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

I

I wonder if the Cori cycle might be impaired or dysfunctional.

Metabolic stress can arise when the Cori cycle is interrupted or not functioning properly. This cycle is a key metabolic pathway responsible for recycling lactic acid produced by muscles during intense activity or times of high energy demand. It plays a crucial role in maintaining blood glucose levels and in replenishing glycogen stores in the muscles.

If glucose is not effectively returned to the muscles, it cannot be used for energy, leading to fatigue and an inability to restore glycogen—a critical component for sustained physical function.

To date, I haven't found any research publications that specifically examine the Cori cycle as a potentially dysfunctional pathway in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome). While lactic acid buildup and glucose metabolism are occasionally mentioned, the Cori cycle itself appears to be overlooked in this context.

I first raised the question of Cori cycle dysfunction during an endocrinology appointment in August 2021. After a 50-mile trip on a very hot day (as a passenger), I arrived for an ACTH test feeling completely exhausted. My muscle weakness was so severe that I couldn't walk. Shortly after my blood was drawn, I collapsed. My blood glucose was measured at 65 mg/dL. A rapid IV glucose infusion restored some of my energy within about 40 minutes.

Once I felt well enough, I asked the lab doctor whether a dysfunctional Cori cycle could explain the recurring hypoglycemia and energy crashes I had been experiencing. He didn’t respond directly, but his expression made it clear he didn’t understand what I was referring to.

SWA

© 2025-2030 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9  

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