Can you be sure the symptoms weren't just temporarily masked?
I can't say that it wasn't just masking, but it seems unlikely. I had those temporary remissions from at least 3 different chemicals (prednisone, cuminaldehyde, and T2 (3-5 diiodothyronine). I think it's extremely unlikely that those three chemicals could have exactly the same masking effect. It seems more likely that they're switching something off in ME's mechanism. If ME is a feedback loop with multiple factors, these chemicals could affect the loop the same way by adjusting different factors.
 
I can't say that it wasn't just masking, but it seems unlikely. I had those temporary remissions from at least 3 different chemicals (prednisone, cuminaldehyde, and T2 (3-5 diiodothyronine). I think it's extremely unlikely that those three chemicals could have exactly the same masking effect. It seems more likely that they're switching something off in ME's mechanism. If ME is a feedback loop with multiple factors, these chemicals could affect the loop the same way by adjusting different factors.

Yeah, that'd be great if that was reality. There's also the potential for subtypes that are permanently switched on though. I imagine it might be possible that something like a stroke permanently destroying a part of the brain could cause an ME/CFS-like illness.
 
There is a significant percentage (over 30% I seem to remember)of Pwme with gradual onset. I’m one. I was diagnosed 8 years ago 7 years ago I saw a specialist who said I had had ME for 10-12 years.
True, gradual onsets would take more time to the diagnosis. But I thought that 30% was non-viral cases. From MEPedia.com: "85% of patients report a trigger. 72% of ME/CFS patients report that a bacterial or a viral infection was their onset of ME/CFS; 4.5% trauma; 4.5% surgery or childbirth; 2.2% allergic reaction; 1.7% stress or trauma."

So, it appears gradual onset is about 15%, if was equate non-trigger cases as gradual onset.
 
So, it appears gradual onset is about 15%

Not necessarily. People with a reasonably well established viral trigger (e.g. a positive EBV test in the months beforehand) may still have a gradual onset.

My own case was more circumstantial, because although I was exposed to EBV via my boyfriend several months before my ME symptoms started to emerge as a pattern, I didn't develop symptoms of glandular fever in the weeks after exposure. There was no routine EBV testing back in the 1970s, so it was only possible to be sure you'd got infected at that time (as opposed to earlier on in childhood) if you had fairly distinctive acute symptoms.
 
@forestglip I bring good news!---

Of course common variant genetic studies - GWAS [DecodeME] - is also a way to identify potential enviromental triggers --- genes which decrease/increase risk.

I'm hoping that DecodeME will provide clues and indeed metabolomics studies - Dr Li states that metabolite coverage is very low in ME/CFS - we haven't looked at most metabolites.

I'm hoping that this is an iterative process e.g. DecodeME finds genetic clues to focus research and metabolomics can therefore be more focused/targeted --- I'd settle for progress via other routes though!
@forestglip further thought - check out Gulf War Syndrome* - "weak form of the PON1 gene were nine times more likely to develop GWI. Normally the PON1 gene protects you from low-level nerve gas, but there is a strong form and a weak form of the gene."
So basically:
  • common variant genetic studies [GWAS (samples a portion - 10%? - of the whole genome sequence) DecodeME]; or
  • rare variant (whole genome sequence - families with more than 1 family member affected & at least 1 severe) genetic studies;
could be a way to identify environmental factors.
Chris Ponting has said that ME is (20?) years behind re genetic studies. @Jonathan Edwards was part of the MRC expert panel which identified GWAS as an option - another thing they identified was sleep studies.

Getting funding has been a big problem - although Jonathan highlighted that there are limited "ways in" i.e. things like GWAS which provide opportunities.

*
https://utswmed.org/medblog/gulf-war-illness-cause/#:~:text=In May 2022, UT Southwestern,War veterans became chronically ill.
 
Super interesting, thanks!
One of the things to keep in mind is that genetic study (GWAS) in Alzheimer's originally turned up a gene* which was difficult to interpret - it wasn't clear why the form of the gene related to risk. It is now assumed that gingivitis is the environmental factor i.e. explaining why the gene influences risk.
Guess best to not get to hopeful re DecodeME at this stage - results out within 12 months!
*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032519/
 
It is now assumed that gingivitis is the environmental factor

Environmental factor or comorbid conditions? I haven't read the paper you linked yet, but I don't know if I'd refer to another disease as an environmental factor. Does something in the environment cause gingivitis, and then gingivitis goes on to cause Alzheimer's?

Among the risk factors listed for gingivitis on CDC's website are smoking, poor nutrition, and "medication with oral side effects".
 
Environmental factor or comorbid conditions? --

Among the risk factors listed for gingivitis on CDC's website are smoking, poor nutrition, and "medication with oral side effects".
Basically the challenge AKA environmental(?) factor is your response to ongoing infection (gingivitis) but the pathogen isn't the discussion - more that you don't have to look for environmental factors -- just let the genes tell you what's going on.
Jonathan posted that the recent big discoveries in medicine came from genetics --- forget how much X--- you're are exposed to --- go look at the genetic clues (hopefully!).
 
Environmental factor or comorbid conditions?
Ah, think I should have highlighted that genetics doesn't do "comorbid conditions" i.e. things you accidentally/incidentally have --- it just says what the actual problem is --- its advantage. Word of caution is that not every disease is genetic enough (for GWAS - DecodeME) to work --- results within 12 months!
Sure above is poorly worded!
 
Ah, think I should have highlighted that genetics doesn't do "comorbid conditions" i.e. things you accidentally/incidentally have --- it just says what the actual problem is --- its advantage. Word of caution is that not every disease is genetic enough (for GWAS - DecodeME) to work --- results within 12 months!
Sure above is poorly worded!
Environmental factor or comorbid conditions?
My reply was wrong rather than "poorly worded"
I think genetic studies get around "comorbid conditions" by selecting participants. Nath's [NIH] study [not a genetic study] also comes to mind - comments were made that he removed most people from the study i.e. due to comorbidities. DecodeME haven't released full exclusion criteria but I think they didn't e.g. accept people with thyroid problems (psychosis?).
In my earlier reply I was thinking of cause & consequence - GWAS aims to find the cause rather than the myriad of downstream consequences (disease) --- however, GWAS can help to point to environmental factors as per gingivitis/Alzheimer's.
 
My reply was wrong rather than "poorly worded"
I think genetic studies get around "comorbid conditions" by selecting participants. Nath's [NIH] study [not a genetic study] also comes to mind - comments were made that he removed most people from the study i.e. due to comorbidities. DecodeME haven't released full exclusion criteria but I think they didn't e.g. accept people with thyroid problems (psychosis?).
In my earlier reply I was thinking of cause & consequence - GWAS aims to find the cause rather than the myriad of downstream consequences (disease) --- however, GWAS can help to point to environmental factors as per gingivitis/Alzheimer's.

Yeah it'd be very cool if DecodeME gave us any clues like that!
 
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease, Arron et al, 03 June 2024

Thread

Toxin and drug exposure
Some also hypothesise that toxin exposure could trigger ME/CFS (61), such as organophosphate compounds (152, 153) and heavy metals (154). In the early 1960s, researchers found that workers with chronic exposure to organophosphates, mainly in insecticides and after sheep dipping, experienced persistent central nervous system (CNS) changes (153). This included disabling fatigue exacerbated by exercise and associated with myalgia, excessive sleep, night sweats, irritable bowel syndrome (IBS) symptoms, and mental changes. It was hypothesised that the organophosphates induce various abnormalities such as an elevated prevalence of lymphoproliferative disorders associated with impaired natural killer (NK) cell and cytotoxic T cell function. Additionally, exposure to heavy metals, such as cadmium, may also contribute to the development of ME/CFS (154). Cadmium is a widespread environmental and occupational heavy metal pollutant and can potentially cause neurological symptoms. Cadmium induces neuronal death in cortical neurons through a combination of apoptosis and necrosis, involving reactive oxygen species (ROS) generation and lipid peroxidation (155). This action may explain decreased grey matter volume in ME/CFS (156), as well as certain effects on the CNS such as reduced attention levels and memory (157). Exposure to cadmium also potentially reduces cerebral blood flow (158) [particularly cortical blood flow (159)], as cadmium has a disruptive effect on angiogenesis (160). This reduced blood flow can result in neurological dysfunction and the abnormal neuroimaging observed in ME/CFS (158). Cadmium may accentuate inflammatory processes, which may in turn disrupt the HPA axis and trigger symptoms of ME/CFS (161, 162). However, the exact organ that cadmium toxicity targets is still unclear (154).

Furthermore, various drug exposure has been found to trigger symptoms that are typically present in ME/CFS (172). For example, widely prescribed fluoroquinolone antibiotics are usually prescribed to treat various infections such as pneumonia and sinusitis (173175). However, these fluoroquinolones have been found to increase tendinopathy involving oxidative stress and mitochondrial toxicity (176180). Hence, the use of such drugs may have a multisystem effect and lead to the development of chronic illnesses such as ME/CFS.
 
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