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Rights and permissions About this article Cite this article Akhurst, R., Hata, A

This theory also proposes that malfunction of an as yet undiscovered lactate shuttle within the NMJ may be a pathological feature of ALS, suggesting that supporting mitochondrial function may optimize lactate metabolism and combat the toxicity caused by accumulation of excess lactate

This means decisions about supplementation remain largely based on mechanistic plausibility and practitioner experience rather than randomized controlled evidence