Lactic

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.

- If pyruvate is high and lactate is lower, then the person may not be able to interconvert the two compounds. This can occur if the person 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.

- Phthalate exposures can inhibit the enzyme that interconverts pyruvate and lactate.

High levels of lactate can occur if there are nutrient inhibitions on the breakdown pathway, if there are inherited low-activity enzyme variants present, if there are high levels of precursors (glucose, amino acids) or if there are high levels of downstream products (pyruvate). High carbohydrate loads, poor antioxidant status, or hypoxia (low oxygen levels) can also raise levels. Extreme athleticism may also raise lactate levels. Liver and kidney problems or dysbiosis of the gastrointestinal microbiome may also increase levels.

- If pyruvate is low and lactate is higher, then the person 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.

- Increased levels of methylmalonate, quinolinate and pyroglutamate, with decreased levels of cis-aconitate and isocitrate, may indicate poor antioxidant status.

• Antioxidant supports may include CoQ10, alpha-lipoic acid, vitamins C and E, curcumin, resveratrol, etc. Fresh fruits and vegetables are rich in antioxidant compounds. 

- There are two forms of lactate: L- and D- forms. The D-form may accumulate when there is dysbiosis.

• Zinc and glutathione support the conversion from D-lactic acid to L-lactic acid (lactate), which may be used in the Citric Acid Cycle. 

- Secondary lactic acidosis

    -- Sleep apnea, blood infections, seizures, respiratory or cardiac insufficiency may result in lactic acidosis

• General symptoms of acidosis in infants include poor feeding, vomiting, loss of appetite, weak muscle tone (hypotonia), and lack of energy (lethargy). In adults, acidosis or acidemia is characterized by headaches, confusion, feeling tired, tremors,sleepiness, and seizures.

    -- In conditions of hypoxia (insufficient oxygen) or in cells with few functional mitochondria, pyruvate is reduced to lactate to re-oxidize NADH back into NAD+; this increases lactate and decreases pyruvate. 

- Diabetic ketoacidosis

• Dicarboxylic acids (cis-aconitate, isocitrate, succinate, malate, suberate, adipate, alpha-hydroxybutyrate, and beta-hydroxybutyrate) may also be elevated

- Phthalate exposures can inhibit the enzyme that interconverts pyruvate and lactate.