Why Supplementing With Probiotics May Make You Ill – Part 4: D-lactate

Why Supplementing With Probiotics May Make You Ill – Part 4: D-lactate

Many people with digestive issues cannot tolerate probiotics. Some people mention that when they ingest probiotics, their brain fog worsens. Does the increase of cognitive issues from ingesting probiotics occur only from immune system up-regulation and die off, or could it be caused by something else? Increased D-lactate production might be your issue.

What is the Difference Between L-lactate and D-lactate?

Lactic acid bacteria in our gut produce both forms of lactate from carbohydrate fermentation.

L-lactate is produced in our body from lactic acid bacteria in our microbiome and is a natural byproduct produced during the Kreb’s cycle for metabolism. L-lactate is also up-regulated during exercise because of the increased need for mitochondrial energy and oxygen to support our muscles. L-lactate is oxidized back into glucose by our liver and is further used for energy production by our body. Finally, our brain can metabolize lactate for energy.1 2 3

D-lactate is produced in minute concentrations in human metabolism via the methylglyoxal pathway that converts acetone derivatives to glutathione. Larger quantities of D-lactate are only produced by lactic acid producing bacteria in our microbiome and by ingestion of substances that metabolize into D-lactate including propylene glycol. Usually, our body has little issue with the usual amounts of D-lactate that are produced by lactic acid bacteria that live within our gut. Minute amounts are produced by these bacteria unless there is a significant dysbiosis or severe carbohydrate malabsorption. D-lactate can be metabolized into pyruvate by our liver and kidney’s (by the enzyme D-2 hydroxy acid dehydrogenase) and what is left is eliminated in our urine by our kidney’s and in our stool. The main issue associated with D-lactate metabolism is that our body is slow in metabolizing it and if its concentrations increase quickly or in large amounts before we can metabolize it, toxicity occurs.4 5 6 7 8

Leaky Brain/Gut Worsens Symptoms

D-lactate acidosis does exist in medical literature but is an infrequent occurrence. It is documented to occur in short bowel syndrome, a medical condition where carbohydrate malabsorption occurs from the absence of the small intestine causing overgrown of lactic acid bacteria. It is also documented in people who have had a roux-en-y gastric bypass performed. Increased D-lactate production over time by D-lactate producing bacteria, combined with leaky gut and overburdened kidneys and liver creates lactic acidosis. Symptoms of D-lactate acidosis include:9 10 11 12 13

  • Altered mental status
  • Ataxia
  • Brain fog (cognitive issues)
  • Coma
  • Confusion
  • Delirium
  • Fatigue
  • Headaches
  • Memory loss
  • Reduction of mitochondrial function (fatigue, weakness)
  • Respiratory issues and failure
  • Slurred speech (dysarthria)
  • Syncope
  • Violent behavior

D-lactate acidosis has been diagnosed in people who have kidney and liver disease as well. D-lactate acidosis has also rarely been diagnosed in people suffering from severe leaky gut and in people diagnosed with IBD (inflammatory bowel disease).14

Is it possible for people who ingest D-lactate producing probiotics or fermented food that contains lactic acid bacteria to develop elevated D-lactate and cause issues similar to lactic acidosis? Possibly, if they have severe enough leaky gut and brain that allow the d-lactate to cross the intestinal barrier, not be metabolized by the liver, and cross the blood-brain barrier into the brain.15

Most of the studies, however, with D-lactate acidosis and SBS (short bowel syndrome) show that it takes awhile for the body to build up enough D-lactate from excessive carbohydrate fermentation to cause severe notable health issues. In most cases, the kidney’s and liver can metabolize normal amounts of D-lactate quick enough to reduce concentrations of it in the bloodstream before it causes issues. Finally, severe leaky gut and brain would also need to occur for side effects of excessive buildup D-lactate in the bloodstream to become symptomatic.16 17 18 19 20

Reduction of short-chain fatty acid production has been theorized in people with D-lactate producing dysbiosis which may contribute to the development of leaky gut. The short chain fatty acid butyrate is a potent anti-inflammatory agent which is produced by the probiotic microbiome. Butyrate feeds cells that make up the epithelium of the colon known as colonocytes, which improve the integrity of our gut junctions and reduce leaky gut. The reduction of short-chain fatty acid’s is also hypothesized to cause a reduction of neurotransmitters and propionic acid being produced by the gut microbiome causing motility issues and poor mitochondrial health.21

Many people have adverse side effects from ingesting probiotics that produce D-lactate. Bacteria that produce D-lactate include:22 23

  • Enterococcus faecalis
  • Lactobacillus acidophilus
  • Lactobacillus bulgaricus
  • Lactobacillus delbrueckii subsp lactis
  • Lactobacillus johnsonii
  • Lactobacillus fermentum
  • Lactobacillus plantarum
  • Lactobacillus reuteri
  • Leuconostoc
  • Pediococcus
  • Oenococcus
  • Weissella

Avoidance of the use of intravenous Ringer’s lactate might be useful as well since some formulations contain minute amounts of D-lactate. Finally, I would avoid the ingestion of anything containing propylene glycol if you believe you are suffering from D-lactate metabolism issues because it is metabolized into lactic acid by the body by the enzymes alcohol dehydrogenase and aldehyde dehydrogenase for detoxification.24

So What Might be Done to Relieve D-lactate acidosis?

Enhancing the metabolism of D-lactate may help improve symptoms. Pyruvate derived from glucose is metabolized into lactate by the enzyme lactate dehydrogenase during anaerobic glycolysis. Pyruvate can also be metabolized into acetyl CoA by pyruvate dehydrogenase to produce adenosine triphosphate during aerobic glycolysis later. Lactate can also be metabolized into pyruvate as well. The B vitamin thiamine (vitamin B1) functions as a cofactor in mitochondrial oxidative decarboxylation, converting pyruvate to acetyl-CoA and α-ketoglutarate to succinyl-CoA for use in the citric acid (Krebs) cycle. In the absence of thiamine, pyruvate cannot enter the Krebs cycle and, instead, is converted to lactic acid. Oral or intravenous supplementation of thiamine may help favor the production of pyruvate instead of lactate, reducing the bodies load of lactate and improving energy by enhancing adenosine triphosphate production and mitochondrial function.25

In addition, severe reduction of dietary carbohydrates might be necessary for a short period to reduce the amount of lactate being produced by our body (through glycolysis) and microbiome. An extremely low carbohydrate diet (no more than ten grams daily) only consisting of meat, healthy sources of fat (pastured butter, ghee, extra virgin coconut oil, and extra virgin olive oil), herbs and spices, and low FODMAP and oxalate (dietary oxalates inhibit D-2 hydroxy acid dehydrogenase) vegetables might be needed to reduce the amount of lactate produced by the body and reduce its overall load. Diets that are very low in carbohydrates may worsen certain health issues and should be monitored by a health care professional. People who are suffering from adrenal fatigue or diabetics that are prone to ketoacidosis (which is seen in people suffering from D-lactate acidosis). I also do not recommend the ingestion of fermented foods in people with D-lactate metabolism issues which can increase overall lactic acid burden by the body.26 27

Maintaining proper hydration also helps improve the clearance of lactate by the kidneys.

Peoples sensitivities from ingesting D-lactate producing strain probiotics, however, might stem from other issues besides D-lactate sensitivity. However, if you suffer from headaches, brain fog, or fatigue when ingesting D-lactate producing probiotic strains, I would avoid them and search out a D-lactate free probiotic. Finally, if you are suffering from D-lactate metabolism issues I would recommend getting a microbiome test performed like GI MAP to know the contents of your microbiome and consulting with me to resolve your health issues.

  1. https://secure.megazyme.com/files/Booklet/K-DLATE_DATA.pdfhttps://secure.megazyme.com/files/Booklet/K-DLATE_DATA.pdf
  2. http://www.sciencedirect.com/science/article/pii/S0014579308007783
  3. http://www.sciencedaily.com/releases/2014/02/140211084053.htm
  4. http://www.mommypotamus.com/popular-probiotic-strain-may-induce-neurotoxicity/
  5. http://ajpendo.physiology.org/content/293/2/E558.full
  6. http://www.hindawi.com/journals/grp/2015/476215/
  7. http://www.ncbi.nlm.nih.gov/pubmed/16306301
  8. http://ndt.oxfordjournals.org/content/26/4/1432.full
  9. http://www.mommypotamus.com/popular-probiotic-strain-may-induce-neurotoxicity/
  10. http://ajpendo.physiology.org/content/293/2/E558.full
  11. http://www.hindawi.com/journals/grp/2015/476215/
  12. http://www.ncbi.nlm.nih.gov/pubmed/16306301
  13. http://ndt.oxfordjournals.org/content/26/4/1432.full
  14. http://ajpendo.physiology.org/content/293/2/E558.full
  15. http://ajpendo.physiology.org/content/293/2/E558.full
  16. http://www.mommypotamus.com/popular-probiotic-strain-may-induce-neurotoxicity/
  17. http://ajpendo.physiology.org/content/293/2/E558.full
  18. http://www.hindawi.com/journals/grp/2015/476215/
  19. http://www.ncbi.nlm.nih.gov/pubmed/16306301
  20. http://ndt.oxfordjournals.org/content/26/4/1432.full
  21. http://ajpendo.physiology.org/content/293/2/E558.full
  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570418/
  23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155354/
  24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853765/
  25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865064/
  26. https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-September-15.pdf
  27. https://www.hindawi.com/journals/grp/2015/476215/
  1. Hi. I appreciate the section on relieving D-lactate acidosis. So I understand that thiamine can assist with this but what other supplements can one use to reverse this D-lactate acidosis state? You mention some things about pyruvate, etc. in the opening sentences of that section, but I’m not quite sure what we should be looking for in terms of supplements there. Are there any supplements besides thiamine that you would recommend to reverse this D-lactate acidosis state? I would very much appreciate your thoughts.

  2. Do we know of any pathogenic strains that also produce D Lactic acid?

  3. Hello John.
    Thanks for your work.
    Could you recommend me probiotics that are d-lactate free?

  4. Are L Plantarum and L Paracasei D-Lactate free?

  5. Hi John, is there any particular protocol that you suggest for someone who has an overgrowth of D-Lactic Acid bacteria? Thanks.

    • See updated blog for recommendations.

      • Thanks John. Any suggestion for a specific anti-bacterial/anti-microbial agent?

        If this could help, my condition started after various rounds of antibiotics and subsequent use of high potency probiotics (VSL #3 and Elixa amongst others), and got far worse recently after I ate sauerkraut daily for a couple of weeks.

  6. Would it be wise to just get the GutPro without d-lactate, if you’re not sure what exactly your issue is?

  7. Hi – bit late to respond here but I am having disturbing reactions to GutPro. I have my kids on it and so far, they seem fine, but I have tried it twice now and it appears to cause severe symptoms. For the record, I’ve started with a tip of the ‘drop’ serve and I only need one or two days of that and I react. Symptoms include general increase of CFS symptoms – weakness and aggravation of nervous system or adrenals so more weak and shaken type feelings but also very distinct perhaps neurological reaction where my head feels woozy and spacey and like it’s floating – massive increase in anxiety and feelings of derealisation. It’s hard to believe I’m getting all this from a tiny amount of this product but it does appear to be the culprit. Any thoughts?

    • Hi Yana,

      I am experiencing something similar after taking probiotics. Did it eventually go away? How long did it take? I recently had a negative breath test for SIBO and am in the healing process. I am worried I have SIBO again as the bloating is terrible along with the symptoms you describe.

    • It could range from an elevation of Th1/Th2 cytokines to die off. I doubt it is D-lactate issues, but GutPro does contain Lactobacillus plantarium which can cause D-lactate issues. Probiotics are medicine and even the best one can trigger differing reactions in people. If you are having this reaction to a probiotic that is so severe it is probably best to discontinue it, do research on Th1/Th2/Th17 and maybe try individual strains of probiotics and see how you react to them.

  8. Hi, thanks for this article!

    I just wanted to point out that “which include the strains, Lactobacillus acidophilus, L. bulgaricus, L. fermentum, and L. delbrueckii subsp lactis.” – none of these are strains. Those are the genus and species.

    • Correct, but I thought in low level taxonomy strains are species? Lactobacillus is the genus, acidophilus is the species, both together are the individual strain?

  9. Hi John,

    Are you able to recommend probiotics that are d-lactate free?

  10. Hi! I have this exact issue. I had many antibiotics that contributed to gut dysbiosis then decided to consume coconut keifer which was lactic acid lactobacillus galore! Now I struggle with SEVERE lactic acid build up! I take bifido bacteria to hopefully one day starve off some of those lactobacillus bacteria but do you have any pointers on how I can do this with a quickness?

    • Why not you take some diluted ceylon cinammon oil and lactoferrin to see if it will reduce the Lacto overgrowth and then rebuild your gut from there? Of course ask your doctor first. Lacto live in the upper gut and Bifido in the colon so taking them probably will not do much.

  11. John, you mention

    “Reduction of SCFA production has been theorized in people with d-lactate overgrowth which may contribute to the development of leaky gut. The reduction of SCFA is also hypothesized to cause a reduction of neurotransmitters and ATP being produced by the gut microbiome causing neurological and lack of energy symptoms.21”

    I am wondering, is the the solution to then increase SCFA? And how might I go about doing this? Is there an optimal diet that includes necessary foods for this to occur, and are there certain kinds of foods that one would definitely want to avoid to fix an issue like this? Thank you so much for any insight.

  12. Is Bifidobacterium lactis the same as d or l lactate?

  13. I never had a problem taking my non dairy probiotic. After a few years of not taking I took some and within seconds my head felt like it was not my own and i felt really ill, had to lie down. every now and again i try them if my tummy is upset/gurgling and instantly the same. Last time i ate some fresh mango right away when i felt so ill and the symptoms started to calm down. Do you think this is Herx? If it’s a non dairy probiotic there shouldn’t be a problem with D-L. Interestingly the ingredients list a bulking agent and i’m wondering if this contains gluten.

  14. Wow, what a complex issue! Hard to know if these probiotics are causing die-off symptoms or d-lactate acidosis.

  15. Would be L-lactic acid safe to drink in such products as molkosan?

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