Lactic acid, lactate in ME/CFS

Yes it is logical that it should be higher. But I just a read study that said that half of the participants had normal lactate at rest. I think lactate abnormality should be more pronounced when exercising. And even more when comparing CPET tests. Another study showed no lactate reduction on the second CPET in people with ME, but a reduction in controls (which would be expected of course).
 
I bought a lactate monitor, one with paper strips to soak up blood from a fingerprick and a monitor that gives a read-out. I tested my blood at rest, at time intervals after short periods of intense exercise, and when I felt good and when I had PEM and felt as though my body was crushed and my muscles were fatigued.

And I didn't find anything abnormal.

(Edit - but when doing a 2xCPET in a study, I did show the typical ME/CFS reduction in output at ventilatory threshold etc on the second test.)
 
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For what it's worth I had 2x blood lactate tests in an outpatients myopathy clinic.

For the first I was told I had the highest result the doc had seen outside of ICU, 7.4 with normal range 0.6 - 2.0. Other refs I found suggested it was on par with what you'd see post-marathon. The repeat test a few months later was high-normal.

I was experiencing PEM on the first day. Before the test I'd walked 5-10mins from the train station and went up several flights of steps to the point of burning muscles and needing to use my arms to get up them (a rapid onset of that was always obvious on a "bad day"). That trip was the only thing I'd done all day, certainly no 'exercise', and I wasn't sick (no more than usual).

The second trip I was well rested, without PEM, though the train journey and walk was always still enough to do me in the next day, it just didn't impart the immediate issues.

I did get a muscle biopsy off the back of that first result. Unfortunately I was never that satisfied with the follow-up, it took months of chasing to get a report saying "There is a possibility of mitochondrial changes but the staining needs to be repeated due to some technical issues". After more months of chasing the lab apparently confirmed there were only mild, non-specific changes after all, but I never saw any written report and it sounds like someone messed something up, so who knows if it did ever get properly analysed. Unfortunately the negative biopsy meant no genetic screening & I was discharged, so dead end.
 
And if it's impossible to avoid intense activity coz sometimes I need to get a drink.......or use the bathroom.....

Of course opening the curtains is right up there, requiring leaning bent over on things to recover enough to sit/lie down....

My point us...intense activity is relative.
 
I'm not sure where the lactic acid is supposed to be. I don't think there is good evidence for increased levels of lactic acid in the blood of people with ME/CFS, or for abnormal responses to exercise in terms of lactic acid?

I know there was that n=1 paper by Vink, but I think members' experimentation with lactic acid monitors, including my own, didn't find that issues with lactic acid were a common problem.
 
Hutan said:
I'm not sure where the lactic acid is supposed to be. I don't think there is good evidence for increased levels of lactic acid in the blood of people with ME/CFS, or for abnormal responses to exercise in terms of lactic acid?

I know there was that n=1 paper by Vink, but I think members' experimentation with lactic acid monitors, including my own, didn't find that issues with lactic acid were a common problem.
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For what it's worth, in the PEM conference the other day, I believe three different groups (Putrino, Puta and another one) showed either preliminary or clinical data from their clinics - all of them seeing increased plasma lactate during rest and activity compared to healthy adults. It was explained with dysfunctional TCA / increased anaerobic glycolysis iirc (pyruvate -> lactate -> exported lactate). I don't remember them trying to explain that this increased lactate is anything else but an outcome of the former - I don't think they made lactate more than a potential diagnostic marker. Not a main driver of disease state I think. Not 100% certain I remember correctly.
 
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My lactate was 1 decimal point below the top end of normal when first seen in the emergency dept. Really, that was quite abnormal for a supposedly fit and healthy 50yo (at the time). I was doing nothing and the normal range encompasses the full adult age and fitness range.

@Kiwipom I wonder if you might have a comment on your experience with looking at lactate.
 
Adding this n=2 data from a reddit post today here, noting elevated lactate readings after a long delay. Someone who classifies themselves as very severe and another responding.

Lactate levels 24 hours after an appointment at which I was told I'm just deconditioned and need to exercise. FML
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The reading in the submitted image is 7.2 mmol/L

For context, the 'exertion' involved in this was being taken into hospital on a stretcher in an ambulance, lying down for the entirety of the appointment, and then being taken home and not being able to get out of bed since.

Interestingly, my lactate levels were only somewhat elevated (2.4 mmol/l) immediately after the appointment. This huge increase seems to have come later, i.e. some time after the actual activity itself.
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A reply from someone who classifies themselves as suspected/undiagnosed —

I once did a test where i had to sit down and stand back up for 3 minutes at the pneumologists, with the point being to text my blood oxygenation. My oxygenation was perfectly fine but my lactate went from 1,2 mmol/l to 8,0 mmol/l in these 3 min- No one gave a single fuck about this, while it felt like a very clear "this could be something" moment for me. Since i dont have any other clue as to whats going on with me and why im in so much pain during and after any exhaustion.
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My lactate was below 1mmol/l only twice, and both times after a shower, 1000 mg ibuprofen and much rest.
It was always way above 1mmol/l the other days. I didnt ever exercise or do anything straining and yet it was always above 2 mmol/l in the morning and on average 3-4mmol/l in the evening. And after exhaustion i noticed 4-5mmol/l HOURS afterwards (example exhaustion at 10am, measuring at 3pm).
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For reference and informational purposes.

1) During a recent immune treatment of a month my lactate was measured regularly (using a catheter) in the morning waking up at rest and I stayed inpatient. So literally zero activity.

Lactate (09.09.25) – 9.0 mmol/l (range 0.5 – 1.6)
Lactate (16.09.25) – 3.6 mmol/l (range 0.5 – 1.6)
Lactate (18.09.25) – 3.4 mmol/l (range 0.5 – 1.6)
Lactate (22.09.25) – 2.6 mmol/l (range 0.5 – 1.6)
Lactate (25.09.25) – 3.1 mmol/l (range 0.5 – 1.6)
Lactate (30.09.25) – 3.8 mmol/l (range 0.5 – 1.6)
Lactate (06.10.25) – 2.7 mmol/l (range 0.5 – 1.6)

2) as you can see my values started very high and slowly went down
And this corresponds with improvement of all symptoms, most importantly, OI and PEM.
- Also burning muscles feeling (and poisonous feeling) diminished while I was exerting much more every day.
So for me there’s a direct correlation with symptoms/severity and lactate levels
Unfortunately I have relapsed since then

3) as far as I can asses now I think the temporary improvements were caused by high dosage Dexamethasone (and many IV fluids)

4) I think levels are a downstream effect - but for me - and probably for a subgroup - it’s an important marker of our severity and pain levels
- I have continuous burning muscles, specially my arms, with the least exertion
 
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My lactate hovers between 9 and 12 mmol/l so its extremely elevated. I don't notice much of a difference between those levels however its not correlated particularly with how I feel.

Edit - I am taking this with a meter straight from my blood drops so there is no delays or issues with processing of the blood. I did have a high lactate in a GP ordered test as well that corroborated within 0.1 mmol/l where I took the drop sample minutes after the blood draw by the phlebotomist so I have good confidence in the results. GP wasn't at all interested in the high lactate.
 
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