Gulf War Veterans and Irritable Bowel Syndrome (IBS)

In August of 2011, the Department of Veterans Affairs (VA) implemented a new assessment rule for disability benefits. This was due to the fact that there was a high rate of veterans returning from Iraq and Afghanistan experiencing irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders. The VA presumed that it was directly linked to veteran’s military service during their service in the Gulf War is responsible for the development of functional GI disorder in veterans. More detailed information: Gastrointestinal problems in modern wars: clinical features and possible mechanisms

IBS In Iraq and Afganistan Veterans Is Part Of Gulf War Syndrome

Many veterans might be familiar with the term “Gulf War syndrome.” However, the U.S. Department of Veterans Affairs now uses the term “medically unexplained chronic multi-symptom illnesses.” The VA recognizes that irritable bowel syndrome may have been a direct result of service on active duty during the Gulf War. As many as 20% veterans returning from active duty, with no prior IBS-related symptoms, may develop IBS. Numerous studies investigating Gulf War veterans have found that many fulfilled the diagnostic criteria for irritable bowel syndrome, as well as depression, anxiety, chronic fatigue syndrome, and multiple chemical sensitivity. See: Gulf War syndrome: an emerging threat or a piece of history?

Nancy Norton, president and founder of the International Foundation for Functional Gastrointestinal Disorders (IFFGD) said, “Otherwise healthy individuals are experiencing digestive issues that can be debilitating. These issues began during deployment and then continue long after they have returned home. These conditions disrupt veterans’ regular daily activities and, sometimes, their efforts to return to a normal life.”

What is irritable bowel syndrome (IBS)? It is a common condition that can affect the normal function of the large intestine. IBS is the most common functional gastrointestinal disorder with worldwide prevalence rates ranging from 9 to 23 percent. IBS is characterized by a group of symptoms which include abdominal pain, bloating, constipation, and diarrhea. IBS is common among the civilian population, and also has been diagnosed in the combat veteran population.

IBS may cause discomfort, but it does not permanently harm the intestines and does not lead to intestinal bleeding. IBS also does not cause inflammatory changes or increase your risk of cancer as ulcerative colitis and Crohn’s disease do.

Most people with IBS can control their symptoms through:

1. Diet (SCD, GAPS Low FODMAP, Elemental, Paleo…)
2. Stress management (yoga, Tai Chi, walking, grounding…)
3. Targeted nutritional supplementation (antimicrobial, probiotics, adaptogens…)
4. Medications (if unresponsive to the above 3. Such as Xifaxan, rifaximin, Tinidazole, Nitazoxanide )

The research on post-infectious IBS may explain why many veterans are returning from service with IBS. The risk of IBS is heightened in individuals who experienced higher levels of anxiety, particularly in conjunction with stressful life events. The stressors inherent in military service such as traumatic combat experiences, ongoing fear of being harmed, and being far from home may be contributing to the increased risk of developing IBS.

Scientists have not identified a singular cause for IBS and other functional GI disorders. Here is a list of most common causes of IBS that would specifically relate military personnel in an active combat environment.

• Low Stomach Acid: Hypochlorhydria or achlorhydria are cases in which the stomach doesn’t produce enough acid in response to the food eaten.
• Small Intestinal Bacterial Overgrowth (SIBO): Is an overgrowth of bacteria in the small intestine.
• Intestinal Dysbiosis: a condition in which the gut flora is disrupted.
• Yeast Overgrowth or Candida

Additional causes of IBS that may have previously existed before deployment or were exacerbated, or newly developed during deployment:

• Carbohydrate Malabsorption: sugars from the starches eaten are not broken down properly
• Fat Malabsorption: Fat/oils from the food eaten is not properly broken down
• Egg Intolerance: Due to a leaky gut, the body can mount an immune response to egg, causing inflammation, abdominal pain, and/or diarrhea
• Dairy Intolerance: Inability to properly digest and assimilate cow, goat, or sheep milk products
• Gluten Sensitivity: New research shows that a group of people still have measurable inflammatory reactions to wheat even though they are negative for Celiac disease
• Celiac Disease: Is an autoimmune condition in which the villi of the small intestine get flattened/destroyed causing reoccurring diarrhea, loose stools, and many other non-GI health problems.
• Inflammatory Bowel Diseases (IBD). The two main inflammatory bowel diseases are Crohn’s and Ulcerative Colitis.

All of the above are both causes of IBS as well as being their own unique condition. Each, by itself, may not cause IBS and may be manageable with minor dietary changes, and without medical intervention. When exacerbated, left unchecked, or combined with other co-factors, IBS or IBD may develop. All of the above causes and conditions can be created or exacerbated by the chronic stressors a soldier faces in combat or deployment to a combat zone.

Stressors that may be associated with combat or deployment to a combat zone:

• *Chronic Exposure to Physical and/or Emotional Stress
• Vaccinations (anthrax) or medications received prior to or during deployment
• Exposure to Chemical, Infectious, or Biological Agents (Pyridostigmine Bromide and Gulf War Veterans)
• Improper Nutrient Intake (MRE’s)
• *Antibiotics
• *Exposure to Pathogens – Traveler’s Diarrhea (TD)
• Depleted Uranium

*Additional Data:

Antibiotics – Extended or repeated use, for any reason, can lower the total number of bacteria and lower the number of bacteria species that live in a normal healthy digestive tract.

Stress – “Long-term or repeated exposure to high levels of stress can cause physical changes in the brain and the intestines. Military personnel also often are exposed to gastrointestinal infections from food or water and other environmental factors. These combined factors could trigger the long-term debilitating GI symptoms we are seeing in returning veterans.” – Brennan Spiegel, MD, MSHS, leads the Cedars-Sinai Center for Outcomes Research and Education and Associate Professor of Medicine in the Division of Gastroenterology, VA Greater Los Angeles Health Care System

• Emotional Stress – Being chronically or overly nervous, anxious or scared can cause acute diarrhea. if this continues and is left unhandled it can turn a correctable problem into chronic IBS or IBD
• Physical Stress – Over training or aggressively moving through a combat can create an environment in which the tissues of your intestines overheat. This can lead to inflammation and irritation of the gut.

Exposure to pathogens (Traveler’s Diarrhea) – Current recent research has shown that just one experience with Traveler’s Diarrhea can significantly change your gut flora leading to the development of SIBO and/or gut dysbiosis. This can potentially be exacerbated by antibiotics given to treat the TD.

• Bacteria – Bacteria are the most common cause of TD – 80-90%. Overall, the most common pathogen is enterotoxigenic Escherichia coli, followed by Campylobacter jejuni,Shigella spp., and Salmonella spp.
• Virus – Viral diarrhea can be caused by a number of pathogens, including norovirus, rotavirus, and astrovirus. Intestinal viruses usually account for 5%–8% of TD
• Protozoa – Giardia is the main protozoal pathogen found in TD