Besides peeing on strips, what are other ways to tell I’m in Ketosis?

Today, most people I speak with are constantly peeing on ketone testing strips to test whether they are in nutritional ketosis. If you are in the beginning stages of the Keto Diet, this method may be effective.

However, once you have become ‘keto-adapted’ (which can take several months), the ketone levels in the urine may no longer be elevated.

This is because your brain is now using the ketones as its primary energy source and your muscles revert to using fatty acids. So that means that after you have become ‘keto adapted’, ketones will no longer be spilled in the urine, which means that the readings from these “ketone testing strips” will eventually become inaccurate as your body adapts to the Keto lifestyle! Additionally, if you are supplementing your diet with BHB salts (exogenous salts), your reading from the testing strip may be too high since taking BHB salts may just increase the amount of ketones in the urine without putting you into ketosis.

The most accurate way to test whether you are in nutritional ketosis is to test your ketone levels with a blood ketone monitor, which measures one of the ketones, beta-hydroxybutyrate, or BHB. However, there are also several physical clues that are commonly associated with nutritional ketosis.

Physical Clues Associated with Nutritional Ketosis

  • Weight loss: this is the most obvious—and most often anticipated—clue of all. After the initial rapid drop in water weight, you should continue to lose body fat for several more weeks, and even months, as long as you continue restricting your carbohydrate intake, eat moderate amounts of protein, and incorporate the recommended amounts of fats.
  • Decreased hunger: hunger suppression, or a lack of appetite, is a common symptom associated with being in ketosis. Although the mechanisms remain unclear and continue to be investigated, there are several possible explanations, including a change in the body’s hunger hormones, the effect of a high fat and/or moderate protein intake on satiety, and even the presence of ketones themselves can have an impact on appetite.
  • Reduced ‘sweet cravings’: this is mostly anecdotal as there are few research studies that have studied this effect. However, it appears that people who claim to have been in a perpetual sweet craving mode are some of the strongest advocates of the ketogenic diet, stating that this very low carb eating style has ‘cured’ these cravings—some even noticing this change within a couple of days of starting this diet.
  • Fatigue: most pronounced during the first few days to a few weeks after starting the ketogenic diet, weakness and fatigue are common physical signs of entering into ketosis, caused by the body undergoing necessary physiological changes to adapt to a different fuel system. New Keto dieters should not let this be the ‘deal breaker’, quitting before reaping the benefits of this eating style. Our Managing Fatigue on a Keto Diet guide offers several tips for managing this side effect, and our recommendation for a gradual change in both fat and carbohydrate intake could also help mitigate this problem.
  • Upset stomach: ranging from mild symptoms such as bloating and gas, to the more uncomfortable symptoms of constipation and potentially problematic diarrhea, the early stages of ketosis can wreak havoc on your gut. Once again, this has a lot to do with your body adapting to a new way of eating, which incorporates high amounts of fat, and perhaps even a greater amount of fiber (from low-carb vegetables, nuts, seeds, low carb flours, etc). Developing these digestive enzymes takes time, so taking the gradual approach to change could be helpful in this regard as well.
Mary Paley

Fearless Dietitian; 30+ years as a professional dietitian; Master’s Degree in Nutrition and Dietetics at the MGH Institute of Health Professions; Lead research dietitian for several major pharmaceutical companies; Currently focused on health and wellness and the benefits of ketogenic diets for both obesity and diabetes management. MS, RDN, CDE, LD/N

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