That's very good, Cort. I wonder about the language, "ME/CFS patients have a lower VO2-max *because* of deconditioning" though. I'm not sure I've seen anything about that. But maybe someone showed it and I missed it. Not that deconditioning isn't a problem, but if we're blaming the mechanism of the disease on it, it's only a short step from that, back to PACE. Just saying "in part because" would help that.
Another thing is what happens when a person switches to keto? Why did that work for a couple of years for me, and then not so much? I never was able to do the long distance running that some keto-philes do. But now I know that's probably genetic for me. I was able to do much more exercise, as long as it was short term and strength based. If I showed someone a video of me breaking the 100 lb mark with chest presses, they'd wonder if I was deconditioned, because I wasn't. I was still totally wiped out 90% of the time, and if I pushed it, I often got the worst of it. My lifelong preference for strength training was instinctive, but it also hid the larger problem.
Anyway, long story short, if someone is in a keto state, there are some interesting discussions on the deeper chemistry of that on reddit. If I can scrub usernames, I might post a private chat I had with a grad student about it. The upshot was, lactic acid metabolism is extremely poorly understood. One probable fact not mentioned in that video is that the liver is the ultimate "clean up crew" for lactic acid. If that can be proven, if that flow from muscle to liver and ultimately recycling the energy, if that can be proven, then we might be back to something that works for me: being very careful about liver health. Much more careful than an average person.
Now that I've been talking to people about liver health and what they think of it, I'm getting the most interesting stories. Like women who are infertile if they don't actually eat liver regularly. This is real people I know. It seems so odd that we treat our organs like they're binary: good/bad. I'm glad at least the organelle, mitochondria is getting some more respect though.