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I disagree, Trish, purely on the grounds that somehow we have to get health care professionals to come to a consensus understanding of the reality of what is going on and what is needed. That may involve giving some ground. It reminds me of the discussions we had long ago about what would...

I have no idea what dysautonomia means and previous discussions here indicate that there are several conflicting views. Dysautonomia is another of those buzzwords used by physicians who want to sound clever to patients but do not themselves really understand. Moreover, whatever is understood by...

It is all physical problems. That is the position of the 'biomedical approach'. Everything works through physical mechanisms whether or not there are mental correlates. The distinction is unhelpful. The BPS people believe that mental and physical causes interact, which means they think they are...

I am not suggesting we call it a psychosis. The eating disorders due to hypothalamic tumour damage are not psychoses. They are all eating disorders in that it is impossible to eat effectively unaided. And I think the working hypothesis has to be that in ME it is driven by a brain problem.

Not quite, because nobody has any more idea what the causal mechanism is for psychosis. The treatment is entirely pragmatic.

I am. suggesting that this was probably mediated by the hypothalamus through vagal input and output - so it can come under eating disorder.

Well, we have to educate people. Eating disorder just means eating disorder. People whose hypothalamus has been damaged so that it no longer control appetite have an eating disorder. Rather than perpetuating this psychological/physical argument why not get people to understand something that...

Yes, this seems to be what the Guardian article is flagging up. It is useful to be aware of that but it still looks as if amongst gastroenterologists in charge of nutrition that bad policy, based on on no adequate evidence, is being recommended for conditions like ME.

At the moment we have the gastroenterologist Peter Paine on one side and Drs Speight and Weir on the other saying completely different things, with patients fallen through the gap in the middle. Surely, what we need is for health professionals to agree on a way of understanding the problem and a...

I realise that it will be unpopular but I am going to say that I think people with severe ME and severe difficulties with eating do have an eating disorder, just as children after treatment of craniopharyngeoma have an eating disorder, and people with anorexia nervosa and my wife with her...

But surely the whole point is that nobody actually knows anything about the psychodynamics here and it is irrelevant. There is no need to get a psychologist involved if we have no evidence for it being beneficial. Why pry into childhoods when it makes no difference? The need is to get the...

I think that would be previously invented thing but I don't know when. I strongly suspect it reflects a movement within gastro similar to the Stone et al. movement in neurology.

So it seems the problem isn't local and is recognised by more than us: https://www.theguardian.com/society/2023/feb/27/eating-disorder-patients-repeatedly-failed-says-england-watchdog

Looking at those gastro articles I am not sure about that. It looks as if we now have three categories clearly laid out: 1. structural/physical 2. psychiatric, as in psychosis or anorexia nervosa 3. 'functional' The implication being that 'functional' cases, which seems to include my own GI...

Tachycardia is not a diagnostic requirement for ME as far as I am aware and in fact I thought there was evidence that OI in ME is most often not POT. Certainly odd.

Call me old fashioned but I would like to see just one protein consistently (80%) well outside normal range. This sort of study might lead to something very interesting but I am tempted to wait to hear about a replication.

The BSG guideline on functional dyspepsia is a hoot - hard to believe really. All the recommendations are strong or very strong and all the evidence is of low or very low quality. What a load of t........

Thanks @cassava7. That seems to identify what we are up against! From the quotes it looks like the usual unsubstantiated psychologisation with some interesting new pseudo-concepts like DGBI.

It would certainly be useful if physicians managed to gather some reliable information on it. Considering Greenhalgh's history of critical remarks this lukewarm dish of washing-up water comes as a reminder that such people commonly commit the very crimes they criticise. The treatment section...

No, ligaments do not vary in function over days, weeks or months. They can become lax over years in the context of severe muscle weakness but maybe only during growth and development. People with hyper extensible knees, such as a professional ballet dancer I know, do not hyperextend during...