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This sort of mishmash of results basically means they didn't find anything interesting I suspect.

Yes, and there is a significant issue when dealing with, for instance, people who have just had major surgery for gut problems with fluid imbalance. The serum level may hold up while total body stores deplete. However, if this really a problem for people with chronic illness at home, without...

That looks wrong. The Mg level in serum and cells seems to be similar - about 2meq/L. Intracellular volume may be a bit more than extracellular but not that much. Serum is a relatively small compartment but not that small and anyway the serum size is irrelevant. It is the extracellular...

From what I can see from the Mayo Clinic serum levels do not give a reliable indication of stores but symptoms are unlikely to be due to magnesium deficiency unless serum levels are very low. Most of the stuff about serum levels being unreliable seems to come from commercial supplement sources...

I never got a reply from Mrs Floptop and PG Tips. Maybe I forgot to put on the address @Planet.Zog.com

It seems that proline is a weak glutamate receptor agonist but I don't see how this would change to produce an acquired intolerance.

I cannot think of any possible mechanism for becoming sensitive to proline. The immune system would not respond to it. I don't think any receptors are going to respond to it abnormally. It is an interesting concept but I find it hard to believe it could be validated.

The really amazing thing is that they know what will be definitive in 7 months time when the book is released.

I am getting a bit confused between your own plans and discussion of policy. The hope is that practices will change with the new NICE guideline. The guideline suggests care should occur in the sort of environment we call a fatigue clinic rather than a rehab unit. Although at the round table it...

I am not sure what referral to a rehab centre is expected to achieve? If there is an ME specialist then surely they should manage care? They should have the skill set? The skill set is mostly understanding how little we know about ME and having practical experience of patients' accounts of how...

Weak muscles do not make a very big difference to joint stability. Muscle tone doesn't really exist. 'Tone' as assessed in a neurological examination is a specific reflex response to passive motion. Yes, people who are very weak may fall but by and large the people who I have looked after with...

Nobody is doubting the need to listen. What is at issue is how that is then interpreted in terms of disease categories. Clinging to disease categories that do not apply can reasonably be seen by medical personnel as unhelpful. I am not justifying safeguarding orders but I think it is very...

We are clearly going to disagree, @Tilly. I base what I say on having worked alongside a hyper mobility clinic most of my working life, having read published population studies showing no clear relation between ME and hypermobility and discussion with paediatric colleagues involved in these...

I think what they mean by rapid physical exhaustion is the sort of thing you get with heart failure or respiratory failure (or my mother aged 100) - becoming unable to continue, with shortness of breath, after a minute or less of walking or climbing stairs. After ten minutes rest the problem has...

The structural level of injury can vary, yes. In Alzheimer's the injury is microscopic (until the brain actually shrinks). In boxers the changes are at a fine level. But there is nothing about ME that suggests injury to me. I am trained in clinical neurology. I have looked after many people...

I think there is a confusion here. injury means structural damage - more or less. In ME we see no structural damage so as far as we know it is not an injury of any sort. Similarity of symptoms is irrelevant because very similar symptoms will occur either from injury to something or from...

Not according to Mr GRADE - Gordon Guyatt. His handbook for GRADE indicates that different people can come to different conclusions and it is not objective. On the other hand he has also said in the BMJ that there is a right way to do GRADE and it would disagree with NICE. I fear this is not a...

Absolutely. That was not intended even if it might seem so!

I think this is a useful discussion because it relates to how Cochrane might defend itself in the face of the sort of criticism being made. I think two different things are getting confused. I think most people would regard the central purpose of Cochrane as providing reviews that accurately...

Welcome to posting here @mikecunn11. An awful lot of research for ME is poor quality and the general view of this particular work is that the methods used are not reliable enough for it to be meaningful in terms of clinical care. None of it should be taken as reliable guidance. Work on the...