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
*********************************************************