The cruel mystery of ALS and military veterans

November 12, 2015 11:42 AM

"Studies show that if you've served in the military -- any branch, any war, or even if you served in a time of peace -- you have a much higher risk of dying from amyotrophic lateral sclerosis, or ALS (Lou Gehrig's disease) than if you were not in the military. And no one seems to know why."

ALS Risk Appears Increased in Veterans: New Government Report Agrees

Why is Lou Gehrig’s Disease Closely Related to Veterans?

From 2003-2007, the VA's registry identified more than 2,100 cases of ALS among veterans.

posted by roomthreeseventeen (39 comments total)

Smoking, being male, white and older than 60 are the most closely associated risk factors for the general population. Beyond that, studies are contradictory or unclear, especially when it comes to the military connection. Basically what we know is that veterans have a 60% higher risk of getting ALS than the general population.

I would bet that veterans are also more likely to be male, white, over 60, and smokers, but hopefully they controlled for that.
posted by leotrotsky at 11:53 AM on November 12, 2015 [7 favorites]

What would be very interesting is if they could break the cases down by the MOS of the vet. If there's some environmental component that might help narrow it down.
posted by leotrotsky at 11:56 AM on November 12, 2015 [8 favorites]

Interesting. From the ALS Association:

One of the first clues that ALS might involve an environmental factor was obtained on the island of Guam in the Pacific, where an unusually high proportion of people over the past century have developed symptoms similar to ALS as they age.

Guam's got a both ton of military and a ton of vets. I wonder how the causation flows.
posted by leotrotsky at 11:59 AM on November 12, 2015

I'll stop MCing the thread now. My mother-in-law and her brother both died from ALS in the past few years, so it's a personal concern of mine.
posted by leotrotsky at 12:01 PM on November 12, 2015 [7 favorites]

Disclosure, my grandfather died of service-related ALS. He trained at an Army base in Texas in the early 1940s as a military physician, and never saw combat. He developed Lou Gehrig's in 1985, and died in 1988.
posted by roomthreeseventeen at 12:02 PM on November 12, 2015

Perhaps head trauma during training rituals?
posted by srboisvert at 12:07 PM on November 12, 2015 [1 favorite]

Perhaps head trauma during training rituals?

It is a possibility...
posted by vacapinta at 12:12 PM on November 12, 2015 [1 favorite]

Sometimes correlations like this mean something and sometimes they don't.

With thousands of potential group affiliations and hundreds of diseases, simple probability says that once in a while one group affiliation will have a disproportionate number of cases of one particular disease, for no other reason than simple luck.

The CDC runs into this kind of thing all the time, geographically. Suddenly there will be a large number of cases of some condition which isn't communicable in one location. Maybe it's the result of something there (e.g. chemical pollution) and they always check. But sometimes no cause is ever determined, and it seems they are simply due to probability.
posted by Chocolate Pickle at 12:15 PM on November 12, 2015 [4 favorites]

On the face of it this seems like a sound argument - random stuff sometimes happens - and yet I feel there's a logical flaw in there somewhere.
posted by Dr Dracator at 12:19 PM on November 12, 2015 [1 favorite]

FWIW, the federal government already recognizes ALS as having a presumptive service connection and regularly sends settlement checks to the windows and widowers of service members who died from this disease.
posted by roomthreeseventeen at 12:20 PM on November 12, 2015 [2 favorites]

Aren't military folks sometimes given experimental vaccines?
posted by fiercecupcake at 12:26 PM on November 12, 2015 [4 favorites]

Guam was a major US military base in the Second World War, the Korean War and the Vietnam War, and today over one third of the island’s land area is under the control of the US military. The US armed forces have transported and stored vast quantities of war materials to Guam to support their activities. Over the years, these materials included nuclear weapons; chemical weapons such as phosgene and mustard gas; cleaning compounds now proven to be hazardous to human health and the environment; and insecticides and pesticides that are now banned as being carcinogenic or dangerous to human health and the environment...

Guam, today, is a major site for environmental clean-up under the US Super Fund program. The required clean-up is ongoing but the pace at which it is being undertaken is not satisfactory for the indigenous Chamorro people; especially as the promised return of former military lands cannot occur until the land is deemed to be environmentally safe.

The major source for potable water for Guam is the northern aquifer. This aquifer enjoys federal protection by being designated as a sole-source aquifer for Guam. However, several of the production wells have had to be shut down because of chemical contamination. It should be noted that the bulk of the US government’s land holdings are over or adjacent to this aquifer.

Superfund sites:

• Ordot Landfill
• Andersen Air Force Base
posted by a lungful of dragon at 12:26 PM on November 12, 2015 [2 favorites]

But sometimes no cause is ever determined, and it seems they are simply due to probability.

The probability of a population of 21.8 million people having an elevated risk for a particular medical condition with no underlying factor is pretty small. This isn't 12 unrelated people in Vermont who have six fingers on their left hand that we're talking about.
posted by Etrigan at 12:30 PM on November 12, 2015 [11 favorites]

Oh, Army, the gift that keeps on giving. Thanks for posting.
posted by corb at 12:37 PM on November 12, 2015 [3 favorites]

A friend from high school, back in the 70s, had two step brothers (one by his mother, one by his father) die from ALS within 5 years of each other. The first one to die had been in the Navy in the Pacific. I thought it was freaky then and it seems more freaky now.
posted by Bee'sWing at 12:40 PM on November 12, 2015

Does every branch of the military tear gas their trainees the way that the army does? It's not a huge affair but being exposed to a potent irritant in the form of CS gas is part of basic training.
posted by aydeejones at 12:43 PM on November 12, 2015

The correlation/causation is not at all related to branch, however.
posted by roomthreeseventeen at 12:43 PM on November 12, 2015 [1 favorite]

The claim that they don't know what's going on is highly dubious:

Cyanobacteria and BMAA exposure from desert dust: a possible link to sporadic ALS among Gulf War veterans.


Veterans of the 1990-1991 Gulf War have been reported to have an increased incidence of amyotrophic lateral sclerosis (ALS) compared to personnel who were not deployed. An excess of ALS cases was diagnosed in Gulf War veterans younger than 45 years of age. Increased ALS among Gulf War veterans appears to be an outbreak time-limited to the decade following the Gulf War. Seeking to identify biologically plausible environmental exposures, we have focused on inhalation of cyanobacteria and cyanotoxins carried by dust in the Gulf region, particularly Qatar. Cyanobacterial crusts and mats are widespread in the deserts of Qatar, occupying up to 56% of the available area in some microhabitats. These cyanobacterial crusts, which help bind the desert sands, are dormant throughout most of the year, but during brief spring rains actively photosynthesize. When disturbed by vehicular traffic or other military activities, the dried crusts and mats can produce significant dust. Using HPLC/FD, an amino acid analyzer, UPLC/MS, and triple quadrupole LC/MS/MS we find that the dried crusts and mats contain neurotoxic cyanobacterial toxins, including beta-N-methylamino-L-alanine (BMAA) and 2,4 diaminobutyric acid (DAB). If dust containing cyanobacteria is inhaled, significant exposure to BMAA and other cyanotoxins may occur. We suggest that inhalation of BMAA, DAB, and other aerosolized cyanotoxins may constitute a significant risk factor for the development of ALS and other neurodegenerative diseases.

posted by jamjam at 12:46 PM on November 12, 2015 [11 favorites]

r317: ...the federal government already recognizes ALS as having a presumptive service connection…

For real?! I had never heard that before. Jesus...
posted by wenestvedt at 12:47 PM on November 12, 2015

From the ALS website re: guam:
"dietary factors such as the indigenous preference for eating entire bats cooked in coconut milk"

And so I look that up:

"Recent evidence indicates that a substituted amino acid, BMAA, produced by cyanobacteria and bioconcentrated through fruit bats, may be responsible for the ALS-parkinsonism-dementia complex of Guam."

This is, of course, how the army attempts to make flying super-soldiers.
posted by smidgen at 12:47 PM on November 12, 2015 [5 favorites]

wenestvedt, yeah, my family receives settlement money, and my grandfather served in the early 1940s, in Texas.
posted by roomthreeseventeen at 12:49 PM on November 12, 2015

And that lead me to a bunch of studies of the relationship of cyanobacteria/BMAA in algae blooms in lakes.

And of course, this year: we have a huge bloom off the west coast Fuck you, pond scum, fuck you...
posted by smidgen at 1:02 PM on November 12, 2015 [1 favorite]

I was active reserves during the gulf war, I never left the states fortunately. I was stationed on a tug boat in southern California. I've always felt like I dodged a bullet for not having to go over seas, now it looks like I might have been luckier than I knew. Happy Veteran's Day, indeed.
posted by doctor_negative at 1:05 PM on November 12, 2015 [1 favorite]

My mother is developing a progressive neurodegenerative disease that's looking a lot like (and may turn out to be) ALS. She dates the beginning of feeling weak to a herbal antibiotic she took - and given what we've learned about all the random stuff they put in herbal "remedies", I wouldn't be surprised if it's related somehow. Maybe some weeds harvested from Qatar or some water from Guam...
posted by clawsoon at 1:11 PM on November 12, 2015 [1 favorite]

leotrotsky, from the first link in the first article:

However, ALS is a disease that occurs predominately between the ages of 40 and 70 years-old, with an average age of 55 at the time of diagnosis. By contrast, the vast majority of Gulf War veterans, including those diagnosed with ALS, were young, outside of the ages at which ALS is more common. Because of these concerns, two further studies were conducted, both of which concluded that those deployed to the Southwest Asian theater of operations during the Gulf War are at an increased risk of ALS — that Gulf War veterans are approximately twice as likely to develop ALS as those not deployed to the Gulf.
posted by damayanti at 1:35 PM on November 12, 2015

"The probability of a population of 21.8 million people having an elevated risk for a particular medical condition with no underlying factor is pretty small. This isn't 12 unrelated people in Vermont who have six fingers on their left hand that we're talking about."

The IOM has issued a report saying that the evidence suggests an association between military service and later development of ALS, and I'm sure they've made a strong statistical case for that, but we're talking about a disease that we know has a heritable component, is extraordinarily rare even in adversely affected populations, only appears well after exposure to the known vague co-factors, and appears to exist at a background level across all populations. The arguments for any kind of correlation will need to be statistically sophisticated in order to be even the least bit convincing.

For example, breaking the cases down by the MOS of veterans as was suggested upthread would likely create an unmanageably high multiple testing bias, which especially at this scale is the kind of thing that can only really be corrected for properly by someone who actually knows what they're doing.
posted by Blasdelb at 1:48 PM on November 12, 2015 [1 favorite]

Didn't read the whole thing. Assuming the sampled population were military vets from the US Military and not other countries?
posted by Chuffy at 2:33 PM on November 12, 2015

We suggest that inhalation of BMAA, DAB, and other aerosolized cyanotoxins may constitute a significant risk factor for the development of ALS and other neurodegenerative diseases.

Why am I drawn to thinking about Burning Man all of a sudden...?
posted by Chuffy at 2:38 PM on November 12, 2015 [1 favorite]

Ugh, as if I wasn't terrified enough of ALS (I watched my mom die from it), now I have to worry about the algae in my pond. Who do I call to get the algae and air tested for cyanotoxins?
posted by amro at 2:46 PM on November 12, 2015

Does every branch of the military tear gas their trainees the way that the army does?

My dad was in the Navy and he was gassed, yeah.
posted by chainsofreedom at 3:01 PM on November 12, 2015

Jamjam mentioned the blue-green algae connection in a comment previously. Terrible disease, crummy for veterans to have yet another challenge.
posted by theora55 at 5:02 PM on November 12, 2015

The claim that they don't know what's going on is highly dubious

It's been a couple of years since I worked in this area, but there have been numerous hypotheses proposed regarding the cause of Gulf War syndrome, and to my knowledge none of them are definitive. It's a nebulous constellation of symptoms, manifesting inconsistently and years after the fact. The Department of Defense sponsors research about it by groups unaffiliated with the military and the results get published without any particular guidance. I don't think there's a conspiracy at work apart from DoD's initial reluctance to acknowledge the problem. Neurological diseases in general are something we just don't understand very well, and army researchers (at least the ones I've worked with) don't seem to know more than anyone else.
posted by dephlogisticated at 5:02 PM on November 12, 2015 [3 favorites]

Huh. My uncle died of ALS a few years ago. He was in the Army during Vietnam. AFAIK, he was stationed in Monterey (Fort Ord) the whole time. There's been much debate in my family about ALS being in our genes. Perhaps that isn't the case.
posted by oozy rat in a sanitary zoo at 7:25 PM on November 12, 2015 [1 favorite]

I wonder if it has to do with primers or the nitrate based explosives (including smokeless powder in cartridges). Those compounds are long lasting and get on everything.
posted by wuwei at 8:42 PM on November 12, 2015 [1 favorite]

I don't know if it's changed in the ensuing years (I suspect not) but the diagnosis of ALS is the ELSE at the end of a very long chain if if (symptom) then tests. And each test along the way rules out something else that's awful: stroke, MS, OPCA; each disease ruled out removes something you really wouldn't want to have, and leaves only worse options.

ALS is so rare, there's very little money to treat it. A drug company has to spend a fortune to create a new drug, and there's very little to be made on ALS, because the population of sufferers is relatively small: rare disease plus short life expectancy means not much of a market.

I will be very happy when there's a meaningful treatment for this disease.
posted by zippy at 9:21 PM on November 12, 2015 [2 favorites]

With thousands of potential group affiliations and hundreds of diseases, simple probability says that once in a while one group affiliation will have a disproportionate number of cases of one particular disease, for no other reason than simple luck.

And with small groups this might be the case, but veterans (which is a cohort of millions) and a 1.6-fold increase? That's getting close to all the air Brownian motioning over the the other side of the room and suffocating you level of "luck".

I'd like the see the MoS correlation study that leotrotsky suggests.
posted by Kid Charlemagne at 12:03 AM on November 13, 2015 [1 favorite]

Back in the '70s and early '80s, I went to school with a kid whose father had been stationed on Guam. The whole family went, and he would occasionally talk about life on Guam. Now I'm wondering whether he might be at higher risk by virtue of being in the same place as his military father. And is anyone looking into the risk for military families who relocated to various bases?
posted by bryon at 12:58 AM on November 13, 2015 [1 favorite]

Huh. My Grandfather served in the Candian Navy during WWII, and died of ALS.
posted by Canageek at 10:25 AM on November 13, 2015

The range of risk factors which have been associated with ALS is huge:

Workers in various occupations with seemingly disparate exposures have been reported to be potentially at altered risk of ALS, including athletes, carpenters, cockpit workers, construction workers, electrical workers, farm workers, hairdressers, house painters, laboratory technicians, leather workers, machine assemblers, medical service workers, military workers, nurses, power production plant workers, precision metal workers, programmers, rubber workers, shepherds, tobacco workers, veterinarians, and welders.

Pretty much everything that can hurt you, and a few things that normally help you (e.g. exercise) have been associated with ALS.
posted by clawsoon at 7:05 AM on November 16, 2015