Keto made easy

Signs You're in Ketosis (and Which Ones Actually Mean Anything)

Quick answer: Most of the "signs of ketosis" on lists online are really signs of something else: water leaving with your glycogen, or your body missing the sugar it's used to. A positive urine strip or blood reading tells you ketones are there. The sign worth noticing day to day is simpler: you stop being hungry, and you find yourself eating less without forcing it.

In this article

The usual list, sorted

Sign people mention What it mostly tells you Worth tracking?
Fast early weight drop Glycogen and water leaving No, not as fat loss
Fatigue, headaches, poor sleep in weeks 1–2 Withdrawal and the gap before fat adaptation Only to know it passes
Cramps Probably electrolytes Yes, act on it
"Keto breath," body odour changes Ketones (acetone) leaving the body Mildly; it's a real side effect
Positive urine strip Ketones spilling into urine Early on, yes; less so later
Steady energy, clearer head His reported experience once adapted Personal, varies
Not hungry, eating less without trying The thing keto is for Yes

Signs that are really water loss

Your body stores glycogen with water, roughly two grams of water per gram (video 9Hk0jRb_9Es). Burn through the glycogen and the water goes too. So a quick drop in the first week is mostly water.

KetoDick shows this with his own numbers. About 28 days in, he was down about 12 pounds and said it was mostly water (video 9Hk0jRb_9Es). He suggests ignoring the scale for the first 30 days for exactly this reason (video uDw65ERtsA0). The drop shows carbs are low. It doesn't prove fat loss, and it comes back fast if carbs do.

Signs that are really withdrawal

The tired, foggy, headachy, can't-sleep stretch in weeks one and two gets called keto flu. KetoDick doesn't like the name. In his view, much of it is withdrawal from sugar and carbohydrate, and blaming it on keto makes the diet look unhealthy. He says plainly that this is more his opinion than science (video 9r2Y74AnjUQ).

He splits the symptoms by cause:

His own early experience, described live to friends: energy crashes and irregular sleep, no cramps (video 9Hk0jRb_9Es).

So what you do is treat these as signs that you've cut carbs, not proof of ketosis. And if cramps show up, look at your electrolytes. Sodium and potassium supplements in particular can be serious if you overdo them, so he says to talk to a doctor before supplementing (video 9r2Y74AnjUQ). That goes double if you take blood pressure medication or have kidney disease.

Signs that do point to ketones

Keto breath and body odour. Acetone is one of the three ketone bodies, and it leaves partly through your breath. KetoDick calls keto breath and body-smell changes real side effects (video DoSUgIr2rNo).

Urine strips. These detect acetoacetate that "spills" into urine (video 8wOheKcBEd8). A positive strip shows ketone production is running. Three cautions from the same video:

  1. The shade reflects your urine, not your blood level.
  2. As you become fat adapted, less spills, so strips fade even when you're still in ketosis.
  3. A dark strip isn't proof of dehydration. Check the colour of your urine instead.

Blood and breath meters. More accurate, much more expensive. His figure was about $3.50 per blood strip against roughly 7–15 cents for a urine strip (video 8wOheKcBEd8). By 2019 he was saying most people don't need a monitor at all (video 1JbK1_ClDmY).

If you have diabetes, a dark strip can mean something different. He says type 2 diabetics and anyone with kidney risk should talk to a doctor about what their readings mean (video GojQvo_2GS0).

The one that matters: hunger goes quiet

Here's the sign the lists bury. The point of keto, for weight loss, is that it makes eating less easier. Lower insulin, easier access to stored fat, less hunger.

KetoDick reported this from his own logs in his first month: for the first time on a diet he wasn't hungry, and he often finished 800 to 1,000 calories under his allowance without wanting more food (video 9Hk0jRb_9Es). He also described alertness, mental clarity and steady energy. That's his experience; yours may differ.

Don't expect it in week one. Insulin stays up for a while and month one can be hungry. His advice for that stage is to eat fat to fill hunger rather than restrict. If you're still hungry past week six, look for hidden sugars, triggers or psychological factors (video 7Aixw4uRksI). More in why am I not hungry on keto.

What the research says

The evidence pages here don't include a study validating hunger, breath or energy as markers of ketosis. Those are experiences, useful to you, not measurements.

KetoDick's take

I've said that if you're doing keto hungry, you're doing keto wrong (video 8Jk5ShSUpFY), and that if you willpower your way through keto you're probably doing it wrong (video DoSUgIr2rNo). Hunger is the test.

I've also said none of the meters are needed for ketosis. They're biofeedback, useful when you suspect hidden carbs (video 8wOheKcBEd8).

Key takeaways