By SWA

Ed Yong is pointing several times to lactic acid.
https://www.theatlantic.com/podcasts/archive/2023/08/fatigue-can-wreck-you/675030/

I wonder if the "Cori cycle" is damaged somehow.

The Metabolic Stress begins if the Cori cycle is interrupted or damaged.
The Cori cycle is a metabolic pathway that plays a crucial role in maintaining blood glucose levels and recycling lactic acid produced by muscle cells during intense exercise or periods of high energy demand.
If glucose is not returned to the muscles it cannot be used and energy goes down and no replenishing of glycogen stores can take place.

I could not find any publication where the Cori cycle was included in ME/CFS research, as a dysfunctional part of low energy. Yes, lactic acid and glucose are mentioned, that's all.
At an incident at endocrinology in August 2021 I raced for the first time the question about the Cori cycle.
After a 50 mile drive on a very hot day, even a friend was the driver, to the endocrinologist for an ACTH test I arrived completely exhausted and my muscle weakness did not allow me to walk.
Blood was drawn and I collapsed. My blood sugar was down to 65. A quick IV glucose intervention restored some of my energy in 40 minutes.
Having gained enough energy I ask the Lab doc if my Cori cycle is damaged since hypoglycemia happen many times before.
He did not answer but I could see in his reaction that he did not understand what I was asking for.
SWA

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