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Blood cannot really build up in the brain because it is in a closed bone box filled with non-compressible fluid. Pressure rises very quickly if blood is not flowing out. There are rare situations where outflow is slow, such as sagittal sinus thrombosis, but there is no indication of anything...

Blood flow out of the brain is always the same as blood flow into the brain. If it is reduced, metabolite clearance is likely to be at the same rate but driven by a slightly higher local build-up concentration.That higher concentration could cause issues.

CSF isn't going to be a route for metabolite clearance anyway - that would be via reabsorption into blood vessels. The whole thing seems a lot of confusion - as the authors of this current paper point out.

Well 'having symptoms identical with' does not require 6 months. The 6 month limit has I think been reduced by NICE 2021 but even at 6 months the recovery rate is likely to be higher than for established ME/CFS. I guess the question becomes what more is said by saying 'they have ME/CFS'. In some...

It's a fair question but there is a reason for being cautious. ME/CFS as a concept is not just a concept of having certain symptoms now. It is the concept of having certain symptoms that are very likely to go on for a long time. Chronic bronchitis is defined in terms of symptoms that go on for...

BMC Med. 2014 Oct 1:12:167. doi: 10.1186/s12916-014-0167-5. Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008-2012 Inger Johanne Bakken 1, Kari Tveito 2, Nina Gunnes 3, Sara Ghaderi 4, Camilla Stoltenberg 5 6...

There are all sorts of reasons why these data show apparent anomalies. People whose illness started thirty years earlier may never have got a relevant diagnosis. People get better. People may stop wanting to say they are ill. Response rates at different ages may bias sampling in different ways...

They say with a diagnosis i.e. prevalence of having a diagnosis, not time of being diagnosed. I don't remember the details but the most useful incidence study is from Norway and it shows peaks in late adolescence and thirties roughly. We had a discussion about it maybe around 2018. The second...

I think those are prevalence data rather than incidence? The peak times of incidence of ME/CFS are in adolescence and mid thirties for women (probably not men for that). Most typical autoimmune disorders have an incidence that rises with age, like breast cancer, with a slight downturn in very...

Yes, most of it. It was quoting weak papers at the fringe of research that suggest something is significant when the weight of evidence goes the other way. The scientific literature is now awash with disinformation from people writing stuff that hypes fringe ideas (and also mainstream dogma...

I don't actually think you should not try to do that because it isn't justified by anything useful. Medical terms are always less than ideal. Chronic fatigue syndrome isn't that bad. It describes a syndrome - which is what ME/CFS is - and fatigue is the simplest commonly used word to label it...

And their genes would be different and their microbial exposure different and about everything else. I guess my view is that if there isn't a scrap of evidence for a role for environmental pollutants why go for it as a theory?

You can always find 'some studies suggest...' for anything. And AI is becoming a brilliant source of scientific disinformation in this regard. That list looks about as plumb negative as you can get to me!! If there were know environmental factors they would go into guideline advice. We tell...

I think both biomedical scientists and philosophers have come to the conclusion that there is no such thing as a 'root cause' in this world much. All events have vastly multifactorial origins.

I don't think you would need to go to South America. Levels of exposure to environmental factors are likely to vary hugely nearer at home - either within regions of a Western state or maybe between states. Or there should be sudden changes with time. Covid-19 may give us just that, but nobody is...

But none of those conditions has anything much to do with environmental factors as far as we know. Smoking predisposes to RA but the others seem to be largely genes + stochastic.

Except that we don't have any epidemiological patterns to fit with that as far as I can see. There ought to be hot spots.

I think a lot of these arguments could be applied equally to the autoimmune and auto inflammatory diseases. Interestingly, it seems that most of these indicate a tolerance of somewhere around 1/100-1/1000 (e.g. RA and lupus). That includes Crohn's disease, ulcerative colitis, ankylosing...

These are all relevant questions to ask, but the causation of disease is more complex than just bad genes and environment. A major third class of factor is internal stochastic - random events generated from within. These are important in most autoimmune diseases and of course cancer. We are all...

Old age.