ASPARTAME AND JOINT PAIN
JOINT PAIN ASSOCIATED WITH ASPARTAME USE
by H. J. Roberts, M.D. West Palm Beach, Florida
from the Townsend Letter for Doctors May 1991
Summary
Joint pain requiring analgesics was experiencedby 58 patients who
consumed moderate to large amounts of aspartame, a popular sweetener. This
association seems convincing in light of (1) the prompt improvementof both
these pains and other aspartame-associated complaints after abstinencefrom
aspartame, and (2) their prompt recurrence following aspartame rechallenge,
known or inadvertent.
Clinicians should inquired about aspartameuse in all patients who
present with unexplained join pain or the exacerbations of rheumatologic
disorders. A therapeutic trial of aspartame avoidance is warrantedbefore
ordering expensive studies, consultations and potent drugs.
An impressive, but unexpected, finding in an analysisof complaints
associated with aspartame, a sweetener currently being consumed byover 100
million persons in the United States, was troublesome joint pain.
Accordingly, this symptom was incorporated in both the routinequestioning
of apparent aspartame reactors and a computerized nine-page nationwidesurvey
of such individuals.
Methods
Data were obtained from 551 persons havingapparent systemic reactions
to aspartame. They consisted of 160 private patients and individualswho
were personally interviewed, and 391 persons who described theiradverse
side effects in a questionnaire – including observations after rechallenge.
The names of the latter group were supply by Aspartame Victims andTheir
Friends (courtesy of Mrs. Shannon Roth), the Community Nutrition Institute
(courtesy of Mr. Rod Leonard), and Dr. Woodrow Monte of Arizona State
University.
The completed questionnaires were analyzedwith assistance of the
Management Information System staff at the Good Samaritan Hospital,West Palm
Beach.
Results
Joint pain was a major complaint in 58 (10.5%)of 551 aspartame
reactors. Its convincing association with aspartame is derivedfrom the
following clinical evidence.
* These patients suffered “severe joint pain” as a recentcomplaint,
requiring analgesics in most instances.
* They also experienced many of the symptoms reported byother aspartame
reactors.
* Both the join pain and nonrheumatic complaints subsidedwhen
aspartame-containing products were avoided…generally within
several days or weeks. The most notable exceptions were severevisual and
neuropshychiatric disturbances.
* These symptoms promptly and predictably recurred on rechallengewith
aspartame, known or inadvertent.
The average age was 45 years. Femalesoutnumbered males 3:1.
Representative Case Reports
Case 1. A 55-year oldsecretary developed “arthritis” and aching of the
lower extremities one week after she began drinking an aspartame-flavoredtea
mix. Concomitant symptoms included memory loss, severe dizzinessand
depression. These features subsided within one week after stoppingthe
aspartame product. After each of several rechallenges, “my wholebody ached
from my toes to the neck. I felt as though I had arthritis inmy whole body
and it hurt to move an arm or even my hand….Since that time, I havenot
touched anything sweetened with aspartame, and have experienced nounusual
aches, memory loss or dizziness.
Case 2. A 45-year oldtechnician consumed two packets of an aspartame
tabletop sweetener daily for three weeks. He became markedlyimpaired
because of “severe joint irritation” and “less that 1/4 my normal strength.”
These complaints improved within one day after avoiding aspartame. The
joint symptoms recurred within one day after retesting himself withthis
product on three separate trials.
Case 3. A 62-year oldsupervisor complained that “all my joints ached all
the time” while consuming aspartame. He used eight packets ofan aspartame
tabletop sweetener in his coffee, one glass of aspartame hot chocolate,and
two services of aspartame puddings or gelatins daily. Other
aspartame-associated symptoms included loss of vision in one eye, marked
sensitivity to noise in both ears, intense headache, severe drowsiness,
paresthesias of the limbs, atypical facial pains, extreme irritability,and a
paradoxic weight gain of 30 pounds. His joint pains and othercomplaints
regressed within five weeks after stopping aspartame. All recurredwithin
eight hours during two rechallenges.
Discussion
Experienced clinicians understandably willbalk at the suggestion that a
correlation exists between joint pain and consumption of a popular
RDA-approved sweetener for several reasons. First, they havenot heard or
reach of such an association. Second, the frequency of rheumatologic
complaints in the general population is likely to be superimposed uponthe
use of any drug, food or additive. Third, this pilot investigationlacks
“controls” and objective quantifiable measurements during prospective
double-blind studies. Fourth, the proposition that foods andadditives can
induce joint symptoms in not novel.
On the other hand, the occurrence of jointpain, generalized or focal,
in 58 individuals so closely associated with aspartame use ought notbe
dismissed as “anecdotal” or “idiosyncratic.” The prompt regressionof such
complaints after abstinence from this chemical, and their prompt and
predictable precipitation on rechallenge seems convincing. Ineffect, such
patients served as their own controls.
These observations offer intriguing insightsconcerning various
rheumatologic disorders. A case in point was the occurrence oftransient
“dry eyes” in 46 (8.3%) of 551 reactors while taking aspartame. The frequent
occurrence of arthropathy in the Sjogren syndrome is recognized.
Other interesting rheumatologic associationswere encountered in
aspartame reactors.
* Some patients emphasized the prompt exacerbation of theirlong-standing
arthropathies after using aspartame, and improvement within severaldays
after stopping it.
* Resort to considerable aspirin for the relief of joint panintensified
aspartame-associated ear and neurologic problems – especially tinnitus,
dizziness and hearing impairment.
* Several patients with polymyalgia rheumatica who had been wellcontrolled
on small doses of a corticosteroid experienced severe exacerbationsafter
ingesting aspartame. They also promptly improved when it wasavoided.
The probably underlying pathogenetic mechanismsof aspartame reactions
included direct effects of its three ingredients (phenylalanine, aspartic
acid, methanol), altered neurotransmitter metabolism, decreased tissue
substrate due to the combination of increased insulin release and decreased
food intake by persons attempting to lose weight, and immunologic reactions
to aspartame or its metabolites – perhaps acting as haptenes. Concerning the
latter, the following allergic-type reactions were encountered among551
aspartame reactors: severe itching without a rash – 44 (8.0%);severe lip
and mouth reactions – 21 (5.3%), urticaria – 25 (4.5%); other eruptions- 48
(8.7%); and the aggravation of respiratory allergies – 10 (1.8%)
Correspondence
H. J. Roberts, M.D.
300-27th St.
West Palm Beach, FL 33407