A Bit About Me…
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Light form of rickets and told by MD that I couldn't play ANY sport
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Judo and skiing since the age of 6yrs
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Cycling from 11yrs of age
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Triathlon
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Nutritionist and PT, LifeGuard
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Researcher
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Disclosure: I have no financial interests in any of the companies by me mentioned in this presentation and I am not paid to
represent or take commissions on any of their products. Any reference is for educational/monitoring purposes only.
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The information in this presentation are for didactical use only for health professionals. These information are not intended to
treat or diagnose and Alessandro Ferretti can not be held responsible for the use or misuse of such information.
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Tracking Data for best
Patient Outcome
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Tracking Revolution
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25 million fitness trackers such as Jawbone,
Fitbit or Nike+ FuelBand will be sold
worldwide this year.1
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Research studies have shown an average
increase in vigorous physical activity of an
2.
hour a week in female users
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Problems defining health
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Errors of interpretation?
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Self perception?
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Open questions follow by open answers?
e.g. “How have your headaches been
over the last few months…?”
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How can tracking help?
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We have a defined starting point !
…to which we can assign a defined goal.
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Provides direct insight into the patient’s health: how good? how bad?
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Gives an understanding of how well (& if) the patient is improving.
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Helpful in understanding and refining direction for treatment.
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Potential for huge patent motivation: black & white data.
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Remote monitoring of patient by practitioner
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Choosing what to track
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Making tracking meaningful?
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•
What markers are relevant to track?
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How will each help to steer the protocol?
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Choice of Data
Data of Limited use
Useful Data
Very Useful Data
Very Practical
Practical
Less Practical
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Choosing Markers
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Relevancy
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User friendliness
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Data Noise
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Cost
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Time
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What gives you the most value out of the minimal client’s effort?
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Type of Tracking
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There are 3 types of measurements:
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Whilst your body is at rest or ‘normal’ to determine a baseline - i.e. first thing
in the morning. “Snapshot” i.e. fasting insulin-glucose level,
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At specific times to measure how the environment is influencing health/
physiology -i.e. Glucose OGTT
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24hr ongoing measurement to understand how the body is affected by
specific factors - i.e. HRV, Physical activity, hormones…
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n=1
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Started with this…
Date
Time
Tag
Glucose
Ketones
8 April
9:00
Fasting
5.6
0.2
6
4.5
8 Apr
14:43
Pre Lunch
4.2
0.7
9 Apr
09:25
Fasting
5.9
0.4
9 Apr
14:45
Pre Lunch
5.2
0.3
10 Apr
09:03
Fasting
4.7
0.5
10 Apr
14:30
Pre Lunch
5.0
0.9
3
1.5
0
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…and ended with this!
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My Kit…
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Glucose (mmol/L)
6.0
Ketones
R² = 0.0856
4.5
Ketones
3
R² = 0.6107
R² = 0.6107
2.25
3.0
1.5
1.5
0.75
0.0
0
-1.5
-0.75
Glucose/Ketones Ratio
30.0
R² = 0.6382
R² = 0.021
22.5
1.95
15.0
1.3
7.5
0.65
0.0
0
HRV
11
Ketogenic Ratio
2.6
Training
Life-load
10.0
R² = 0.1257
8.25
7.5
5.5
5.0
2.75
2.5
0
0.0
Glucose (mmol/L)
Life-load
Calories
4,200
Body Fat %
15
Body FAt %
15
R² = 0.0076
R² = 0.7967
3,150
11.25
11.25
2,100
7.5
7.5
1,050
3.75
3.75
0
0
Weight
77
11
Sleep
HRV
R² = 0.0335
75.75
8.25
74.5
5.5
73.25
2.75
72
0
9
Sleep
Glucose (mmol/L)
Sleep
10
6.75
7.5
4.5
5
2.25
2.5
0
0
Life-load
Trends and Correlations
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What is the the data you're measuring affected by?
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Correlative or causative?
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Is higher fasting glucose causative of weight
gain?
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Or is insulin resistance the causative factor?
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Findings and Correlations on Ketogenic Diet with Time Restricted Feeding
Variable Measured
HRV Increase
Life-Load
Increase
Training or Recovery
Increase
Ketogenic Ratio
Increase
F: (P+C)
Body Fat %
Decrease
Calories Increase
Effect on
Glucose
decrease/
unchanged
increase (Mild
decrease
overall)
increase >7
decrease
decrease
mild decrease in absence of
high Life-Load and Training/
recovery
Effect on
Ketones
increase/
unchanged
mild decrease/
unchanged
decrease only if glucose increase
increase (insulin
response)
increase
mild increase in absence of
high Life-Load and Training/
recovery
Effect on HRV
n/a
decrease
decrease >7
potential mild
increase
potential mild increase
(hormones driving repair?)
potential mild
increase or less
recovery needed
Dynamics and Observations on Exercise and Performance with a Ketogenic Diet
Time Restricted Feeding
(Protein,Carbs for 16hrs +)
Training Performance
Life-load Increase
Glucose Levels
decrease of 0.5mmol
(maintaining the same training
& life-load regime)
Endurance: Trend showing
Increase.
decrease. Mixed activity: slight It can take 24-48hrs after high life-load to
decrease.
normalise.
Ketones
Substantial increase
Endurance: increase.
Mixed activity: slight increase
High Intensity: substantial
decrease
Generally stable/unchanged.
Decrease when the intensity of the Life Load
is >7.
Decrease if glucocorticoids are engaging.
Taking 12-24hr to normalise once glucose
levels are reduced again.
Exercise (Performance)
Endurance: Trend showing
increase.
Mixed Activity: slight increase.
High Intensity: substantial
decrease/potential mass loss.
N/A
HRV
Endurance: increase.
Mixed Activity: slight increase.
High Intensity: substantial
decrease/potential mass loss.
Decrease if intensity is >6 or
Decrease if intensity is >7 or multiple session
multiple session consecutively. consecutively.
Finding new correlations
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Alcohol raises Blood Glucose till noon the following day (especially if consumed in the hour before bed time).
Negatively affects HRV.
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Poor Sleep (both quality and length) negatively affects HRV (0.7) and increases fasting glucose (most times by
0.4 mmol).
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Injury, PTMS and illness (inflammation) reduce HRV and increase both fasting and postprandial glucose levels.
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Insulin directly reduces ß-HBA but doesn't affect general ketosis if carbs are restricted to the evenings and
during HIT.
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Caffeine did not increase glucose levels in presence of fats.
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Life Load increases Glucose Levels (blood) except when in Ketogenesis, or when very high Life-Load.
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Increases HRV? Reduced Inflammation? Glucocorticoids? Adaptation? Less Insulin?
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Is Self Quantification ruling
my life?
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How to choose?
No Tracking
Useful Data
Over Tracking
Unawareness
Dynamic Guidance
Ruled by Tracking
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Activity
Time
Wake up:
Breathing exercises whilst taking HRV readings
Measurements
Time (mins)
Application
HRV
2
Influences me training and life-load/recovery choices
Glucose: Blood
1
Influences dietary choices: types of foods and timing (eating vs fasting)
Ketones: blood/breath
1
Influences dietary choices: types of foods and timing (eating vs fasting)
Sleep, Life-Load,
1
Influences resting time and planning my day
Food Diary
2
Work
Intense uninterrupted work.
15’ break.
Glucose
1
Influences dietary choices: types of foods and timing (eating vs fasting)
Ketones
1
Influences dietary choices: types of foods and timing (eating vs fasting)
Food diary
2
14:00 - 14:45
Lunch
Preparing and eating.
14:45 - 15:45
Rest / Nap.
6:00-7:00
Day Planning: work/rest, training recovery and family time,
personal time.
Measurements.
8:00-8:15
Breakfast:
Fasting, fatty coffee or solid food.
8:15 - 9:30
Soul and Brain nourishing:
Woods with the dogs, practicing ‘soft’ Karate - meditation/
visualisation.
9:30 - 14:00
18:30 to 20:30
Work
Consolidating work, emails, ‘tidy up loose ends’,
or picking up my son from school and family time.
Training
Karate, Judo, HIIT.
20:30 to 21:30
Dinner
Preparing food and eating.
Food Diary
2
Family time, relaxing, watching chosen programs.
Glucose
1
Influences dietary choices: types of foods and timing (eating vs fasting)
Ketones
1
Influences dietary choices: types of foods and timing (eating vs fasting)
15:30 - 18:30
21:30 to 12:00
HR Dynamics
1 set up
1 read data
Understanding the work load, effort, length etc…
Cross checking ‘how I felt’ vs ‘what the data shows’
Retiring.
Total = 17
Understanding Physiological impact of the environment
Choosing Markers
Overweight
Sports Injuries
Fatigue
• glucose/ketones
• HRV
• glucose
• morphometrics
inc. waist to hip
• sleep
• HRV - life load
• glucose
• activity level
• activity level
• pain
• food photos
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Food Photo Diaries
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Photographs can be used as a tool in 24hr
recall and as a tool in dietary assessment3.
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Weight-loss patients who kept regular food
journals were found to lose twice as much
weight as patients who kept no records4.
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Zepeda and Deal compared food journaling
with paper versus a camera - in-the-moment
photos increased awareness of unhealthy
eating5.
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Blood Glucose
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Blood Glucose
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Blood Glucose
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Sleep
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HRV4Training
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HRV4Training
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FirstBeat BodyGuard2
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FirstBeat BodyGuard2
Conclusions
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Helps to steer your protocol.
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Choice of markers is essential.
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Client motivation and awareness.
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Even some of the more cost effective options can be remarkably useful.
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Remote monitoring of clients.
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Appendix
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Tool-Kit
Glucose measurements:
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FreeStyle Optium (Precision Xtra US), iBGStar iOS, Accu-chek (blood)
Ketone measurements:
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FreeStyle Optium (blood),
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Ketonix (breath)
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Ketosticks (urine)
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HRV apps and devices
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HR, HRV Monitor (Polar H7, Armour, FirstBeat).
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Camera Optical Lens (PPG) on fingertips (phones) or finger (OURA)- Optical
wrist monitors seem not to be reliable.
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HRV app (HRV4Training iOS, iThlete iOS/Android, EliteHRV iOS/Android,
HRVLogger iOS, Stressed Out iOS, HeartMath System with Monitor).
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Sleep monitor app (‘Sleep Cycle’, ‘Sleep Time’, Beddit)
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For in depth reviews of most common devices go to www.dcrainmaker.com
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HRV Apps
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•
•
•
•
•
•
•
•
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Biocom Technologies
Biofeedback Stone
Bioforce HRV
BLE Heart Rate & HRV Recorder
Breathe Sync™
CardioMood HRV Expert
Elite HRV
emWave2 and emWave PRO
Firstbeat Technologies
FitPal
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•
•
•
•
•
•
•
•
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Health Reviser
HRV4Training
Inner Balance
iRelief
iThlete
MyCalmBeat
OPzone Connect
Somatic Vision Alive
SweetBeat
Vitness Rx
www.wikipedia.org/wiki/Heart_rate_variability
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Does it have to be
expensive to be useful?
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HRV - FirstBeat BodyGuard 2
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HRV - HRV4Training
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Blood Glucose - iBGStar
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Blood Glucose - Abbott FreeStyle NEO
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Common Markers for Tracking
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Food
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Specific data e.g. www.myfitnesspal.com
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Photos
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Glucose/Ketones
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Sleep
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Life-Load
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Activity: steps, exercise
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Morphometrics
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Pain
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HRV/HR
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References
1.GfK self-funded survey of 5000 smartphone owners in China, Germany, South Korea, UK and US. http://
www.gfk.com/Industries/technology/Pages/Wearables.aspx.
2.Cadmus-Bertram, Lisa A. et al. Randomized Trial of a Fitbit-Based Physical Activity Intervention for WomenAmerican
Journal of Preventive Medicine , Volume 49 , Issue 3 , 414 - 418.
3.Lazarte CE, Encinas ME, Alegre C, Granfeldt Y. Validation of digital photographs, as a tool in 24-h recall, for the
improvement of dietary assessment among rural populations in developing countries. Nutrition Journal. 2012;11:61.
4.Zepeda, L. and Deal, D. (2008). Think Before You Eat: Photographic Food Diaries as Intervention Tools to Change
Dietary Decision Making and Attitudes. Int J Consum Stud, 32(6), 692-698.
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