Q. What is the role of the pancreas?

A. The pancreas is a vital organ with several major functions. It has a digestive function by virtue of making the pancreatic enzymes that digest the food and an important endocrine function by virtue of having the islets that secrete insulin and other hormones.

Q. What are some of these hormones?

A. In addition to insulin, there is glucagon, along with several others.

Q. What is aspartame?

A. Aspartame is a chemical that originally was conceived as a treatment for peptic ulcer. The molecule closely simulates the hormone gastrin, which is involved with hydrochloric acid secretion. Aspartame consists of three components-phenylalanine and aspartic acid (both amino acids) and a methyl ester, which becomes free methyl alcohol when it enters the stomach. The combination is approximately 50 percent phenylalanine, 40 percent aspartic acid, and 10 percent methyl alcohol. Around 1965, this chemical was found to taste sweet. It was therefore submitted as a sweetening supplement and the drug application with-drawn.

Q. Was aspartame ineffective as a drug?

A. It was never really marketed as a drug for a peptic ulcer, although that was the original intent.

Q. Are artificial sweeteners that contain aspartame safe?

A. A number of artificial sweeteners, including saccharin, have been around for a long time. In my opinion, aspartame has many hazards. Saccharin is essentially safe. The sweetener called stevia, which is increasingly being used, comes from a shrub found in Paraguay, South America. It tastes very sweet. In my experience, it is also safe. I have reservations about the other sweeteners, such as acesulfame-K (e.g., Sunette, Sweet One(R)), sucralose (Splenda(R) No Calorie Sweetener), and the cyclamates. Then there are the analogues of aspartame, such as the high-intensity product Neotame (R). For example, acesulfame-K induces chromosomal aberrations; sucralose is associated with several effects in animals, is weakly mutagenic, and increases the glycosylated hemoglobin in diabetic patients. The cyclamates were initially withdrawn in the U.S. because of concern about bladder tumors. The National Academy of Science has subsequently concluded that cyclamates were not carcinogenic in humans. However, there is a great deal of concern in Europe about their wide-spread use, especially in children. As for Neotame(R) and other analogues of aspartame, they pose problems similar to those of aspartame. Again, stevia and saccharin appear to be safe.

Q. How do sweeteners affect the pancreas?

A. They can have direct and indirect effects. One result, of course, is the secretion of insulin. When humans take something that is sweet, the body infers that sugar is being ingested. In anticipation of its arrival, the pancreas reflexively releases insulin. This is one way in which aspartame affects the pancreas. It can also cause considerable stimulation of the exocrine part of the pancreas that involves the pancreatic juices. This may even produce pancreatitis-inflammation of the pancreas-which in the process might disturb the islet cells.

There is an enormous reserve of pancreatic juices. At least 60 percent or more of the pancreas would have to be destroyed before interfering with pancreatic function would occur. One way to stimulate the pancreas to produce its secretions is to give amino acids, including phenylalanine, with or without another amino acid.

In my experience, aspartame products have produced clinical pancreatitis. To my knowledge, neither the long-term effects to the secretory pancreas nor the relationship to the subsequent overstimulation of the pancreas, in terms of tumors, has been studied.

Q. If the safety of aspartame has been questioned, why has no one been able to prove the dangers?

A. To me, it is quite clear that aspartame products can cause severe illness. Indeed, I feel that this product should not have been approved for human consumption, as it was in 1981. The sweetener was released over the violent objections of in-house FDA [Food and Drug Administration] scientists, consultants for the General Accounting Office, and even a public board of inquiry in 1980-all of whom were emphatic that it should not be released, especially in light of the high incidence of brain tumors in animals.

I have repeatedly listed and detailed the many complications and side effects of aspartame products. My recent book, Aspartame Disease, has more than 1000 pages of what I consider direct complications of the use of these products.

In regard to those who say this is not so, it seems to be a phenomenon of denial on the part of the FDA. This is a multibillion-dollar industry that has proponents for self-serving economic interests who maintain that all reservations are nonsense. There is an overwhelming input of complaints indicating that this is a frequent and severe disorder, which I call "aspartame disease." Now the problem with many of these studies they refer to is that protocols were flawed in terms of how the product was prepared and administered and how subjects were followed. It has been very difficult to detail these objections about published studies asserting that aspartame is safe for various reasons, including the power of this industry.

In my opinion, those "negative studies" all require confirmation by corporate-neutral investigators using real-world products taken from market shelves that have been exposed to excessive temperatures or prolonged storage. Indeed, that is currently the subject of considerable interest by the European Parliament as to whether aspartame should be considered unsafe.

Q. What do you think will come about from that?

A. Ultimately, I think there will be no question-with the anecdotal information that has already been accrued-that aspartame products are found unsafe for many individuals. These products are being consumed by more than two thirds of the population. This is a very large number in terms of the many neurologic and neuropsychiatric problems, the allergic problems, the effects on patients with diabetes and hypoglycemia, and the long-term effects in pregnancy and infants... along with numerous other problems, including the issue of brain tumors in humans.

Q. Should diabetic patients, in particular, be concerned about aspartame?

A. Yes. I believe that aspartame can aggravate diabetes and its complications, especially eye problems and neuropathy, or it can simulate the complications of diabetes. In other words, aspartame disease can simulate diabetic retinopathy or peripheral neuropathy. When patients discontinue these products, they usually get better. In terms of aggravating diabetes, consuming aspartame either can bring out latent diabetes clinically or can lead to insulin resistance, which would require patients to take oral drugs to increase the amount of insulin required. The bottom line is that when people stop ingesting these products, the symptoms usually improve.

Q. Have there been cases in which people did not improve after discontinuing aspartame?

A. There are certain criteria for diagnosing aspartame disease...similar to the Koch postulates for infection:

• Patients either took or increased the amount of aspartame products, such as drinking more presweetened iced tea in hot weather.

• Patients then experienced symptoms and realized that they might be related to aspartame.

• When the aspartame products were discontinued, these features either totally subsided or improved in a relatively short period of time.

• Finally, patients re-challenged themselves, either knowingly (saying it was just a coincidence) or inadvertently (with a prompt return of symptoms).

This sequence would happen five, ten, or twenty times, and the patients realized a cause-and-effect relationship. These criteria hold true for many of the disorders related to aspartame. In most instances, there would be marked improvement. If there were severe ocular or other damage, especially in the nervous system, much of the harm might have already been done.

Q. How does aspartame affect the pancreas in diabetic patients?

A. There can be several outcomes. First, patients might be making too much insulin and can have severe hypoglycemia (low blood sugar) attacks. Aspartame can release almost as much insulin as glucose. It has been known for many years that oral and intravenous phenylalanine and other amino acids cause marked elevation of insulin. In my books, I go into this in great detail. On the one hand, we are talking about the stimulation of more insulin and hypoglycemia. Further study is needed to determine whether, over the long term, this will overstimulate the islets that make insulin. The other aspect is the diabetogenic state and loss of diabetic control through various mechanisms that include the wasting of insulin, the impairment of glucose transport, the increase of the growth hormone and glucagon, and perhaps blocking insulin receptors.

Q. Do artificial sweeteners affect patients with type 1 diabetes and patients with type 2 diabetes differently?

A. Approximately 10 to 15 percent of diabetic patients have type 1 (formerly called juvenile) diabetes, and the rest have so-called adult-onset or insulin-dependent (type 2) diabetes. In type 1 diabetes, which may be largely an autoimmune effect early in life, there is a marked decrease in the amount of insulin produced. In patients with type 2 diabetes, especially among those who are overweight, there is still considerable insulin. In many of my earlier studies in the 1960's, we showed an "exhaustion" effect with hyperinsulinism, leading into diabetes-which is why I call it diabetogenic hyperinsulinism. Thus, aspartame products can affect both types of diabetes, albeit through different mechanisms.

Q. How do you know if your pancreas is being damaged by aspartame?

A. We can check the blood sugar (glucose) in various ways-either randomly or during the course of glucose tolerance testing. A person's blood glucose level may decrease, with a tendency toward hypoglycemia, or it may go up, as a tendency toward diabetes. Of course, this occurs in a cyclic manner because we change metabolically as the day goes along. Early in the evolution of the diabetogenic tendency, elevations may not show up in the morning but they do so later in the day.

In the early 1960's, I devised the afternoon glucose tolerance test; the glucose load is given at noon, and blood glucose and insulin levels are followed. The more dramatic rise in insulin later in the day than in the morning also has been shown in five or six different animal species. In people who are potentially diabetic, one can show these changes by a grossly diabetic glucose tolerance response with a marked increase or decrease in insulin.

In terms of the pancreatic enzymes, more studies are required. Considerable loss of pancreatic functioning occurs before these changes are evident. Of course, if someone has severe pancreatitis induced by aspartame, it could influence both the secretions and insulin production. A number of patients have shown this dual problem clinically.

Q. What can be done to protect the pancreas from aspartame?

A. I think that aspartame products should be taken off the market because of my belief that this artificial sweetener is an imminent public health hazard. I have stated this recommendation to Congress and have mentioned it in many articles and texts.

Q. Can sugar damage the pancreas?

A. Sugar might be one of the contributing factors leading to the exhaustion of the insulin reserve, and, ultimately, to diabetes. Sugar can also cause changes in triglyceride and cholesterol levels and can lead to carbohydrate- induced hypertriglyceridemia (high serum triglyceride levels).

Q. How do sweeteners affect hypoglycemic patients?

A. Sweeteners cause an increased elaboration of insulin, especially as the day goes on and during the night, when the brain is most vulnerable to decreased circulating glucose levels. Glucose is the central nervous system's chief source of energy. It is during the night when many of the complications of hypoglycemia occur.

Q. Why do you think pancreatitis is increasing?

A. There are many causes of pancreatitis; it can be related to alcohol use and other factors. In this case, there has to be more thinking about the contributory role of dietary products containing aspartame. Then there is the matter of pancreatic cancer, the incidence of which has decidedly increased. Whether aspartame or other sweeteners are related to this increase has yet to be determined.

Q. Why do you think pancreatic cancer is on the rise?

A. Cancer of the pancreas is definitely on the increase, but the reasons are not clear. Certainly,if you have a substance that can irritate the pancreas, as with aspartame products, corporate-neutral studies are in order.

Q. Why does type 1 diabetes seem to be on the rise?

A. I think there is a spectrum. Today we use the terms "type 1" and "type 2" diabetes. In my earlier publications on diabetogenic hyperinsulinism, I pointed out that this is probably the same disorder seen in different age groups. The tendency to hyperinsulinism is a biological trait that we have inherited. Before the 20th century, it was a defense mechanism against famine. The extra insulin laid down more body fat, which gave people metabolic protection in times of famine. As we changed our diet radically with the consumption of a large amount of carbohydrates and more calories and a change in our lifestyle and eating habits-this protective mechanism became a pathogenic mechanism culminating in obesity, changes in lipid metabolism, heart disease, and other problems.

Q. How accurate is the glucose tolerance test, and how do sweeteners affect it?

A. The glucose tolerance test must be done under proper circumstances. Patients should consume adequate calories for at least several days before the test. Under general circumstances, it is a helpful test to see whether people have a tendency to diabetes and hyperinsulinism. As noted, the patient's carbohydrate metabolism and insulin release may be more accurately shown later in the day and by conventional morning glucose tolerance testing.

Q. How effective are the hemoglobin A^sub 1C^ tests?

A. An elevated glycosylated hemoglobin level (above 6 percent) can indicate the average increased glucose concentration over the previous several weeks. It is a useful parameter for diabetes control.

Q. How do sweeteners affect glucose levels after we fast and after we eat?

A. Glucose levels can decline if the sweeteners produce a great deal of insulin, or they can go up if a tendency toward diabetes already exists.

Q. What is the ideal glucose level?

A. We are interested not only in the fasting level but also in the ideal level during the greater part of the day when we are active. The ideal glucose level should less than 115 milligrams per deciliter (mg./d1.), but that is not an accurate reflection of what it is during the entire day. Certainly, at random measurements during the day, it should probably be less than 140 mg./d1. This value changes during the course of the day.

HawaiiReporter.com reports the real news, and prints all editorials submitted, even if they do not represent the viewpoint of the editors, as long as they are written clearly. Send editorials to mailto:Malia@HawaiiReporter.com

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