What is Gulf War Syndrome?

By Liji Thomas, MD

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.

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.

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.


Last Updated: Oct 12, 2015

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  1. david Hill david Hill uk says:

    Simon Wessely of Kings collage London has done a lot to help governments not to pay out compensation to veterans calling gulf war syndrome  rumor he has also worked on ground zero  and lung problems in firefighters caused by the collapse of the twin towers and calls it hysteria for his work he was awarded a knighthood by the British government .

    Rumors shaped veterans' view of Gulf War ills: syndrome was defined by informal communication.
    After the bullets stopped flying the rumors took off among British veterans of the 1991 Gulf War. Early accounts of physical and emotional reactions to wartime experiences spread from one person to another through networks of veterans. Within a few years, these former soldiers had decided among themselves that the symptoms they were suffering from collectively amounted to the controversial illness known as Gulf War Syndrome, a new study concludes. Simon Wessely of King's College London and his colleagues analyzed extensive written accounts provided in 1996 by 1,100 British Gulf War vets. The research team doesn't regard the rumors as necessarily untrue or misleading, Rumor proved to be critical among the British Gulf War vets because it counteracted a lack of communication from military and government authorities, Wessely says. Vets turned to their own social grapevine for answers, Wessely's group reports in a paper to appear in Social Science & Medicine.

    What's Causing 'Mass Faintings' at Cambodian Factories?
    By Andrew Marshall Tuesday, Sept. 20, 2011
    Sufferers of World Trade Center syndrome, meanwhile, blamed proximity to Ground Zero for coughs and other respiratory problems long after airborne contaminants posed any health threat.
    All these are examples of mass hysteria, a bizarre yet surprisingly common phenomenon that is increasingly recognized as a significant health and social problem. For centuries it has crossed cultures and religions, taking on different forms to keep pace with popular obsessions and fears. In our post-9/11 world,
    Simon Wessely King's College London

    • Dawn Thomas Dawn Thomas United States says:

      I can say with all clarity of mind that the symptoms the veterans are experiencing are real. What is not clear is the methods used to study the veterans. An error has been made in trying to find a single common cause of the illnesses presented. Any one with a medical background should now understand that genetic makeup of the personnell is a definitive factor as to how a causitive agent may present as an illness. It is not apparent that this has been included in the studies.
      If we continue to try to use studies that do not clarify this factor it will obviously be flawed in the outcome or results. Any quality study is only as good as the data used hence the old expression "garbage in garbage out."

  2. Phil Gardner Phil Gardner United Kingdom says:

    I served in thr RN during the Gulf war and had the vaccines and naps tablets.I developed sleep apnoe and have a heart nerve block plus other health issues.I was super fit whilst serving in the Gulf and came back with all these health problems.Now don't tell me that these things are a figment of my imagination.

    • Sherry Chestnut Sherry Chestnut United States says:

      my husband juts had to have a pacemaker installed due to a nerve block issue and he has sleep apnea now where he was ok while in service. Its been a while sicne but he also has had a tia stroke and suffers from unaccounted headaches that last just a few minutes and then leaves him tired for a while after it. He was told he has to prove these are from the gulf war. How does he do that?

  3. Dawn Thomas Dawn Thomas United States says:

    I developed the first symptoms of Fibromyalgia in 1995. I was a nurse corp Officer in the Navy. I was healthy as could be prior to my service. While in the service in 1995,  I developed pain in my right shoulder. At first I thought it was related to packing too much weight on my shoulder but I had been weight lifting and was quite strong able to bench press my own weight. So it was curious to me. I didnt think anything was wrong and waited several months to even visit my PCP. Unfortunately the pain began to progressively get stronger and began to radiated down my arm to my hand. I the sought help from my PCP. It continued to progress the pain now presenting in both arms to hands and my neck. I was continuously having to draw on diagrams of the human body where and how my symptoms presented themselves. After two years the pain traveled to become bodywide. I had no hx of depression for the record.
    One day after describing my symptoms for the nth time now to numerous PCP'S, unbeknownst to me a Rheumatologist was sitting on the sidelines and heard me talking to the PCP. He saw me and in 1997 I wad given a diagnosis of "Fibromyalgia." I didn't believe it. I hadn't even heard of this disorder never mind understanding what it meant.
    My pain progressively worsened. I had a high pain toleranced as evidenced by having both of my children by natural childbirth methods not having any form of pain control. My first child was 8pds 12oz.  Now though my pain on a 0 to 10 scale was an 7. I later developed sleep disorders and cognitive memory problems. I had graduated from my BS degree in Science with a major in Nursing with a 3.86 g.p.a. But by 2000 I had to utilize flash cards to remember many of my patients info.
    By 2003 I was deployed to Iraq. I had been given a smallpox vaccine and my 6th? Anthrax vaccine on the same day. I became so ill I couldn't make it to sick bay which was four decks above my quarters. My commander found me  24 hrs later after not reporting to work for my shift. I was escorted to sick bay, an I.V. was placed and I was given something via the line. It did nothing to relieve the excruitating migraine, photophobia or nausea  I was experiecing. I was medivaced off the ship to Rota Spain. I remember the helo that removed me from the ship but I can't recall how I got from there to the C130? that transported myself and other patients to Spain. I dont remember much but I remember being in Rota Spain and waking up in a bed in a tent. I recovered from the migraine attack within a few days.
    As a side note, I did develope PTSD in 2003 but only after being locked in a room with enemy prisoners of war known as  EPW's for 12 hour shifts. But that is another story.
    In 2005 I was given a medical discharge from the military but denied my military retirement. I developed Reflexive Sympathetic Distrophy or RSD in 2000 after having both of my first ribs surgically removed. This progressed........or was my Fibro dx wrong.....not sure but to end the story the NOW BODYWIDE RSD was dx'd in 2013 by an internationally known neurologist. On the McDill  pain scale RSD or CRPS is rated as the most excrutiating pain a human being can experience. This has left me with Chronic fatique, sleep disorders, and never ending torturous pain. I am bedridden often times more than not.
    I am attempting Ketamine I.V. F. for the neurological disorder labeled CRPS. It is helping me to stop my Opioid patch but I still need oxycodone each day. Today I am bedridden for the third day in a row this week this is Thursday.
    My exhusband was deployed in the Airforce in 1990 to Iraq. He was very healthy when he left but developed MCS after that war. It was the first time I had ever really seen him sick and we had been married since 1978. I wish there were research truly done well for both the veterans and their family members. There are many crosses to bear in our lives but none heavier than being denied recognition that the one you carry is not visible to others eyes and understanding......

  4. Sergio Lainz Sergio Lainz Spain says:

    Sorry, my english is not alot ok!
    I am photojournalist from spain, I was working into Saudi Arabia and Kuwait from Jenuary to March ..I'am working in the capital, pipeline road, and Hafar el Batin fist one. And then,  when troops entry in Kuwait, we going into Kuwait City by the deseert after de Desert Rats. I'am living in the hotels whit no one something to eat, except the Iraquian 'rice' rest in the hotel. also, i was work in the road to Iraqui frontiere and i take the pictures in the middle of the iraqui caravan take to pullout Kuwait. She was destroyed by low-uranium bombimg. The Desert Rats gave me pills and injection for the case of a chemical attack, but did not use it.
    I also provided some ranch USA packaging, and snuff tobacco, which use the first days in Kuwait.
    I'm not a soldier, not kill anyone, and I do not think I've suffered post traumatic stress, but I have the symptoms of "GWS".
    I'm always tired since. I have muscle and tendon pain. And the non-alcoholic 'fatty liver'.
    As yet my 59 years, no doctor has prescribed me anything useful.

    • Michael Bailey Michael Bailey United States says:

      Sergio, my company was one of the first in and one of the longest serving at the time. We set up all of those Convoy Support Centers. Remember the CSC camps? Each had a name, CSC Vulture, CSC Wombat etc. I drove through Hafr al Batn every day or two. I spent a lot of time between Dharan, KKMC, Riyadh and west towards Jordan where the French were at. I also was there for the "Death Valley" destruction and drove through the oil fires frequently. Some of us saw nearly everything that happened, others were left to sit for month after month without ever leaving their camp. Yet very high proportions of personnel grouped around KKMC, Hafr al Batn and CSC Vulture, and most of those that went in with them on the feint to the west, the actual thrust to the north and the sweep to the east exhibit confirmed symptoms at a rate of 42 percent. The rest of the deployed report and confirm at a rate of about 16 percent.

      Deployed personnel that were not vaccinated with experimental vaccines (our AZ Guard unit received as many as 70 different vaccines, for some people) only report at about 3 percent, less than the general population. Those that received vaccines- but did not deploy -report and confirm at about 12 percent.

      It's not commonly known, but the Dept of Defense was ordered by a Federal judge to cease use of the experimental Anthrax vaccine after failing to report to Congress that over 20,000 hospitalizations resulted from complications attributed to the experimental Anthrax vaccine. The Army was banned from using that vaccine, and was forced to develop another and to obtain FDA approval. That new vaccine, being used on today's troops, is not the same Anthrax vaccine we were given in the Gulf War.

      In addition, my best friend, even though he is 16 years younger than I am, was in that unit with me. He suffers from the same symptoms, for the same length of time, and we both share the same rare vitamin D deficiency, developed since our return. He was in charge of the M9 chemical alarms. They went off over 25 times a day, over 18,000 times for the American military and over 9,000 times for the British. The official response when an alarm was reported was that it was a false alarm caused by "diesel fuel and exhaust".

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