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I suspect they mediate much of the symptomatology but then the question is what is upsetting the hypothalamus and vagus, which may be immunological.

Yes, all through the vagus nerve, which operates according the instructions of the hypothalamus. We have no evidence for anything being primarily wrong in the gut. It is hard to believe that there are enough different things primarily wrong in the gut to make eating impossible. If the problem is...

It is worth reading the stuff cited above in the thread "One author of the BSG’s guideline on functional dyspepsia, Dr Peter Paine (from the Salford Royal NHS Foundation Trust), wrote about ME/CFS as a central sensitization disorder that should require removal of tube feeding and rehab, in a...

They emphasise that the cause of inability to eat is physical, contrasting it with psychological.

Psychosis implies a belief that is outside what can reasonably be considered an imbalanced version of normal beliefs and reasons. So believing that you can't eat or shouldn't eat based on some misunderstanding of what is going on is not psychosis. In my wife's case her beliefs had bizarre...

Yes, that's OI, not POT.

It doesn't need a thread. The vagus provides the neural control for the gut - input and output. The hypothalamus controls nausea. Unless the gut is actually blocked by a stricture, which has never been reported as far as I know, this is about all there is.

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