Pseudotumor cerebri due to aspartame disease

Townsend Letter for Doctors and Patients,  June, 2002  by H.J. Roberts

• E-mail
• Print
• Link

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.

Aspartame disease caused by the use of products containing this chemical sweetener is a frequent but usually overlooked disorder. (1-7) In the author's data base of persons so afflicted, six women developed pseudotumor cerebri (benign intracranial hypertension). This appears to be the first report of such an association.

The clinical and public health implications are significant. An estimated 70% of the United States adult population currently consumes aspartame products. The more common neurologic problems caused or aggravated by aspartame are noted in the discussion.

Patients

All six women were in their 20s and 30s. Preoccupied with their weight, they used considerable aspartame, chiefly as "diet" sodas. The representative case reports illustrate the extensive studies and treatments undertaken -- ranging from repeated lumbar puncture for reducing cerebrospina] pressure to ventricular shunt procedures - prior to awareness of aspartame disease.

Representative Case Reports

Case 1

A registered nurse with an extensive background in neurology and psychiatry was diagnosed as having pseudotumor cerebri in February 1997. Intent upon losing weight, she began consuming considerable amounts of aspartame products. One month later, she suffered "fullness in my head, dizziness that wouldn't go away, impaired vision, panic attacks, and a squishy feeling in my head." Several neurologic consultations and multiple studies ensued when severe headache developed.

The patient realized that the only significant change in her habits had been the use of aspartame products. She avoided them in April 1997, with a progressive disappearance of symptoms. The repeat lumbar punctures being done in an attempt to decrease cerebrospinal fluid pressure were discontinued. Her "headache and strange feelings" would recur, however, if she drank an aspartame soda.

Case 2

The mother of two young children stated, "I used to drink aspartame by the hour." She was diagnosed as having pseudotumor cerebri by five neurologists.

This patient had experienced "floaters" and a large blind spot in the left eye. A neuro-ophthalmologist told her that she would become blind if a ventricular shunt was not performed to drain the excess cerebrospinal fluid causing pressure on the optic nerve. This was done in March 1998. Most of her symptoms persisted, however, especially severe headache, numbness of the feet and fingers, nausea, and extreme fatigne.

Several persons, including her father-in-law, supplied information about aspartame disease. She ignored it initially, but then decided to stop aspartame products on a trial basis. "I saw major results. The headaches were not as bad, and the other symptoms did not bother me as much."

Discussion

Each of these patients had been formally diagnosed by neurologists as having pseudotumor cerebri. Fortuitously, aspartame disease was considered thereafter by relatives or friends who had heard about aspartame disease, leading to aspartame abstinence.

Discussing pseudotumor cerebri in a previous text, (8) the author noted "the greatest frequency of this disease among women under the age of thirty." Wilson and Gardner (9) similarly emphasized the association of obesity and pseudotumor cerebri. Forty-eight of their 61 cases were characterized as "fat young women."

The importance of considering aspartame disease under these circumstances is obvious. The patients usually have a good prognosis, and can be spared much anxiety and formidable medical or surgical interventions if this condition is recognized.

The diagnosis of pseudotumor cerebri was based on evidence for increased intracranial pressure, and the absence of infection, a mass lesion (brain tumor), obstruction of the ventricular system, and focal neurologic signs. The most prominent features were headache, papilledema and other ocular abnormalities (decreased vision; visual field loss; extraocular palsies).

The following considerations are germane:

* No patient had taken corticosteroids, excessive vitamin A, or other possible contributory drugs (tetracycline; nalidixic acid).

* One patient developed concomitant diabetes insipidus, which also improved dramatically after aspartame avoidance.

* A female third-year medical student was excluded from this series because definitive tests were not done to exclude an inferred "membrane blockage between the third and fourth ventricle." She refused to quit aspartame products despite pleas from her parents (nationally known writers.) She developed blurred vision, severe headache, and problems with speech while consuming considerable diet sodas and aspartame-sweetened coffee prior to her. final exams. A shunt procedure was being considered.