Abnormal blood lactate accumulation during repeated exercise testing in ME/CFS

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Physiol Rep. 2019 Jun;7(11):e14138. doi: 10.14814/phy2.14138.
Abnormal blood lactate accumulation during repeated exercise testing in myalgic encephalomyelitis/chronic fatigue syndrome.
Lien K1,2, Johansen B3, Veierød MB4, Haslestad AS1, Bøhn SK1, Melsom MN5, Kardel KR1, Iversen PO1,6.
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Abstract
Post-exertional malaise and delayed recovery are hallmark symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Studies on repeated cardiopulmonary exercise testing (CPET) show that previous exercise negatively affects oxygen uptake (VO2 ) and power output (PO) in ME/CFS. Whether this affects arterial lactate concentrations ([Laa ]) is unknown. We studied 18 female patients (18-50 years) fulfilling the Canadian Consensus Criteria for ME/CFS and 15 healthy females (18-50 years) who underwent repeated CPETs 24 h apart (CPET1 and CPET2 ) with [Laa ] measured every 30th second. VO2 at peak exercise (VO2peak ) was lower in patients than in controls on CPET1 (P < 0.001) and decreased in patients on CPET2 (P < 0.001). However, the difference in VO2peakbetween CPETs did not differ significantly between groups. [Laa ] per PO was higher in patients during both CPETs (Pinteraction < 0.001), but increased in patients and decreased in controls from CPET1 to CPET2 (Pinteraction < 0.001). Patients had lower VO2 (P = 0.02) and PO (P = 0.002) at the gas exchange threshold (GET, the point where CO2 production increases relative to VO2 ), but relative intensity (%VO2peak ) and [Laa ] at GET did not differ significantly from controls on CPET1 . Patients had a reduction in VO2 (P = 0.02) and PO (P = 0.01) at GET on CPET2, but no significant differences in %VO2peak and [Laa ] at GET between CPETs. Controls had no significant differences in VO2 , PO or %VO2peak at GET between CPETs, but [Laa ] at GET was reduced on CPET2 (P = 0.008). In conclusion, previous exercise deteriorates physical performance and increases [Laa ] during exercise in patients with ME/CFS while it lowers [Laa ] in healthy subjects.
© 2019 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.
KEYWORDS:
Elevated lactate; exercise intolerance; metabolism; oxygen uptake; post-exertional malaise
PMID: 31161646 DOI: 10.14814/phy2.14138
 

percyval577

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The article lists this review:
Brooks 2018 The Science and Translation of the Lactate Shuttle Theory
abstract
Once thought to be a waste product of anaerobic metabolism, lactate is now known to form continuously under aerobic conditions.

Shuttling between producer and consumer cells fulfills at least three purposes for lactate: (1) a major energy source, (2) the major gluconeogenic precursor, and (3) a signaling molecule. “Lactate shuttle” (LS) concepts describe the roles of lactate in delivery of oxidative and gluconeogenic substrates as well as in cell signaling. In medicine, it has long been recognized that the elevation of blood lactate correlates with illness or injury severity.

However, with lactate shuttle theory in mind, some clinicians are now appreciating lactatemia as a “strain” and not a “stress” biomarker. In fact, clinical studies are utilizing lactate to treat pro-inflammatory conditions and to deliver optimal fuel for working muscles in sports medicine. The above, as well as historic and recent studies of lactate metabolism and shuttling, are discussed in the following review.
My paragraphing.

and this article:
Rogatzki et al 2015 Lactate is always the end product of glycolysis

Through much of the history of metabolism, lactate (La−) has been considered merely a dead-end waste product during periods of dysoxia. Congruently, the end product of glycolysis has been viewed dichotomously: pyruvate in the presence of adequate oxygenation, La− in the absence of adequate oxygenation.

In contrast, given the near-equilibrium nature of the lactate dehydrogenase (LDH) reaction and that LDH has a much higher activity than the putative regulatory enzymes of the glycolytic and oxidative pathways, we contend that La− is always the end product of glycolysis. Cellular La−accumulation, as opposed to flux, is dependent on (1) the rate of glycolysis, (2) oxidative enzyme activity, (3) cellular O2 level, and (4) the net rate of La− transport into (influx) or out of (efflux) the cell. For intracellular metabolism, we reintroduce the Cytosol-to-Mitochondria Lactate Shuttle.

Our proposition, analogous to the phosphocreatine shuttle, purports that pyruvate, NAD+, NADH, and La− are held uniformly near equilibrium throughout the cell cytosol due to the high activity of LDH. La− is always the end product of glycolysis and represents the primary diffusing species capable of spatially linking glycolysis to oxidative phosphorylation.
My paragraphing.
 
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1568241971499.png

I thought that bottom graph was cool. Shows a nice separation between patients and controls. Unfortunately they didn't seem to get a bigger lactate response in the seond CPET, which I find surprising.