Ketogenic Diet

#282: Ketones: not as Important as Metabolic Flexibility w/ Alessandro Ferretti

by Mike Mutzel

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About Alessandro Ferretti, Dip ION, mBANT

Alessandro graduated from the Institute of Optimum Nutrition in 2001 and formed Equilibria Health Ltd with my partner Jules in 2004. With a growing team of Nutritionists and a Medical Doctor, Equilibria Health is now recognized as one of the UK’s leading providers of nutrition education.

Connect with Alessandro


Related Books and Products

Save Money and Time by Creating Low-Carb, OMAD Meals for You and Your Family!


Past Discussions with Alessandro

#160: Alessandro Ferretti, Dip ION- Time-Restricted Feeding, Sleep and Ketogenic Applications


Episode Show Notes

01:31 The goal is to be metabolically flexible. Simply being in ketosis does not lead to being metabolically flexible.

02:12 The more flexible your metabolism, the healthier your metabolism. The healthier the metabolism, the less likely you are to store fat.

02:16 A side effect of metabolic flexibility is weight loss. To lose weight, make sure the body functions optimally so it does not need to store fat. It can use energy efficiently from fat stores.

03:56 Some of us bring in a caloric value below what is needed to store fat, yet they do not lose any weight. Something is preventing this. Many theories point to metabolic flexibility.

05:05 Over Feeding Study: A study by Alessandro’s team took a large group of metabolically flexible people and overfed them by 3,500 and 4,000 calorie equivalents for a prolonged period of time. The most any participant gained was 1 kilo (2.2 lbs). Long term, Alessandro believes, that the weight would pile on.

07:18 If you are on a ketogenic diet, you may not have the same glycogen stores in the cells in your muscles as you would have on a high carbohydrate diet. Fast well. Feed well. If you are going to fast, do water only. If you are going to eat, eat well.

09:03 To Alessandro, fasting means water only. Water only garners the most benefits. How you fast should be based upon what you want to achieve. A small amount of calories taken in the body switches off certain mechanisms.

10:35 In a fed state, we are mainly in an anabolic state. Through fasting, we enter catabolism in order to stimulate autophagy and recycle certain proteins. Fasting benefits, when done intermittently, are associated with health.

11:00 Time restricted feeding does not give all of the benefits of fasting. Certain pathways are only beneficially affected during a full fast.

13:10 Adding fats and other liquids may increase ketones, but it is not fasting. Complete fast is 24 hours water only, nothing of energetic value.

18:04 Ketone esters can be used for a hard workout. Alessandro is still unsure of ketone salts.

17:47 We don’t know enough to be able to determine what defines us as being in ketosis. There are too many variables.

22:13 When we over train, under recover or there is some sort of chronic low-grade inflammation, reducing carbs will not reduce blood glucose.

23:00 It takes 6 days to deplete glycogen stores in an athlete. It may take months to be metabolically flexible. Ketones appear in 2 to 6 weeks, but you may not feel good. Ketogenic diet is not for everyone.

25:10 If you fail on your ketogenic diet, it may be food quality, lack of proper gut flora and gut permeability.

27:48 Time restricted feeding and fasting is one of the best ways to adapt to a ketogenic diet.

30:10 There are specific scenarios in which someone is not suited to a ketogenic diet. These are generally issues with the body’s ability to use certain types of fat of a certain length for energy.

31:08 Periodized ketogenic diet has great advantages to use in training. High performance athletes can have prediabetic blood glucose levels.  After a period of time, Alessandro found that he would not run empty while performing athletically while keto.

36:05 Ketogenic diet does not impair HIIT performance. It does not improve it. The hypothesis was that the ketogenic diet does not work with HIIT training. It did work. They measured different levels of lactates, glucose and triglycerides. There were many changes over the period of 4 weeks, but performance did not drop. People on the ketogenic diet lost more fat mass.

41:31 As people transition from a normal diet to a ketogenic diet, Alessandro notices that a substantial erratic behavior in HRV. Eventually, HRV rises and stabilizes there. In high volume sports, the damage occurs from training seems to be less. The physiological cost seems to be less.

46:08 High performance athletes can have visceral fat of mid 5s and above. These people may do better on a low carb/high fat diet. Though, it may be a stress for some individuals. A good reason to put an athlete on a ketogenic diet would be to reduce the amount of damage done by burning purely glucose.

48:26 For an athlete who trains keto, adding glucose on competition day, is like rocket fuel.

49:35 Fat is a more energetically efficient fuel. There is more ATP being made and less heat lost.

50:00 Calorie is a measure of heat. When mitochondria make more heat than ATP, it becomes inefficient for energy production, but more efficient for heat. Mitochondria can go up to 50 degrees centigrade.

53:04 Fat is a more concentrated form of fuel. In the same mass, you have the potential for more ATP. Damage produced from training primarily on fats seems to be less, with fewer free radicals, less dissipation of heat and more ATP production.

54:24 The calculation based on heat calories may not apply to someone on a low carb/high fat diet who is fully adapted. The fat adapted person makes less heat (so you may feel cold), creates fewer free radicals and makes more ATP. You can make more energy with less food while still maintaining muscle mass.

59:40 Insulin resistance occurs in the brain. Fat for fuel would probably bring great advantage in mental clarity.

01:01:27 Eating little and often is thought to keep blood glucose steady, but that is not reflected in Alessandro’s data as reliable blood sugar management.

01:02:45 Low consistently healthy blood glucose with metabolic flexibility is the goal. The better we adapt, the healthier we are.


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