Lactate testing in ME/CFS & Long Covid #TheAcidTest
Increased lactate is produced during anaerobic respiration. It is proposed that the exertion intolerance and fatigue in ME/CFS and Long Covid (LC) may be in part due to abnormal initiation of anaerobic metabolism, due to low oxygen conditions and/or dysfunctional mitochondria. A study in ME/CFS patients demonstrated elevated blood lactate levels in ME/CFS at rest compared with healthy controls. A recent hypothesis paper has suggested that elevated lactate may play a role in LC pathology also.
Twitter users following the hashtag #TheAcidTest are testing their own lactate levels at home. Please find some helpful guidelines here for using your at-home lactate monitor accurately. These are quite important, it is more difficult to obtain accurate lactate readings for example than a glucose reading.
The study showed that almost half the people with ME/CFS had elevated lactate levels. Although they measured 8 timepoints, we will focus on replicating the two most significant time points:
- After waking (fasting test)
- 1 hour after breakfast (with no exertion for 30 minutes before this test).
A minimum of just these two measures would be needed to compare your data to others, but it could be helpful to repeat the two tests on a separate day to look for stability. If you have additional strips and would like to test after exercise, during PEM etc, please do, just record the details of the sample.
It is also helpful to note whether you are feeling well or in a crash/ flare/ PEM and what kind of breakfast you ate, after how long of fasting overnight. The study used 16 hours of fasting, but we are all individuals and have different routines so this is not necessary. Lactate may increase after eating due to altered blood flow and normal metabolism. A high carb meal will result in higher lactate production. Note that lactate is also produced by some gut bacteria, and other bacteria are present that utilise lactate. Excess lactate producers may contribute to overall lactate.
Normal lactate levels are between 0.5-1 mmol/L. Above 2mmol/L is considered elevated or hyperlactaemia.
Guide to using an at-home lactate monitor
Materials
Lactate Monitor e.g. EDGE monitor (US) EDGE Lactate Meter Test Kit - Home Blood Monitor (edge-usa.com), and GlucoRx multifunctional monitor (UK) GlucoRx X6 Multi Parameter meter | GlucoRx
Lactate test strips
Clean paper towel
Optional: oximeter that gives a PI%
Place to make notes (paper or phone etc)
Set up device
Please follow manufacturers instructions to insert the lactate strip into the monitor. You may need to prime a multifunctional device for the lactate strips using the lactate key.
Please do not touch the part of the strip that takes up the blood as it may be contaminated and cause false readings.
Set up lancet setting the device to the deepest setting to ensure you hit a good capillary.
Taking the sample - please read carefully before commencing test
*Both samples should be taken after at least 30 minutes resting, with no exercise before*. For this purpose we presume exercise is used in the traditional sense, i.e. going for a walk, climbing stairs, doing muscle reps etc.
Wash hands thoroughly, ensuring no soap residue. Do not use alcohol rub, or if you do, please allow it to fully evaporate over several minutes.
Ensure hands are warmed thoroughly - use hot water, rub hands vigorously for 30 seconds at least, massaging from wrists towards fingers.
If energy allows, rapid arm rotations can increase blood flow to the fingers. Alternatively, if sitting or lying down, lower your arm below the rest of your body.
Apply the lancet with pressure to the soft pad of your finger and activate the lancet. Allow one small drop of blood to form and clean this away very well with a clean paper towel. You will need to use the second drop of blood. The finger can be squeezed to form the second blood, massaging blood down into the finger from the hand. The blood drop needs to form reasonably quickly so the blood underneath does not start to clot. The blood drop should be 2-3mm, rounding off the skin, deeply red and not 'watery'.
Take up the testing monitor and stabilise your hand with your other hand or leaning it on something. Gently apply the testing strip to the outside of the blood drop, being careful not to actually touch your skin. The blood will rapidly travel up the strip and the test device should indicate testing is underway.
How to perform a Lactate test on a GlucoRx X6 Meter - YouTube
Optional: test & note your perfusion index using a pulse oximeter and note down the PI%.
After the test
Note down your lactate reading, your PI% (if measured) and whether you had to squeeze your finger to get blood out.
For the waking/fasting measurements note down how long ago you ate (e.g. 12 or 14 hours).
For the 1 hour after breakfast measurement, note down briefly what you ate for breakfast.
Note your current level of wellbeing (relative to your usual) e.g. in a crash, severe PEM, average day, better than average day, high pain level etc.
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In-Brief for those who need less text
A research study has shown people with ME/CFS sometimes have elevated resting lactate, possibly due to poor circulation or energy metabolism. The same may be happening in people with Long Covid.
Twitter users following the hashtag #TheAcidTest are testing their own lactate levels at home. Please find some helpful guidelines here for using your at-home lactate monitor accurately.
The study showed that almost half the people with ME/CFS had elevated resting lactate levels. Although they did 8 tests in one day, for simplicity, we're going to focus on replicating the two most significant time points:
- After waking (fasting test)
- 1 hour after breakfast (with no exertion for 30minutes before this test).
A minimum of just these two measures would be needed to compare your data to others, but it could be helpful to repeat the two tests on a separate day to look for stability.
If you have additional strips and would like to test after exercise, during PEM etc, please do, just record the details of the sample.
Normal lactate levels are <2mmol/L.
Guide to using an at-home lactate monitor
Materials
Lactate Monitor e.g. EDGE monitor (US) EDGE Lactate Meter Test Kit - Home Blood Monitor (edge-usa.com), and GlucoRx multifunctional monitor (UK) GlucoRx X6 Multi Parameter meter | GlucoRx
Lactate test strips
Clean paper towel, cotton pad or tissue
Optional: oximeter that gives a PI%
Place to make notes (paper or phone etc)
Set up device
Please follow manufacturers instructions to setup the device, first priming it for the lactate strips using the lactate key, then insert the lactate strip into the monitor.
Do not touch the part of the strip that takes up the blood as it may cause false readings.
Set the lancet device to the deepest setting to ensure you hit a good capillary.
Taking the sample - please read carefully before commencing test
*Both samples should be taken after at least 30 minutes resting, with no exercise before*. For this purpose we presume exercise is used in the traditional sense, i.e. going for a walk, climbing stairs, doing muscle reps etc.
Wash hands thoroughly, ensuring no soap residue.
Do not use alcohol rub, or if you do, please allow it to fully evaporate over several minutes.
Ensure hands are warmed thoroughly. Many of us struggle with blood flow to our fingers, so warming hands first helps. Place on a heated pad/bottle if able to beforehand, or under a blanket, to help blood flow better. Lower your arm below your body i.e. off the side of the bed if possible. Or if able, massage hands or do quick arm rotations.
Optional: test & note your perfusion index using a pulse oximeter and note down the PI%.
Apply the lancet pen with pressure to the soft pad of your chosen finger and activate the lancet.
Clean away the first drop that forms with a clean paper towel/cotton pad/tissue.
Let the second drop form until 2-3mm across.
The finger can be squeezed to form the second drop, massaging blood down into the finger from the hand.
The blood drop should be rounding off the skin, deeply red and not 'watery' and not smeared.
Ideally it should form fairly quickly to prevent clotting.
Gently apply the end of the testing strip to the outside of the blood drop, being careful not to actually touch your skin.
The blood will rapidly travel up into the strip and the test device should indicate testing is underway.
After the test:
Note down your lactate reading, your PI% (if measured) and whether you had to squeeze your finger to get blood out.
For the waking/fasting measurements note down how long ago you ate (e.g. 12 or 14 hours).
For the 1 hour after breakfast measurement, note down briefly what you ate for breakfast.
Note your current level of wellbeing (relative to your usual) e.g. in a crash, severe PEM, average day, better than average day, high pain level etc.
How to perform a Lactate test on a GlucoRx X6 Meter - YouTube
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