Gulf War Illness - causes

Thanks @Lucibee for posting the links.

I hope to have time this weekend to read over.

I have assessed in detail the symptoms and severity of functioning/dysfunction along with neuropsychological difficulties in veterans with GWI/GWS in my clinic. It is very similar to ME. All that I have worked with have PEM, debilitating fatigue and flu-like symptoms after any type of activity, sleep and cog issues, autonomic, gastro dysfunction and so forth.

Having listened to them a few things stick out to me:
1) If this is true, then where is the evidence that it impacted on the civilian population? Perhaps this has not been studied?
2) If this were true, how does it explain the high levels of GWI/GWS in veteran groups who were made 'battle ready' as in given vaccines, tablets and so forth - who were never deployed to the Gulf!
3) How does it explain the French troop paradox? They were not vaccinated in the same way, nor do I recall they were given the tablets to take either (apologises it has been a while since I read so bear with) - and their troops did not appear to develop GWI/GWS?

It may be part of the answer for some with GWI/GWS - but it can't really explain it all. Perhaps it can - I'll have a wee read. Any thoughts?

 

Interesting that you found this re Wessely:

"Wessely, like many researchers in the field, believes that Gulf War illness arose from a combination of the stress of war, the use of experimental vaccines, and possibly exposures to environmental hazards such as oil-well fires."

I'd put my money on the experimental vaccines and / or a mixture, interaction with the anti-nerve agents they took. The National Gulf Veterans and Families Association (NGVFA) told me that they have no sick veteran with GWI/GWS who was not vaccinated. I have not met or assessed an ill GW vet who was unvaccinated.

@dave30th

 

One of the issues I tried to address in the thread is that this study is being widely misreported as "finding the cause of GWI" and that sarin gas is it. It doesn't and it isn't.

As Haley says (in @Lou B Lou's previous post), “Studies using nonspecific definitions of Gulf War neurological syndrome are biased toward finding negative results."

That's why this study takes a particular, specific gene-environment interaction and concentrates just on that for the purposes of showing whether there may be a causal association. His previous papers have shown that this association is far from simple, and suggest that the preventive treatments (so-called "experimental vaccinations" - actually pyridostigmine bromide - not a vaccine as such) taken may also have played their part in the development of the illness (but are not necessarily the cause in and of themselves). However, without those treatments, the deleterious effects of a gas attack or exposure would have much worse - in much the same way that vaccination against infectious diseases is necessary in the majority, but may lead to serious adverse reactions in a very tiny minority. And just because everyone is "vaccinated" doesn't mean that the vaccine is the cause. All veterans would have received vaccines and other treatments before being sent to the Gulf, so of course there are no sick veterans who were not vaccinated.

In some ways, like Wessely, Haley agrees that there is no single Gulf War illness. The "syndrome" is an umbrella for a collection of different symptom presentations. However, unlike Wessely, he has done a lot of work to categorise these, and to suggest and investigate putative causal pathways for some of them in animal models. Not all will be due to sarin exposure. Different illness presentations may be due to different combinations of exposures and gene interactions, which, again, is why it is extremely difficult to identify definitive causal associations.

As Sarah Williams said about her press release (here: https://www.utsouthwestern.edu/newsroom/articles/year-2022/sarin-nerve-gas-gulf-war-illness.html), "The important thing here, he [Haley] emphasized many times to me, is not that they showed an association between sarin exposure and GWI. Instead, they showed that a gene affecting how sarin is processed in the body mediated that interaction."

 

Just to add - you might know pyridostigmine bromide by another name - Mestinon.

 

Just a few more interesting points...

Here is Haley's first paper about PON1, pyridostigmine and sarin (from 1999): https://pubmed.ncbi.nlm.nih.gov/10373407/
in which the abstract says: "A history of advanced acute toxicity after taking pyridostigmine was also correlated with low PON1 type Q arylesterase activity."

Pyridostigmine is used in advance of chemical nerve agent attack because it blocks the pathways that the nerve agents use. However, if it is used too late, once a person has already been exposed to sublethal amounts of nerve agent, it can exacerbate the effects of the agent.

I'm wondering whether the reason it [Mestinon] doesn't work for some as a treatment for POTS is because of their particular PON1 subtype and/or activity?
Maybe there's also an interaction with pesticides too (pet flea treatments)?

 

Thanks for sharing this @Hutan. Really interesting.

 

My recall, which might be inaccurate, is that the troops took the pyridostigmine pre deployment to the Gulf AND during there time out there too.

Really interesting what you have shared here about this as it has been a while since I looked it up. Thanks for sharing.

 

Not true that all veterans receive vaccines. Some veterans declined vaccines pre-deployment. Some were ordered to be vaccinated. Other parts of the military were more flexible. Some of the press teams too decline vaccination. Word got about regarding the experimental nature of some of the vaccines being used.

I'm unsure if those declining vaccines would have taken or not the pyridostigmine.

 

[QUOTE="As Sarah Williams said about her press release (here: https://www.utsouthwestern.edu/newsroom/articles/year-2022/sarin-nerve-gas-gulf-war-illness.html), "The important thing here, he [Haley] emphasized many times to me, is not that they showed an association between sarin exposure and GWI. Instead, they showed that a gene affecting how sarin is processed in the body mediated that interaction."[/QUOTE]

Would it not make sense to state that a gene affecting how sarin is processed in the body mediated that interaction - along with how anti sarin medication, such as pyridostigmine, also is processed and interacts?

 

It strikes me as a blame deflection exercise;

They seem to be saying that GWI is caused by a combination of genetics (not the militaries fault) and the presence of sarin in weapons dumps (not the militaries fault - the fault of a dead guy).

So in no way is 'our' military responsible, even if they did know that the weapons dumps contained sarin, and chose to order them blown up.

and of course, if they aren't responsible, then they owe no compensation, to anyone, in any form.

It's all the fault of the nasty dead rotter.

Much the same as the radiation exposure caused by ordering people to stand in a circle around nuclear tests wasn't their fault. They couldn't be expected to know that it might be dangerous, standing around watching a nuke go off, to see what happens.

Someone else's fault, but not the people who gave the orders.

 

Shocking and sad. The impact on the veterans that I worked with was profound.

 

Yes - that's what he did in his 1999 paper. I think the point of the current paper is to look specifically at the gene-environment interaction in the context of gas attack warnings (recall thereof). Precise recall of when and whether pyridostigmine was taken on each occasion (it's short-lived) is probably beyond the scope of any investigation 30 years after the fact.

I wonder why they would take pyridostigmine pre-deployment though? Maybe it was to check whether anyone was going to have a bad reaction?

 

[QUOTE="I wonder why they would take pyridostigmine pre-deployment though? Maybe it was to check whether anyone was going to have a bad reaction?[/QUOTE]

I think it was more to get them into the habit of taking them. Which is curious as evidence already existed that taking pyridostigmine could make some people sick. But then again, troops were readied in short order and deployed. Instructions and information probably got mangled in the process. And the threat of chemical attack was very real / prominent as Saddam had a history of using chemical weapons.

 

Another couple of reports:

Haley's 1997 JAMA paper - Is there a Gulf War Syndrome? Searching for syndromes by factor analysis of symptoms - https://pubmed.ncbi.nlm.nih.gov/9005271/

and a report in the LA Times from 1994 - https://www.latimes.com/archives/la-xpm-1994-10-21-mn-53035-story.html

In their letter to The Lancet in 2009, Wessely et al. make the point that pyridostigmine was also used in Iraq in 2003, and yet no GWS-like cases were reported as a result of that conflict.

And in their 1999 paper, Unwin et al. (Wessely is a co-author) do concede that "A specific mechanism may link vaccination against biological warfare agents and later ill health..."
although in later reports, they back away from that somewhat.

 

[QUOTE="In their letter to The Lancet in 2009, Wessely et al. make the point that pyridostigmine was also used in Iraq in 2003, and yet no GWS-like cases were reported as a result of that conflict.[/QUOTE]

Thanks for posting this information. It may well be that in 2003 pyridostigmine was 'used' (according to Wessely at al., ) however, having learned perhaps more about 'how' it should be taken, or taken appropriately, perhaps this was given out, distributed but not necessarily taken, if that makes sense? So in essence 'used' as in used up, not the the store anymore, but not necessarily ingested - although Wessely at al., do say it was 'taken' by 73%, but who is to know what actually occurred on the ground. Perhaps the instructions regarding when/how to take pyridostigmine were quite different the 2nd time around.

 

Won't somebody rid me of these meddlesome soldiers?

First prize is a knighthood.

Interesting to see the strategy of botching up case definitions on purpose, same as they did with us. Of course it's probably consistent with their beliefs that all illness is basically psychological, or whatever. The obsession with psychology needing to always be the most important factor has guaranteed this failure. Now they basically can't think outside of this fully-shielded enclosed box.

 

Merged thread

https://twitter.com/user/status/1524763543559712768

 

If Sarin is indeed the cause of GWI, then I guess we need to figure out how Sarin exposure leads to a permanent CFS-like state. I'm guessing it is likely damage to a certain part of the brain. After all post concussion syndrome is quite similar to GWI and CFS. The bad news though is, if it is indeed brain damage, then I don't see how we could possibly cure it.