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Vestibulocochlear toxicity in a pair of siblings [doctor & nurse] 15 years apart secondary to aspartame: two case reports, Paul Pisarik & Dasha Kai, Cases J 2009.09.15 free full text: Rich Murray 2010.05.04

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  • Rich Murray
    Vestibulocochlear toxicity in a pair of siblings [doctor & nurse] 15 years apart secondary to aspartame: two case reports, Paul Pisarik & Dasha Kai, Cases J
    Message 1 of 1 , May 4, 2010
      Vestibulocochlear toxicity in a pair of siblings [doctor & nurse] 15 years
      apart secondary to aspartame: two case reports, Paul Pisarik & Dasha Kai,
      Cases J 2009.09.15 free full text: Rich Murray 2010.05.04
      Tuesday, May 4, 2010

      [ Other formaldehyde sources include alcohol drinks and
      tobacco and wood smoke,
      while adequate folic acid levels protect most people. ]

      "For both, subsequent intentional challenges with aspartame
      and unintentional exposures brought back each of their
      respective symptoms."

      "After the last occurrence of her nausea, headaches, and
      vertigo, she has since not consumed aspartame in any product
      or form and has been symptom free for 22 years."

      "Except for six mild reoccurrences of his symptoms within 24
      hours of unintentionally consuming something with aspartame
      (hypoesthesia anterior to the tragus and mild tinnitus) lasting
      2-4 hours, he has been symptom free for over six years now."

      Cases J. 2009 Sep 15; 2: 9237.
      Vestibulocochlear toxicity in a pair of siblings 15 years apart
      secondary to aspartame: two case reports.
      Pisarik P, Kai D.
      University of Oklahoma College of Medicine, Tulsa,
      1111 S. St. Louis Ave. Tulsa, OK 74120-5440, USA.



      Aspartame may have idiosyncratic toxic effects for some
      however, there are few case reports published in the medical
      We present two case reports in a pair of siblings, one with a
      vestibular and the other with a cochlear toxicity to aspartame.
      The cochlear toxicity is the first case to be reported, while
      the vestibular toxicity is the second case to be reported.


      A 29-year-old white female had a 20-month history of nausea
      and headache, progressively getting worse with time and
      eventually to also involve vomiting, vertigo, and ataxia.
      She was extensively evaluated and diagnosed with a vestibular
      neuronitis versus a chronic labyrinthitis and treated
      symptomatically with limited success.
      In response to a newspaper article, she stopped her aspartame
      consumption with total cessation of her symptoms.

      Fifteen years later, her then 47-year-old white brother had a
      30-month history of an intermittent, initially 5-10 minute long
      episode of a mild sensorineural hearing loss in his right ear that
      progressed over time to several hour episodes of a moderately
      severe high-frequency sensorineural hearing loss to include
      tinnitus and a hypoesthetic area in front of his right tragus.
      After a negative magnetic resonance scan of the brain, he
      remembered his sister's experience with aspartame and
      stopped his consumption of aspartame with resolution of
      his symptoms, although the very high frequency hearing loss
      took at least 15 months to resolve.
      For both, subsequent intentional challenges with aspartame
      and unintentional exposures brought back each of their
      respective symptoms.


      Aspartame had a vestibulocochlear toxicity in a pair of siblings,
      suggesting a genetic susceptibility to aspartame toxicity.
      Even though the yield may be low, asking patients with
      dizziness, vertigo, tinnitus, or high-frequency hearing loss
      about their aspartame consumption and suggesting cessation
      of its use, may prove helpful for some.
      PMID: 20126318 [PubMed - in process]
      PMCID: PMC2815650
      Free PMC Article

      4 pages 165 KB


      Cases J. 2009; 2: 9237.
      Published online 2009 September 15.
      doi: 10.4076/1757-1626-2-9237.
      PMCID: PMC2815650
      Copyright ©2009 Pisarik and Kai;
      licensee Cases Network Ltd. licensee BioMed Central Ltd.

      Vestibulocochlear toxicity in a pair of siblings 15 years apart
      secondary to aspartame: two case reports
      Paul Pisarik 1 and Dasha Kai 2
      1 University of Oklahoma College of Medicine, Tulsa,
      1111 S. St. Louis Ave. Tulsa, OK 74120-5440, USA
      2 University Physician's Hospital,
      2800 E. Ajo Way, Tucson, AZ 85713, USA
      Corresponding author.
      Paul Pisarik: paul-pisarik@...;
      Dasha Kai: dasha456@...
      Received January 2, 2009; Accepted August 25, 2009.
      This is an Open Access article distributed under the terms of
      the Creative Commons Attribution License
      ( http://creativecommons.org/licenses/by/3.0 ), which permits
      unrestricted use, distribution, and reproduction in any
      medium, provided the original work is properly cited.


      Aspartame was approved by the United States Food and
      Drug Administration (FDA) in 1981 for use in dry products
      such as breakfast cereal and as a tabletop sweetener [1].
      Later in 1983 it was approved for use in sodas and in 1995
      as a general sweetener in all foods and drinks.
      Because of its very sweet taste, aspartame has been
      extensively used as a food additive.
      It is included in over 6000 products and consumed by
      200 million people around the world [2].
      Because of its ubiquity in our food supply, the FDA has
      received many complaints over the years that allege that
      aspartame was responsible for a myriad of consumers'

      A PubMed search only shows only 14 case reports or case
      series regarding potential aspartame toxicity.
      The neurotoxic reactions reported include migraines,
      carpal tunnel syndrome, a movement disorder of the arms
      and legs, an orofacial sensitivity reaction, vertigo and ataxia,
      and seizure and mania.
      This will be the first paper to show a sensorineural hearing
      loss temporally related to aspartame and the second to show
      a vestibular toxicity temporally related to aspartame [3].

      Case presentation

      Case report 1

      The first case was a 29-year-old white non-Hispanic female
      nurse (one of the authors) who started experiencing nausea
      and vomiting 3 weeks after conceiving her first pregnancy that
      persisted throughout her pregnancy.
      Her pregnancy was complicated with a 114-pound weight
      gain and pre-eclampsia.
      Her delivery was complicated with shoulder dystocia and
      post partum hemorrhage.
      After her delivery in January 1985, her symptoms got better
      in that she only had nausea in the mornings that cleared by
      1 or 2 P.M.
      She also had headaches on awakening in the morning up to
      3 days a week.

      She was on no medications and had no allergies to
      She denied use of alcohol, cigarettes, or any other drugs.
      Her past medical history was significant for intermittent
      She had multiple right eye surgeries for strabismus in the
      early 1960s and a tonsillectomy and adenoidectomy in 1965.
      She was 5 foot and 11 inches tall and weighed 165 lbs
      prior to her pregnancy, 264 lbs just after her delivery that
      decreased over the time to 180 lbs at time of her

      She went to see her physician in July 1985 with these
      Her physician treated her with oral prochlorperazine and
      however, these medications did not have much effect on her.

      In January 1986, she again saw her physician with the same
      The neurological exam was normal except for showing a few
      beats of nystagmus on lateral gaze.
      She was again treated symptomatically with metoclopramide
      and trimethobenzamide.
      Over the next several months, the nausea progressed to
      encompass the entire day along with some vomiting.
      In addition, she was experiencing vertigo with motion and
      lying in bed.

      She saw her physician in June 1986 and was noted to have
      nonfatiguing nystagmus on looking to the right.
      She had audiologic testing that was normal but had an
      electronystagmograph (ENG) that showed a direction-fixed
      right-beating positional nystagmus of about six degrees.
      She was referred to an otolaryngologist who noted a
      positioning nystagmus consistent with the ENG that was
      easily reproduced and persistent.
      Radiographs of the internal auditory canals were normal.
      Because of the persistence of her symptoms, she was then
      referred to a neurologist.
      He ordered a brainstem auditory evoked response test and
      a magnetic resonance imaging scan of the brain, both of which
      were normal.
      His final diagnosis was a vestibular neuronitis versus a chronic
      labyrinthitis and he gave her diazepam to take as needed.

      Over the next two months, her symptoms got worse to where
      she was experiencing problems with muscle coordination
      manifested by occasionally not being able to negotiate
      doorways and occasionally not being able to place a spoon
      squarely in her mouth.

      In September 1986, she read a doctor-advice column in the
      local paper that mentioned aspartame was anecdotally
      associated with nausea and headaches.
      She had first begun to drink an aspartame-sweetened
      drink -- Crystal Light (R) -- right after the birth of her son
      and was drinking 16 to 32 ounces per day, sipping on it
      throughout the day.
      She made sure that she did not consume it during her
      After reading the article, she stopped drinking Crystal
      Light (R), her only source of aspartame, and within a week,
      she was symptom free.
      About a month later, she challenged herself with 8 ounces of
      Crystal Light (R) and within 1 to 2 hours started having
      nausea, headaches, and vertigo that lasted for 48 hours.
      About 3 to 4 weeks later she drank a 12-ounce can of Diet
      Pepsi (R) and within 1 hour started to have the exact same
      symptoms, again lasting about 48 hours.
      She had a recurrence of the symptoms two times after that,
      each time after accidentally drinking a beverage with
      aspartame in it.
      After the last occurrence of her nausea, headaches, and
      vertigo, she has since not consumed aspartame in any product
      or form and has been symptom free for 22 years.

      Primary diagnosis is a vestibular neuronitis versus chronic
      labyrinthitis secondary to aspartame.
      Secondary diagnosis is nausea and vomiting of pregnancy.

      Case report 2

      In January of 2002 at the age of 47, a non-Hispanic white
      male physician (one of the authors and brother of case
      report 1) had an intermittent right-sided tinnitus associated
      with a hearing loss that would last 6-8 hours at a time.
      In addition, at the same time, he had a 1.5 cm diameter area
      of hypoesthesia in the region just anterior to the tragus of his
      right ear.
      He had noted a very minor right-sided hearing loss for at
      least two years prior to this, but it would never last more
      than for a few minutes, perhaps once a month, and he never
      thought much about it.
      There was no vertigo, nausea, headaches, or other
      neurological symptoms associated with this.

      He was 6' 3'' tall and weighed 180 pounds.
      His past medical history was pertinent for benign prostatic
      hypertrophy treated with finasteride since January 1998.
      He had no allergies to medications.
      He denied use of alcohol, cigarettes, or other drugs.
      His past surgical history was pertinent for a tonsillectomy and
      adenoidectomy in 1963 and an open reduction and internal
      fixation of a comminuted left distal radius fracture in May of
      2001 with subsequent removal of hardware in August of 2001.
      Family history was pertinent for a sister 15 years earlier having
      a vestibular neuronitis versus chronic labyrinthitis secondary to

      Between January and August 5, 2002, he had five such prolonged episodes,
      along with the episodes that lasted for a few minutes.
      On August 5th, he woke up with one such episode that lasted
      10 hours before it went away.
      On August 8th, he had another episode that started at noon
      and unlike his previous episodes, lasted three days with a
      severe tinnitus and hearing loss.
      He contacted an otolaryngologist and was started on
      He had an audiogram on August 9th that showed a
      right-sided high frequency sensorineural hearing loss
      (see table 1).
      By the time he saw the otolaryngologist on August 12th, the
      hearing loss resolved clinically and another audiogram was
      done and was much improved and similar to a previous
      audiogram he had done in 1987, except for a remaining
      35-decibel loss at 8000 Hertz (Hz) (see table 1).

      At the time of his otolaryngologist appointment, his physical
      exam was normal.
      A magnetic resonance imaging scan of the brain with and
      without gadolinium was normal.

      Table 1

      Hearing threshold levels in dB (re: ANSI-1969) of case
      report 2 for each ear at different points in time

      When the otolaryngologist did not have an explanation for his
      symptoms, the patient remembered that his sister had the
      adverse reaction to aspartame 15 years earlier.
      Up until now, he had consumed foods with aspartame,
      undeterred by his sister's experience.
      At this time, he was consuming aspartame in the form of one
      to two cans of Caffeine Free Diet Coke® along with a bowl
      of Fiberall (R) cereal a day.
      Thereafter he stopped consuming aspartame in any form.
      Over the next two months, he had no more severe episodes
      of tinnitus and hearing loss but did have two further episodes
      of milder right-sided tinnitus and hearing loss (30% of prior
      intensity) and only lasting 3-4 hours.

      Thinking that it might not be due to aspartame, he drank a can
      of Caffeine-free Diet Coke® a day for four days in a row.
      On each of these days, he had a mild episode of right-sided
      tinnitus and hearing loss for 2-3 hours each day.
      He permanently stopped his aspartame consumption after that.
      He had one milder episode of tinnitus and hearing loss a couple
      of weeks after he finished his challenge.

      Follow-up audiograms showed a slowly improving 8000 Hz
      hearing loss:
      November of 2002 showed only a 20 decibel loss compared
      to 1987
      and November of 2003 showed a 10 decibel loss compared
      to 1987 (see table 1).

      Primary diagnosis is tinnitus and sensorineural healing loss
      secondary to aspartame.

      Except for six mild reoccurrences of his symptoms within 24
      hours of unintentionally consuming something with aspartame
      (hypoesthesia anterior to the tragus and mild tinnitus) lasting
      2-4 hours, he has been symptom free for over six years now.


      Aspartame had a vestibulocochlear toxicity in a pair of siblings
      suggesting an idiosyncratic genetic predisposition to aspartame
      In addition, the cochlear toxicity in case report 2 took at least
      15 months to clear after his cessation of aspartame use
      suggesting that aspartame's cochlear toxicity can be long

      Patients with dizziness, vertigo, tinnitus, and hearing loss
      present not only to otolaryngologists and neurologists, but
      also to primary care clinicians frequently.
      Even though the yield may be low, asking them about their
      aspartame consumption and suggesting cessation of its use,
      may prove helpful for some.


      ENG: electronystagmograph;
      FDA: Food and Drug Administration.


      Written informed consent was obtained from the patients for
      publication of these case reports.
      A copy of the written consent is available for review by the
      Editor-in-Chief of this journal.

      Competing interests

      The authors declare that they have no competing interests.

      Authors' contributions

      DK obtained copies of her medical records when her health
      clinic closed down in the late 1980s and contributed both
      subjective and objective findings to case report 1.
      PP contributed to case report 2 and did the literature search.
      All authors read and approved the final manuscript.


      US FDA.
      Artificial Sweeteners: No Calories ... Sweet!
      FDA Consumer Magazine. July-August 2006.

      Butchko HH, Stargel WW.
      Aspartame: scientific evaluation in the postmarketing period.
      Regul Toxicol Pharmacol. 2001;34:221-233.
      doi: 10.1006/rtph.2001.1500. [PubMed]

      Gulya AJ, Sessions RB, Troost TR.
      Aspartame and dizziness: preliminary results of a prospective,
      nonblinded, prevalence and attempted cross-over study.
      Am J Otol. 1992;13:438-442. [PubMed]

      Articles from Cases Journal are provided here courtesy of
      BioMed Central

      recent aspartame (methanol, formaldehyde, formic acid)
      symptoms in English professor: Kristi Siegel:
      Rich Murray 2010.04.17
      Saturday, April 17, 2010

      "Shortly after seeing the ophthalmologist and about two
      weeks or so into my Crystal Light regimen, I had my first
      episode of vision loss. [ last week of January ]
      This incident was completely different in degree and kind
      than the normal visual problems (increased far-sightedness
      and visual lability) I had been experiencing.
      Rather abruptly, I lost the visual field of the left hemisphere
      of my left eye.
      The vision loss lasted for about 20 or 30 minutes and after
      approximately 15 minutes, I started to develop a crushing
      headache which lasted for hours.
      I've never had a history of headaches, so the intensity and
      duration of this headache was unusual."

      formaldehyde from 11% methanol part of aspartame causes
      severe allergic dermatitis in boy, JE Jacob et al,
      Pediatric Dermatology 2009 Nov: Rich Murray 2010.03.30
      Tuesday, March 30, 2010

      Pediatric Dermatology. 2009 Nov-Dec;26(6):739-43.
      Systematized contact dermatitis and montelukast in an atopic
      Castanedo-Tardan MP,
      González ME,
      Connelly EA,
      Giordano K,
      Jacob SE.
      University of Miami, Miller School of Medicine, Department
      of Dermatology and Cutaneous Surgery, Miami, Florida,

      Upon ingestion, the artificial sweetener, aspartame is
      metabolized to formaldehyde in the body and has been
      reportedly associated with systemic contact dermatitis in
      patients exquisitely sensitive to formaldehyde.

      We present a case of a 9-year-old Caucasian boy with a
      history of mild atopic dermatitis that experienced severe
      systematized dermatitis after being started on montelukast
      chewable tablets containing aspartame.

      Patch testing revealed multiple chemical sensitivities which
      included a positive reaction to formaldehyde.

      Notably, resolution of his systemic dermatitis only occurred
      with discontinuation of the montelukast chewables.
      PMID: 20199453

      four Murray AspartameNM reviews in SE Jacob & SA
      Stechschulte debate with EG Abegaz & RG Bursey of
      Ajinomoto re migraines from formaldehyde from aspartame,
      Dermatitis 2009 May: TE Hugli -- folic acid with V-C
      protects: Rich Murray 2009.08.12
      Wednesday, August 12, 2009
      [ extracts ]

      Formaldehyde, aspartame, migraines: a possible connection.
      Abegaz EG, Bursey RG.
      Dermatitis. 2009 May-Jun;20(3):176-7; author reply 177-9.
      No abstract available. PMID: 19470307

      Eyassu G. Abegaz *
      Robert G. Bursey
      Ajinomoto Corporate Services LLC, Scientific & Regulatory
      Affairs, 1120 Connecticut Ave., N.W., Suite 1010,
      Washington, DC 20036
      * Corresponding author. Tel.: +1 202 457 0284;
      fax: +1 202 457 0107.
      abegazee@... (E.G. Abegaz),
      burseyb@... (R.G. Bursey)

      "For example, fruit juices, coffee, and alcoholic beverages
      produce significantly greater quantities of formaldehyde than
      aspartame-containing products. [6]"

      "[6] Magnuson BA, Burdock GA, Doull J, et al. Aspartame:
      a safety evaluation based on current use levels, regulations,
      and toxicological and epidemiological studies.
      Crit Rev Toxicol 2007;37:629-727"

      [ two detailed critiques of industry affiliations and biased
      science in 99 page review with 415 references by BA
      Magnuson, GA Burdock and 8 more, Critical Reviews in
      Toxicology, 2007 Sept.: Mark D Gold 13 page:
      also Rich Murray 2007.09.15: 2008.03.24
      Monday, March 24, 2008

      "Nearly every section of the Magnuson (2007) review has
      research that is misrepresented
      and/or crucial pieces of information are left out.

      In addition to the misrepresentation of the research,
      readers (including medical professionals) are often not told
      that this review was funded by the aspartame manufacturer,
      Ajinomoto, and the reviewers had enormous conflicts of
      interest." ]


      Dermatitis. 2008; 19(3): E10-E11.
      © 2008 American Contact Dermatitis Society
      Formaldehyde, Aspartame, and Migraines:
      A Possible Connection
      Sharon E. Jacob; Sarah Stechschulte
      Published: 09/17/2008
      [ Extract ]


      Aspartame is a widely used artificial sweetener that has been
      linked to pediatric and adolescent migraines.
      Upon ingestion, aspartame is broken, converted, and oxidized
      into formaldehyde in various tissues.
      We present the first case series of aspartame-associated
      migraines related to clinically relevant positive reactions to
      formaldehyde on patch testing.

      Case Series

      Six patients (ages 16 to 75 years) were referred for evaluation
      of recalcitrant dermatitis. By history, five of the patients were
      noted to have developed migraines following aspartame
      consumption; the sixth reported dermatitis flares associated
      with diet cola consumption of >2 liters/day.

      All six patients had current environmental exposures to
      formaldehyde or formaldehyde-releasing preservatives in
      their personal hygiene products and/or regular consumption
      of "sugar-free food" artificially sweetened with aspartame.

      Based on their histories and clinical presentations, these
      patients were patch-tested with the North American Contact
      Dermatitis Group 65-allergen Standard Screening Series and
      selected chemicals from the University of Miami vehicle,
      fragrance, bakery, and textile trays.

      All six patients had positive reactions to formaldehyde, and
      four had additional positive reactions to
      formaldehyde-releasing preservatives (FRPs).
      Expert counseling on allergen avoidance (including avoidance
      of formaldehyde, FRPs, and aspartame) and alternative
      product recommendations were provided to the patients.

      At their follow-up appointments (between 8 and 12 weeks),
      all the patients showed clearance of their dermatitis. Four
      patients (two inadvertently) resumed their consumption of
      aspartame and subsequently returned for an additional
      follow-up visit. Three of the first five patients had recurrences
      of both their migraines and their dermatitis; the sixth patient
      (who had no migraines) had a positive rechallenge dermatitis.
      These four patients were again counseled on avoidance

      formaldehyde, aspartame, and migraines, the first case series,
      Sharon E Jacob-Soo, Sarah A Stechschulte, UCSD,
      Dermatitis 2008 May: Rich Murray 2008.07.18
      Friday, July 18, 2008

      formaldehyde from many sources, including aspartame, is
      major cause of Allergic Contact Dermatitis, SE Jacob,
      T Steele, G Rodriguez, Skin and Aging 2005 Dec.:
      Murray 2008.03.27
      Thursday, March 27, 2008

      "For example, diet soda and yogurt containing aspartame
      (Nutrasweet), release formaldehyde in their natural biological

      One of aspartame's metabolites, aspartic acid methyl ester, is
      converted to methanol in the body, which is oxidized to
      formaldehyde in all organs, including the liver and eyes. 22

      Patients with a contact dermatitis to formaldehyde have been
      seen to improve once aspartame is avoided. 22

      Notably, the case that Hill and Belsito reported had a 6-month
      history of eyelid dermatitis that subsided after 1 week of
      avoiding diet soda. 22"

      Avoiding formaldehyde allergic reactions in children,
      aspartame, vitamins, shampoo, conditioners, hair gel, baby
      wipes, Sharon E Jacob, MD, Tace Steele, U. Miami,
      Pediatric Annals 2007 Jan.: eyelid contact dermatitis,
      AM Hill, DV Belsito, 2003 Nov.: Murray 2008.03.27
      Thursday, March 27, 2008

      Sharon E. Jacob, MD, Assistant Professor of Medicine
      University of California, San Diego 200 W. Arbor Drive
      #8420, San Diego, CA 92103-8420
      Tel: 858-552-8585 ×3504 Fax: 305-675-8317
      Sarah A. Stechschulte, BA sstechschulte@...

      methanol (11% of aspartame), made by body into
      formaldehyde in many vulnerable tissues, causes modern
      diseases of civilization, summary of a century of research,
      Woodrow C Monte PhD, Medical Hypotheses journal:
      Rich Murray 2009.11.15
      Sunday, November 15, 2009

      Rich Murray, MA
      Boston University Graduate School 1967 psychology,
      BS MIT 1964, history and physics,
      1943 Otowi Road, Santa Fe, New Mexico 87505
      505-501-2298 rmforall@...

      http://RMForAll.blogspot.com new primary archive

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