Lactic acid and pyruvic acid are byproducts of glycolysis. Carbohydrates, which contain glucose, are broken down through glycolysis to form pyruvate and two ATP molecules. Pyruvate can also be generated through the catabolism of various amino acids, including alanine, serine, cysteine, glycine, tryptophan and threonine.92 Magnesium is an important cofactor for a number of glycolytic enzymes necessary to produce pyruvate.93 Optimally, pyruvic acid is oxidized to form Acetyl-Co-A to be used aerobically via the Krebs Cycle to produce energy. In an anaerobic state, lactic acid is formed instead.
Decreased urinary pyruvate if:
Problems with glycolysis, gluconeogenesis, or fatty oxidation
Low levels of pyruvate may occur if there are low levels of precursors (glucose, amino acids), if there are nutritional enzyme inhibitions, or if a low-activity enzyme variant is inherited. Low levels can indicate problems with the glycolysis pathway, fatty acid oxidation, or problems with gluconeogenesis. If the person is on a low-carbohydrate or “keto” diet, the CAC will obtain precursors from amino acids or fats, instead of carbohydrates. During long-term fasting, most pyruvate will be diverted into gluconeogenesis rather than into the Citric Acid Cycle.
Consider supporting pyruvate production from carbohydrates or proteins with biotin, r-lipoic acid, B1, B3, B6, magnesium, potassium, zinc, and glutathione (antioxidants)
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 person cannot synthesize enough NAD+ or if there is an inherited low-activity enzyme variant.
Phthalate chemical exposures can inhibit the enzyme that interconverts pyruvate and lactate.
High levels of pyruvate may occur if there is nutritional inhibition of the breakdown enzymes if inherited, inherited low-activity enzyme variations are present on the breakdown pathway, if there are high levels of precursors (glucose, amino acids) or if there are high levels of downstream products (lactate, citrate). High pyruvate levels can indicate problems with entry into the CAC; check citrate levels. Medical conditions, such as acidosis or chronic fatigue syndrome, may increase pyruvate levels. High levels of pyruvate may prevent the synthesis of carbohydrates, fatty acids, ketone bodies, alanine, and steroids needed by the body.
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.
If pyruvate is high and citrate is low, consider supporting pyruvate’s entry into the Citric Acid Cycle with B1, B3, biotin, r-lipoic acid, magnesium, manganese, potassium, zinc, and glutathione.
Pyruvate entry into the CAC may be inhibited by arsenic or other toxic metal exposures. Arsenic exposure can increase alpha-ketoglutarate and pyruvate, while citrate and succinate levels decrease.
Medical conditions may increase pyruvate levels
Secondary lactic acidosis
Sleep apnea, blood infections, seizures, respiratory or cardiac insufficiency
Dicarboxylic acids (cis-aconitate, isocitrate, succinate, malate, suberate, and adipate) may also be elevated
Levels of citrate, cis-aconitate, isocitrate, malate may be low
Phthalate exposures can inhibit the enzyme that interconverts pyruvate and lactate.
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