Optimal Result: 10.6 - 62.6 nmol/mg Creatinine.

a-hydroxybutyric acid (2-hydroxybuturic acid [2-HB]) is a marker that relates to oxidative stress.

a-hydroxybutyric acid is an organic acid produced from a-ketobutyrate via the enzymes lactate dehydrogenase (LDH) or a-hydroxybutyrate dehydrogenase (HBDH).

These enzymes are catalyzed by NADH. Oxidative stress creates an imbalance in NADH/NAD ratios, which leads directly to the production of a-hydroxybutyric acid. Being that a-hydroxybutyric acid’s precursor a-ketobutyrate is a byproduct in the glutathione (GSH) synthesis pathway, an increased demand for GSH may ultimately result in increased a-hydroxybutyric acid.

Increased oxidative stress associated with insulin resistance increases the rate of hepatic glutathione synthesis. Plasma a-hydroxybutyric acid is highly associated with insulin resistance and may be an effective biomarker for prediabetes.

A study on type 2 diabetics showed that GSH infusion restored the NADH/NAD balance and resulted in improvement of insulin sensitivity and beta cell function.


- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565252/

- https://pubmed.ncbi.nlm.nih.gov/20526369/

- https://pubmed.ncbi.nlm.nih.gov/1737525/

- https://pubmed.ncbi.nlm.nih.gov/168632/

What does it mean if your a-Hydroxybutyric Acid result is too low?

There are no known clinical associations with low levels of a-hydroxybutyric acid.

What does it mean if your a-Hydroxybutyric Acid result is too high?

Higher circulating levels of a-Hydroxybutyric Acid are associated with insulin resistance and prediabetes.

Elevated a-hydroxybutyric acid may be seen with oxidative stress.

Treatment options:

Evaluate oxidative stress markers such as lipid peroxides and 8-hydroxydeoxyguanosine (8-OHdG) and ensure adequate antioxidant intake and glutathione status. Hard physical exercise can result in lactic acidosis and accumulation of 2-HB.

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