Unexplained shortness of breath represents an increasing clinical challenge. The frequency and severity of dyspnea in patients with reactions to widely-used aspartame products, coupled with a pertinent fatal case of pulmonary hypertension, appear to provide new insights concerning treatment and causation.
Significant dyspnea was a primary complaint in 110 of 1200 persons (9 percent) with reactions to aspartame products; it could not be attributed to known lung or heart disorders. The majority were weight-conscious women in their 20s to 40s. Most experienced gratifying improvement after avoiding aspartame. Another women who died at the age of 27 with severe dyspnea and other features attributed to aspartame disease was found to have primary pulmonary hypertension at autopsy.
A trial of abstinence from all aspartame products ought to be recommended for patients with unexplained dyspnea, especially when pulmonary hypertension exists - and prior to administering drugs aimed at reducing pulmonary pressure.
Aspartame disease has emerged as a serious disorder since the approval of aspartame as a sugar substitute two decades ago. This chemical is in thousands of "diet" products currently being consumed by over 70% of the population.
The frequency and severity of chest complaints in persons with this disorder among a database of 1200 aspartame reactors have been impressive. One hundred and ten individuals (9%) without known or demonstrable pulmonary or cardiac disease complained of shortness of breath. The FDA also received comparable volunteered complaints of "difficulty breathing" by 112 consumers in its April 20, 1995 report.
The majority of individuals in the present series experienced marked relief of both dyspnea and other aspartame-associated symptoms, including unexplained chest pain, within several days or weeks after avoiding these products.
The reason for such dyspnea remained an enigma until the author learned that a young woman with apparent aspartame disease developed fatal pulmonary hypertension without demonstrable cause, confirmed by autopsy. Her detailed diary and observations by relatives provided additional relevant information.
This experience offers constructive insights about similar problems now challenging primary care and consulting physicians. It also provides an important environmental (dietary) clue concerning the pathogenesis of "primary" pulmonary hypertension that is consistent with the metabolism of aspartame, especially its vasoactive breakdown products. To the best of my knowledge, these observations have not been published previously.
Symptomatic Dyspnea: Representative Case Reports The following case reports illustrate the clinical context in which patients with aspartame disease suffered dyspnea and concomitant complaints. Various correlates, including the female preponderance, are later discussed.
Case 1: A 40 year old woman had suffered marked shortness of breath that intensified during the night. Other complaints included blurred vision, dizziness, headache, and fainting episodes with falling. She saw many physicians who remained perplexed about the nature of her problem despite numerous tests and one hospitalization on an intensive care unit for suspected pulmonary embolism. This diagnosis could not be confirmed. Her past medical history was not remarkable. She did not use drugs or alcohol.
Shortly after her hospitalization the patient chanced to hear my interview with a talk show host in Philadelphia. She had been consuming six to eight glasses of diet cola daily for three years. There was prompt and gratifying improvement after abstinence.
Case 2: A 35 year old woman developed persistent "shortness of breath" for which she consulted many physicians. She would awaken during the night "unable to breathe." Other problems included dizziness, fatigue, irritability, hair loss, heavy menstrual bleeding, abdominal pain, weight gain, and dryness of the skin.
The patient had been variously diagnosed as having atypical asthma, "a swollen larynx," and "stress." She disagreed with the latter in view of leading an exemplary personal and professional life. There was a history of treated hypothyroidism. She chewed aspartame-containing gum daily.
By a process of elimination, the patient made the diagnosis herself. She stated, "I already had spent a small fortune on tests that included asthma studies, upper/lower GIs, ultrasounds, X-rays, blood work, cholesterol and heart, lung and gynecologic testing. I even considered seeing a psychiatrist. I then stopped using this gum, and felt relief almost immediately. I retested myself numerous times to see if I had really found the answer. I am completely assured that the aspartame causes all my problems. At one later time, I consumed a diet soda, not knowing that they had switched from saccharin to aspartame. Within the hour, I could not catch my breath."
Case 3: A female athlete became concerned about her weight. She had run five to 13 miles daily for eight years without difficulty. After beginning to consume diet sodas, she experienced dyspnea while on a treadmill. The diagnosis of asthma was made. Chest films and other studies failed to reveal any cause. Concomitant symptoms included severe headache, impaired vision, confusion, rapid heart rate, numbness and tingling of the limbs, and joint pains.
The diagnosis of aspartame disease was fortuitously made when she happened to see an article about it. Reading the details, "I almost began to cry." A gratifying remission occurred after stopping aspartame products.
Documented Case of Fatal Pulmonary Hypertension A 23 year old woman began consuming 2-3 cans of diet cola daily. She felt poorly thereafter and recorded her symptoms in a dairy. Her chief complaint: "I have difficulty breathing. I can't get enough air. Chest pains are sometimes associated with this."
Other symptoms included dizziness, headache, facial pains, abdominal pain, nausea, sore throat, intense exhaustion ("I get very tired and have to take naps in the afternoon. My whole body feels like someone sapped the strength out of me"), panic attacks, joint pains (especially of the hands, wrists and knees), and episodic hypotension.
These complaints at first seemed to "run in cycles," on the basis of which her physician felt it was a "classic seasonal allergy." Treatment aimed at her presumed allergy, however, proved unsuccessful. She wrote, "it still doesn't tell me what causes this in the first place. If I knew that, I would avoid it at all costs!" Other therapeutic measures, including thyroxine and Florinef, failed to provide relief. She also was seen in consultation at a major medical center.
The patient developed impaired vision the last week of her life. When coupled with intensification of the other symptoms, she sought hospitalization.
A detailed autopsy was performed. The final pathologic diagnosis was "pulmonary hypertension". It was based on "marked hypertrophy and luminal narrowing of the pulmonary vasculature; plexiform lesions, lungs; dilatation of the right atrium and ventricle." The pathologist specifically searched for other known causes of pulmonary hypertension. He also emphasized the absence of alcohol intake or drug abuse prior to death.
Discussion: The spectrum of complaints experienced by patients in this series and in the reported fatal case are consistent with aspartame disease. 1-3 Several noteworthy aspects include the 3:1 female preponderance, the usual occurrence of multiple symptoms in addition to dyspnea, the oft-dramatic remissions following abstinence from aspartame products, and prompt exacerbations after rechallenge - both on self-challenge and from inadvertent exposure.
Aspartame consists of the amino acids phenylalanine (50%) and aspartic acid
(40%) and a methyl ester (10%) that promptly becomes free methanol after entering the stomach. Each component contributes to its toxicity, especially derangements in the nervous system, eyes, heart, lungs, joints, endocrine glands and general metabolism. The occurrence of sleep apnea in aspartame users1 may reflect neurotransmitter dysfunction within the respiratory center. The breakdown of phenylalanine to highly vasoactive substances - dopamine; norepinephrine; epinephrine - is clearly relevant to pulmonary hypertension and cardiac arrhythmias. Their arterial manifestations have been documented as hypertension (at times suspected of being due to a pheochromocytoma), and the Raynaud phenomen. 1 Another pertinent clinical observation is the hypertensive summation of phenylalanine and tyramine effects.
These observations warrant the rethinking of "primary" or "idiopathic" pulmonary hypertension. In an earlier text," I elaborated on the need to seek out the multiple possible causes of pulmonary hypertension before applying the label "primary." The observation of the Raynaud phenomenon in such patients suggested a concomitant vasospastic process affecting the pulmonary arterioles.
The diagnosis of aspartame disease is important because avoidance of aspartame
and other substances that contain its components can be therapeutic and potentially
life-saving. It deserves special emphasis in the case of weight-conscious young
women with previously normal pulmonary and cardiovascular systems for several
reasons. First, this group has been known to be at greater risk for pulmonary
hypertension. 5,6 Second, about
300 new cases of pulmonary hypertension are diagnosed annually according to the National Institutes of Health. Third multiple environmental causes may be operative as suggested in l957 by Wade and Ball. 8 The occurrence of pulmonary hypertension in Europe during the late l960s following the introduction of aminorex fumarate, an amphetamine-like drug used to suppress appetite, is germane.
Another factor underscores the importance of specifically seeking out aspartame and other contributory factors: the introduction of potent new drugs aimed at reducing pulmonary hypertension. 7 They ought not be administered until the result of a trial of aspartame abstinence is evaluated. This precaution may prevent sudden death caused by aspartame-related cardiac arrhythmias.
Correspondence: H. J. Roberts, M. D., FCCP, FACP Director, Palm Beach Institute for Medical Research P. O. Box 17799 West Palm Beach, Florida 17799 USA
1. Roberts, H. J., Aspartame Disease: An Ignored Epidemic. West Palm Beach. Sunshine Sentinel Press; 2001
2. Roberts, H. J. Reactions attributed to aspartame containing products:
551 cases. J Appl Nutr 1988;40:85-94
3. Roberts, H. J. Aspartame (NutraSweet) Is It Safe? Philadelphia. The Charles Press; 1989
4. Roberts, H. J. Difficult Diagnosis: A Guide to the Interpretation of Obscure Illness, Philadelphia. W. B. Saunders Company; 1958
5. Blount, SG Jr. Primary pulmonary hypertension. Mod Concepts Cardiovas Dis 1967,36-67-72
6. Yu PN Primary pulmonary hypertension: Report of six cases and review of literature. Ann Int Med 1958;49:1138-1161.
7. Middleton O. FDA panel backs Actelion drug to treat pulmonary hypertension. Wall St J 2001; August 13: B-2
8. Wade, G. Ball J. Unexplained pulmonary hypertension Quart J Med
Martini: Aspartame triggered Sudden Death has become quite prevalent. An autopsy report is similar to the one mentioned in this article. Acute and chronic methanol poisoning, metabolic acidosis, pulmonary edema. For a month prior to death this aspartame victim complained of some shortness of breath. History of intermittent nausea, continuing shortness of breath. History of admission to hospital with profound metabolic acidosis and death due to acute and likely chronic methanol poisoning. (See Aspartame: Methanol and the Public Health by Dr. Woodrow Monte on www. dorway. com ) Patient was drinking about 10 diet drinks laced with aspartame a day, Metrex with aspartame. (and more) In molecular chemistry its one molecule of aspartic acid (an excitotoxin) to one molecule of methanol, a neurotoxin, to one molecule of phenylalanine, as an isolate, a neurotoxin. No one involved knew that aspartame causes sudden death and that it contains methanol and triggers methanol toxicity. His wife after losing her husband and her home has been imprisoned for 50 years. She has three children. Her attorney says she committed no crime and passed a polygraph. Anyone who wants to help free this woman and return her to her children please contact me.
Betty Martini, Founder, Mission Possible Intl, 9270 River Club Parkway, Duluth,
Georgia 30097 770
242-2599 www. dorway. com