As many as 250,000 US veterans of the 1990-91 Gulf War suffer from symptoms of a disorder that is likely caused by exposure to toxins, such as nerve gas.

In a new report, the Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC) says there’s been progress to pinpoint the causes and possible treatments for the disorder, but that much more research is needed.

The RAC report updates scientific research published since the committee’s landmark report in 2008, which established that Gulf War illness was a real condition. The RAC committee is composed of scientific experts and veterans, and was mandated by the US Congress.

(Credit: //www.flickr.com/photos/46809989@N08/4626985218/" target="_blank">VA Comm/Flickr)

“The conclusions of the 2008 RAC report had a substantial impact on scientific and clinical thinking about Gulf War illness, as well as the public acceptance of this disorder,” says RAC’s scientific director, Roberta “Bobbie” White.

White, who is chair of environmental health at the Boston University School of Public Heath, presented the report to Veterans Administration Secretary Eric Shinseki on April 28.

Causes and symptoms

Gulf War illness refers to the chronic symptoms that affect veterans of that conflict at markedly elevated rates, compared to other veterans’ groups and to the US population as a whole.

Symptoms can vary from person to person, but typically include some combination of widespread pain, headache, persistent problems with memory and thinking, fatigue, breathing problems, stomach and intestinal symptoms, and skin abnormalities.

“Studies published since 2008 continue to support the conclusion that Gulf War illness is causally related to chemical exposures in the combat theater,” White says of the new report. “And many studies of the brain and central nervous system, using imaging, EEG and other objective measures of brain structure and function, add to the existing evidence that central nervous system dysfunction is a critical element in the disorder. Evidence also continues to point to immunological effects of Gulf War illness.”

Exposure to the nerve gas agents sarin and cyclosarin has been linked in several studies to changes in magnetic resonance imaging (MRI) that are associated with cognitive impairments—further supporting the nervous-system effects of those agents cited in the 2008 report.

Studies also continue to show that Gulf War illness is not associated with psychological stressors during the war, the panel notes. Rates of PTSD and other psychiatric illnesses in Gulf War veterans are far below the rate of these disorders in veterans of other recent wars, and far below the rate of Gulf War illness.

Brain cancer

According to the report, new evidence has emerged suggesting that certain exposures may be linked to brain cancer in Gulf War veterans. Studies show that veterans who were most exposed to the release of nerve gas during the destruction of the Khamisiyah arms depot in Iraq have significantly elevated rates of death due to brain cancer.

Veterans who were exposed to the highest level of contaminants from oil well fires also have increased rates of brain cancer deaths, the report says.

The committee encourages studies exposing animals to toxic agents involved in Gulf War illness “because they can help to determine treatment targets in subgroups of veterans with specific exposures, for which there are known mechanistic pathways that cause illness and symptoms.”

In addition, “results from this work can be useful in protecting the health of future military personnel who will experience these exposures, as well as non-military populations with occupational or environmental exposures.”

More research needed

The panel cited a number of “promising” treatment studies, including those testing certain dietary supplements, intranasal insulin, and continuous positive airway pressure to ease fatigue and pain and improve cognitive function.

While the RAC panel applauded an increase in the number of treatment studies funded by the Department of Defense’s Congressionally Directed Medical Research Program, it expressed grave concerns about a lack of research on other health problems and mortality among Gulf War veterans.

“Very little research” has been conducted to determine rates at which veterans have been affected by neurological diseases such as multiple sclerosis or Parkinson’s disease, cancers, and reproductive problems, the panel says.

“No comprehensive information has been published on the mortality experience of US Gulf War era veterans after the year 2000,” according to the report.

Source: Boston University