More than a quarter-century after the Gulf War, female combat veterans have nearly double the risk of reporting more than 20 total medical symptoms, including cognitive and respiratory issues, compared to their fellow female veterans who were not deployed, according to a new study published in the Journal of Women’s Health.
When troops started to come home from the Middle East following the conflict that lasted from August 1990 through February 1991, they reported a myriad of symptoms. These included headaches, gastrointestinal complaints, skin ailments, forgetfulness, fatigue, particularly after exertion, and musculoskeletal pain, said Dr. Steven S. Coughlin, interim chief of the Division of Epidemiology in the Medical College of Georgia Department of Population Health Sciences.
The leading theory early on was that it was a psychogenic illness, somewhat similar to the post-traumatic stress disorder (PTSD) experienced by many Vietnam War veterans. Now the consensus is that much of the condition derives from the neurological impact of neurotoxins soldiers on the frontline were exposed to, Coughlin said.
“They were inundated with pesticides, there are a lot of biting flies and pests in that part of the world so they had uniforms infused with pesticides, a lot of them even wore a dog’s flea collar for extra protection,” he said.
Soldiers also were asked to take pyridostigmine bromide — a drug typically given to patients with myasthenia gravis to improve muscle strength — as a preventative measure to protect against nerve agents in the field. But the drug itself is mildly toxic to nerves and there is some evidence that, in combination with some of the insecticides used, it becomes more potent.
“Every time the alarms went off, they would have to take these little white pills,” said Coughlin, who served as a senior epidemiologist with the Department of Veterans Affairs Central Office in Washington, D.C.
The troops faced other environmental toxins as well, like blown up munitions factories and low dose exposure to sarin nerve gas and others.
“It’s similar to what you see among agricultural workers exposed to pesticides,” he said.
The veterans also were exposed to hazards such as smoke from oil well fires and burn pits used to incinerate waste, the authors write.
A total of 301 female Gulf War veterans from all military branches participated in the study, including 203 who were deployed and 98 who were not sent directly into a war zone.
The findings show that about a third of the war zone veterans say they frequently cough when they do not have a cold. Many of their symptoms fit the definition of Gulf War illness, which includes having at least three of the following six symptom categories: fatigue, neurological/cognitive/mood problems, pain, respiratory, gastrointestinal and skin problems. Younger, non-white, female Army veterans were likely to report the most symptoms.
This significant symptom burden would likely impact the veterans’ quality of life and require medical evaluation and treatment, the authors write.
About two-thirds report difficulty remembering new information and trouble concentrating. Combat veterans also had more headaches, and there were “strong associations” between deployment status and respiratory symptoms with 39% of combat veterans still reporting difficulty breathing or shortness of breath. More than half also report a low tolerance for heat and cold.
The new findings indicate the women are showing increased frequency of symptoms over time and above the rate expected with normal aging.
“It’s been over 25 years since the war ended and these are very persistent health outcomes,” Coughlin said. “This tells us that the way the Gulf War illness manifests itself may be different in female than male veterans, so it’s important to take gender into account.”
The veterans reported symptoms also correspond with higher rates of diabetes, osteoporosis, thyroid problems, asthma and irritable bowel syndrome in this and similar groups.
More research is needed to find biomarkers of Gulf War illness in these former soldiers and effective treatments, the authors write.
“We think this has a lot of importance for the health of these veterans and hopefully, when combined with information from other studies, it will lead to improved treatment,” Coughlin said.
“We are trying to fill in this gap in the published literature about Gulf War illness among women veterans because they have been greatly understudied,” Coughlin said, referencing the first conflict in which the United States included a sizeable female contingent directly in warfare.
The gender differences in Gulf War Illness are consistent with earlier studies as well as other current ones coming out of Florida-based Nova Southeastern University, for example, where they are conducting a clinical trial to try to reverse some of the ill effects, he said.
Furthermore, the findings add to the growing evidence that female Gulf War veterans may have more chronic health issues and conditions than other groups of women generally or female veterans specifically.
Coughlin theorizes that females may be more susceptible to some of the wartime hazards because on average their body size is smaller and because of other differences in physiology. “We can only speculate,” he noted.
Those deployed were more than twice as likely to report more total symptoms and nonwhites — including American Indians, Alaska natives as well as Asian Americans and Pacific Islands Americans — were four times more likely to report symptoms than whites.
Older women were less likely than younger women to report symptoms and those enlisted in the Air Force and Navy were significantly less likely to report more symptoms than those in the Army.
Participants were a mean age of early 50s and other demographics, like race, ethnicity and education, were similar, but those who saw combat were more likely to have served in the Army or Navy and less likely to have served in the Air Force.
Female veterans who have been involved in conflicts since the Vietnam War report higher rates of poor sleep quality, fatigue, insomnia, chronic pain, including headache and musculoskeletal complaints, respiratory problems and skin problems, as well as cognitive and mood related complaints, Coughlin and his colleagues write.