Whether you’re a keto newbie or you have some skin in the game, testing ketones is just one of the things you should be interested in, there are a bunch of other biomarkers that are super important too. In this article we outline what to test, why and where if you’re in Dubai or the UAE.
6-Aug 2018, by Bronwyn MacRitchie
So… Why Test At All
‘Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.’
When embarking on a lifestyle change, such as selecting to go keto or to eat in alignment with primal choices, we all have goals. Very often our only goal is weight loss and we assume we will be satisfied with watching the number on the scale or the measuring tape move, and so feeling more confident in a swimsuit on Kite Beach in Dubai. We make the mistake of thinking this is the only form of measurement we need to do.
However, we overlook two critical points when we allow our goals to stop there.
- Many disease markers are evident decades before a disease actually begins to take hold in the body and effect health.
- Not all bodies will respond to the dietary and lifestyle choice in the same way.
Both of these are of vital importance if we are interested in taking care of our future selves, so let’s delve into their importance in a little more detail.
1. Disease Markers
While we may still feel entirely healthy at this point in life, (despite being dissatisfied with our weight) many of the markers of diseases that can have fatal consequences later in life begin decades before the disease fully develops.
If we have a window into those markers now, we still have the chance to make lifestyle choices that can alter the course of disease development and increase our chances of living a long, healthy life. Note that I say long, HEALTHY, the problem with our notion of aging today is that we have simply come to believe that this gradual loss of strength and vitality and descent into illness and poor physical and cognitive function is a normal part of human aging. There are very few among us who haven’t lost someone we love to cancer, heart disease, diabetes or stroke.
However, that this is the way we are programmed to age simply isn’t true! It is the lifestyle choices that the modern world has forced upon us and made us think are normal that have created this notion, and we have the knowledge and the tools at our fingertips to challenge it (1,2,3)!
Most of the markers associated with what has become known as metabolic syndrome are things that should definitely be tested at the beginning of any attempt to improve health.
Metabolic syndrome is defined by the Mayo Clinic as, ‘A cluster of conditions, increased blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol or triglyceride levels that occur together, increasing your risk of heart disease, stroke and diabetes (4).’
For these reasons we strongly recommend that you go in for basic blood work and have at least those markers tested.
- Blood pressure
- Blood sugar
- Waist to height ratio
- Lipid panel
BUT, since you’ve already gone in to request blood work, we also suggest you have the following levels tested since having a deficiency in any of these could be causing chronic inflammation or sub-optimal functioning in your body that you aren’t even aware of, and may have come to think of as normal.
For more detailed information on any of these please have a look at our resources page.
- Vitamin D
- Vitamin B12
- Thyroid (free T3 and T4)
The four basic electrolytes are listed here because of their absolute necessity for the correct functioning of almost all systems in the body. And also because with ketosis specifically it is easy to become deficient in these as your muscles no longer store as much water as before, meaning there is less room for the storage of electrolytes. This is often called the keto flu (8,9). Hence the need to consistently ensure your intake is high enough while you are in a carbohydrate depleted state.
We list testosterone and thyroid to be tested as these are two hormones that can greatly influence the functioning of the body and provide clues to imbalances which may lie elsewhere. They are also two hormones which have been known to fluctuate with the introduction of a ketogenic or severely carb restricted diet, and this fluctuation varies from person to person (10,11,12,13). It is always good to know where on this scale you lie and to correct anything that may be out of balance after being on the diet for a while, or noting any improvements that may happen after being on the diet for a while.
2. Not All Bodies Will React the Same Way
After sticking to your new way of eating and lifestyle for at least 3-6 months we strongly recommend that you go back and get the full panel of blood work done again. This retesting is imperative for you to know how your own body is reacting to the dietary choice you have made. You may be a cholesterol hyper-responder, and have to reconsider the types and amounts of fat you are eating like Lee (read about his story here, and about things you can do if you have the same problem here), or you may be like me and have an excellent lipid panel despite familial tendencies toward high HDL cholesterol and triglycerides. You may find that a certain vitamin, mineral or hormone has improved with the diet, or you may find a deficiency has appeared that you need to take note of.
If you don’t test you simply don’t know. And there is nothing to be fearful of. Once you have the information in your hands you also have the power to make the necessary adjustments. Maybe your body’s hormone profile calls for slightly higher carbs, or doesn’t react well to an intermittent fasting protocol you have been implementing along with the diet.
Once you have the data you can simply stop, look, adjust and move!
Where to Test in Dubai and Things to Watch Out For
The easiest and cheapest option available to you is to make an appointment with an internal medicine doctor in a medical facility that is covered by your health insurance for full blood work. We have had very positive experiences with Mediclinic across the country in terms of willingness to support patients to get full blood work done.All of the basic tests we have listed will be available under almost all Dubai and UAE health insurance providers. Unless you are quite sure that your doctor already knows about keto or primal eating, you may want to avoid discussing this choice with him or her as most healthcare professionals in Dubai and the UAE are still unfamiliar with these dietary and lifestyle choices.
Once the tests are done, DO ask for a print out of your results! In our personal experience virtually every doctor has simply said, ‘Yes everything is fine !’ And tried to send us out the door without offering us a printout of our results. And then, when we do get the printout there are some numbers on there which actually ARE of concern.
Remember, your goal is not to be within the reference range!
Micronutrient, mineral and hormonal reference ranges are adjusted yearly according to the average numbers collected in blood test data in the region throughout the year. This frightening fact means that the sicker or more nutrient deficient people become, the wider the range becomes, making deficiencies become more and more of the status quo and giving doctors less reason to address nutrient issues with their patients.
An example is the reference range for Vitamin D, a vitamin that is chronically low among residents of Dubai and the UAE. The reference range on the test sheet will generally range from 20/30ng/mL to 100ng/mL, however closer research reveals that OPTIMAL levels for health and disease prevention are closer to upwards of 45ng/mL (14, 15). I personally want to be in the optimal range wherever possible to prevent any unnecessary inflammation or disease formation in my body.
With this in mind, when reviewing your results, if there are any numbers that are closer to the bottom or the top of the reference range, take the time to research them and find out what that means. It maybe something you can easily seek out more of in your diet, or you may want to supplement it for safety.
If you feel unsure about going through these yourself you may want to employ the services of a health coach to assist you, or try to find a doctor in the UAE who is keto and primal educated and aligned.
In Depth Testing – What’s on Offer Globally and Where to Get it in Dubai and Abu Dhabi
If budget is not a constraint for you, and you really want the most complete window into what is happening inside your body, there are more testing options available. Depending on the level of your health cover or your own personal means, you may want to go for one of the following tests on offer.
- Full Micronutrient Profile
- 24hr Hormone Panel
- Genetic Testing
- Gut Health Testing
- Food Intolerance Testing
Do note, all vitamin, nutrient and hormone levels are important. The ones I previously listed focused on the minimum to test to give an overall window into the general health of the body.
A full micronutrient panel will examine the levels of all nutrients in the body, finding even the most obscure of deficiencies. The DUTCH or ZPR test for hormones will give you the most comprehensive view on your hormones and how their levels change throughout the day, this is considered to be the most insightful as hormones constantly fluctuate with circadian rhythm and stress levels through the day.
Genetic testing will give you insight into genetic predispositions you may have to certain behaviours or diseases. These are by no means life sentences, as we know that through correct lifestyle choices and following a primal approach to diet and exercise we can manipulate the expression of those genes. However, it can be helpful to recognise a predisposition in order to place more emphasis on behaviours that discourage that gene from expressing.
Hippocrates stated that, ‘All disease begins in the gut.’ The more we are learning about the gut microbiome and the gut/mind connection the more it becomes evident that he was right. If you are able to get some insight into what is going on in your gut this may be extremely helpful in correcting any health concerns you are battling with. Anything from incessant sugar cravings to anxiety and depression can often be healed through a more comprehensive look at what is going on in the gut.
While strongly believed to be merely a symptom of poor gut health or of leaky gut, food intolerances can wreak havoc in your body, causing unexplained chronic inflammation, histamine reactions, IBS, fatigue and even depression. The accuracy and usefulness of such tests is being increasingly questioned, as it appears that food intolerances change with some frequency, depending on what is going on in other areas of the body. The tests have also been shown to give false readings on certain foods and can cause a narrowing of nutritional intake on patients who exhibit intolerances to too many foods
Always do the most comprehensive testing that will cause the least financial burden!
It’s no use raising your stress hormones about financial issues and increasing inflammation that way while trying to heal your health through testing.
If you DO decide you would like to go for the more comprehensive testing, some options in Dubai and the UAE include:
Why Test Ketones?
The keto masses (even the UAE keto community) are divided on the testing issue. There are those out there who feel passionately that we shouldn’t be chasing ketones. Although I often find their reasoning for this to be somewhat underdeveloped, they argue that everybody is different and this will affect their ability to produce ketones.
Personally, we believe this is even more of an argument FOR testing rather than against, as there is no one size fits all approach for the level of carbs and other macros that will actually get a person into ketosis. Depending on how insulin resistant the person currently is, how long they have been eating a diet that promotes high insulin and then even their genetics, the amount of carbs and protein they will need to eat to enter a state of ketosis may be vastly different.
When it comes down to deciding which camp you belong to (the testers or the non-testers) it will come down to a clear assessment of your own, personal diet and lifestyle goals when it comes to ketosis.
Firstly, you should be very clear on what ketosis actually means.
It is defined as being in such a carbohydrate or calorie deprived state that the body runs out of glucose and produces a fuel supply called ketones. This is said to have been achieved when the ketones (specifically beta-hydroxybutyrate or BHB) in a person’s blood reach 0.5mM or above, or their urine of 15mg/deciliter or above (16,17,18). A far more in depth look at optimal ketone levels can be found at KetoSummit (19).
Learn more about the best ways to get into ketosis here.
Any diet which doesn’t actually produce this state in the body is not a keto diet, but rather a low-carb-high-fat, paleo or myriad other possible diets. The keto diet is named as such due to its ability to induce or create a state of ketosis in the body. This is not a subjective state or one that bows to opinions, it is a scientifically defined threshold of ketone production in the body.
If your only goal is to lose weight, then maybe you don’t actually need to be in ketosis or need to test your ketones, however, being in ketosis can make that goal easier to reach too.
If you aren’t sure what your goals are, have a quick read through some of the benefits of being in ketosis and then consider whether those would be things you would like to achieve.
The benefits of actually being in ketosis are many and you can find more detailed information on them here. But here are some of our favourites just briefly.
- Less hunger, increased weight loss. Training your body to use ketones as fuel rather than glucose allows the body to tap into its own fat stores and burn them rather than demanding more food from you. This has the added effect of reducing your hunger.
- Optimized focus and productivity and reduced cognitive disease risk. The brain has been shown to run more efficiently on ketones than on glucose, and ketones easily cross the blood brain barrier. This is why many people report increased focus and productivity in a state of ketosis. Studies are also showing a reduction in Alzheimer’s biomarkers in mice in a state of ketosis.
- Many of the benefits of fasting… without actually fasting. Being in a state of ketosis mimics the effects of fasting, which has multiple benefits for the body, such as inducing autophagy (the regeneration of damaged cells) which is required by the body to heal the beginnings of possible disease and to function optimally.
- Less inflammation, greater overall well-being. A reduction in general inflammation through the body has been noted in the presence of BHB (20).
If you’ve had a read through all of this, decided you just want to lose weight and aren’t concerned with actually being in ketosis, then read no further! Your decision is made! You are a non-tester! And that’s just fine, at least you have taken the time to make an informed decision.
But… If you read all that and DO want to be in ketosis, you would be putting in a whole lot of effort and commitment (we know this isn’t always the easiest diet to follow) and then short changing yourself by not allowing yourself to confirm whether you are actually in or out!
Some people find they are able to stay safely in ketosis eating 35 grams of net carbs or more, allowing them even more freedom with the diet, others can’t go over 15 while they are becoming fat adapted.
Testing gives you a window into YOUR body and what it responds to, which might be completely different from your diet buddy’s or someone running a blog or youtube channel.
Some personal examples, some people can eat 90% Lindt chocolate and stay in Ketosis, but if I have ANY (even if it’s within my daily carb limit), I’m knocked straight out! I never would have known this without my meter. I have a friend who is knocked out of ketosis by eggplant of all things. And the more research that is done on the topic the clearer it becomes that no two bodies react exactly the same way to all foods (21, 22).
Now… if you’ve decided you are a tester, and want to know for sure if you are reaping all the benefits of being in this state, there are three ways to go about it, with three tiers of accuracy.
Urine testing is a cheap and easy option for testing ketones, but sadly also the least accurate. It relies on excess ketones in the form of acetoacetate being excreted in the urine.
However it has been shown to produce frequent false positives, especially while you are becoming fat adapted, since while your body is not yet using the acetoacetate there will be much more in your urine, leading you to think you are in ketosis, while in fact the truth is the exact opposite.
Another problem with it is the amount of water you drink, if you stay extremely hydrated the ketone concentration will be less, but in someone who doesn’t drink enough or may be mildly dehydrated, a very high ketone reading can be seen (23,24,25).
These problems are pretty significant, and our opinion is it might be wiser to save the money you would have spent on the sticks for something more reliable.
To test for ketones in your breath you would need a ketone breath meter, the most popular being the Ketonix. You breathe into the meter and it measures the amount of acetone (a ketone body) in your breath.
This is favoured by some, since you only need to pay for the meter and then can continue to measure your ketones, and you also don’t need to keep pricking your finger!
Factors such as how much water you have had to drink or if you have just eaten a high fat meal have an effect on the reading you will get, and the accuracy of the readings decrease the deeper into ketosis you go. This means a breath test may be a good way to check if you are in ketosis, but not to measure how deeply in you are (26,27,28).
Overall, the breath test is widely considered to be the second most accurate measure (29).
This is the most accurate reading you can get at home. Blood meters measure the level of BHB in your blood, which is widely agreed by the medical community to be the most accurate indication of whether a person is in ketosis or not (30,31).
You do need to buy the strips for the meter, which are not cheap, however, once you get to know what your body responds to and doesn’t, as well as how you physically feel when you are confirmed to be in ketosis, you will need to test less and less often. I’m down to a once weekly test now, unless I’m trying something new in my diet or lifestyle.