A masterclass in lactate: Its critical role as metabolic fuel, implications for diseases, and therapeutic potential from cancer to brain health and beyond | George A. Brooks, Ph.D.

Peter Attia

Aug 5, 2024

Episode description

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George A. Brooks is a renowned professor of integrative biology at UC Berkeley. Known for his groundbreaking "lactate shuttle" theory proposed in the 1980s, George revolutionized our understanding of lactate as a crucial fuel source rather than just a byproduct of exercise. In this episode, George clarifies common misconceptions between lactate and lactic acid, delves into historical perspectives, and explains how lactate serves as a fuel for the brain and muscles. He explores the metabolic differences in exceptional athletes and how training impacts lactate flux and utilization. Furthermore, George reveals the significance of lactate in type 2 diabetes, cancer, and brain injuries, highlighting its therapeutic potential. This in-depth conversation discusses everything from the fundamentals of metabolism to the latest research on lactate's role in gene expression and therapeutic applications.

We discuss:

Our historical understanding of lactate and muscle metabolism: early misconceptions and key discoveries [3:30];
Fundamentals of metabolism: how glucose is metabolized to produce ATP and fuel our bodies [16:15];
The critical role of lactate in energy production within muscles [24:00];
Lactate as a preferred fuel during high-energy demands: impact on fat oxidation, implications for type 2 diabetes, and more [30:45];
How the infusion of lactate could aid recovery from traumatic brain injuries (TBI) [43:00];
The effects of exercise-induced lactate [49:30];
Metabolic differences between highly-trained athletes and insulin-resistant individuals [52:00];
How training enhances lactate utilization and facilitates lactate shuttling between fast-twitch and slow-twitch muscle fibers [58:45];
The growing recognition of lactate and monocarboxylate transporters (MCT) [1:06:00];
The intricate pathways of lactate metabolism: isotope tracer studies, how exceptional athletes are able to utilize more lactate, and more [1:09:00];
The role of lactate in cancer [1:23:15];
The role of lactate in the pathophysiology of various diseases, and how exercise could mitigate lactate's carcinogenic effects and support brain health [1:29:45];
George

Mindsip insights from this episode:

Utilize lactate shuttle to fuel muscle performance

Through the 'cell-cell lactate shuttle,' fast-twitch muscle fibers produce lactate that is immediately shuttled to and consumed by adjacent slow-twitch fibers as fuel.

#lactate

#muscle

Double mitochondrial mass through consistent training

Consistent training can double the mitochondrial mass within your muscle cells, dramatically increasing your capacity to clear lactate and produce energy.

#exercise

#mitochondria

Utilize lactate from exercise to suppress appetite

Lactate produced during exercise crosses the blood-brain barrier and works in the hypothalamus to suppress the hunger hormone ghrelin, which is why you may not feel hungry after a hard workout.

#appetite

#lactate

Utilize intravenous lactate infusion to support traumatic brain injury recovery

Intravenous lactate infusion is a potential therapy for traumatic brain injury (TBI) because the injured brain prefers lactate as a fuel source over glucose.

#brain

#lactate

Understand lactate's role in blocking fat burning during intense exercise

During intense exercise, lactate shuts down fat metabolism by inhibiting the transporters (CPT1/2) that allow fatty acids to enter the mitochondria.

#lactate

#metabolism

Utilize lactate as primary mitochondrial fuel for energy

Contrary to textbook teachings, lactate is a preferred fuel that enters mitochondria directly to be used for energy, a process enabled by transporters on the mitochondrial membrane.

#lactate

#mitochondria

Utilize lactate to modify gene expression through lactylation

In a process called 'lactylation,' lactate can directly bind to histones to alter gene expression, potentially explaining some of the long-term adaptations to exercise.

#genetics

#lactate

Leverage Metformin to enhance glucose conversion into lactate

The rise in lactate from taking Metformin may be a beneficial mechanism where the drug encourages your gut to convert glucose into lactate, a more easily utilized fuel.

#lactate

#metformin

Utilize gut's conversion of sugar to lactate for quick energy

After you eat carbohydrates, your gut immediately converts some glucose into lactate, which enters the bloodstream as a rapid energy source even before your blood glucose rises.

#gut

#lactate

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