimer’s).
- Insulin regulates the release of both glucose and ketones into your bloodstream from storage. When you eat insulin goes up. When you don’t eat insulin comes down to release stored energy.
- You become ‘insulin resistant’ when your fat cells become full and can no longer store excess energy efficiently.
- When your adipose tissue fills beyond your Personal Fat Threshold, excess energy is stored in places that are still insulin sensitive (like your liver, pancreas, heart, brain and eyes) and excess energy overflows into your bloodstream as elevated glucose, triglycerides and ketones.
- Exogenous ketosis occurs when you consume extra fat or exogenous ketone supplements to raise the level of ketones in your blood.
- Endogenous ketosis occurs when you consume less food, insulin and blood sugars decrease and ketone production from your body fat increases.
- While a low carb or ketogenic diet will help to stabilise your blood sugars, the vast majority of the benefits of ketosis occur due to endogenous ketosis.
- Reducing your intake of processed carbohydrates will help you to avoid hyperpalatable nutrient-poor “junk food” which will improve satiety and helps you to eat less and thus lose weight sustainably with less effort.
- Reducing your carbohydrate intake to very low levels is not necessarily better, especially if it causes you to significantly increase your intake of dietary fat.
- There is nothing magical about having a particular blood ketone value, ketosis or a high fat ‘ketogenic diet’ that will cause you to lose weight more quickly.
Low-carb diets reduce blood sugar levels
Many people follow a low carbohydrate diet to manage their blood sugar levels. Foods that contain less carbohydrate cause a smaller rise in blood sugar.   If you have prediabetes or type 2 diabetes, it makes a lot of sense to reduce your intake of carbohydrates to drain the glucose from your bloodstream.
According to mainstream medical definitions:
- “normal” blood sugar is defined as having an HbA1c of less than 6.0%,
- “Prediabetes” occurs when you have an HbA1c between 6.0 and 6.4%, and
- Type 2 diabetes is diagnosed when you have an HbA1c of 6.5% or above.
However, these mainstream definitions of “normal” are far from optimal! Your risk of diabetes, stroke, heart disease, cardiovascular disease and cancer increase with an HbA1c above 5.0%.
If you’re interested in pursuing optimal rather than what passes as “normal” metabolic health, the table below shows suggested HbA1c and blood sugar targets based on the risk categories for stroke, cardiovascular disease and heart disease shown in the charts above.
A metabolically healthy person will store excess energy in their fat cells for later use. But in time, you get to the point your fat stores cannot continue to expand and absorb more energy from your diet. Once you exceed your Personal Fat Threshold, you become “insulin resistant” and it takes more and more insulin to store and hold energy in your fat cells.
As you become “insulin resistant” the expansion of your fat cells slows. Your pancreas cannot produce enough insulin to jam the excess energy from your diet into your fat stores.
Unfortunately, a reduced ability to increase body fat is not as good as sounds. Once your fat cells are full, any excess energy will be redirected to other parts of your body that are still insulin sensitive (i.e. your liver, pancreas, heart, brain and other vital organs).
Your pancreas then has to work overtime, secreting more and more insulin to hold back your stored energy while you use up the energy in your bloodstream that continues to be topped up from the food coming in via your mouth.
How to manage your dietary insulin load
The good news is that you can tailor the insulin load of your diet to help you stabilise your blood sugars. Managing your insulin load can be particularly useful if you are injecting insulin to control your blood sugars as it is almost impossible to match large bolus doses of insulin with large amounts of dietary carbohydrate and protein.
A person with type 1 diabetes cannot produce enough insulin to keep energy locked away in their liver and fat stores. Without exogenous insulin, someone with type 1 diabetes will see both their blood sugar and blood ketone levels rise as their stored energy leaches into their bloodstream.
As shown in the image of “JL” below, one of the first children with type 1 diabetes to receive insulin, people with type 1 diabetes quickly regain weight with exogenous insulin injections. Exogenous insulin regulates the release of stored energy from your body.
If you are injecting insulin, you need to think in terms of finding the optimal dose of insulin required to keep your blood sugars stable.
- Too much insulin can slow the release of fat from your body to be used for fuel, your blood sugars will drop and you will feel compelled to eat.
- With too little insulin you will effectively disintegrate, with all your stored energy pouring into your bloodstream
Where this insulin-centric view of diabetes management and obesity falls down is that it doesn’t translate to someone who is not injecting insulin.
Your pancreas will not secrete more insulin than it needs to hold back your fat in storage while your body uses up the energy coming in from your mouth.
Your glucose has to be burned off before your dietary fat or body fat. A low-carbohydrate diet helps to stabilise your blood sugars. However, if you want lower blood sugar levels and to reverse your diabetes, you need to find to eat that keeps you satisfied while also getting the nutrients you need.
When you go without food, the glucose stored in your bloodstream, liver and muscles (glycogen) is reduced. Once excess glucose is used up, your body will turn to your body fat stores for fuel. Your liver then converts body fat to ketones to use as an alternative fuel for use by the brain, heart and other vital organs.
This process is known as “endogenous ketosis” (note: endogenous means that the ketones originate from inside your body).
Most of the beneficial effects of a ketogenic diet occur during endogenous ketosis (i.e. autophagy, mitogenesis, mitophagy, upregulation of SIRT1 and increase of NAD+). Your body goes into repair mode to make sure it can survive to procreate when food is more available.
The chart below shows my blood sugar and blood ketone (BHB) levels during a seven day fast. As glucose levels decrease, blood ketone levels rise to compensate for the lack of energy coming in from your diet. The sum of glucose and ketones can be thought of as the “total energy” (i.e. glucose + ketones = total energy).
When fasting, your body may allow the total energy in your bloodstream quite high levels. This enables you to be ready at a moment’s notice to hunt or gather food to survive. However, unfortunately, we can not mimic the benefits of energy restriction by adding extra fat or exogenous ketone supplements to drive our blood ketones higher.
As with any source of energy, your pancreas will raise insulin to actively manage your blood sugars and ketone levels and keep your body fat in storage while you clear the food coming in from your diet.
What should your blood sugars and ketone levels be in ketosis?
Our understanding of the ketogenic diet is evolving quickly as “keto” is growing in popularity over recent years.
However, there is still a lot of confusion around what constitutes optimal ketone levels.
While there are many people eager to try a ketogenic diet and achieve ketosis, the reality is that it is hard for most people to achieve and maintain “optimal ketone levels” (i.e. 1.5 to 3.0mmol/L according to this chart from The Art and Science of Low Carbohydrate Performance) without extended fasting or continuing to add more and more dietary fat.
Prioritising dietary fat is typically counterproductive over the long term if your goal is weight loss or diabetes management. Before long you’ll likely find that you are putting on extra body fat which in turn will lead to higher basal insulin levels and elevated blood sugar levels.
I had the privilege of having Dr Steve Phinney (pictured below in our kitchen making his famous blue cheese dressing) stay at our place fora couple of days when he spoke at a Low Carb Down Under event in Brisbane. During this time I quizzed him about the background to this optimal ketosis chart. Steve said the optimal ketosis chart is based on the blood ketone levels of participants in two studies done in the 1980s. One was with cyclists who had adapted to ketosis over a period of six weeks and another ketogenic weight loss study. In both cases, these ‘optimal ketone levels’ (i.e. between 1.5 to 3.0 mmol/L) were observed in people who had recently transitioned into a state of nutritional ketosis.
However, as more people are continuing on a low carb or ketogenic diet these days, many people find that their blood ketone levels continue to decrease after a few weeks or months. Even Keto Clarity author Jimmy Moore recently stated that elevated ketones will not necessarily lead to weight loss and that there is limited use in tracking them!
Do we get better at using ketones so they don’t build up in the bloodstream?
Urine ketone strips (which measure acetoacetate in the urine) are considered by many to be of limited use because before too long the body stops excreting ketones into the urine as it learns to use them rather than wasting them.
It seems that your body also adapts to use blood ketones more efficiently the longer you follow a lower carbohydrate diet. Most people move beyond the ‘keto adaption’ phase as their bodies learn to use fat more efficiently, and their ketone levels reduce further.
You can think of BHB ketones are the storage and transport form of ketones that allow ketones to move around your body. Your body converts BHB back to acetoacetate to be used for energy.
The BHB ketones that you measure in your bloodstream simply tells you how much energy you have stored as ketones in your bloodstream. Unfortunately, the level of BHB in your bloodstream doesn’t tell you anything useful about your ability to burn fat for fuel. High blood ketones may mean that you have excessive levels of unused fuel backing up in your bloodstream.
Similar to high blood sugar levels, chronically high blood ketone levels are not necessarily a good thing. A healthy metabolism operates efficiently with less fuel needing to be mobilised in the bloodstream (whether in the form of glucose, ketones or triglycerides).
Just like a fuel-efficient car doesn’t need a massive fuel tank, you don’t need high levels of ketones or glucose in your bloodstream if you have a more efficient metabolism.
Crowdsourced ketone and glucose values
Back in 2014 when ‘keto’ was new and fresh I was eager to experiment, learn and do whatever I could to lose weight and optimise my health.
After still being confused after reading everything I could and ending up a lot fatter after pursuing ‘optimal’ ketone levels’, I decided to compile some data from my own testing and online friends who were also tracking their blood sugar and ketones levels.
I wanted to understand what typical ketone levels were for people who had been following a reduced carbohydrate diet for a while. Once I shared this initial data, other people sent me their data to add to the chart. Later, Michel Lundell from Ketonix shared an extensive set of anonymised data which enabled me to build a substantial dataset.
The resulting chart below shows the sum of the blood sugar and ketones (i.e. total energy) from nearly three thousand data points from a broad range of people following a low carb or ketogenic dietary approach. Blood ketones are shown in blue (on the bottom) while glucose is shown in orange (on the top).
On the right-hand side of the chart, we have a high energy state where both glucose and ketones are elevated. While not as dangerous, this high energy situation is similar to someone with Type 1 diabetes with high glucose and high ketone levels due to inadequate insulin.
Note: Diabetic ketoacidosis is diagnosed when we have glucose levels above 15 mmol/L or 270 mg/dL and ketones above 0.5 mmol/L.
On the left-hand side of the chart, we have a lower total energy state. It seems that because they burn fuel efficiently, these metabolically healthy people don’t need large amounts of fuel circulating in their bloodstream.
Based on the analysis of this crowd-sourced data it seems the average blood sugar value for someone on a low-carb diet is around 4.9mmol/L (or 88 mmol/L) with a blood ketone level (BHB) of about 1.5 mmol/L.
Blood sugar and ketone levels during exogenous ketosis
Some people come to low-carb or keto for therapeutic purposes (i.e. to manage chronic conditions such as cancer, epilepsy, traumatic brain injury or dementia). These people may benefit from higher ketone levels to fuel the brain when glucose used efficiently.
If you are trying to avoid muscle wastage that occurs in cancer cachexia or trying to feed a growing child who has epilepsy an energy-dense high fat low satiety diet can be an advantage. However, most people do not require this degree of therapeutic ketosis, particularly if weight loss, improved satiety or blood sugar control is the highest priority.
People following a therapeutic ketogenic diet may choose to load up with MCT oils and other added fats to achieve high ketone levels and low glucose:ketone index values (GKI) values. Others target high levels of ketones for brain performance. Others load up on exogenous ketones and glucose together to ‘dual fuel’ for elite athletic performance.
While it may be useful if you’re about to race in the Tour de France, chronically elevated energy from glucose and ketones is not ideal, particularly if you are sedentary, trying to lose weight or improve your blood sugar control. The Tour de France cyclists have perfected training in a low energy state to maximise mitochondrial biogenesis and then fueling for the work required.
One of the benefits of a low-carb diet is that it largely eliminates hyper-palatable processed foods that are typically a combination of refined starches and vegetable oils. The mixture of refined starch and vegetable oils tends to be very easy to overconsume. The danger, however, with trying to drive high levels of ketones by eating more fat is that it will lead to an energy excess intake which will drive up insulin and promote fat storage.
As shown in the chart below from our satiety analysis, reducing your carbohydrate intake can help you to avoid carb+fat hyperpalatable junk food, increase satiety, help you to eat less and lose weight. However, pushing carbohydrates to very low levels can lead to lower satiety and increased energy intake.
So, while reducing carbohydrates is beneficial if it moves you away from hyperpalatable processed foods that are a combination of carb+fat, too much dietary fat will not be optimal if it leads you to significantly increased energy intake.
How low should your blood glucose be in ketosis?
Many people embark on a ketogenic diet in the hope of managing their diabetes and lose weight. They want lower insulin levels to enable them to burn more body fat for long-term insulin sensitivity and health.
On the left-hand side of the total energy chart below, we have endogenous ketosis (meaning that your body fat is being burned for fuel). With lower levels of energy in your blood, your body will draw on your body fat stores to make up the difference, as well as use excess stored fat and old proteins in your liver, pancreas, brain and other organs (i.e. autophagy). This is a great place to be if you are trying to reduce your blood sugar or lose body fat.
What are normal ranges for blood sugar and blood ketones?
The chart below shows the data divided five quintiles, from lowest to the highest total energy.
For each quintile, I have calculated the average, 25th percentile and 75th percentile blood ketone (BHB) value (i.e. half the values fit between the 25th and 75th percentile).
If you are on a ketogenic diet and relatively metabolically healthy, you may see BHB ketone values between 0.3 and 1.5 mmol/L. Ketones will be higher if you are fasting, restricting calories, exercising or consuming more dietary fat than usual.
However, blood ketones will probably decrease over time as your body adapts to a ketogenic diet, so try to resist the temptation to keep adding extra dietary fat to maintain elevated ketone levels.
Virta ketone values
The crowd-sourced data above align well with ketone data from the Virta study one-year results (Phinney et al., 2017) where they aimed to get participants with diabetes into nutritional ketosis to improve blood sugar management and reverse diabetes.
The distribution of BHB levels over the first ten weeks of the Virta trial are shown in the chart below. While there were some higher ketone values, many people had blood ketone values less than 0.5 mmol/L.
In spite of consuming a ketogenic diet under the supervision of Steve Phinney and the Virta team, most of the study participants did not achieve ketone levels that qualified as “nutritional ketosis” (I.e. BHB > 0.5 mmol/L). In spite of this, their reduction in HbA1c was substantial. Many of the people on insulin were able to reduce or eliminate their insulin requirements. They also lost a significant amount of weight.
The chart below shows the average Virta results over the first year, with ketones rising from 0.18 mmol/L to 0.6 mmol/L initially, but then decreasing to less than 0.3 mmol/L and one year.
The soon to be published two-year results show that blood ketone levels remained at 0.27 mmol/L after two years of a ketogenic diet. The chart below summarises the change in ketone values over the two-year duration of the study.
While the participants in the Virta program initially saw an increase of blood ketones into the ‘nutritional ketosis zone’ (i.e. greater than 0.5 mmol/L) on average after ten weeks, their blood ketones settled back to just above the control group on the standard western diet. At no time did their ketone values approach the optimal ketone zone (i.e. 1.5 mmol/L according to the commonly accepted definition of ketosis).
We also saw a similar trend in our Nutrient Optimiser Weight Loss Challenge, with blood sugars rising initially over the first couple of weeks of weight loss when people focused on high satiety nutrient-dense foods. But after about four weeks blood ketone levels decreased substantially as people continued to lose weight and lower their blood sugars.
It was interesting to see that the people who identified as insulin resistant tended to have slightly higher blood ketone values compared to the people who said they were insulin sensitive. It seems that people who are physically fit and metabolically healthy may tend to have lower blood ketone levels as well as lower blood sugar levels, especially after they have been following a low-carb or ketogenic diet for a while.
However, regardless of blood ketone values or whether people believed they are insulin resistant, the data from the Nutrient Optimiser Challenge also showed that people tend to lose weight at a similar rate regardless of whether they identified as insulin resistant or insulin sensitive.
What ketone level should you target?
Unless you are managing a chronic condition that may benefit from elevated ketone levels (e.g. Alzheimer’s, Parkinson, dementia or epilepsy), you could potentially save a lot of money and angst by focusing on keeping your blood sugars closer to optimal and not worry about your blood ketone levels.
In line with oxidative priority, the glucose in your blood needs to be burned before the fat in your diet and the fat in your body. If your glucose stores are constantly overfull, you will be ‘stuck’ burning glucose, and you will not get to use your body fat.
Your blood sugar provides an actionable understanding of whether your glucose fuel tank is full and if you should consume fewer carbohydrates in your diet.
How can the Nutrient Optimiser help?
If you require therapeutic ketosis to help with the management of a chronic condition such as Alzheimer’s, Parkinson’s or dementia the Nutrient Optimiser Smart Macros algorithm can guide you to reduce your insulin load to the point that you achieve the ketone levels necessary to alleviate our symptoms. However, the reality is that most people are don’t require a super high fat therapeutic ketogenic diet with elevated ketones.
If you need to control your blood sugar, the Nutrient Optimiser Smart Macros algorithm will guide you to reduce your carbohydrate intake until your blood sugars stabilise while focusing on nutritious foods and meals.
If you are looking to lose weight, the Nutrient Optimiser will help you focus on nutritious, high satiety foods and meals that will help you control your appetite, so you don’t have to fight a battle with your hunger that you will eventually lose.
We’d love you to check to get your Nutrient Optimiser Free Report now to get your initial macro targets along with nutritious foods and meals that will get you moving on your journey.
- Nutrient Optimiser Free Report
- Nutrient Optimiser Four Week Challenge
- What are normal blood glucose and ketone levels?
- A hundred people used Nutrient Optimiser for six weeks. Can you guess what happened to their weight?
- Blood glucose, ketone and insulin changes after six weeks using Nutrient Optimiser
- Systematising satiety