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Over 90% of ATP, as the main source of energy for cellular processes, is produced in the mitochondria through oxidative phosphorylation, the Krebs cycle, and -oxidation of fatty acids

Moreover, lactate is a critical energy substrate for astrocytes and neurons, and its dysregulated metabolism in ME/CFS and FM patients may reflect an impaired ability to use lactate effectively for energy (Blanger et al., 2022