“…We found increased LAC in ME/CFS patients in the bilateral insula, bilateral parietal cortex, left hippocampus, left middle cingulate gyrus, left precuneus, right thalamus, right rolandic operculum, left temporal cortex, right calcarine sulcus, right fusiform gyrus, right lingual gyrus, and cerebellum. LAC is a byproduct of anaerobic cell metabolism (glycolysis) that is not found at high levels in the healthy brain, but is produced by various immune cells under inflammatory conditions (Dienel, 2012;El Ghazi et al, 2010). Because anaerobic glycolysis results in much less efficient synthesis of adenosine triphosphate (ATP) than healthy metabolism, the resultant energy deficits at the cellular level may drive the profound fatigue experienced by ME/CFS patients (Castro-Marrero et al, 2013;Lawson, Hsieh, March, & Wang, 2016;Myhill, Booth, & McLaren-Howard, 2013).…”