Higher rate of ALS among members of the military.

Amyotrophic lateral sclerosis (ALS) is a dreaded disease for which there is no treatment, certainly no cure and no definitive cause. One of the harshest realities too is that most Americans know next to nothing about this horrible disease; even 2014’s viral Ice Bucket

Challenge only went so far in raising and maintaining awareness among the general population.
 
One of the biggest risk factors for acquiring this cruel neurodegenerative pathology is having served in the military. The VA recognized this connection in 2008. According to the ALS Association a veteran is 60% more likely to get ALS than someone that did not serve our country.
 
While those who served in the Persian Gulf War in 1991 have double the risk, according to a report from the Institute of Medicine, those who served in Vietnam, Korea, or World War II also have a higher risk of ALS. However, Agent Orange has not been linked to this increased risk.
 
In a 2005 study published in the American Academy of Neurology Journals (https://n.neurology.org/content/64/1/6), it was speculated that environmental exposures specific to Gulf War service may have triggered the disease in susceptible individuals. These agents included organophosphorus pesticides and chemical nerve agents or multiple mercury-containing vaccinations.
 
Other studies have shown electromagnetic fields, high-intensity radar waves, diesel exhaustion, and electric shock treatments have been identified as risk factors for ALS along with traumatic brain injuries (TBI). (McKee AC, Robinson ME: Military-related traumatic brain injury and neurodegeneration. Alzheimers Dement  2014; 10(3): S242–53.) 
 
In a recent study published in Military Medicine October 2019  Amyotrophic Lateral Sclerosis Among Veterans Deployed in Support of Post-9/11 U.S. Conflicts, we see this unfair correlation again in not just our Gulf War Veterans but those that served in Iraq and Afghanistan as well. The study funded by the Veterans Administration identified 1,149,620 veterans who received care through the Veteran’s Health Administration (VHA) between October 1, 2001 and September 30, 2015.
 
Interestingly, both the prevalence and cumulative incidence of definite ALS were significantly higher among Air Force personnel, tactical operation officers, and health care workers compared with general officers and administrators.  Consistent with other studies, members of the U.S. Marine Corp were not as likely to develop ALS.
 
In this study neither TBI nor individuals younger than 45 years, were associated with an increased risk or diagnosis of ALS. On the other hand, also consistent with previous literature, the researchers found an elevated risk for all males and specifically among Caucasians.
 
Depression, cardiac disease, cerebrovascular disease, high blood pressure, and obstructive sleep apnea were found to be significantly associated with ALS in this population of veterans.
 
The article also discusses the possibly of vaccinations as a causal factor in ALS diagnoses. "Our findings of no association between smallpox vaccination and ALS, but a borderline significant trend for total number of preventive vaccinations, suggests ALS may be associated with vaccinations only at high levels of exposure or only for other vaccines."  
 
Additional theories have proposed that cynaobacteria contained in the surface layer of desert soils may play a role in the link to ALS occurrence in our military. If dust containing cyanobacteria is inhaled, significant exposure to BMAA (a powerful neurotoxin) and other cyanotoxins may occur. Cyanobacteria also grows in blue green algae blooms so there can be increased exposure around certain bodies of water including freshwater lakes, streams, ponds and brackish water ecosystems.
https://www.scientificamerican.com/article/are-algae-blooms-linked-to-lou-gehrig-s-disease/
https://www.ncbi.nlm.nih.gov/pubmed/19929742
 
A recent study of “self-cannibalizing mitochondria” are "thought to have set the stage for ALS development"   Frontiers in Cellular Neuroscience.  While the study investigators weren’t able to determine what causes or why motor neurons start to self-cannibalize, they noted, “To overcome neurodegeneration, we need to improve the health and the stability of mitochondria. If we improve the health of the mitochondria early, we may even eliminate protein aggregate formation, a pathology broadly observed in many diseases."
 
So it appears that once again, we are faced with the “Perfect Storm” unleashing an onslaught of environmental influence of epigenetic changes, front line attack on biological systems and a subsequent dysregulated immune system. It is clear that more work needs to be done to identify all the individual triggers that send our immune systems into battle and subsequently place our brave military members under even greater siege.   
 
Onward and in gratitude to all those who have served,    
Dr. Suzy Gazda