Gulf War Syndrome

Exercise Intolerance
Deeper understanding of the energy processes involved in human physiology and the role of the mitochondria, the powerhouse of the cell, may help in managing chronic disease processes. According to Bland (2000), an intermittent or sporadic form of mitochondrial myopathy, in which exercise intolerance is the predominant symptom, has been observed in individuals suffering from FMS, GWS, and encephalomyopathies.

The nucleus and the mitochondria each possess genetic information contained in DNA, a trait not shared with other organelles. Mitochondria can be damaged in such a way that communication with fellow mitochondria or other cellular organelles becomes faulty. Bland lists factors suspected as contributory events in malfunctioning mitochondria. Among them are the following:

1. Oxidative stress is associated with low oxygen tension or ischemia, which contributes to mitochondrial oxidation and can result in injury to mitochondrial DNA. According to Bruce Kristal, Ph.D., of the department of biochemistry at Cornell University Medical College, about 90% of oxygen supply is used by the mitochondria for oxidative phosphorylation, a process that produces ATP, an energy molecule. Electron leakage, perhaps less than 1-4%, occurs during oxidative phosphorylation and becomes a harbinger for free radicals. Free radicals perform a cyclic dance, as one radical may be neutralized only to produce another. An aggressive complex of antioxidants increases protection against oxidative stress. Consider traditional antioxidants, such as vitamin C, vitamin E, vitamin A, selenium, garlic, glutathione, green tea, grape seed extract, and lipoic acid.
2. Glucose intolerance or increased concentrations of glucose reportedly potentiate injury to mitochondrial DNA. Individuals suffering dysinsulinism and dysglycemia, with increased glycosylated hemoglobin levels, may have a greater propensity for mitochondrial DNA damage.
3. Sleep debt appears associated with impaired metabolic and endocrine performance, which may have physiopathologic consequences over time.
4. Dietary factors, such as calorie restriction in animals, have lessened the incidence of mitochondrial injury and mutation.
5. Environmental injury imposed by persistent or exaggerated contact with noxious agents may overwhelm the ability of the natural antioxidant systems to accommodate the exposure, and cellular damage results. The susceptibility of mitochondrial DNA to environmental mutagens appears even greater than the vulnerability of the nucleus, according to Johns (1995).
6. Medications, such as an antiretroviral nucleoside analogue like AZT, specific antibiotics, nucleoside-analogue reverse-transcriptase inhibitors, and the fibrate drugs, that is, antihyperlipoproteinemic drugs, appear to increase mitochondrial oxidative injury.
7. Chronic inflammation is associated with increased release of cell messengers, for example, tumor necrosis factor alpha, or interleukin-1 and interleukin-6, which may have effects on the mitochondria.

Exercise intolerance hearkens back to the work of Dr. Nicholas Gonzalez. Exercise may intensify parasympathetic expression and further tame the sympathetic nervous system by "burning off" epinephrine and norepinephrine hormones released by the adrenal medulla. Recall that cholinesterase inhibitor insecticides, to which the Gulf War veterans were exposed, may amplify parasympathetic expression, a metabolic type that may have been dominant from birth in individuals more vulnerable to GWS. It is possible that exercise tolerance will increase, if choices are made to balance the autonomic nervous system.

Elite athletes have benefited from large doses (20 grams) of creatine supplements when compromised ATP production was suspected. The benefits observed in muscular performance among athletes may extend to individuals suffering the pain and fatigue of myalgia. Use 5 grams of creatine, 4 times a day for 5 days. Thereafter, use 1 gram of creatine, following exercise. Though creatine is considered remarkably safe, individuals with kidney impairment may find it advisable to avoid crea-tine supplements.

Dioxychlor increases oxygen supply throughout the body and may be of benefit in preserving mitochondrial integrity.

Exercise Conclusion
Air travel, excessive exercise, and a lack of sleep worsen symptoms of GWS. Flying lowers oxygen tension and can stimulate borderline anaerobes. Exercise, though essential in moderation, should not be aggressive, for a relapse due to overexertion can occur.

Dry saunas help rid the system of chemicals. Saunas may be considered 3 times a week, followed by 15-20 minutes of dry sauna and a tepid shower. Repeat saunas no more than 2 times a day. Work up a sweat, eliminating chemicals, without goading the body into stressful activity. Always replace body fluids during and after each session.

Should individuals choose to incorporate walking into their rehabilitation program, select the exercise arena carefully. Roadside exercise, because of contaminants, negates the value of the activity. Become good environmental stewards, screening the entry of pollutants and allergens into an already challenged biochemistry. For recovery, after light exercise and to decrease muscle soreness, use a Jacuzzi or hot tub, adding 2 cups of Epsom salt, after a sufficient cool down period. The final caution in regard to exercise is to keep it simple, without taxing or exhausting the system.

SUMMARY

1. Implementation of detoxification techniques to stimulate extraction of noxious materials from the system is highly recommended. Fasting, if employed as a detox mechanism, should be performed under the supervision of a qualified professional, who will fully structure the fast and assist in ridding poisons from the system.
2. Herbs that are often complexed to assist in blood purification and detoxification include dandelion root, yellow dock root, sarsaparilla root, echinacea, licorice root, stillingia root, burdock root, buckthorn, barberry, Cascara Sagrada bark, prickly ash bark, Pau D'Arco, red clover, kelp, Oregon grape, and cayenne.
   
   The following dosages represent general guidelines only for individual herbs. Drug interactions and contraindications regarding long-term use and specific medical conditions must first be evaluated. An herbal detoxification program should be considered only under the supervision of an experienced healthcare provider.
   • Dandelion root (Taraxacum officinale): A typical dosage of dandelion root is 2-8 grams 3 times daily of dried root; 250 mg 3-4 times daily of a 5:1 extract; or 5-10 mL 3 times daily of a 1:5 tincture in 45% alcohol. The leaves may be eaten in salad or cooked.
   • Licorice (Glycyrrhiza glabra): For supportive treatment of ulcer pain along with conventional medical care, the standard dose of deglycyrrhizinated licorice (DGL) is two to four 380-mg tablets of DGL taken before meals and at bedtime. A typical dose of whole licorice is 5-15 grams daily. However, doses this high are not recommended for longer than a few weeks. For long-term consumption, about 0.3 grams of licorice root daily can safely be taken by most adults.
   • Pau D'Arco or Lapacho (Tabebuia impestiginosa, T. avellanedae)(also known as Pau d'Arco and Taheebo): Pau D'arco contains many components that don't dissolve in water, so making an herbal tea is difficult. As a capsulized powdered bark, the typical dose is 300-500 mg 3 times daily. The inner bark of the lapacho tree is believed to be the most effective part of the plant.
   • Yellow dock (Rumex crispus): Typical doses of yellow dock root are 2-4 grams of the dried root, 2-4 mL of the liquid extract, or 1-2 mL of the tincture.
   • Sarsaparilla root (Sarsaparillae radix--sarsaparilla root derived from Smilax species): Dried root, 2-4 grams 2-3 times daily as a decoction; liquid extract (1:1, 50% ethanol), 2-4 mL 2-3 times daily.
   • Stillingia root (Stillingia sylvatica): Tincture (Fresh root, 1:2, Recent Dry root, 1:5, 50% alcohol) 10-30 drops, preferably in small frequent doses.
   • Burdock root (Arctium lappa): A typical dosage of burdock is 1-2 grams of powdered dry root 3 times a day.
   • Barberry (Berberis vulgaris): Powdered bark, 1/4 tsp several times daily. Fluid extract (1:1, 1:5), 20-40 drops daily. Solid extract, 5-10 grains.
   • Oregon grape root (Mahonia aquifolium) (also known as Mountain grape): Available in homeopathic formulations.
   • Cascara Sagrada bark (Rhamnus purshiana): Cut bark, powder or dry extracts for teas, decoction, cold maceration, or elixir. One 450-mg capsule daily or 2 grams of finely cut drug strained in hot water as a tea.
     Buckthorn bark (Rhamnus frangula): Cut bark, powder or dried extracts for teas, decoction, cold maceration, or elixir. The daily dosage is 2-5 grams corresponding to 20-30 mg hydroxyanthracene derivatives, calculated as glycofrangulin A. A tea may be made of 4 grams of cut drug strained in hot water.
   • Echinacea (Echinacea augustifolia): The typical dosage of echinacea powdered extract is 300 mg 3 times a day. Alcohol tincture (1:5) is usually taken at a dosage of 3-4 mL 3 times daily, echinacea juice at a dosage of 2-3 mL 3 times daily, and whole dried root at 1-2 grams 3 times daily. Long-term use of echinacea is not recommended.
   • Kelp: There is no appropriate therapeutic dosage of kelp because it is not yet known whether kelp is truly therapeutic for any conditions. However, because of its high iodine content, it is important not to overdo your use of kelp. The iodine content in 17 different kelp supplements studied by one group of researchers varied from 45 to 57,000 mcg a tablet or capsule (Food Addit. Contam. 1988; 5: 103-109). The recommended daily intake for iodine is 150 mcg a day for people over the age 4, and taking a great deal more than this can cause thyroid problems.
   • Algin: Algin is any hydrophilic, colloidal substance found in or obtained from various kelps. Algin prevents living tissue from absorbing radioactive materials and encourages the action of dietary fiber, by supplying nutrients and normalizing bowel functions. Dosage not available.
   • Cayenne (Capsicum frutescens, Capsicum annuum): Two 500-mg capsules daily may be taken.
3. Silibinin, 500 mg along with 1800 mg of phosphatidylcholine is particularly valuable as a hepatoprotective.
4. It is extremely important to reinoculate the gut after antibiotic therapy. Select a probiotic touted to survive through antibiotic therapy and that contains Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum, and Bifidobacterium breve. L. acidophilus has a wide variance of live-culture activity, ranging from 20 million/cap to 4 billion/cap to 10 billion/gram. During the course of antibiotic therapy, L. acidophilus should be taken about 2 hours after the medication. The antibiotic will destroy the beneficial cultures if taken together; only some of the activity will be obliterated if taken separately from the antibiotic. After the course of antibiotic therapy is completed, probiotic therapy should be doubled or tripled for 2 weeks, depending upon the quantity of the cultures present in the formulary.
5. Chelation therapy may be valuable to the Gulf War veteran. In chelation, heavy metals and contaminants are pulled from the system by intravenous administration of ethylenediaminetetraacetic acid (EDTA). It is best administered by a physician following the Chelation Protocol, subscribed to by the American College of Advancement in Medicine.
6. Selecting foodstuffs with high fiber content and supplementing with additional fiber, such as psyllium, acacia, apple pectin, and oat and wheat bran, assist in ridding poisons from the body. Fiber complexes, containing a variety of soluble and insoluble materials, can be added (1 heaping tsp) to a full glass of liquid and used 1-3 times a day. The smaller dose should be used until the system adjusts to the fiber. Should gas or bloating occur, reduce the dose size until tolerance is achieved.
7. "If you cannot eat it, don't smell it." Chronic exposure to noxious materials may overwhelm the body's natural antioxidant system, and a generation of endogenous toxins may allow cellular damage to occur. For many individuals, the process of detoxification is maximally amplified just cleaning up from everyday pollutants. For the Gulf War veteran, whose detoxification mechanism has been inordinately stressed, it reflects good judgment to avoid exposure to pollutants and chemicals that further frazzle this essential process. Avoid yard and garden sprays, household cleansers, emissions from gas and diesel engines, industrial pollutants appearing in water and the atmosphere, freshly dry-cleaned garments (air before wearing), paint, varnishes, stains, creosote and wood emissions from a fireplace, dust, insulation, insecticides, and foods exposed to sprays of uncertain safety. The list is endless in our society; prudent persons work toward improving their health status by continuously monitoring their exposure to hazardous substances.
8. Antibiotic therapy has proven to be of advantage in reducing the population of mycoplasmas. Administering antibiotic therapy requires prescriptions and monitoring by a qualified medical professional. A regime representing natural medicine should also be administered. Consider vitamin C (5-15 grams daily, in divided doses), vitamin E (400-1000 IU daily), CoQ10 (100-300 mg daily), bioflavonoids (200 mg 3 times a day), choline (1000 mg daily, in divided doses), inositol (750 mg daily), vitamin B5 (500-1500 mg a day), PABA (500-1000 mg daily), vitamin B12 (a 1000 mcg sublingual daily dose), and fish oil (2-3 grams daily), along with minerals such as zinc (50 mg daily), calcium (1000 mg a day), and selenium (up to 300 mcg a day). Minerals should be taken apart from antibiotics because minerals can affect antibiotic absorption. Garlic (Allium sativum) is a potent detoxifier. Use 2 300-mg capsules 3 times a day with meals. Use L-cysteine, L-tyrosine, L-glutamine, and L-carnitine (500 mg each, daily) on an empty stomach.
9. Yellow sweet clover, Melilotus officinalis, has analgesic, anti-inflammatory, digestive, diuretic, hepatoprotective, immunostimulant, myorelaxant, proteolytic, sedative, spasmolytic, and mycoplasmotic activity (see the section entitled A Single Herb that Appears Helpful in Gulf War Syndrome Complaints for the names of suppliers and dosing instructions).
10. A hyperbaric oxygen chamber kills both anaerobic and aerobic bacteria while improving immune function and displacing noxious gases. HBO is well seeded as a primary therapy in the treatment of medical disorders such as carbon monoxide poisoning and gas gangrene. HBO therapy is increasingly being used as an adjunctive process in the management of a variety of refractory disorders such as GWS.
11. Dioxychlor may assist in the control of sensitivities observed in GWS and also in the ridding of mycoplasmas. By increasing oxygenation, Dioxychlor may help preserve mitochondrial integrity. An oral dose of 5-20 drops dissolved in 2 oz of water, 1-3 times a day, may be appropriate. Should symptoms intensify, the dosage should be reduced until the body "catches up" with the die-off. Dioxychlor can be administered intravenously with the assistance of a qualified physician.
12. Administering an aggressive complex of antioxidants increases protection against oxidative stress. Consider a combination of traditional antioxidants such as vitamin C, vitamin E, vitamin A, selenium, garlic, glutathione, green tea, grape seed extract, zinc, N-acetyl-cysteine, and lipoic acid. An approximate dosage is 3 capsules daily, depending upon the strength of the antioxidants complexed.
13. Creatine may be of benefit if impaired ATP production is suspected. Use 5 grams of creatine per day for one month. Thereafter, use 1 gram of creatine following exercise. People with impaired kidney function should discuss creatine use with their doctor.
14. Working with a physician trained in autonomic balancing appears vital to full resolution of GWS.
15. Exercise should be approached cautiously, for activity will further encourage parasympathetic nervous system expression, which may already be abrasively dominant. Perspiration will, however, promote toxin excretion. A sauna may provide the better means of encouraging expulsion of contaminants through pores. Even in this environment, caution should be taken. Replace fluids, as internal stores are lost.

For more information

Call the VA Gulf War Veterans Information Helpline at (800) PGW-VETS. The Special Assistant for Gulf War Illnesses can be reached at (800)497-6261.

Product availability

Vitamin Depot Online.com Mix, HepatoPro (contains phosphatidylcholine), dandelion, pao d’arco, sarsaparilla, cascara sagrada, echinacea, kelp, cayenne, silymarin, Silibinin Plus (silibinin is the most active extract of silymarin), Life Flora (probiotic), Fiber Food, Pure Gar w/EDTA, green tea extract, grape-seed extract, N-acetyl-cysteine (NAC), alpha-lipoic acid, creatine, vitamin C, vitamin E, liquid emulsified vitamin A, vitamin B5, CoQ10, choline bitartrate powder, inositol, PABA, methylcobalamin, Super GLA/DHA, flaxseed oil, Udo's Choice Oil, calcium citrate, zinc, selenium, glutathione, L-cysteine, L-tyrosine, L-glutamine, and L-carnitine are available by telephoning (800) 544-4440, or order online.