I am not saying Prof Ewald is wrong. I have heard other scientists argue that if the disease is chronic then its cause must be chronically present. Metabolic traps are just an alternative hypothesis. Traps are interesting because they do not require a chronic cause. A transient trigger is all you need.
It is certainly important to consider all angles to a mysterious disease like ME/CFS, and to its great to see ideas like your metabolic trap hypothesis being explored. I did mathematics and physics as my first degree, so can relate to concepts like the metabolic trap, involving system equilibrium points and non-linear effects.
When I was exploring IDO a bit some years ago, I came across several studies showing that IDO activation may be involved in the brain fog of post-stroke and meningitis conditions:
So at that time I was thinking that perhaps high IDO might explain the brain fog of ME/CFS. Interferon gamma induces IDO, so I thought perhaps a viral brain infection may raise IDO levels in the brain.
Though of course the IDO metabolic trap hypothesis posits that IDO is underactive, rather than overactive.
To me, there is an important difference between the trigger of the disease and the cause of the disease.
Yes agreed, that is an important distinction.
it's very difficult to explain all the cases of ME/CFS that do not begin with an infection - the ones beginning with trauma, or surgery, or overtraining,
In the light of the newly-discovered link between ME/CFS and craniocervical instability (CCI), I am guessing that ME/CFS triggered by physical trauma could be explained in terms of physical damage to the craniocervical junction, leading to CCI.
Some people claim that their ME/CFS had no apparent trigger, but it's worth bearing in mind that you can also catch all the ME/CFS-associated viruses asymptomatically with no acute symptoms; so it's possible to acquire such a virus without knowing it. This may explain the ME/CFS cases with no apparent trigger.
We are, I think, both saying that ME/CFS is not infectious. You can meet and marry someone who has ME/CFS and not fear contracting this illness.
Chances are that if you marry someone with ME/CFS you will not contract this illness yourself, I agree. But according to a
paper I mentioned earlier, spouses/partners and children of ME/CFS patients are in the order of 10 times more likely to have ME/CFS than the general population.
Now that higher prevalence in spouses and children might be due to sharing a home environment that may predispose to ME/CFS (eg, a moldy home, which Dr Brewer found is linked to ME/CFS), and/or it might arise because of the higher chances of viral transmission when a person lives in close social contact with another.
but if he means that these diseases are caused by a chronic infection with these pathogens, then it's difficult to explain why someone has not isolated non-human RNA or DNA from ME/CFS patients who have been sick for years.
In the case of enterovirus, its RNA is is now routinely found in ME/CFS patients, thanks to Dr Chia.
Originally British researchers used to perform muscle biopsies on ME/CFS patients (these British studies are listed
here), and detect the RNA in the muscle tissues. But Dr John Chia realized that it was easier to take a stomach tissue biopsy, as enterovirus usually inhabits the GI tract too. So Dr Chia now routinely tests stomach tissues in his clinical practice, and finds enterovirus RNA, dsRNA and enterovirus VP1 capsid protein in these tissues.
You do also find (at a much lesser prevalence) enterovirus infections in the muscle and stomach of healthy people too, so these muscle and stomach infections cannot explain ME/CFS just on their own. Furthermore, these chronic enterovirus infections are low-level infections, so you need to explain why a low-level infection can produce such strong symptoms.
As for herpesviruses, I only know of
one study which detected EBV DNA in the muscle tissues of ME/CFS patients, but apart from that study, I am not aware of any research where someone has actually tried to detect herpesviruses in the tissues of ME/CFS patients. I am not sure why such studies have not been conducted.
Why does the body fail to heal - fail to cure itself - how did a person make it through childhood and often through young adulthood and suddenly encounter an infection the immune system cannot handle?
The most simple answer to this question might be the strength of the immune system at the time of catching the virus.
It's known that ME/CFS is associated with periods of chronic major stress in the year before ME/CFS first appeared. Chronic stress down-regulates antiviral immunity, so if you were unfortunate enough to catch a nasty virus during a time of major stress, that virus may be given the opportunity to insinuate itself more deeply into the body's organs (like the brain) which it would not otherwise have been able to do.
Toxic exposures might also weaken the immune system, making it easier for viruses to gain a hold in the body. So perhaps ME/CFS is only triggered in dual-factor circumstances: the first factor is the virus, and the second is some immune weakening factor.