HRV and Ketones, Blood Glucose, and Food Sensitivities with Alessandro Ferretti

Nov 21, 2016 | Android, Blog, Data, Health, iOS, News, Podcast, Research, Science, Training

Listen to the full episode here:

What was your favorite topic or point from the episode? Let us know in the comments.

Episode Guest

Alessandro Ferretti, Dip ION mBANT NTCC CNHC

Nutritional Therapist, Lecturer, Researcher, Co-Founder of Equilibria Health Ltd.

Website(s): Equilibria Healthhttp://alessandroferretti.co.uk/

Social Media:

In This Episode

In this episode, Alessandro Ferretti joins us to discuss blood glucose, ketones, ketogenic diets, and of course how it all relates to health, performance and Heart Rate Variability. We also cover some useful topics such as how to use HRV for food sensitivity testing, how to establish a personal glucose baseline and when best to measure blood glucose, and ideal ketone thresholds for exercise and training.

TOPICS

  • 24/7 HRV, ketones, glucose monitoring
  • Food sensitivity testing with HRV and the % changes to look for to identify offending foods
  • Correlations between blood glucose and HRV
  • “Normal” vs. healthy blood glucose levels
  • How to establish a personal glucose baseline
  • When to measure blood glucose (two key times)
  • Nutrient timing
  • Glucocorticoids and the inflammatory response
  • Substrate efficiency during exercise
  • GLUT4
  • Cortisol resistance
  • “Pseudo paleo”
  • Low carb vs. ketogenic diet
  • What is a ketogenic diet, really?
  • The dangers of doing ketogenic diet incorrectly
  • What are ketones?
  • Becoming fat adapted
  • Phases of ketogenesis
  • Ideal ketone thresholds for exercise & training
  • Ketoacidosis
  • How the brain uses ketones
  • Breath vs. blood vs. urine ketones
  • Type 1 and type 2 diabetes
  • Acetyl acetate and beta hyrdoxybuterate
  • Gluten cross-reactivity
  • Fungal infections in the gut
  • 24/7 continuous monitoring vs. snapshot morning HRV measurements
  • Comparing the foot print of various life stressors
  • The individuality of the sympathetic response
  • Timing recovery for optimal performance

Episode Transcript

Jason Moore: Hey folks, Jason Moore here. I’m excited to share another great episode of the Elite HRV Podcast with you. We’ve been so fortunate to have amazing guests on the show already, and today is no different. Today we go deep into blood glucose, ketones, ketogenic diets, and of course, how all of that relates back to health, performance, and heart rate variability. Alessandro Ferretti is our guest, a quick bit about him, he’s an Italian that enjoys living in the beautiful UK countryside with his family, and he also competes at a very high level in karate, and I believe judo as well. He’s basically a super intelligent, fat burning machine, that is constantly monitoring a handful of bio-markers, and he’s always tweaking and experimenting with some sort of held to performance marker, so he fits right in in our data nerd community here. Speaking of community, for those listening in from the United States, Happy Thanksgiving. Thanksgiving’s a holiday that involves stuffing our faces, of course, and it’s the perfect time to learn about blood glucose management. So, in the spirit of giving thanks, I’d like to say that I am truly grateful for the experts who take time to share their knowledge on this show, and for the thousands of you that have already downloaded, listened, and started reviewing the show in these critical early weeks. We’ve just been launched for a couple of weeks, and it’s very flattering and, we’re very honored to have so much feedback. Positive feedback. So, to Michael, Francisco, Jennifer, Nicholas, Elisa, Amanda, Dwight, Alexander, and Stefan, and many more, thank you for your kind messages and emails regarding the show, and of course sticking those kind messages over on iTunes also helps tremendously as well. As long as the show is useful to you, we will do our best to keep publishing new episodes. Speaking of episodes, back to this episode. What are we covering today? Alessandro and I talk 24/7 HRV ketone and glucose monitoring, so that’s like continuous, all day monitoring. Food sensitivity testing, with heart rate variability. Kind of, percent change thresholds to look for with, for identifying offending foods. Correlations between blood glucose and HRV, ideal ketone thresholds for exercise and training, the dangers of doing ketogenic diet incorrectly, how to become fat adapted, the breath versus blood versus urine ketone discussion, because there’s many ways to measure ketone activity. A whole lot more, but before we dive in, I will warn you, we go deep into the weeds on this episode. We do our best to explain and recap the topics, but if there’s anything that you don’t quite understand, just leave a comment on the show notes, and we’ll be happy to explain that. I mention it a couple times throughout the episode, that’ll be hrv.com/podcast, you can find the show notes and everything over there. So with that, let’s dive in. Welcome to the show, Alessandro, thanks for joining us.
Alessandro Ferretti: Very much my pleasure.
Jason Moore: I believe we originally connected because someone was tweeting about all the crazy things that they were learning in one of your live presentations. I thought, I have to reach out to this guy and see what’s going on here. So, it was kind of nice to find out when I reached out, that you’d already come across our app in the past, and were also a generous and very easy to talk to guy on top of doing some really fantastic research. So, since then, whenever we’ve spoken, you’ve often been on your way to give a lecture or presentation, or consult with some group or another, could you give us a quick rundown of what it is that you do?
Alessandro Ferretti: Yeah, sure. I, primarily I’m focusing on research right now. So, I’m just trying to understand, have a better understanding of correlations between different variables. So, I am a nutritionist with an interest in performance and mainly metabolic diseases. So, I decided a few years ago to start to expand that specific area, and through recommendations of patients, really try to apply all my learning, so we don’t sell anything. We don’t sell tests, we don’t sell apps, we don’t sell vitamins and minerals, it’s primarily a research company, and companies will hire my company or myself in order to deliver findings and deliver part of my work. So, in a nutshell, it is that. I also embarked in a few projects, there is a new one which is really exciting as well, which is really looking for a whole month, so four weeks length on an n equals six. The effects on low carbohydrate, high fiber diet, actually say more ketogenic diets, so not necessarily always high fat, where we track HOV, HR, we track ketones, breath and blood, glucose, ongoing later, will have sensors on clients and me personally. I have two censors, implanted to actually compare different pieces of kit and hardwares and softwares, and really wanting to refine these correlations well. There’s been so many hypotheses about it, but actually, no group of individuals have tested with all of these variables. So, that’s really exciting.
Jason Moore: Very exciting indeed. So, you’ll be monitoring glucose, ketones, and HRV 24/7 for an entire month with six individuals on a ketogenic diet? This is a basically a perfect intro into this conversation, because as you mentioned, nobody has done this type of research before, or at least there’s no public knowledge of such an experiment. Both, so both myself and the folks listening will be pretty interested in hearing about the results of that. So, definitely keep us posted. So, anyways, on top of being a human guinea pig, you dabble with the martial arts as well, don’t you?
Alessandro Ferretti: Yep. Just a bit.
Jason Moore: World champion, right?
Alessandro Ferretti: My latest performance was appalling.
Jason Moore: I’m sure it’s all relative. You know, one of the things I love about you, Alessandro, is that you have a lot of energy, you walk the walk, and when you talk about wanting to increase performance, you’re talking about for yourself as well, not just for some people that you’ve never met. So, you have this really interesting background, coming from the nutrition side and being really experienced with blood glucose monitoring, ketones, and heart rate variability. You know, have you seen any kind of general relationship between blood glucose and HRV specifically?
Alessandro Ferretti: Yes. Generally, there has been a few good research projects that I’ve done that pointed towards looking at these correlations being a positive correlation. I wasn’t able to extrapolate P values or R values, because one of these devices actually doesn’t allow the extrapolation of raw data, so I had to more use like a visual kind of thing. However, even in the snapshot reading, definitely there is a trend. So, for example, when there are instances where the glucose is elevated, or elevated, or slightly more elevated compared to baseline, generally there is an association with a lower HRV. Now, that seems to be more connected to inflammatory response, not just sympathetic activation. So, if we can see that sympathetic activation, so sometimes, someone can have a mild sympathetic activation, without fetching the glucose, but if inflammation, so recovering from training or having eaten certain types of foods or whatever that may be, then when the HRV is down, and in a snapshot meant someone takes a blood reading, then generally yes. There is a correlation.
Jason Moore: Interesting. So a sympathetic response, in combination with an increase in inflammation, may cause a decrease in HRV and increase in blood glucose. Have you see any correlations with ketones as well?
Alessandro Ferretti: Yes. I mean, it’s not as clear, so I’m not as certain on the results. Get to a certain degree of inflammatory response, then because one of the areas of research, I am focusing on is the application of ketogenic diets or fat adaptation for sport and performance, when we measure ketones, and there is a substantial level of inflammatory response, generally speaking, the ketones are lower. Given the same macro, given the same type of training, given, you know, so when we maintain the variables are the same, you cannot efficiently try to get a higher level of ketones, which is normally used in a medical scenario for application of ketogenic diet, so epilepsy, cancer, etc, etc. Taking this away from that medical aspect, then the correlation is not as clear, but definitely there is. We don’t know if the ketones are low because of the high glucose, we don’t know if it is the inflammation that keeps you, in a way, out of ketones, if it is a stress response, but definitely there are some fluctuation trending down.
Jason Moore: Great. So, there will be plenty to learn from your 24/7 multi-variant monitoring project. So let’s take a step back. I’d like to ask you some more general questions about blood glucose and about ketone monitoring in general. What does it typically mean when your fasted or resting blood glucose, is elevated above normal values?
Alessandro Ferretti: Okay. So, I think the first thing I would want to clarify is the definition of normal. So, a couple of years ago, no, 3 years ago now, my glucose was still within normal, which would be my 5.6, that would equate to 100, 105 mg for the deciliter. Yet, fasting at that level for me is really, you know, starting to ring a few alarm bells, because depending upon the lifestyle, then the very same glucose level can be considered totally normal, or can be considered actually alarming. So, with my lifestyle at the time, I was training. Good physical activity. Eating well, organic food, good micro ratio in a kind of paleo style with some carbs, kind of same. Lots of fish. That level of glucose was still normal, but it was not justified. I couldn’t improve that much in my life who would have got that down to mid 80’s or my low 5’s and before. So, given a healthy level of glucose, which for me is between 4 and 5, so that would be your 70-90, I would classify anything that is 1 1/2 mm higher than the top figure, which would be 18 mg deciliter higher, than US for example, mg for the deciliter generally speaking would correspond to some degree of either inflammatory response, sympathetic activation, or in whichever way we want to see it, some form of glucocorticoid activation, and that would have an impact on how well the glucose is disposed from the actual blood. I mean, fasting glucose level can also be affected by something called dawn phenomenon, or the Somogyi effect, and this can have only the fasting glucose level that is elevated, but within an hour or an hour and a half, that goes back to normal. That’s a slightly different scenario. Someone has ongoingly went fasting, you know, either after a nice sleep or in between meals. The slightly elevated glucose, then there is some form of insulin resistance. Normally insulin resistance can be associated very often to some form of inflammatory response or poor cellular efficiency, let’s call it.
Jason Moore: Okay. Just to make sure the listeners and I are all on the same page with you, in general, you don’t want your fasted morning glucose levels to be excessively high, and an upper limit that may be considered, quote, normal, so to speak, is around 5.6mm per liter in your measurement system, or around 100 mg per deciliter in the US, but actually in your opinion this is unjustifiably high, and it should actually be between more like 4-5 mm, or between 70 to 90 mg per deciliter here, and if the fasted levels are actually maybe 10 to 10% higher than those ranges you recommend, it may actually indicate an excess of inflammation or sympathetic activation, or could even be indicative of some form of insulin resistance, so I just wanted to get all that kind of summarized. So what would you say to someone who maybe fit, or even an athlete, but the fasted morning glucose levels are above the ranges that you just mentioned?
Alessandro Ferretti: Ideally you want, so they’re tracking their HRV daily and they’re tracking their glucose daily, that snapshot over a period of time can give them a trend. Obviously, if you measure your glucose once a week, then it’s a little bit like in your HRV course, which I found brilliant, really. If someone takes a snapshot, there are so many variables to take into consideration, but the trend is very weak, so if I suggest two people to try to measure the glucose under normal parameter or parameters in their lives, over a period of one or two weeks, and then we have a much, much better understanding of what are the changes. Ideally, we want to track it ongoingly, however given that, then we would have a much better insight on the actual person, so if an athlete has an elevated fasting glucose level, then first question is okay, how was your day yesterday? What did you eat? Did you eat too late before you went to bed? Did you have, I don’t know, any alcohol, any inflammatory food, did you have a really hard session training the day before? So, this morning my glucose was elevated for me, at 4.9 which is your just sub 90, and it was a substantial 15 points above normal. My HRV was down, and etc, because yesterday I had quite two heavy training sessions in a row, and that’s pretty normal so for me, today is totally justified, whereas at times we are starting to see that other variables, not only training, can impact that. What is really alarming is the amount of athletes that are not aware of it, but because they spend most of their time in sympathetic activation due to training, or under-recovery or over-training, then their glucose keeps creeping up all the time, and eventually they can have substantial dysfunctions in the way how their body actually uses substrate for energy and potentially affecting going towards mild type two diabetics.
Jason Moore: To relate that to the performance side, not only are we talking about this affecting health, but this can also potentially affect an athlete’s ability to use glucose efficiently as fuel for their athletic performance?
Alessandro Ferretti: Yeah. In what, to add that, eventually when they start exercising, the problem is not as noticeable, because obviously through activation of GLUTS within the cells, then the glucose is dragged in whichever way, you know, the inflammatory response may not be as noticeable as it is at rest, because obviously, being at rest, we remove the variable, or having to use and manufacture energy forcefully, but at rest is a brilliant market because we then have an understanding of what’s actually happening in the body. So, just to put this in numbers, this year alone, three colleagues of mine with a very good degree of health, exercising they thought correctly, recovering they thought correctly, all three of them that came to see me had substantially elevated glucose levels. It was above 110 fasting. The diet was pseudo paleo, one of them was attempting to be ketogenic, but got completely wrong, and that was quite dangerous because he ended up with really high blood lipids, not high healthy high. Actually, unhealthy high. So, Tim Noakes Professor Tim Noakes some time ago, mentioned he was exercising his way to diabetes. Well, there is an element of truth in that statement, that is applicable to these three colleagues of mine.
Jason Moore: That’s powerful. Real quick, before we dive into more detail, when you mentioned forming this blood glucose baseline, you know, like you said, we talk about in heart rate variability when you’re taking HRV snapshots, that the best time to do it is in the morning before you really do anything else, because that kind of eliminates a lot of the variables that potentially could occur, and also getting several samples per week greatly increases your confidence that you’re actually capturing your true baseline. So is that the same time that you should like, maybe what I’ve done in the past is I measure my HRV and then pretty much immediately afterwards I also measure my blood glucose in the morning. Is that a good way to get that baseline?
Alessandro Ferretti: Yes, precisely. I covered this on my website, I have a few videos just there, they’re all free, and people can just watch them. The website is my full name, Alessandro Ferretti dot co dot UK. What I’m going through, you know, when I consider meaningful or some of the times which I consider to take glucose readings. I like to do as soon as you wake up, and then within an hour, well after an hour, an hour and a half, after you woke up, obviously still fasted.
Jason Moore: Still fasted. Okay.
Alessandro Ferretti: Yeah, because then you also have an effect on glucocorticoid activation, because the first parts, as soon as we release cortisol, interestingly enough, if there’s a healthy response, cortisol will dampen inflammatory response and seemingly reduces the blood glucose levels, whereas an excessive activation of glucocorticoid then is going to start glycogenesis and more for the inflammatory response, insulin resistance, and so there is a difference between the mild normal peak of cortisol, versus a very acute or chronic level of cortisol, and cortisol resistance. Say, generally speaking, even if someone has a slight elevated glucose level, but within an hour, an hour and a half, is actually back to a healthy level, to a health range, then it’s a slightly different problem. Then, I will actually look. What is the inflammatory response during the night? Is the liver starting to go into glycogenesis during the night, because it cannot maintain a healthy glucose level? What is the sleep like? Did they see actually, that kind of problem in willingness to sleep? Did they feel it? How do they feel in the morning? Starting to correlate that through HRV and what has happened the previous day. So, in a way, in the same way as you have suggested in your course to track HRV and start to track subjective data, or even other data, you can apply pretty much the same methodology in relation to glucose or ketones.
Jason Moore: So, in my own experimentation, I’ve used the precision extra, and other kind of finger prick style monitors that are typically targeted to folks with diabetes, and can be found at like, many stores. Do you have any super fancy special devices that you use to track blood glucose, or are you using the same devices kind of as the rest of us?
Alessandro Ferretti: Yeah, yeah. You can use that, the, I’ve done quite a few experiments on the ongoing glucose monitoring system, not quite as reflective of blood, but it is great to reflect trends. So, I’ve noticed there was a difference at nearly one whole million molar, which is 18 milligrams of deciliter, because in measures, the glucose concentration under the skin, and then they work out given that, an estimate of what is in the blood. In my case, whatever they measure was giving a reading that was higher of about 1 mm. Which is a lot. However, the trends, were actually very good. So, it was always high. It wasn’t going up and down. So, the arrows were constant, so it’s either a conversion reading, algorithm, or calibration error, I don’t know. However, even a glucose monitor from the local pharmacy can be very useful as a snapshot, as long as they don’t take it, I don’t know, right in the middle of the meal. Is it going up? Is it, surely, you know, there has to be some criteria to do that. So, yeah. General, you know, Accucheck, or Abbot, these are all brands that, there will be just a good indication of what good glucose is.
Jason Moore: Great. Thank you. You know, you mentioned links to your site and some videos, and we’ve talked about some of these monitors, and I’ll put links to these all in the show notes of this so that people can find your website easily from the podcast notes, and also find those videos and some links to blood glucose monitors if people are interested in doing that. Just to summarize as well, you mentioned that the continuous monitor that’s based on the blood glucose levels under the skin in our measurement could be up to 18 points different from what your blood measurement was, but that it appears to be at least that the trends kind of hold the same.
Alessandro Ferretti: Precisely. So, if you are interested in seeing fluctuation in relation to food, stress response, work, exercise, whatever, it’s still good, you just need to take into account for that error. At least the error is constant. Any vary is between individual and individual. So with me, was a very strong error. With someone else, was absolutely bygone.
Jason Moore: Excellent. So, let’s shift gears a bit and talk ketones. I believe I have a pretty good understanding of the subject, especially after several discussions with you, but I believe that many folks still couch the ketogenic diet as simply an ultra low-carb diet, and I know that many of the listeners probably are beyond that, but just in case let’s start there, and if you look at the word ketogenic itself, I believe it’s actually more about generating ketones than it is about actually eliminating other things, though reducing carbohydrates and other substrates do contribute to ketogenesis. So how would you describe a ketogenic diet or a keto adapted diet, which is a term I’ve heard you use before. How would you describe those?
Alessandro Ferretti: Yeah. Sure. As in anything, different people have slightly different interpretations of it. So, the first distinction to make is a low-carb diet and a ketogenic diet. Low carb diet, it can be a low carb diet without the person actually and constantly being in ketosis. That may have certain benefits, or for sure have some benefit for certain group of people, that is one thing, but they don’t necessarily have to be ketogenic. Ketogenesis is a process of metabolism where the body produces a certain level of ketones, and that is what is called ketogenic diet. I like, I personally like to refer to a body that constantly uses a higher degree of fat versus using glucose as fat adapted. So, is all, a bit of a gray area, some people say okay. What’s the difference between ketogenic diets and fat enacted? Where do I know that I’m fat adapted? Well, generally speaking, you’ll have certain physiological behaviors and physiological signatures that you can actually see, that the body preferentially uses fat as a main source of fuel. I mean, you can go all the way, and do tests and, you can take it very far. However, normally ketogenic diets, they have, they were born with a medical obligation, not only for weight loss but also more for epilepsy and cancer. These people are required to have a constantly raised level of ketones in order to ripen the benefit of these ketones in these specific medical scenarios. Then we started with a sport performance and more of the kind of weight loss, in which scenarios we are really aiming at is not to have high level blood ketones, but actually to use fat in ketones as a primary form of fuel. See, it doesn’t really matter if you’re accumulated in your blood, but what really matters is that the body’s using them very, very efficiently for whatever is the purpose. Most of the times it is sport performance. So, I think there is a lot of confusion, hence I stated, this is how I say it. This is how I refer to it. I’m sure the other people may have slightly different variations. To recap, low fat, sorry, low carb is one type of diet, which does not necessarily mean its ketogenic. Ketogenic diet is aiming, for medical purposes, is aiming to have high level of ketones in the blood constantly, i.e, epilepsy, cancer, and etc, in support of these disease, I’m not saying it’s curative. Then you have fat adaptation, most likely to happen in long distance athletes, or athletes in general in some other cases, where the body preferentially uses fat as the main source of fuels, where normally we would see slightly less level of blood ketones, and perhaps higher level of breath ketones.
Jason Moore: Okay, so that makes a lot of sense. Outside of specific medical reasons, the goal is not to have elevated blood glucose or elevated blood ketones, the goal is to have the right amount of substrate in the blood, whether ketones or glucose, for the task at hand. Then, to be able to efficiently utilize that substrate. So, just like we don’t want blood glucose to be unnecessarily high, are there toxic levels of blood ketones to avoid as well?

Alessandro Ferretti: Oh, yeah, yeah, yeah. There is a process called ketoacidosis, but normally ketoacidosis also would involve high level of glucose at the same time. Say, in the utmost vast majority of cases, that is when type one diabetics misjudge insulin, and they end up both with elevated glucose and elevated ketones, and I’m talking all the 10 mm or 12 mm, I can’t remember off the top of my head what is exactly the cut-off point, but it’s pretty high. So, generally speaking we, yeah, this is when you may not actually, you know, be healthy at all in that specific moment in time. If the glucose is already elevated, and the ketones are really high, and they are type one, ideally they need to get rid of the glucose, and just by reducing the glucose, then, they remove the acidosis kind of event. I have not yet seen a single person entering ketoacidosis that is not a type one diabetic. So, can this be applicable to a member of the public? We need to be cautious about it. Yet, amongst me and colleagues, I have not encountered one yet.
Jason Moore: Wow, okay. Interesting. So, do you, what do you use typically to measure ketones? I know you mentioned breath and blood, maybe we could talk about a couple of the different devices, and when it makes sense to use which ones?
Alessandro Ferretti: Yeah. I mean, the ketones are generally speaking, manufactured in a one to one ration between acetoacetate and beta hydroxybutyrate. Beta hydroxybutyrate is the one that you measure via fingerprint with the monitor. I mentioned earlier, the precision x-strain in the US and the neo here in the UK measure both lupus and ketones, hence that’s the one I want to use. The beta drug, so, the two different ketones. There are three, but these are the two that I’m just speaking about for a second. The beta hydroxybutyrate seems to be reflective of an accumulation within blood. I mean, once upon a time I called it, as a storage. That is not technically correct. However, sometimes the blood, it is my personal belief, acts as a buffer. So, for example before training, I want to see that in the region of the two mm. So, in a way, can be ready to be used. Acetoacetate, degrades to breath, into acetone. So, we can’t really measure efficiently, acid to acetate, because the urine test in fat adapted people is not actually reflective very well of the status, but through breath we can detect what is the users, the exhausted level, of ketones, especially acetoacetate, because acetoacetate goes into acetone, and that is exhaled through the lungs. So, being the ratio of production one to one, acetoacetate and beta hydroxybutyrate, they have, let’s say health benefits and properties, and some of them are actually slightly different, so for example, the brain, preferentially would use beta hydroxybutyrate, whereas acetoacetate has other functions. So, personally, for someone that is fat adapted, I would focus on the breath to actually see how this, how the ketones have been exhausted, and how the body, you know, is it actually using the fat in order to make energy. This is a generalization, and then each of the cases may have to be, you know, assessed individually. Whereas the beta hydroxybutyrate, unless there is a medical condition in which you want to have very high levels of it, good levels of it, anything just under the mm up to whatever someone has, 2, 3, 4, mm, that could be a good level to actually have. Then in some scenarios you may want to have a little buffer in the blood, that case beta hydroxybutyrate is the same, prior training, prior long hike, or whatever, or a bike ride. If I’m fasted, and I want to go for a long bike ride, ideally I want to see a little bit of beta hydroxybutyrate in blood, and decent to good level of acetone.
Jason Moore: Okay. So, the beta hydroxybutyrate in the blood is kind of a good marker of what’s available in the blood for usage, and you said that, the brain preferentially uses that, so if you’re going to go through a period of, intense brain activity, then it might be beneficial to have elevated blood ketones, and then similarly if you’re going to prepare for some type of athletic event, it might be beneficial to have some elevated blood ketones and then when you’re actually curious about the usage of those, then measuring those breath ketones and seeing those being used efficiently. Then there’s also, urine or keto sticks, or whatever that you can pee on, how do those play a role?
Alessandro Ferretti: So, it seems that that is the unused acid to acetate, which is released in urine. A common train of thinking, seems to point out that as the body becomes more and more efficient in utilizing fat as a primary source of energy, it is going to let less and less acid to acetate in urine. So you may find traces, but it isn’t really reflective, so at times, I had either myself or patients with reasonably good levels of beta hydroxybutyrate, very good levels, medium to good levels of acetone, which is a reflection of acid to acetate, or used acid to acetate, and yet the keto sticks were actually barely pink. The more efficient seems, the longer someone has been on a fat adapted state, the least you’re able to detect acid to acetate in urine. So ideally, we want to test acid to acetate in blood. That will give us a completely different new paradigm of questions that we can ask about the correlation, you know, the behavior there is between the two, between beta hydroxybutyrate and acid to acetate.
Jason Moore: Excellent. That actually corroborates with my personal experimentation as well. Earlier this year, I decided to do a period of very targeted and measured ketogenesis, and I was already eating a fairly high fat diet with fairly low carbs, and compared to the standard recommendations at least, without being too neurotic about it, I’m always kind of experimenting with some aspect of tweaking health & performance, and from the nutrition side, I pretty much stick to an evolutionary biology template for most things, but that’s another story, so I’ll digress. So I cut carbs down to around 30 grams per day, mostly from nutrient dense vegetables. I added in MCT’s and coconut oil for the ketogenic affects of medium train, excuse me, medium chain triglycerides. Within the first few days, urine ketones started to spring up, and blood ketones were basically negligible in those first few days. After a few days, urine ketones started to titrate back down to trace levels and blood levels actually started to increase to two mm in the morning, and a bit lower than that in the evening. I started to notice that when I consumed more carbohydrates on any given day, let’s say up to 50 grams, for example, that the urine levels of ketones would actually jump back up and a little on the following morning. Perhaps that the, the extra glucose that was being introduced was elevating the glucose substrate available and my body was preferentially using that over the available ketones. Does that sound feasible?
Alessandro Ferretti: Well, in a way how I think of it, is given the same metabolic demand that the body has to maintain energy, balance, and at the same time, make up for extra energy requirements like training, stress response, working, children, children may have a lot to do with that. If the body, all of these are pre-cursors for energy. Glucose and ketones and obviously fat, for oxidation. So, there seems to be a kind of, I wouldn’t say a cap, but an optimal band, and a guy called, an engineer called Martin Kendall and I interestingly came to reasonably similar findings in relation to the levels of beta hydroxybutyrate and the glucose sum, in order to understand – more than understand, to give an indication of where the person, metabolically is at, in some cases. All of these are substrate for energy, so acetoacetate, beta hydroxybutyrate, glucose, it’s fairly normal that there are some trends amongst these. Can we predict the trends? Starting to have some ideas, but not all the time. Basically, we don’t know it. We don’t fully know it. I think, it’s good to observe them, but it’s, I think what you’re experiencing is totally normal.
Jason Moore: Okay. So, let’s shift gears a little bit and talk about a question that I mentioned to you that a lot of people have had recently, and that is, testing for dietary offenders or food that maybe don’t agree with the system, and using heart rate variability testing to possibly gain a little bit of insight into that, you know. Could you talk a little bit about that?
Alessandro Ferretti: Sure, sure, Jason. Well, interestingly enough, I was, I came across a couple of years ago, totally by chance, I was using an ongoing measurement, an ongoing kind of monitoring system, and it was a two side sensor that the patient was actually wearing, and I was noticing that something lunchtime didn’t quite fit, in the sense that the person mentioned, she was relaxing. She was totally okay with it, and she was having healthy foods, and obviously being a nutritionist, what people consider healthy food, 1) isn’t really healthy, 2) it may be healthy for the vast majority of people, but maybe your body is reacting to it. Obviously, I’m sure that you’re aware of food allergies, food sensitivities, or just normal food reactions are costly, and involve also you having to be on a certain type of food for a period of time, perhaps if you want to go more advanced test, if you’re talking about gluten for example, it’s not just gluten. It’s what the body might confuse for gluten, so you need to do like, a cross of activity tests. So, it can end up being very expensive.
Jason Moore: Right.
Alessandro Ferretti: So, I kind of noticed that the typical lunchtime, the person was, the heart rate was reasonably, the heart rate variability was reasonably stable, and then during the lunchtime, there was the usual up and down and parasympathetic is trying to take over to try to digest the food, but then, it wasn’t going back to baseline afterwards. It actually kept being elevated. So, I started to run some little tests. I said look, do you know what you’re reacting to. I said, yes, I know. Okay. So wear this wrap, relax for five to ten minutes beforehand, eat the food, and see what happens afterwards. You can actually see, really, really well, even without using an advanced piece of equipment like I used. You can use your app, you have HRV, elite HRV, and your app allows to have an ongoing measurement of HRV, so I generally speaking, I made a person, okay, download the app and say okay. Wear this app, relax, ideally if they read something, as long as they keep reading roughly the same thing, they relax 5, 10 minutes, eat whatever they had to eat, and then actually see where the HRV by going back to the same activity will actually stabilize. If it’s substantially higher, it’ll keep being high, then obviously something in that meal has affected the person. Unless they were arguing, so obviously, there has to be some control within the variable. It doesn’t tell the person what has impacted on that meal. Then the person can start to experiment, right? So, if someone has a normal meal with, I don’t know, a salad, fish, and some grains, maybe my guess will go more on the grain rather than the fish and the salad. However, everyone is different. So, I think it’s like, it’s a quick and simple way to potentially identify some foods that can cause a sympathetic activation within the body, or reduce the parasympathetic dominance that should be when we are digesting.
Jason Moore: Okay. So, this is kind of similar to the coca test, which is basically looking at just heart rate, and that was kind of a test that’s been around for many years, but basically because people didn’t have access to the accurate hardware and accurate apps and things that you need to measure heart rate variability, and so it’s interesting to hear HRV can kind of take that to the next level. What we’re still talking about here is, just kind of getting an idea if something may be potentially offending your system by keeping your heart rate variability down, and so to summarize, what we’re talking about is, starting an open reading within our app, where if you could have another app or some other device, and just starting that reading, but you also need to, and then eating like five minutes later, and kind of measuring throughout the eating, and then post eating for like, at least an hour. Then during that time, it’s also important to, if you get up and move around and exercise or something like that, you’ll definitely expect to see that that will raise heart rate and change the results, so if you’re going to do this test it’s important to, like I think you mentioned when we talked previously to kind of sit quietly and maybe read a book or do something that’s not really going to be stimulating.
Alessandro Ferretti: Yeah. Yeah. Well, sometimes you can take the average of your, if the work, the person is at work, and they tend to do roughly the same thing, so I don’t know, at a desk, etc, etc, where they can’t control the stimuli that they have from their environment, as long as they can’t go back and do the same thing, then you can actually see still the variation. So, they’re a lot easier to detect than what we think. If someone is looking for it, I’m very happy to share a screen and show you that some of the ones I’ve done on an ongoing HRV reading, you know, if it needs to be, or I can give you this slide and you can put it in the show notes or whatever.
Jason Moore: Okay, we’ll attach the slides in the show notes over at elite HRV dot com slash podcast. For folks listening, if you want to see what a food sensitivity test looks like in HRV readings, then definitely head over there and check it out. We’ll also do our best here to kind of talk through the slides and describe what we’re seeing as well.
Alessandro Ferretti: Sure. Sure, sure. Absolutely. So, in here, you can see, with the red circle, the person was kind of reasonably stable, coming down, relaxing, and then post the dye is nearly an hour, and that was a quite substantial change. Interestingly enough, it didn’t happen with dinner or breakfast. We, in this case, we identify that that was the only time. In this case, we’re grains that a person was having. We’re healthy grains, but not maybe healthy for her. That’s the typical scenario, so the person had good ratio between recovery and, you know, expenditure on this specific day. Not so good on the next day, but what I was noticing is that post, post that meal, she actually wasn’t feeling great, and in addition to that, there was some kind of, that would actually affect later on even the sleep. So, you can see there are two completely different baselines, to a point on some days that that was actually the highest stress response. The highest of the stress response that she had in a day.
Jason Moore: Wow.
Alessandro Ferretti: Yeah, you can do that with a normal ongoing measurement with an app, so you don’t have to buy, you know, a kind of hundreds and hundreds of pounds or dollars worth of actual kit. You can take just the usual strap that is precise enough to pick up HRV internals and heart rate variability, for this kind of scenario, I use a lead HRV as mentioned to you, and I just turn it on and just let it run, and then actually see what are the changes comparing in life or like.
Jason Moore: Okay, so have you seen, have you been able to kind of do this frequent enough to come up with some basic like, either percentage thresholds, or absolute thresholds, maybe that people could look out for, saying like, the coca test is I think, if heart rate increases more than 16 bpm, then that might be an indication, you know, and then we could further refine that with, heart rate variability. Have you come up with any kind of like, percentages that you’ve noticed that may be indicative?
Alessandro Ferretti: Yeah. I think the lowest changes that start to become noticeable is around in a lead HRV, I don’t know on any other apps, they would take the going measurement, it’s around maybe 5 and 7, so anything, someone has a decent, good high number, HRV number, HRV score, then I would probably look at 7. If someone, if the score is quite low, the RMSSD is quite low, then even 5 could actually be meaningful. That is on the average of the second snapshot. So, but this is just to give people an indication, because as you amply covered in your course, everything is relative to that individual. So, an increase of seven for one is less meaningful than an increase of five for another one.
Jason Moore: Right. Yeah, that’s a great point, and so generally what I tell people is that get some kind of baseline values for food testing as well, so kind of like if you’re going to do this, then a great way in my opinion to kind of rule out some of those and refine the accuracy of your testing is to, measure kind of right down or take a picture, or log the foods that you eat, and see if sometimes that it behaves one way, and other times it behaves another way, and then you can say, well, which one of these is the offender? Then maybe you can start narrowing it down that way, and then I think ultimately, in another podcast actually that we recorded with Dr. Eldred Taylor. He says that people can be sensitive to something that everyone thinks is healthy, like broccoli, right? So, you don’t know, because it’s so individual, that broccoli may be the thing for you that can really set you off. This is just trying to help find what it might be, but then you might want to do further testing by eliminating that food and then reintroducing it after 30, 60 days or something, or doing blood testing or something along those lines.
Alessandro Ferretti: Yeah, precisely, and also, the fact that the body is reacting to it does not necessarily mean it is a bad thing.
Jason Moore: That’s important to note, too.
Alessandro Ferretti: Well, yeah, because sometimes I think people reacting to garlic, okay, let’s assume the person has a fungal infection in the gut, the reaction can be reasonably pronounced, but yet garlic may be the very thing that they actually need to have in their diet in order to minimize fungal gut infections. I’m saying this as an example, whereas if someone has a substantial reduction of HRV, and increases sympathetic response onto, for example, grains might be a different thing. I’m not saying everyone should be grain free. That’s not what I’m saying. Many people are totally fine with grains. Even that, there has to, it has to be put into context. So, if someone reacts to broccoli, what would broccoli have? Okay, high level of certain type of antioxidant. Is that going to stimulate a certain liver pathway, this liver pathway, are perhaps detoxifying too much, so maybe a lower version of that food can actually promote HRV and health benefits, but in too high a level, then can be too much for the body to deal with. So, even that has to be put into context in my view.
Jason Moore: Yeah. It’s important to recognize that quantity does indeed play a role. For example, I’ve noticed that high quantities of FODMAPs tend to affect me pretty strongly, and apparently many other people as well. I’ll put a link to those in the show notes, but smaller quantities seem to be find for me. Similarly, as we’ve been discussing, just having excess energy substrate in the blood could be inflammatory in and of itself. So something like a sweet potato, which may be benign for most people in most cases, could be bad if you sat down and ate several large ones, and subsequently caused your blood sugar to go through the roof.
Alessandro Ferretti: Yeah. Yeah. So, it’s just that, I’ve noticed that sometimes people may not, may take things literally on, well, they’re here, and I think everything has to be put back into contest.
Jason Moore: I believe you have someone of a kind data regarding the 24/7 or continuous HRV monitoring? You know, with the adhesive based sensors, like the first beat, and the relationship between that and the snap chart HRV values that are taken from smart phone apps, typically first thing in the morning. Not many people are willing to be the guinea pig, and be hooked up to all sorts of devices for a long period of time to gather this type of data. What have you learned by comparing the continuous HRV readings and the snapshot HRV readings?
Alessandro Ferretti: Yeah, I mean, they, because I was wondering, okay, so, the correlation could be right as long as I select the same snip of time that I would select in both snapshot and obviously, at that time, in a continuous reading. I thought, well, how about the resources? Why someone would measure HRV for 24 hours? Mainly, it’s to actually have a look at how the environments affect the person, so what is within the environment that affects the person’s HRV, i.e sympathetic activation? So, then someone can make decisions actually me speaking on the phone to that person, then that has cause to me, the biggest stress in the day. Then, that type of training, it took ages to recall that the sleeve was pulled, and so the snapshot will give us a baseline of where we are at on that specific day, so that will tell us, where we are at. Whereas the ongoing measurements, they can, if connected to a diary, of course, it can pinpoint the fluctuation in the day, and then we can start to make relation of what affects us the most. So, certain things that affect me the most may not affect someone else the most, but it could be exactly the opposite. So, what I’ve notice was, I find really interesting because if we see an overall kind of trend of resources, maybe not so much in a day today, but over a period of a week, or two weeks, actually the trends were very, very similar, so I’m happy to actually show you again, within the action screen.
Jason Moore: Hey folks, in the post production we decided that it was a bit too difficult to follow the screen sharing session via audio, so even better, I’ve posted a YouTube video on the show notes page of Alessandro, exploring the topics even deeper while showing his screen. So, it’s a really great presentation, and you can find that over at elite HRV dot com slash podcast, on the show notes page for this episode. At one point that Alessandro drives home, is that continuous monitoring allows you to see which events specifically, throughout the day, have the greatest impacts on your stress levels. So, both in the acute situation, when it happens, and the residual effect throughout the day. The discussion also quickly leads into the power of context and keeping a diary of potentially relevant events throughout the day, to help really determine what is moving the needle for you. This is where we’ll pick up the conversation again, a quick hint, the things that move the needle the most are quite often, very different from person to person. We’ll let Alessandro tell us more.
Alessandro Ferretti: That, I think, brings our attention back to the individuality, which is one of the things that I thought in your course was brilliant. The footprint left by a simple half an hour, I think it was around 35 minutes journey, on the tube was way longer than what my body kind of showed, being completely stationed in traffic. So, it’s still in London, it’s still the same city, you know, I’m just comparing the two, but I compared the two multiple times. It’s not, it wasn’t just, you know, a kind of unicorn scenario kind of thing. I thought, what’s going on in here? Then you start to think the why’s. Okay, so why, okay, I enjoy driving. Okay, stationary is not exactly driving. However, technically, it’s still driving. Practically it isn’t, but then I listened to podcasts, I maybe hear from friends, or I don’t know. Whatever is in that environment, is having a much much less of an impact on my sympathetic activation. Someone else that they hate driving, and they love the tube, then it’s just going to be different. It’s really interesting to see the sympathetic activation at that time, but also the footprint that that leaves behind. That to me, is even, not even more important, but is definitely something to highly consider.
Jason Moore: Yeah, and you know, that’s, it’s really interesting now that people have the tools to be able to do these types of experiments on themselves, because like you mentioned, somebody may hate driving, and have the opposite reaction, actually. You know, a couple more examples of that is, there’s definitely applications for health for this. I mean, you’ve mentioned that you really enjoy presenting and that type of thing. It’s definitely a positive stress similar to exercise for you, but what you have noticed is that, when you have a series of speaking events or speaking engagements all in a row, it’s the same as if you had, you know, a jujitsu competition or something, in the effects, the lasting effects it has on your body. That’s just, it’s fascinating to see that, and even though you enjoy it, it’s positive, it actually does have a systemic and residual impact that you need to recover from.
Alessandro Ferretti: That isn’t why I’m smiling, it’s because I can pinpoint which groups of practitioners I enjoy the most given by the location, and cross reference that with the HRV, which is really sad. Unfortunately, it’s true. So if I do a lecture with a certain group of people, in a certain city, I know my HRV is going to, I don’t know it’s going to drop, but there is a likelihood that I want, it will take me longer to recover. Many times, I actually think, okay. If I’m lecturing in that city, I might not be able to train afterwards, even if I get to class on time. That’s interesting.
Jason Moore: Yeah, that is. I’m sure now all of your, the groups that you lecture to are going to say, I want to see your data afterwards to see if you like us or not.
Alessandro Ferretti: I want to see your data. Precisely.
Jason Moore: So along those same lines, I was just talking to Daniel Plews and Paul Laursen, who are now called officially the Plews & Prof, and you’re familiar with both of those guys. So they mentioned kind of offhandedly in the podcast episode that I recorded with them, that their athlete, specifically Dan’s athlete, I think, Tim Van Berkel, he’s one of the top triathlete competitors in the world. They kind of mentioned offhandedly that they actually, you know, travel has a huge impact on the health and readiness to perform, and that there’s all of these kind of individual ideas of when should the triathlete arrive? A week before competition, and try to recover for the week, or should they try to arrive two days before and just kind of like, deal with it, or you know, I don’t know all the specifics because I’m not as into iron man and triathlon as they are, but he just kind of offhandedly mentioned that they actually arrive later than most of the other athletes, because that seems to work better for Tim, and they wouldn’t know that unless they were actually measuring heart rate variability and other aspects of performance, which kind of is just another example of, we’ve talked about some of the health side, it also is applicable on the athletic side, that you can do some of that experimentation to see, what has the biggest residual effect.
Alessandro Ferretti: Yeah, I mean, if you roughly have an idea on how the body will potentially react to something, then you can make your judgement calls. So, I think in that specific case, in the way how I would look at it, would be either, you arrive there later, in order for the HRV not to drop long enough, or arrive way earlier, in order to recuperate it. This is only, this is only experimentation. If someone knows and is very deeply affected, there may be, like Paul mentioned, that would be my instinct. However, if certain people, like for me lecturing for certain lectures, I want to go and get there way in advanced. Stabilize, go through bits and pieces, feel really comfortable in my environment and that environment, recuperate the energy, especially with jet lag, well I don’t suffer from jet lag, but you know, from the changes within the environment, and try to adapt in a, to the new environment as quickly as I possibly can, and that can take a few days. So, for certain things, I want to be there very, very early. For some others, I just want to get there the day before, and don’t allow that drop in resources because I just haven’t had the time to drop it that much, if that makes sense.
Jason Moore: Right. Yeah that makes complete sense. I mean it’s like, show up, get the job done, and get out, and then recover after you’re back.
Alessandro Ferretti: Yeah. Or get there early early, and then just recuperate it, and then start on a fresh. I think it also depends by the, outlook of the individual.
Jason Moore: Right. So I think there’s a lot of information here that people can kind of digest and play with, and I think that we’ll, maybe we’ll get some questions back from folks that can contact us through the podcast page and things, and I know that Alessandro, let’s wrap up, but maybe you can tell people where they can find you. You know, I’m sure that people will have questions, so where can people find you?
Alessandro Ferretti: Sure. I tend to use a website, I’m just about to publish a couple of videos. It’s alessandroferretti.co.uk, really simple. They can go in with their guards down, I’m not selling anything, eventually we’ll look at courses, but you know, not for a time. I try to keep people up to date on what I’m up to. You know, there is an email section. I’m not currently seeing any patients, and I have a few that I’ve referred that we’re doing, studying and research on, but if it is a question in relation to what we’ve been speaking about today, yeah, most welcome. Just, click on contact us through the website. Or, via, yourself if it’s in relation to this podcast, I’d be happy to share what is my view on it.
Jason Moore: We’ll definitely post links to you, your contact info, and the additional notes, images, and video from this episode over in the show notes at elitehrv.com/podcast and next time we can go deeper into some of the experimentation. You know, I mentioned briefly that I’ve done some of my own experimentation comparing HRV, blood glucose, and ketones, so we can talk a little deeper into that, and we can also talk more about the big monitoring project that you’ve got coming up, which is going to produce some really fascinating data.
Alessandro Ferretti: Absolutely. Interestingly enough, we are actually, I’m going to do this next project with Paul Laursen as well, so there’s a few of us. Yeah. We’re going to do that, and the person’s going to have two continuous glucose monitoring, plus the snapshot to actually check how they correlate with each other, so yeah, I’d be very happy to share that. That would be cool.
Jason Moore: Hey folks, Jason here for a quick note before signing off. First, as always, you can find the notes and links to everything we’ve discussed over at elitehrv.com/podcast, and second, we’ve got more great guests lined up to discuss many different topics here in the coming weeks, and again, I am honored to be able to host this show and receive such positive feedback and encouragement from you all. We already have everyone from Doctors to Olympians, to folks just optimizing their own health, that are all listening and sending nice messages. As podcast host Robb Wolf once said, six listeners can’t be wrong. So lastly, if you get the chance to stick a short review over on iTunes, that will really help continue to propel the show forward, and it’ll help attract more fantastic guests that will all be able to share their knowledge with us. So, please hit up iTunes or use the review link provided in the description of this episode. Enjoy your week. See you next time. This is Jason Moore, signing out.

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