What is the Glucose Ketone Index (GKI)?

The Glucose Ketone Index (GKI) is calculated by dividing your blood glucose level in mmol/L by your blood ketone (beta-hydroxybutyrate, BHB) level in mmol/L. A GKI below 9 indicates mild ketosis, below 6 moderate ketosis, below 3 therapeutic ketosis, and below 1 intense therapeutic ketosis.

What is the Dr Boz ratio?

The Dr Boz ratio, developed by Dr Annette Bosworth, is calculated by dividing blood glucose in mg/dL by blood ketones in mmol/L. A ratio below 80 indicates conditions suitable for autophagy, and below 40 indicates deep autophagy. It is numerically equivalent to GKI multiplied by 18.

How do I convert mmol/L to mg/dL for blood glucose?

To convert blood glucose from mmol/L to mg/dL, multiply by 18.0182. To convert from mg/dL to mmol/L, divide by 18.0182. For example, 5.5 mmol/L equals 99 mg/dL.

How do I convert breath ketone PPM to mmol/L?

Breath acetone in PPM can be approximately converted to blood BHB equivalent by multiplying by 0.06 to 0.10. For example, 10 PPM on a breath ketone meter corresponds to approximately 0.6–1.0 mmol/L blood BHB equivalent. Note that individual variation is significant.

What Dr Boz ratio indicates autophagy?

A Dr Boz ratio below 80 is associated with conditions that may support autophagy — the cellular self-cleaning process. A ratio below 40 is associated with deep autophagy. These thresholds were established by Dr Annette Bosworth based on clinical observation.

GKI Calculator & Ketosis Tracker — Blood Glucose, Ketones & Dr Boz Ratio

Blood glucose unit converter

✓ Values entered here are shared across all tabs automatically.

mg/dL

⇄

mmol/L

Reference ranges

Hypoglycaemia
< 3.9 mmol/L · < 70 mg/dL

Normal fasting
3.9–5.6 mmol/L · 70–99 mg/dL

Pre-diabetic
5.6–7.0 mmol/L · 100–125 mg/dL

Diabetic range
≥ 7.0 mmol/L · ≥ 126 mg/dL

Reference values are for fasting blood glucose. Post-meal values are typically higher. Not a substitute for medical advice.

Enter your readings

✓ Values are shared with the Glucose tab — enter once, available everywhere.

Blood glucose

Unit

Blood ketones (beta-hydroxybutyrate, BHB)

mmol/L

Breath ketone converter

Breath acetone (PPM)

⇄

Approx. mmol/L (breath)

Conversion: 1 PPM ≈ 0.06–0.10 mmol/L equivalent. Enter either field.

Heuristic GKI from breath + blood glucose

No blood ketone reading? Enter your breath meter value above and a blood glucose below to estimate a GKI range without a finger-prick ketone test.

✓ Glucose value is shared with the Glucose and GKI tabs.

Blood glucose

Unit

Breath acetone (acetone) and blood beta-hydroxybutyrate (BHB) are different ketone types. This is an estimate only. A blood ketone reading gives a precise GKI. Individual breath-to-blood ratios vary by up to 3×.

Trend chart

Log entries

Date	GKI	Dr Boz	Ketones	Glucose	Notes

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Therapeutic ketosis — serious research

Peer-reviewed and clinical research on therapeutic ketosis. Links go to PubMed abstracts or journal pages. Last reviewed: June 2025.

Cancer

Ketogenic diet as an adjuvant cancer therapy: History and potential mechanism (2020)

Khodabakhshi et al. — Redox Biology

Reviews the theoretical basis for ketogenic diets in oncology, including the Warburg effect — the tendency of cancer cells to rely on glucose fermentation. Summarises preclinical and early clinical findings.

Cancer

Feasibility and safety of a ketogenic diet in patients with glioblastoma (2021)

Noorlag et al. — Clinical Nutrition

Prospective feasibility study in glioblastoma patients. Found the diet achievable and generally safe in this population during standard treatment, paving the way for larger trials.

Cancer

Ketogenic diet combined with anti-cancer treatments: a systematic review (2022)

Talib et al. — Nutrients

Systematic review of human studies combining ketogenic diet with chemotherapy or radiotherapy. Mixed but encouraging results; calls for larger randomised trials.

Bipolar disorder

Ketogenic diet as a metabolic therapy for bipolar disorder: clinical developments (2023)

Norwitz & Naidoo — BJPsych Open

Reviews evidence and proposed mechanisms for ketogenic diet in bipolar disorder, including mitochondrial function and neurotransmitter regulation. Summarises early case reports and one Stanford pilot trial showing remarkable remission in some participants.

Schizophrenia

Pilot study of a ketogenic diet in schizophrenia (2023)

Calabrese et al. — Psychiatry Research

Small but notable pilot study showing improvements in psychiatric symptoms and metabolic markers in patients with schizophrenia on a ketogenic diet alongside standard medication. Calls for controlled trials.

Mental health

Stanford psychiatric ketogenic diet pilot: feasibility and improvement in serious mental illness (2024)

Sethi et al. — Psychiatry Research

Inpatient pilot (Stanford, 2024): participants with schizophrenia and bipolar disorder showed clinically meaningful improvements in Global Assessment of Functioning alongside weight loss and improved metabolic markers.

Alzheimer's / Cognition

Medium-chain triglyceride ketogenic diet for Alzheimer's disease: systematic review (2021)

Avgerinos et al. — Ageing Research Reviews

Systematic review finding consistent but modest cognitive improvements with MCT-supplemented ketogenic diets in Alzheimer's patients. Mechanism proposed: ketones as an alternative fuel for glucose-impaired neurons.

Epilepsy

International consensus statement on ketogenic diet therapies for epilepsy (2018, updated 2020)

Kossoff et al. — Epilepsia Open

The definitive clinical guidelines from the International League Against Epilepsy. Ketogenic diet has Level 1 evidence for drug-resistant epilepsy — the best-established therapeutic indication.

Type 2 diabetes

Two-year outcomes of a very-low-carbohydrate programme in type 2 diabetes (Virta Health, 2019)

Athinarayanan et al. — Frontiers in Endocrinology

Landmark 2-year study (n=349) showing sustained HbA1c reduction, weight loss, and significant reduction or elimination of diabetes medication in a continuous care ketogenic intervention.

Metabolic health

Autophagy and the ketogenic diet: mechanisms and therapeutic potential (2020)

McCarty et al. — Nutrients

Reviews how sustained ketosis — particularly as indicated by low Dr Boz ratios — may induce autophagy, the cellular self-cleaning process implicated in longevity and metabolic health.

All links go to peer-reviewed publications or PubMed abstracts. This section is informational only. Therapeutic ketosis protocols — particularly for cancer or psychiatric conditions — must be undertaken under medical supervision. This tool does not constitute medical advice.

Ketosis zones — GKI & blood ketones

BHB (beta-hydroxybutyrate) is the primary ketone body measured by blood ketone meters such as the BeKeto. Values shown are typical ranges — individual readings vary.

No ketosis — GKI > 9 · blood BHB < 0.3 mmol/L

Standard metabolic state. Glucose is the primary fuel. Typical with a normal or high-carbohydrate diet.

Mild ketosis — GKI 6–9 · BHB 0.3–0.5 mmol/L

Light ketone production. Typical for low-carb eating without strict calorie restriction. Good starting point.

Moderate ketosis — GKI 3–6 · BHB 0.5–1.5 mmol/L

Clear ketogenic state. Common target for weight management and metabolic health. Most people feel well here.

Therapeutic ketosis — GKI 1–3 · BHB 1.5–3.0 mmol/L

Deep ketosis used in clinical research for epilepsy, cancer metabolism, and mental health. Requires strict dietary control and ideally medical supervision.

Intense therapeutic ketosis — GKI < 1 · BHB > 3.0 mmol/L

Extreme ketogenic state typically requiring extended fasting or a very strict therapeutic protocol. Medical supervision is strongly recommended.

Autophagy thresholds (Dr Boz ratio)

Autophagy possible — Dr Boz < 80 (GKI < ~4.4)

At this ratio, the metabolic conditions for autophagy — cellular self-cleaning — are thought to begin. Evidence is preclinical; individual variation is significant.

Deep autophagy likely — Dr Boz < 40 (GKI < ~2.2)

Ratio associated with robust autophagy induction. Typically achievable with extended fasting combined with very low carbohydrate intake. Dr Annette Bosworth's clinical protocol targets this zone for metabolic reset.

Breath ketone levels

No ketosis — < 2 PPM · < 0.12 mmol/L (breath)

Negligible acetone in breath. Normal metabolic state.

Mild ketosis — 2–5 PPM · ~0.12–0.4 mmol/L (breath)

Detectable ketone production. Consistent with low-carb eating or light fasting.

Moderate ketosis — 5–10 PPM · ~0.4–0.8 mmol/L (breath)

Good ketogenic state. Corresponds roughly to blood BHB of 0.5–1.5 mmol/L.

Deep ketosis — 10–40 PPM · ~0.8–3.0 mmol/L (breath)

High acetone output. As you note, readings above ~1 mmol/L on breath meters like the Ketoscan typically require several days of fasting or very strict therapeutic protocols.

Very deep / fasting ketosis — > 40 PPM · > 3.0 mmol/L (breath)

Extreme acetone output. Typically seen only with prolonged fasting (3+ days). Always verify with a blood reading if precision is needed for a therapeutic protocol.

Units quick reference

1 mmol/L = 18.0182 mg/dL

1 mg/dL = 0.05551 mmol/L

GKI = glucose (mmol/L) ÷ BHB — beta-hydroxybutyrate (mmol/L)

Dr Boz = glucose (mg/dL) ÷ BHB — beta-hydroxybutyrate (mmol/L)

Dr Boz ÷ 18 ≈ GKI

1 PPM breath ≈ 0.06–0.10 mmol/L BHB — beta-hydroxybutyrate (estimate)

This tool is for informational purposes only. It does not constitute medical advice. Blood glucose and ketone management — particularly for diabetic individuals or those following therapeutic ketosis protocols — should be supervised by a qualified healthcare professional.