What is Gulf War Syndrome?

This is a commonly used term which refers to the presence of several undiagnosed illnesses in veterans of the Gulf War of 1991. It includes a constellation of widely divergent symptoms like tiredness, headaches, joint pain, indigestion, sleep problems and memory difficulties. It affects from a quarter to a third of these soldiers.

Image Credit: Photographee.eu / Shutterstock

Many of these are without obvious cause. Therefore this condition is also called “chronic multi-symptom illness” in Gulf War veterans. The diagnosis is made when the symptoms exist for 6 months or more, and cause 10% or more disability.

Oil well fires rage outside Kuwait City in the aftermath of the First Gulf War. Retreating Iraqi troops set fire to Kuwait's oil fields. Mar. 21 1991. – Image Image Credit: Everett Historical / Shutterstock

Possible etiologies

Exposure to nerve gas
Pre-medication with pyridostigmine bromide as a preventive measure against the effects of nerve gas
Post-traumatic stress disorder
Other psychiatric disorders
Exposure to toxic chemicals other than those directly employed in warfare. These include burning oil fumes, pesticides, uranium which has been used in nuclear plants or bombs (called “depleted uranium”), or chemicals used in repair and service of war machinery.

One common hypothesis is that the symptoms of Gulf War illnesses are due to chemical exposure, rather than stress or brain injury. Support for this theory comes from clinical trials which show that improvement in multiple symptoms was reported by an astounding 80% of subjects, when they took high doses of Coenzyme Q (CoQ). This chemical is an anti-oxidant which supports mitochondrial function. The improvement in symptoms correlated with the dose of CoQ, and was seen with both physical symptoms such as muscle aches, tiredness, and cognitive or psychological symptoms such as memory loss and irritability. In addition, mitochondrial function was found to be impaired in these subjects, pointing to a possible causative link.

It has also been suggested that Gulf War illness subjects had a genetic makeup which slowed down or reduced detoxification processes in the cell, allowing pesticides, or other toxic chemicals, to accumulate in the body over time.

Some important manifestations include:

Chronic fatigue syndrome – continuous and unexplained severe tiredness which persists after rest.
Post-exertional malaise – unusual tiredness after any physical or mental effort.
Fibromyalgia – widespread muscle pain, with or without muscular stiffness on awakening, headache, sleeplessness and memory deficits.
Functional gastrointestinal disorders – this group of illnesses is marked by chronic or repeated bouts of gastrointestinal symptoms without any demonstrable physical cause, such as irritable bowel syndrome, diarrhea or symptoms of indigestion without explainable cause.
Symptoms related to the skin such as rashes as well as menstrual or psychological symptoms.

Treatment of Gulf War illness is chiefly symptomatic. After excluding an organic cause for the symptoms, cognitive-behavioral therapy (CBT) has been found to be a very useful tool in helping to restore normalcy and usefulness to the lives of those affected. Other researchers have concentrated on the use of intranasal insulin to reduce neuronal inflammation. This inflammation is postulated to be the result of exposure to mixed toxic chemicals, and may cause continuing activation of the immune system, leading to multiple symptoms.

References

http://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp
http://www.uchospitals.edu/online-library/content=P00487
http://health.ucsd.edu/news/releases/Pages/2014-11-03-CoQ10-helps-gulf-war-illness-symptoms.aspx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447801/
http://www.bu.edu/today/2013/helping-veterans-with-unseen-injuries/

Possible etiologies

References

Further Reading

Dr. Liji Thomas