Formaldehyde, Aspartame and Migraines: A Possible Connection

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Formaldehyde, Aspartame, and Migraines: A Possible Connection

 

Sharon E. Jacob; Sarah Stechschulte

 

Dermatitis. 2008;19(3):E10-E11. ©2008 American Contact Dermatitis Society

Posted 09/17/2008

 

 

Abstract and Case Series

 

 

 

 

Abstract

 

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 regimen.

 

 

Discussion

 

Aspartame is a widely used artificial sweetener

that has been linked to a multitude of ailments,

particularly pediatric and adolescent

migraines[1] (

<http://www.medscape.com/viewarticle//viewarticle/579335_Tables#T1>Table

1 and

<http://www.medscape.com/viewarticle//viewarticle/579335_Tables#T2>Table

2 ).[2-4] Studies suggest that aspartame is a

significant migraine trigger, especially when

consumption is prolonged.[1] Upon ingestion,

aspartame is broken down into aspartic acid,

aspartic acid methyl ester, and phenylalanine in

the gut wall.[5] The methyl ester is subsequently

converted into methanol, which is oxidized to

formaldehyde and formic acid in various

tissues.[6] Formaldehyde is known to form

chemical adducts with nucleic acids and proteins.

These adducts have been found to be difficult to

remove by normal metabolic pathways; hence, accumulation may occur.[6]

 

To our knowledge, aspartame-associated migraines

related to clinically relevant positive reactions

to formaldehyde on patch testing have not

previously been reported. In 2003, Hill and

Belsito reported a case of a nonmigraine patient

with chronic eyelid dermatitis that cleared when

aspartame was discontinued. This case presented

the possibility that formaldehyde from aspartame

breakdown could trigger a systemic contact

dermatitis in formaldehyde-sensitive patients.[7]

Like Hill and Belsito's patient, our sixth

patient (the only patient who did not have

migraines) demonstrated a flare of his dermatitis

with consumption of aspartame and clearance with

avoidance of aspartame. Our five migraine cases

suggest that aspartame-induced migraines may be a

harbinger for formaldehyde sensitivity and an

important historical point to be elucidated

during the initial work-up of a patient with

presumed allergic contact dermatitis.

 

Although we recognize the limitations of drawing

conclusions from a small sample of patients, we

believe this observed association warrants

further investigation. A larger case study with a

double-blind placebo-controlled challenge study

with aspartame capsules and placebo capsules

(including nondermatitic control patients with

aspartame-induced migraines) is needed to firmly

establish the association between aspartame

breakdown products, migraines, systemic contact

dermatitis, and positive patch-test reactions to formaldehyde and FRPs.

 

 

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Table 1. Aspartame in Foods and Drinks

 

 

Food or Drink Average Amount of Aspartame per Unit

Carbonated soft drink 180 mg/12 oz can (354 mL)

Yogurt 124 mg/8 oz (237 mL)

Powdered soft drink 120 mg/12 oz (354 mL)

Gelatin 95 mg/4 oz (118 mL)

Fruit drink (10% juice) 70 mg/6 oz (177 mL)

Ice cream 50 mg/4 oz (118 mL)

Hot chocolate 50 mg/6 oz (177 mL)

Chewing gum 6–8 mg per stick

Chewable children's vitamins (Flintstones

Vitamins, Bayer, Morristown, NJ) 4 mg per vitamin

Breath mints 1.5 mg per mint

 

 

 

 

Table 2. Artificial Sweetener Brand Names

 

 

Artificial Sweetener Brand Names

Aspartame Equal, NutraSweet

Sucralose Splenda

Saccharin Sweet 'N Low, Sweet Twin, Necta Sweet, Hermesetas

Acesulfame potassium AceK, Sweet One, Sunett

Cyclamate Sugar Twin, Sucaryl, Weight Watchers TM

Neotame No Name Brand

 

 

 

 

 

 

References

 

* Millichap JG, Yee MM. The diet factor in

pediatric and adolescent migraine Pediatr Neurol 2003;28:9-15.

* The NutraSweet Company: statments.

Available at:

http://www.nutrasweet.com/articles/article.asp?Id=47 (accessed July 19, 2007).

* Flintstones vitamins - the heading brand

moms trust and kids love! Available at:

http://www.bayercare.com/htm/flintfaq.htm (accessed February 6, 2007).

* US Food and Drug Administration: artificial

sweeteners: no calories...sweet! Available at:

http://www.fda.gov/fdac/features/2006/406_sweeteners.html

(accessed July 19, 2007).

* Murray TG, Burton TC, Rajani C, et al.

Methanol poisoning. A rodent model with

structural and functional evidence for retinal

involvement Arch Ophthalmol 1991;109:1012-6.

* Trocho C, Pardo R, Rafecas I, et al.

Formaldehyde derived from dietary aspartame binds

to tissue components in vivo Life Sci 1998;63:337-49.

* Hill AM, Belsito DV. Systemic contact

dermatitis of the eyelids caused by formaldehyde

derived from aspartame? Contact Dermatitis 2003;49:258-9.

 

Sharon E. Jacob and Sarah Stechschulte,

Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL

 

 

 

More information on aspartame on www.mpwhi.com, www.dorway.com, www.wnho.net

Aspartame Information List, www.mpwhi.com scroll down to banners

Aspartame Toxicity Center, www.holisticmed.com/aspartame

 

Dr. Betty Martini, D.Hum, Founder

Mission Possible International

9270 River Club Parkway

Duluth, Georgia 30097

770 242-2599