General Aspects of Aspartame

Reactions

Observation is more than seeing; it is knowing what you see and comprehending its sign~ficance. The

process is far more mental than photographic. True observation implies studying the object and drawing conclusionsfrom what is seen.

—CHARLES Gow

S

OME GENERAL OBSERVATIONS ABOUT the 551 aspartame reactors in this series are summarized here. They encompass their age tange, the preponderance of females, the latent period (time lapse) before complaints began, the severity of reactions, inadvertent rechallenge, withdrawal symptoms, and comparable reactions among close relatives.

lIJE AGE RANGE

The average age of aspartame reactors when symptoms began was 43 years; most were in their 20s to SOs. The age tange extended from infancy to 92 (two persons).

A 2-year-old girl developed a “violent rash” after drinking an aspartame soda. The eruption, and ensuing facial swelling, recurred every time she drank an aspartame—containing beverage or chewed “diet” gum.

67

ASPAR TAME (NUTRASwFETY): Js IT SAFE?

A 92-year-old woman remained active notwithstanding a recently broken leg that confined her to a wheelchair. She developed severe vomiting and diarrhea after consuming aspartame products. These complaints did not recur when she avoided aspartame and resumed sugar. Aware of her age, she added, “1 am in my right mmd.”

FEMALE PREPONDFRANCE

Women consistently outnumbered men by a 3:1 ratio—specifically, 74 percent females and 26 percent males. This preponderance remained consistent both among my patients and correspondents who submitted the survey questionnaire.

A comparable predisposition of females was found by the FDA based on complaints it received from 3,326 complainants (Tollefson 1987). Women comprised 77 percent; three-fourths were between

20 and 59 years.

Factors lhat May Influence Female Preponderance

A number of factors may explain the vulnerability of women to aspartame products. The following facts are germane.

• Iron deficiency in menstruating women (Lehman 1986), which appears to impair the conversion of phenylalanine to tyrosine (Chapter 5).

• The increased proneness of women to severe depression (Holden 1986), diabetes mellitus (National Conference on Women’s Health 1986), allergies (McLain 1986), and autoimmune disorders—all of which may be affected adversely.

• The significantly greater insulin responses of non-obese healthy females to phenylalanine, whether given orally or intravenously (Shah 1986).

• lhe higher frequency of severe reactive hypoglycemia (“functional hyperinsulinism”; “low blood sugar attacks”) in women—even among the older age groups (Morton 1950, 1953; Zeytinoglu 1969).

• The considerably greater release of the hormone prolactin in normal women (compared to normal men) by phenylalanine in doses as low as one gram (1,000 mg), presumably due to an enhanced effect of estrogen on prolactin secretion.

• Depression of glucose oxidation in brain tissue by diethylstilbestrol, a female hormone (Gordon 1947).

• The greater mobilization of fat from fat cells (adipocytes) in the abdominal region and other depots among women after drastic caloric restriction (Leibel 1987).

• The aggravation of aspartame reactions by fluid retention and other features characteristic of the premenstrual syndrome

(PMS).

• The chronic state of hyperinsulinism during pregnancy and in women taking “the pu¹” (Spellacy 1966, Javier 1968, Yen 1968).

• The unique responsiveness of the immune system to selfgenerated chemicals (antigens) in women, perhaps explaining their greater vulnerability to such autoimmune diseases as rheumatoid arthritis (3:1 ratio) and lupus erythematosus (10:1 ratio) (Science 238:159, 1987).

“Fear offat,” a widespread cultural phenomenon that afflicts contemporary American women, also warrants mention. Forty-two percent of aspartame reactors who completed the survey questionnaire indicated that “an overweight problem” was their prime reason for using these products. Teenagers—and even younger girls—often couple their reduced intake of calones with excessive consumption of aspartame-containing foods or beverages due to pressure from peers and the influence of high priests of fashion.

lhe goals of this thinness cult not only may be unattainable, but also are fraught with danger. 1 have described elsewhere the senious medical complications of such arbitrarily severe caloric restriction (Roberts 1985). Someone suggested that an observation by Coco Chanel, the famous fashion designer, ought to be placed on large posters in schools, churches and medical offices: “Fashion is generated by men who actually hate women.”

lhere is an ironic aspect to the considerable use of aspartame prod— ucts by weight-conscious women: paradoxic weight gain. This subject will be díscussed in Chapter 17.

ASPARTAME (NuTRÁSwEET’j: Is IT SAFE?

ASPARIAME CONSUMPIION

The 397 persons who completed the survey questionnaire provided detailed information concerning their consumption of aspantame products. lhe data are summanized in lable 8-1. It also includes the approximate aspartame content of each product, based on information supplied by the FDA.

LAIENT PERIOD

lhe interval between use of aspartame products and the beginning of complaints vanied not only among individuals, but also in the same person at different times. lhe initial peníod usually was several weeks on months. In contrast, many who improved after avoiding such pnoducts suffered a severe recurrence within hours or days after resun-ung aspartame. lhis sequence is reminiscent of allergic reactions to drugs once patients become sensitized to them.

A 61-year-old computen operaton expenienced visual difficulty, headache, memory loss, dizziness, facial pains and irnitability after taking aspartame.

“It seemed to take several weeks to build up the reaction the first time, but when 1 tested it a month or so after 1 stopped its use, I got the same feelings after just a day or two of use. And one time someone gaye me a glass of a soft dnink that 1 didn’t know contained aspartame. I had the same symptoms within one hour or less after the dnink.”

However, some individuals expenienced an unequivocal severe reaction within minutes to several days following thein apparent flrst exposure to an aspartame product. lhe most notable complaints in such persons were dizziness, swelling of the lips, itching, hives and other rashes. lhey offered vaniations of the same expression: “1 knew almost immediately that aspartame was the cause.”

A 60-year-old woman drank two cans of an aspartame soft dnink fon two days. She then developed severe lightheadedness, slurred speech, decreased vision in both eyes, and ninging in one ear.

“1 knew night away on my own it was aspartame. 1 was in 100% perfect health before 1 took aspartame. 1 got sick. Stopped it. Feel great now.”

Table 8-1. .Estimated Consumption of Aspartame-Gontaining Products by

397 Respondents When Adverse Symptoms Began

Size and Mean Percentage of
Estimated Aspar- of Users Total
Product tame Content Users (Daily) Consumers*

Cola soft drinks 12 ounce can 192 2 61%

(16 mglounce, 6 ounce bottle 12 2

550 mg/liter) 1 liter bottle 24 1 liter bottle 14 1

Other soft

drinks 12 ounce can 50 2 18%
(16 mg/ounce, 6 ounce bottle 6 2
550 mg/liter) 1 liter bottle 12 1
2 liter bottle 5 1

Tabletop

sweetener Packet 171 3 43%
(35 mg)

Presweetened

ice tea Glass 61 2 15%
(100+ mg)

Presweetened

drink nuxes Glass 102 3 26%
(100+ mg)

Presweetened

hot chocolate Glass 52 1 13%
(100+ mg)

Presweetened

cereal Cup 26 1 7%
(60—100 mg)

*Multiple aspartame-containing products used by many individuals.

Table 8-1. Estimated Consumption of Aspartame-Containing Products by 397 Respondents When Adverse Symptotns Began—continued

Presweetened

pudding or

gelatin Serving 61 1 15%
(100+ mg)

Chewing gum Stick 47 4 12%

(10+ mg)

A 62-year-old woman tnied one serving of an aspartame soft dnink that had been “sent free through the mail.” She promptly expenienced severe dizziness, tremors, insomnia, and chills “to the point that 1 wrapped in an electric blanket turned to maximum.” These symptoms stopped within one day—only to recur within hours after retesting herself onfour occasions with either this product or a diet cola. She recalled:

“1 could not function fully due to lack of sleep, and the chills

made it impossible fon me to wnite or dness norma1ly... As a

graduate home economist, 1 recognized that 1 was expeniencing

a reaction to something—so started checking out the possible

sources.”

SEVERITY OF REACTIONS

Statements by the 397 aspartame reactors who completed the questionnaire attest to the sevenity of adverse effects. One-halfrefused to subject themselves even to a single rechallengeforftar of irreparable damage to their health.

Data from the FDA’s Adverse Reaction Momtoning System (ARMS) underscore the potential sevenity of such reactions. Eight percent of 3,326 complainants were classified as Type 1 (Tollefson 1987). It was defined as including, but not limited to, “severe respiratory distress or chest pain; cardiac arrhythmias; anaphylactic or

hypotensive episodes; severe gastrointestinal distress such as protracted vontiting or diarrhea leading to dehydration; severe neuro— logical distress such as extreme dizziness, fainting, or seizures; or any reaction requining emergency medical tneatment.”

Some patients specifically attnibuted severe reactions to the use of a more concentrated form of an aspartame product. Several made pointed reference to the onset or dramatic exacenbation of such complaints after consuming “100 percent” aspartame.

A 31 -year-old secretary drank up to four cans of a diet cola daily. She wrote, “When aspartame was switched fnom the blend to full strength, 1 passed out after dinner three days laten.”

Ordeal By Rechallenge

A surpnising number of aspantame reactors netested themselves at least ten times before being convinced. Several kept challenging themselves on more than a score of occasions “just to be certain.”

Concontitant Hypothyroidism

1 have been impressed by the sevenity of aspartame reactions in patients with underactive thyroid function (hypothyroidism). It is known that the effects of drugs and chemicals tend to be exaggenated and more prolonged among hypothynoid individuals. This condition was known to exist in 22 cases, but had gone unrecognized in other patients prior to consulting me.

A 20—year-old college student suffened sevene intellectual detenoration, sleepiness, intense headaches and aggravated reactive hypoglycemia after using aspartame products. Several of her maternal relatives were known to have a goiter. Previously—undiagnosed hypothyroidism was documented by the finding of markedly elevated thyroid stimulating hormone (TSH) levels. Hen response to aspartame abstinence and thynoid (thyroxine) replacement was gnatifying.

INADVERTFNT RECHALLENGE

Many reactors suffered repeat attacks aften inadventently consuming products they did not reaiize contained aspartame. A few exampies are cited.

A 59-.year-oid professional expenienced recurrent convulsions on three separate occasions when he unknowingiy drank aspartamesweetened beverages.

A 3O-yean-old computen programmer would promptiy develop severe iightheadedness, dizziness and abdominal pain after unknowingly dninking any beverage containing aspantame.

A 51 -year—old negistered nurse pneviously had suffered severe itching and a rash after dninking aspartame-containing beverages. She stated:

“1 thought about a retest even though 1 was convinced, but decided against subjecting myself to this discomfont... 1 went to a pooi panty a year laten. It was hot and 1 sat in a lounge chain at the pool from 3—5 pm with three glasses of diet soda—never gaye it a thought. By 10:30 pm, the naised itchy red nash was again present on my chest. 1 stopped the soda, and used Benadryl and hydrocortisone cneam. It left.”

A 72-year-old female with known aspartame reactions continued to suffer unexplained headaches, visual problems, and “burning and swelling” of the lips and tongue fon months. Aithough she initially denied the further use of aspartame, it was present in the gingen-ale she had been dninking.

A 28-year-old woman “immediately” developed sevene abdominal pain after dninking a diet cola. It gradually subsided. . . but then recurred when she tnied another brand. Her next attack occurred as she drank a bevenage not suspected of containing aspartame.

“A year after I’d stopped using it, we ordered out lunch at work. 1 had asked someone to get me a diet cola which did not have aspartame at that time. They told me that’s what they got me.

(It was in a fountain cup, so 1 couldn’t tell.) It never even crossed rny mmd that it could contain aspantame until the all-too-familian cramps returned. So 1 called the food place and then found out 1 had an aspartame cola. You can’t ask fon a better test than that.”

It is impontant to consider less obvious sources of aspartame wheneven the question of rechallenge anises. Fon example, “health pnoducts” such as vitamins and laxatives may contain aspantame. One notable offender in this category is a popular “sugar—free, effer— vescent, natural—fiben laxative” sweetened with aspantame. Panadoxi— cally, sorne patients using it fon gastrointestinal pnoblems—whethen constipation or diarnhea—then developed more intense abdominal pain, nausea and even bloody stools. These complaints pnomptly subsided aften shifting to the aspartame-fnee fonm.

Once aware of the aspartame-is-everywhere phenomenon, many aspantame neactons become leery of dining out fon fean of suffening necunnence of this “restaurant syndnome”.

A 57-yean-old woman expenienced extreme nausea, y omiting, dizziness, violent headaches, mental confusion and abdominal pain within four hours after ingesting any product containing aspantame. She studiously attempted to avoid such products when eating away from home. Even so, she suffered several attacks aften having been wnongly reassuned that thene was no aspantame in the food or bevenage senved hen. As a result, she resorted to carrying plastic bags in her punse and can wheneven she travels.

Attitudes Concerning Rechallenge

As noted, most patients with sevene neactions to aspartame prod— ucts asserted that they would “never” knowingly re-expose themselves to this chemical. A few thought they might do so unden specific conditions, such as a research pnoject unden close ob— servation.

A 60-year-old female vowed that she would “neven knowingly take it again!”. . . “1 would only consume aspantame unden a stnictly-supenvised medical environment, and even then 1 would have to think long and hard before giving permission fon same.

REACTIONS TO SMALL AMOUNTS

Many patients and correspondents emphasízed that dninking, eating or chewing even small amounts of products containing aspartame would pnomptly and pnedictably induce a severe reaction. Sorne children expenienced headaches, convulsions, or both, within minutes after chewing gum or an over-the-counten analgesic containing aspartame.

A 61 -yean-old businessman suffered severe visual symptoms, confusion and amnesia while playing golf. He had taken one cup of coffee sweetened with an aspartame tabletop sweetenen at a fast food restaurant enroute to the counse. (It did not stock the sacchanin—containing sweetener he had requested.) He recalled muden reactions on two occasions after being served similanly sweetened coffee at a neighbor’s home.

A 1 9-year-old woman had convulsions that wene finally attnibuted to aspartame. She remained seizure—free fon 11 months by avoiding such pnoducts. She then was handed a piece of “sugarfnee” gurn at a bali game. Multiple grand mal convulsions recurred within minutes after chewing it.

A 45-year—old salesman noted extreme drowsiness after chewing gum containing aspartame. He wrote:

“Just recently, 1 discovered as I’m dniving my automobile that chewing aspartame gum caused drowsiness after only chewing one-half a stick. It caused me to yawn, and to feel sleepy and weak. Sornetimes 1 have to stop dniving and close my eyes fon a few minutes.”

There are several intniguing explanations fon the rapidity of reactions to smail amounts of aspartame. First, the reactions may nepne— sent an “allergy” to aspantame, its components, or breakdown products (Chapter 5). In his classic analysis of “addictive eating and dninking,” Dr. Theron Randolph (1956) emphasized that”... small quantities of a specific excitant may effectively penpetuate an addiction response in view of the extreme degrees of specific sensitivity commonly involved.”

Another possibility may entail prompt absorption of aspantarne

from the mouth. It then enters the general circulation (comparable to placing a nitnoglycenin tablet under the tongue fon the immediate reiief of angina pectonis), on even niight go directly to the brain. It is known that small molecules can diffuse from the back of the mouth into the brain (Mallen 1967).

ASPARTAME WITHDRAWAL SYMPTOMS

Sorne aspartame reactors who had consumed large amounts of products containing this sweetener wene impnessed by “withdrawal” syrnptoms that began several days or weeks after stopping it. Such cornplaints included severe irnitability, tension and sweating. They were generally reduced by eating or drinking sugan or resuming aspar~ame... suggestive of sorne form of quasi-addiction.

One contnibutory element could be the caffeine-withdrawal syndrome (Roberts 197 ib). Enormous amounts of caffeine often were ingested with the compulsive dninking of diet colas.

This phenomenon rnight be related in part to increased endonphins (opium-like substances within the brain) that can provoke the excessive consumption of sugar, fat and calones (Atkinson 1987). A similar response has been induced with sacchanin (Lieblich 1983).

ASPARTAME REACTIONS IN FAMILIES

The discovery of severe aspartame reactions in ciose relatives— up to seven—was unexpected, both by myself and my patients or correspondents. One out of five aspartame reactors reported such a familial occurrence. Sorne persons first learned of this phenomenon at family reunions.

1 wás impressed by the apprehension of grandparents who had suffered reactions to aspartame products, and then learned that relatives rnay be more prone to such reactions. They understandably expressed concern about the welfare of thein grandchildren. A registened nurse poignantly pleaded with her daughter: “Please see that none of my grandchildren are given anything contaimng aspartame.”

Representative Case Reports

A 62-year-old woman suffered a marked decrease of vision in both

eyes, insomnia, slurred speech, intense tnemors, depnession with sui

cidal thoughts, anxiety attacks, unexplained facial and chest pains, diarnhea, marked joint pains, and severe itching while consuming aspantame. These complaints (except for the impaired vision) dramati— cally improved after stopping such products.

Hen younger sister expenienced severe headaches, depression, unex— plained chest and joint pains, and palpitations when she dnank five cans of an aspartame cola beverage. Her symptoms abated within several days after avoiding it.

Other relatives with severe aspartame reactions included two daughters, a ten—year-old grandson (who became “veny hypen” after dninking aspartame), and a brothen whose “large sores on the face” promptly healed after abstinence from aspartame.

Her husband also had unexplained heart symptoms and nervousness that subsided after avoiding aspartame.

A 59-year-old engineer concluded that aspartame products had been inducing or aggravating several problems. They included recunrent lightheadedness, trernors, manked memory loss, depression, respiratory allergies, intermittent loss of heaning, intense thirst, and recunnent bron— chial—sinus infections.

His 23—year—old daughter suffered severe headache, dizziness, lightheadedness, unsteadiness of the legs, depression, “anxiety attacks,” and marked frequency of urination the day aften drinking up to foun diet colas. There was concomitant impained vision and pain in both eyes. (None of these symptoms occurred while taking sacchanin.) She gaye a history of migraine. These products provoked her complaints on each of four challenges. She wrote:

“1 find that when 1 have aspantame, usually in soft dninks, 1 feel unusual:

lightheaded, headache, queasy, funny, nauseous. My vision also be-comes somewhat distonted, and my balance goes. It’s kind of a tunnel vision feeling.”

A 56-year-old woman complained of markedly decreased vision, ringing in both ears, sensitivity to noise, headache, extreme irritability, and unexplained chest pain whiie drinking three cans of a diet cola daily. Concenning her sisters, she wnote:

“1 have sent two copies of this form to my two sisters living in Ohio, as they both had a much stronger reaction to aspartarne than I’ve had— one with pain and depression, and the other with severe depression.

Their problems disappeared in a few short days after they quit dninking aspartame drinks.”

Bilateral Inhenitance

The children of families wherein both the fathen and mother evidenced reactions to aspartame products seemed even more vulnerable. None had known phenylketonuria (PKU) (Chapten 29) or a faniily history of this disorder. A young mother stated:

“My four—year—old son has always reacted to aspantame with personality changes, headaches and sleep. My husband cornplains of memory loss withjust one bottle of pop containing aspartame. 1, rnyself, react with swelling and headaches. 1 would like to know more about aspartame and why it affects us like this, since we don’t have the PKU problem.”

Comparable Reactions Among Relatives

Another interesting finding among such nelatives was the similarity of their reactions to aspartame products.

Three close relatiyes developed diarrhea after dninking aspartame soft dninks.

Two 40-year-old identical twin sisters suffered severe abdominal pain when they ingested aspartame.

Two women with aspartame-associated convulsions had consurned aspartarne duning pregnancy and while breast-feeding. The several children of each mother also de’veloped convulsions.

A 62-year-old wornan expenienced “immediate difficulty in swallowing” after ingesting an aspantame soda. She wrote, “My throat became paralyzed and 1 could not swallow. My daughten asked if 1 had checked fon aspartame. When 1 did, that’s when 1 realized that 1 was using it.” The reason fon this inquiry: her daughter also suffered “throat paraiysis” frorn aspartame beverages.

the Notion of Suggestibility

It could be argued that the element of suggestibility must be considered when such “victims” inquired about comparable symptoms or other reactions to aspartame-containing products among close relatives. 1 agree. (A similar argument focused on correspondents who “discovered” more than one cornplaint while completing the questlonnasre.) Qn the other hand, the detailed descniptions of reactions by rnost persons, descnibed in this and other sections, are sufficiently convincing to negate such a sweeping assertion.

The Genetic Link

The nature of this possible genetic link remains to be clanified. One of several inhenited charactenistics affecting enzyniic or other metabolic activities rnay be operative.

• Ninomiya and associates (1987) suggested that the site of action of the dpa gene among certain strains of mice that prefer D-phenylalanine resides in the taste cell membrane.

• There may be one or more deficiencies or genetic variants of an enzyme required to break down the combined amino acids (aspartylphenylalanúne) in the intestine.