Measuring Lactic Acid.

[Ema]

I read that under anaerobic conditions, glucose goes to lactic acid as opposed to creating energy. I've also read that the liver is unable to recycle the lactic acid and so all of it is converted to fat which may contribute to the weight struggles so many of us experience.

I know that low CO2 levels on the CMP reflects anaerobic metabolism but I am wondering if measuring lactic acid would offer any insights into whether or not that pathway is the problem?

Or is this too tightly controlled to offer any useful information? I know if it is TOO high it is indicative of sepsis, so I wouldn't expect to see if over range in those of us with ME/CFS...but maybe in the top half of the range? Is there any way to interpret this test in light of the metabolism and how it is functioning?

Is there any point of ordering a plasma lactic acid test to try to determine metabolic status?

Thanks!
Ema

Under anaerobic conditions, glycolysis becomes the predominant mode of hepatic energy production. As such, the liver becomes a lactate-producing organ rather than using lactate for gluconeogenesis (Fig. 4).

 

[Emootje]

According to Meirleir healthy subject have a resting lactate ranging from 0,6 - 1 mmol/l. Most ME/CFS patients have a resting lactate ranging from 2-2,5 mmol/l. I think it's a cheap and easy way to diagnose anaerobic conditions (at home).
My lactate is around 2,3 mmol/l

 

[Ema]

According to Meirleir healthy subject have a resting lactate ranging from 0,6 - 1 mmol/l. Most ME/CFS patients have a resting lactate ranging from 2-2,5 mmol/l. I think it's a cheap and easy way to diagnose anaerobic conditions (at home).
My lactate is around 2,3 mmol/l

I haven't had a chance to watch the video yet, but does he indicate (or do you know?) how to encourage the body to switch back over to aerobic metabolism if it is found to be high? Supplemental oxygen?

 

[Emootje]

I don't think there is a easy answer. Cellular oxygen deprivation can have many causes.
I guess that supplemental oxygen is only helpful in hypoxic hypoxia.

1. Hypoxic hypoxia occurs when there is a deficiency in oxygen exchange in the lungs.
Some causes include:
* Decreased partial pressure of oxygen available at altitude
* Conditions that block the exchange at the alveolar capillary level (e.g. pneumonia, pulmonary edema, asthma, drowning)

2. Anemic hypoxia occurs when the body cannot transport the available oxygen to the target tissues.
Causes include:
* Anemia from acute or chronic blood loss
* Carbon monoxide poisoning
* Medications such as aspirin, sulfonamides and nitrites
* Methemoglobinemia
* Sickle cell disease

3. Stagnant hypoxia occurs when there is insufficient blood flow.
Causes include:
* Heart failure
* Decreased circulating blood volume
* Excess vasodilatation
* Excess vasoconstriction
* Hyperventilation

4. Histotoxic hypoxia occurs when the bodys tissues are not able to use the oxygen that has been delivered to them.
Causes include:
* Hydrogen sulfide (mitochondrial toxin)
* Cyanide (mitochondrial toxin)
* Alcohol (mitochondrial toxin)
* Narcotics (mitochondrial toxin)
* Pesticides (mitochondrial toxin)
* Peroxynitrite (mitochondrial toxin)
* Antiretroviral drugs (mitochondrial toxin)
* Low CO2, hyperventilation (high oxygen affinity of hemoglobin)
* Carbon monoxide (high oxygen affinity of hemoglobin)
* Hypothermia (high oxygen affinity of hemoglobin)
* Alkalosis (high oxygen affinity of hemoglobin)
* Low phosphate (high oxygen affinity of hemoglobin)

Most important causes of hypoxia in ME/CFS:
* Anemic hypoxia: Low red cell mass
* Stagnant hypoxia: Low blood volume, Excess vasoconstriction (high norepinephrine/endothelin/angiotensin)
* Histotoxic hypoxia :All mitochondrial toxins, High oxygen affinity of hemoglobin.

 

[MeSci]

This paper:

http://ceaccp.oxfordjournals.org/content/6/3/128.ful

provides lots of info about lactate production.

In ME there are two main sources of lactate as far as I understand:

1. The gut, due to overgrowth of lactate-producing bacteria, which is likely to be due to excessive consumption of carbohydrates coupled with abnormal carbohydrate metabolism. Going low-carb seems to help.
2. The muscles, due to mitochondrial dysfunction.

The two are likely to reinforce each other, with the gut dysfunction causing leaky gut, allowing foreign substances direct access to the bloodstream and leading to/perpetuating autoimmune activity (perhaps including autoantibodies against mitochondria) - see this paper:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886850/

and overexertion pushes the muscles (and neurons?) into lactate production too quickly due to mitochondrial dysfunction, thus acidifying the bloodstream and probably thus making it harder for the gut to attain the correct pH.

It would appear that to break the vicious cycle one needs to both cut carbs and rest and pace as much as possible.

 

[Ema]

1. The muscles, due to mitochondrial dysfunction.

It would appear that to break the vicious cycle one needs to both cut carbs and rest and pace as much as possible.

Any ideas on how to test for mitochondrial dysfunction? Is a muscle biopsy the only way or are there blood tests?

I've already tried low carb and resting...Now I'm all about encouraging the mitochondria. I just bought some PQQ and butyrate. Any other thoughts?

Thank you!

Ema

 

[MeSci]

Any ideas on how to test for mitochondrial dysfunction? Is a muscle biopsy the only way or are there blood tests?

I've already tried low carb and resting...Now I'm all about encouraging the mitochondria. I just bought some PQQ and butyrate. Any other thoughts?

Thank you!

Ema

I'm not sure whether there would be any point in testing for mitochondrial dysfunction. I think you can have a good degree of certainty just from symptoms. If you have the range of symptoms typical of ME and everything else has been excluded, I'd lay odds that you have mitochondrial dysfunction.

Recovery, if it happens, is likely to take a long time. The Leaky Gut study here:

http://integrativehealthconnection....1/Leaky-gut-in-CFS-treatment-of-leaky-gut.pdf

followed patients for 10-14 months, and all improved to some degree within that time. I would be very interested to know if there was any longer-term follow-up.

It seems that the older you are, and the longer you have been ill, the longer remission/recovery is likely to take. It is likely to require a lot of self-discipline and patience.

I started properly with the low-carb last May, but have had setbacks due to unavoidable over-exertion and accidental carb consumption, but live in hope...

I have briefly tried a couple of things that some people consider have helped them with mitochondrial function - d-ribose (very bad effects) and Co-Q10 (dizziness - suspected hypoglycaemia). I think that Healthspan's Lipo-Carn helps me a bit, but that I'm going to have to wait for the autoimmunity to decline before my mitochondria will really start working effectively again.

 

[Sushi]

Any ideas on how to test for mitochondrial dysfunction? Is a muscle biopsy the only way or are there blood tests?

I've already tried low carb and resting...Now I'm all about encouraging the mitochondria. I just bought some PQQ and butyrate. Any other thoughts?

Thank you!

Ema

I also think we can almost assume it. But I did have it confirmed with blood tests--so it is possible. Can't think what they tested at the moment except one was ATP--they tested 3 things.

The De Meirleir video is only about 7 minutes--well worth the watch.

Sushi

 

[Ema]

So my lactic acid result came back...4.8 mg/dL (4.5-19.8).

I guess I can check that off the list of possible problems then?

I'm not sure how that corresponds to the results in mmol but it sure as heck isn't high! (ETA: I found the conversion factor and it is 0.5 mmol/L).

So is it an issue to be TOO low as well?

Grrr. Always more questions than answers...

Ema

 

[Ema]

OK, so is too low lactic acid bad too??

However, there has been an ever increasing volume of research that challenges the belief in a “lactate threshold”. The volume and quality of research that has accumulated directly contradicting the fatigue causing effect of lactate is now sufficiently strong that the exercise physiology world generally accepts there is no “lactate threshold” and that lactate does not cause fatigue. Instead, it is now believed by scientists that lactate is actually a potent and important source of fuel for the muscles.

 

[MeSci]

OK, so is too low lactic acid bad too??

It may be the case that lactate itself does not cause fatigue, but switching to lactate-based (anaerobic) ATP production after a small amount of exertion is likely to indicate a mitochondrial abnormality, or pH imbalance, etc. And it must surely follow that continuing exertion in this pathological state will cause hyperlactaemia.

As for whether low lactate levels are problematic, I'm not familiar with this, but from your figures it would appear that yours was normal at the time of sampling.

I thought of two possibilities:

• Your illness is not caused by a pathology involving hyperlactaemia
• Your have successfully lowered your lactate levels through rest and diet

If the latter is the case, then - assuming that the leaky gut-autoimmunity theory is correct - it will still take time for your mitochondria to normalise. An appropriate analogy for the autoimmune process might be vaccination. Vaccination leads your body to produce antibodies, but production gradually declines over time, and you will then need a booster.

If leaky gut leads to production of autoantibodies (and there is good evidence that it can), then likewise this unwanted antibody production should decline gradually as long as you don't allow the gut wall to become leaky, and the blood to become too acidic, again.