For those of you who made it through my mammoth post of last week, re: d-lactate acidosis…well done! (For those of you who skipped it, you’re going to fail the pop quiz.)
I have spent even more time on this, looking more into studies that have been done regarding treatment. There’s not a whole lot out there. But here are a couple of interesting tidbits:
A case study was literally just published in Pediatrics, the most eminent journal in the field. How’s that for an amazing coincidence?! The authors describe a child with short bowel syndrome and recurrent D-lactate acidosis for whom antibiotic treatment only provided short-term relief. The researchers analyzed his stool for D-lactate producing Lactobacillus species and then started the child on a probiotic cocktail of species that don’t produce it. The child did not relapse while on the probiotics, and after a year, there was no further need for antibiotics. His stool reflected the change in bacterial species, with D-lactate producing ones disappearing after a few weeks.[i]
I also found another interesting case study from 2013. An adult patient with recurrent short bowel syndrome and D-lactate acidosis (with subsequent “neuralgic dysfunction”). Antibiotics had failed to stop the recurrence, so the patient was treated with a synbiotic product which consisted of Bifidobacterium breve, Lactobacillus casei, and the prebiotic, galactooligosaccharide (GOS). With the synbiotic treatment, serum D-lactate returned to normal and had no recurrence of the acidosis during the 3 years of follow up, even with no dietary restrictions.[ii]
I really have no idea what the incidence of D-lactate acidosis is, in general, in the chronic fatigue community, in the autism community, and so forth…I can’t find any statistics on it. But I do know that over the years, in talking to other parents of kids on the spectrum, that it’s not nearly as uncommon as it should be to hear tales of terrible reactions to probiotics. That, by the way, includes my own son. It was not until Alex had been on the Specific Carbohydrate Diet for at least 6 months that he was able to tolerate probiotic bacteria. In his early life, even the smallest amount would send him into bouts of frenetic head-banging.
I want to share this excellent blog post I just found on Mommypotamus. Here, the author points out that on a cellular level, “D-lactate buildup causes cellular metabolism of glucose to switch from an aerobic (oxygen-rich) process to an anaerobic (oxygen-deprived) process. In this oxygen-starved environment, cells are unable to produce adequate amounts of adenosine triphosphate (ATP), which is needed for the synthesis, degradation and ‘firing’ of neurotransmitter molecules. Low ATP can affect cognitive function, create feelings of fatigue and impair coordination among other things.”[iii]
In one of the papers mentioned in her post, there is reference to a paper from 1998 in Medical Hypothesis which states (italics added for emphasis): “A likely etiological possibility may involve mitochondrial dysfunction with concomitant defects in neuronal oxidative phosphorylation within the central nervous system. This hypothesis is supported by a frequent association of lactic acidosis and carnitine deficiency in autistic patients.”[iv]
For those of you who think this might be a factor, there are several excellent d-lactate-free probiotics on the market. The one many of us autism moms used, and that I would typically recommend to my clients when I was practicing nutritional consulting, was made by Custom Probiotics.
[i] Yilmaz, B, Schibli, S, Macpherson, AJ, Sokolik, C. D-lactic acidosis: successful suprresion of d-lactate-producing Lactobacillus by probiotics. Pediatrics. 2018 Aug 8. pii: e20180337. doi: 10.1542/peds.2018-0337
[ii] Takahashi, K, Terashima, H, Kohno, K, ohkohchi, N. A stand-alone treatment for the prevention of D-lactic acidosis in short bowel syndrome. International Surgery. 2013:98(2):110-3. doi: 10.9738/CC169
[iv] Lombard, J. Autism: a mitochondrial disorder? Medical Hypothesis. 1009:50(6):497-500.