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2) In the interview Ryback explains that this age pattern is notable and that it might reveal something about the underlying pathology of ME/CFS. There are basically two possible explanations.

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.

4) The second possibility is that there is one biological process that has vulnerabilities at those particular ages. For example, the peaks might correspond to hormonal changes (puberty and peri-menopause).

Maybe there is one group of people who are extremely vulnerable to ME so that, for example, the first EBV infection is enough to trigger ME, and another group in whom cumulative harm is needed to reach the ME threshold (with the number of triggers needed typically reached after 35 years or so)?

Yes but why does the risk drop between the peaks? Suggests the second peak isn't merely about cumulative harm

Perhaps the risk is highest during life stages when the menstrual cycle is irregular (puberty, perimenopause)? 🤔