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This metabolic bottleneck forces the body to rely on less efficient, anaerobic energy production, which generates lactic acid and contributes heavily to the sensation of heavy, aching muscles and post-exertional malaise (PEM)

doi: 10.1007/BF02373021 171 WangY

An isolated complex V inefficiency and dysregulated mitochondrial function in immortalised lymphocytes from ME/CFS patients

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