Q:My husband had been having “waterworks” problems for many years. He had given up quite a few hobbies and his life had been curtailed by the incontinence. As it became steadily worse with pain in his back and the washing line full of clothes, at l

Several hospital visits and various tests, later, he was prescribed oxybutynin, with follow up appointments. About a year later, we went on a week’s holiday to Scotland and were alarmed to find no toilet on the coach. However, to our surprise, as the holiday progressed, my husband found he was having no desperate problems.

On our return, we realized the only thing that had been different was the fact that he had forgotten to take his artificial sweetener and had used ordinary sugar.

Perhaps there should be a note on the container; on doing a little research there are very many unpleasant side effects to these little white pills. B H, Fareham, Hants……

A:The story of some of those little white pills is an incredible saga. Aspartame, which is sold under the brand names NutraSweet, Hermesetas Gold Choice and Canderel, is an artificial sweetener, 180 to 200 times sweeter than sugar. Fifteen years after it was first approved in America, it has gained wider and wider use, so that it is now found in some 9000 foods in America and hundreds of products in Britain: diet soda, fruit drinks, frozen lollies, as a sugar substitute for coffee or tea, instant breakfasts, mints and chewing gum, cocoa and other instant drinks, supplements, drugs, yoghurt and even wine coolers. It took over where saccharin left off, once studies were published showing a link between the sweetener and bladder cancer in laboratory animals (saccharin is still in the UK in such products as Sweetex, Sweet n’ Low and Natrena).

Enter aspartame, which is now approved in 90 countries around the world, although it is still not permitted in Austria, France, Belgium, Greece, Italy, Holland or Portugal. According to Dr H J Roberts, a diabetic specialist who is something of a world expert on aspartame, the sweetener began life as a drug for peptic ulcer until a drug chemist licked some off his finger and found it to be sweet.

Aspartame is a “dipeptide”, composed of L-phenylanine (50 per cent), and aspartic acid (40 per cent), which are both amino acids, plus methanol (10 per cent). Defenders of aspartame claim that the first two of these components are identical to those which occur after the digestion of all protein foods, and are rapidly and completely digested.

Thus far, the US FDA has sanctioned aspartame as safe for everyone other than people with phenylketonuria (PKU). In this condition, present from birth, the patient lacks the enzyme required to process phenylalanine, and the build up of this amino acid is poisonous to brain tissue. If you have this disorder, the FDA recommends that you avoid any substances with aspartame, and indeed, you must take dietary precautions to prevent ingesting excessive levels.

For years, criticism of aspartame has been limited to a number of specialist groups, like Mission Possible, whose founder, activist Betty Martini stages guerilla warfare campaigns against giants like Coca Cola. Dr Roberts and others claim to have evidence that the phenylalanine itself can cause all sorts of problems. Another danger is the possibility that pheylalanine can break down to methyl ester, which quickly turns into methyl alcohol or methanol another name for wood grain alcohol. At excessive levels, methanol is poisonous and can cause blindness. Although the US Environmental Protection Agency recommends that consumption of methanol be limited to 7.8 mg per day, one can of diet soda contains about twice that, and a diabetic using aspartame all day long might consume more than 30 times that amount. It can also be metabolized into formaldehyde embalming fluid a known carcinogen. It’s known that aspartame causes a blockage of the formation of serotonin in the brain, which would cause insomnia, premenstrual syndrome and a variety of psychiatric disorders like depression.

This breakdown is likely if an aspartame product is exposed to high heat or after prolonged storage. According to Consumer Reports (October 1995), aspartame only has a shelf life of about two to three months, after which it loses some of its sweetness and the product begins to break down. Outrageously, the FDA has approved the use of aspartame in a number of foods which require heating.

Lately, aspartame has come under fire in the medical literature. University of Washington psychiatrist John Olney analyzed National Cancer Institute data from 1975 to 1992 and claimed to find a 10 per cent rise in the incidence of glioblastomas, or brain tumours, between 1975 and 1992, three years after aspartame was approved in the US. Olney, who published his findings last month (J Neuropathol Exp Neurol, 1996; 55: 1115-23), argues that this sudden jump in the statistics was in all likelihood caused by some sort of environmental carcinogen, and the epidemiological evidence appeared to point the finger at aspartame. The FDA counters that the incidence of these cancers has now flattened and even decreased.

Olney has implicated diketopiperazine (DKP, a byproduct of aspartame metabolism) because it produces a compound which is similar to N-nitrosourea, a powerful brain tumour causing chemical. The Journal of Agriculture and Food Chemistry (33 (4): 734-8) discovered that 135.66 mg of DKP is present in liquids with aspartame after six months, and 173.28 mg after 30 months.

In Britain, Dr Erik Millstone of the Sciency Policy Research Unit at Sussex University maintains that aspartame was accepted in the UK on the basis of animal tests which weren’t properly conducted. According to his evidence, the 15 pivotal studies leading to aspartame approval both in the US and the UK had serious flaws or demonstrated risk.

In one of those studies, seven monkeys received varying dosages of aspartame in powdered milk formula. According to the study, all the monkeys exhibited grand mal seizures after 218 days, and one monkey in the high dose group died, although the cause of death wasn’t determined.

Then once the aspartame was withdrawn, the monkeys were kept under observation for three months on unsweetened powdered milk formula. “No further convulsions were detected,” said the study.

Despite the FDA’s assurances of safety, aspartame accounts for more than 75 per cent of the adverse reactions to food reported to the FDA. Some of these reactions are very serious, including death (Department of Health and Human Services, “Report on All Adverse Reactions in the Adverse Reaction Monitoring System”, 25-28 February 1994).

According to the US based Aspartame Consumer Safety Network, several hundred pilots have reported symptoms including memory loss and confusion, headaches, seizures, visual disturbances and even gastrointestinal reactions. Pilots are classically high consumers of diet soda, because of their need to consume large quantities of liquid, coupled with a desire to keep their caloric consumption down.

One study showed significantly more headaches in people taking aspartame (Neurology, 1995; 45: 1631; 1994, 44: 1787-93). Aspartame has also been implicated in psychotic reactions such as mania. In another study, depressed patients given aspartame exhibited such bizarre behaviour that the study had to be abandoned (Biological Psychiatry, 1993; 34: 13-7).

Besides Roberts and Olney, Professor Richard Wurtman of Massachussetts Institute of Technology has published a number of studies demonstrating that aspartame can affect the biochemistry of the brain. He also claims that his clinical evidence demonstrates that very high doses of aspartame can provoke epileptic seizures in humans.

Dr Roberts claims that he has found scores of patients with “unequivocal reactions to aspartame, including nausea, bloating, abdominal pain, gas, diarrhea (sometimes bloody) symptoms which he was able to reproduce after the patients stopped taking the products and then reintroduced them (New Eng J Med, 333 (20): 1359). At least 7,300 Americans have reported serious reactions to the FDA. Dr Wurtman and others have also found that aspartame makes you gain weight because it increases the appetite for carbohydrates and sugar, and in diabetics it can throw off insulin control.

The other worry with artificial sweeteners are their effect on the baby during pregnancy or breastfeeding. Dr Roberts says there is scientific evidence that during pregnancy, the placenta concentrates pheylalanine and methyl alcohol, causing mental retardation in the fetus. Pregnant women consuming large quantities of diet cola to avoid weight gain also risk maternal malnutrition because of the gastrointestinal problems and diarrhea often associated with these products.

In his studies and his book (Aspartame (NutraSweet): Is It Safe? (Philadelphia, The Charles Press), Dr Roberts claims that the side effects of artificial sweeteners tend to be exacerbated in children. Besides those listed for adults, children can have rashes, asthma, weight loss or gain, hyperactivity, depression, antisocial behaviour, low intelligence, poor school performance and irritability. And of course, these risks multiply in diabetic children, who are most likely to be fed a steady diet of chemical soda and candy.

There is even a suggestion that aspartame can be toxic to the liver. In one case, a man who’d undergone a successful heart transplant developed diabetes. Subsequently, his liver began failing. Doctors were at a loss as to what to do, and it seemed as though he might reject the heart too. At her wit’s end, his wife read up on liver problems and discovered her husband should reduce intake of phenylalanine. She realized that her husband’s liver condition was probably linked to all the diet foods her husband was eating since he’d become diabetic. Once she removed them and his artificial sweetener, her husband’s liver quickly returned to normal (Townsend Letter for Doctors & Patients, June 1996).

Because it is classified as a food additive, post marketing studies of aspartame aren’t required. More worryingly, it isn’t always listed as an ingredient, particularly in such things as vitamin supplements. If you have any doubts about sweetened substances like kiddy vitamins, gum or juice “drinks”, write to the manufacturer and ask what the sweetening agent is. No artificial sweetener has had a good history. There are even indications that the latest, acesulfame K, may be carcinogenic (BMJ, 1996; 323: 386). It makes good health sense to avoid them like the plague and stick to natural, unprocessed foods.

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Written by What Doctors Don't Tell You

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