Lindsay Venn, PA-C, RD, MHPOne of the most common questions I hear in my medical practice is:
“How high should my ketones be?”
My answer is almost always the same: “It depends on your goals, symptoms, and health concerns.”
For most people, nutritional ketosis is highly beneficial. Research — and my own clinical experience — consistently shows improvements in metabolic health, energy, and overall well-being when blood ketone levels are in the range of 0.5–3.0 mmol/L.
However, there are specific populations who may benefit from driving ketones a bit higher. In these individuals, ketone levels in the 1.5–5.0 mmol/L range may provide additional therapeutic effects. Let’s look at three key groups.
1. Individuals with Mental Health Concerns
The brain thrives on ketones. They provide a cleaner, more efficient fuel source compared to glucose and also improve insulin sensitivity within the brain. This is particularly important for those struggling with conditions such as depression, anxiety, or cognitive decline, where impaired brain energy metabolism may play a role.
How to support higher ketone levels:
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Limit carbohydrate intake to under 20 grams per day
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Incorporate intermittent fasting or time-restricted eating
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Pair with nutrient-dense, whole foods to avoid nutrient gaps
By doing so, patients often notice improvements in mood, mental clarity, and overall brain function.
2. Individuals with Inflammatory Bowel Disorders
Conditions such as ulcerative colitis, Crohn’s disease, IBS, and diverticulitis all share one common feature: chronic inflammation.
Ketones are not just a fuel — they are also one of the body’s most powerful anti-inflammatory signaling molecules. By lowering inflammation in the gut and providing a steady energy source for intestinal cells, nutritional ketosis can help calm symptoms and support healing.
In my practice, many patients with GI issues report reduced bloating, less abdominal pain, and more regular bowel habits once ketone levels rise above the standard range.
3. Individuals with Autoimmune Conditions
Autoimmune diseases such as multiple sclerosis (MS), Hashimoto’s thyroiditis, rheumatoid arthritis, psoriasis, and inflammatory bowel disease are also driven by chronic inflammation.
Since ketones help regulate inflammatory pathways, they can reduce the overactive immune response that fuels autoimmune flare-ups. While nutritional ketosis is not a cure, I’ve seen patients experience meaningful improvements in pain, fatigue, and quality of life when maintaining higher ketone levels.
What Does “Higher” Actually Mean?
For the general population, a range of 0.5–3.0 mmol/L is usually ideal.
For the groups above, I often recommend a target of 1.5–5.0 mmol/L — but with important caveats.
- Medication considerations: Some drugs, such as SGLT2 inhibitors, can increase the risk of ketoacidosis and make higher ketone levels unsafe.
- Individual variability: Age, activity level, genetics, and other health conditions all play a role.
- Medical supervision: Always work with a knowledgeable healthcare provider before attempting to push ketone levels higher.
The Takeaway
Nutritional ketosis is a powerful tool that benefits most people. But for those dealing with mental health challenges, inflammatory bowel issues, or autoimmune conditions, aiming for slightly higher ketone levels may unlock even greater benefits.
If you fall into one of these categories, seek guidance from a medical professional experienced in ketogenic therapies. With the right support, you can safely tailor ketosis to your unique health needs.
