From: Rich Murray [rmforall@att.net] Sent: Sunday, August 04, 2002 7:55 PM To: fdadockets@oc.fda.gov Subject: RTM: FDA: (Section C) Roberts: the life work of a brilliant clinician: aspartame toxicity 8.2.2 rmforall RTM: FDA: (Section C) Roberts: the life work of a brilliant clinician: aspartame toxicity 8.2.2 rmforall http://groups.yahoo.com/group/aspartameNM/message/859 [Comments by Rich Murray are in square brackets.] http://www.dorway.com/tldaddic.html 5-page review Roberts HJ Aspartame (NutraSweet) addiction. Townsend Letter 2000 Jan; HJRobertsMD@aol.com http://www.sunsentpress.com/ sunsentpress@aol.com Sunshine Sentinel Press P.O.Box 17799 West Palm Beach, FL 33416 800-814-9800 561-588-7628 561-547-8008 fax Dr. Roberts is Director of the Palm Beach Institute for Medical Research (since 1964), and a member of the American College of Physicians, The Endocrine Society and the American Academy of Neurology. His writings include nine acclaimed texts and more than 220 original articles and letters. Many deal with original researches on challenging metabolic and neurological disorders. http://groups.yahoo.com/group/aspartameNM/message/790 RTM: Moseley: review Roberts "Aspartame Disease: An Ignored Epidemic" 2.7.2 rmforall http://groups.yahoo.com/group/aspartameNM/message/669 Rich Murray: Roberts: "Aspartame Disease" 1038 page expert magnum opus 7.5.1 rmforall published May 30 2001 $ 85.00 postpaid data from 1200 cases available at http://www.amazon.com over 600 references from standard medical research http://www.aspartameispoison.com/contents.html 34 chapters July 5 2001 I turned 59 July 3, and got a wonderful, long-anticipated gift from H.J. Roberts, MD, FACP, FCCP.: "Aspartame Disease: An Ignored Epidemic". I will be studying this very helpful comprehensive review carefully, and composing summary posts on almost all of the 34 chapters, to explore this immense tapestry of data, observations, conclusions, and questions, making it easier for potential readers to decide whether to pay the price, $ 85.00 postpaid. The size of a Santa Fe phone book, the 1038 pages are 8.5X11, and appear to be composed in HTML. I will quote various passages, and give comments. Roberts' style is throughout lucid, dignified, high-minded, plain-spoken, direct, calm, succinct, and often shows a dry wit. wp 7 ADDITIONAL COMMENTS: Several added points deserve clarification for critical readers. ITEM 1: I wrote this book myself. (The term "authentic" comes from a Greek word meaning "one who does things with his own hands.") There were no collaborators, "ghost writers," or editors. p 8 Corporate Neutrality: I take pride in my corporate neutrality. No grants or salary were received for this effort, which originated in clinical practice. p 27 EVOLVING DOUBTS: "GOING PUBLIC' Like most physicians, the author had no reason to doubt the scientific basis for its safety when aspartame was approved by the FDA [in July, 1981]. My attitude changed, however, after repeatedly encountering serious reactions in my patients (Section 2) that seemed justifiably linked to use of such products. These doubts increased after learning by mid-1986 that over 10,000 consumers had sent complaints to the FDA, the Centers for Disease Control (CDC), the manufacturer, interested investigators, and consumer organizations. p 28 More On the Author's Background: The reader is entitled to specifics about the author's interest and credentials. At the time my observations on aspartame disease first evolved, I was a primary-care internist, medical consultant, and director of a corporate-neutral medical research organization. Patients with a broad spectrum of diagnostic and therapeutic difficulties were seen, generally after having consulted with a number of physicians and clinics. The unique role stemmed from having authored many scientific articles and books. The first, "Difficult Diagnosis: A Guide to the Interpretation of Obscure Illness (W.B. Saunders Company, 1958), has been used by more than 60,000 physicians in the United States. In the mid-1980s, I became aware of subtle changes and challenges pertaining to both the diagnosis and management of patients whose difficulties later could be related directly to the use of aspartame products. A 16-year-old girl (Case III-2) had recurrent seizures that baffled several neurologists. Her convulsions stopped after avaoiding aspartame products. An attack was then reproduced within three hours following rechallenge with one small serving of an aspartame pudding." [This paragraph epitomizes the 1200 case reports that are the foundation of this text.] These insights led to routinely inquiring of "problem patients" about aspartame consumption. Their prompt improvement following abstinence indicated an evolving public health problem... at least within the context of my practice. Numerous persons having "mysterious ailments" came to realize that they were afflicted with aspartame disease when striking improvement occurred after stopping such products. Virtually every day became a learning experience as I delved into the numerous facets of aspartame disease. [This indicates that a single doctor who inquires about aspartame use by all his own clients is likely to find many cases a week of aspartame disease, and this in turn is evidence for a huge degree of prevalence. Skeptical professionals have an opportunity to confirm or refute this in their own clinical practice. I will gladly post any observations, and critical reviews, pro or con, sent to me, on http://groups.yahoo.com/group/aspartameNM/messages ] p 31 On July 30, 1986, I presented my data on 100 aspartame reactors at a press conference in West Palm Beach... I delivered my first scientific report on 360 aspartame reactors to the Section on Medicine of the Southern Medical Association on November 10, 1986. The first article on 496 aspartame reactors appeared in the January 1987 edition of "On Call", official publication of the Palm Beach County Medical Society. The flood of calls and letters from grateful aspartame "victims" and their families dispelled my earlier misgivings about "going public." A husband wrote, "Without someone publishing this information that was so helpful to me, my wife could have died from illness due to this cause." p 6 I have engaged in independent patient-based clinical research involving various realms for more than four decades. They include pesticides (notably pentachlorophenol), products contaminated with toxic metals, arbitrary severe caloric restriction, megadoses of vitamin E, antistatic clothes softeners, fluoridation of water, and even vasectomy. I repeatedly stressed two pertinent issues. First, a long time may be required to identify the hazards of new products and medical interventions, particularly drugs and industial chemicals. Second, it may take even longer for these risks to be acknowledged by physicians and public health officials. ********************************************************** I spent about nine hours scanning Asparame Disease for cases of small doses of aspartame in breath mints [1.5 mg aspartame per mint], pills [about 4 mg per pill], and chewing gum [6-8 mg aspartame per stick], since if there are a variety of symptoms to such small doses, then it is a foregone conclusion that much more serious reactions must exist to diet drinks [180-330 mg aspartame per 12 oz]. Many cases describe people who had become reactors to large doses of aspartame, who then find severe and immediate reactions to a stick or less of chewing gum. [Excerpts, pp 79-85] D. REACTIONS TO SMALL QUANTITIES Some reactors evidenced severe symptoms and signs after ingesting or chewing small amounts of aspartame products. * Mention was made of convulsions occurring in a nursing infant as its mother drank an aspartame soft drink. * Children developed severe headache, convulsions, or both, within minutes after chewing either acetaminophen (given for fever) or gum containing aspartame... * Case III-1, a 31-year-old nurse with an aspartame-induced seizure, subsequently drank "only three sips" of a drink believed to be "regular" soda, but which contained aspartame. She promptly became "very incoherent." [case described on pages 113-115] * A chemist who developed migraine from certain foods and additives performed six double-blind experiments on himself. He found that as little as 4.0 mg aspartame in a capsule predictably induced headache (Strong 2000).... [ http://groups.yahoo.com/group/aspartameNM/message/285 Strong FC Why do some dietary migraine patients claim they get headaches from placebos? Clin Exp Allergy 2000 May; 30(5): 739-43.] The precipitation of severe neurological and other reactions within minutes or a few hours after ingesting aspartame (see below) casts doubts on the assertion by the FDA: "The agency does not regard the possible consumption of aspartame in a single large dose as posing any safety problem whatever." (Federal Register February 22, 1984, p. 6678)... E. ASPARTAME GUM I have been impressed by the role of aspartame gum in patients suffering severe neurologic aspartame reactions, especially headache and seizures (see below). * A 24-year-old woman stated that she was "on the very verge of dying" from aspartame disease. Dramatic improvement occurred when she learned about this disorder, and then stopped such products. She emphasized her marked sensitivity to even a single stick of aspartame gum. Symptoms would recur within minutes after chewing it, and lasted one week. [6-8 mg aspartame per stick of chewing gum] * Aspartame gum was specifically incriminated by Case IX-C-16, a 35-year-old woman with shortness of breath, dizziness, irritability, fatigue, heavy menstrual bleeding, hair loss and weight gain. (She did not drink diet sodas.) These reactions-- "within the hour I could not catch my breath"-- reoccurred on multiple retests. Few realize the enormity of gum consumption. It is estimated that Americans chew $2.5 billion worth of gum annually, the equivalent of 190 sticks per person. Some aspartame reactors chewed 15-20 sticks or more daily, in addition to using other aspartame products (see Case II-4). [20 sticks would be as much as 160 mg aspartame, almost as much as 12 oz diet drink] Owing to its prolonged sweetness, persons tend to chew aspartame as much as five time longer than regular gum.... The habitual sucking of popular mints containing aspartame may induce seizures and other neuropsychiatric disorders. An aspartame reactor with prior complaints (vision impairment; slurred speech; loss of muscle strength) remained symptom-free after avoiding aspartame. She then experienced "painfully dry eyes" immediately after taking a breath mint containing aspartame...[1.5 mg aspartame per mint] Absorption Chewing gum exposes the body to aspartame thorough its absorption in the upper gastrointestinal tract, and from the lining of the mouth. Additional ingredients could pose added problems. For example, I have repeatedly encountered difficulty with peppermint gum and wafers (Roberts 1983). [see case on page 456] The rapidity with which reactions can occur after chewing aspartame gum is not necessarily an "allergy". The prompt absorption of aspartame or its breakdown products (Chapter XXV) from the mouth is akin to placing nitroglycerine under the tongue for the rapid relief of angina pectoris. Pharmacologists recognize that absorption through the oral mucosa (without swallowing) can be an efficient route of delivery for amino acids and small proteins because the basal lamina under the epithelial layer contains blood vessels. Moreover, the enzymatic activity of the oral cavity is relatively low (principally, an amylase that hydrolyzes only sugars.). * The blood flow in the buccal mucosa is comparable to that of the sublingual mucosa. Absorbed molecules are collected by the internal jugular veins, thereby directly reaching the circulating blood. * The buccal route for drug administration is illustrated by its effectiveness in treating childhood seizures with midazolam (Scott 1999). The rich blood supply to the mouth enables absorption directly into the systemic circulation, thereby avoiding the considerable "first-pass" metabolism by the liver. A rapid effect on the central nervous system has been demonstrated electroencephalographically. Another possible mechanism involves the transport of aspartame from the back of the mouth (oropharynx) directly to the brain. This phenomenon has been documented for small molecules such as glucose, sodium chloride and ethyl alcohol (Editorial, British Medical Journal, 1: 184, 1966; Maller 1967). Gum-Induced Headache Aspartame induced reactions occurred in children who received aspartame gum on Halloween from thoughful neighbors wishing to avoid giving them sugared gum as presents. Headache was the most frequent reaction; vomiting and severe tremors also occurred.... The promptness with which aspartame gum can precipitate recurrent headache is shown by these encounters. * A female aspartame reactor developed headache after consuming aspartame in sodas and food. Offered gum in a darkened theater, she experienced severe pain in her face and eyes that radiated to the back of her skull within five minutes of chewing it. She spit it out when her friend confirmed it contained aspartame. The pain subsided over the course of the film. * A correspondent wrote, "I decide to lose a few pounds, so I watched my fat and cut out the sugar. I bought diet sodas and other products containing aspartame. Within a week, I started having headaches. My head felt stuffed up, and generally I was not feeling like my self. I happened to see a local news story about the side effects of aspartame and cut out all these products. Within a few days, I started to feel like my old self. About one month later, I accidently had a piece of gum with aspartame; within fifteen minutes, I had a splitting headache." Gum-Induced Seizures The precipitation of grand mal seizures after chewing ONE stick of aspartame gum is illustrated below and in Chapter III. Induced Hunger Some aspartame reactor described an uncontrollable craving for sweets related to chewing aspartame gum. There are corroborative studies. Tordoff and Alleva (1990) reported greater hunger by oral stimulation when gum base containing aspartame in four concentrations was chewed 15 minutes.... [Tordoff MG, Alleva AM Oral stimulation with aspartame increases hunger Physiol Behav 1990 Mar;.47(3): 555-9. Monell Chemical Senses Center, Philadelphia, PA 19104] Representative Case Reports Case II-8 A 19-year-old woman with prior convulsions caused by diet drinks remained seizure-free for 11 months after avoiding aspartame products. She then inadvertently chewed a piece of gum that had been handed to her as presumed "regular" gum whicle attending a ball game. Multiple grand mal seizures recurred within minutes. [also on page 129: Case III-19 A: A 19 -year-old female suffered frequent seizures while ingesting aspartame soft drinks. Once she and her parents appreciated this relationship, she discontinued all aspartame products and remained seizure-free. During this time, she functioned well without anti-epileptic medication which she refused to take. Eleven months later, the patient attended a ball game. Someone handed her a piece of gum, which she reflexively began to chew. Within minutes she had several grand mal seizures, followed by violent headaches and depression. The gum contained aspartame.] Case II-9 A 52-year-old bank executive in previous good health experienced severe sleepiness, marked depression with suicidal thoughts, intense anxiety, joint pains and a convulsion after consuming six cups of an aspartame hot cocoa mix daily on eight consecutive nights. She also became blind temporarily. Many studies during an ensuing hospitalization proved normal. Her symptoms disappeared within two weeks after avoiding aspartame, enabling her to resume work. When a friend later handed her a stick of aspartame gum in a darkened movie house, she "fell flat on my face in the lobby." [also on page 304 as Case VII-C-3 A 52-year-old bank executive developed convulsions after drinking an aspartame hot chocolate mix for eight consecutive nights. She also experienced severe anxiety, marked aggravation of phobias, and intense depression with suicidal thoughts. She recalled, "I wanted to jump off the top of a parking garage."] This patient's family history of aspartame disease included a son who developed headache after using aspartame products, and a niece who reacted with tingling of the limbs. Case II-10 A 32-year-old woman wrote, "I couldn't believe how fast I reacted to the aspartame gum after being given a piece by my boss. I never got dizzy like that before. I had to spit it out." She was pregnant at the time. Case II-11 A 45-year-old salesman found that even a bit of gum containing aspartame induced extreme drowsiness. "Just recently, I discovered as I'm driving my automobile that aspartame gum caused drowsiness after chewing only one-half a stick. It caused me to yawn, and to feel sleepy and weak. Sometimes I had to stop driving and close my eyes for a few minutes." [also on page 264-265 as Case VI-K-1 A 45-year old salesman listed severe drowsiness as his foremost reaction to consuming aspartame. This sequence was repeated on at least four occasions. He stated,...[the same statement] Other aspartame-induced complaints included dizziness, unsteadiness, marked hyperactivity of the limbs, abdominal pain, weight gain, frequency of urination (both day and night), and poor control of diabetes notwithstanding strict adherence to diet and taking his oral medications.] page 129 Case III-19 B A 27-year-old woman developed recurrent grand mal seizures after chewing ONE stick of aspartame gum. She was hospitalized on each of the three occasions these seizures occurred. Numerous tests proved normal. She experienced severe reactions to Dilantin, and subsequently to Tegretol. The patient suggested to her neurologist that the seizures might have been triggered by aspartame. "He literally laughed at me and said, 'One stick would not do it.' " Her chiropractor happened to be interested in aspartame disease. After hearing the details, he concurred. The neurologist's arrogant response to the chiropractor's written opinion was, "I don't see the letters M.D. after his name." The patient remained seizure-free without medication for several years until flying and inadvertently chewing a stick of gum that was not identified as containing aspartame. She wrote, "Fortunately, I was buckled in and the flight attendants were well trained. My husband knew what to expect, and there happened to be a doctor sitting behind us. I developed a grand mal seizure on the plane, and the repercussions were great. My speech returned to normal within a few weeks, but my ability to spell and perform mathematical equations took well over a year to recover." page 134 * A two-year-old developed a fever for which the mother administered chewable acetaminophen containing aspartame. The child suffered seizures ten minutes later. [probably about 4 mg per pill] page 136 Case III-23 A 31-year-old housewife used aspartame early in 1982 when samples of an ATS [aspartame table sweetener] were received in the mail. Thereafter, she consumed four cans of diet sodas, eight packets of an ATS, up to eight glasses of an ASD [aspartame soft drink], four glasses of aspartame hot chocolate, and three bowls of aspartame-presweetened cereal daily. There was a history of longstanding migraine. She did not smoke or drink alcohol. The headaches intensified to the point "I couldn't stand them." She subsequently suffered multiple epileptic seizures for which medication was prescribed. Other complaints included severe confusion and memory loss, numbness of the arms and legs, slurred speech, shortness of breath, palpitations, abdominal pain, difficulty in swallowing, intense thirst, and the virtual cessation of her menstrual periods. Her eight-year-old son and three-year-old daughter also became epileptic. She had consumed aspartame during the entire nine months of the second pregnancy, including an aspartame-containing acetaminophen preparation. Both children experienced intense headaches and seizures after taking chewable acetaminophen sweetened with aspartame. (At the time, she did not realize aspartame was an ingredient.) Her son also developed extreme thirst, severe impairment of vision, marked intolerance to noise, and profound depession with suicidal behavior. page 416 Case IX-D-15 B A college student was diagnosed as having the irritable bowel syndrome. She was an avid user of aspartame products-- including soft drinks, a tabletop sweetener and gum. She stated: "Abdominal pain, embarrassing flatulence, and alternating diarrhea and constipation were a way of life for me. There were many occasions when I was awakened from a deep sleep by excruciating abdominal pain accompanied by cold sweats and nausea. Another disturbing problem I experienced was an uncontrollable, almost violent, craving for sweets. I worked very hard to stay thin, so I chewed a lot of sugarless gum to keep from putting fattening foods in my mouth." She found reference to aspartame-induced gastrointestinal problems in the course of writing a research paper. There was dramatic improvement of her gastrointestinal symptoms after abstinence, along with a reduction of her "sweet craving." This victim "experimented" with aspartame products on two occasions-- once chewing aspartame gum for five consecutive days; the other time taking aspartame yogurt on five consecutive days. "At the end of both weeks, I experienced the same severe abdominal pains that I had in the past." page 456 Case IX-G-15 A homemaker used peppermint mints containing aspartame to freshen her breath. [1.5 mg aspartame per mint] "After a few weeks of consuming a six-pack a week [of mints], I started to have aches in my back and shoulders which got worse. It also started to affect my neck area. Finally, it became so intense I was going to the doctor to find out what my problem was. About the same time, I happened to read the packaging and discovered the ingredient aspartame. Having heard various discussions about this sweetener, I decided to eliminate the breath mints. After five or six days, there was no more shoulder pain!" "About March of this year (1997), without thinking about it, someone offered me hard candy. I accepted it. A few days later, the shoulder and neck aches returned, but were much more intense. When I discovered the candy was 'sugar free,' I immediately stopped it. Again, the pain left." page 476 Case IX-J-1 A 10-year-old girl began consuming various aspartame products at the age of eight, initially during summer weekends. She developed marked swelling of one shoulder which then involved the neck. Her arm almost tripled in size. There was no history of allergies or aspirin use existed. The patient also evidenced a high fever, pleural effusion (fluid in the lung cavity), striking enlargement of both the liver and spleen, and a precipitious decline in the platelet count to 1,000 per cubic mm (normal, 150,000 or higher.) A striking increase of histiocytes was found in her bone marrow. Several "liver enzymes" were markedly elevated-- i.e., SGOT 3,080 units/L (normal, up to 50); CPK 30,000 units/L (normal, up to 50). Numerous physicians and consultants saw this child. Most diagnosed histiocytic leukemia. The patient received large doses of prednisone. Dramatic clininal improvement and virtual normalization of the foregoing blood changes occurred when the mother closely monitored her diet and eliminated additives. The prednisone was then stopped. The patient subsequently ate several bowls of an aspartame cereal. Marked swelling of the cheeks developed, coupled with recurrence of the aforementioned features. When aspartame was discontinued, the swelling receded without prednisone. Several months later, the girl was given aspartame chewing gum with the mother's knowledge. Swelling of her entire body, recurrent enlargement of the liver and spleen, a dramatic increase of bone marrow histiocytes, and severe pain in many joints ensued. Total abstinence from aspartame again effected the disappearance of her symptoms and blood abnormalities within six months. At the time of my last discussion with her mother, the child had minimal enlargement of the liver, and was receiving prednisone in low doses only intermittently. This patient had two sets of head x-rays, three CT scans of the brain, two spinal punctures, four bone marrow studies, two electroencephalograms, two heart monitoring studies, two barium enemas, and a host of other studies. Her mother estimated the medical costs at $750,000! page 503 Similarly, a 6-year-old boy had been well until he vomited and was given a popular pediatric acetaminophen product. A fatal seizure followed for which no abnormality could be found at autopsy. page 782 Case XXVII-C-2 An 8-year-old girl complained of daily headaches. Concerned over the frequency with which she was giving her child aspirin, the mother made arrangements for a neurologic consultation. The girl then volunteered that her headaches occurred exactly 10 minutes after she began chewing aspartame-containing bubble gum. They disappeared when it was avoided. Case XXVII-C-3 A young woman described her reactions in this letter sent to Aspartame Victims and Their Friends. "In April of 1984, I started chewing aspartame gum. I had just quit smoking. I chewed perhaps three sticks a day. In October 1984, I started to feel strange, and discovered I was reacting to the gum. I stopped chewing it. The symptoms are primarily * Headache or pressure around the skull * Tingling primarily in head and face, although sometimes in extremities as well * Occasional numbness on the left side of the face and sometimes in extremities, particularly on the left side * Mental confusion * Blurred vision * A general "spaced-out feeling" page 790 * A pilot experienced in aerobatics would become temporarily disoriented "every time I was drinking a diet soda or chewing gum with aspartame in it." ********************************************************** http://www.dorway.com/tldaddic.html Courtesy of Dr. Roberts and "The Townsend Letter for Doctors and Patients" Aspartame (NutraSweet) addiction. January, 2000; 52-57. HJRobertsMD@aol.com http://www.sunsentpress.com/ sunsentpress@aol.com Sunshine Sentinel Press P.O.Box 17799 West Palm Beach, FL 33416 800-814-9800 561-588-7628 561-547-8008 fax [also discussed on pages 318-319 in Aspartame Disease] SUMMARY The habitual consumption of "diet" products containing the chemical aspartame not only risks aspartame disease but also clinical addiction. Thirty-three (5.6 percent) of 540 aspartame reactors in the author's recent series found it difficult or impossible to discontinue them because of severe withdrawal effects. They or their reporting relatives (especially parents of afflicted children) specifically used the terms "addict" and "addiction." Others who used comparable terms were excluded even though they experienced similar withdrawal symptoms. The FDA and members of Congress have been repeatedly urged by me and housands of outraged aspartame reactors to declare aspartame products an "imminent public health hazard," and remove them from the market. The mounting evidence for their causation or aggravation of headache, seizures, depression, many neurologic disorders (most notably multiple sclerosis), visual difficulty, allergies, diabetic complications, and a host of other conditions — coupled with the potential for addiction — can be ignored no longer. [Extract] The habitual chewing of aspartame gum poses a unique threat, as evidenced by the dramatic development of generalized symptoms in some aspartame reactors. Its flavor and sweetness can last 30 minutes, compared to about five minutes for sugar-sweetened gum. The chemical may be absorbed through the mucosa of the mouth (as used therapeutically with nitroglycerin), and via simple diffusion from the oropharynx directly into the brain. The latter phenomenon has been demonstrated with small molecules such as glucose, sodium chloride and ethyl alcohol (20). The Methanol Issue The chronic intake of free methanol in significant amounts is highly germane to aspartame disease and addiction, particularly for alcoholics. Six years before FDA approval of aspartame, Dr. Herbert S. Posner (21) of the National Institute of Environmental Health Sciences wrote a review titled, "Biohazards of Methanol in Proposed New Uses." He stressed the failure to recognize the "delayed and irreversible effects on the nervous system" of methanol... at widely varying levels of exposure and at rather low levels." Furthermore, he suggested "...when a safer compound is available, methanol should not be utilized." The daily intake of methyl alcohol from natural sources averages less than 10 mg (22). Aspartame beverages contain 55 mg methanol per liter, and nearly double as much in some carbonated orange sodas. Persons ingesting five liters a day can therefore consume over 400 mg methanol. These facts are pertinent: • Methyl alcohol is probably the first component of aspartame released within the small intestine, and rapidly absorbed. Blood and methanol concentrations correlate with aspartame intake. "Abuse doses" (100 mg/kg or more) ingested by normal subjects significantly elevate blood methanol concentrations, remaining detectable for eight or more hours (23). • Humans are more vulnerable to the toxic effects of methanol than animals because several enzymes required for its metabolism have been lost during evolution. • The toxicity of methanol is enhanced by its slow rate of oxidation — only one-seventh that of ethyl alcohol — occurring chiefly in the liver and kidneys. Even though the half life in human volunteers ingesting small amounts (1-5 ml) is about three hours, complete oxidation to carbon dioxide usually requires several days. • The body attempts to detoxify methyl alcohol by oxidizing it to formaldehyde (a deadly neurotoxin and Class A carcinogen), and then to formate or formic acid within minutes. Formate and formaldehyde each may contribute to toxicity and nervous system/immune dysfunction through various mechanisms. One is the conjugation of formaldehyde with human serum albumin (F-HSA) to form a new antigenic determinant. Patients with multiple health complaints who had been exposed chronically to formaldehyde develop anti F-HSA antibodies and elevated Tal cells (antigen memory cells), consistent with sustained antigenic stimulation of the immune system (24). • Concerning the methyl alcohol component of aspartame, Hugh C. Cannon, Associate Commissioner for Legislative Affairs of the FDA, wrote in a letter dated September 8, 1986: "The Agency has recently become aware, however, of clinical data that indicate that the toxic effects of methanol are due to formate accumulation and not to formaldehyde or methanol itself. Formate is the oxidation product of formaldehyde which is itself formed from the metabolism of methanol." The eye manifestations experienced by one-fourth of aspartame reactors (1 - 4) are probably at least partly due to methanol and its breakdown products. It is of interest that several persons had severe visual deterioration diagnosed as toxic amblyopia (including transient blindness diagnosed as optic neuritis) on different occasions following the excessive intake of either aspartame or alcohol. [End of report.] REFERENCES 1. Roberts HJ The Aspartame Problem. Statement for Committee on Labor and Human Resources, U.S. Senate Hearing on "NutraSweet"-Health and Safety Concerns, November 3, 1987. 83-178. U.S. Government Printing Office, Washington, 1988:466-467. 2. Roberts HJ Reactions attributed to aspartame-containing products: 551 cases. J Appl Nutr 1988; 40: 85-94. 3. Roberts HJ Aspartame (NutraSweet®): Is It Safe? Philadelphia, The Charles Press, 1989. 4. Roberts HJ Sweet'ner Dearest: Bittersweet Vignettes About Aspartame (NutraSweet®). West Palm Beach, Sunshine Sentinel Press, 1992. 5. Roberts HJ Aspartame and headache. Neurology 1995; 45: 1631-1633. 6. Roberts HJ Aspartame (NutraSweet®)-associated epilepsy. Clin Res 1988; 36: 349A. 7. Roberts HJ Complications associated with aspartame (NutraSweet®) in diabetics. Clin Res 1988; 3: 489A. 8. Roberts HJ Defense Against Alzheimer's Disease: A Rational Blueprint for Prevention. West Palm Beach, Sunshine Sentinel Press, 1995. 9. Roberts HJ Preclinical Alzheimer's disease (Letter). Neurology 1997; 48: 549-550. 10. Roberts HJ Does aspartame cause human brain cancer? J Adv M 1991; 4 (Winter): 231-241. 11. Roberts HJ Joint pain associated with aspartame use. Townsend Letter for Doctors 1991; May: 375-376. 12. Tollefson L, Barnard RJ, Glinsmann WH Monitoring of adverse reactions to aspartame reported to the U.S. Food and Drug Administration. In Proceedings of the First International Meeting on Dietary Phenylalanine and Brain Function, ed by RJ Wurtman and E Ritter-Walker, Washington, D.C., May 8-10, 1987, 347-372. 13. Department of Health & Human Services: Summary of adverse reactions attributed to aspartame. April 20, 1995. 14. Roberts HJ Aspartame-associated dry mouth (xerostomia). Townsend Letter for Doctors 1993; February: 201-202. 15. Rudgley R The Alchemy of Culture: Intoxicants in Society. London, British Museum Press, 1998. 16. Randolph, TG The descriptive features of food addiction: addictive eating and drinking. Quart J Studies Alcohol 1956; 17: 198-224. 17. During NJ, Acworth IN, Wurtman RJ An in vivo study of dopamine release in striatum: The effects of phenylalanine. In Proceedings of the First International Meeting on Dietary Phenylalanine and Brain Function. ed by RJ Wurtman and E Ritter-Walker, Washington, D.C., May 8-10, 1987. 18. Myers RD, Melchior CL Alcohol drinking: Abnormal intake caused by tetrahydropapaveroline in brain. Science 1977 Apr 29; 196 (4289): 554-556. 19. Koob G Cited by The Lancet 1998; 352: 1290. 20. Maller O, Kare MR, Welt M, Bohrman H Movement of glucose and sodium chlorine from the oropharyngeal cavity to the brain. Nature 1967 Feb 18; 213 (77): 713-4. 21. Posner HS Biohazards of methanol in proposed new uses. J Toxic Envir Health 1975; 1: 153-171. 22. Monte WC Aspartame: Methyl alcohol and the public health. J Appl Nutr 1984; 36: 42-54. 23. Stegink ID, Filer LJ Jr Aspartame: Physiology and Biochemistry. New York, Marcel Dekker, Inc. 1984. 24. Thrasher JF, Broughton A, Micevich P Antibodies and immune profiles of individuals occupationally exposed to formaldehyde. Six case reports. Am J Indust M 1988; 14: 479-488. 25. Roberts HJ Submission to FDA regarding Docket No. 981F-0052 (Food Additive Petition for Neotame), March 3, 1988. 26. Roberts HJ Testimony: Analysis of Adverse Reactions to Monosodium Glutamate. Federation of American Societies for Experimental Biology, Bethesda, April 8, 1993. 27. Wolraich ML, Lindgren SD, Stumbo PJ, et al Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N Engl J Med 1994; 330: 301-307. 28. Roberts HJ Aspartame effects during pregnancy and childhood. (Letter) Latitudes 1997; 3 (Number 1): 3. *********************************************************** Roberts HJ Aspartame and headache. Neurology 1995 Aug; 45(8): 1631; discussion 1632-3. Comment on: Neurology. 1994 Oct; 44(10): 1787-93. Publication Types: Comment Letter PMID: 7644072 To the Editor: The report by Van Den Eeden et al (1) validates my repeated encounter of headache specifically atttributable to the ingestion of products containing aspartame (NutraSweet.). (2-7) About 47% of persons in my series of more than 650 aspartame reactors reported recurrent or de novo headaches, even when previously controlled by medication. Moreover, one-half of the patients with aspartame-induced seizures (more than 130) experienced increasingly severe headache before their first convulsion. (5-7) [I did not here copy this specific list of references, but have (above) given the references for his Dec 2000 report in Townsend Letters.] [Three independently funded double-blind studies that show that aspartame causes headache are contrasted with three industry funded studies to the contrary, along with a critique of the vulnerability of these studies to faulty design and execution. The validity of Roberts' main research strategy of assessing hundreds of clinical cases and consumer complaints is butressed by recent clinical reports of headache caused by 3.75 mg aspartame in migraine medication and by the 6-8 mg aspartame in chewing gum, as well as the report in 2001 of four cases of intractable fibromyalgia, finally resolved by avoiding all aspartame and MSG. The pattern of pathology in the total of 9 cases in these 3 reports is the same as the over thousand case reports summarized by Roberts in letters, articles, and texts, replicating closely his clinical methods, data, and conclusions: http://groups.yahoo.com/group/aspartameNM/message/622 Rich Murray: Gold: Koehler: Walton: Van Den Eeden: Leon: aspartame toxicity 6.4.1 rmforall http://groups.yahoo.com/group/aspartameNM/message/623 Rich Murray: Simmons: Gold: Schiffman: Spiers: aspartame toxicity 6.4.1 rmforall http://groups.yahoo.com/group/aspartameNM/message/854 RTM: Newman & Lipton: 3.75 mg aspartame in Merck Maxalt-MLT worsens migraine Oct 2001 7.28.2 rmforall http://groups.yahoo.com/group/aspartameNM/message/855 RTM: Blumenthal & Vance: aspartame chewing gum headaches Nov 1997 7.28.2 rmforall http://groups.yahoo.com/group/aspartameNM/message/652 Smith JD, Terpening CM, Schmidt SO, Gums JG Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. terpening@fpmg.health.ufl.edu cterpeni@ufl.edu Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA. gums@fpmg.health.ufl.edu siggy@shands.ufl.edu http://groups.yahoo.com/group/aspartameNM/message/782 RTM: Smith, Terpening, Schmidt, Gums: full text: aspartame, MSG, fibromyalgia 1.17.2 rmforall Also, some older published case reports: Ralph G. Walton, MD Seizure and mania after high intake of aspartame. Psychosomatics 1986; 27: 218-20. Prof. of Clinical Psychology, Northeastern Ohio Universities, College of Medicine, Dept. of Psychiatry, Youngstown, OH 44501 Chairman, The Center for Behavioral Medicine, Northside Medical Center, 500 Gypsy Lane, P.O. Box 240 Youngstown, OH 44501 330-740-3621 rwalton193@aol.com http://www.neoucom.edu/DEPTS/Psychiatry/walton.htm An age 54 woman with 20 years of depression had been stable for 11 years with medication. She had a grand mal seizure, followed by mania, insomnia, flight of ideas, and irritability. A brief hospitalization and CT scan found no apparent cause. After three weeks, this led to psychiatric hospitalization. Two days later, it was found that during the several weeks before the seizure and onset of mania, she had started using aspartame in place of sugar in her iced tea, a gallon daily. Four days later, the mania subsided, and 13 months later she continued to function well, and enjoying her large amounts of iced tea, with sugar, not aspartame. http://groups.yahoo.com/group/aspartameNM/message/31 Wurtman RJ. Aspartame: possible effect on seizure susceptibility. Lancet 1985 Nov 9; 2(8463): 1060. Richard J. Wurtman, Ph.D. dick@mit.edu 617-253-3091 Professor of Neuroscience Prof. of Health Sciences and Technology Director of the Clinical Research Center Massachusetts Institute of Technlogy Cambridge, Mass. 02139 [describes 3 cases] "The possible role of aspartame in seizure induction," 1987 Proceedings of the First International Conference on Phenylalanine and the Brain, Wurtman, RJ, Walker E (eds.), Center for Brain Sciences and Metabolism Charitable Trust, Cambridge, England: Nine cases, ages 19 to 91, briefly summarized: "Case 4: A 61 year-old woman had been in excellent health until she began consuming an average of half a gallon per day of sugar-free beverages prepared with "Crystal Light" mixes. She experienced the onset of headaches, in the absence of a previous headache history. After three months of daily headaches, she experienced a generalized seizure and was hospitalized. CAT scan and EEG were normal. After discontinuing the use of all aspartame-containing products, she has been headache- and seizure-free." http://groups.yahoo.com/group/aspartameNM/message/32 Drake ME Panic attacks and excessive aspartame ingestion. Lancet 1986 Sep 13; 2(8507): 631. [describes 1 case] http://neurology.med.ohio-state.edu/faculty/drake.html Miles E. Drake, MD (614) 293-6195 Department of Neurology and Psychiatry, Ohio State University Medical Center, Columbus, Ohio 43210, USA Director of EEG and Evoked Potential Laboratory; Codirector of Comprehensive Epilepsy Program; Associate Professor of Neurology ] This report undoubtedly underestimates the frequency of the problem. It also raises several issues pertaining to the methodology used by these and previous investigators. They warrant comment because I believe these investigations have misled researchers and readers both within this realm and in the realm of other neuropsychiatric reactions to aspartame products. The latter include convulsions, depression, hyperactivity and cognitive changes in children, confusion, dizziness, visual problems, tremors, and insomnia. (2-7) For example, I disagree with the assurance offered by Shaywitz and Novotny in your journal (8) that "aspartame consumption will not provoke or exacerbate seizures." I have challenged the administration of aspartame as capsules or in freshly prepared cool solutions rather than in "real world" products-- viz, soft drinks and other products sold in markets. The latter undergo changes upon exposure to high temperature and with prolonged storage (ie, more than 2 months). Similar considerations apply to the addition of aspartame tabletop sweeteners to hot beverages. The ensuing stereoisomers and multiple metabolites of aspartame may be as neurotoxic as the chemical itself. Furthermore, capsules of aspartame do not elevate phenylalanine, aspartic acid, and methanol concentrations to levels comparable to those following ingestion of aspartame in liquid form. [ http://groups.yahoo.com/group/aspartameNM/message/830 RTM: Tholen: Diet Coke has 5 ppm formaldehyde from aspartame 5.29.2 rmforall For a science project, Randy Tholen, age 11, had six cans of Diet Coke analyzed on 3.7.2: Contact/Phone: Bill Katz 952-942-1774 bkatz@brauncorp.com Braun Intertec Corporation http://www.brauncorp.com/ (800) 279-6100 (952) 941-5600 fax (952) 833-4701 6875 Washington Ave. S. Minneapolis, MN 55439 For 6 cans of diet soda, this is 5 times the daily limit of 1 PPM for formaldehyde in drinking water, set by the EPA. ] I also must voice reservations about both the aspartame and the placebo used. In view of the need to avoid criticism of double-blind studies along these lines, I recommend that the aspartame be obtained from independent chemical suppliers and analyzed by corporate-neutral persons. [ It is prudent to doubt all independently unconfirmed research, however voluminous, by industry or industry funded researchers, especially when there is a dismal historical record of research integrity: http://groups.yahoo.com/group/aspartameNM/message/857 RTM: www.dorway.com: original documents and long reviews of flaws in aspartame toxicity research 7.31.2 rmforall ] A case in point is the experience of Walton et al. (9) They sought to ascertain whether persons with a history of depression are more vulnerable to the adverse effects of aspartame. Aspartame capsules and placebos of identical appearance were administrated in a double-blind challenge involving patients with a history of unipolar depression and a control group. Inasmuch as the NutraSweet Company refused to sell these investigators aspartame, they purchased analytically certified USP-grade aspartame from a distributor. The frequency and severity of psychiatric, neurologic, eye and other complications in the depression group forced the institutional review borad to terminate the study prematurely. [The implication is that the independently provided aspartame is far more potent than that supplied by NutraSweet to researchers. Suspiciously, Schiffman et al, 1987, found that 40 aspartame sensitive students had fewer headaches (35% headache incidence rate) from a single dose of aspartame than with a placebo (45% incidence rate), a non-significant result, clearly at odds with the many case reports and three independently funded double-blind experiments.] The composition of placebos also must be clarified to exclude the presence of excitotoxins. The need for such exclusion recently came to light when the placebo given persons with alleged reactions to monosodium glutamate (MSG) was found to contain aspartame! This probably accounted for the striking frequency of reactions in the "control" group. I regret having to raise these matters. They must be clarified, however, because more than half the population now consumes enormous amounts of a chemical that I regard as an imminent public health neurotoxic hazard. H.J. Roberts, MD West Palm Beach, FL *********************************************************** http://groups.yahoo.com/group/aspartameNM/message/829 RTM: Roberts: Pseudotumor Cerebri Due to Aspartame Disease: Townsend Letter 5.25.2 rmforall http://www.tldp.com/ tldp@olympus.net 360-385-6021 H. J. Roberts, MD, FACP Pseudotumor Cerebri due to aspartame disease. Townsend Letter for Doctors & Patients June, 2002; #227: 66-68. [also discussed on pages 207, and 278-281 in Aspartame Disease] Abstract: Objectives. Clinical insights concerning a remediable cause of pseudotumor cerebri (benign intracranial hypertension) due to aspartame disease. Materials and Methods. Observations of six women with pseudotumor cerebri who consumed considerable aspartame products, especially "diet" sodas. Results. The ocular and other manifestations of aspartame disease disappeared or dramatically improved in all subjects after avoiding aspartame products, even obviating surgery. Conclusions. Aspartame disease should be considered in patients presenting with pseudotumor cerebri, especially weight-conscious young women. The associated clinical features and underlying mechanisms are reviewed with emphasis on chronic methanol toxicity. [Roberts mentions that a number of the cases had headaches, and discusses the role of methanol and formaldehyde toxicity.] *********************************************************** http://groups.yahoo.com/group/aspartameNM/message/635 Rich Murray: Roberts: some abstracts in PubMed 1965-1990 6.15.1 rmforall June 12 2001 I did a quick scan on "Roberts hj" in PubMed. It is easy to sort out a few items from the other H.J. Roberts, leaving about 70 for our man, most of which are not abstracted, indicating that they are letters, not peer reviewed, if I have that right. I give here all the abstracts, some obviously from reputable peer-reviewed journals. They show a clinician of independent and practical, empirical mind, relying on his own hands-on experience, and willing to investigate toxicity from Vitamin E, pesticides, dolomite and bonemeal, thus offending many sides in various toxicity debates. Some journal published articles are not in PubMed -- why? Is something wrong with J Appl Nutr? A search on http://www.google.com gives: http://www.md-phc.com/nutrition/cell_ess.htm JOURNAL OF APPLIED NUTRITION VOLUME 48, NUMBER 3, 1996 ORIGINAL REPORT Copyright - International Academy of Nutrition and Preventive Medicine NUTRITIONAL SUPPLEMENT PROGRAM HALTS PROGRESSION OF EARLY CORONARY ATHEROSCLEROSIS DOCUMENTED BY ULTRAFAST COMPUTED TOMOGRAPHY Matthias Rath, M.D. and Aleksandra Niedzwiecki, Ph.D. So at first glance, the JAN may be a house organ: http://www.iapm.org/ The Internation Academy of Preventive Medicine 7078 Airlie Road Warrenton, Virginia 20187 800-296-3651 Fax - 540-349-4236 scooper@iapm.org http://www.airlie.com 3000 acre Airlie campus Roberts HJ. Reactions attributed to aspartame-containing products: 551 cases. J Appl Nutr 1988; 40:85-94. And neither is this seminal, prescient review: Monte WC. Aspartame: Methyl alcohol and the public health. J Appl Nutr 1984; 36: 42-54. Here are 10 journal letters on aspartame: Roberts HJ Aspartame, tryptophan, and other amino acids as potentially hazardous experiments. South Med J. 1990 Sep; 83(9): 1110-1. Roberts HJ Aspartame (NutraSweet®)-associated epilepsy. Clin Res 1988; 36: 349A. Roberts HJ Complications associated with aspartame (NutraSweet®) in diabetics. Clin Res 1988; 3: 489A. Roberts HJ Joint pain associated with aspartame use. Townsend Letter for Doctors 1991; May: 375-376. Roberts HJ Does aspartame cause human brain cancer? J Adv M 1991; 4 (Winter): 231-241. Roberts HJ Aspartame-associated dry mouth (xerostomia). Townsend Letter for Doctors 1993; February: 201-202. Roberts HJ Aspartame and headache. Neurology 1995; 45: 1631-1633. Roberts HJ Aspartame as a cause of allergic reactions, including anaphylaxis. Arch Intern Med. 1996 May 13; 156(9): 1027-8. Roberts HJ Preclinical Alzheimer's disease (Letter). Neurology 1997; 48: 549-550. Roberts HJ Aspartame and brain cancer. Lancet. 1997 Feb 1; 349(9048): 362. Here are all PubMed abstracts on other topics: Roberts HJ J Fla Med Assoc 1990 Feb; 77(2): 86-90. Pentachlorophenol-associated aplastic anemia, red cell aplasia, leukemia and other blood disorders. Good Samaritan Hospital, West Palm Beach. Aplastic anemia, pure red cell aplasia, leukemia, lymphoma and other hematologic disorders have followed exposure to products containing the pesticide pentachlorophenol (PCP). Information in a 25-year compilation of documented case reports is summarized, involving industrial and home exposure and accidental poisoning in a nursery. The potential hematologic, mutagenic and carcinogenic effects of PCP and its dioxin-dibenzofuran contaminants also are reviewed. Owing to widespread contamination of the environment by PCP products, and latent periods of up to several decades after exposure before these disorders become manifest clinically, it is necessary to consider their etiologic or contributory role. These issues continue to surface in toxic tort litigation relative to causation. Publication Types: Review Review of reported cases PMID: 2106570 Roberts HJ Endangered individualism in medicine. With emphasis upon the ongoing need for competent primary care. J Fla Med Assoc 1989 Sep; 76(9): 777-82. The essential nature of primary care and the attitudes of physicians who provide it--whether on a fee-for-service or corporate basis-- are being severely undermined. Since these issues threaten American medicine and individualism, they demand stocktaking. Publication Types: Review Review, tutorial PMID: 2693584 Roberts HJ Potential toxicity due to dolomite and bonemeal. South Med J 1983 May; 76(5): 556-9. Large amounts of dolomite and bonemeal are being consumed, especially by nutrition-conscious persons. The mineral content of commercial samples has been analyzed by different laboratories, and significant amounts of lead, arsenic, mercury, and other potentially toxic metals, which also exist in conventional vitamin-mineral and calcium supplements, were detected. Physicians must consider the possibility of unrecognized self-poisoning from the consumption of such substances, especially in the context of unexplained neurologic, gastrointestinal, cutaneous, and hematologic disorders. The use of dolomite and bonemeal by pregnant women, children with suspected milk allergy, and elderly persons requires careful evaluation. PMID: 6844959 Roberts HJ Aplastic anemia and red cell aplasia due to pentachlorophenol. South Med J 1983 Jan; 76(1): 45-8. Repeated exposure to commercial (technical grade) pentachlorophenol (PCP) preceded aplastic anemia in four patients and pure red cell aplasia in two. Two patients developed concomitant or subsequent Hodgkin's disease and acute leukemia. The hematologic, mutagenic, and carcinogenic effect of PCP and its chemical contaminants have been documented in other clinical and experimental reports. In view of the widespread contamination of our environment by PCP, clinicians and public health investigators must seek out such exposure in these and related disorders and initiate measures to reduce it. PMID: 6823577 Roberts HJ Timed repetitive ankle jerk responses in early diabetic neuropathy. South Med J 1982 Apr; 75(4): 411-6. A 14-year experience with timed repetitive ankle jerk (TRAJ) testing provides fundamental insights into diabetic neuropathy (DN), both its diagnosis and treatment. Advantages of TRAJ include ease of performance, relative economy of the equipment, reproducibility of results, and a parameter that encompasses the entire reflex arc. Euthyroid patients with features suggesting DN often have prolongation of ankle jerk responses on one or both sides only after repetitive stimulation. Prolongation of TRAJ responses were elicited from 41% of overt diabetics and from 27% and 30% of patients with decreased glucose tolerance demonstrated by morning or afternoon testing, respectively. This characteristic response appears to reflect altered neuromuscular function in DN and was not encountered in patients with myasthenia gravis or thyroid dysfunction in the absence of concomitant glucose metabolic aberrations. PMID: 7071636 Roberts HJ Controversies and enigmas in thrombophlebitis and pulmonary embolism: Perspectives on alleged overdiagnosis. Angiology 1980 Oct; 31(10): 686-99. Increased criticism concerning the alleged misdiagnosis and overdiagnosis of deep vein thrombophlebitis (DVT) in the lower extremities, and of pulmonary embolism is being leveled at clinicians when unequivocal documentation by venography, lung scanning, and pulmonary angiography is lacking. The excessive adoption of this attitude by audit and utilization committees could prove dangerous for patients with these conditions, particularly when rigid criteria intimidate the physician and override his clinical judgment and experience. The matter assumes added importance in view of the increasing magnitude of DVT and pulmonary embolism. The following pertinent issues will be discussed: 1. Failure to consider DVT and pulmonary embolism in the appropriate clinical settings, especially when they are still minor and atypical. 2. Deficiencies in the physical examination. 3. Failure to recognize the inherent limitations of existing diagnostic methods. 4. The perpetuation of diagnostic bias and dogma by teachers and the literature. 5. Confusion introduced by coexisting disorders. The combination of these insights, greater confidence in clinical skills, and newer noninvasive diagnostic methods promise to help resolve this heated controversy. PMID: 7447076 Roberts HJ Transcutaneous electrical nerve stimulation in the symptomatic management of thrombophlebitis. Angiology 1979 Apr; 30(4): 249-56. Transcutaneous electrical nerve stimulation (TENS) afforded significant relief of the pain associated with acute and recurrent thrombophlebitis in 90% of 39 patients so treated. The method is simple to administer, noninvasive, and apparently free of side effects. It can be self-administered by the patient after appropriate instruction. TENS can be given in conjunction with analgesics, anticoagulant therapy, and other supportive measures to achieve greater relief and mobility in patients with thrombophlebitis whose occupations and other activities are severely limited by their pain. Further clinical trials involving larger numbers of patients, and clarification of the analgesic mechanisms involved, are warranted because of the magnitude of this problem. TENS therapy can be uniquely beneficial in certain clinical situations. They include the contraindication of conventional treatments for the pain of thrombophlebitis, pelvic vein phlebitis, and the presence of concomitant painful orthopedic and neurologic disorders. PMID: 443590 Roberts HJ Thrombophlebitis associated with vitamin E therapy. With a commentary on other medical side effects. Angiology 1979 Mar; 30(3): 169-77. I have encountered 50 patients with clinical thrombophlebitis involving the lower extremites, with or without associated edema and pulmonary embolism, in whom longstanding self-medication with large amounts of vitamin E appeared to be a significant factor. The majority improved following cessation of vitamin E. In view of the epidemic nature of thrombophlebitis and deep vein thrombosis in the United States, the presumed innocuousness of vitamin E therapy requires reevaluation. Other clinical side effects also have been noted in patients receiving large doses of vitamin E. They include breast tenderness, elevation of blood pressure, a fatigue syndrome, myopathy, intestinal cramps, urticaria, and the possible aggravation of diabetes mellitus. The influence of concomitant metabolic, endocrine, and cardiovascular disorders on the thrombogenic potential of vitamin E is raised, and several possible mechanisms conducive to thrombophlebitis are reviewed. PMID: 434574 Roberts HJ The noninvasive diagnosis of thrombophlebitis in the lower extremities: clinical value of plethysmography combined with augmentation methods and a new scoring system. Angiology 1978 Apr; 29(4): 275-95. Venous impedance plethysmography and respiratory-compression Doppler augmentation responses have proved to be diagnostically valuable in suspected thrombophlebitis of the lower extremities. These noninvasive methods can provide quantitative and reproducible data on the basis of which the presence of increased deep venous resistance can be confirmed, suspected, or doubted. A new scoring system for the composite evaluation of data from 100 consecutive patients with possible thrombophlebitis, pulmonary embolism, or both, is presented. These procedures assume added importance in view of the diagnostic limitations, and even potential hazards, of other methods. These methods indluce lung scanning, radioactive fibrinogen scanning, venography, and pulmonary angiography. Serial studies can be performed with impunity for following highrisk patients and evaluating various therapeutic or prophylactic measures. The importance of monitoring the femoral-popliteal segment is emphasized, because of the greater propensity for massive pulmonary thromboembolism from thrombi in these veins than in the calf vessels. Clinical observations coupled with these studies underscore the fallacy of several widely-held diagnostic biases pertaining to deep venous thrombosis and pulmonary thromboembolism. The long-term followup of 12 patients in whom inferior vena cava unbrellas has been inserted for life-threatening pulmonary embolism is presented. The possible propensity to deep vein thrombosis from vitamin E therapy is raised. PMID: 306791 Roberts HJ Transcutaneous electrical nerve stimulation in the management of pancreatitis pain. South Med J 1978 Apr; 71(4): 396-8. The application of transcutaneous electrical nerve stimulation (TENS) to the abdomen produced prompt and sustained relief of the pain associated with pancreatitis in five patients and in another patient with probable acute pancreatitis. The disorder was acute in two patients and recurrent in four. Multiple hospitalizations, including the need for analgesics and opiates, had been required during previous attacks in five patients. In view of the simple and noninvasive nature of such treatment, more extensive clinical trials appear to be warranted. Some of the possible mechanisms of action for TENS analgesia are reviewed. PMID: 76340 Roberts HJ Amphetamine. Lancet. 1965 Oct 30; 2(7418): 909-10. ******************************************************** Rich Murray, MA Room For All rmforall@att.net 1943 Otowi Road, Santa Fe NM USA 87505 505-986-9103 http://groups.yahoo.com/group/aspartameNM/messages for 862 posts http://groups.yahoo.com/group/aspartameNM/message/861 brief summary http://groups.yahoo.com/group/aspartameNM/message/862 long summary http://groups.yahoo.com/group/aspartameNM/message/860 RTM: FDA: objections to neotame approval (Section A) 8.4.2 rmforall *********************************************************