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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...