Keto Urine Tests: Which Ones Are The Most Accurate?

The ketogenic diet has gained a lot of popularity in recent years, with people adopting it for a variety of reasons, including weight loss, improved mental clarity and energy, and even for health conditions like diabetes, polycystic ovary syndrome (PCOS), acne, and respiratory and cardiovascular disease risk.

To ensure they are in the fat-burning state of ketosis, many people choose to test their ketone levels. There are three primary ways to do this: blood, urine, or breath testing. While blood testing is the most accurate, it is also the most expensive, and many people find it inconvenient and invasive. Breath testing is a relatively new method and is quite convenient, but it is not as accurate as blood testing and only measures acetone, a waste product, rather than the ketones being used by the body.

Urine testing, on the other hand, is a cheap, easy, and non-invasive way to get a quick snapshot of your ketone levels. You can purchase urine test strips over the counter from most drug stores or online, and a pack of 100 test strips typically costs around $10. To use them, you simply hold the strip in your urine stream or dip it into a collected sample, and then compare the colour of the strip to the colour guide provided to determine your ketone level.

While urine testing is not as accurate as blood testing, especially for those who have been on the ketogenic diet long-term, it is still a useful tool for those new to the diet who want to know if their body has entered ketosis. Here are some of the best keto urine test strips on the market:

- Perfect Keto Urine Strips

- So Nourished Urine Keto Strips

- Smackfat Ketone Strips

- JustFitter Ketone Test Strips

- One Earth Ketone Strips

- Nurse Hatty Ketone Strips

How to test for ketones in urine

Ketones in the urine can indicate that your body is in a state of ketosis, which is when your body burns fat for fuel instead of carbohydrates. Testing for ketones in the urine can be particularly useful for people on a ketogenic diet or those with type 1 or type 2 diabetes.

Urine test strips are a cheap and convenient way to test for ketones. They are available over the counter at pharmacies and supermarkets, as well as online. The strips are relatively inexpensive and usually come in packs of 50 to several hundred.

• Wash your hands.
• Collect a urine sample in a small container.
• Immerse the absorptive end of the strip into the sample for a few seconds, then remove it.
• Wait for the amount of time specified on the package for the strip to change colour.
• Compare the colour of the strip to the colour chart on the packaging.
• Dispose of the urine and strip appropriately, then wash your hands.

The colour of the strip will correspond to the concentration of ketones in your urine, which can range from none to high levels. The darker the colour, the higher your ketone levels.

Tips for Accurate Testing

• Check that the test strips are not expired.
• Store the test strips in a cool, dry place with the lid tightly closed.
• Do not remove the desiccant (the tiny white packet) from the bottle.
• Stay hydrated but avoid becoming overly hydrated, as this can affect the results.
• Test at the same time of day for consistency.
• Keep your hands away from the test strip material.

When to Test for Ketones

Studies suggest that the reliability of urine ketone testing is highest in the early morning or in the late evening, several hours after dinner. However, you can choose a different time of day if that works better for you, as long as you stick to the same time for consistency.

When to Seek Medical Attention

If you are testing for ketones because you have diabetes, the American Diabetes Association recommends testing for ketones every 4 to 6 hours if you experience any of the following:

• Blood glucose level above 240 mg/dL
• Vomiting or nausea
• Other illnesses, such as a cold or flu
• Dry mouth or constant thirst
• Fruity-smelling breath
• Fatigue
• Abdominal pain
• Rapid breathing
• Racing heartbeat
• Skin that appears flushed

If your test results show moderate or large amounts of ketones in your urine, contact your healthcare provider immediately.

The pros and cons of urine testing

Urine testing is a cheap and convenient way to measure ketosis. The strips are relatively inexpensive and can be purchased over the counter at pharmacies and supermarkets, as well as online. They are also easy to use and can be carried around with you.

However, urine testing may not be suitable for long-term use as the body becomes more adapted to using and producing ketones, meaning fewer are excreted. Urine testing may also be inaccurate if you are dehydrated, and the strips expire within three to six months. Blood testing is more accurate but more invasive and expensive.

For those new to the keto diet, urine testing is a good way to determine whether you are in ketosis. However, if you are following a ketogenic diet for several months, blood testing may be more suitable.

For people with diabetes, urine testing can be a good way to monitor ketone levels and prevent diabetic ketoacidosis (DKA), a serious and potentially life-threatening complication.

How urine testing compares to blood and breath testing

Urine testing is a good low-cost option when starting a keto diet and for its primary medical safety purpose: to monitor urine ketones for diabetics in order to prevent diabetic ketoacidosis. However, urine testing is not as accurate for measuring nutritional ketosis as other methods. Urine testing is also less precise than blood testing, as it gives a colour range rather than a numerical reading. In addition, urine testing is more susceptible to human error when comparing the colour on the strip to the colour on the package. It is also important to note that urine strips are only good for 30 days from opening the vial, as they are very sensitive to air and humidity.

Breath testing is a non-invasive method that measures acetone, a byproduct of acetoacetate breaking down and not a measure of the ketones your body uses as fuel. Breath testing is also susceptible to interference from external factors such as breath mints, chewing gum, tobacco and e-cigarettes, and drinks like alcohol, coffee, green tea and fermented drinks. Breath testing is also more expensive than urine testing.

Blood testing is the gold standard for measuring ketone levels. It is the most accurate test for measuring your level of ketosis and provides a real-time reading of the ketone level in your body. However, blood testing is more expensive than urine testing, requires a machine meter to use, and may not be covered by insurance.

Who should use urine testing

Urine testing for ketones is a good option for people who want to check if they are in ketosis, a natural metabolic state where the body burns fat for fuel. This can be particularly useful for people following a ketogenic or "keto" diet, which is low in carbohydrates and high in fat. Here are some specific groups of people who may benefit from urine testing:

People with Diabetes

Urine testing for ketones is commonly used by people with diabetes, especially those with type 1 diabetes. Type 1 diabetes is an autoimmune condition where the body attacks the insulin-producing cells in the pancreas. Without enough insulin, the body cannot effectively use glucose for energy and turns to burning fat, leading to a build-up of ketones in the blood and urine. Testing for ketones is crucial for people with diabetes as high ketone levels can indicate a serious complication called diabetic ketoacidosis (DKA), which requires immediate medical attention.

People on a Keto Diet

Those following a keto diet may use urine testing to monitor their ketone levels and ensure they are in ketosis. The keto diet is high in fat, moderate in protein, and very low in carbohydrates. As the body adapts to burning fat for energy, urine testing may show only trace amounts of ketones, even though the person is still in ketosis.

People with Certain Risk Factors

Urine testing for ketones may also be recommended for individuals with specific risk factors, such as those with eating disorders, starvation, certain digestive diseases, or alcohol use disorder. Additionally, intense and prolonged exercise can cause the body to burn fat instead of glucose, leading to increased ketone production.

People with Symptoms of Ketoacidosis

Anyone experiencing symptoms of ketoacidosis, such as fruity-smelling breath, dry mouth, nausea, vomiting, or abdominal pain, should test their ketone levels. Ketoacidosis is a serious condition that requires prompt medical attention.

People Monitoring Their Health

Finally, urine testing for ketones can be a useful tool for anyone interested in monitoring their health and understanding how their body responds to different diets and lifestyle choices.

It is important to note that while urine testing is a convenient and affordable option, it may not provide accurate results for individuals who have been on a keto diet for a long time. In such cases, blood ketone testing may be a more suitable option.

How to improve the accuracy of urine testing

Urine tests are a common, quick, easy, and cost-effective method of screening for drugs or health issues. However, there are several factors that can impact the accuracy of urine tests, and errors are inevitable. Here are some ways to improve the accuracy of urine testing:

• Use a confirmatory test: Screening tests like immunoassays (IA) are not definitive and can produce false positives and negatives. A follow-up test called gas chromatography-mass spectrometry (GC-MS) is more reliable and can detect more substances.
• Be aware of cut-off levels: Urine tests have cut-off levels, meaning that a result is only considered positive if the amount of drug detected is above a certain level. This helps to reduce false positives due to passive exposure and false negatives due to diluted urine.
• Consider timing: The early morning or after dinner are the best times to test urine for ketones as research has found that results are most reliable at these times.
• Check expiration dates: Always check the expiration date on the testing kit. An expired kit can give false results.
• Proper storage: Store test strips in a tightly closed container. Exposure to moisture or air can cause the strips to work improperly.
• Supervision: In some cases, a technician may accompany the person giving the sample to ensure it is done correctly, which can help improve accuracy.
• Avoid certain substances: Consuming certain legal substances can lead to false positives. For example, dextromethorphan, a common ingredient in cough syrups, can cause a positive result for PCP on an IA test.
• Disclose medications: Certain medications and supplements can also cause false positives. It is important to inform the tester of any prescription medications, over-the-counter medicines, or supplements being taken.
• Follow instructions: The instructions for using urine test strips can vary by brand. Follow the specific instructions provided with the test kit for the most accurate results.
• Collect a mid-stream sample: For urine tests, it is generally recommended to collect a "clean-catch" or mid-stream sample. This involves urinating into a toilet and then holding a collection cup in the urine stream to collect a sample.
• Improve collection accuracy: The accuracy of 24-hour urine collections is often low and can be impacted by factors such as age and partner status. Methods to improve collection accuracy include providing clear instructions, utilizing instructional videos, and offering financial incentives.

By following these guidelines and being aware of the limitations of urine testing, you can improve the accuracy of your results.

Frequently asked questions