The Mystery of Gulf War Syndrome

i-884eb5fc5ab25b1446721361549e13dd-shelley icon.JPG I once had a conversation with a doctor about Gulf War Syndrome (GWS). They said,"Its frustrating to treat something that you can't describe and that has no definite cause." However, the numbers of affected soldiers, coming back to the US after the first Gulf War with a bevy of mysterious chronic ailments, speak to the reality of *some* cause.

Officially, symptoms attributed to this syndrome encompass chronic fatigue, loss of muscle control, headaches, dizziness and loss of balance, memory problems, muscle and joint pain, indigestion, skin problems, shortness of breath, and even insulin resistance. Brain cancer , amyotrophic lateral sclerosis and fibromyalgia are now recognized by the Defense and Veterans Affairs departments as potentially connected to service in the Gulf War.

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Seeing as how we are currently engaged in another war in the same region (and under potentially more damaging and toxic conditions), it's important to try to pinpoint the root of the syndrome. Speculation has roamed from blaming the anthrax vaccine that troops received, to depleted-uranium weapons, to intense exposure to pollution from burning oil wells. Now, a provocative article in the Economist suggests that the symptoms may be the result of neurochemical warfare. Specifically, that troops were exposed to acetylcholinesterase inhibitors (AChEis) found in pesticides used to protect the troops from sand flies, in the nerve gas Sarin, and in pyridostigmine bromide pills given to troops as pre-treatment against nerve gas. AChEis prevent the breakdown of the neurotransmitter acetylcholine, causing it to remain in the synpase for longer than it should. This causes those neurons to fire excessively, causing abnormal brain and muscle activity as well as possible loss of white matter (myelin).

Dr. Beatrice Golomb, whose theory is currently published in PNAS, points out that severe exposure to AChEis mimics the range of chronic symptoms that many veterans suffering from Gulf War Syndrom report.

One study modeled the amount of exposure to organophosphates (another kind of AChEi) received by veterans and found that higher estimates of exposure are associated with greater losses of the brain's white matter. Another study found that among veterans, those who were sick were more likely to have a genetic variation that means their bodies are less able to detoxify AChEis. Finally, there is a study of veterans given pyridostigmine bromide pills. Separate studies of American and Australian Gulf-war veterans show that the more pills veterans took, the worse their health is today.

Dr Golomb adds that patients with a low level of occupational exposure to acetylcholinesterase inhibitors in agriculture--for example through sheep-dipping or work in greenhouses--report symptoms that mirror those of sick veterans. Taken together, she argues, the evidence suggests that AChEis do have a role in the chronic illnesses experienced by many veterans.

Whether this hypothesis is exactly true or not, I do think that Golomb's argument is worth investivating. Unfortunately, we will have a slew of new test subjects returning to the US over the next few years who may be able to shed more light on the causes, since (other than the Sarin) exposure to AChEis continues.

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Of course, there are millions of potential subjects who've been exposed to Gulf War I battlefield residues for about, oh, 17 years now (the full lifetimes of about half of the potential study population) - but since they weren't deemed worthy of examination even when GWS was getting significant attention, who's going to send medical researchers to report on their condition now?

By Pierce R. Butler (not verified) on 18 Mar 2008 #permalink

Is there evidence that these problems are more common in veterans than matched controls? Because severe and baffling problems of this type are surprisingly common in the general public also--and equally neglected because they don't fit into the usual 'diagnosis amd fix' mentally of health care.

So, um, what's the treatment?

By Punditus Maximus (not verified) on 18 Mar 2008 #permalink

Interesting Shelley.

I've been looking at GWS and ALS for a few months. A number of researchers however have been closely studying probable/possible links for many many years. Contact me if you would like some Papers from that section of my Library.

For a flavour, see herehere

Hi Shelly,

I do share your concern about pesticides in Iraq and who knows where else.

Unfortunately even more than 35 years after Vietnam the risks of herbicides are not well known, for example, Agent Orange and Cancer and other illnesses; "Although there is now quite a bit of evidence available about the health effects of Agent Orange, many questions have not yet been answered" and "Although the immune system is a target of dioxin, evidence to date has not demonstrated an increase in immune disorders in veterans."

There was an in-theatre release of a nerve agent when US forces blew-up a depot in our first Gulf War. There has been speculation of whether GWS was caused by this event or by (endemic) exposure to DU.

MRI's of several highly affected individuals did reveal brain damage consistent with exposure to a nerve agent. But this more deterministic approach to diagnosis was never used in proper scale here.

There was a weird GAO report several years ago saying that the estimate of exposure in the nerve agent event was incorrect. What caught my attention was that the part of the report which stipulated the scope of the exposure was classified.

I encourage you to follow-up on this story. Although at this late point it's largely a story of deception and misdirection; the Pentagon has been covering this up and muddying the waters since it happened.

I think veterans should receive treatment and service related compensation for this. Period. It is part of the cost of waging war, and the US Government should pay it. I also don't think vets should have to prove they have the disease.

Why? It's devilishly hard to prove the existence of a "disease." The controversy surround whether something should be called a disease is centuries old. The famous German surgeon Koch defined disease as a pathological condition that occurs when a pathogen is introduced, and which goes away when the pathogen is removed. A clear N=1 experiment at its core. Even Koch's definition is obsolete in the age of imaging, autoimmune assays, and genomic medicine. Most so-called diseases are actually "syndromes"-- a cluster of co-occuring symptoms and (sometimes) physical signs. The debate over whether something is a syndrome (not so good) or a disease (much better) does not end, and cannot be proven. So, for example, we look for more correlates such as organophosphate exposure and Gulf Ware Syndrome. But such correlations never information about causation needed to prove the existence of a disease state. Read the Sci Am book "Investigating Disease Patterns" if you need more proof.

So, lets not get all wound up in a debate on whether GWS is a real disease. Treat it and compensate the vets.

By Bottlerocket (not verified) on 21 Mar 2008 #permalink