While the ‘anaerobic threshold’ concept was an important and arguably laudable application of late 19th and early 20th century biology, the mechanistic basis for the concept is inadequate in terms of what is known today (Brooks,
2018; Ferguson
et al.
2018). La− is produced continuously under fully aerobic conditions (Rogatzki
et al.
2015) and is an important energy source (Mazzeo
et al.
1986; Stanley
et al.
1986; Bergman
et al.
1999b; Messonnier
et al.
2013), the major gluconeogenic precursor (Bergman
et al.
2000; Meyer
et al.
2002a), and an important signalling molecule that works by changing cellular redox (Brooks,
2002), allosterically binding to receptors (Ahmed
et al.
2010), signalling via a transforming growth factor β2 signalling cycle (Takahashi
et al.
2019) and gene expression by lactylation of histones (Zhang
et al.
2019). Further, recent evidence suggests that a gut microbiome-to-host La− shuttle exists that may enhance endurance exercise performance (Scheiman
et al.
2019). Classic as well as contemporary findings in biology lead to the conclusion that La− turnpoints or high blood [La−] provide little or no information on adequacy of tissue oxygenation, but rather that the balance between La− production and disposal is perturbed for reasons that are not always understood. We know that during physical exercise La− disposal is accomplished mainly by oxidation (75–80%) in working muscle (Bergman
et al.
1999b), the heart and elsewhere (Gertz
et al.
1988), and the remainder mainly by gluconeogenesis (Bergman
et al.
2000). Historically, rising or high blood [La−] under conditions of physiological or metabolic stress have been misinterpreted (Brooks,
2018; Ferguson
et al.
2018). La− production is an important strain response, the purpose of which is to mitigate stress. Understood in this light, blood [La−] can be an important biomarker of physiological stress/strain relationships, and ironically, as now appreciated by investigators conducting a variety of clinical experiments and clinical trials, La− supplementation can be an important adjunct to therapy across a broad array of physiological or life-threatening conditions (Brooks,
2018).