Low Pyruvate in blood (high L:P ratio)

[Mrparadise]

Dear PR

I have just checked my blood work again and I have noticed that pyruvate was always pretty low and therefore the lactate/pyruvate ratio is too high. Does this mean that I have some genetic defect regarding pyruvate metabolism? Is this an indication that I should look more into lactic ascidosis as something that perpetuates ME/CFS for me? Or is this nothing to worry about?

Interestingly, in the urine (above was in the blood) it looks different:

 

[Martin aka paused||M.E.]

Dear PR

I have just checked my blood work again and I have noticed that pyruvate was always pretty low and therefore the lactate/pyruvate ratio is too high. Does this mean that I have some genetic defect regarding pyruvate metabolism? Is this an indication that I should look more into lactic ascidosis as something that perpetuates ME/CFS for me? Or is this nothing to worry about?

View attachment 43684

I think many have this profile. Me too. Some have high lactate… studies are contradictory (as usual)

 

[Mrparadise]

Thank you for your extremely fast answer, Martin - much appreciated! So does that mean that it does not provide us with any valuable insights, I guess?

 

[Martin aka paused||M.E.]

Thank you for your extremely fast answer, Martin - much appreciated! So does that mean that it does not provide us with any valuable insights, I guess?

Right.

 

[Martin aka paused||M.E.]

Dear PR

I have just checked my blood work again and I have noticed that pyruvate was always pretty low and therefore the lactate/pyruvate ratio is too high. Does this mean that I have some genetic defect regarding pyruvate metabolism? Is this an indication that I should look more into lactic ascidosis as something that perpetuates ME/CFS for me? Or is this nothing to worry about?

View attachment 43684

Interestingly, in the urine (above was in the blood) it looks different:

View attachment 43685

Now I just saw your urine measurements… raises questions… same day/lab? Same nutrition? Supplements?

 

[Mrparadise]

Not same day, but the measurements in the blood seem to be consistent (low pyruvate). I am not sure which supplements I took back then (maybe vitamin D).

 

[godlovesatrier]

It isn't very clear what these mean also almost no studies to back up any ideas about what they mean. Mine are the same if memory serves me right. Some also say OAT tests are pretty unreliable if you want to know what's going on inside the body, I guess it's debatable if they are any good or not.

Ultimately though I don't think it's appeared in very many studies linked to ME, but I might be wrong!

 

[nerd]

I think it has been established that lactate accumulation is very frequent in CFS/ME patients, especially during exercise, but it doesn't answer why pyruvate levels would be low.

This is just my own theory. The chronically elevated ADP/ATP ratio and NADH/NAD+ ratio have effects on the glycolytic pathway. First, they prevent glucose from being broken down into pyruvate precursors. Second, they trigger Lactate Dehydrogenase (LDH) to be prioritized in order to quickly get some energy and NAD+ recycling. This would explain such results in the blood. The urine tests are odd. I have no good explanation for the inverse ratio in the urine.

 

[Mrparadise]

Is there anything I could try to get that corrected?

 

[nerd]

Is there anything I could try to get that corrected?

Pacing, NAC, low doses of Niacin, high doses of Thiamine, Q10, Vitamin C. This helps upregulating the inhibited NAD+-dependant enzymes. As for ATP and pyruvate replenishing, D-Ribose should help compensate.

 

[Mrparadise]

Thanks @nerd

But what about this:

An elevated lactate-to-pyruvate (L) ratio may indicate inherited disorders of the respiratory chain complex, tricarboxylic acid cycle disorders and pyruvate carboxylase deficiency. Respiratory chain defects usually result in L ratios above 20.

SOURCE: https://www.mayocliniclabs.com/test... elevated lactate-to-pyruvate,ratios above 20.

 

[nerd]

An elevated lactate-to-pyruvate (L) ratio may indicate inherited disorders of the respiratory chain complex, tricarboxylic acid cycle disorders and pyruvate carboxylase deficiency. Respiratory chain defects usually result in L ratios above 20.

You'll find such associations with many of the CFS/ME pathology findings because CFS/ME pathology is so extensive. For example, muscarinergic-cholinergic receptor antibodies are associated with LEMS, MG, and other conditions as well. The evidence for these is just researched better, so this is what you find on websites like these. You barely find anything on CFS/ME. From my understanding of the pathophysiology of CFS/ME, it is a mitochondrial and TCA cycle (CAC) disorder, so it actually matches what they write. What I described in the last comment is a dysregulation of glycolysis and the CAC.