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Based on a multivariate analysis, peak blood lactate concentration was the only factor independently associated with L-carnitine administration (odds ratio, 1.9, 95% confidence interval, 1.22.8

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Given this complex picture, although mitochondrial dysfunction, suggested by a number of studies [60], is a plausible reason for lactate elevations in ME/CFS, the other possibilities should not be discarded

Chen B, Patel S, Bao L, Nadeem D, Krittanawong C

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Acetyl-coenzyme A is also an allosteric activator of pyruvate carboxylase that catalyzes the gluconeogenesis pathway, which is active during catabolic states such as fasting