To my mind, this multiple causation theory is the only theory that explains why ME/CFS and other "chronic illnesses of unknown origin" aren't more common than they are. If it's environmental, then why don't all members of a moldy household always get sick? If it's solely genetic, again, why haven't we seen a clear lineage of ME/CFS being passed down in affected families? (Sometimes we do, sometimes we don't). If it's a pathogen, why don't all people with high EBV and CMV titers get ME/CFS? Why don't we all have borrellia?
I personally don't believe there's some mystery pathogen out there that we haven't identified yet (ala XMRV). I believe if it existed, it most likely would have been found by now. One even hears the theory that ME/CFS tends to hit "type A" personalities more often, but if that's true, I know quite a few people who are much bigger "stress cases" than me and they're doing just fine. Vaccines? Well, you know where I'm going with that....
Instead, I believe that when they finally solve ME/CFS, they'll discover that us PWMEs are the unlucky few who suffered the chance convergence of triple or quadruple insults to our systems, often all within a short period of time. If you read enough PWMEs' "origin stories" they almost all describe a piling on of various factors: a stressful event, then a viral infection, followed by a vaccine, etc.
By the way, take a moment to think about what order of importance you would have placed these five commonly suspected factors in ME/CFS. My order, from most significant to least would probably be:
6. Stress-related (I question whether this even belongs on the list)
(Have I left anything major out?)
I couldn't even tell you why I've ordered the list in this way. It's the gestalt product of hundreds, maybe thousands, of articles, blogs and forum posts that have washed over me and are now sloshing around in my head. My ordering is likely to shuffle at any time based on the latest CFS Facebook link, or some fad theory making the rounds.
Now consider that the path to ME/CFS is likely different for each patient. Maybe Patient A's path to ME/CFS was 80% environmental, and he was then pushed to the brink (another 19%) by pathogens and a little stress was the coup de grace.
And Maybe Patient B has a homogenous MTHFR genetic polymorphism, which gets her 50% there, and a vaccine at an inopportune time finishes the job. The different pathways to ME/CFS could be endless.
(Side note: with these complexities, not to mention the complexities of our ever evolving symptoms is this "multi-system" disorder, I believe the best chance we have to get to the bottom of ME/CFS is through compiling vast data banks of detailed patient histories and then applying complex data analysis techniques. This, of course, depends on as many of us as possible participating in patient databanks like the Open Medicine Institute's, discussed in this post)
All of that was my prelude to saying that I've been rethinking the role of environmental issues, particularly mycotoxins (mold-related toxins). For a friend of mine, this has been the key to his improvement in recent years. He had to go to great lengths to enact this improvement, even moving to a city with drier, cleaner air, and then renovating his home to remove mycotoxins and environmental chemicals. It hasn't cured him, but he has done a remarkable 180 and can do things that I can't even consider right now. And more importantly, he has control over his crashes, for the most part. If he crashes, he knows why and he knows what he can do about it (get out of the triggering environment.)
That same friend recently posted this article that has me rethinking the role that environmental factors might play in my illness. I think all patients should read it and consider whether mold is an issue for them (if you haven't already): http://www.bulletproofexec.com/how-your-house-can-make-you-weak/
As I told my friend, I have always intended to investigate mold issues as a factor in my illness, but it becomes hectic when you're chasing so many different possibilities and treatments. Even high priority questions like mold could take me years to get around to at my current rate. There's only so much I can investigate at once. But I'm now moving "mold" up higher on my list of priorities.
For those like me that haven't had a chance to consider mold very much, here are a few other sources to get you started:
- Mycotoxins are the main focus of one of ME/CFS's more well-know physicians: Dr. Shoemaker. I admit, I haven't even had the chance to learn the first thing about Shoemaker's theories.
- Detection of Mycotoxins in Patients with ME/CFS (a study finding that "Urine specimens from 104 of 112 patients (93%) were positive for at least one mycotoxin..." Apparently ZERO of the 55 controls tested positive.
- And a post from Health Rising, discussing the same study and putting it in context.
One thing that gives me pause: When I search the Internet for studies or articles on the role of mold exposure in ME/CFS, all results point back to this one study linked above. I'd like to see it replicated and peer reviewed. (This is when the progress of ME/CFS research becomes frustratingly slow...)