Free blood gases analysis [Netherlands]

[Gondwanaland]

I have noticed that my blood pH is completely normal in the fasted state:

Have you looked into Biotin? IME it was the single vitamin to require more bicarbonate production from the pancreas (not measured, just by symptoms).

In my case I suspect some block of biotinidase (I took accutane in the past and it does block biotinidase preventing one to extract biotin from food) and I had some signs of excess acidity (bursitis, teeth demineralization, non celiac gluten sensitivity, ETA smelly sweat, hair loss).

Biotin is said to be mostly produced by gut flora and you could have excess production? In that case B5 would be the antidote since it competes with Biotin for transporters/receptors.

(Does it make sense to you @Lolinda ?)

I know my wild theories aren't very popular since I base them on my reading of basic metabolism + personal experiences, but this could be one underlying factor since it is tightly related with food intake for you.

 

[Lolinda]

I have noticed that my blood pH is completely normal in the fasted state:

Possible explanation:
Fasting produces ketone bodies which lowers blood pH
Fating lowers sympathetic nervous system which lowers ventilation > more CO2 > Lower pH [1]
Less stomach acid is produced in the fasted state > less alkaline tide (Lolinda, thank you for introducing me with that phenomenon).

In order to find out if the alkaline tide has anything to do with it, I would do a measurement 3h after eating. The alkaline tide lasts ~2h after the end of the meal. I suggest the 3h to be safely out of it. Or, better: repeated urinary ph tests to see when you are out of alkaline tide. Be sure to buy a PH stripes with 0.3 graduation. every pharmacy carries these for kidney stones patients.

fasting and breathing: The strongest and quickest to ramp up CO2 and calm down the sympathicus is 5-2-5 breathing. I am curious what it does for you and for your PH measurements. if breathing and sympathicus is involved, I have buckets of tricks

Ketone bodies: it is difficult to get into ketosis. Was your fasting just as much as having not yet eaten breakfast? the body is programmed to avoid ketosis. Ketosis loses a lot of nutrients into urine. While ketosis may be a good therapeutic option today, it is only so because you can supplement. Where would you buy that Mg tab in stone age?
in any case, keto-teststicks will tell. But a simple overnight fast doesnt get anyone into ketosis... I think I needed a day or so, others need more or even fasting and then coco oil to kickstart it.
Another point is: imagine it like a big switch: you are in ketosis or you are not. but you are rarely a little bit.

certainly the best would be to arrive at sthg like vitamin x does the trick, as @Gondwanaland suggested. In order to get a step closer, why dont you get a detailed test with not only the co2, bicarb but also the electrolytes, etc? I have a generally poor opinion of doctors' abilities, but they will be able to tell if it is metabolic or respiratory, and if there are different PH norms postprandially...

 

[Lolinda]

Have you looked into Biotin?

One more thought in this line: At a time when I really did not know any further with quite some difficult issues, I just t!ried one vitamin / mineral after the other, starting very low dose, and giving each some time to show what it does for me, noting experiences meticulously. @Gondwanaland gave me some hints for some more likely candidates, but I also tried unlikely ones, many. Looking back, this was the time when I made the most progress. Now, many month afterwards, I can explain effects scientifically. But I never would have made those discoveries when I had used the normal approach (test for deficiencies, read science about symptoms, discuss experiences with people, ...). My favourite example is B5: Its almost impossible to eat too little. Crono showed that I eat fully enough. I could not have named any single deficit syndrome in me. BUT: when I tried it, a wonder happened: gainig much desired weight, slightly better sleep, slight positive influence in mood, ...

➞ "Probieren geht über Studieren" (in German it is a nice rhyme: trying out things is better than studying)

or, my favourite version of the same: Act first, think later!!

 

[Manganus]

Cheney uses a rebreather mask with the O2 so that CO2 rise:
"Oxygen through nasal prongs will not work. Oxygen alone in a mask will not work. It has to be a parietal rebreather mask, which has a bag attached. This allows you to rebreathe your expired carbon dioxide along with the oxygen that is flowing into the mask. Breathing increased levels of both CO2 and O2 at the same time is essential. The CO2 breaks the cycle. It corrects the alkalosis and frees the O2 in your blood to move into your cells. With proper functioning, vessels dilate and you start perfusing your brain and tissues, bringing out the toxins and brining in the nutrients"
http://www.prohealth.com/library/showarticle.cfm?libid=8812

For me, it's not entirely clear why he use oxygen when he thinks it's toxic...

Thanks, Emootje. Your results are interesting.

and... how much did you pay?

 

[Gondwanaland]

normal approach (test for deficiencies, read science about symptoms, discuss experiences with people, ...). My favourite example is B5: Its almost impossible to eat too little. Crono showed that I eat fully enough. I could not have named any single deficit syndrome in me.

If I remember right there was an excess of an urine metabolite in your results pointing to excess biotin (which implies a B5 deficit)...

 

[Emootje]

@Gondwanaland, I'm not that into biotin metabolism, so I hope I understand you correctly. In a nutshell... biotin excess causes alkaline blood? B5 antagonize the biotin induced blood alkalinisation? Right?

@Lolinda, I did experiment extensively with the alkaline tide. Normally my urine pH is low (5,6, lowest on my strips) and after a meal it goes up to 6,8, but not always... I think, it depends on the content of the meals... Also tried a PPI to inhibit the alkaline tide, it did inhibit the alkaline tide a bit but it didn't influence the blood pH. I also notice that potassium chloride alkalized my urine but also didn't have a pronounced effect on my blood pH and on my symptoms.
It's a little confusing...

In past I have monitored my exhaled CO2 with a Nonin LifeSense during Ujjayi breathing. I manged to keep my CO2 in the high normal range. It was very relaxing but it made my orthostatic intolerance much worse and made me dizzy.

It's questionable if keto-sticks are reliable... if they are reliable then it's not likely that my blood pH normalization is because of ketosis after a 12 hour fast (skipping breakfast).

@Manganus
I bought my blood gas analyser on eBay for 600 euro. You need a calibration gas bottle (~80 euro) and test cassettes (~220 euro/25 tests). Additional (not necessary for testing) I bought two quality control SRC cassettes (~80 euro) and analyte controls (~ 120 euro /30 vials).
Dotmed is also a good site to buy used medical stuff.

 

[Gondwanaland]

@Gondwanaland, I'm not that into biotin metabolism, so I hope I understand you correctly. In a nutshell... biotin excess causes alkaline blood? B5 antagonize the biotin induced blood alkalinisation? Right?

I am not expert, but I read that Biotin demands bicarbonate from pancreas. If it will make your blood alkaline or not will depend on how (un)healthy your kidneys are I suppose...
Theoretically a surplus of B5 could potentially inhibit Biotin action... Like @Lolinda said, it can only be determined by trial and error, because so many people do so well on a X supplement, while others do poorly... And individual responses will shift over time with replenishment and new depletions...

 

[Emootje]

I guess ketones don't play a major roll in my fasted state pH normalization. Results at 6:51 pm of my blood gases and blood ketones after skipping breakfast and low carb lunch (6 avocado) :

 

[Lolinda]

I have noticed that my blood pH is completely normal in the fasted state:

View attachment 22377

Possible explanation:
Fasting produces ketone bodies which lowers blood pH
Fating lowers sympathetic nervous system which lowers ventilation > more CO2 > Lower pH [1]
Less stomach acid is produced in the fasted state > less alkaline tide (Lolinda, thank you for introducing me with that phenomenon).

check out this:
Chronic administration of 1,25(OH)2D or PTH increases the set point at which plasma bicarbonate concentration is regulated by the kidney and thereby maintains metabolic alkalosis in a variety of species.

I just went to gscholar and looked for "vitamin acid base". I think that using this and similar keywords it should be possible to find all vitamins and minerals somehow involved in acid-base homeostasis.

 

[Emootje]

check out this:
Chronic administration of 1,25(OH)2D or PTH increases the set point at which plasma bicarbonate concentration is regulated by the kidney and thereby maintains metabolic alkalosis in a variety of species.

That's interesting, maybe dietary calcium could help?
But first my next experiment: a carbonic anhydrase inhibitor.
I order it online at a 'no prescription pharmacy' but the the local post office lost my package
Btw thiamine is also a carbonic anhydrase inhibitor: https://www.ncbi.nlm.nih.gov/pubmed/22145674

 

[enna]

Hi @Emootje

Maybe you are interested in my blood gas values. I tried to research about them, but I'm very cognitively impaired so it ist very hard. I had a very severe reaction to metformin too (maybe interesting for @Valentijn ). It was in early April and I had very bad air hunger, a heart rate up to 170 lying in my bed and arrhytmia. I could't almost sleep for over a month. I sweated like never in my life bevore and at the same time i froze and had chills. I really felt like dying. Still now, months later, my brainfog is worse than ever bevore and I still have problems getting air. All I understood is, that the anion gap indicates a acidosis but the blood was always alkalin. The lactate was still high over a month after I took the metformin. In the organix test from June it shows that I have high L-lactate and very high D-lactate but no sign of dysbiosis. I can't interprete the results and it would be very interesting to me if you could tell me something about them.

Thank you very much and nice regards
Enna

 

[Valentijn]

Still now, months later, my brainfog is worse than ever bevore and I still have problems getting air.

For me it took several months for my shoulders to work normally again, and most of cognitive function to recover. At 6+ months now, I think my brain is pretty much back to where it was before the metformin episode. So hopefully you'll continue to improve too.

 

[pattismith]

For me it took several months for my shoulders to work normally again, and most of cognitive function to recover. At 6+ months now, I think my brain is pretty much back to where it was before the metformin episode. So hopefully you'll continue to improve too.

Do you know if your post exercise blood lactates curve has improve since then?

 

[Valentijn]

Do you know if your post exercise blood lactates curve has improve since then?

There's no reason to think it has. Several months later it was at 2.8 at bedtime, approximately 5-6 hours after going up and down a large flight of stairs at the hospital as fast as I (safely) could.

 

[Emootje]

Interesting data Enna, thanks for posting!

I can't interprete the results and it would be very interesting to me if you could tell me something about them.

Your pH/CO2 (tends to a) respiratory alkalosis (hyperventilation) and your high pO2 also support this.
Things that can cause this:
- respiratory stimulants (epinephrine, norepinephrine, progesterone, nicotine, salicylates, caffeine, theophylline)
- oversensitive carotid bodies
- anemia

High lactate on 5.5: still a consequence of the metformin?
Other options:
- low thiamine!
- increase in free fatty acids, blocking PDH (beta agonists, epinephrine, norepinephrine)
- hyperventilation can also cause high lactate. [source]

Very high D-lactate is normally associated with blood acidosis so that's a bit weird...
If you want to treat this:

[source]

The high anion gab on 17.4 could be lots of ions, including D-lactate:

 

[enna]

Hi @Emootje

Thank you very much for your answer. Now I understand more but at the same time less. When the high anion gap and the high D-lactate as well as the negative base excess indicate an acidosis, how can i have a alkalosis at the same time? Is it possible that somehow my breathing overcompensates a metabolic acidosis into a respiratory alkalosis. It os said that overcompensation is not possible, but it seems like that to me. I don't know where the respiratory alkalosis could come from but I don't do/have the causes you listed or I read elsewhere.

I never noticed myself hyperventilate neither did my partner and when I have very bad air hunger, i tried to breathe in bag, but it did'nt help at all. But maybe my breathing is constantly a bit deeper. My problems with getting air is stronger at night and often i wake up with acute breathlessness but I have no sleep apnoe. The feeling is hard to describe. It is like the feeling you get in your brain, when you hold your breath for a very long time but much stronger and the back of my head tingles and ihave very cold and a low body temperature. This problem started with the metformin (early april), but the respiratory alkalosis was already before, when i didn't notice problems with my breathing.

I've just seen that the lactate was not initially rising after the metformin, because it wasn't high at the 17.4. A found more data and completed the table. This makes even less sens to me, because I can't explain the raise. I drink very much, do not eat sugar or drink alcohol, few carbs and no more probiotics for a few months. Also I had three monts of antibiotics last autumn and no sign of disbyosis in my organix test from June where the very high D-lactate was measured.

Thanks and nice regards
Enna

 

[pattismith]

There's no reason to think it has. Several months later it was at 2.8 at bedtime, approximately 5-6 hours after going up and down a large flight of stairs at the hospital as fast as I (safely) could.

If I have read well, you had mitochondrial toxicity from Metformin treatment, am I right?

 

[Valentijn]

If I have read well, you had mitochondrial toxicity from Metformin treatment, am I right?

I don't know what "mitochondrial toxicity" is. I had the symptoms which are attributed to metformin-induced lactic acidosis on the drug's information sheet.

 

[pattismith]

I don't know what "mitochondrial toxicity" is. I had the symptoms which are attributed to metformin-induced lactic acidosis on the drug's information sheet.

Metformin is known for its toxicity over mitochondrias. Metformin alter mitochondrial oxydative function by inhibition of NADH dehydrogenase (= NADH ubiquinone oxydo reductase), which leads to increased lactic acid production by the cells. I was wondering if your strange post exercise blood lactates curve was related to the metformin toxicity.
If you stopped this drug month ago, your curve may have improved with time, I was interested to know !

 

[Valentijn]

I was wondering if your strange post exercise blood lactates curve was related to the metformin toxicity.

Sorry, I'm still not aware of any support for "toxicity" in the mechanism of metformin contributing to lactic acidosis, nor what is specifically meant by "toxicity". My lactic acidosis symptoms were definitely a result of taking metformin, but likely partially due to predisposing factors related to ME. If toxicity were the primary cause, lactic acidosis would be a much more common side-effect from metformin.