Gulf War Syndrome (GWS), which is also known as 'Desert Storm Diseases' or simply 'Gulf War Illness', is a collection of symptoms reported by veterans (and civilians like press and government employees) of the first Gulf war since August 1990. Veterans from every country that made up the Coalition forces have been affected; in the US alone more than 110,000 cases had been reported by 1999, according to official government sources. There is even a report relating to military personnel in Kansas developing flu-like symptoms and chemical sensitivities after handling archived documents returned from the Gulf (full text available here). In the UK, veterans of the 2003 conflict began reporting symptoms, identical to those reported by the first war, shortly after they returned from duty.
The symptoms reported by veterans include:
- Persistent Headaches
- Muscle Aches/Pains
- Neurological Symptoms e.g. tingling and numbness in limbs
- Cognitive Dysfunction - short term memory loss, poor concentration, inability to take in information
- Mood and Sleep Disturbances - Depression, Anxiety, Insomnia.
- Dermatological Symptoms - Skin Rashes, Unusual Hair loss.
- Respiratory Symptoms - Persistent Coughing, Bronchitis, Asthma
- Chemical Sensitivities
- Gastrointestinal Symptoms - Diarrhea, Constipation, Nausea, Bloating.
- Cardiovascular Symptoms
- Menstrual Symptoms
You have probably noticed that these symptoms are remarkably similar to those attributed to chronic fatigue syndrome, multiple chemical sensitivities and other environmental illnesses. This similarity hasn't gone unnoticed which is why many people, including healthcare professionals and researchers, are coming to the conclusion that all these illnesses share common causes and etiologies. In 1997 the Centers for Disease Control (CDC) in the US funded a study by the University of Medicine and Dentistry of New Jersey in an attempt to define the illness. In the study Gulf war syndrome was compared to chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities and other similar illnesses to determine if the current definition for those illnesses could adequately describe Gulf war syndrome. The researchers are currently preparing manuscripts for publication, as of May 31st 2003. With an institution of the CDC's caliber funding research into Gulf war syndrome, and it's link to the other illnesses discussed within this website, it is clear that this link is being taken seriously.
What Caused Gulf War Syndrome?
There were many factors present in the Gulf during the war that could have played a role in causing illness in those present at the time. It is likely that a combination of a number of these factors together is what led to the illness.
The potential causative factors include:
1. Infectious Diseases - A number of infectious agents were present in the Gulf but medical records generally show that they weren't a major problem for personnel due to extensive precautionary measures (1). Of cause many infectious agents may lie dormant without causing an acute illness. The most common infectious agents present were thought to be cutaneous leishmaniasis, travelers diarrhea, sandfly fever and malaria. One unique infectious disease has been linked to the Gulf war deployment: viscerotrophic leishmaniasis (1). This infectious disease has been found in 12 U.S. veterans but none of the other Coalition forces personnel.
There is substantial evidence for mycoplasma infection playing a role in veterans illnesses. Mycoplasma can be defined as the smallest organisms lacking cell walls that are capable of self-replication and can cause various diseases in humans. Although usually associated with respitory and urinary disease, mycoplasma are thought by a growing number of medical professionals to be responsible for a number of unexplained symptoms, especially chronic fatigue states. Mycoplasma fermentans has been found in the blood of gulf war veterans at a much higher rate than in the overall population (2, 3, 4).
In an article entitled 'Scientific Facts Versus Fiction About Mycoplasma', Aristo Vojdani, Ph.D., M.T. describes recent findings about Mycoplasma fermentans:
"Although mycoplasmas are recognized primarily as extracellular parasites or pathogens of mucosal surfaces, recent evidence suggests that certain species may invade the host cells.
The molecular and cellular bases for the invasion of M. fermentans from mucosal cells to the bloodstream and its colonization of blood remain unknown.
Also, it remains unclear whether M. fermentans infection of white blood cells is transient, intermittent or persistent. It is not clear how these stages influence any disease progression. The invasion of host blood cells by M. fermentans is due to inhibition of phagocytosis by a variety of mechanisms, including antiphagocytic proteins such as proteases, phospholipases and by oxygen radicals produced by mycoplasmas."
2. Biological Weapons - Exposure to biological warfare agents has been put forward as a possible causative factor in Gulf war syndrome. No evidence that such an agent was deployed has been found however. BW agents are also designed to kill rapidly in minute amounts and there were no reported fatalities that could be attributed to this. It should be noted however that Iraq was known to be experimenting with the use of anthrax and an organism responsible for gangrene (5). There is also the possibility that Iraq deployed biotoxins; toxins produced by living organisms such as bacteria. Endotoxins, those given off when a cell dies, can produce similar effects to chemical toxins/weapons and do not cause infectious disease as a living organism would.
3. Chemical Weapons - As with biological agents, chemical warfare agents have also been suggested. There is more concern here however as it is known that a number of Iraqi facilities containing chemical agents were hit during the air and ground offensives which could have led to low level exposure to Coalition troops. Sarin and Cyclosarin were detected 8 months after the war by a UN inspection team, for example. It is now widely accepted that Iraq had sizeable stockpiles of sarin which could be used in SCUD missile warheads for example. There have been a number of animal studies with subclinical levels of sarin to ascertain whether a possible low level exposure could cause long term injury and illness in veterans. A 2002 study on rats found that low level exposure to sarin for a period of 1 week caused significant suppression of the immune system (6). Other researchers have had similar findings regarding immune-suppression and also found that low dose sarin "resulted in brain alterations in densities of chlonergic receptor subtypes that may be associated with memory loss and cognitive dysfunction."(7) There is considerable ongoing research into possible CW exposures in all countries involved.
4. Other Chemical Agents - Besides possible exposure to chemical warfare agents, the coalition troops were constantly exposed to chemicals whose use is considered safe. It must be noted however, that they were just the type of chemicals reported to cause symptoms in multiple chemical sensitivity (MCS), i.e. volatile organic compounds (VOC's), mainly hydrocarbons. Some of these chemicals are:
- Organophosphate Pesticides
- Other Chemical Pesticides
- Pyridostigmine Bromide - A drug given to troops to counteract chemical warfare agents
- CARC - Chemical Agent Resistant Coating painted on vehicles
- Various Petroleum based products like diesel and JP4 fuel used in tent heaters and cooking stoves and used on the ground to stop the sand from blowing.
- Decontamination Solution 2 - contains propylene glycol, monomethyl ether, and ethylene glycol
Organophosphate Pesticides - It is well known that exposure to high concentrations of organophosphate pesticides is harmful. There have been a number of studies designed to find out if exposure to moderate amounts of these chemicals, as many gulf war veterans were, can also damage health. Most studies have found that exposure to moderate amounts can indeed result in increased incidence of neurological symptoms and changes in neurobehavioral performance, reflecting cognitive and psychomotor dysfunction. Some researchers feel that these findings of low level cognitive dysfunction could also explain the fatigue experienced by sick veterans (8).
Other Chemical Pesticides - Most studies have focused on the potential effects of organophosphate based pesticides but some have also found neurotoxic effects from other pesticides, including fungicides, fumigants, and organochlorine and carbamate insecticides (8). Many pesticides have also been implicated in an increased risk for developing Parkinson's disease. The similarities between this disease and the cognitive dysfunction in gulf war syndrome has not escaped a number of researchers.
Pyridostigmine Bromide - Commonly referred to as the "Nerve Gas Pill", pyridostigmine bromide was given to servicemen in the gulf to protect them against nerve gas attack. However, pyridostigmine bromide also has toxic effects itself due to its inhibition of the enzyme cholinesterase. This causes acetylcholine to have a prolonged effect which can result in over activation of the parasympathetic nervous system. This type of over activation results in a number of unpleasant effects such as respiratory and muscular problems. Of particular importance is the fact that stress, more specifically the adrenaline response, is known to increase the toxicity of PB (9). In epidemiological studies, PB consumption has been shown to correlate with sickness during and after the war, with higher consumption meaning a higher risk of sickness (10). It's thought that PB may compromise health and contribute to gulf war syndrome by triggering autoimmune responses, particularly in the nervous system, as a result of its toxicity (9, 11).
CARC - Chemical agent resistant coating is a specialized form of automobile paint, designed to prevent chemical warfare agents leaching into a vehicle's finish. According to manufacturers data sheets, chronic overexposure to the paint's vapour can lead to asthma-like symptoms. Prolonged exposure can permanently damage the brain, nervous system, liver and kidneys. CARC is also known to cause hypersensitivity pneumonitis, with symptoms of fever, muscle aches, headaches, malaise and shortness of breath. A US Department of Defense report released on July 27, 2000, estimated that 200 members of the 325th Maintenance Company were exposed to CARC and concluded that the troops were not properly equipped with air-assisted respitory systems.
Fuel - Gulf war veterans often recall an association between diesel and petrochemical fume exposure and symptoms during service. Many suspect these exposures may be the cause of their ongoing health complaints after the war. Recently researchers have sought to determine if this could be the case. A 2004 study exposed 12 sick gulf war veterans, who complained of chemical sensitivities, and 19 healthy gulf war vets, to controlled 5ppm (parts per million) diesel fumes. The researchers monitored the participants symptoms, odor ratings, neurobehavioral performance, and psychophysiologic responses. The results of the experiment showed that the sick gulf war veterans reported significantly increased symptoms such as disorientation and dizziness and displayed significantly reduced end-tidal CO(2) just after the onset of exposure. End tidal CO(2) indicates the amount of CO(2) exhaled per breath and is a measure of respiration rate and also of blood flow. Decreased end tidal CO(2) therefore indicates decreased respiration and blood flow which would account for feelings of disorientation and dizziness. As exposure increased over time, sick veterans reported significantly increased symptoms of respiratory discomfort and general malaise and were also physiologically less responsive to behavioral tasks administered during, but not before exposure, comparted to the healthy controls (12). The researchers concluded that diesel fumes did indeed worsen the sick veterans condition and this was caused by both physiological and psychological mechanisms.
Decontamination Solutions - Decontamination solutions were widely used in the gulf to sterilize vehicles, equipment etc. The decontamination agent used most widely in the first gulf war was decontamination solution 2 (DS-2). DS-2 is an effective decontamination agent but is highly caustic and is known to damage equipment, pollute the environment and cause personal injury, according to experts. As a result DS-2 is no longer deemed safe to use and thousands of gallons are sitting in stockpile. Although there is little research involving this chemical in gulf war veterans, it is possible or even probably that it contributed to the symptoms experienced by veterans.
5. Oil Well Fire Smoke - The retreating Iraqi army ignited approximately 600 oil wells in February 1991 which burned for about 9 months. These fires produced massive amounts of thick smoke which sometimes drifted to ground level causing increased exposure to ground troops. When this occurred the air pollution was far greater than would be experienced in the average traffic congested western city. Questionnaires filled in by US troops indicated higher rates of eye and upper respiratory tract irritation, shortness of breath, cough, rashes, and fatigue than unexposed troops. The smoke from oil well fires contained a cocktail of chemicals, notably, benzene, hydrogen sulfide and sulfur dioxide as well as quantities of particulate matter. The latter two chemicals can cause eye and nose irritation, decreased pulmonary function, and increased airway reactivity. Particulate matter is associated with increased rates of asthma and can exacerbate other chronic respiratory conditions.
Benzene is a a volatile organic compound (VOC) that is implicated in triggering symptoms in multiple chemical sensitivity (MCS). Benzene exposure fits with a number of theories that aim to explain the etiology of MCS. Dr. Martin Pall, who has conducted extensive research into the causes of MCS, explains that elevated nitric oxide levels in the brains of MCS sufferers may play a significant role in their symptoms (13). Benzene, along with other common MCS triggers such as formaldehyde and organochlorine pesticides, increases levels of nitric oxide. Another leading theory suggests that upon acute exposure to high levels, or chronic exposure to lower levels, of certain chemicals, the limbic system of the brain can become sensitized. Subsequent exposure to minute amounts of the chemicals may then cause activation of the limbic system and resulting symptoms. Experiments on rats have proven this to be the case with certain hydrocarbons, a class of chemicals to which benzene belongs (14).
6. Vaccinations - Troops sent to the Gulf were given a large cocktail of vaccinations in a short period of time. In total, US servicemen may have received as many as 17 different vaccines, including live vaccines (polio and yellow fever) as well as experimental vaccines that had not been approved (anthrax, botulinum toxoid) and were of doubtful efficacy . In the UK, the Ministry of Defence (MoD) has declared only 10 vaccines given but reports from veterans and official documents seem to tell a different story.
A large 2002 study of 900 veterans found a strong correlation between the anthrax vaccine and subsequent ill health (15). The study indicated that those who received anthrax vaccines reported more adverse reactions than those who did not receive the anthrax vaccine. It also found that the more severe any initial reaction to the vaccine was, the more severe long term health effects were.
A lot of recent research has involved studying the effects of vaccines that use pertussis, the bacteria responsible for whooping cough, as an adjunct. It has been proposed that the use of pertussis as an adjuvant could trigger neurodegeneration by increasing secretion of certain immune chemicals, such as interleukin-1beta, in the brain. In turn, brain lesions may be sustained by stress or neurotoxic chemical combinations (16) Pertussis vaccine was used in the gulf "off-label", which means it wasn't approved to be used on servicemen as it was. It's use in the gulf war can thus be classed as experimental. The manufacturers of pertussis were not advised of this unlicensed use.
Dr. Philip F. Incao of Denver, Colorado provides what may be an explanation of why some people given this cocktail of vaccinations remained healthy while the health of others was sent into decline resulting in chronic illness. Dr. Incao explains that the immune system and mechanism by which vaccinations work, is much more complicated than was thought until recently. Rather than stimulating the whole immune system against a certain pathogen, vaccinations only stimulate the humoral, or Th2, branch of the immune system which is responsible for producing antibodies that recognize pathogens as invaders. Over activation of the Th2 mediated immune response leads to allergic and autoimmune disease. Dr. Incao suggests that giving vaccinations to people whose immune systems are already Th2 dominant will exacerbate exiting conditions and may lead to what we know as Gulf war syndrome. A large body of research seems to confirm this, showing that those veterans with gulf war syndrome tend to have an immune system shifted towards a Th2 response (17, 18, 19).
Read a full explanation from Dr. Incao here
7. Depleted Uranium - During the Gulf war, depleted uranium was used for the first time, both in vehicle armour and offensive munitions, as well as in various other components of vehicles and other equipment. It was used widely due to it being cheap and widely available as a by-product of nuclear energy and nuclear weapon production. In Operation Desert Storm over 350 metric tons of DU was used, with an estimate of 3-6 million grams released in the atmosphere (20). Inhaling particles of depleted uranium may have contributed to sickness after the war due to DU's chemical and radiological toxicity and mutagenic and carcinogenic properties. Internal contamination with inhaled DU has been demonstrated by the elevated excretion of uranium isotopes in the urine of the exposed veterans 10 years after the Gulf war (20). Further research of veterans who were struck by shrapnel containing DU show that the DU continues to leech out of the shrapnel for at least a decade with a resulting increase in the concentration of DU in body tissues over this time (21). This research showed that the accumulation of DU in the kidneys was associated with increased incidence of functional kidney disease.
It should be noted that many detractors cite reports that exposures to any single one of the factors listed above were mostly within levels considered safe. These "safe" levels however, do not take into account concurrent exposure to numerous other chemicals and other agents. Along with the above, psychological and physical stress may play a major role in the onset of illness. As has been suggested as a mechanism for CFS and fibromyalgia, stress, with concurrent exposure to volatile chemicals and infectious agents could cause a physiological change in certain individuals that leads to a spiral of illness. These factors most likely cause changes in the brain and nervous system, immune and endocrine systems. Low level brain damage has been observed in Gulf war veterans as well as in sufferers of CFS, fibromyalgia, MCS etc (see a study illustrating this here).
At no other time have so many people been exposed to such a heavy load of diverse stressors as the coalition forces in the Gulf war. It is little wonder that so many have since fallen victim to ill health. Military equipment is designed for such an environment, the human body, clearly, is not.
Government and Medical Opinion
Those affected by Gulf War syndrome have struggled for many years to have their health problems recognised as something other than psychological. This has led to a large amount of bitter wrangling over funding for the care of sick veterans. Official opinion however has slowly begun to come around to the fact that veterans are suffering from physical illness as evidence from medical studies has grown.
In March 2008 a US Congress-appointed committee released its findings after analysing more than 100 studies relating to Gulf War illnesses. The committee concluded that there was a clear link to exposures to specific kinds of chemicals. The chemicals identified included pesticides, the anti-nerve gas drug pyridostigmine bromide, and the nerve-gas sarin that troops may have been exposed to during the demolition of a weapons depot. The committee's chief scientist Dr Beatrice Golomb singled out the acetylcholinesterase (AChE) inhibitor drugs such as pyridostigmine bromide as having a particularly strong connection to the development of ill-health in veterans. She also revealed that some people appear to be particularly at risk from such chemicals due to genetic variations which impair enzyme function. When exposed these people run a much higher risk for developing symptoms and disease.
Importantly, the committee concluded that Gulf War illnesses are almost certainly physical in nature, Dr. Golomb commenting that "Psychological stressors are inadequate to account for the excess illness seen."
In the UK the government has repeatedly refused to acknowledge the existence of Gulf War syndrome as a physical illness caused by service in the Gulf despite independent inquiries repeatedly finding that this is likely to be the case. There have been hints of a change in this position in recent years however. See this news article for more information.