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The Edge blood lactate monitoring

Monitoring blood lactate levels gives athletes “the edge”. Could it help with people with diseases which have high blood lactate levels like ME/CFS, FM and long COVID

Wearables abound (Fitbit, Oura ring, Apple Watch, STAT earpiece) and who knows what’s lurking on the horizon in the wearable world but a recent paper, suggested something that might be quite attuned to the problems found in chronic fatigue syndrome (ME/CFS), fibromyalgia and long COVID. How about assessing blood lactate levels to get insights into post-exertional malaise?

That’s next in Health Rising’s continuing series on ways to monitor one’s health

Blood Lactate Monitoring

The paper “Attenuating post-exertional malaise in  myalgic encephalomyelitis/chronic fatigue syndrome and long-COVID: Is blood lactate monitoring the answer?“, came as something of a surprise. The lead author Mark Faghy, a clinical exercise physiologist at the University of Derby in the UK, has never studied ME/CFS before. He has, however, published voluminously on long COVID and early on warned about the effects of exercise in long COVID.

Faghy et. al’s working hypothesis is that the coronavirus (or another virus) has damaged mitochondria, leading to mitochondrial dysfunction that extends beyond expected post-viral infection deconditioning and may be caused by reduced oxygen delivery to the tissues.

The idea – measuring lactate levels to help manage post-exertional malaise (PEM) – seems like an obvious thing to do. Monitoring blood lactate levels, after all, works for athletes. Could doing so give people with PEM an edge in their health?

Exercise studies suggest that people with ME/CFS and long COVID tend to quickly burn through their aerobic energy stores and turn to breaking down glucose anaerobically to produce energy. That leaves behind lactate and reduces pH levels in our muscles – causing symptoms like burning muscle pain and fatigue.

While we know now that lactate itself doesn’t cause the burning muscle pain and fatigue we experience after excessive exercise (it’s the acidosis), we know that blood lactate levels are a good analog for them; i.e. if your blood lactate levels are increased, you’ll probably be feeling poorly.

Indeed, a 2019 Norwegian 2-day exercise test found that people with ME/CFS had an earlier lactate turnpoint – a sign of earlier entry into anaerobic energy production – and significantly increased lactate levels at any work level (power output).

Norwegian 2-Day ME/CFS Exercise Study Adds Crucial Factor to Exercise Intolerance Findings

While things got better for the healthy controls during the second test – their energy production systems adapted and got stronger and their lactate levels decreased – the ME/CFS patients got worse – their lactate levels significantly increased.

A subsequent Norwegian “energy strain” study found concluded that low oxygen conditions during exercise were associated with alterations in fatty metabolism, amino acid utilization, and glycolysis. Their findings suggested that ME/CFS patients’ metabolism can be stressed even in the absence of activity.

High brain lactate levels and reduced blood flows (read ‘oxygen delivery’) to the brain have also been documented in both ME/CFS and fibromyalgia. The lead researcher in that study, Dikumo Shungo got interested in ME/CFS when he found high ventricular lactate levels similar to those that he’d observed in patients with primary mitochondrial disorders. In fact, Shungu reported that elevated ventricular lactate levels are found in nearly every disorder in which mitochondrial dysfunction is present. Given the recent blog on oxidative stress, it’s interesting the Shungu pegged oxidative stress, reduced blood flows, and neuroinflammation as the key players ME/CFS and fibromyalgia.

Study Suggests “Bad Energy” is Core Problem in Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)

A rare French ME/CFS study that examined lactate levels outside of exercise demonstrated, however, that lactate levels can be quite variable. The study – which controlled for activity and diet – uncovered a higher lactate group and a lower lactate group. While the higher lactate group experienced more PEM, lactate levels varied dramatically over the day-long study. The study’s controlled environment – it tightly regulated activity and diet – was not, however, emblematic of a normal day.

Lactate Levels Elevated Even at Rest In ME/CFS?

Jones’ exercise study also found distinct subgroups in ME/CFS as well as a jaw dropping 50 times increase in levels of acidosis (h+) in people with ME/CFS as well as much longer (4x’s) lactate clearance times. Studies have also found increased lactate in the brains of fibromyalgia patients and their trapezius muscles and blood and in the brains of people with migraines.

In other words, increased lactate seems like a thing in chronic fatigue syndrome (ME/CFS).

Long COVID

They’ve taken a bit to get going, but mitochondrial studies in long COVID are starting to pop up. A recent study that surveyed the metabolic pathways disrupted by the SARS-CoV-2 virus that causes COVID-19 concluded that the virus “strongly inhibits” the oxidative phosphorylation (OXPHOS) pathways involved in aerobic energy metabolism, resulting in increased mitochondrial reactive oxygen species (mROS) production. That finding fits in very well with Shankar’s recent study which highlighted high mitochondrial oxidative stress levels and reduced ATP production in both ME/CFS and long COVID.

The Big Energy Sink? Pt. 2 – ME/CFS and Long COVID Study Suggests Immune Cells Robbing the Body of Energy

Other long-COVID studies have found reduced mitochondrial energy production in immune cells, lower levels of fatty acid oxidation in two exercise studies and altered expression of mitochondrial RNAs.

Lactate can be tricky, however. As noted above lactate levels can vary throughout the day and a recent book chapter, Potential Biomarkers of Mitochondrial Dysfunction Associated with COVID-19 Infection“, indicated people with lactate levels in “normal ranges” could still have an underlying mitochondrial disorder. Plus, although elevated blood lactate levels may indicate mitochondrial dysfunction, they can also be caused by a deficiency of vitamin B1 (thiamine). That’s an interesting finding given the relief some people with ME/CFS get from high-dose B1 supplementation.

Could High-Dose Thiamine (B-1) Help with ME/CFS, Fibromyalgia, and the Neurological Complications of Ehlers-Danlos Syndrome?

Mark Vink’s Long Trip to the Bathroom

Mark Vink has produced the most startling evidence of lactate problems in any of these diseases. A former physician, judo brown belt, marathoner, triathlete and captain of a Dutch national field hockey championship team (!) Vink got so blasted by an infectious onset of ME/CFS that it was taking him 12 hours to recover from a trip to the bathroom.

How Walking to Bathroom Can Be Harder Than Running a Marathon: A Doctor’s ME/CFS Case Study

Vink reported the results of his n=1 study of himself in “Aerobic Energy Production and the Lactic Acid Excretion are both Impeded in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

THE GIST

  • Wearables abound (Fitbit, Oura ring, Apple Watch, STAT earpiece) but a recent paper brought something that might be quite attuned to the problems found in chronic fatigue syndrome (ME/CFS), fibromyalgia and long COVID. How about assessing blood lactate levels to get insights into post-exertional malaise?
  •  Lactate is produced when the body can’t produce enough energy aerobically (there’s the reduced oxygen delivery) and so it turns to anaerobic energy production to fulfill its needs. The acidification that’s associated with lactate buildup results in things like burning muscle pain and fatigue.
  • Perhaps not surprisingly several studies have found increased lactate production in the blood, muscles and brains of ME/CFS, fibromyalgia, Gulf War Syndrome and/or Long COVID patients.
  • Former doctor, marathoner, judo black belt and all around athletic specimen, Mark Vink’s story demonstrates just how bad lactate levels can get in these diseases. After coming down with ME/CFS Vink found that simply walking from his bed to the bathroom elevated his lactate levels to those seen in marathon runners.
  • Measuring lactate can be a little tricky. Lactate levels can vary throughout the day and not everyone with these diseases will have high lactate levels. Plus people with lactate levels in “normal ranges” could still have a mitochondrial disorder. Elevated blood lactate levels can also be caused by a deficiency of vitamin B1 (thiamine). That’s an interesting finding given the relief some people with ME/CFS get from high-dose B1 supplementation. (See blog).
  • Still, if monitoring blood lactate levels is widely used by athletes to determine their optimum activity levels, why not do the same in ME/CFS? Monitoring them may help some people with ME/CFS with pacing and assessing treatment effectiveness. One could even envision a study that gathered ME/CFS, FM and long COVID patients together to  lactate levels from their home upon awakening, after different levels of activities, and after meals.
  • Blood lactate monitors are readily available, if not cheap. The Edge – the model Vink used which comes with 30 sticks – is currently $299 on Amazon US. Extra sticks cost about $2 each.
  • What can you do if your blood lactate levels are high? There are unfortunately no easy solutions. One suggestion is to use deep breathing techniques to increase oxygen levels. Hyperbaric oxygen chambers, H2 water or other means that can help increase oxygen levels might be helpful as well. Doing small bouts of exercise/activity may help as well. Some websites suggest eating more alkaline foods.
  • Monitoring blood lactate levels might, however, provide some personal insights into what’s triggering PEM and how to avoid it.
  • Coming up – a blog on another monitoring possibility – monitoring blood glucose levels.
Vink’s normal CK levels suggested no muscle damage had occurred and his lactate levels before his little 6 yard walk to his bathroom were normal as well, but five minutes later, they were high – so high that Vink reported they were beyond the level at which healthy people would stop exercising. Then in a big surprise, they shot up again 30 minutes later to levels higher that professional athletes like marathoners reach during their most strenuous exercise efforts. As in the French study, eating a meal tended to cause his lactate levels to peak about an hour later as well.

Vink is undoubtedly an outlier: he’s severely ill and clearing lactate is a huge problem for him, in particular, but he demonstrates just how whacky lactate production can get in these diseases.

Monitoring Blood Lactate Levels?

If monitoring blood lactate levels is widely used by athletes to determine their optimum activity levels, why not do the same in ME/CFS? It seems likely that a wide range of lactate levels are present in ME/CFS and that monitoring them may help some people with ME/CFS with pacing and assessing treatment effectiveness. One could envision a study that gathered ME/CFS, FM and long COVID patients together to  lactate levels from their home upon awakening, after different levels of activities, and after meals.

Blood lactate monitors are readily available, if not cheap. The Edge – the model Vink used is currently $249 on Amazon US. You need to get the sticks as well. They cost about $2 each.

Monitoring your lactate levels brings up the question what can you do if your blood lactate levels are high? There are unfortunately no easy solutions for removing blood lactate or reducing the acid conditions that come along with it. It simply takes time and rest for your body to reabsorb the lactate. Interestingly, though, the most commonly suggested solutions are things that have been suggested for these diseases.

One suggestion is to use deep breathing techniques to increase oxygen levels. (That incidentally, is the first thing exercise physiologist Staci Stevens recommends for her ME/CFS clients.) Hyperbaric oxygen chambers, H2 water or other means that can help increase oxygen levels might be helpful as well. Doing small bouts of exercise/activity may help as well. Some websites suggest eating more alkaline foods.

Until we know the cause or causes of the mitochondrial dysfunction found (reduced oxygen flows, oxidative stress, mitochondrial calcium buildup, problems with fatty acid oxidation, endoplasmic reticulum dysfunction, autophagy… all of the above?) in these diseases we’re shooting blind. Monitoring blood lactate levels might, however, provide some personal insights into what’s triggering PEM and how to avoid it.

  • Coming up – a blog on another monitoring opportunity – monitoring blood glucose levels.

Health Rising is not affiliated with The Edge or any other blood lactate monitoring products

 

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