The consequence of excess lactic acid

Most of us at some point in our lives have done some intense anaerobic exercise like running very fast, or an exercise class and felt a burn in one or more muscles to the point where it was uncomfortable and had to stop while we gasped for air.  While the common reference to this is “excess lactic acid”, what really is occurring is a buildup of L-lactate because of the inability of our body to provide enough oxygen to convert energy inside our cells to continue exercising.  If exercise is done excessively this way, our blood pH can become acidotic where under normal circumstances it is alkaline.  Luckily, when we rest our bodies we remove L-lactate efficiently and the benefits of exercise outlast the short-term muscle soreness from the workout and there isn’t any long-term effect to our blood pH. 

However, there are two forms of lactate.  Another one is called D-lactate and it is becoming increasingly apparent that the accumulation of D-lactate is not easily removed from our body even under ideal conditions and causes development of acidosis in the blood.

What causes excess D-lactate?

1. Lack of oxygen
2. Bacterial fermentation of simple sugars such as glucose, lactose and fructose
3. Antibiotic use. It leaves the gut susceptible to opportunistic strains.  Streptococcus and Enterococcus are two strains that increase D-Lactate. 
4. Diabetic ketoacidosis from low insulin levels, (not dietary ketosis)
5. Gastric bypass surgery or short bowel syndrome, where part of the small intestine has been removed. 
6. Kidney or liver impairment. 
7. Certain medications such as metformin, antiretroviral drugs, acetaminophen, aspirin, simvastin, and propylene glycol (anti-freeze) which is commonly added to foods, drugs in small amounts. 

Symptoms of D-lactate Acidosis

1.  Lack of muscle coordination (ataxia)

2.  Balance and gait issues

3.  Slurred speech (dysarthria)

4.  Personality changes (grouchy, distant, angry, cold, hostile, aggressive, agitated, abusive.

5.  Memory loss (brain fog, spaciness)

6.  Fatigue (chronic fatigue syndrome-lack of energy)

7.  Air hunger (shortness of breath for no apparent reason), hyperventilation.

8.  Gas, bloating, distention, GI symptoms (unclear if these may have another common cause (S.I.B.O.)

9.  Symptoms get worse after eating sugar or carbohydrates.

10.Encephalopathy symptoms such as anxiety and panic attacks. 

Research

In 2010 Scientific American published an article on Anxiety and Panic Attacks.  The article was based on the work of John Wemmie at the University of Iowa who discovered that a new clue in the underlying reason for panic attacks may be a problem with pH and acidity at key junctures in the brain, specifically in the amygdala.  The pH of our brain is carefully regulated and Wemmie’s research showed an increase of acidity can seriously disrupt brain functioning.  He found that synapses between neurons have specialized proteins called acid sensing ion channels or ASIC’s that stimulate neurons when acid is detected.  Genetically modified mice lacking these ASIC’s showed a reduced capacity to show instinctive or learned fear and when they restored the ASIC gene of the fearless mice they had a normalization of fear behaviors.  They also studied Carbon Dioxide and how it acts like an acid in the brain and how it triggered strong fear reactions in normal mice.  Patients with panic disorders would experience a panic attack if they inhaled air containing 35% carbon dioxide.   They also discovered that patients with panic disorder tend to generate excess lactic acid in their brains.  This confirms that aberrations of pH due to the acid accumulation of either carbon dioxide or lactic acid, induced panic attacks by altering the pH of the acid sensitive fear circuits. 

In the Journal of Psychiatry and Neurological Sciences 2013, there was an article written studying MELAS (mitochondrial encephalopathy, lactic acidosis, and stroke like episodes) syndrome and migraines.  The study evaluated 30 patients with migraine, 30 with tension headaches and a control group of 30. They found that lactic acid and pyruvic acid (a result of glucose metabolism) were significantly higher in the migraine and tension headache patients than the control group.

Lab tests

Most labs only check L-lactate however Quest Diagnostics has a test for plasma D-lactate and the Mayo Clinic has a urine test for it.  Below are more common tests that would be a sign for further testing.

LDH: Lactic Dehydrogenase.  This is in most body tissues and becomes elevated when those tissues break down such as the liver, heart, skeletal muscle, adrenal, lung, kidney, pancreas, red blood cells.

CO2: Carbon Dioxide.  When elevated it could indicate hypoxia. (lack of oxygen) This could indicate hypoxia due to a lack of exercise or lung problems.

Anion Gap: Is a measurement of four markers.  It is sodium (Na) plus potassium (K) minus chloride (Cl) plus bicarbonate (HCO3), or (Na +K) – (Cl + HCO3).  It should result in a number between 7-12.  Elevations are considered indicative of either functional dysglycemia or lactic acidosis. 

Solutions

It is estimated that one out four adults in the world don’t get enough exercise.  It is also estimated that one out of three adults in the U.S. suffers from metabolic syndrome and therefore is consuming too many refined carbohydrates. One of the benefits of aerobic exercise training is the efficient use of oxygen in metabolically active tissues (including the brain) to become more efficient at consuming and removing excess lactic acid.  It could have a powerful anti-anxiety and anti-panic effect at least partly for this reason.

Takeaways

It was once believed that only people with shortened bowels from surgery ran the risk of elevated D-lactate, but we now know that isn’t so.  In one study of 470 randomly selected hospital patients it revealed 3 percent had elevated D-lactate and less than 2/3 of these patients had a history of gastrointestinal surgery. Obviously, with any problem as serious as panic attacks there are multiple causes and a careful history should be taken and lab tests done to confirm whether it is due to D-lactate problems.  However, these two areas (aerobic exercise and refined carbohydrate restriction), are key points to address helping reduce D-lactate excess and the common symptoms that are associated with it. 

Additionally, the carbon dioxide in our atmosphere is rising.  Between preindustrial times and now the carbon dioxide in our atmosphere has risen from .028 percent to .041 percent, (2018) so true success may also require societal interventions in addition to personal.