Alessandro (Alex) Ferretti has been practicing nutritional therapy for over 15 years.  He formed Equilibria Health Ltd. in 2004, which is now recognized as one of the UK’s leading providers of nutrition education. He has lectured internationally on the subjects of nutrition and human performance, and his current focus is on research in the areas of heart rate variability (HRV) and blood glucose, nutrigenomics, and factors affecting metabolic flexibility.

In this podcast, Alex describes the metric he has developed which can provide a signal of an inflammatory response and preview athletic performance. He and Dr. Tommy Wood also discuss his online Mitokinetics tool, developed for the purpose of estimating caloric requirements in the context of different macronutrient ratios.

Here’s the outline of this interview with Alex Ferretti:

[00:00:33] Robb Wolf, Ben Lynch, Dan Plews, Paul Laursen.

[00:04:17] Metabolic flexibility; Podcast: How to Assess an Athlete: The Best Principles, Methods, and Devices to Use, with Mike T. Nelson.

[00:04:29] Weikko Jaross.

[00:06:30] Immune system cells requiring carbohydrate metabolism; Studies: MacIver, Nancie J., et al. "Glucose metabolism in lymphocytes is a regulated process with significant effects on immune cell function and survival." Journal of leukocyte biology 84.4 (2008): 949-957; Also: 1, 2, 3.

[00:12:40] Metabolic health correlates with quick adaptation to ketogenic diet.

[00:16:00] New Zealand cyclists study: Zinn, Caryn, et al. "Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes." Journal of the International Society of Sports Nutrition 14.1 (2017): 22.

[00:16:20] Genetic factors affecting metabolic flexibility.

[00:17:20] DNAFit test.

[00:18:31] Environmental factors affecting metabolic flexibility.

[00:18:39] DIETFITS study: Gardner, Christopher D., et al. "Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial." Jama 319.7 (2018): 667-679.

[00:21:48] Eating: When, how, and how much.

[00:22:28] Training low/competing high, sleep.

[00:23:35] Disrupted sleep cycles affecting fasting blood glucose (FBG), heart rate variability (HRV).

[00:24:36] Assessment to determine the best dietary approach.

[00:25:23] 5 points: Life load (stress), chronobiology, sleep, physical activity, diet.

[00:27:30] Food preferences in relation to stress response and sleep deprivation; Studies: McHill, Andrew W., et al. "Later circadian timing of food intake is associated with increased body fat." The American journal of clinical nutrition 106.5 (2017): 1213-1219; Also: 1, 2, 3, 4.

[00:29:59] HRV Apps: HRV4Training, Elite HRV.

[00:31:00] Validity of ultra-short HRV measurements; Study: Munoz, M. Loretto, et al. "Validity of (ultra-) short recordings for heart rate variability measurements." PLoS One 10.9 (2015): e0138921.

[00:31:09] Oura ring.

[00:32:10] Ferretti Index (HRV/BG Index).

[00:35:36] FBG in relation to mortality; Study: Bjørnholt, JØRGEN V., et al. "Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men." Diabetes care 22.1 (1999): 45-49.

[00:35:43] HRV in relation to mortality; Study: Camm, A. John, et al. "Mortality in patients after a recent myocardial infarction. A randomized, placebo-controlled trial of azimilide using heart rate variability for risk stratification." Circulation (2004).

[00:36:41] Ferretti Index formula: RMSSD/(FBG mmol/L)²; In US: RMSSD/(FBG mg/dL/18)².

[00:38:00] Every other day HRV readings; Study: Li, S. J., Y. Y. Su, and M. Liu. "Study on early heart rate variability in patients with severe acute cerebral vascular disease." Zhongguo wei zhong bing ji jiu yi xue= Chinese critical care medicine= Zhongguo weizhongbing jijiuyixue 15.9 (2003): 546-549.

[00:38:27] Study using hs-CRP: Aeschbacher, Stefanie, et al. "Heart rate, heart rate variability and inflammatory biomarkers among young and healthy adults." Annals of medicine 49.1 (2017): 32-41.

[00:41:56] Eating later in the day (8PM or later) correlated with higher FBG, sleep disruption, HRV.

[00:44:08] Frequent small meals led to higher blood glucose.

[00:45:33] Dawn Phenomenon.

[00:48:12] DUTCH test.

[00:49:52] Homocysteine test as part of a cardiovascular assessment.

[00:51:56] Macronutrient ratio may not be as important as other factors.

[00:53:41] Interleukin-6; insulin as anti-inflammatory hormone.

[00:54:36] Mitokinetics tool, developed by Alessandro Ferretti and Weikko Jaross, as discussed in this NBT blog post by Dr. Tommy Wood. Information about using the tool can be found on this help page or in this video.

[00:55:57] Dr. Kevin Hall.

[00:56:17] Keto and low-carb dieters - may require lower caloric intake.

[01:00:18] alessandroferretti.co.uk.

[01:00:41] Videos.