Abstract
Gulf War Illness (GWI) is a multisymptom disorder including widespread chronic pain, fatigue and gastrointestinal problems. The objective of this study was to examine the low glutamate diet as a treatment for GWI. Forty veterans with GWI were recruited from across the US. Outcomes included symptom score, myalgic score, tender point count, dolorimetry and the Chalder Fatigue Scale. Subjects were randomized to the low glutamate diet or a wait-listed control group, with symptom score being compared after one month. Subjects then went onto a double-blind, placebo-controlled crossover challenge with monosodium glutamate (MSG)/placebo to test for return of symptoms. Symptom score was compared between diet intervention and wait-listed controls with an independent t-test and effect size was calculated with Cohen’s d. Change scores were analyzed with Wilcoxon Signed Rank tests. Crossover challenge results were analyzed with General Linear Models and cluster analysis. The diet intervention group reported significantly less symptoms (p = 0.0009) than wait-listed controls, with a very large effect size, d = 1.16. Significant improvements in average dolorimetry (p = 0.0006), symptom score, tender point number, myalgic score and the Chalder Fatigue Scale (all p < 0.0001) were observed after the 1-month diet. Challenge with MSG/placebo resulted in significant variability in individual response. These results suggest that the low glutamate diet can effectively reduce overall symptoms, pain and fatigue in GWI, but differential results upon challenge suggest that other aspects of the diet, or underlying differences within the population, may be driving these changes. Future research is needed to identify potential nutrient effects, biomarkers, and underlying metabolic differences between responders and non-responders.
Highlights
Gulf War Illness (GWI) is a multisymptom disorder common to veterans of the first Gulf War (GW).It includes symptoms such as widespread chronic pain, fatigue, cognitive dysfunction, sleep issues and gastrointestinal problems [1,2]
While the etiology of GWI is unknown, it is thought to be connected to central nervous system (CNS) dysfunction that began during the Gulf War due to various neurotoxic exposures such as chemical warfare agents, pyridostigmine bromide (PB) pills, pesticides, burning oil fields and depleted uranium [5,6]
This study assessed the effectiveness of the low glutamate diet as a treatment option for GWI and demonstrated a very large treatment effect, with symptoms significantly remitting after one month on the diet
Summary
Gulf War Illness (GWI) is a multisymptom disorder common to veterans of the first Gulf War (GW). It includes symptoms such as widespread chronic pain, fatigue, cognitive dysfunction, sleep issues and gastrointestinal problems [1,2]. No treatment has been found to result in an improvement in all of the symptoms of GWI [4]. While the etiology of GWI is unknown, it is thought to be connected to central nervous system (CNS) dysfunction that began during the Gulf War due to various neurotoxic exposures such as chemical warfare agents, pyridostigmine bromide (PB) pills, pesticides, burning oil fields and depleted uranium [5,6]. PB pills and pesticides are all acetylcholinesterase (AChE) inhibitors
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