- Lactic acid is produced endogenously under anaerobic conditions.
- Main route of lactic acid disposal is conversion to pyruvic acid or excretion via urine.
- Higher urine lactic acid levels have been associated with diabetes, fasting glucose, HOMAIR, IBD, chronic kidney disease, Fanconi syndrome, and age-related macular degeneration.
» Both L- and D-lactic acids were elevated in diabetes
- Nutrient deficiencies of B1, CoQ10, and/or lipoic acid, have been associated with elevated lactic acid levels in both urine and blood.
- Limited research noting a higher decline of T4 was associated with a low lactic acid, alanine and glycine.
Nutritional Considerations: Though clinically not common low lactate may arise when insufficient carbohydrates have been consumed, or when pyruvate levels are low. Common nutrients used to support the balance of lactate include: B1, B3, CoQ10, Biotin.
Possible Interfering Factors: Low Pyruvate, Acid/Base Imbalance.
Clinical Considerations: Though not common, a low lactate can arise from insufficient cofactors, particularly vitamin B3. Insufficient levels of pyruvate can result in low lactate. Clinical observation suggests that excess alkalinity can result in changes in lactate levels, as can excess acidity. Testing urinary pH can be helpful in exploring acidity/alkalinity, as can blood pH.
Nutritional Considerations: Nutrients that may help support proper lactate metabolism include, B1, B2, B3, B5, Lipoic Acid, CoQ10 and Biotin. Making sure that blood sugars are controlled, that the diet is sufficiently balanced with carbohydrates, fats and proteins is essential. Prolonged fasting of few days or dieting occur prior to testing may contribute to higher lactate levels, as would vigorous exercise on the borderline of anaerobic. The heart, brain and most slow twitch fibers are very apt at clearing lactate from the blood to the extent that they prefer lactate as a source of fuel. Note however, that lactate must first be converted into pyruvate before it can be used as a source of energy. Thus making sure that the pyruvate pathway is fueled is essential. Clearance of lactate from the blood can occur either through oxidation within the muscle fibers in which it was produced or it can be transported to other muscles fibers for oxidation. Lactate results are the total of D & L-lactate. In most cases L-lactate predominates. Elevated D-lactate can occur if there is dysbiosis.
Possible Interfering Factors: Poor metabolism or excess intake of alcohol.
Clinical Considerations: High lactic acid had been correlated with muscle tenderness and even fibromyalgia like symptoms. Possible causes can include, high intensity exercise, low oxygen conditions such as asthma or other pulmonary disease, sleep apnea, cardiac insufficiency, ketoacidosis, poorly controlled diabetes and prolonged fasting or severe dieting.
Clinically, some individuals with high lactate will experience anxiousness, nervousness and at times sensation of shortness of breath. Increased water intake can assist in some patients. It is important to know that if clinical correlation is made with lactic acidosis, medical intervention needs to occur immediately. There are many symptoms related to lactic acidosis which include nausea, vomiting, hyperventilation to remove carbon dioxide, nausea and vomiting, hyperventilation, abdominal pain, lethargy, low blood pressure, rapid pulse, heart rhythm irregularities and acidosis.
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