The importance of Thiamine(B1) for Lactic Acid in Chronic Illnesses
Lactic acid, often misunderstood, plays a pivotal role in various bodily functions. In this blog, we'll talk about its complexities, shedding light on its significance in chronic illnesses like Chronic Fatigue Syndrome (CFS), Fibromyalgia, Postural Orthostatic Tachycardia Syndrome (POTS), Dysautonomia, Panic attacks, and Irritable Bowel Syndrome (IBS). Before delving into solutions, let's understand the fundamentals of mitochondrial energy function.
From Food Breakdown to Lactic Acid Production
Our body's energy production begins with the breakdown of macromolecules from food—carbohydrates, fats, and proteins.
Through digestion, these molecules are transformed into usable forms: glucose from carbohydrates, fatty acids from fats, and amino acids from proteins. These substances enter cells for further processing.
Digesting Macromolecules for Energy
In essence, glucose becomes pyruvate in the cell's cytoplasm, while amino acids and fatty acids undergo distinct metabolic pathways. Pyruvate and acetyl-CoA, derived from these processes, fuel the Krebs cycle, generating ATP, the body's main energy currency.
The Lactic Acid Metabolism: From Glycolysis to Fermentation
The human body has redundant systems that can offer similar outcomes when it is as important as energy for your cells.
In cases where oxygen isn’t abundant and there is not enough cofactors to produce ATP through glycolosis, the body uses another energy cycle called the Cori cycle. During intense activity or low oxygen levels, glycolysis converts glucose to pyruvate without needing oxygen.
In such scenarios, pyruvate can turn into lactic acid through fermentation, supporting energy production in muscles and red blood cells.
Energy Production in Low Oxygen Conditions
Recent findings reveal muscles can metabolize up to 75-80% lactate, showing the importance of maintaining muscle function.
However, almost all body organs and tissues contribute to lactate release and clearance. After meals, lactate is mainly released by skeletal muscles, brain, and adipose tissue, while being taken up by heart, liver, and kidneys.
The human body is incredibly good at recycling lactate into necessary compounds. For example, cardiac muscles take up lactate and convert it back into pyruvate with the help of lactate dehydrogenase where it is used to create energy through the Krebs cycle.
Lactate travels to liver cells as well, where it is also converted to pyruvate, which can be used for synthesis of ATP via Krebs cycle and electron transport chain, glucose via gluconeogenesis, or other molecules.
The Cori Cycle's Role in Energy Metabolism
Each of these examples provides ample evidence of the importance of the Cori cycle, and lactate, in energy metabolism in the human body. However, let’s explore common symptoms of too much lactate in the body.
Symptoms of Lactic Acid Buildup in CFS, Fibromyalgia, POTS, Dysautonomia, MS, and IBS
Chronic illnesses like CFS, Fibromyalgia, POTS, Dysautonomia, and IBS often involve elevated lactate levels.
The issues associated with lactate build-up can only occur when there is mitochondrial dysfunction, meaning energy metabolism issues. Factors such as thiamine deficiency, gut dysbiosis, and high-carb diets contribute to this buildup.
As with many chronic health issues, there may be a combination of different causes rather than a single one.
Mitochondrial Dysfunction and Energy Metabolism
Thiamine (B1) deficiency disrupts glucose metabolism, favoring lactate production through the Cori energy cycle.
However, B1 is not only important in glucose metabolism but also fatty acid metabolism. Thiamine is also a cofactor for alpha ketoglutarate dehydrogenase (KDH) during fatty acid metabolism.
Furthermore, thiamine is a cofactor for the enzyme called transketolase, which bridges glycolysis and an alternative pathway of further glucose oxidation called the pentose phosphate pathway.
This specific enzyme is most important for cells with a high turnover rate such as epithelial cells of the intestinal lining: it provides complex sugars, nucleic acids, coenzymes, and other necessary products for rapidly dividing cells.
Thiamine Deficiency and Its Impact
With the high demand for thiamine for biochemical processes of virtually all body cells, it’s not shocking that thiamine deficiency plays a role in multiple disease states, including small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), and leaky gut syndrome.
Gut dysbiosis also alters bacterial balance, increasing lactate-producing strains and exacerbating symptoms.
The Microbiome’s Impact on Lactic Acid Build-Up
The two different forms of lactate, D-lactate vs L-lactate, are differentiated by where they are produced in the body.
L-lactate is standard in all body cells, while D-Lactate is primarily from certain gut bacteria, stemming from limited carb, protein, and fiber breakdown.
Disruption of digestion from microbiome dysbiosis can lead to increased D-lactate and disrupt short-chain fatty acids, a crucial fuel for the gut intestinal lining health.
D-Lactate vs. L-Lactate Production
The delicate balance of gut bacteria is easily upset by diet, lifestyle, antibiotics etc.
Excess carbs and carbohydrate maldigestion lead to lactate production, altering gut pH and promoting D-Lactate-producing bacteria growth and chronic illness.
Elevated D-Lactate from specific gut bacteria like Enterococcus and Streptococcus spp is linked to ME/CFS symptoms. This imbalance can heighten intestinal permeability, exacerbating inflammation and oxidative stress.
Consequences of Elevated D-Lactate Levels
The liver and kidneys can only metabolize small D-Lactate amounts. Elevated D-Lactate levels lead to acidemia, hindering pyruvate conversion to acetyl-CoA. Metabolism and mitochondrial health suffer.
A healthy gut requires a dynamic bacterial balance. For instance, the beneficial E. coli strain Nissle 1917 plays a role in inhibiting pathogenic bacteria invasion and reinforcing gut lining integrity, potentially mitigating D-Lactate buildup and leaky gut issues.
Lactic Acid's Impact on Chronic Illnesses: A Closer Look
In conditions like CFS and Fibromyalgia, lactate-producing bacteria in the gut correlate with symptom severity, highlighting its role in disease progression.
Some studies also tie the severity and progression of multiple sclerosis (MS), a demyelinating disorder of the central nervous system, to significantly higher levels of lactate in the cerebrospinal fluid. Dysautonomia and POTS patients also exhibit gut dysbiosis, potentially exacerbating symptoms.
CFS, Fibromyalgia, and Lactate Correlation
Subclinical thiamine deficiency is supported by data from a clinical trial where MS patients were given high-dose intravenous thiamine therapy, despite normal blood levels of thiamine before intervention.
After supplementation, patients reported significantly improved fatigue. This suggests intracellular deficiencies regardless of normal blood levels.
Another study reported that although B1 consumption may be appropriate according to the RDA, actual imbalances in food metabolism caused by high intake of simple carbohydrates from processed foods may lead to functional thiamine deficiency.
In cases of high-caloric malnutrition, the rate-limiting factor thiamine, and enzyme activity from thiamine-dependent enzymes decreases.
Neurological Symptoms from Elevated Lactate
The result of elevated lactate levels in the brain disrupts neuronal function, contributing to cognitive impairment, fatigue, and other neurological symptoms such as depression and anxiety.
Gut-Brain Axis and Lactic Acid Levels: The Good and the Bad
Contrary to popular belief the brain can burn more than just glucose. In fact, ketones are a major fuel source for neuro cells but also lactate.
Lactate consumption in the brain can vary from 10-60% under normal to high L-lactate peripheral concentrations in the body.
While some brain cells store lactate, others will use it readily as fuel. For example, oligodendrocytes can supply lactate to axons of neurons, thus providing them with energy.
Lactate also acts as a signaling molecule in the brain by binding to HCAR1 receptors on neurons and lowering neuronal activity in the hippocampus, cerebellum, and neocortex.
Brain Fuel Sources and Lactate
While all of this is good, the form of lactate matters. L-lactate is preferred in the brain and will even be shuttled through the blood brain barrier (BBB) to provide L-lactate to the brain, even though it can be produced in neuron cells.
D-lactate on the other hand is a competitive inhibitor of L-lactate and can trigger loss of axonal function, significantly decreasing transmission of electrical impulses within the brain. This happens because D-lactate virtually blocks glycogen-derived lactate from being used by axons.
Symptoms of D-Lactate Buildup
Coupled with gut dysbiosis and SIBO, leaky gut potentially leads to both brain and muscle symptoms due to the buildup of D-lactate. These symptoms include:
difficulties with muscle coordination
issues with balance and gait (particularly because the cerebellum appears to be the most sensitive to D-lactate)
irritability
shortness of breath
brain fog (mental confusion, difficulty concentrating, poor short-term memory, and impaired judgment)
memory loss
constant lack of energy and fatigue.
The area of the brain that is mainly involved in fear and panic attacks is called amygdala. The presence of acid-sensing ion channels in the amygdala will detect changes in the pH within the synapses.
Research has revealed hypersensitivity to acid as well as a concurrent increase in lactic acid levels in the same brain areas in people who suffer from panic disorders and anxiety.
In research settings, lactate infusion is used to induce panic attacks in humans, and the resulting symptoms include fear of losing control, fear of choking, sweating, nausea, temperature change sensations, chest pain, and feeling dizzy (interestingly these are common symptoms of dysautonomia).
In another part of the brain, the locus coeruleus (LC) in the frontal part is most affected by L-lactate levels to release norepinephrine, a major excitatory neurotransmitter.
LC and lactate levels play a role in sleep-wake cycles, appetite, emotions and respiration. Considering the multiple effects of norepinephrine in the brain as well as the fact that D-lactate is a competitive inhibitor of L-lactate, this may explain the symptoms of D-lactate acidosis, especially in individuals with gastrointestinal disorders.
Solutions for Chronic Health Conditions: Addressing Lactic Acid Buildup for CFS, POTS, Dysautonomia, IBS, SIBO, MS
Understanding lactic acid's role offers insights into managing chronic illnesses. Solutions involve:
Dietary Adjustments: Cutting simple carbs and adopting gut-friendly diets. Consider a ketogenic diet for 3-6 months to reconstitute the mitochondria.
Supplementation: High dose B1 in the fat-soluble forms and Vitamin B complex supplementation to address deficiencies.
Gut Healing Protocols: Restoring gut balance through targeted interventions.
Stress Management: Implementing stress reduction techniques for overall well-being and nervous system regulation.
Comprehensive Treatment: Employing detoxification strategies, chelation and probiotic-building protocols for holistic healing.
By comprehending lactic acid's impact and addressing its buildup, individuals with chronic illnesses can embark on a path to improved health and well-being. Through targeted interventions and holistic approaches, we pave the way for optimal health and wellbeing.
Lactic Acid Buildup vs. Lactic Acidosis
Lactic acid buildup and lactic acidosis are often confused but are two different conditions.
Understanding Lactic Acid Buildup
During intense exercise, muscle cells produce lactic acid due to anaerobic glycolysis, leading to an increase in blood lactate levels and temporary muscle soreness. This lactic acid buildup is typically harmless and subsides with rest.
In contrast, lactic acidosis is a serious medical condition characterized by high levels of lactate in the blood, resulting from impaired lactate clearance or excessive production. Causes of lactic acidosis include severe infections, certain medications like metformin, and conditions that reduce oxygen levels, leading to an anion gap metabolic acidosis.
Recognizing and Managing Lactic Acidosis
Symptoms of lactic acidosis may include rapid breathing, confusion, and abdominal pain, and it is diagnosed via a lactic acid test showing elevated serum lactate levels.
Unlike transient lactic acid buildup from exercise, lactic acidosis requires immediate medical attention or dietary interventions to address the underlying cause and prevent complications.
References:
Van Hall, G. (2010). Lactate kinetics in human tissues at rest and during exercise. Acta Physiologica, 199(4), 499–508.
https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-September-15.pdf