New Atmosphere, New Vision: Gibson and Whittemore Kick Off Invest in ME Conference 2016
Mark Berry reports on Dr. Gibson's introduction and Dr. Whittemore's keynote speech, at the 11th Invest in ME International ME Conference in London.
Discuss the article on the Forums.

Who Would Like to Participate in a Simple Study to Measure Blood Lactate Levels?

Discussion in 'Post-Exertional Malaise, Fatigue, and Crashes' started by Hip, Sep 26, 2015.

  1. Hip

    Hip Senior Member

    Messages:
    8,886
    Likes:
    13,120
    This thread is about getting forum members interested in doing a very simple, informal study to measure blood lactate levels (using a lactate meter) before and after a short bout of exercise. If you are interested, please post.

    Using a lactate meter, severe ME/CFS patient Dr Mark Vink discovered that his blood lactate levels were abnormally high after exercise, and remained high for much longer than would normally be expected.

    This abnormal lactate response that Dr Mark Vink detected in his own blood might be unique to ME/CFS, so I thought it might be a good idea for some of us to try to replicate his results using a relatively cheap blood lactate meter.

    Mark Vink's story is given below.



    Mark Vink is a doctor in the Netherlands who was hit by severe ME/CFS. His condition is such that it takes him twelve hours to recover from just the 5 to 6 yard walk from his bed to the bathroom.

    Dr Vink decided to test some of his blood parameters before and after doing this 5 to 6 yard walk to his bathroom — which for his body is intense physical exercise. In particular, he used a handheld blood lactate meter (the EDGE Lactate Analyser), which works on a pinprick of blood (a bit like a blood glucose meter), to measure his minute-by-minute blood lactate levels before and after this 5 to 6 yard walk intense exercise.

    His minute-by-minute testing showed his blood lactate levels initially peaking five minutes after exercise, which is what you would find in a normal healthy person. And in a normal healthy person, after this initial lactate level peak, blood lactate will quickly start going down again (it normally goes back to its baseline level around 60 minutes post exercise).

    But Dr Vink found that rather than continuing to go down after the five minute peak, his blood lactate rose again to another even higher peak at 30 minutes post-exercise. The readings he took using his blood lactate meter were:
    Note: normal resting blood lactate in healthy people is in the range 0.5 to 2.2 mmol/L.

    The second peak at thirty minutes is not found in any medical literature. Dr Vink said his blood lactate levels were higher than even those seen in marathon runners.

    Mark Vink's published study (the full paper) is here:
    The Aerobic Energy Production and the Lactic Acid Excretion are both Impeded in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

    And there is this interesting article on Cort's blog about ME/CFS Vink's study.


    What I am wondering is whether this very simple blood lactate after exercise test might have any diagnostic implications. Might a relatively cheap blood lactate meter be a useful diagnostic tool for ME/CFS?

    And how does it relate to the 2-day CPET test for ME/CFS (which among other things measures a patient's lactate threshold — the exercise intensity at which lactic acid starts to accumulate in the blood)?

    Note: in the theory of PEM proposed by Myhill, Booth and McLaren-Howard, they provide a model to explain this high lactate found in ME/CFS patients; see this post.



    I think it's worth trying to reproduce Dr Mark Vink's results.

    Possibly his prolonged elevations in lactate level will not be found in all ME/CFS patients; but it would be interesting to know how many other patients have these prolonged post-exercise lactate elevations, and whether the manifestation of such prolonged elevations might correlate to ME/CFS severity, or correlate to some specific ME/CFS subtype.
     
    Last edited: Feb 3, 2017
  2. halcyon

    halcyon Senior Member

    Messages:
    2,253
    Likes:
    5,276
    There's an existing thread about it here.
     
    MeSci and alex3619 like this.
  3. Hip

    Hip Senior Member

    Messages:
    8,886
    Likes:
    13,120
    Ah thanks. I did search the forum for similar threads before starting this one, but somehow missed that existing thread.



    I was thinking that since you can buy the EDGE Lactate Analyser quite cheaply, if say 10 or 20 members of this forum clubbed together to get one, we could repeat this experiment. Each member need only contribute the approximate price of a jar of vitamins to buy the meter as a group purchase.

    We could then pass the meter from one person to the next, so that each member could use it to measure their own rise in lactate after a very short bout of intense exercise. It's a small unit weighting just 64 grams, thus mailing it to another forum member would cost very little.

    Then we could collate the results, and see what findings we uncover. This would be good science, yet on a tiny budget.



    Incidentally the EDGE Lactate Analyser appears to be the most accurate meter according to this published study which tested six different blood lactate analyzers that are available on the market. The EDGE Lactate Analyser appears to be a Polish-made device. More info on the EDGE Lactate Analyser here and here.

    Amazon UK sell the EDGE Lactate Analyser for £195 ($296), which includes 50 test strips. Additional test strips cost £38 ($58) for 25 strips.



    The EDGE Lactate Analyser can be bought more cheaply from www.redmed.pl in Poland:
    LactatEDGE device — €137 ($154)
    25 test strips for the LactatEDGE — €38 ($43)

    You need to click on the British flag on the top left of these webpages to get the English version. And if you click on the Polish flag on the top left of the above webpages, for some reason the price in Polish Zloty works out even cheaper than the euro price.

    Assuming each person in our informal study uses just 3 or 4 test strips, if we have 10 people doing this, we would only need two boxes (2 x 25) of test strips. So that's a total cost of $154 + $43 x 2 = $240, excluding shipping.
     
    Last edited: Oct 6, 2015
    taniaaust1, South, MEMum and 4 others like this.
  4. justy

    justy Senior Member

    Messages:
    5,128
    Likes:
    11,052
    U.K
    I think this is a great idea! perhaps re post this post over on the other thread, not just the link? I am definitely up for it. One big thought though - wouldn't we be a mixture of severe, moderate and mild patients - is that important? should it only be severe patients? how severe - bedbound or housebound? what is an appropriate amount of 'exercise' how do people take part in this without making themselves possibly a lot more ill?

    If there were enough people interested, then whoever had the time/energy could set up a 'group' page here on PR to discuss it further and make plans...
     
  5. gregh286

    gregh286 Senior Member

    Messages:
    570
    Likes:
    777
    Londonderry, Northern Ireland.
    hi,
    and what can we do in the event we replicate marks findings which i am pretty sure would follow a similar pattern.
    just another symptom of cfs.
     
    MEMum likes this.
  6. Marky90

    Marky90 Science breeds knowledge, opinion breeds ignorance

    Messages:
    1,152
    Likes:
    4,181
    Interesting, my serum lactate was just above the reference area as well, and that was not after exercise..
     
    MEMum likes this.
  7. gregh286

    gregh286 Senior Member

    Messages:
    570
    Likes:
    777
    Londonderry, Northern Ireland.
    cos we are in anaerobic energy production all time.
    constantly running marathons even when we sit.
     
    PennyIA, pemone, MEMum and 5 others like this.
  8. Marky90

    Marky90 Science breeds knowledge, opinion breeds ignorance

    Messages:
    1,152
    Likes:
    4,181
    Crazy..
     
    MEMum likes this.
  9. Marky90

    Marky90 Science breeds knowledge, opinion breeds ignorance

    Messages:
    1,152
    Likes:
    4,181
    "Funny" thing, the way I feel now, is exactly how i felt after running 30 km with full army equipment in the military..
     
    PennyIA, MEMum, Sushi and 2 others like this.
  10. gregh286

    gregh286 Senior Member

    Messages:
    570
    Likes:
    777
    Londonderry, Northern Ireland.
    yep...me too....lactic all the time.
    you can feel the "lactic burn" just going up stairs.
    brutal.
    something bollocksed in the krebs cycle.....so body switching to anaerobic.
    best guess is body blocking O2 uptake into the mitochrondria.
    an autoimmune deregulation.
     
  11. Emootje

    Emootje Senior Member

    Messages:
    346
    Likes:
    232
    The Netherlands
    For what it's worth:
    Lactate (rest): 1.2 mmol/l
    Lactate (after a shower): 2.3 mmol/l
    Lactate (after a 40 km bike ride): 5.8 mmol/l
    (I classified myself as a mild ME/CFS patient and I significantly been able to decrease my PEM symptoms by fasting and by not lying down after exercise)
    I'm using the Accutrend plus (100 euro's) to monitor my lactate.
     
    Valentijn, Noah GB, Theodore and 4 others like this.
  12. Gijs

    Gijs Senior Member

    Messages:
    639
    Likes:
    1,288
    Emootje, can you ride a bike for 40 km? Wow...
     
    MeSci likes this.
  13. Emootje

    Emootje Senior Member

    Messages:
    346
    Likes:
    232
    The Netherlands
    Intermittent fasting did wonders for me...
     
    MastBCrazy likes this.
  14. alex3619

    alex3619 Senior Member

    Messages:
    12,249
    Likes:
    33,561
    Logan, Queensland, Australia
    I have implied as much before, and I even put a comment to Workwell on their Facebook page. I never heard back. I think we could do testing of patients even at rest and learn a lot, just from exhaled gas analysis. Fingerprick testing, as used by athletes, could also be useful. Indeed, we could possibly have a patient initiative and record the data. Think of it as an informal pilot study.
     
    helen1, MEMum, MeSci and 1 other person like this.
  15. Hip

    Hip Senior Member

    Messages:
    8,886
    Likes:
    13,120
    I think the patient's severity of ME/CFS (mild, moderate or severe) needs to be noted in the results, but I think this test should be open to all severity levels. The intensity of exercise needed to trigger a bit of PEM would be different for each patient though.

    For very severe patients like Mark Vink, it was just the 5 or 6 yard walk to his bathroom. For a moderate patient, some PEM may be triggered from a 10 minute walk.

    ME/CFS patients are normally quite good at knowing what level of exercise will begin to trigger PEM. So each participant in our informal study would have to choose their own level of PEM-inducing exercise; they would need to do just enough exercise to trigger some PEM (but obviously you don't want to do too much and trigger a major crash).

    I believe this sort of lactate testing normally uses a short bout (ie, one to two minutes) of intense exercise, and then measures the lactate levels in the minutes following this short bout.

    So for a moderate patient, instead of a 10 minute walk, in order to "compress" their exercise into a short 2 minute intense bout, they may need to do two minutes of running, and then measure their lactate 5 minutes after this exercise, and then 30 minutes after this exercise.

    For a severe patient, perhaps just walking up and down the stairs once or twice will be enough to trigger some PEM.

    For a mild patient, it's possible that they would have to do very intense exercise for two minutes (like sprinting at absolute top speed) in order to trigger some PEM.



    If we did replicate this (and even if we did not), I think we could then post up the results as an informal study in a PR forum thread, and then email a few ME/CFS researchers that are interested in the PEM and exercise aspects of ME/CFS. This may well help get more research done in this area.

    What I am (optimistically) thinking is that if many ME/CFS patients exhibit this exaggerated production of lactate after a short bout of exercise, then ultimately this might become the basis of a useful diagnostic test for ME/CFS.

    It would be much simpler and cheaper (and much less strenuous on the patient) than the 2-day CPET test. If it were viable, this lactate test could even be done in a primary care doctor's surgery: the doctor would simply ask a (say moderate) ME/CFS patient to jog on the spot for two minutes in the doctor's office, then measure their lactate level 5 and 30 minutes later. It could be a quick and easy diagnosis.



    I don't think that is the case, unless patients are pushing themselves past their limits.
     
    Last edited: Oct 5, 2015
    MEMum, justy and John Mac like this.
  16. John Mac

    John Mac Senior Member

    Messages:
    308
    Likes:
    1,470
    Liverpool UK
    Count me in as well
     
    MEMum, justy and Hip like this.
  17. daisybell

    daisybell Senior Member

    Messages:
    1,564
    Likes:
    7,033
    New Zealand
    I would be interested. Perhaps we should think about getting a few of the meters so we have a Southern Hemisphere one as well as a northern!
     
    MEMum, rosie26 and Hutan like this.
  18. alex3619

    alex3619 Senior Member

    Messages:
    12,249
    Likes:
    33,561
    Logan, Queensland, Australia
    A lactate pinprick test, if validated, would have an additional benefit. We might be able to tell if a crash is due to PEM or something else. It would be nice to remove as much guesswork as possible.

    I have not costed a lactic acid meter lately, I do recall they are in the hundreds of dollars range, but there was a large variety of costs, from maybe $100 to $300. That was some time ago now.
     
    ukxmrv likes this.
  19. John Mac

    John Mac Senior Member

    Messages:
    308
    Likes:
    1,470
    Liverpool UK
    Valentijn likes this.
  20. Research 1st

    Research 1st Severe ME, POTS & MCAS.

    Messages:
    681
    Likes:
    2,188
    What about this device John, one in the device review you linked (thanks): EKF Lactate Scout +

    The marketing claims that individuals hematocrit can skew results and this unit compensates for it making it suitable for a 'medical setting'.



    It's also got Bluetooth and with paid software, you can analyse the results on a PC. One advantage of this is then no one can be accused of 'faking' the results if there is digital stored data that has graphs etc, rather than people in our proposed forum study saying ''I had a lactate of 6.7''.

    If people wanted to, we could do this professionally and get the findings published.
    Personally I would add that I wouldn't expect patients Lactate to be especially high, but I would expect the length of time the Lactate is spent elevated to be abnormal (lactate clearance problem).

    We need someone clever to tell us the timing of blood samples needed and, for example, the predicted normal levels of lactate at rest, post exercise (15 mins, 30 mins, 45 mins, 60 mins - 2hrs etc).

    EKF Lactate Scout +
    http://www.ekfdiagnostics.com/lactate_scout_121.aspx
     
    helen1, MEMum and Valentijn like this.

See more popular forum discussions.

Share This Page