Gulf War Illness

Map of ground operations of Operation Desert Storm starting invasion February 24-28th 1991. Shows allied and Iraqi forces. Special arrows indicate the American 101st Airborne division moved by air and where the French 6th light division and American 3rd Armored Cavalry Regiment provided security

Gulf War Illness (GWI), also known as Gulf War Syndrome (GWS), is a term used for unexplained illnesses occurring in veterans of the 1991 Gulf War in Southwest Asia. According to the Institute of Medicine in 2013, about one-third of US Gulf War veterans (250,000 of 700,000 personnel) suffer from “chronic multi-symptom illness (CMI): a series of symptoms that cannot be medically explained.” Science News summary of June 29, 2016, states: "Veterans of the Gulf War are more than twice as likely to have medically unexplained symptoms known as "multisymptom illness" (MSI), compared to Iraq/Afghanistan War veterans, according to an updated research."

In a May 2022 study Robert W Haley et al. have concluded that "exposure to sarin gas that occurred after coalition airplanes blew up chemical storage tanks" was the cause, and that genetic differences in the PON1 gene resulted in different risk levels to GWI. The PON1 gene determines the genetic risk of susceptibility to organophosphate cholinesterase-inhibiting chemicals including nerve agents such as sarin.

Symptoms

The U.S. Department of Veterans Affairs has a list on Gulf War Veterans' Medically Unexplained Illnesses.

• Myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS) with long-term severe fatigue.
• Fibromyalgia characterized by chronic widespread muscle pain and may include insomnia, morning stiffness, headache, and memory problems.

Functional gastrointestinal disorders

A group of conditions marked by chronic or recurrent symptoms related to any part of the gastrointestinal tract. Functional condition refers to an abnormal function of an organ, without a structural alteration in the tissues.

• functional abdominal pain syndrome
• functional dyspepsia (indigestion)
• irritable bowel syndrome

Undiagnosed illnesses

These symptoms may be connected to undiagnosed illnesses.

• abnormal weight loss
• cardiovascular disease
• fatigue
• headache
• joint pain
• menstrual disorders
• muscle pain
• neurological and psychological problems
• respiratory disorders
• skin conditions
• sleep dysfunction

Other symptoms

• dizziness
• memory problems

Multisystem condition

In March 2003, New Scientist magazine's print edition reported on Dr. Robert Haley and his team identifying three distinct syndromes in Gulf war veterans that involved brain damage.

• Syndrome 1: Symptoms are impaired cognition, distractions, and insomnia from the exposure of pesticide with basal ganglia damage.

• Syndrome 2: The symptoms are confusion, disorientation, ataxia, and vertigo due to exposure to sarin and pyridostigmine with damage to the brainstem and basal ganglia.

• Syndrome 3: Symptoms are pain, tingling, and numbness from exposure to DEET and pyridostigmine with damage to the brainstem.

175,000 of 700,000 US Gulf War personnel are affected by the brain damage syndromes categorized by Dr. Haley and 75,000 are ill due to other exposures; in total 250,000 are chronically ill with GWI.

Cause of illness

Causation include vaccinations; oil well fires; chemical and biological weapons; depleted uranium; noise; CARC paint used on military vehicles; occupational hazards; pyridostigmine bromide; pesticides or other organophosphates; sand, dust, and particulates; toxic embedded fragments; infectious diseases; heat injuries; fuel; decontamination solutions; and the fluoroquinolone antibiotic ciprofloxacin.

Toxins

The conclusions and recommendations of the Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations, 2009-2013 report conclude "exposure to pesticides and pyridostigmine bromide are causally associated with Gulf War illness" as well as other hazardous exposures including gas agents sarin/cyclosarin. "Mixed exposures include not only mixtures of chemicals but also chemicals combined with heat, dehydration, infection and other environmental stressors."

A May 2022 study by Robert W Haley et al. - "have concluded that "exposure to sarin gas that occurred after coalition airplanes blew up chemical storage tanks" was the cause of Gulf War Illness.

Vaccinations

Mass vaccinations "against infectious diseases including medical counter-measures against biological weapons" were given prior to military deployment. Vaccination in the presence of elevated cortisol levels can drive cytokine expression toward Th2 dominance.

Comorbidities

Gulf War Illness increases the risk of developing other medical conditions. The U.S. Department of Veteran's Affairs found that "1990-1991 Gulf War deployment is associated with an increased risk for ME/CFS, fibromyalgia, skin conditions, and dyspepsia."

Potential treatments

Vagus nerve stimulation has been identified as a possible treatment for GWI.

Controversy

U.S. Department of Veterans Affairs' cover-up of GWI

• Aug 28, 1997, The Cover-up of Gulf War Syndrome -- A Question of Natinal Integrity
• Mar 13, 2013, Whistleblower: Veterans Affairs Covered Up Data on Mental Health, Gulf War Syndrome
• Mar 13, 2013, Researcher says officials covered up vets' health data - USA Today

WASHINGTON — U.S. Department of Veterans Affairs officials purposely manipulate or hide data that would support the claims of veterans from Iraq and Afghanistan to prevent paying costly benefits, a former VA researcher told a House subcommittee Wednesday.

"If the studies produce results that do not support the office of public health's unwritten policy, they do not release them," said Steven Coughlin, a former epidemiologist in the VA's public health department.

"This applies to data regarding adverse health consequences of environmental exposures, such as burn pits in Iraq and Afghanistan, and toxic exposures in the Gulf War," Coughlin said. "On the rare occasions when embarrassing study results are released, data are manipulated to make them unintelligible."

• Apr 12, 2013, Dr. Robert Haley, What Caused Gulf War Illness (Video) Dr. Haley speaks about the United States Department of Veterans Affairs' cover-up of US Gulf War troop illness being due to environmental exposure.

• Mar 14, 2014, Congress Confronts VA Over Gulf War Illness Research
• Mar 30, 2015, Former VA Chief Of Staff Linked To Gulf War Scandal

Simon Wessely's past stress related beliefs in GWI

Professor Simon Wessely, psychiatric paradigm researcher of chronic fatigue syndrome, believed that stress was the common denominator of GWI.

• 2004, Interview with New Scientist, US in U-turn over Gulf war syndrome

Wessely told New Scientist: “There is not one single cause for the ill health,” adding that he believes we may never fully know what happened to the people who became ill.

Wessely asked both Gulf and non-Gulf veterans about 50 standard symptoms. “Gulf veterans reported every symptom twice as often,” he told the Lloyd inquiry. If there were a unique Gulf syndrome, some would be relatively more frequent in the Gulf group. “But they are just experiencing more ill health. There is no unique syndrome here.”

Wessely favours psychological explanations for Gulf war illnesses. The only thing that could have affected so many different people, he says, was stress, especially anxiety about chemical weapons, misinformation about Gulf war syndrome afterwards, and the many vaccinations Gulf troops received. His team found the more vaccine Gulf, but not non-Gulf veterans, received the more likely they are to be ill.

Haley says the questions in Wessely’s study were too vague to distinguish between a real syndrome and people who have, say, occasional dizziness or joint pain. He says this will confound efforts to uncover a meaningful pattern behind the veterans’ symptoms.

• 2006, A study published in The Lancet that Wessely was involved with, The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study interpretation:

For regular personnel in the UK armed forces, deployment to the Iraq war has not, so far, been associated with significantly worse health outcomes, apart from a modest effect on multiple physical symptoms. There is evidence of a clinically and statistically significant effect on health in reservists.

• 2006, Something old, something new, something borrowed, something blue: The true story of Gulf War Syndrome

So my story then: something old, we have seen some of these before; something new, there was a definite hazard with some of the precautions that were taken to protect Gulf veterans; something borrowed, soldiers can also be civilians and the things that concern us also can concern them; something blue, the psychiatry of Gulf War is the psychiatry more of depression than it is of PTSD.

• 2010, A second study What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study interpretation:

Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel.

• 2011, Two decades on, battle goes on over 'Gulf War Syndrome' - BBC News

Professor Simon Wessely is director of the King's Centre for Military Health Research in London and an adviser to the Ministry of Defence. He does not believe Gulf War Syndrome exists as a distinct illness.

Even so, he has no doubt that a significant number of Gulf veterans became ill as a direct result of their military service.

"The evidence is incontrovertible that there is a Gulf War health effect," he says.

"Something to do with the Gulf has affected health and no-one serious has ever disputed that.

"Is there a problem? Yes there is. Is it Gulf War Syndrome or isn't it? I think that's a statistical and technical question that's of minor interest."

The Ministry of Defence echoes Professor Wessely's view.

News articles and interviews

• 2022, Researchers Think They've Found the Cause of Gulf War Illness - Military.com
• 2013, Researcher says officials covered up vets' health data - USA Today
• 2011, Two decades on, battle goes on over 'Gulf War Syndrome' - BBC News
• 2004, US in U-turn over Gulf war syndrome - New Scientist

Notable studies

• 2015, Cytokine expression provides clues to the pathophysiology of Gulf War illness and myalgic encephalomyelitis - (Full text)
• 2017, Role of mitochondrial DNA damage and dysfunction in veterans with Gulf War Illness - (Full Text)
  • Researchers find evidence of DNA damage in Vets with Gulf War illness
• 2018, The Multiple Hit Hypothesis for Gulf War Illness: Self-Reported Chemical/Biological Weapons Exposure and Mild Traumatic Brain Injury - (Full Text)
• 2018, Fatigue in Gulf War Illness is associated with tonically high activation in the executive control network - (Full Text)
• 2018, Gulf War agents pyridostigmine bromide and permethrin cause hypersensitive nociception that is restored after vagus nerve stimulation - (Full text)
• 2019, Gastrointestinal neuroimmune disruption in a mouse model of Gulf War illness - (Full text)
  • GI neuroimmune disruption contributes to Gulf War Illness

    Many Persian Gulf War veterans experience Gulf War Illness (GWI), a chronic condition with symptoms ranging from gastrointestinal to neurological. While exposure to the anti-nerve gas pyridostigmine bromide (PB) is linked to the development of GWI, the exact cause and mechanisms of the illness remain unclear. Recently, an animal study tested the hypothesis that exposure to PB contributes to the development of GWI by disrupting the neural and immune systems of the intestine.

• 2020, In-vivo imaging of neuroinflammation in veterans with Gulf War illness - (Full text)
• 2020, Acetylcholinesterase inhibitor exposures as an initiating factor in the development of Gulf War Illness, a chronic neuroimmune disorder in deployed veterans - (Full text)

• 2020, Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - (Full text)
• 2021, Exposure to Gulf War Illness-related agents leads to the development of chronic pain and fatigue - (Full text)
• 2021, Vagal nerve stimulation as a possible non-invasive treatment for chronic widespread pain in Gulf Veterans with Gulf War Illness - (Full text)
• 2021, Pyridostigmine bromide, chlorpyrifos, and DEET combined Gulf War exposure insult depresses mitochondrial function in neuroblastoma cells - (Full text)
• 2022, Evaluation of a Gene-Environment Interaction of PON1 and Low-Level Nerve Agent Exposure with Gulf War Illness: A Prevalence Case-Control Study Drawn from the U.S. Military Health Survey's National Population Sample - (Full Text)

See also

• Vagal nerve stimulation
• Organophosphate
• Mestinon (pyridostigmine bromide)
• Vaccine

Learn more

• 2019, Veterans Study Suggests Two Subtypes of Gulf War Illness - Georgetown University Medical Center
• 2019, Brain studies show chronic fatigue syndrome and Gulf War illness are distinct conditions
• 2016, Testing nine potential treatments for Gulf War Illness pain and fatigue - Jarred Younger
• 2015, GULF WAR RESEARCH STRATEGIC PLAN 2013-2017
• 2014, Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations, 2009-2013
• 2014, Advisory Group: Exposures, Not Stress Caused Gulf War Illness - U.S. Medicine
• 2008, Gulf War Illness and the Health of Gulf War Veterans Scientific Findings and Recommendations - Research Advisory Committee on Gulf War Veterans' llnesses
• 2004, Independent Public Inquiry on Gulf War Illnesses - The Lloyd Inquiry (Report Resume)

See medically unexplained physical symptoms.

medically unexplained physical symptoms (MUPS) - Technically, this term means that no cause or explanation for the patient's symptoms has yet been found. However, patients diagnosed with "MUPS" are generally lumped into a psychosomatic, or psychologically-caused category by those in the medical profession, without any scientific basis for doing so.

ganglion A ganglion is a group of neuron cell bodies in the peripheral nervous system. Plural: ganglia / ganglions

Region of the midbrain in adults, includes midbrain, pons, and medulla oblongata and develops.

brainstem Region of the midbrain in adults, includes midbrain, pons, and medulla oblongata and develops.

The use of special strains of mice to study a human disease or condition, and how to prevent and treat it

mouse model The use of special strains of mice to study a human disease or condition, and how to prevent and treat it

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

mitochondria Important parts of the biological cell, with each mitochondrion encased within a mitochondrial membrane. Mitochondria are best known for their role in energy production, earning them the nickname "the powerhouse of the cell". Mitochondria also participate in the detection of threats and the response to these threats. One of the responses to threats orchestrated by mitochondria is apoptosis, a cell suicide program used by cells when the threat can not be eliminated.

cytokine any class of immunoregulatory proteins secreted by cells, especially immune cells. Cytokines are small proteins important in cell signaling that modulate the immune system. (Learn more: me-pedia.org)

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).