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3) One is that there are two different paths leading to ME/CFS, one for the early onset in late teens, and a different path for the second onset in your mid 30s. So, two different disease that look the same but are different under the hood.
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The bimodal pattern has been shown to be true here in the US too. I can’t remember right now how to locate the reference, but @exceedhergrasp1.bsky.social would know.