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, MD** (0:11)
Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is George Brooks. George is a professor in the Department of Integrative Biology at UC Berkeley and is the Director of the Exercise Physiology Lab. You may recognize George's name as it's come up a couple of times in interviews with Inigo Sanmolan. I also wrote about George briefly in Outlive when I referred to his work in lactate. George was the scientist who first proposed the lactate shuttle theory in the 1980s, arguing that lactate was actually a fuel source rather than an unfortunate byproduct of exercise. His research has focused on the metabolic adjustments to exercise and explores many topics surrounding exercise physiology including the pathways and controls of lactate formation and removal before, during and after exercise. My conversation with George dives deep into all things lactate. It's a little bit technical, but again, not particularly egregious relative to the depth that we normally will cover things. But I do encourage you to stay with this even if at times it seems a bit heavy on the biochemistry. We probably start a little bit in that direction, but I promise it's a very fascinating episode. We obviously start with some semantics and definitions. We clear the air a little bit on the difference between lactate and lactic acid. We touch briefly on a historical discussion, looking back at the work of Meyerhoff and the early misconceptions around lactic acid and its role in muscle activity and fatigue. Talk about George's work, which highlights lactate's integral role in energy processes and not just merely as a waste product as I said a moment ago. We talk about the monocarboxylate transporters, and I learned quite a bit in this podcast because up until this point, I had no idea that the MCTs, as they're called, were also located on mitochondrial membranes. We talk about some misconceptions in the educational practices today, including what I learned, and basically discover a lot, at least for me, about the relationship between lactate in other disease states such as type 2 diabetes, cancer, and most surprisingly to me, brain injuries. There's a lot more we go into here, but I think I will leave it to say that I emerged from this podcast with both a better understanding of what I already knew, and more importantly, perhaps a new understanding of what the potential of lactate is in the therapy of human conditions in ranging everything from cancer to, as I said, traumatic brain injury. So without further delay, please enjoy my conversation with George Brooks.
Hey, George. Thank you so much for making time to sit down with me today. This has been a long time coming, as you know. Your colleague and partner in crime on much of the work you've done, Inigo Sanmilan, has been a multiple time guest on this podcast. And of course, your name has come up many times. I've referenced you and your work in my book. So it's great to be sitting down with you to talk about lactic acid, which is something that I think it would be safe to say at the outset, is probably a misunderstood molecule. Would that be a safe statement to start this out?

**George A. Brooks** (4:00)
Yes, it is. And thank you, Peter, for having me on. Really helped make my career because my physician, wife's friends know my name. But after reading your book, they say, that's George. So that's really great. Not to be difficult, but he did mention lactic acid.

**Peter Attia, MD** (4:17)
Yeah, I was about to say, and I'm glad you brought that up, but I assume you're going to say, should we really think about this as lactate or lactic acid? And let's have you get the semantics right out of the gate for us.

**George A. Brooks** (4:27)