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Since the carrier molecule of fatty acids, acyl-CoA, can not cross the cell membrane of the mitochondria, a deficiency of carnitine causes a reduction in the concentration of fatty acids in the mitochondria and, consequently, a reduced production of energy

doi: 10.1016/j.bbagen.2017.05.019 72 SeibtTMPronethBConradM

The results of that fairly routine clinical brain MRI/MRS scan piqued my interest because and here are the answers to your how? and why? questions above they revealed elevations of ventricular lactate similar to those that we had observed in patients with primary mitochondrial disorders, which I was investigating at the time as a Radiology faculty member at Columbia University Medical Center. Those increased lactate levels are basically synonymous with mitochondrial dysfunction We have found elevated ventricular lactate in nearly every disorder in which mitochondrial dysfunction has been implicated