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

[Seven7]

Hi @inester7.
How much baking soda do you take. I find it irrates bowel
Lemon water decent for it also.

yeah I noticed the upset stomach too, I do away from foods, and I put 1/4teaspoon on one liter, If I am with a lot latic acid I do one liter every 2h? maybe something like that. I try not to drink unless I have too much latic acid. But I drink it until the pain is gone then go back to 1/4t as needed. I don't find much of a pattern.

 

[Hip]

I mean someone walking a mile will inevitably have a different level than someone walking 30 metres, regardless of illness level - it's too variable.
I'm mostly housebound and couldn't run a mile if my life depended on it.

I'm fascinated but my brain is melting. God, I wish I could study.

You are not the only one with a melting brain; I am also struggling myself trying to get a clear sense of what we need to do in this study.

From Mark Vink's results, it seems that there are two aspects that were different about his lactate production, compared to healthy people. These two aspects are:

(1) Vink found that huge amounts of lactate were produced from very trivial amount of exercise: after walking just 5 or 6 yards to his bathroom, Vink produced massive amounts of lactate.

So we would want to try to reproduce this. To do so, we can give an ME/CFS patient a suitably strenuous short bout of exercise to do, and also give exactly the same exercise to a healthy control (such a friend or family member without ME/CFS, but of the same sex and similar age). Then we can compare their blood lactate levels after exercise. If we succeed in reproducing Vink's results, then we would expect the ME/CFS patient to produce much more lactate than the healthy control from the same exercise.

Deconditioning may be a factor we have to try to account for in this, though. If you read the "Lactate Threshold and Training" section of this webpage, it explains how lots of physical training lowers the lactate levels induced by exercise. So some of the increased lactate that an ME/CFS patient may produce will result from physical reconditioning. Thus when We choose our healthy controls, we probably don't want to use our more athletic friends, but rather people we know who have a sedentary life.

(2) Vink observed a second, delayed peak in blood lactate 30 minutes post-exercise. This second peak has never been found in any other group of people. So we can see if other ME/CFS patients also have this second peak at around the 30 minute point.

 

[Hip]

Where can I buy the EDGE lactate or something similar in USA???

I think Amazon UK will ship to the US. There is one left in stock.

The Polish site (click UK flag for English version) will ship to the UK, but unfortunately not to the US.

 

[Hutan]

I think for this first study we should try to reduce the variability as much as possible.

Maybe we could define three exercise tests to cover the range of activity levels that might trigger a lactic acid response. e.g. 1. walk 20 steps
2. walk 200 steps
3. 30 star jumps (or maybe squats or walking up stairs?)

Then each person could choose to do as many of the exercise tests as they felt were safely possible, each separated by say 5 days. And people could do multiple replications of each exercise test.

We would need to specify the pre-test conditions eg
1. lie down for 1 hour
2. don't eat food in the 3 hours prior
3. no unusual activity in the two days prior
4. ME symptoms stable (ie not in an unusual PEM state)

We would need to categorise each person as mild, moderate or severe according to some defined scale. And record gender and age.

And we would need to define the times when the measurements are taken eg pre-trial, 1 minute after etc

Having healthy controls is a good idea.

Mendus might be a useful resource for this study. We could use that platform to record and report the results.

 

[Hip]

Maybe we could define three exercise tests to cover the range of activity levels that might trigger a lactic acid response. e.g. 1. walk 20 steps
2. walk 200 steps
3. 30 star jumps (or maybe squats or walking up stairs?)

That's a good idea, though possibly there could be one precisely defined exercise test for each severity level of ME/CFS, and then each person uses the exercise specified for their level of severity. There is a good description of the mild, moderate and severe levels of ME/CFS in the NICE guidelines.

I am thinking in terms of keeping costs down here, since test strips are priced at $43 for a box of 25, so we don't want to perform too many tests on each person.



We also need to decide on how many test strips each person uses in this test.

The minimum number would be 3 test strips: one for measuring the resting state pre-exercise level of your blood lactate, one for measuring your blood lactate 5 minutes post-exercise, and a final test strip for measuring your blood lactate 30 minutes post-exercise.

However, if you read Mark Vink's paper, he took measurements every minute, and by doing this noted an unusual pattern, which was that after his first lactate peak at around 5 minutes post-exercise, lactate levels then went down (which happens in healthy people), but after that they went up again to an even higher peak at around 30 minutes post exercise. So his muscles seemed to produce two distinct "gushes" lactate.

If we want to get a more detailed picture of lactate levels over time, then taking blood lactate measurements every two minutes might be necessary. In which case, you will need 15 test strips to cover the 30 minute period post-exercise.

 

[Apple]

I do like the idea of comparing it to a healthy control such as a (sedentary) family member. I think whatever we study do, deconditioning will be thrown at us. I remember asking my GP about mitochondrial testing and he dismissed it and said that anyone who is inactive would have changes to the mito function (or something along those lines).

Shame the testing strips are so expensive. It would be interesting to repeat the test over a few days, during a case of PEM. Like the repeat CPET test.

 

[Hip]

I think whatever we study do, deconditioning will be thrown at us.

I was trying to find some blood lactate research on astronauts in long term space flight, when they come back to Earth, but could not find any. I don't think there is anybody who gets quite as deconditioned as such astronauts. Even their muscles atrophy. So they would set the standard for extreme deconditioning, and if ME/CFS patients did worse than long term astronauts in terms of lactate elevation, then this elevation could not be blamed on ME/CFS deconditioning.

 

[Snookum96]

I'll participate as well

 

[MeSci]

How about using heart rate? People could estimate their own anaerobic threshold from age and severity. Maybe some people actually know theirs?

 

[MeSci]

I mean someone walking a mile will inevitably have a different level than someone walking 30 metres, regardless of illness level - it's too variable.
I'm mostly housebound and couldn't run a mile if my life depended on it.

I'm fascinated but my brain is melting. God, I wish I could study.

So do I - I know know how I got that Master's degree.

I would be able to walk a mile some days but not others, so there is also a lot of variation within each person. I think this is just to gauge how consistent is the finding that Vink got of a lactate level that continues to rise after the activity has stopped, and stays high for a long time.

I'm not willing to do formal-type exercise unless it is in controlled settings - e.g. a hospital, because I struggle enough to get through what I have to do anyway, but am willing to measure my lactate levels in response to normal activities, which are often to exhaustion or thereabouts.

 

[MeSci]

I was trying to find some blood lactate research on astronauts in long term space flight, when they come back to Earth, but could not find any. I don't think there is anybody who gets quite as deconditioned as such astronauts. Even their muscles atrophy. So they would set the standard for extreme deconditioning, and if ME/CFS patients did worse than long term astronauts in terms of lactate elevation, then this elevation could not be blamed on ME/CFS deconditioning.

But you already said that the second lactate peak wasn't seen in any other group, so I presume that doesn't happen in deconditioning.

If it's going to be very structured as @Hutan suggests, I'm afraid you'll have to count me out. I might be willing to do that in really controlled conditions, but not for an informal study like this - I have too much to do!
EDIT:

And astronauts may have some other physiological processes going on due to the lack of gravity.

 

[Hip]

But you already said that the second lactate peak wasn't seen in any other group, so I presume that doesn't happen in deconditioning.

As detailed in this post, Vink observed both (1) high levels of lactate from trivial amounts of exercise; and (2) a second delayed peak in blood lactate appearing 30 minutes post-exercise.

I think the deconditioning issue is more of a confounding factor with (1), but not (2).

However, Vink says in his paper that the timing of the arrival of the second delayed lactate peak can vary; it depends on whether you ate a meal just before the exercise. When you eat a main meal an hour before the exercise, Vink found the second delayed lactate peak appears 55 minutes post exercise. But if you ate your main meal 2 or more hours before the exercise, then the delayed lactate peak appears 30 minutes post exercise.

So it seems the more food in your stomach, the more the second lactate peak is delayed.

One evening I checked my lactate after exercise yet for some unknown reason the second peak of lactate in the blood, 30 minutes after exercise, didn’t happen. The strange thing was that my legs remained very painful and the 30% reduction in pain, which normally happens at the 30 minute mark didn’t happen either, and it took another 25 minutes before the noticeable 30% reduction in pain was there, this time at the 55 minute mark, whereby my lactate peaked at 9.4 mmol/l.

A few days later I checked my lactate after exercise again, which lasted about as long as the previous exercise, yet this time the lactate was only 8.1, and it was reached after 35 minutes instead of 55, again for no apparent reason, which obviously raised the question why was it not as usual at the 30 minutes mark and what is the main difference between the two episodes, responsible for this difference?

When the maximum lactate in the blood was reached after 55 minutes, I had my evening meal about one hour before the exercise and when it was reached after 35 minutes, I had it about 2 - 2 1/2 hours before the exercise.

Thinking about the issue of whether to use standardized exercises as per @Hutan's suggestion, versus an ad hoc exercise or activity that the patient themselves chooses (one that they know from past experience causes a certain degree of exhaustion or PEM): I have just realized that the deconditioning factor comes into this:

If a patient chooses their own exercise that they know causes some exhaustion or PEM, but that they do regularly out of necessity (eg, vacuuming the carpet), then deconditioning is going to be less of an issue, because of the fact that they are regularly performing that exercise (and thus should have become conditioned to it to some degree).

But if a patient has to do some standardized strenuous exercise that they do not regularly do, then deconditioning is more likely to play a role. Just a thought.

I don't yet know the right way to conduct this study; like everybody, I am still thinking the issues through.

 

[Hutan]

If it's going to be very structured as @Hutan suggests, I'm afraid you'll have to count me out. I might be willing to do that in really controlled conditions, but not for an informal study like this - I have too much to do!

Maybe I made it sound complicated @MeSci. It need not be very time consuming. If your illness is say of medium level, you would just do the exercise suitable for that level before a meal and at the end of an hour's rest. Depending on the schedule of lactic acid measurements we think should be done, the activity and the measurements might take less than an hour. If you can only do one replication, then that would be fine. (Of course if you can do more replications and/or want to try the other exercise test levels, great). If we have an online facility for data entry, you would then just answer a few questions (e.g. age, gender) and enter your results.

Actually I think having clear instructions for the experiment would make things easier, as each person doesn't have to invent their own rules and worry about whether they have done it right And of course it makes any results more convincing.

The most time consuming activity would probably be arranging to get the meter (and test strips) and sending it on to the next person.

 

[MeSci]

Maybe I made it sound complicated @MeSci. It need not be very time consuming. If your illness is say of medium level, you would just do the exercise suitable for that level before a meal and at the end of an hour's rest. Depending on the schedule of lactic acid measurements we think should be done, the activity and the measurements might take less than an hour. If you can only do one replication, then that would be fine. (Of course if you can do more replications and/or want to try the other exercise test levels, great). If we have an online facility for data entry, you would then just answer a few questions (e.g. age, gender) and enter your results.

Actually I think having clear instructions for the experiment would make things easier, as each person doesn't have to invent their own rules and worry about whether they have done it right And of course it makes any results more convincing.

The most time consuming activity would probably be arranging to get the meter (and test strips) and sending it on to the next person.

It's not just the time; it's the energy. I don't have any to spare. I need it all for all the many irons I already have in the fire. One must remember that this is to be exercise that gives us PEM. That for me is likely to mean leg weakness, polyuria, insomnia, nausea and diarrhoea, visual problems, possible migraine with aphasia, possible low mood, etc., and is very likely to involve not being able to do important things due to the PEM. I may lose a day to migraine. I may not be able to get to the shops. I would need a more formal, controlled study to subject myself to that. Life is already too short and I want to cram as much into it as I can!

EDIT-

You can see how late I am running to keep up with PR threads at the moment!

 

[gregh286]

Well accutrend plus arrived today.
Took 3.readings.....all showed low lactate levels.
Therefore it couldnt measure it as was less than 0.8mmol.
Turn up for the books indeed. Expected it to be out of range high.
Result maybe tainted as i had 35g vit c IV infusion yesterday...apparently can drop lactate quickly.
Will try again mid week.
Bizarre as my legs are heavy.
Lactate in muscles/cells but not in blood? Possible.?
The madness.continues.☺

 

[MeSci]

Well accutrend plus arrived today.
Took 3.readings.....all showed low lactate levels.
Therefore it couldnt measure it as was less than 0.8mmol.
Turn up for the books indeed. Expected it to be out of range high.
Result maybe tainted as i had 35g vit c IV infusion yesterday...apparently can drop lactate quickly.
Will try again mid week.
Bizarre as my legs are heavy.
Lactate in muscles/cells but not in blood? Possible.?
The madness.continues.☺

Were you at rest? @alex3619 theorises that we may be alkaline at rest and acidic during/after exertion.

 

[gregh286]

Yea at rest.
Barely moved 2day.
Will check it later after some activity etc.
Alex could be right.

 

[Hip]

Well accutrend plus arrived today.
Took 3.readings.....all showed low lactate levels.
Therefore it couldnt measure it as was less than 0.8mmol.

I take it your meter cannot measure lactate levels lower than 0.8 mmol/L.

Normal resting blood lactate levels are 0.5 to 2.2 mmol/L (or 4.5 to 19.8 mg/dL). 1

The best time to measure high lactate is at around 5 minutes after a short bout of say 90 seconds of intense exercise (as intense as you can manage with your ME/CFS). It is at this 5 minute post-exercise time that blood lactate levels from the exercise reach their peak value.

And then of course Vink found a second higher lactate peak 30 minutes post-exercise (though this second peak appeared 55 minutes post-exercise when he ate his evening meal just an hour before the exercise — so it is best do this exercise test at least 2 hours after your last main meal).

 

[alex3619]

This would be a pilot study. Given the huge range in severity in patients I think a standardized exercise cannot work.If you know where your limits are then working to those limits, doing whatever it is you need to do (not just formal exercise) would suffice. The pilot study is about demonstrating the concept, not fully characterizing the science. Follow up studies do that.

 

[alex3619]

I was trying to find some blood lactate research on astronauts in long term space flight, when they come back to Earth, but could not find any. I don't think there is anybody who gets quite as deconditioned as such astronauts. Even their muscles atrophy. So they would set the standard for extreme deconditioning, and if ME/CFS patients did worse than long term astronauts in terms of lactate elevation, then this elevation could not be blamed on ME/CFS deconditioning.

Its very likely if we wrote a nice letter to NASA then someone might help us.