Dealing With CFS As Metabolic Acidosis

[alex3619]

Fat burning is primarily post the energy wall. Its where the body switches energy source. Any sustained long exercise session will start burning fat. However fat requires more oxygen than glucose, putting more demand on the energy production if oxygen is limited, and so increasing lactic acid production. Again, its about which system dominates, we don't just switch from one system to another entirely.

Burning fat for fuel does not require glycolysis. That is restricted to glucose (and possibly pyruvate and glycerol from other sources at the end) as a fuel source. Fats use a process called beta oxidation instead. Some models might imply that beta oxidation is compromised, which might mean that at high intensity we cannot properly fat for burn fuel, so we cannot switch to fat burning metabolism. There are other models of ME though.

Fat feeds into the Krebs cycle, just as the glucose product pyruvate does, but the common substrate is acetyl coA. However amino acids go directly to the Krebs cycle and where depends on the amino.

My memory of this stuff is now very bad, its been too long since I studied it.

 

[alex3619]

Ordinary low energy activity is primarily aerobic, using fat and oxygen. Thats a resting energy demand, or very low demand.

Slightly more demand is when stored energy kicks in.

Glycolysis appears fine in ME. While much of the research is now focussed on the Krebs cycle or the electron transport chain, I wonder if a beta oxidation problem might not contribute. Mind you in the late 90s many thought there was a glycolysis problem, which made me unpopular as I was saying it was mitochondrial.

Carbon dioxide is made by the electron transport chain, and uses oxygen. Its where the carbon is finally "burned" if you like to think of it as that. Carbonic acid is cleared by breathing. Its just dissolved gas.

Our persistent muscle acidity appears to be lactic acid though. Then this eventually resolves, and our muscles become too alkaline. Its like we are compensating too much, but that is somewhat speculative. It also looks like our mitochondria persist in failed function for too long after exercise ceases. Without the hard evidence though, too much of this is speculation at this point.

Personally I am very interested in cytokine and other hormone regulation of mitochondria, and the availability of critical substrates. There is some evidence (Sarah Myhil) that we have a problem transferring a range of substances across the mitochondrial membrane.

 

[stevesayshi]

This is a fascinating discussion, and I need to pay close attention to it, which means I will have to come back later.

Alex, I wonder what your thoughts are -- I have a high anion gap, indicating possible metabolic acidosis, but I only breathe 3 or 4 times a minute and often forget to breathe for long periods. I definitely feel the lactic acid burn in the muscles, and probably the brain too, when I exert myself. It's like my cells simply refuse to utilize the oxygen in the bloodstream for whatever reason. I feel oxygen starved at times but my pulse oxymeter shows normal readings around 96%.

 

[Ambrosia_angel]

What happens when the muscles become too alkaline?

 

[xchocoholic]

Great info thanks. I'm interested because I'm noticing a quick improvement in my energy level right after drinking strong cranberry juice. All I can understand right now is that this juice alters ph. Maybe this would be better than bicarb ?

I'd like to see studies on pwcs divided by those with and without OI and those with different levels of OI and those with ataxia. I can't sprint. My brain doesn't allow my body to do anything fast. I just got used to walking normal again in 2006.

I was wondering if glucose regulation may be playing a role here.
Taking dextrose tablets for energy before starting and every 15-20 minutes thereafter keeps me going long enough to do my grocery shopping, etc. It clears some of my brain fog too until my hypoperfusion gets too bad.
I'd read that available glucose is used within 20 minutes. Seems to be true for me.

Tc .. x

 

[Valentijn]

@pone - Dr de Meirleir has an office in Nevada now. He does very cheap CPET testing (maybe just one-day) in Belgium, and might be doing it in Nevada too. He also does a lot of testing for infections and inflammatory markers. Office visits are basically on a non-profit pricing scheme, but it sounds like that still costs a fair bit in the US, and blood tests can go up to $3,000+ depending on how much investigating you want.

 

[alex3619]

What happens when the muscles become too alkaline?

I don't know. What I can say is that normal enzymatic activity will be altered. This has yet to be properly investigated.

Please note that someone who is always pushing themselves, and engaged in a push crash cycle, will probably only have alkaline muscle when asleep or in a crash.

 

[alex3619]

This is a fascinating discussion, and I need to pay close attention to it, which means I will have to come back later.

Alex, I wonder what your thoughts are -- I have a high anion gap, indicating possible metabolic acidosis, but I only breathe 3 or 4 times a minute and often forget to breathe for long periods. I definitely feel the lactic acid burn in the muscles, and probably the brain too, when I exert myself. It's like my cells simply refuse to utilize the oxygen in the bloodstream for whatever reason. I feel oxygen starved at times but my pulse oxymeter shows normal readings around 96%.

http://emedicine.medscape.com/article/2087291-overview

Kidney failure is a known possibility for causing such metabolic acidosis. However it is clear that ME alone can induce major issues in pH. So its hard to be certain.

Low breathing rate and metabolic acidosis might indicate you have a problem in breath regulation. Only might though. Has this been independently observed by medical staff?

Oxygen starvation, or hypoxia, can have many reasons. Normal blood oxygen saturation only eliminates one option, though one that doctors typically find useful to know about.

For example, metabolic poisoning will produce hypoxia under normal oxygen. Poor microcirculation can do the same. In both these cases a normal blood oxygen saturation is misleading. We simply don't know. Hypoxia is a dominant hypothesis in ME at the moment, so far as I am concerned. WHY that is the case is subject to heated debate, and will be the focus of continued research.

When I was very sick with not just ME but a flu and then oral candida, I lost my breathing reflex entirely. This is possibly a brain thing, when automatic regulation of breathing is compromised. I wonder how they treat it if they do not know the cause. I have also had times when I just stop breathing. When breathing rate is too low carbonic acid concentration could rise.

The acidity from carbonic acid will compromise metabolic function if it goes on too long. High acid states for more than three days can induce what is effectively lactic acidosis - but without the lactic acid. Enzymatic activity in the red blood cells will alter, and they will not dump oxygen into the tissues so well. This can in turn increase lactic acid production. It will also artificially prop up blood oxygen saturation.

In my opinion any metabolic acidosis state needs to be taken seriously and investigated.

 

[stevesayshi]

In my opinion any metabolic acidosis state needs to be taken seriously and investigated.

In my doctor's opinion it was worth ignoring. Just like every other obscure test that had come back abnormal the past several months.
Thanks for the detailed reply, though. Much appreciated.

 

[alex3619]

In my doctor's opinion it was worth ignoring. Just like every other obscure test that had come back abnormal the past several months.
Thanks for the detailed reply, though. Much appreciated.

This is typical with ME patients. Most patients have some version of this story. I do.

 

[pemone]

This is a fascinating discussion, and I need to pay close attention to it, which means I will have to come back later.

Alex, I wonder what your thoughts are -- I have a high anion gap, indicating possible metabolic acidosis, but I only breathe 3 or 4 times a minute and often forget to breathe for long periods. I definitely feel the lactic acid burn in the muscles, and probably the brain too, when I exert myself. It's like my cells simply refuse to utilize the oxygen in the bloodstream for whatever reason. I feel oxygen starved at times but my pulse oxymeter shows normal readings around 96%.

This is definitely something you need to talk to a doctor about, but something in your result is contradictory. The key point to understand is that the body fights metabolic acidosis by compensatory respiratory alkalosis. If you have too much acid in the blood, the body makes you breath deep and fast, and it is NOT the inhalation of oxygen that the body wants. It is the *exhalation* of CO2 that gets rid of the acid. So if you had high anion gap (what is the number, and how are you calculating it?), that would suggest metabolic acidosis. You should be breathing fast, not slow.

The fact that your body breathes slow suggests the opposite condition: you are in metabolic alkalosis, and the body wants to hang onto acid, so it doesn't let you exhale often.

I know exactly nothing about these issues. I would say you should consult a doctor.

P.S., My doctor totally missed the fact that I had high anion gap, and what's more once I pointed it out he didn't even care. Hope that makes you feel better.

 

[pemone]

It's interesting to hear that your issues started after you went low carb. I went low carb and suffered the worst in my life with my muscles. I didn't connect the two until I started back on eating more carbs.

I was drinking sodium bicarbonate at one stage but that wasn't for my muscles even though that was around the time I was having issues with them. I didn't notice a physical improvement but I wasn't deteriorating either.

Thank you for this. I might try drinking bicarb of soda again. Its worth a shot.

Ambrosia, I am interested in hearing your experience with low carb. How well developed was your CFS before that diet? How many starchy carb grams were you eating before and after that diet? How did symptoms worsen?

How many carb grams are you eating now, and how has that changed your symptoms?

 

[pemone]

We do not yet know the cause of elevated muscle lactic acid in CFS or ME, but we do know its been found in lab testing and is a result of low mitochondrial function.

Not holding onto water is a common problem though. Electrolyte solutions are often used. Potassium and sodium need to be kept in balance ... its about balance even more than dosage.

Alex, regarding the above:

1) What test would show the lactic acid? My doctor wanted to check lactate - which seems right to me since it is lactate not lactic acid, that works into blood serum - but my stupid lab Labcorp doesn't appear to have a test for lactate. They have a "Lactic Acid, Serum" test and their lactate tests are:

001859 Creatine Kinase (CK) and Lactate Dehydrogenase (LD), Totals and Isoenzymes
100156 Lactic Acid Dehydrogenase (LD), Body Fluid
001842 Lactate Dehydrogenase (LD) Isoenzymes

I have no idea what we should be ordering. The Lactic Acid test shows a normal range, but as I understand it that would not be the right thing to measure.

2) How should we measure the hydration issue? My BUN/Creatine tests were always normal, even after I had lost 12 pounds and could easily loose 5 pounds of body weight in a single night just by breathing. It was so obvious to me that part of the fatigue was loss of fluid / water, but I couldn't get any doctor to believe in this because the blood tests said I am not dehydrated!!

It's a devilish condition, because it literally destroys you at the most basic cellular level, yet leaves no big traces behind in lab tests.

 

[alex3619]

Lactate is lactic acid. However almost no purely clinical doc has the tech to easily measure this. It is a research test for now. We need to know brain lactate and muscle lactate, not serum lactate. I think the test is usually nuclear magnetic resonance test, but I could be wrong. In other words it uses a big clunky expensive machine that most docs know very little about.

We are not dehydrated usually. We have low blood volume. So when they look for blood abnormalities they are hard to find. Determining blood volume is nuclear medicine, and requires a nuclear medicine department at the hospital.

Standard lab tests rely on presumed conditions. If those presumed conditions are not stable, or deviate a lot from the usual, then the test is not useful. Blood tests have rarely but not always been unhelpful with ME. We still hope to get a good blood test in time, but first we have to know exactly what to look for.

This is all classed as experimental medicine though, and often not covered by insurance.

 

[pemone]

Lactate is lactic acid. However almost no purely clinical doc has the tech to easily measure this. It is a research test for now. We need to know brain lactate and muscle lactate, not serum lactate. I think the test is usually nuclear magnetic resonance test, but I could be wrong. In other words it uses a big clunky expensive machine that most docs know very little about.

My understanding is that lactate in the muscle leaks out into the serum and is a favored fuel for the heart. If the heart doesn't use it up then the liver gets it and converts it back to glucose.

So a lot of lactic acid should become a lot of lactate, and you would think there ought to be a way to measure that in the serum, without resorting to expensive magnetic resonance?

We are not dehydrated usually. We have low blood volume. So when they look for blood abnormalities they are hard to
find. Determining blood volume is nuclear medicine, and requires a nuclear medicine department at the hospital.

That seems like a very important point, but I don't really get it. What - technically - is the difference between dehydration and reduced blood volume?

 

[alex3619]

Lactate IS lactic acid. Its an alternate name. Like citrate IS citric acid. I think there might be a distinction in that its dissolved lactic acid, that is in water.

Dehydration means you do not have enough water for the substances in your blood vessels. The blood can thicken, chemical diffusion and possibly other reactions can be altered.

Low blood volume means that a decreased amount of water is NORMAL. Blood chemistry is normal. There are no diffusion problems. However with decreased blood comes decreased oxygen carrying capacity.

Let me put it another way. If you are dehydrated your blood cells increase in concentration, but total red blood cell oxygen capacity is the same.

In low blood volume, you have a lot fewer blood cells. The impact is like anemia, but with immune complications.

So dehydration is a loss of water. Low blood volume is less blood.

 

[Ambrosia_angel]

Ambrosia, I am interested in hearing your experience with low carb. How well developed was your CFS before that diet? How many starchy carb grams were you eating before and after that diet? How did symptoms worsen?

How many carb grams are you eating now, and how has that changed your symptoms?

I went from eating mainly home cooked healthy foods, with some oven foods and sweets too. I have had cfs since sept 2012 and then around dec/Jan I started on a low carb candida diet (gluten free, fruit free, dairy free) eating mainly complex carbs when i did eat them. Buckwheat, quinoa and millet were my grains. I did eat rice when I was making gluten free pancakes and my attempt at bread. I couldn't tell you how many grams though.

A few weeks later I became considerably ill with muscle pains and weakness. My legs and newly my arm were considerably bad. I even went to see a muscle specialist who did a basic neuro exam, emg and ck serum test which was expensive!

In no way did I think it was the diet because I hadn't been improving from before I had changed it. But after a months I decided to not do it strictly but I was still low/moderate carb up till April when I decided going raw vegan. It hasn't been that raw tbh and I have given into meat twice but the diet has helped. I have been (attempting) high carb vegan and I have more energy, my muscles have improved so much that I rarely experience pain. Especially not to the extent of before. Most of my diet is fruit and veg. Recently I've gone of the band wagon and have been eating ice cream, wheat and all sorts of non healthy foods but I'm going to get back on track once i find better recipes. I eat lots of potatoes, fruits, rice, veg.

Now I'm going to start methylation soon and I'm hoping this is the last bit in my recovery. Fingers crossed. In the meanwhile I might drink bicarbonate of soda as you have though. Ill tell you how it goes later today.

 

[stevesayshi]

This is definitely something you need to talk to a doctor about, but something in your result is contradictory.

Hmmmm... now that you mention it, something interesting comes to mind. I had a lot of health problems leading up to the virus that took me out. My urinary pH steadily rose over that time. That is sort of also the time frame where my respiration slowed down. I described it once as "feeling unmotivated to even breathe." Then I got sick and my pH rose even further as did the anion gap.

So, basic blood, basic urine, but an excess of detected anions would mean an even larger number of undetected cations. What the heck could be that high of a concentration without flat out killing me?

 

[pemone]

Hmmmm... now that you mention it, something interesting comes to mind. I had a lot of health problems leading up to the virus that took me out. My urinary pH steadily rose over that time. That is sort of also the time frame where my respiration slowed down. I described it once as "feeling unmotivated to even breathe." Then I got sick and my pH rose even further as did the anion gap.

So, basic blood, basic urine, but an excess of detected anions would mean an even larger number of undetected cations. What the heck could be that high of a concentration without flat out killing me?

What is your anion gap (typically) and how are you calculating it?

Apparently anion gap can be associated with metabolic alkalosis as well:

http://cjasn.asnjournals.org/content/2/1/162.full

Do you still get these slow breathing attacks now? Is it frequent?

What I might do is ask your doctor if the slow breathing together with high pH readings (use saliva too) and high anion gap might indicate metabolic alkalosis with compensatory respiratory acidosis. Ask him to give you a lab form and hold onto it. Then during the acute phase of the attack go in for that blood test.

I'm not sure doctors will pay any attention to it. During an acute attack, in the emergency room they could do an arterial gas and that would probably confirm it.

Very frustrating to have such a clear view of something being wrong, yet doctors do nothing about it.