Lactate

Urine
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Lactate serves as a valuable metabolic marker that provides insights into various physiological processes within the body. Elevated levels of lactate can signify multiple underlying factors, including impaired mitochondrial function, nutrient deficiencies, or metabolic disorders. Monitoring lactate levels on the panel aids healthcare practitioners in assessing energy metabolism, identifying potential issues with oxygen delivery and utilization, and recognizing conditions like lactic acidosis. 

What does it mean if your Lactate result is too high?

Elevated lactate levels within the body can result from various factors, including nutrient inhibitions along the breakdown pathway, the presence of low-activity enzyme variants due to genetic inheritance, increased levels of precursor molecules such as glucose and amino acids, or elevated downstream products like pyruvate. Additional contributors to high lactate levels encompass factors such as high carbohydrate consumption, inadequate antioxidant status, or hypoxia (insufficient oxygen levels), which can be seen in extreme athleticism. Lactate levels may also be influenced by liver and kidney issues, as well as dysbiosis of the gastrointestinal microbiome. When pyruvate is low and lactate is high, patients may struggle to interconvert the two compounds, potentially due to insufficient NAD+ synthesis or inherited enzyme deficiencies, which may benefit from vitamin B3 supplementation. Elevated methylmalonate, quinolinate, and pyroglutamate levels, along with decreased cis-aconitate and isocitrate levels, may indicate poor antioxidant status, suggesting the potential use of antioxidants like CoQ10, alpha-lipoic acid, vitamins C and E, curcumin, resveratrol, or a diet rich in fresh fruits and vegetables. Dysbiosis may lead to the accumulation of D-lactic acid, which can be addressed with zinc and glutathione support to convert it to L-lactic acid. Secondary lactic acidosis can occur in various medical conditions, including sleep apnea, blood infections, seizures, and respiratory or cardiac insufficiency. In infants, acidosis manifests as poor feeding, vomiting, hypotonia, lethargy, while in adults, symptoms include headaches, confusion, fatigue, tremors, sleepiness, and seizures. In situations of hypoxia or limited functional mitochondria, pyruvate is converted to lactate to regenerate NAD+, increasing lactate levels and reducing pyruvate. Diabetic ketoacidosis may elevate dicarboxylic acid levels. Furthermore, phthalate exposures can inhibit the enzyme responsible for pyruvate-lactate interconversion, prompting consideration of the US BioTek Environmental Pollutants Profile to assess phthalate exposure.

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What does it mean if your Lactate result is too low?

Low levels of lactate may occur if there are nutritional enzyme inhibitions or inherited low-activity enzymes are present on the synthesis pathway, or if there are low levels of precursors (glucose, amino acids) available. Low levels are rarely seen but may be induced by medications that treat hyperlactemia (high lactate levels). Lactate is a breakdown product of propionic acid, a key precursor in lipid (fat) biosynthesis. Lactate levels may be lower than average in trained athletes on “keto” diets.

1. If pyruvate is high and lactate is lower, then the patient may not be able to interconvert the two compounds. This can occur if the patient cannot synthesize enough NAD+ or if there is an inherited low-activity enzyme variant.

- Consider vitamin B3 supplementation to improve NAD+ levels.

- High-lycopene tomato sauce (160 g/day) increased both lactate and pyruvate in human subjects.

2. Phthalate exposures can inhibit the enzyme that interconverts pyruvate and lactate. Consider US BIOTEK’S ENVIRONMENTAL POLLUTANTS PROFILE to assess phthalate exposure.

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