by Katherine Brind’Amour, PhD
Lactic acidosis happens when there is too much lactate in your blood. This makes the blood too acidic, which causes the condition’s telltale symptoms: nausea, exhaustion and muscle cramps. In most cases, symptoms go away once your body breaks down the lactate.
Lactic acidosis is most often caused by intense exercise. (1) However, people with other health problems or those who take certain medications can also develop the condition. Left untreated, lactic acidosis can increase the risk of death. (2) Thankfully, most cases are easily treated and can be prevented. (3) Follow the advice below to avoid lactic acidosis or help your body recover.
What Is Lactic Acidosis?
Normally, oxygen in your blood breaks down glucose (sugar) to turn it into energy. When there is not enough oxygen in your blood to break down the glucose for energy, your body makes lactate instead. (4) Lactate can be converted to energy without using oxygen. However, if your body can’t break the lactate down fast enough, it builds up in the blood, causing lactic acidosis. (1)
Is lactic acidosis dangerous?
In most cases, lactic acidosis happens because of intense exercise. It just means you need to stop whatever activity you’re doing and rest. (4) The symptoms go away as your body catches up with itself and breaks down the extra lactate.
In people with lactic acidosis due to medication or other health problems, the condition usually goes away once the underlying cause is addressed. However, lactic acidosis can be very dangerous if you ignore it or if you have certain health problems. In critically ill people (for example, people in septic shock or people who just had a heart attack), lactic acidosis makes death more likely. (2)
Signs & Symptoms
What are the symptoms of lactic acidosis?
The most common lactic acidosis symptoms include: (3, 4)
- Feeling extremely weak or tired
- Cramped or burning muscles
- Nausea or belly pain
- Feeling physically unwell or uncomfortable
- Loss of appetite
- Shortness of breath
- Fast heartbeat
Acidosis symptoms usually develop quickly (for example, during or right after after intense exercise). However, they can also begin and get worse over the course of several days. The above symptoms may not be present in everyone with lactic acidosis. Depending on the underlying cause of the acidosis, signs and symptoms can vary. (2)
For example, in people with diabetes, fruity-smelling breath may be a symptom of ketoacidosis, a disease complication. In others, confusion, jaundice or difficulty breathing may be the only signs of acidosis. (3) If you have any of these rarer symptoms, seek emergency care.
Causes & Risk Factors
What causes lactic acid to be high?
Lactic acidosis is a form of metabolic acidosis. This just means that it is caused by the body’s inability to break down (metabolize) enough of a type of acid (lactate). As it accumulates in the body, the acid can actually change the pH of body fluids and tissue, including the blood. Causes of metabolic acidosis vary by the metabolism-related body process affected.
Causes of lactic acidosis
Lactic acid buildup (really, lactate buildup) occurs for one (or both) of two main metabolic reasons: (5)
- The body makes too much lactate (usually because there’s not enough oxygen in the blood).
- The body can’t clear lactate quickly enough (usually because of a drug or underlying disease).
These causes may also be classified as hypoxic (not enough oxygen) and non-hypoxic (oxygen isn’t the issue). (2)
Causes of lactic acidosis related to not having enough oxygen include: (2)
- Intense exercise
- Respiratory failure
- Heart attack or heart disease
- Carbon monoxide poisoning
- Severe asthma or other breathing problems, such as COPD or suffocation
- Severe anemia
Causes of lactic acidosis not related to how much oxygen is in your blood include: (2, 3)
- A problem metabolizing lactic acid caused by your genes
- Liver damage or failure (also known as cirrhosis)
- Kidney disease or failure
- Thiamine deficiency
- Diabetic ketoacidosis
- Seizures or epilepsy
- Short bowel syndrome or former gastric bypass
- Antiretroviral medicines, like the ones used for people with AIDS
- Frequent use of acetaminophen
- Metformin, a medicine used for people with type 2 diabetes
- Please note: This is controversial. A review of over 200 trials did not find that metformin actually increased lactic acidosis rates. (6) Any apparent increase in risk may actually be caused by diabetes or common diseases that people with diabetes also have, such as heart disease or kidney problems. Many reputable sources still cite metformin use as a risk factor, since overdoses can cause lactic acidosis. However, experts usually acknowledge that in most cases the risk is still so low that it’s still appropriate to use the drug to prevent diabetes complications that are far more common than lactic acidosis. (7)
You are more likely to experience lactic acidosis if you: (3, 6)
- Exercise intensely or for a long time, especially if you do not regularly exercise
- Have congestive heart failure, cancer, low blood sugar, liver disease, or kidney failure
- Drink a lot of alcohol on a regular basis
- Take antiretrovirals, metformin, or acetaminophen
Lactic acidosis treatment typically involves just treating the underlying cause. (2) In healthy people who experience symptoms of lactic acidosis from intense exercise, no treatment is usually needed, beyond rest and hydration. (4)
In people with other diseases, however, lactic acidosis may go away when the illness that leads to the buildup of lactate gets treated. (2) For example, if lactic acidosis is caused by severe infection after an operation, treatment may involve antibiotics, wound cleaning and drainage of the surgical site. Similarly, if cancer causes the problem, chemotherapy or radiation may be used to treat the tumor. If antiretroviral drugs cause acidosis in patients with AIDS, a doctor may change or stop the drug.
There are no medications that treat lactic acidosis in all ill people. Depending on the cause, treatment varies. For example, acidosis caused by poisoning or problems with the kidney or heart may benefit from dialysis. Other drugs that may be offered, depending on the suspected cause, include sodium bicarbonate, dichloroacetate, and carbicarb. (8)
In emergency cases, the immediate goal is to help get the body enough oxygen. This may involve giving resuscitation, putting the patient on an oxygen machine, giving fluids or disease-specific drugs directly into a vein (via an IV), monitoring the heart, and identifying the underlying cause as quickly as possible. (8) In these cases, patients are usually admitted to the hospital until the cause can be identified and treated.
4 Natural Ways to Recover from Exercise-Induced Lactic Acidosis
If you are healthy and have lactic acidosis caused by exercise only, you can recover safely at home. (8) Your goals should be to get enough oxygen, rest, and get hydrated. If your symptoms don’t go away after you have stopped and rested, get help from a medical professional. (4)
Do controlled breathing exercises
Controlled breathing exercises can improve the amount of oxygen in your blood. If you have lactic acidosis caused by exercise, “warm down” or slowly stop what you are doing to rest. (4) Avoid short, shallow breaths and focus on slowing your breathing. (10) Once you have regained your ability to control your breathing:
- Try pursed lip breathing. This technique is often taught to help people with chronic obstructive pulmonary disease to improve their shortness of breath. You can use the technique to slow your breathing down and get your oxygen levels up: (11, 12)
- Breathe in through your nose for two counts, keeping your mouth closed.
- Purse your lips as if you are going to blow out a candle. Breathe out of your mouth over a count of four.
- As you relax, you can increase how long you take to breathe in and out. However, you should always take longer to breathe out than in.
- Practice diaphragmatic/belly breathing. Once your body is relaxed, try sitting or lying down. Belly breathing can help you focus on using your diaphragm to pull more air into your lungs. (13) It can also decrease how much air you need to pull in to get enough oxygen. (14)
- Put one hand on your upper chest and the other on your belly just below your ribs.
- Breathe through your nose, slowly pulling the air in. As you breathe in, your belly should rise, pushing against your hand. The hand on your chest shouldn’t feel much movement at all.
- Gently tighten your stomach muscles to help push the air out through your lips. Keep your lips pursed as in the pursed lip exercise. Again, your chest should be still as possible.
Get fresh air
Areas with a lot of carbon monoxide, fumes and other chemicals in the air can make it hard for your body to get enough oxygen, even at rest. (15, 16, 10) Find an area with clean, fresh air. If you do not have access to healthy outdoor areas that are free of vehicle emissions or gas fumes, find a space indoors that has plants and/or an air filtration system. (17, 18)
Drink plenty of fluids
Dehydration can create many problems for your body, particularly when you exercise intensely. Without enough fluid, you may experience kidney problems, seizures, and low blood volume. (19) All of these problems can lead to a lack of oxygen and lactic acidosis (and many other problems!).
If you did not drink enough liquid before exercising, start rehydrating to help your body recuperate. A well-hydrated body has an easier time carrying oxygen to cells. Try these simple ways to hydrate after intense exercise: (19)
- Drink water and natural fruit and vegetable juices or smoothies. Fresh fruit and vegetable juices have the added benefit of vitamins, minerals and antioxidants. (9)
- Try an electrolyte drink. These contain a lot of sugar but may help your body balance electrolytes that can get out of whack during intense exercise.
- Eat foods high in water, such as melon, citrus, peaches, tomatoes, lettuce, celery, and other fruits and vegetables. The extra fluid will help your body carry nutrients and oxygen where it needs to go. (9)
Avoid drugs and alcohol
While you are recuperating from lactic acidosis of any cause, it is important to avoid alcoholic drinks and drugs, such as cigarettes. Not only can drug use, overdose, or alcoholism cause lactic acidosis, but having drugs and alcohol in your system means your liver and kidneys may break down the excess lactate more slowly. As your body breaks down alcohol, it makes even more lactate as well. (20) This means that you will recover more slowly with these in your system, even if you just have lactic acidosis caused by exercise.
7 Ways to Prevent Lactic Acidosis
There are ways people can minimize their chances of a lactic acidosis diagnosis. Furthermore, exercise-related lactic acidosis is almost always preventable. By following the steps below, you may be able to reduce your chances of experiencing this condition.
Manage other health problems
For people with certain diseases, such as cancer or diabetes, lactic acidosis may seem to come from out of the blue. It can happen when your body is fighting a serious health problem. (2) In these cases, there is very little you can do to prevent the lactic acidosis, other than managing your other known health conditions. Even then, lactic acidosis is rare, and among people with other illnesses it may be impossible to predict and very hard to prevent.
That being said, doing what you can to safeguard your health can keep your body functioning better, which can in turn reduce your chances of lactic acidosis. Because the problem arises in people with liver and kidney problems, respiratory and heart failure, and other health conditions, and those taking antiretroviral drugs, you can know that you are at higher risk. Talk to your doctor about steps you can take to keep your health on track. The better your organs work and the healthier you keep yourself with your underlying conditions, the less likely you are to develop lactic acidosis. (2)
Gradually build up to intense workouts
Most people with lactic acidosis just pushed their body too hard during a workout. To prevent this from happening, build up your exercise tolerance.
- Start slowly with any new regimen and increase the intensity or duration of your workout each week. This helps your body increase its “lactate threshold” — your ability to get enough oxygen to your cells without lactate build-up. (4)
- Endurance training will also help you build up your body’s ability to deliver oxygen to your muscles during workouts. (21)
- Do high-intensity aerobic endurance training in intervals to get the best improvement in how much oxygen you can take in and deliver to your muscles. (22, 23)
- You should rest well between each workout and get plenty of sleep at night. (4) This allows your body to recover so that you have your full strength for the next bout of activity.
Practice effective breathing techniques
How you breathe can be very important. Different breathing techniques can change how much oxygen you have in your bloodstream. These techniques can help you be more aware of your breathing so that you focus on controlling your breathing during exercise, too. They can also strengthen your diaphragm to make it easier for you to get enough air when you breathe.
- Slow yogic breathing exercises can improve blood oxygen and decrease blood pressure. (24)
- Slow, steady breathing (rather than fast, shallow breaths) during exercise is also more effective at preventing a lack of oxygen. (25) If you cannot catch enough breath to speak a few words at a time while you are exercising, you are pushing yourself too hard. Focus on slowing your breathing down by breathing in through your nose and out through pursed lips.
- Practice respiratory muscle training (RMT). This technique does not improve oxygen circulation but does improve sports performance, possibly because it may help you delay feeling out of breath. (26)
Use a pulse oximeter during exercise
Perhaps the simplest way to know if you’re getting enough oxygen is to simply track it! Pulse oximeters tell you what your oxygen saturation is in your blood. (27) According to experts at the National Academy of Sports Medicine, if your levels drop below 85 percent saturation, you should stop exercising. Levels between 85 and 90 percent are acceptable, but 90 percent saturation or higher is better. (26)
According to the American Council on Exercise, having enough fluid in your body helps remove metabolic waste that your body makes during intense exercise. But having enough fluid in your body starts before the workout. Not only does it help your body transport the oxygen it needs, but it also keeps your blood pressure and body temperature in a healthier range. The American Council on Exercise recommends this hydration protocol: (28)
- Drink 17–20 ounces of water two to three hours before you exercise
- Have another eight ounces of water 20 to 30 minutes before you exercise
- Drink seven to 10 ounces of water every 10 to 20 minutes during your workout
- Finish with another eight ounces of water 30 minutes after you’re done working out
Eat a diet to support blood oxygenation
The main way to increase blood oxygen levels by eating is to help your body build healthy hemoglobin, which pick up oxygen and carry it throughout your body. (29)
Consider these dietary approaches to boosting your hemoglobin and thereby the availability of oxygen: (29)
- Eat foods rich in the building blocks of hemoglobin: iron, vitamin C, and folic acid
- Iron-rich foods include liver meats, beef, lentils, dark chocolate, leafy greens, black beans, raisins and nuts. Other good sources include oysters, tofu, turkey, tuna, eggs, shrimp, lamb, brown rice, and blackstrap molasses. (30)
- Vitamin C-rich foods include tropical fruits like guava, mango, pineapple and papaya, as well as citrus fruits, parsley and kale, broccoli, strawberries, red and green peppers, black currant, peas, Brussels sprouts and cauliflower.
- Foods rich in folate (folic acid) include chickpeas, beans, black-eyed peas, and lentils. High levels of folate can also be found in spinach and other leafy greens, beets, liver, avocado, and broccoli. Many cereals and processed grains also have added folate.
- Eat iron-rich foods and vitamin C-rich foods at the same time so that your body can use them most effectively. (30)
There have been many fad diets and gimmicks claiming to increase oxygen in the blood by consuming it in various forms. However, there is some research that suggests certain supplements may be helpful in boosting oxygen in the blood or exercise-related health in general.
- A study in rats with high cholesterol found that coenzyme Q10 helped improve respiratory control and liver function. (31)
- Nitrate (NO3-, found in spinach and beet roots or beet juice, or in supplement form), has been linked to improved oxygen delivery in rats (32) and, in sodium nitrate (NaNO3) form, to lower resting metabolic rates in humans. (33) In another study, after six days of drinking beetroot juice (with 0.07 mmol nitrate per kilogram of body weight per day), researchers found the juice supplement improved muscle oxygenation during workouts compared to people who did not have the beetroot juice. (34) It is possible that a diet rich in nitrate-heavy vegetables or a sodium nitrate supplement could improve oxygen circulation in the blood, as well as how long you are able to exercise before you feel exhausted. (35, 36)
- A study of humans taking L-carnitine L-tartrate supplements found that the supplement did not help improve muscle oxygenation (in fact, it seemed to reduce it). However, the study found that it did help hold off damage to cells. (37) The researchers proposed that the supplement (also called LCLT) might improve how the muscles use oxygen, since it stopped damage to the muscles even when there didn’t seem to be much oxygen available.
- Iron supplements and an iron-rich diet may help athletes (women in particular) maintain high-enough levels of hemoglobin to keep up their exercise performance. (38) In a study of female athletes with iron-deficiency anemia, iron supplements improved their blood oxygenation after two months. (39) Women with iron deficiencies may improve their blood oxygenation and how long they can exercise by taking an iron supplement. (40, 41)
- Magnesium supplements may help reduce lactate production during physical activity. (42) This may hold off the accumulation of lactate that causes symptoms of lactic acidosis during exercise.
- Sodium phosphate supplements may also improve exercise duration in athletes. (43)
You should always speak with a health professional before adding a supplement to your regimen. Supplements can interact with other medications and health conditions.
If you experience the symptoms of lactic acidosis and you have not been exercising, seek medical help immediately. If you are healthy and have been exercising, but do not feel better after resting, call a doctor for advice or seek medical attention.
As always, it is essential to speak with a health care professional about any changes to your diet, exercise routine, medications, or supplements. This is particularly important if you have health problems or if you take prescription medications.
Lactic Acidosis Key Points
- Lactic acidosis is caused when the body either makes too much lactate or cannot clear it from the blood fast enough.
- The condition can be caused by a lack of oxygen, problems with the liver or kidneys, certain medications, and many health conditions. Its most common cause is intense exercise.
- Lactic acidosis goes away quickly without treatment in healthy people who exercised too hard, but it can increase the risk of death in people who are already ill.
- Immediately seek medical help if you have another health condition and you experience symptoms of lactic acidosis.
4 Tips to recover from exercise-related lactic acidosis
- Doing controlled breathing exercises
- Getting fresh air
- Drinking plenty of fluids
- Avoiding drugs and alcohol
You can also give yourself the best chances at preventing lactic acidosis by doing the following:
- Manage other health problems
- Gradually build up to intense workouts
- Practice effective breathing techniques
- Use a pulse oximeter during exercise
- Stay hydrated
- Eat a diet to support blood oxygenation
- Consider supplements
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