PREVENTION OF THE IRAQ WAR-ASSOCIATED SICKNESS
A Prediction and a Challenge to the Department of Defense
Majid Ali, M.D.
I dedicate this column to the courageous and valiant women and men who fought and/or are fighting the Iraq War. Many of them are sick now. Many more will become sick with passing months, and will remain so for years to come. I predict that a large fraction of them will be disabled for many years. That is sad because I believe most of that sickness is preventable. However, it cannot be prevented with antidepressants, anxiolytic agents, broad-spectrum antibiotics, or talk therapy. To be effective, the sick veterans will have to be managed with a new model based on solid scientific knowledge concerning the dysfunctional cellular energetics — redox dysequilibrium and oxygen dyshomeostasis — in the chronically ill veterans caused by the growing burden of incremental and functional nutritional deficits, environmental toxins, and stress-related issues.
I could not have made the above prediction of disabling disorder of cellular energetics in the 2004 Iraq War veterans except in light of experience with the veterans of the 1991 conflict in the Persian Gulf. In 1991, while writing The Canary and Chronic Fatigue, I saw a flash picture of the Kuwait oil field in smoke and recognized two things clearly: First, that many returning veterans will develop a largely preventable chronic illness; and second, that illness will be chalked up to a psychosomatic disorder and the sick veterans will be prescribed antidepressants, anxiolytic drugs, and talk therapy — measures that provide temporary relief but mask the worsening deeper problem of seriously disrupted cellular energetics.
I devoted a few pages to my sense of that upcoming disaster in Canary.1
TERROR TURNS INTO TOXICITY, TOXICITY INTO TERROR
My warning in Canary about the Gulf War veterans went unheeded. Why? Because the experts of the Department of Defense (DOD) were unable to reach beyond the old and obsolete one-cause/one-disease/one-drug model of thinking. They could not—or did not want to—accept a simple fact of human biology: At cellular level, terror turns into toxicity, and toxicity into terror. Both terror and toxicity feed on each other, and cumulatively lead to cellular oxidosis, acidosis, and dysoxygenosis.2-5 It is important to point out that I did not find a single reference to severe and persisting derangements of redox equilibrium and oxygen homeostasis in the sick veterans of the 1991 war in hundreds of reports on the subject. Needless to say, psychological evaluations were not an acceptable substitute for laboratory tests to detect crucial defects in cellular energetics. Nor, were the prescriptions for sleeping pills, anxiolytic drugs, antidepressants, and talk therapy satisfactory responses to deepening energy and immune crises of the sick veterans.
In this column I challenge the DOD to consider a proposal for the prevention of the Iraq War-associated sickness (“I-WAS”) based on an energetic-molecular model of chronic disabling illness focused on solid scientific evidence for redox dysequilibrium and oxygen dyshomeostasis seen in persons with intracellular accumulation of toxic substances — metabolites of Krebs cycle, products of impaired hepatic detoxification pathways, mycotoxins, mitochondrial uncouplers, and others.6-9 Why should the DOD consider my proposal for this clinical trial? I ask the DOD to consider the following three quotes, one from Navy News and two from The New York Times:
1995: Navy News
Gulf War Syndrome—Who’s Addressing the Issue? Long before the first veterans returned from the Persian Gulf Dr. Majid Ali, associate professor of pathology at the College of Physicians and Surgeons at Columbia University in New York, predicted five outcomes: (1) That a large number of service men and women in the Persian Gulf region would return with a variety of chronic environmental, immune and stress-related problems; (2) The disabling fatigue would be a dominant clinical feature while other symptoms would include recurrent infection, food allergy reactions, abdominal problems, disorders of mood and memory, and skin rashes, among others; (3) That sick veterans would initially be dismissed as malingerers and labeled with various psychiatric diagnoses and prescribed large doses of mind- numbing drugs; (4) That the chronic health disorders of these veterans would worsen with multiple drug therapies; and (5) That when everything else failed, these veterans would be prescribed long-term broad-spectrum antibiotic therapy that would play further havoc with their bowel systems. Five years later these predictions are now observable facts. Headlines debate the cause and fate of those men and women who left healthy and returned home sick—nearly 75,000 at last count. (Navy News, September 13, 1995)
1996: The New York Times
[Currant evidence does not support a causal link between the symptoms of chronically ill veterans of the 1991 war in the Persian Gulf. (Report of the President’s Advisory Committee to President Clinton. (Quoted by The New York Times, October 15, 2004.)
2004: The New York Times
Chemicals Sickened Gulf War Veterans, Latest Study Finds: A federal panel of medical experts studying illnesses among veterans of the 1991 war in the Persian Gulf has broken with several earlier studies and concluded that many suffer from neurological damage caused by exposure to toxic chemicals, rejecting past findings that the ailments resulted mostly from wartime stress . . . the Research Advisory Committee on Gulf War Veterans’ Illnesses concluded in its draft report that “a substantial proportion of Gulf war veterans are ill with multisymptom conditions not explained by wartime stress or psychiatric illness.” (The New York Times, front page, October 15, 2004)
NO TO $5 MILLION FOR THE SICK,
YES TO $450 Million FOR THE SYNDROME
Truth was systematically perverted during discussions of the Gulf War syndrome. Stated bluntly, the health and lives of the sick veterans were sacrificed at the alter of the pseuoscience of the one-disease/one-cause/one-drug model of the prevailing medical thought. Am I being melodramatic? Consider the following three quotes from the prestigious science journal Nature concerning the issue:
Nature October 19, 2000
Desperately seeking a syndrome- The US Congress should stop pushing researchers to invent a medical definition for Gulf War syndrome, the collection of maladies associated with veterans of the 1991 conflict in the Persian Gulf. (page 819)
Nature March 8, 2001
Fracas over $5 million Gulf syndrome grant. The battle over Gulf War syndrome has broken out again … this time over a US$5 million grant. The funding has been granted without peer review, to the laboratory of clinician Robert Haley, whose research on veterans is controversial. Ross Perot…Hutchinson’s action. “Those goofballs in the Pentagon are trying to just sell stress [as the cause of Gulf War illness] and not do anything for the men,” he says. (page 135)
Nature July 4, 2002
On 25 June, an advisory panel appointed by veterans’ affairs secretary Anthony Principi concluded that research into whether neurological damage had been caused by vaccination or exposure to nerve agents “should be aggressively pursued”, and recommended that Congress commit $450 million over three years to the project.
EAGER AND READY TO MEET THE VETERANS’ MEDICAL NEEDS
Today is Veteran’s Day, November 11, 2004. This morning on CNN, the Secretary of Veterans’ Affairs assures the nation that the VA hospital system is eager and ready to meet all the medical needs of all Iraq War veterans. What does he mean?, I wondered. In hundreds of the conferences of nutritionist-physicians and clinical ecologists I have attended during the last twenty-five years, I do not recall meeting any physician working in the VA hospital system. Nor am I aware of nutritional or detox therapies administered in that system. So how is the VA system eager and ready to serve the Iraq War veterans? I do not know anyone in the VA system who is seriously addressing — even merely writing about — the crucial issues of expanded nutritional and detoxification needs of the sick veterans. Does the Secretary mean that those veterans have no special nutritional or detox needs?
An hour later, while driving to the Institute, I heard a Florida Congressman, an Iraq War veteran, pronounce that he is not aware of any unmet medical needs of the veterans. When probed by the host, he conceded that he knew of some veterans who had emotional problems, but in his view those problems probably existed before the veterans went to Iraq. Like the Secretary, the Congressman was unburdened by any knowledge of how terror and toxicity at cellular levels cause massive loss of essential nutrients, and how toxic organic acids build rapidly in the cells under the conditions of redox dysequilibrium and oxygen dyshomeostasis.
The Secretary and that Congressman seem not to have any memory of how chronic illness and cancers in the Vietnam veterans caused by Agent Orange and related chemicals were ignored for several years. Nor do they seem to recall any of the much larger tragedy of the Gulf War syndrome, recently acknowledged by the DOD, reported by The New York Times, and referenced earlier in this column.
No, the VA system is neither eager nor ready to meet the special nutritional and detoxification needs of the sick veterans of the Iraq War. I fervently hope someone at the DOD will give some thought to the merit of the proposal in this article, and be open to the possibility of preventing another major disaster.
WHO SHOULD EXPRESS OPINION ON DYSFUNCTIONAL CELLULAR ENERGETICS?
Surgeons let pathologists express opinions on biopsy materials. Cardiologists let pulmonologists express opinion on matters of chronic lung disorders. Gastroenterologists refrain from passing judgement on the work of rheumatologists. In the case of the Gulf War syndrome, it was curious — and tragic — that the DOD allowed those with no training in the laboratory evaluation of the status of redox equilibrium and oxygen homeostasis to pass judgement on whether or not the chronically ill veterans suffered from cellular toxicity, respiratory-to-fermentative shift in ATP production, and other forms of functional cellular derangements. That grievous error led to the tragic neglect of the sick veterans for nearly fourteen years. The central tragedy of the medical injustice done to the chronically ill veterans of the Gulf War was that their varying symptom-complexes were attributed to psychological abnormalities without making an effort to uncover the sources of toxic exposures. The veterans played a huge price for the ignorance of those who were required to provide sound medical advice. I have no doubt that a similar fate will befall veterans of the Iraq War who are being ‘treated’ by ‘medical experts’ who neither learn the biochemistry of systemic toxicity, nor have any interest in detoxification strategies.
In the past columns, I have furnished data about toxicity caused by respiratory-to-fermentative shift, hepatic overload of chemicals, and mycotoxicosis. Here, I include a case history of severe toxicity reaction arising from a source that is overlooked nearly universally, except by a handful of clinicians. A 43-year-old woman presented with severe fatigue and myalgia; orthostatic intolerance; difficulties of mood, memory, and mentation; and environmental sensitivities. An analysis of 24-hour urinary excretion of organic acids revealed increased excretion of Krebs cycle metabolites, indicating the existence of respiratory-to-fermentative shift. She showed a moderate initial response to our initial integrative oxystatic management plan. Then she underwent dental work and suffered a severe relapse of all of her symptoms and developed cardiac rhythm disorder which necessitated hospitalization. Following an extensive diagnostic work-up, she was discharged with a diagnosis of tachycardia of unknown cause. Some days later, I received a call from her primary physician who thought her problems were supratentorial and she needed psychotherapy. Then he asked me if I would support his decision.
Table 1. Severe Inhibition of Crucial Enzymes of cellular Energetics by Toxins from Dental Cavitation and Tooth Materials
*Cavitation biopsy tissues.
In Table 1, I present data revealing the real source of toxic exposure that destabilized her and led hospitalization. Note the severe — in some cases near total — suppression of enzymes with crucial roles in cellular energetics by factors (mostly microbial toxins) released from the tissues surrounding dental cavitation and other parts of dead or dying teeth. The laboratory range of suppression of those enzymes in non-toxic subjects was less than five percent. How many cardiologists or internist in the country, might one ask, have been trained or are even aware of this potentia source of serious and potentially life-threatening toxicity?
What does dental toxicity have to do with I-WAS? My essential point in the above case history is this: Those unfamiliar with clinical and laboratory diagnosis of cellular toxicity should not be permitted to dismiss Iraq War as a mere psychosomatic problem. The second reason for including the above case study is to underscore the point that integrative physicians diligently search for causes of cellular toxicity — mycotoxins, excess Krebs cycle metabolites, heavy metals, mitochondrial uncouplers, and others — which most mainstream doctors do not even think about.
A PROPOSAL FOR A CLINICAL TRIAL FOR THE IRAQ WAR VETERANS
Looking back, the experience with the Agent Orange-related sickness in Viet Nam veterans and the Gulf Was syndrome among veterans of the Persian Gulf conflict makes it abundantly clear that the one-disease/one-cause/one-drug model of the prevailing pharmacologic medicine neither provided us any understanding of the true nature of the veterans’ chronic sickness, nor did it solve their medical problems. In the proposed clinical trial, I submit that the Oxygen Model be applied for the clinical evaluation and management of the unwell veterans. I described the Oxygen Model at length in Integrative Nutritional Medicine — Looking Through the Prism of Oxygen Homeostasis, the fifth volume of The Principles and Practice of Medicine.
The Goal of the Proposed Clinical Trial
The goal of the clinical trial will be to determine by true-to-life, long-term follow-up study whether or not optimal nutritional, detox, and self-regulatory measures can prevent the development of chronic debilitating illness among the Iraq war veterans, as it happened to a large number of Gulf War veterans.
Subjects of the Clinical Trial
I propose that four hundred veterans of the Iraq War who state they are not as healthy one year after their service as they were before that should be entered in the clinical trial, to be conducted by the DOD as follows: (1) one-half of that veterans cohort be taken from the Eastern USA and be assigned to ten university internists, who have the freedom to manage their cases according to prevailing standards of laboratory testing and drug therapies of the pharmacologic model; (2) the second half of the veterans be taken from the Eastern USA and be assigned to ten integrative physicians, who are given freedom to evaluate the redox equilibrium and oxygen homeostasis of the veterans with established laboratory methods, and then manage their cases according to the accepted nutritional, detoxification, and self-regulatory approaches; (3) the trial be conducted for three years; and (4) the outcome of the study be decided by using predetermined clinical and laboratory criteria.
Two Entry Criteria for the DOD Trial
I propose that the following two sets of criteria for establishing the presence of I-WAS be established:
1. A set of clinical criteria that depends on self-evaluation of chronically unwell veterans. This criteria would be considered met when a veteran reports steady deterioration in health during the year after the tour of duty—including recurrent infections; disabling fatigue; tissue pain; the problems of mood, memory, and mentation; and sexual dysfunctions. Simply stated, the criterion would be met if a veteran utters the words “I am not what I was,” for the purpose of this study; and
2. A set of biochemical criteria that assesses oxygen homeostasis, redox dynamics, and acid-base equilibrium. Specifically, it should include measurements of urinary excretion of metabolites of the Krebs cycle, the increased levels of which show incontrovertible evidence for disruption of cellular oxygen homeostasis (see Townsend Letter of July/August 2004 for a large body of data concerning the respiratory-to-fermentative shift in chronic energy deficit states).
The Clinical Trial Outcome
The outcome of the study will be assessed at six-month intervals for three years employing predetermined clinical and laboratory parameters. The clinical parameters will include: (1) an overall sense of well being; (2) quality of work at the place of employment; (3) level of energy/fatigue; (4) frequency and degree of pain states; (5) quality of mood, memory, and mentation; (6) quality of sleep; (7) digestive-absorptive functions; (8) sexual health; (9) frequency of infections and frequency of antibiotic use; and (10) the use of antidepressants, anxiolytic agents, and sleep medications. The laboratory parameters will focus on issues of oxygen homeostasis, redox dynamics, and acid-base equilibrium.
In essence, the study will focus on the energetic-molecular basis of health and disease, and not on the prevailing ideas of disease classifications. I believe such an approach is essential if we are to avoid the massive tragedy of the Gulf War syndrome.
GUIDELINES FOR OXYSTATIC THERAPIES
Integrative management plans individualized to serve the specific needs of individual patients — focusing on optimal nutritional support, hepato-enteric detoxification, and self-regulation — cannot be standardized in the fashion of drug regimens. Below, I outline integrative redox-restorative and oxystatic therapies that have been validated by extended clinical use at the Institute as guidelines for designing individualized plans for individual veterans. I discussed the scientific basis, clinical rationale, and dosage schedules of all of the therapies included below at length in Nature’s’s Preoccupation With Complementarity and Contrariety, Dysoxygenosis and Oxystatic Therapies, and Integrative Nutritional Medicine —Looking Through the Prism of Oxygen Homeostasis, the first, third, and fifth volumes of The Principles and Practice of Integrative Medicine.10-13
In writing The Canary and Chronic Fatigue, my primary purpose was to address the one question that had preoccupied me for several years: How do we recapture lost energy? One day I saw the flash image in which the word “energy” stood for:
Restoration (of energy enzyme pathways)
My colleagues at the Institute and I have cared for nearly 8,000 patients with chronic energy and immune deficit states since the writing of The Canary. Extended long-term clinical follow-up results obtained with the above “ENERGY” model have fully validated the clinical efficacy of that approach. The core therapeutic elements of that model are briefly outlined below:
Internal and External Environments
In clinical medicine, as elsewhere in life, no part can be understood except through its relationship with the whole. This must be accepted as one of the core tenets in all discussion of I-WAS. In this context, the suffering of the chronically ill Iraq War veterans must be examined in light of altered conditions in their internal environment— tissue-organ macroecology and cellular microecology— as well as external environment. Specifically, it must include:
1. Effective management of issues of the bowel, blood, and liver ecosystems;
2. A systematic search for the sources of environmental toxins—mycotoxins, toxic metals, pesticides and herbicides, air and water pollutants, and others—that affect individual patients; and
3. Antigen immunotherapy for IgE-mediated responses.
I discussed the above issues at length in the sixth and seventh volumes of The Principles and Practice of Integrative Medicine.14,15
The theoretical and clinical aspects of nutritional therapies have been presented at length in Integrative Nutritional Medicine. There are, of course, many other excellent volumes devoted to this subject which can be used for establishing broad standards of care for the proposed clinical trial. Below, I briefly list the nutrients that require special focus in an integrative management plan for restoring the health of veterans with Gulf War syndrome (and now with I-WAS.
1. Minerals: magnesium, potassium, calcium, zinc, selenium, chromium, and molybdenum;
2. Vitamins: vitamins A, B complex, C, D, E, and K;
3. Sulfur-containing redox-restorative factors [glutathione, taurine, methylsulfonylmethane, lipoic acid, and N-acetyl-L-cysteine];
4. miscellaneous nutrients [coenzyme Q10,
5. Parenteral nutrient support: See Tables 2-4 for examples of two intramuscular and one intravenous protocol.
Table 2. INTRAMUSCULAR PROTOCOL A
Table 3. INTRAMUSCULAR PROTOCOL B
Table 4. INTRAVENOUS PROTOCOL
500 mg/ml=40 ml
250 mg/ml=2 ml
100 mg/ml=1 ml
1,000 mcg/ml=2.5 ml
50 mg/ml=1 ml
10 mg/ml=12.5 ml
500 mg/ml=4 ml
25 mcg/ml=4 ml
5 mg/ml=4 ml
40 mcg/ml=5 ml
Rheologic Agents: As in the Basic Protocol
Solution: As in the Basic Protocol
Misc: *Cyanocobalamine is given as an IM injection (1 ml)
Administration Time: 75 to 120 minutes
Restoration of Enzymes of Cellular Energetics and Detoxification Pathways
The following therapies are valuable in addressing the problem of respiratory-to-fermentative shift in ATP production characteristically seen in Gulf War syndrome-like states.
1. Direct oxystatic therapies: (1) oxygen by mask; (2) hydrogen peroxide foot soaks; and (3) hydrogen peroxide or ozone infusions;
2. Indirect oxystatic therapies addressing the bowel issues: (1) probiotic formula composed of approximately one billion spores of Lactobacillus acidophilus, Lactobacillus bulgaricus, and Bifidobacterium in a suitable base of complex vegetable fiber; and (2) herbal formulas in weekly rotation [author’s preferences include Echinacea, astragalus, burdock roots, goldenseal, artemisia, pau d’arco, and beet root fiber].
3. Indirect oxystatic therapies addressing the hepatic detoxification issues: (1) lecithin; (2) castor oil liver packs; (3) liver flushes [with lemon juice, olive oil, and cayenne]; and (4) hepatoprotective herbs [author’s preferences include milk thistle, turmeric, Jerusalem artichoke, ginger, garlic, and spirolina].
Physical exercise is essential for health preservation and recovery from chronic energy and immune deficit disorders. However, in energy deficit states associated with respiratory-to-fermentative shift, commonly used routines for exercise cause a rapid buildup of organic acids within cells and increase fatigue. In Ghoraa and Limbic Exercise,15 I provide specific information for noncompetitive exercise with mini breaks to prevent cellular acidosis.
In my experience, mere clichés do not suffice for coping with severe cellular stresses creating by terror turning into toxicity, and toxicity into terror. The way out of unrelenting suffering cannot be found without redefining—at least in some measure—the link that binds us to the gentle, sustaining energy of the Presence that permeates each of us at all times. What is required is a wellspring of hope arising from deep within. I present some of my clinical observations in Healing Miracles and the Bite of the Gray Dog.16
When dealing with chronically ill patients who do respond to ordinary drug regimens, we physicians, in general, are deeply troubled by subjects of self-regulation, states of consciousness, and spirituality. That is ironic because the sick nearly always welcome opportunities to explore those areas. I do not speak here of esoteric brands of mysticism. Gurus are not necessary. Good teachers will do. But none of that can be done without the patient being an equal partner in the journey of healing.
During the early 1990s, many in the Department of Defense had hoped that the thorny issue of the Gulf War syndrome will spontaneously disappear with passing years. It did not. As cited earlier, on June 25, 2002, the Secretary for veterans’ affairs recommended that Congress committ $450 million over three years to the study of neurologic damage to the veterans of the 1991 Persian Gulf conflict. Now, I see another looming national tragedy — the Iraq-War-Associated Illness (I-WAS)—and another long period of denial of the cellular energetic and toxicity issues that confront the present generation of veterans. Will they continue to neglected as were the chronically ill veterans of the Gulf war before them? Will their suffering be also chalked to stress? Will the medical care they receive be confined to prescriptions of sleeping pills, anxiolytics, and antidepressants, as was the case with persons suffering from the Gulf War syndrome? Will more salt be poured on their cellular wounds — their leaky cell membranes, uncoupled mitochondria, and blocked Krebs cycles by offering them talk therapy?
Or, will the department of Defense be open to considering the following crucial questions:
1. Why do 140,000 of the total of 693,000 women and men who went to the Gulf conflict fourteen years ago continue to be partially or fully disabled?
2. Why did the Department exclude from the care of the sick veterans clinicians who had published extensively about effective therapies for restoration of redox equilibrium and oxygen dyshomeostasis in chronic illness identical to that suffered by the veterans?
3. What lessons learned from the Gulf War syndrome may be applied to prevent similar disaster happening to veterans of the Iraq War?
4. What possible justification exists for caring for the chronically ill Iraq war veterans with same old one-disease/one-cause/one-drug dogma of medicine that failed so completely in the case of the sick Gulf War veterans?