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Lactate – Is It Everywhere In Fibromyalgia And Chronic Fatigue Syndrome (ME/CFS)?
Thursday 3 March 2016
Lactate – Is it Everywhere in Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)?
Lactate (L-lactate) is an organic compound produced during anaerobic energy metabolism. It’s constantly being formed – even when we are at rest – but is formed in higher quantities when ATP levels are low and anaerobic energy metabolism is high. Several forms of lactate are also produced by anaerobic bacteria in the gut.
Lactate is not bad – it actually reduces muscle fatigue – but the presence of high levels of lactate (lactic acid) signal that the anaerobic energy production process – which produces toxic metabolites that cause pain and fatigue – is in full bore.
Lactic acidosis is a state of low pH accompanied by high lactate levels. It most commonly occurs in its temporary form after excessive exercise but is found in a more permanent form in people with illnesses which produce low oxygen levels (hypoxia/hypoperfusion) including heart or lung disease, sepsis, severe physical trauma, shock, Vit B deficiency, or interestingly enough, decreased blood volume. Symptoms include a burning feeling in the muscles, muscle weakness, rapid breathing, nausea and vomiting.
The question this blog asks is whether the processes that produce lactate/lactic acid levels could be causing pain, fatigue, cognitive and other symptoms in fibromyalgia and/or chronic fatigue syndrome.
First a look at the gut.
D-lactic acidosis is a different form of lactic acidosis caused by the production of D-lactate by bacteria in the gut. Two forms of lactate are produced in the gut. L-lactate in the gut is considered benign but the D-lactate hypothesis posits that D-lactate contributes to leaky gut problems. It proposes that once D-lactate gets into the blood it can push its way through the blood-brain barrier into the brain where it can cause neurological symptoms including feelings of panic, hyperventilation, delirium, ataxia and slurred speech.
Sleep Sci. 2015 Nov;8(3):124-33. doi: 10.1016/j.slsci.2015.10.001. Epub 2015 Oct 23.Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study. Jackson ML1, Butt H2,Ball M1, Lewis DP3, Bruck D1.
This study reported on the effects of using an antibiotic to reduce Streptococcus bacteria levels in 21 ME/CFS patients. Prior tests indicated that these patients – out of about 75 – had increased Streptococcus and/or Enterococcusbacteria. Streptococcus spp. tend to produce lactic acid, including the D-lactic form which has been associated with increased gut permeability.
After the 21 ME/CFS patients were given an antibiotic, erythromycin, to reduce the levels of lactic-acid producing bacteria in the gut, their sleep patterns were measured using an actigraph. Fecal samples were taken after the antibiotic.
Of the 21 ME/CFS with increased bacterial levels, tests indicated significant declines in Streptococcus spp. in a third. The patients with reduced Streptococcus spp. levels slept about 45 minutes longer each day and reported improved vigor. It was expected, given the results of other studies, that mood measures, in particular, anxiety might improve but that did not happen.
Antibiotic treatment alone was not sufficient to significantly alter the Streptococcus levels in the other ME/CFS patients, and increased sleep times or vigor were not seen in these patients.
Erythromycin – a broad spectrum antibiotic – also reduced Lactobacillus and Bifidobacterium levels in some patients – possibly putting their flora further out of balance.
The authors believed that the central finding of the study – that antibiotic treatments can reduceStreptococcus bacterial levels and improve sleep and vigor in someME/CFS patients – supported the D-lactate hypothesis. (They did not directly measure lactate levels in he blood or urine). Antibiotic treatment was not effective in lowering Streptococcus levels in most patients, however, and it may disrupt the flora of other bacterial species, including, presumably, some beneficial ones.
Several factors prevented the study from being definitive. It was small and because it was an open-label study, it was impossible to disentangle placebo effects from the effects of the antibiotic. Actigraphy is also unable to measure restorative vs non-restorative sleep.
(Antibiotics are not the only way to reduce levels of D-lactate producing bacteria in the gut. Galland reports a case of a man with short bowel syndrome and D-lactic acidosis for whom antibiotics and dietary restrictions failed. The use of two probiotics, Bifidobacterium breve Yakult and Lactobacillus casei Shirotaand the prebiotic galacto-oligosaccharide worked by limiting the growth of D-lactate producing bacteria.)
In fact several studies do suggest lactate may be causing problems in chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM). Sheedy’s 2009 study found that two species (E. faecalis and S. sanguinis) found in ME/CFS patients guts were high D-lactic acid producers.
The full article, with comments, can be found here.
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