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

Hip

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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:
Blood Lactate Levels Before and After Exercise
——————————————————————————————————————————————————————————————————
Blood lactate just before exercise:..........1.6 mmol/L
Blood lactate 5 minutes after exercise:......8.0 mmol/L
Blood lactate 30 minutes after exercise:....11.8 mmol/L
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.
 
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Hip

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There's an existing thread about it here.
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.
 
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justy

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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 in this test of 6 different blood lactate analyzers. It 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 for 25 strips.

The EDGE Lactate Analyser can be bought more cheaply for £87 (499 Polish Zloty) from this supplier in Poland. It's not clear how many test strips you get with it for this price, though.
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...
 

Marky90

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Interesting, my serum lactate was just above the reference area as well, and that was not after exercise..
 

gregh286

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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.
 

Emootje

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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.
 

alex3619

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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)?
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.
 

Hip

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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?
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.



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.
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.



cos we are in anaerobic energy production all time.
I don't think that is the case, unless patients are pushing themselves past their limits.
 
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alex3619

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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.
 

Research 1st

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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'.

Studies have shown that the coefficient of variation depends on the lactate concentration. The Scout has a CV of ± 3 % (minimal standard deviation: ± 0.2 mmol/L) within the hematocrit range of 35 – 50% and ± 4 % (minimal standard deviation: ± 0.3 mmol/L) within the extended hematocrit range. Sample quality plays a very important role in the accuracy of the result. To minimise external influences we recommend that the same sampling area is used throughout (finger tip or ear lobe). Different parts of the body provide different results because of differences in blood circulation. Due to the high number of potential interferences in lactate measurement and the specific characteristics of different analysers no standard measurement has been defined. For comparative reasons the general impression of the characteristics and trends of lactate curves (given from step tests) is much more meaningful than a comparison of single/absolute values. Independent reference measurements and studies show a good correlation of the Lactate Scout+ to lab analysers from EKF Biosen, Radiometer ABL, Yellow Springs (YSI) and Analox. Good correlations were also found with Dr.Lange/ Diaglobal and Lactate Pro analysers. The latest version of Lactate Scout+ compensates for the influence of low (<35%) and high (>50%) hematocrit levels on the lactate reading. This leads to a significantly increased accuracy in these ranges.
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