Combat and the brain

A detailed report on why an unusually large number of U.S. soldiers who served in the 1990-91 Gulf War have been affected by illness since their return, blames Gulf War Illness on exposure to toxins during deployment. The report suggests there may be a link between exposure to pesticides, inhaling fumes from oil-well fires, taking pyridostigmine bromide pills to protect from nerve gas exposure as well as exposure to Sarin nerve gas, and the development of Gulf War Illness, up to 20 years later.

What is Gulf War Illness?

Gulf War Illness has been notoriously difficult to understand because it is so variable. The symptoms of Gulf War Illness include memory problems, fatigue and headaches as well as post-traumatic stress disorder and gastro-intestinal problems. Although these symptoms are also seen in the non-combat population, they seem to afflict Gulf War veterans far more frequently and in a more diverse way. Skin conditions and arthritis are seen more frequently in Gulf War veterans and many symptoms cannot be medically explained

What could be going on?

All cells need energy in order to survive. The energy is manufactured by structures known as 'mitochondria'. Brain cells need a lot of energy because they communicate with electrical signals and electrical charge is ‘expensive’. A growing pile of studies show that if a brain cell is ever put under strain, it is more likely to survive if it contains healthy and robust mitochondria. Brain cells and heart cells are among the most energy-reliant cells in the body, but all cells need healthy mitochondria in order to survive.

There is some suggestion that Gulf War Illness may be associated with having damaged mitochondria. A study published in PloS ONE in 2014 found that veterans diagnosed with Gulf War Illness had ‘faulty’ mitochondria when compared with healthy volunteers. The healthy subjects had healthy mitochondria. The investigators also found that unhealthy mitochondria seemed to correlate with difficult-to-understand symptoms in the ill veterans.

Mitochondria may be the connection between toxin exposure and Gulf War Illness, because the toxins that the veterans were exposed to (the drug pyridostigmine bromide given to Gulf War veterans for protection from nerve gas and various organophosphate pesticides) are known to cause mitochondrial damage. Mitochondrial damage can cause a wide range of diseases and symptoms, including the spectrum seen in Gulf War Illness.

Is there a solution?

At the moment, we only see correlations and not a causation, so we need more studies before we know what is really going on. If mitochondrial damage from toxin exposure really is behind this terrible illness then it seems there may be much hope for the future.

A large body of evidence is indicating that a dietary intervention in the form of a high-fat, very-low carbohydrate and moderate protein diet known as the ‘ketogenic diet’ may be extremely beneficial for mitochondria. Not only does the diet seem to make cells grow new mitochondria, but existing damaged mitochondria seem to be able to work well again. A ketogenic diet results in the liver making ‘ketones’ out of fat. Brain cells are able to use ketones as well as glucose for energy. Giving mice ketones reduces brain damage in the setting of a stroke. Ketones also reduce the extent of brain injury after trauma. Other ways of helping mitochondria include reducing oxidative damage through nutrient and anti-oxidant intake, cutting sugar intake and reducing exposure to mitochondrial toxins such as alcohol.

The future

It still remains to be established exactly how exposure to various toxins is causing disease. Although the mitochondrial route seems feasible, there may be other ways in which toxins are leading to illness. There is also the possibility that diseased mitochondria are a consequence of the illness and not a cause.

A partial ketogenic diet administered under rigorous medical supervision has the potential to offer protection to soldiers currently serving around the world who may one day end up facing the same horrors that Gulf War veterans must contend with. Until further studies are awaited with regard to Gulf War Illness, it may be worth investigating the feasibility of such a relatively harmless dietary intervention in the context of various sources of neurotrauma encountered on battlefields around the world today.

Please Note: this site is for discussion only and should not be used as a source of medical advice. Please consult your medical doctor before making any changes to your diet, lifestyle or medications.


1. Roberta F. White, Lea Steele, James P. O'Callaghan, Kimberly Sullivan, James H. Binns, Beatrice A. Golomb, Floyd E. Bloom, James A. Bunker, Fiona Crawford, Joel C. Graves, Anthony Hardie, Nancy Klimas, Marguerite Knox, William J. Meggs, Jack Melling, Martin A. Philbert, Rachel Grashow. Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment. Cortex, 2016; 74: 449

2. Hayley J. Koslik, Gavin Hamilton, Beatrice A. Golomb. Mitochondrial Dysfunction in Gulf War Illness Revealed by 31Phosphorus Magnetic Resonance Spectroscopy: A Case-Control Study. PLoS ONE, 2014; 9 (3): e92887

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