Glucose+keto (Optimal Nutrition) - 7012

optimal ketone and
blood sugar levels for

ketosis
Marty Kendall
optimal ketone and blood sugar levels for ketosis
educing the amount of processed carbohydrate in your diet

R
will stabilise your blood sugar promote ketosis.
Elevated blood sugar levels are associated with a reduction in risk
of many modern metabolic diseases such as diabetes, heart
disease, stroke, cancer, Parkinson’s and Alzheimer’s.
Insulin regulates the release of both glucose and ketones into your
bloodstream.
You become ‘insulin resistant’ when your fat cells become full and
can no longer store excess energy ef ciently.
When your adipose tissue lls 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
over ows 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 bene ts 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.

educing your carbohydrate intake to very low levels is not

R
necessarily better, especially if it causes you to signi cantly
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.

What are optimal blood sugar

levels?
“ normal” blood sugar is de ned 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 de nitions of “normal” are far from optimal! Your risk of
diabetes, stroke, heart disease, cardiovascular disease and cancer increase with
a HbA1c above 5.0%.
By the time you have “prediabetes”, you have an increased risk of many of the most
common western diseases of ageing (such as diabetes, heart disease, stroke and
cardiovascular disease).[4] [5]

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 in the charts above.


Hyperinsulinemia
While high glucose levels are bad news (due to glucose toxicity and glycation), high
glucose typically also go hand in hand with high insulin levels.[6] [7] [8]
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.
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.
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.
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 nding the optimal dose of
insulin required to keep your blood sugars stable.
oo much insulin can slow the release of fat from your body to be
T
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 to lower your blood sugar
and reverse your diabetes, you need to nd to eat that keeps you satis ed while also
getting the nutrients you need.
Endogenous ketones
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 bene cial things that we ascribe to the 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 to reach 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 bene ts of energy restriction by
adding extra fat or exogenous ketone supplements to drive our blood ketones higher.
###p your pancreas will raise insulin to 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.

Consuming a lot more fat is typically counterproductive over the long term if your goal is
weight loss or diabetes management. Before too long you’ll likely nd 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 with us recently 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. As more people are
continuing on a low carb or ketogenic diet these days, many people nd 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?
Urine ketone strips (which measure acetoacetate in the urine) are considered by many to
be of limited use because 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 ef ciently the longer you
follow a lower carbohydrate diet. Most people move beyond the ‘keto adaption’ phase as
their bodies learn to use fat more ef ciently, 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 ef ciently with less fuel needing to be
mobilised in the bloodstream (whether in the form of glucose, ketones or triglycerides).
Just like a fuel-ef cient 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 ef cient 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.
optimal’ ketone levels’, I decided to compile some data from myself and some friends
who were also tracking their blood sugar and ketones levels.
I wanted to understand what ketone levels looked like in 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.
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 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.
On the left-hand side of the chart, we have a lower total energy state. It seems that
because they burn fuel ef ciently, 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.
The table below shows this data in terms of average as well as the 25% percentile and 75%
percentile points (along with corresponding HBA1c, glucose:ketone index (GKI) and
breath acetone values).


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 bene t from higher ketone levels to fuel the brain when glucose used ef ciently.
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 diet can be an advantage.
However, most people do not require this degree of therapeutic ketosis, particularly if
weight loss 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.

This over-fuelled state with elevated glucose and ketones is shown in the chart below
from the people with the highest total energy.
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, especially if you are sedentary, trying to
lose weight or improve your blood sugar control.
One of the bene ts of a low-carb diet is that it tends to eliminate hyper-palatable

processed foods that are typically a combination of re ned starches and vegetable oils.
The mixture of re ned 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.

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 bene cial 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 signi cantly 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 ve 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 t 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. The distribution of BHB levels over the rst ten weeks of the Virta trial
are shown in the chart below. While there were some higher 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 quali ed
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 signi cant amount of weight.
The chart below shows the average Virta results over the rst 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 just
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 de nition of ketosis).
We also saw a similar trend in our recent Nutrient Optimiser Challenge, with blood
sugars rising initially over the rst 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 identi ed as insulin resistant tended to
have slightly higher blood ketone values compared to the people who said they were
insulin sensitive. Anecdotally, it seems that people who are physically t or 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.
The data from the Nutrient Optimiser Challenge also showed that people tend to lose
weight at a similar rate regardless of whether they identi ed as insulin resistant or insulin
sensitive.


What ketone level should you

target?
Unless you are managing a chronic condition that may bene t from high 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. Once your blood
glucose has stabilised with a reduced carbohydrate diet, you can then prioritise high
satiety nutrient-dense foods and meals to continue to lose weight and reverse your
diabetes.
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
ght 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.
Further reading
utrient Optimiser Free Report
N
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

optimal ketone and blood
sugar levels for ketosis

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optimal ketone and

blood sugar levels for

educing the amount of processed carbohydrate in your diet

optimal ketone and blood sugar levels for ketosis

educing your carbohydrate intake to very low levels is not

Low-carb diets reduce blood

optimal ketone and blood sugar levels for ketosis

What are optimal blood sugar

“ normal” blood sugar is de ned as having an HbA1c of less than

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

If you’re interested in pursuing optimal rather than what passes as “normal” metabolic

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

How to manage your dietary

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

This process is known as “endogenous ketosis” (note: endogenous means that the

optimal ketone and blood sugar levels for ketosis

What should your blood sugars

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

Do we get better at using

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

Crowdsourced ketone and

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

Blood sugar and ketone levels

optimal ketone and blood sugar levels for ketosis

One of the bene ts of a low-carb diet is that it tends to eliminate hyper-palatable

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

How low should your blood

On the left-hand side of the total energy chart below, we have endogenous

optimal ketone and blood sugar levels for ketosis

What are normal ranges for

optimal ketone and blood sugar levels for ketosis

Virta ketone values

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

What ketone level should you

optimal ketone and blood sugar levels for ketosis

How can the Nutrient Optimiser

If you need to control your blood sugar, the Nutrient Optimiser Smart Macros

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

optimal ketone and blood sugar levels for ketosis

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