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Adelaide lactic acid research

compiled by Moira Smith

Lactic acid is not the only focus of research by Dr Scroop and Dr Burnett; they are also looking at potassium levels, and gastric symptoms.

TV report

On 17 June 1998, Australia’s Channel Nine program “A Current Affair” reported on research being done by Associate Professor Garry Scroop at the Department of Physiology, University of Adelaide, that it is claimed will lead to the development of the world’s first diagnostic test for Chronic Fatigue Syndrome.

According to this program, Prof Scroop and his team have spent the last two years studying CFS patients matched with normal controls. They have found that people with CFS release twice as much lactic acid into their bloodstream during exercise as healthy people, so that they fatigue much earlier and have a significantly lower endurance level.

The program showed a young woman with CFS - one of Prof Scroop’s subjects - at home in bed, and then in the laboratory on an exercise cycle taking part in the experiment, as a blood sample was taken every minute.

The reporter said that this was the first time anyone in the world had found a consistent abnormality in the blood of CFS patients - in the past all blood tests have been normal and there has been no metabolic proof that a person is ill.

[Note: this is not strictly true - there is a considerable body of scientific evidence of biochemical abnormalities in people with CFS, including the urine analysis and other work being done at Newcastle University's Collaborative Pain Research Unit in Australia. The Newcastle research has found high excretion of tyrosine and other metabolites in the urine of CFS patients, also indicating abnormal muscle catabolism.]

Prof Scroop noted that the Royal Australasian College of Physicians’ draft CFS Guidelines recommend exercise programs for patients and said he didn’t know why, as “exercise training could not help them in any way” and in fact is “potentially damaging”. (See "Aerobic Exercise isn't the Cure") He also said the lactic acid test will provide CFS patients with a sound scientific laboratory test so that they can say “It’s not something in my mind, it’s not Yuppie Flu, it’s a real disease.”

Also featured in the segment was twice world champion motorcyclist Barry Sheen talking about his six and a half year struggle with the disease. He said the many accidents he had had during his career (including having both legs smashed) were “a piece of cake” compared to being ill with CFS, which was worse than any accident he was ever in.

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Article in Sydney Morning Herald

The following item had already appeared in the sports section of the Sydney Morning Herald on Saturday 16 May 1998:

Adelaide scientists this week announced a discovery that will send a chill through sporting bodies across the world. The scientists, from the University of Adelaide, discovered Chronic Fatigue Syndrome sufferers have abnormally high levels of lactic acid in their blood. Lactic acid, which is what makes muscles sore after a hard workout and, during exercise, is responsible for muscles fatiguing as it builds up and is stored in the muscles. Following this breakthrough scientists will now, no doubt, begin inventing drugs to flush lactic acid out of the muscles, meaning it is only a matter of time before it shows up in athletes, making the playing fields a little more uneven. The drug would help athletes in distance events as much as steroids have benefited athletes in power events.

Article in Medical Observer

The same research was previously reported in the Medical Observer, 29 May 1998 in an article called Simple test found for CFS by Jacquie van Santen. According to this article, the research has repeatedly shown lactic acid levels at least 20%, and up to two to three times, higher than normal. Prof Scroop was quoted as saying, "We've got a handle on the disease at the moment that I don't think anyone else has had before. This is a consistent result," and:

"A lot of people think that because CFS patients, as they see it, 'lie about all day' their bodies become deconditioned and that would explain it. But CFS patients actually have a normal exercise engine compared with people of a sedentary lifestyle, but when you work them they just fatigue earlier"

The article said that the discovery came about serendipitously when Prof Scroop was actually measuring potassium levels in a group of CFS sufferers after exercise. He decided to measure lactic acid as well.

Prof Scroop and his colleage Dr Richard Burnet, senior visiting specialist at the Royal Adelaide Hopital's endocrinology unit, are said now to be working on the development of a simple diagnostic test.

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Aerobic Exercise isn't the Cure

This is a short item I wrote for the Canberra Fibromyalgia Self-Help Group's "Fibromyalgia News" (supplement to the quarterly newsletter of the Arthritis Foundation of the ACT) Summer 1998-99

Here is some news that will go a long way to diminishing the guilt and frustration people with fibromyalgia and CFS so often feel about exercise.

Recent research by the Adelaide CFS Research Group on lactic acid in people with CFS and fibromyalgia has had quite a bit of publicity. They think they have found a possible diagnostic test for CFS! I was at the talk by Professor Garry Scroop and his colleague Dr Richard Burnet put on by the ACT ME/CFS Society in October 1998 in Canberra.

Lactic acid is a toxic by-product of exercise - it is what makes your muscles tired. Basically what Dr Scroop has found is that, while it is normal for lactic acid to be released into the blood stream during exercise, people with CFS release about twice as much as “normal healthy” people.

The blood samples are taken from Dr Scroop’s subjects while they are riding an exercise bike for ten minutes. The results have been very consistent and prove that there is a physical abnormality involved, but there is still a lot of work to be done.

Some people who have heard about this have asked if they can get treatment of some kind to lower their lactic acid. Dr Scroop says, although there is certainly some problem in the way our muscles produce energy, he doesn’t think the answer is that simple. And remember the high lactic acid he has found is only a by-product of much more vigorous exercise than we normally do - yet we are still tired!

Others have noted that trained athletes can exercise for longer than “normal healthy people” before their lactic acid levels start to rise. This is one of the objectives of training. So could our problem be that we start producing lactic acid much too quickly - and could training fix this? The answer again is “no”. Dr Scroop’s experiments show that when we exercise we start to release lactic acid at the same time as the “normal healthy people” he was using as comparisons. We are already as fit as they are! It is only the amount of lactic acid we produce that is abnormal. During his lecture he insisted that asking people with CFS or fibromyalgia to do aerobic training (like riding an exercise bike or power walking) is completely pointless.

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May 1999 talk in Hobart, reported by ABC

Saturday 15 May, 1999 (4:15pm AEST)

Australian researchers say they have discovered the first biochemical evidence to support the diagnosis of chronic fatigue syndrome (CFS).

Doctors at the Royal Hospital in Adelaide say chronic fatigue has often been seen as a pyschological problem, but they say they've found concrete physical evidence for the condition.

Their research shows patients with CFS are unable to effectively metabolize glucose.

Chief researcher Dr Richard Burnet, speaking in Hobart today, says when people with CFS use their muscles, the glucose turns into lactic acid - in effect poisoning their system.

"We believe it is very important, because at long last it provides some unifying theory that will fit together the problems these people have," he said.

http://www.abc.net.au/news/newslink/weekly/newsnat-15may1999-50.htm

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Similar findings of research in the UK

Roger Burns reported in CFS-NEWS Electronic Newsletter #73 (30 June 1998) on research being done by R. Lane and colleagues at the Division of Clinical Neuroscience and Psychological Medicine, Imperial College School of Medicine, Charing Cross Hospital, London, UK. These researchers have been doing biopsies and MRIs of the muscles of people with CFS, and have published two studies. They found "abnormal lactate responses to exercise" among other differences.

Here is a quote from the abstract of the second study:

It has been shown previously that some patients with chronic fatigue syndrome show an abnormal increase in plasma lactate following a short period of moderate exercise, in the sub-anaerobic threshold exercise test (SATET). This cannot be explained satisfactorily by the effects of 'inactivity' or 'deconditioning'....

They note that the patients whose lactic acid increased "also showed a significantly lower ATP synthesis rate during recovery ... indicating impaired mitochondrial oxidative phosphorylation."

Lane RJ, Barrett MC, Woodrow D, Moss J, Fletcher R, Archard LC Muscle fibre characteristics and lactate responses to exercise in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry 1998 Mar;64(3):362-367

Lane RJ, Barrett MC, Taylor DJ, Kemp GJ, Lodi R Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle Neuromuscul Disord 1998 May;8(3-4):204-209

There was more information on this research in a March 1999 article by Anne Faulkner about the work of The Persistent Virus Disease Research Foundation on the Action for ME website:

In a study of 145 patients with chronic fatigue, they found that about half showed an early and abnormally high production of lactic acid in response to a moderate exercise test.

The researchers linked these findings to the presence of enterovirus in muscle cells; they also found that people with abnormal lactate response often had fewer Type 1 muscle fibres (the ones that help with aerobic activity).

[www.afme.org.uk/frame/info/research/pvrf.html]

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Exercise a health risk for chronic fatigue sufferers

ABC news, 8 August 2001 "... a study conducted by Adelaide University's Exercise and Physiology Research Unit has found chronic fatigue patients have the same fitness level as the average healthy person. Associate Professor Garry Scroop says exercise can make their condition worse. ... The research team hopes its findings will encourage doctors not to prescribe exercise for chronic fatigue patients."

ABC TV's Health Dimensions on Dr Scroop's Adelaide research, 2 October 2001. "Despite years of research there is still no treatment for chronic fatigue syndrome. Guidelines for managing the condition (such as those produced by the Royal Australasian College of Physicians) tell doctors to treat the symptoms and encourage people with CFS to gradually increase their activity level to stop them becoming unfit. However research at the University of Adelaide has challenged the value of that recommendation. The Exercise Physiology Research Unit has found that people with CFS are nor more unfit than matched controls."

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