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My theory on PEM is that it's a neurological switch of some sort. Cognitive exertion can trigger it directly, with minimal delay. Physical exertion triggers the same switch through cytokines, whose release is delayed by how the immune system works. For me, the type of physical exertion was...

I use the terms "physically-induced PEM" and cognitively-induced PEM".

No, there can be such a switch. Physical exertion triggers an abrupt rise in IFN-g ~24 hrs later, and that cytokine can trigger all sorts of effects, such as activating glial cells. T-cells, and maybe others, have pretty amazing timing mechanisms. My ME started with a type IV delayed food...

To answer the original question, I believe that PEM, and ME overall, arise in the brain, with metabolic problems in the body as common--but not essential--downstream effect. My ME didn't involve any reduction in muscular strength or endurance, or any other indication of impaired mitochondrial...

My physically-induced PEM had a consistent 24 hr delay. That fits with the rise in IFN-g that occurs after exertion. The IFN-g would trigger changes in glial cells, which in turn could cause the symptoms of PEM. Viral infections (I only had two since developing ME) caused the same increase in...

When I asked for some to try, my doctor was fine with prescribing it, because it's at such a low dosage that the chance of bad side effects was negligible. It worked extremely well for me, blocking my neuropathic pains, but didn't affect any other ME symptoms. After a year or two on LDN, I no...

The question is: why is this not being used as a diagnostic tool for ME today? Lack of funding for proper development? I believe that glial cells are involved in ME. Astrocytes working abnormally could account for the cererbral vascular hypoperfusion.

L-carnitine solved a problem I was having with fatty acids a few years ago. Fatty foods--and I think it was specifically the palmitic acid--made my symptoms worse. Taking L-carnitine, which is critical for fatty acid transport into cells, with a meal solved that problem. After a year or so, I...

That's good to know. I tried to find out what was supposed to be 'normal' and didn't find a definitive answer. When I'm feeling normal levels of ME symptoms, my oral temperature is usually 36.65. Yes, that seems like excessive precision, but that's what several different thermometers kept...

It's hard to say whether my ME has gotten worse over time. There have been plenty of changes--new symptoms or sensitivities appearing, and existing ones disappearing--but overall about the same. Of course, over time, age-related problems are going to appear, and it's hard to know whether a new...

I like the concept of linked subsystems failing and affecting other subsystems. It could explain the gradual changes in my ME symptoms over the years. One subsystem weakens, and another gradually strengthens to 'take up the load'.

I've gotten into the habit of including the (Cuminum cyminum) whenever I mention cumin, because there is confusion. The black cumin is frequently mentioned as a health product, while regular cumin isn't. My guess is that it's the 'rare ingredient' marketing approach: sellers of fake treatments...

I think my tinnitus started gradually sometime after my ME did (that was 2001). It might have been age rather than ME. I haven't noticed a correlation between ME symptoms and tinnitus severity, but hadn't really paid attention before. My tinnitus did go away temporarily (hours?) last...

Cumin works wonderfully for me. A level tsp of ground cumin blocks my physically-induced PEM completely for 3 days. I'm pretty sure I posted it on this forum long ago, and on PR and HR as well, but no one has reported that it works for them. It seems something unique to me. I keep hoping...

>'The initial enzyme, indoleamine 2,3-dioxygenase (IDO1) is induced by IFNγ, while tryptophan-2,3-dioxygenase (TDO) is induced by corticosteroids.' That's interesting. My ME symptoms were worse during periods when my IFN-g should have been elevated (24 hrs after physical exertion, or viral...

My PEM seems totally neurological: primarily lethargy and malaise. I don't suffer from physical problems. I'm sure my muscles could manage a 6-hr bike ride while I was suffering from PEM; it would just feel like horrible torture, and I might need someone with a whip to keep me from giving up...

For me, PEM is a general worsening of my ME symptoms. My physically-induced PEM has a consistent delay of 24 hrs and lasts for hours (hard to tell when it ends). My cerebrally-induced PEM (typically from driving or socializing) can start up in less than an hour, and is variable in delay...

LDN (low-dosage naltrexone) worked very well for my neuropathic muscle aches (which went away eventually). Acupuncture also worked for that, but I only tried it once (LDN was cheaper and more convenient).

My first sign of ME was the feeling that I was coming down with a flu: achey, the feeling that if I bumped into anything I'd feel pain all over. lethargy, and just plain feeling unwell and wanting to crawl into bed. It felt exactly like previous flu infections. The symptoms have changed over...

Late to the discussion, but I think there's confusion between PEM and crashes or other worsening of symptoms. We don't have a proper, verifiable clinical definition of PEM but it does seem to be separate from crashes and other worsening. Some of the triggers you listed might apply to those...