Gulf War Illness

ANATOMY OR SYSTEM AFFECTED: Blood, brain, cells, chest, eyes, gastrointestinal system, gums, hair, immune system, joints, muscles, psychic-emotional system, skin

DEFINITION: A term used to describe collectively a variety of symptoms, not a specific disease, suffered by veterans of the Gulf War.

CAUSES: Unclear; possibly exposure to wartime toxins, bacteria, or viruses, or post-traumatic stress disorder

SYMPTOMS: Vary widely; can include chronic fatigue, fever, muscle and joint pain and weakness, intense headaches, episodes of memory loss, insomnia, nightmares, anxiety attacks, mood swings, respiratory and gastrointestinal problems, blurred vision, rashes

DURATION: Chronic

TREATMENTS: Self-medication with over-the-counter pain relievers, prescribed drug and physical therapy, counseling

Causes and Symptoms

A 2008 report by the US Department of Veterans Affairs Research Advisory Committee on Gulf War Veterans’ Illnesses concluded that what has been called Gulf War syndrome should be recognized as an illness, characterized by a complex of multiple symptoms, that resulted from service in the 1990–1991 Gulf War. In 2022, researchers at UT Southwestern concluded that the illness was caused by exposure to the chemical agent sarin along with a gene variant. About 175,000 Gulf War veterans became chronically ill with the Gulf War Illness. As of 2023, researchers were working to find an effective treatment.

Gulf War Illness (GWI) is characterized by flulike symptoms, which sufferers complain of experiencing simultaneously but that do not indicate any specific known disease. Such physical symptoms include chronic fatigue, fever, muscle and joint pain and weakness, and intense headaches. Some patients report episodes of memory loss, insomnia, nightmares, and limited attention spans as well as neuropsychological disorders, such as depression, attacks, and mood swings. Respiratory problems, and distress, blurred vision, arthritis, bleeding gums, loss, and skin rashes sometimes accompany other symptoms.

When returning veterans first complained about these symptoms, physicians disagreed about the causal factors of Gulf War Illness. Many of the symptoms could also be signs of other war-related disorders, such as post-traumatic stress disorder (PTSD), or exposure to wartime toxins, bacteria, or viruses. Furthermore, it was difficult for researchers to prove any laboratory abnormality or unique characteristic for this disorder or to isolate any organ system as the primary system affected by this condition. Given this, most medical professionals assumed that Gulf War Illness was a condition representing factors of several diseases but that is not a separate disease. This diagnostic ambiguity frustrated many Gulf War veterans, who wanted and needed accurate diagnoses and effective treatments.

Gulf War Illness is associated with biological alterations primarily in the and brain. Strong evidence existed that the illness was associated with exposure to two types of neurotoxins: (PB) pills, which had been intended to protect humans from the effects of nerve agents; and organophosphate pesticides, used during deployment. Early evidence suggested that the illness was related to exposure to substances such as multiple vaccines or fumes from burning oil wells, but these causes were ruled out. It was soon clear, however, that Gulf War Illness was not just PTSD. It was true that some Gulf War veterans had PTSD, but this did not explain the separate problem of Gulf War Illness. A 2013 study published in PLoS ONE identified a number of characteristic brain changes in veterans with Gulf War Illness, particularly increased axial diffusivity in the right inferior fronto-occipital fasciculus, a part of the brain involved in fatigue, pain, and emotional regulation.

In May 2022, UT Southwestern researchers announced that the Gulf War Illness (GWI) was caused by exposure to the chemical sarin. This, along with a genetic variation, caused some Gulf War veterans to become chronically ill. Sarin is a nerve agent that is fatal in high doses. Early in the war, US and Coalition planes bombed massive Iraqi storage sites. This exposed troops to low levels of sarin.

Treatment and Therapy

Because they did not think their concerns were being seriously addressed, many veterans relied on self-diagnosis based on other veterans’ accounts exchanged orally, in the press, or on the Internet. Self-medication with over-the-counter pain relievers was a common treatment used by many veterans. Physicians prescribed more potent pharmaceuticals and physical therapy to alleviate symptoms and to reinforce patients’ immune systems.

Physicians recommend that some veterans suffering Gulf War Illness undergo counseling to address neuropsychological symptoms and assist in the readjustment to peacetime or civilian life and the frustration with enduring a chronic and unidentified illness. Exercise, a nutritional diet, and support groups were also helpful to many veterans suffering Gulf War Illness. Genetic testing of veterans and their spouses was also sometimes pursued to determine causation of birth defects in some veterans’ children, which were often incorrectly attributed to Gulf War service. Complications associated with treatment of Gulf War Illness included possible common side effects of pain relievers, such as drowsiness. Patients also risked becoming addicted to the pain relievers that they use to numb the ever-present aches associated with chronic illnesses.

Perspective and Prospects

In 2022, after combing through thirty years of epidemiologic, clinical, and laboratory research at UT Southwestern, researchers felt certain that service members who have a weak form of a gene called PON1 and were exposed to even low levels of the nerve gas sarin developed the Gulf War Illness. Their next step is to develop a test for the illness along with an effective treatment. In early 2023, researchers at UCI (University of California, Irvine) began testing a new drug called Butyrate. They are hopeful that it will alleviate the symptoms suffered by those with the Gulf War Illness.

Bibliography:

"Gulf War and Health: Treatment for Chronic Multisymptom Illness." The National Academies Press, 2013.

"Gulf War Veterans Unexplained Illnesses." US Dept Veterans Affairs, 12 Oct. 2022, www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp. Accessed 2 Apr. 2024.

Haley, Bob. "Unlocking the Causes of Gulf War Illness." UTSouthwestern Medical Center, 12 Jan. 2023, utswmed.org/medblog/gulf-war-illness-cause/. Accessed 2 Apr. 2024.

Hersh, Seymour M. Against All Enemies: Gulf War Syndrome, the War Between America’s Ailing Veterans and Their Government. New York: Ballantine Books, 1998.

Office of the Secretary of Defense. National Defense Research Institution. A Review of the Scientific Literature as It Pertains to Gulf War Illnesses. 8 vols. Santa Monica, Calif.: RAND, 1998–2001.

Rayhan, Rakib U., et al. "Increased Brain White Matter Axial Diffusivity Associated with Fatigue, Pain and Hyperalgesia in Gulf War Illness." PLoS ONE 8, no. 3 (March 20, 2013): e58493.

Research Advisory Committee on Gulf War Veterans’ Illnesses. Gulf War Illness and the Health of Gulf War Veterans: Scientific Findings and Recommendations. Washington, D.C.: Government Printing Office, 2008.

Steele, Lea, Antonio Sastre, Mary M. Gerkovich, and Mary R. Cook. "Complex Factors in the Etiology of Gulf War Illness: Wartime Exposures and Risk Factors in Veteran Subgroups." Environmental Health Perspectives 120, no. 1 (January, 2012): 112–118.

"UCI Researchers Awarded $2.5 Million to Test Drug That Could Relieve Symptoms of Gulf War Illness." UCI Public Health, 2 Mar. 2023, publichealth.uci.edu/2023/03/02/uci-researchers-awarded-2-5-million-to-test-drug-that-could-relieve-symptoms-of-gulf-war-illness/. Accessed 2 Apr. 2024.

Wheelwright, Jeff.The Irritable Heart: The Medical Mystery of the Gulf War. New York: W. W. Norton, 2001.