Patients with mitochondrial disease, some with complex I deficiency, have higher resting lactate levels compared to healthy individuals, with a parallel rise during exercise.

“we published a paper in PNAS a couple of years ago where we placed either healthy individuals or patients with mitochondrial disease on a treadmill at a 10-minute exercise test and then drew their blood at rest peak exercise and post recovery just to look at am at a balloon response to exercise so of course we get lactate and the Myto patients some of whom have complex one deficiency not because of metformin yes of a genetic deficiency they begin with a high resting lactate and there's a parallel rise in their locked date that that parallels what happens to a healthy human and it stays high parallel with the healthy individual post recovery”