Please Help Me Understand Aerobic Energy Production

[alex3619]

@ggingues, microcirculation keeps coming up. Its one of the possibilities that has to be investigated. Yet it might only apply to a subgroup. We need lots more research on this. In post exercise responses, a huge percentage of strictly defined CFS patients have a fibro-like response, but a big percentage don't too, according to the Light's research - or at least as far as I recall, it might be time I went back and reread that research.

Something is stopping the electron transport chain from doing its work. There are a number of plausible candidates. What needs to be considered is nutrient supply (substrate, including oxygen), waste removal (including oxidative products) and regulation (including enzymatic capacity). In us all three appear to be compromised. Indeed, it might turn out to be a combination problem.

 

[rwac]

Perhaps the issue the Workwell group uncovered is that the first eight seconds of anaerobic exercise - when the energy supplied is from ATP and Creatine Phosphate - does not produce acid byproducts because it is not using glucose metabolism?

So the advice there might actually be to find forms of exercise - like weightlifting - where you can do eight seconds of intense exercise, followed by two minutes of rest to recover Creatine Phosphate stores, without creating a lot of acid that may not be metabolizing out of muscle.

Right, short intense exercise.

I know because I do exercise that involves high and intense energy, like sprinting and swim sprints. Believe me you know when you have glycogen, and you know when you don't have it. It enables enormous powerful muscular movements.

At first I thought I had a glycogen storage disease. It was only after months of living with it, experimenting with exercise, and using alkaline fluids to neutralize the acid from muscle and body that I clearly understood that my glycogen was there all along. It was the acid stuck in my muscle that was creating the muscular fatigue. At this point my symptoms are probably only 40% as severe as what they were, and after three days of clearing acid my muscles feel very intact and powerful again. Before I learned to take alkaline solutions, the muscle never cleared the acid fully. My muscles went between very fatigued and nearly immobile.

What exactly do you mean when you say alkaline fluids? Baking soda (bicarb) ?

The bottom line: do you have high d-lactic acid? I plan to get checked for it, but do any CFS patients report a test as high on D-Lactic acid? Is it a significant percentage?

It's easy to test for. Proof is in the accumulated test results.... Is it isolated or common? If it is not common, then unlikely it is a cause of CFS.

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome.

I don't know, I did have high lactate last time I checked. Also, I used to be very sensitive to yogurt but that may have been due to a leaky gut.

 

[pemone]

I think it depends a lot on how well people are at the time. I was able to do a sport during a remission, but I took a lot of breaks and didn't go fast. I still got dizzy. When I first got ill I, (after recovering from the flu) stupidly continued running and otherwise going on with life as usual, but I was almost fainting all the time (I didn't understand why, lol... now i know these things). Other times I was able to take short walks. Right now i can't do anything like that, but I am much worse as compared to when I was able to run or even take short walks.

How long did that initial flu last? Did you lose much water weight / body weight during that illness?

What are your primary symptoms of CFS? I assume you get the post exercise malaise? Do you ever clear the acid from muscle that leaves it fatigued? Do you get any symptoms of systemic acidosis, like rapid deep breathing to force exhaling carbonic acid / CO2 through the lungs?

 

[pemone]

What exactly do you mean when you say alkaline fluids? Baking soda (bicarb) ?

I have had enormous success using my own custom electrolyte, and two dilute acids that may or may not contribute to alkalinity.

For the electrolyte, I am using 150 to 300 mg of elemental sodium in a sodium bicarbonate, together with about 600 mg of elemental potassium in a potassium citrate. I take that in about 16 oz of water on rising, and maybe two or three additional times during the day. NEVER take this with food. One hour before a meal is a minimum.

For the acids, I am taking apple cider vinegar and citric acid. I read that these help to support the citric acid cycle and help to clear acid trapped in muscle. Some sources say these act like acids, and others say they create an alkaline condition. I haven't invested the time to do research in the literature, but all I can say is that these are doing something beneficial, and I need to quantify and define that further. The vinegar in particular seems to clean out my muscles and speed recovery dramatically. I take the citric acid by using a lemon in 12 oz water, once or twice a day. I take the vinegar two tablespoons in 12 oz of water, about three times a day.

I also use d-ribose in these solutions, a single scoop, maybe six times a day.

There is a real question for me about what do I measure to know when I have taken too much of these fluids. Should I be focusing on urine or saliva pH? These are very controversial subjects, with some camps saying that your urine and saliva pH tell you nothing, and other camps saying that they are the key to many diseases. Again, I haven't searched the literature. I'm actually hiring a local biochemist to help me understand pH in the body better and to try to develop a more science-based method to track my pH and adjust it during the day.

Aside from clearing the acid from my muscle more rapidly, what I have also noticed is that the periods when I feel really bad correspond to my urine pH going very acidic. I have no idea what it means yet. Based on your D-Lactate comments, I wonder if the alkaline fluid is just neutralizing D-Lactate directly in the intestine. It does seem like a possible mechanism.

Basically I am at the beginning of this experiment, and early results have been dramatic and beneficial. I am onto something.

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome.

That's a wonderful study thanks for sharing that. BUT does anyone else find it bizarre that these researchers went to a lot of trouble to measure bacterial populations in the gut, but then did not check for D-Lactate in the blood serum? I mean if the D-Lactic acid never gets to the blood, what is the causality to the neurological symptom.

I have long-standing food intolerance issues, but one of the most shocking things I discovered as I started to get tested was that on the Cyrex labs test for leaky gut I do NOT have high LPS in the blood, which strongly suggests that I do NOT have leaky gut. I have horrible problems with wheat, which I have removed from the diet for decades. But the Cyrex test for common gluten-like food intolerances did not show a single adverse reaction for me in other foods.

Is there some way that D-Lactic acid could permeate through the gut, whereas other bacterial particles like LPS could not? What we need here is a study that shows not only high intestinal bacteria, but then demonstrates D-Lactic acid in the blood. Does anyone have references to such a study?

I don't know, I did have high lactate last time I checked. Also, I used to be very sensitive to yogurt but that may have been due to a leaky gut.

Remember that Lactate on most blood tests is L-Lactate. This is DIFFERENT than D-Lactate!! You need to order an entirely different blood test for D-Lactate.

My L-Lactate was 0.65 mmol/L (11.8 mg/dL). What was yours?

 

[pemone]

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome.

And here are some researchers arguing CFS patients should take more Lactic Acid bacteria:

http://www.medical-hypotheses.com/article/S0306-9877(03)00096-3/abstract

I don't really follow their reasoning, and they are ignoring the D-Lactate issue entirely. It seems to me they are giving 100% the wrong advice.

 

[pemone]

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome.

So let's get something practical from this. Does this result imply that a CFS patient with this bacterial profile (test for that!) should be taking Bifidobacteria probiotics, and make sure there are not lactobacillus present in the formulation?

I found one such probiotic on Amazon:

http://www.amazon.com/Dairy-Free-Bifidobacteria-Vegetarian-Seeking-Health/dp/B00A86JHMI

That's very expensive. Can someone suggest a better one?

 

[rwac]

I have had enormous success using my own custom electrolyte, and two dilute acids that may or may not contribute to alkalinity.

I'd worry about the potassium, a large dose outside of food might crash blood sugar. Otherwise bicarb is a performance enhancer for racehorses (and humans).

ACV is a disinfectant, and that's what I think you're seeing, a gut anti-microbial effect.

It's not just LPS which comes from the leaky gut. Other bacterial toxins do as well. LPS are largeish molecules IIRC, so lactate might well slip through even if LPS is blocked.

Plasma LACTATE (Enz, colorimetric ) 29.0mg/dl [4.5-19.8]

 

[rwac]

I don't really follow their reasoning, and they are ignoring the D-Lactate issue entirely. It seems to me they are giving 100% the wrong advice.

This field is full of contradictory advice.

 

[rwac]

So let's get something practical from this. Does this result imply that a CFS patient with this bacterial profile (test for that!) should be taking Bifidobacteria probiotics, and make sure there are not lactobacillus present in the formulation?

I don't really use probiotics anymore. Didn't really do that much good for me, except in the very beginning.

 

[pemone]

I'd worry about the potassium, a large dose outside of food might crash blood sugar. Otherwise bicarb is a performance enhancer for racehorses (and humans).

I studied this issue in detail. Current best recommendation for potassium is about 4.7 gm per day, and the typical diet includes 2 to 3 gm. Paleolithic diets are estimated to have delivered about 11 gm of potassium per day vs 700 mg of sodium (which was scarce), about 16:1 ratio. So getting an additional 2 to 3 gm of potassium per day looks quite healthful, if you are getting the 2 to 3 gm in typical diets.

I looked at how much food you would have to eat to get 5 gm of potassium, and it is a LOT. I don't think heavy doses of fructose are healthful, so the banana diet doesn't make sense. I limit my starchy carb intake because of my prediabetes, so I am limited on how much potassium I get from yams and tubers.

What matters is the *form* of potassium you take. Potassium bicarb and potassium citrate have been given in research studies at about a 3 gm/day dose and have been shown to spare calcium from bone. Other forms of potassium have not had that effect. I had stomach burn with potassium bicarb, so I stopped it. That was my first choice. Potassium citrate goes down well. Potassium chloride slow release pills are associated with damage to the intestinal lining. So you avoid the pill forms.

Now I plan on testing my intracellular potassium (Potassium RBC NOT just Potassium Serum) periodically to make sure I am running normal potassium levels.

ACV is a disinfectant, and that's what I think you're seeing, a gut anti-microbial effect.

That's an interesting idea, and maybe it selectively destroys the more harmful bacteria. But I feel an effect systemically in my muscle pretty quickly after drinking it, so I think there must be a bigger story to figure out there.

It's not just LPS which comes from the leaky gut. Other bacterial toxins do as well. LPS are largeish molecules IIRC, so lactate might well slip through even if LPS is blocked.

I guess what I was getting at is that an acid might metabolize into the system by osmosis whereas LPS requires the entire bacteria (a much bigger particle) to slip through the gut. So even if you have a "tight gut" that does not let bacteria through, it might still be letting D-Lacate through?

Plasma LACTATE (Enz, colorimetric ) 29.0mg/dl [4.5-19.8]

That is about 1.6 mmol/L and yeah that is high. Levels > 2 mmol/L are associated with bad outcomes in Lactic acidosis. You should get your D-Lactate tested.

 

[pemone]

I don't really use probiotics anymore. Didn't really do that much good for me, except in the very beginning.

But based on what you reported with D-Lactic acid bacteria in guts of CFS patients, the problem is that many prebiotics we take might actually make our condition worse!! You would need to profile your gut biome and be very selective about which organisms you want to promote. "mixed" probiotics that have many members of the Lactic-acid producing families would make symptoms worse.

Does anyone know which families of gut bacteria are considered healthful and do NOT produce D-Lactic acid?

 

[WillowJ]

How long did that initial flu last? Did you lose much water weight / body weight during that illness?

What are your primary symptoms of CFS? I assume you get the post exercise malaise? Do you ever clear the acid from muscle that leaves it fatigued? Do you get any symptoms of systemic acidosis, like rapid deep breathing to force exhaling carbonic acid / CO2 through the lungs?

I don't recall losing weight during that flu. In a way, it never went away fully. But the worst of it went away in a normal time.

I meet ICC.

I occasionally have low Co2, but there are other possible reasons for this. I have never had an arterial blood gas taken, which would be the normal way to diagnose acidosis. The few times it was checked, my anion gap was within range. I have only vary rarely noticed rapid deep breathing with no pause after the exhale, but this would be a potential sign of severe acidosis (or of overexertion).

 

[pemone]

I occasionally have low Co2, but there are other possible reasons for this. I have never had an arterial blood gas taken, which would be the normal way to diagnose acidosis. The few times it was checked, my anion gap was within range. I have only vary rarely noticed rapid deep breathing with no pause after the exhale, but this would be a potential sign of severe acidosis (or of overexertion).

It's true that arterial blood gas would diagnose a life-threatening and severe metabolic acidosis, but even if the doctors found this in a CFS patient, what are they going to do about it? They would give intravenous IV with sodium bicarb, and then they would throw their arms in the air and say "We don't know what causes this." I'm not sure it would be helpful.

But I think your breath tells you instantly if you have a metabolic acidosis, and also how severe it is. If you are breathing 19 times a minute and exhaling very strongly, your body is giving you a clear message that it needs to get rid of CO2 / carbonic acid. Your body doesn't shed acid that dramatically unless there is acid building and stressing the system. Kidneys take days to clear acid. Lungs can respond instantly and effectively. This all assumes - by the way - that you have healthy lungs that can inhale adequate Oxygen. If you have impaired lungs that is a different story.

I lived for two or more months with respiratory alkalosis (and I assume there was a metabolic acidosis), but on most days it was very mild. I could simply "feel" my breathing become heavier on the exhale, and it wasn't under my control. But on the days I did any kind of serious exercise - such as sprinting - there was hell to pay that night. I would be exhaling strongly 20+ times a minute all night long. It was horrible. The next two or three days after that it would taper off but the breathing was not normal. I think my highest anion gap was 19. Most doctors are trained to not suspect metabolic acidosis until anion gap is greater than 20. So I was borderline.

Since starting on my alkaline electrolyte and treating acidosis with vinegar / citric acid (and it is not proven that these do that, but the vinegar in particular does dramatically lessen the fatigue and weakness in my muscles), my breathing has normalized. I'm ready to start challenging with more serious exercise now and see at what point the respiration problem returns.

Note that I did NOT have any sensation of low oxygen during any of these periods. It was a sense of needing to breathe out, which I guess makes sense since the body uses CO2 levels to control breathing.

 

[PDXhausted]

Thank you for this thread! This is my biggest struggle right now- my exercise tolerance is so low, I am completely bedridden and can barely lift my arms before getting a feeling of running out of oxygen in my muscles.

I had high D-lactate on an organic acids test (urine), I had no bifidobacterium, lowish lactobacillus, and high E. coli on a CDSA test. Both tests from a year ago, when I was housebound but could still walk (about 15 min per day).

After declining from a pelvic infection, and having some equivocal Lyme results, my doc gave me a low dose of amoxicillin to try. I took it for 6 weeks and gradually felt much better- my aerobic capacity went up and eliminated some of my problems with shaking and dizzy feeling I had when standing up or walking. And my pelvic infection improved.

At around the six week mark, my gut damage from the amoxicillin reached the tipping point- my stool became yellow and thin, I was having problems digesting food, could no longer tolerate even a crumb of dairy or sugar (had already eliminated wheat and most grains, and I had a sour feeling in my stomach after eating. I quit the antibiotics and started regular probiotics- my stool and digestion improved, but the probiotics left me feeling like my muscles were so out of oxygen I could barely move. And I still have the food intolerances.

I suspect the "out of oxygen" feeling has to do with lactic acid and bacteria, but I feel like my hands are tied trying to treat it. If I try antibiotics, my gut gets worse, and if I try probiotics, I feel like my body can't handle them. My pelvic infection returned with added bladder infection-- I tried Bactrim for it, but it didn't seem to touch it-- I'm wondering now if maybe yeast or fungus has developed.

I've tried soil-based organisms (Prescript Assist)-- I think these would be worth a try @pone because I don't believe they are supposed to produce lactic acid, but I'm not sure. I still had issues with muscle fatigue on them, but I maybe didn't try them long enough to be sure. The resistant starch thread has alot of info, but its alot to sift through.

Anyway, I've been really curious about whether something like baking soda would help, but didn't have a good enough understanding to know whether that was the right thing to try. I will try and see. Maybe vinegar as well.

Another question-- when I get into these muscle fatigue states where it feels like my muscles can't get oxygen (or maybe like my cells can't get oxygen-hard to describe), I tend to have to belch alot. Does that make any sense or do others experience that?

 

[alex3619]

Taking vinegar or citric acid to improve performance may have nothing to do with raising pH.

Citric acid as a performance enhancer might help, but not much more than a spoonful of sugar. All carbs are broken down to citric acid in the body, at least under aerobic conditions - that is the job of glycolysis. If the Krebs (Citric Acid) Cycle is not working, or the electron transport chain is not working, it will not help. It can also alter at least one key metabolite, so you don't want to be consuming lots of it.

On the other hand, citrate is a natural chelator. So it might help if you have metal overload.

Vinegar is a gut microbe waste product. I guess it might help the gut due to impact on bacteria. Any mild organic acid might improve digestion slightly, and can offset the impact of taking bicarb at other times. You can get the same benefit by eating fruit for desert, and eat desert first at every meal.

Mild organic acids can positively shift the oxygen dissociation curve. This dumps more oxygen in the short term, but if it is chronic (as in lactic acidosis) then enzymatic activity is damaged and the capacity to dump oxygen declines. This was extensively looked for in the late 90s - the result was they concluded that we actually have a high capacity to dump oxygen in the blood, but that does not tell you about microcirculation, electron transport chain poisons, substrate transporter failure etc.

Finally, if the UK research is right, then we have acidic muscle after activity, and its prolonged, but then it moves to alkaline muscle. So what do we have? Alkaline or acidic? Try both. Treatment should take this into account.

 

[pemone]

Vinegar is a gut microbe waste product. I guess it might help the gut due to impact on bacteria. Any mild organic acid might improve digestion slightly, and can offset the impact of taking bicarb at other times. You can get the same benefit by eating fruit for desert, and eat desert first at every meal.

There is so little published science on vinegar in humans that I can't provide any references, but I read a site that claimed apple cider vinegar would prevent phosphoric acid in meat and other acidic foods from being absorbed. Since those are much more acidic than acetic acid, in effect vinegar is simply preventing greater acidity from other foods.

The same page is claiming that after reacting with calcium in food, acetic acid allows excretion of the acid as carbonic acid and the remaining elements are alkaline.

http://wiki.answers.com/Q/Why_does_vinegar_affect_bone_density

If any of that is true, it might argue for eating the vinegar right before acidic foods like meat.

Mild organic acids can positively shift the oxygen dissociation curve. This dumps more oxygen in the short term, but if it is chronic (as in lactic acidosis) then enzymatic activity is damaged and the capacity to dump oxygen declines. This was extensively looked for in the late 90s - the result was they concluded that we actually have a high capacity to dump oxygen in the blood, but that does not tell you about microcirculation, electron transport chain poisons, substrate transporter failure etc.

Do we care about oxygen in the blood if the defect is intracellular?

Finally, if the UK research is right, then we have acidic muscle after activity, and its prolonged, but then it moves to alkaline muscle. So what do we have? Alkaline or acidic? Try both. Treatment should take this into account.

This part I did not follow. At what point does muscle tissue shift to alkaline? Can you point to any articles that explain that cycle?

 

[alex3619]

@pone, Julia Newton is doing the muscle studies in ME and CFS. I don't have a link handy, but its discussed in many places on this forum. At rest we are alkaline. Its only during and after muscle activity that we are high lactate, or acidic. However the rate of clearing that acid is low in us. That implies the biochemistry necessary is defective, but does not tell us how. Given that many of us have problems with NAD and NADH this might be important.

If the defect is intracellular, then blood oxygen is irrelevant to this condition. IF. We are still operating mostly on incomplete information and guesses.

 

[rwac]

But based on what you reported with D-Lactic acid bacteria in guts of CFS patients, the problem is that many prebiotics we take might actually make our condition worse!! You would need to profile your gut biome and be very selective about which organisms you want to promote. "mixed" probiotics that have many members of the Lactic-acid producing families would make symptoms worse.

There are different ways to keep bacteria in check. Mild anti-microbials like ACV should definitely do something. Cascara will quicken the bowel movements and flush excess gut bacteria. Carrot, bamboo shoots (indigestible fiber) or activated charcoal will absorb toxins and excess bacteria on it's way through the gut.

There is really not a need to promote bacteria, we can just "demote" them instead.

What are good bacteria good for apart from serving as a buffer against the bad?

 

[pemone]

There are different ways to keep bacteria in check. Mild anti-microbials like ACV should definitely do something. Cascara will quicken the bowel movements and flush excess gut bacteria. Carrot, bamboo shoots (indigestible fiber) or activated charcoal will absorb toxins and excess bacteria on it's way through the gut.

There is really not a need to promote bacteria, we can just "demote" them instead.

What are good bacteria good for apart from serving as a buffer against the bad?

Actually, gut biome is extremely important. It turns out those little critters produce short chain fatty acids that nourish the lining of the gut, and help to stimulate cell death of cells that go bad (and could become cancerous). I think one of the best criticisms of low carb diets is that they kill off the bacteria in the gut.

Another big benefit is stool volume and stool motility. Try this simple experiment: take two tablespoons of RAW potato STARCH (do NOT take potato flour!!!) mixed in 12 ounces of water, before going to bed. This stuff is like rocket fuel to colonic bacteria. Most people see almost immediate increases in stool volume. 60% of the starch escapes digestion in the small intestine and gets to the colon where the little beasties have a Christmas feast.

My initial research suggests that there are two broad classes of bacteria: one produces lactic acid and the other produces acetic acid. Wow, isn't that interesting since Vinegar is acetic acid. I wonder if that somehow correlates to my result of "clearing acid more quickly" when I ingest Vinegar? Probably not...thinking out loud.

Does anyone know the names of bacteria that produce acetic acid, and what percentage of these usually appear in the gut? My idea here is let's take probiotics that encourage growth of the acetic acid producers, in the hope that they can outcompete the bad ones that overproduce D-Lactic acid.

This assumes that you are testing for D-Lactic acid and have discovered that you have too much of it.

 

[pemone]

My initial research suggests that there are two broad classes of bacteria: one produces lactic acid and the other produces acetic acid. Wow, isn't that interesting since Vinegar is acetic acid. I wonder if that somehow correlates to my result of "clearing acid more quickly" when I ingest Vinegar? Probably not...thinking out loud.

Does anyone know the names of bacteria that produce acetic acid, and what percentage of these usually appear in the gut? My idea here is let's take probiotics that encourage growth of the acetic acid producers, in the hope that they can outcompete the bad ones that overproduce D-Lactic acid.

This assumes that you are testing for D-Lactic acid and have discovered that you have too much of it.

I just realized that the vinegar I have been using is Bragg's Apple Cider Vinegar *With the Mother*. That means it has living bacteria in it. Perhaps part of the benefit I am getting is that this vinegar could be acting as some kind of probiotic in the gut, promoting acetic acid producers over lactic acid producers.