Diet Soda

Menstuff® has compiled the following information on the downside of diet sodas.


How many packets of sugar do you eat daily?

Diet Cola's Downside
That Sweet Taste. Are Artificial Sweeteners Safe?
Diet Soda Habit as Bad for Teeth as Meth Addiction, Study Claims
Have you ever wondered if people of certain weights buy certain drinks?
Sucralose - Safety and Information
Aspartame Is a Safe Artificial Sweetener

Diet Cola's Downside


If you think you're doing your body a favor by choosing diet soda, the exact opposite may hold true.

Your diet drinking habits may warn of weight problems to come. Studies show a 54 percent greater risk of obesity among people who drink two cans or more daily.

People who drink diet soft drinks don't lose weight. In fact, they gain weight, a new study shows.

The findings come from eight years of data collected by Sharon P. Fowler, MPH, and colleagues at the University of Texas Health Science Center, San Antonio. Fowler reported the data at the annual meeting of the American Diabetes Association in San Diego.

"What didn't surprise us was that total soft drink use was linked to overweight and obesity," Fowler tells WebMD. "What was surprising was when we looked at people only drinking diet soft drinks, their risk of obesity was even higher."

In fact, when the researchers took a closer look at their data, they found that nearly all the obesity risk from soft drinks came from diet sodas.

"There was a 41% increase in risk of being overweight for every can or bottle of diet soft drink a person consumes each day," Fowler says.

More Diet Drinks, More Weight Gain

Fowler's team looked at seven to eight years of data on 1,550 Mexican-American and non-Hispanic white Americans aged 25 to 64. Of the 622 study participants who were of normal weight at the beginning of the study, about a third became overweight or obese.

For regular soft-drink drinkers, the risk of becoming overweight or obese was:

26% for up to 1/2 can each day
30.4% for 1/2 to one can each day
32.8% for 1 to 2 cans each day
47.2% for more than 2 cans each day.

For diet soft-drink drinkers, the risk of becoming overweight or obese was:

36.5% for up to 1/2 can each day
37.5% for 1/2 to one can each day
54.5% for 1 to 2 cans each day
57.1% for more than 2 cans each day.

For each can of diet soft drink consumed each day, a person's risk of obesity went up 41%.

Diet Soda No Smoking Gun

Fowler is quick to note that a study of this kind does not prove that diet soda causes obesity. More likely, she says, it shows that something linked to diet soda drinking is also linked to obesity.

"One possible part of the explanation is that people who see they are beginning to gain weight may be more likely to switch from regular to diet soda," Fowler suggests. "But despite their switching, their weight may continue to grow for other reasons. So diet soft-drink use is a marker for overweight and obesity."

Why? Nutrition expert Leslie Bonci, MPH, RD, puts it in a nutshell. "You have to look at what's on your plate, not just what's in your glass," Bonci tells WebMD.

People often mistake diet drinks for diets, says Bonci, director of sports nutrition at the University of Pittsburgh Medical Center and nutrition consultant to college and professional sports teams and to the Pittsburgh Ballet.

"A lot of people say, 'I am drinking a diet soft drink because that is better for me. But soft drinks by themselves are not the root of America's obesity problem," she says. "You can't go into a fast-food restaurant and say, 'Oh, it's OK because I had diet soda.' If you don't do anything else but switch to a diet soft drink, you are not going to lose weight."

The Mad Hatter Theory

"Take some more tea," the March Hare said to Alice, very earnestly.

"I've had nothing yet," Alice replied in an offended tone, "so I can't take more."

"You mean you can't take less," said the Hatter: "It's very easy to take more than nothing." Lewis Carroll, Alice's Adventures in Wonderland

There is actually a way that diet drinks could contribute to weight gain, Fowler suggests.

She remembers being struck by the scene in Alice's Adventures in Wonderland in which Alice is offended because she is offered tea but is given none -- even though she hadn't asked for tea in the first place. So she helps herself to tea and bread and butter.

That may be just what happens when we offer our bodies the sweet taste of diet drinks, but give them no calories. Fowler points to a recent study in which feeding artificial sweeteners to rat pups made them crave more calories than animals fed real sugar.

"If you offer your body something that tastes like a lot of calories, but it isn't there, your body is alerted to the possibility that there is something there and it will search for the calories promised but not delivered," Fowler says.

Perhaps, Bonci says, our bodies are smarter than we think.

"People think they can just fool the body. But maybe the body isn't fooled," she says. "If you are not giving your body those calories you promised it, maybe your body will retaliate by wanting more calories. Some soft drink studies do suggest that diet drinks stimulate appetite."

Sources: Daniel DeNoon, Fowler, S.P. 65th Annual Scientific Sessions, American Diabetes Association, San Diego, June 10-14, 2005; Abstract 1058-P. Sharon P. Fowler, MPH, University of Texas Health Science Center School of Medicine, San Antonio. Leslie Bonci, MPH, RD, director, sports nutrition, University of Pittsburgh Medical Center. WebMD News: "Artificial Sweeteners May Damage Diet Efforts.""Artificial Sweeteners May Damage Diet Efforts." Davidson, T.L. International Journal of Obesity, July 2004; vol 28: pp 933-955.

That Sweet Taste. Are Artificial Sweeteners Safe?


Do you satisfy your sweet tooth with sugar substitutes? Those packets add up -- and sometimes raise your cravings for calories.

The way artificial sweeteners were discovered could have been a scene out of the classic comedy The Nutty Professor.

In 1879, Ira Remsen, a researcher from Johns Hopkins University in Baltimore, Md., noticed that a derivative of coal tar he accidentally spilled on his hand tasted sweet. While he did not morph into the slim, but obnoxious Buddy Love as the characters played by Eddie Murphy and Jerry Lewis did in their film versions of the comedy, his spill set the stage for the development of saccharin -- an artificial sweetener known today to many seasoned dieters as Sweet-n-Low. This is now the most recognized name brand of the saccharin-based sugar substitutes.

Now more than 125 years later, saccharin is joined by a growing list of artificial sweeteners with varying chemical structures and uses including acesulfame potassium (Sunett); aspartame (NutraSweet or Equal); sacralose (SPLENDA), and D-Tagatose (Sugaree). And there's a whole host of new ones on the horizon.

These products substitute for sugar. For example, they can replace corn syrup, used in many sodas and sweetened drinks, and table sugars. However, the sweet remains in anything and everything from chocolate and ketchup to gum, ice cream, and soft drinks. But are artificial sweeteners safe? Can they help people shed extra weight? What role should they play in person's diet -- if any?

Fewer Calories Means Greater Weight Loss

Artificial sweeteners, also called sugar substitutes, are compounds that offer the sweetness of sugar without the same calories. They are anywhere from 30 to 8,000 times sweeter than sugar and as a result, they have much fewer calories than foods made with table sugar (sucrose). Each gram of refined table sugar contains 4 calories. Many sugar substitutes have zero calories per gram.

"Artificial sweeteners can serve a definite purpose in weight loss and diabetes control," says New York City-based nutritionist Phyllis Roxland. "It enables people that are either carb-, sugar-, or calorie-conscious to take in a wider range of foods that they would either not be allowed to eat or could only eat in such teeny amounts that they were not satisfying." Roxland routinely counsels patients in the offices of Howard Shapiro, MD, a weight loss specialist and author of Picture Perfect Prescription.

In other words, artificial sweeteners allow people to stick to a good diet for a longer period of time, she says. In a diet, artificial sweeteners are considered "free foods." The sugar substitutes don't count as a carbohydrate, a fat, or any other exchange.

"These products can be useful when used appropriately for people like diabetics who need to control their sugar intake and in overweight people," agrees Ruth Kava, PhD, RD, director of nutrition for the American Council on Science and Health (ACSH) in New York City.

Artificial sweeteners do not affect blood sugar levels, but some foods containing artificial sweeteners can still affect blood sugar because of other carbohydrates or proteins in these foods. In other words, while foods that contain artificial sweeteners may be sugar-free, they may not be carbohydrate-free.

Just because a food contains artificial sweeteners instead of sugar is not carte blanche for grazing, Kava points out.

"The real key to weight loss is calories," Kava points out. "If you substitute a diet soda for a sugar soda, you save 100 calories, but if you eat 15 sugar-free cookies [which have calories] instead of two regular cookies, you may not be helping yourself at all," she says.

Satisfying Your Sweet Tooth

"If somebody is trying to lose weight and cut back on calories, artificial sweeteners can add flavor to unsweetened beverages or other products," says Michael F. Jacobson, PhD, executive director of the Center for Science in the Public Interest (CSPI) in Washington. That said, "somebody who consumes a lot of artificially sweetened foods should think twice about their diet and ought to be eating real food," he tells WebMD.

"I don't think [artificial sweeteners] are needed at all," he says. "I fear that in some cases people have a diet soda for lunch and then have a couple of tablespoons of ice cream -- giving up the saved calories," he says.

Using sugar substitutes instead of sugar can lower your risk of tooth decay, but "the acid in diet soda still could contribute to dental erosion," Jacobson points out.

The Saccharin Saga

Safety, particularly as it relates to cancer risk, is on many people's mind as a result of the saccharine saga, which began in the 1970s. In 1977, the U.S. Food and Drug Administration tried to ban this sweetener as animal studies showed that it caused cancer of the bladder, uterus, ovaries, skin, and other organs. But the food industry intervened, urging Congress to keep it on the market with a warning label that (until recently) read: "Use of this product may be hazardous to your health. This product contains saccharin, which has been determined to cause cancer in laboratory animals."

In the late 1990s, the Calorie Control Council stated that the main health concern about saccharin was bladder cancer in male rats -- not people. They stated that further research has shown that male rats have a particular predisposition to bladder cancer and as a result the National Institutes of Health removed saccharin from its hit list of cancer-causing agents.

"Congress said no to the [original call for a] ban due to backlash but stated that there has to be a warning," ACSH's Kava recalls. "More recently, Congress de-listed saccharin as very high doses may cause bladder cancer in male rats -- not in female rats or anyone else," she says. According to the National Cancer Institute, there's no scientific evidence that any of the artificial sweeteners approved for use in the U.S. cause cancer.

"The cancer risks are not something that an individual person should worry about," CSPI's Jacobson says. "It's more a risk for the government as the potential problems occur when millions of people consume the sweeteners for years," he tells WebMD.

But cancer risk may not be the only safety concern with these artificial sweeteners.

More Safety Issues?

"My overlying feeling is that artificial sweeteners are safe," says ACSH's Kava. "The only caveat is asparatame in people with a rare disorder known as phenylketonuria (PKU), who are unable to metabolize phenylalanine. PKU is detected at birth through a mandatory screening program.

Jacobson adds that in the short term, some people develop headaches after consuming foods sweetened with aspartame.

As far as short-term effects, sugar alcohols -- technically not considered artificial -- can cause bloating and diarrhea in some people and the effect may occur with as little as 50 grams of sugar alcohol. These sweeteners include sorbitol. Lactitol and mannitol are lower in calories than sugar, don't promote tooth decay, or cause an increase in blood sugars, according to the FDA.

Some of these "can cause powerful diarrhea and people ought to pay some attention to that," CSPI's Jacobson says.

The key is really to know your body and your limits, Roxland adds. "Sometimes it says right on the package that 'excess consumption may have a laxative effect' but does that mean two Velamints will give you the runs?" she says. "I have known some people who eat two pieces of gum and have the worst diarrhea and others who chew a whole pack and are fine," she says.

Overdosing on Equal?

As far as nonsugar alcohol sweeteners, Roxland does not see a tremendous potential for overdose. "Even if a person binges on low-calorie Fudgesicles or Creamsicles, as long as their diet is otherwise healthy, there is no downside because they would probably be bingeing on something a lot worse," she says.

Artificial Sweetener Pipeline Is Bursting

One thing is clear, consumers embrace these sweeteners. As many as 180 million Americans routinely eat and drink sugar-free products such as desserts and artificially sweetened sodas, according to 2004 statistics compiled by the Calorie Control Council, and with new products in the pipeline and on the shelves, the trend shows no sign of abating.

The newest artificial sweetener on the block is sucralose (SPLENDA). It is not affected by heat and retains its sweetness in hot beverages, baked goods, and processed foods. This has some advantages, Roxland says. "Nutrasweet can't be stored for long periods and you can't cook with it, but Splenda is heat stable so you can use it in cooking."

There are others in the pike including alitame (brand name Aclame™), which is 2,000 times sweeter than sucrose. A petition for its use in a broad range of foods and beverages has been filed in the U.S.

Another sweetener is Cyclamate, which is a 30 times sweeter than sucrose but as such it has the least "sweetening power" of the commercially acceptable intense sweeteners. It was banned in the U.S. in 1970, but currently there is a petition at the FDA for reapproval.

Dihydrochalcones (DHCs) are noncaloric sweeteners derived from bioflavonoids of citrus fruits that are approximately 300 to 2,000 times sweeter than sucrose.

Glycyrrhizin, a noncaloric extract of licorice root, is 50-100 times sweeter than sucrose. It is approved for use in the U.S. as a flavor and flavor enhancer.

Stevioside comes from leaves of a South American plant and is 300 times sweeter than sucrose. It is currently approved for use in 10 countries, including Japan, Paraguay, and Brazil. It can be sold in the U.S. as a dietary supplement only.

Another potential sweetener is Thaumatin (TalinTM), a mixture of proteins from a West African fruit that's approximately 2,000-3,000 times sweeter than sucrose. In the U.S., it's approved as a flavor enhancer for beverages, jams and jellies, condiments, milk products, yogurt, cheese, instant coffee and tea, and chewing gum.

Sources: Denise Mann, Phyllis Roxland Ruth Kava, PhD, RD, nutritionist; and director, nutrition, American Council on Science and Health, New York City. Michael F. Jacobson, PhD, executive director, Center for Science in the Public Interest, Washington.
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Diet Soda Habit as Bad for Teeth as Meth Addiction, Study Claims


Heavy consumption of diet soda can damage teeth as badly as methamphetamine or crack cocaine, a new study contends.

"You look at it side-to-side with 'meth mouth' or 'coke mouth,' it is startling to see the intensity and extent of damage more or less the same," said Dr. Mohamed Bassiouny, a professor of restorative dentistry at the Temple University School of Dentistry in Philadelphia.

Methamphetamine, crack cocaine and soda — sweetened or not — are all highly acidic and can cause similar dental problems, Bassiouny said in a study published recently in the journal General Dentistry.

The acid in soda is in the form of citric acid and phosphoric acid, Bassiouny said. Without good dental hygiene, constant exposure can cause erosion and significant oral damage, he said.

In his study, he found that a woman in her 30s who drank 2 liters of diet soda daily for three to five years experienced tooth rot and decay remarkably similar to that suffered by a 29-year-old methamphetamine addict and a 51-year-old habitual crack cocaine user.

The younger man had used methamphetamine for three years, and often downed two or three cans of regular soda a day because the drugs made his mouth so dry. The older man reported an 18-year history of crack abuse.

The woman said concerns about weight gain led her to choose diet soda over regular, and admitted that she had not seen a dentist in many years, according to the study. She also associated sweetened beverages with a higher risk of tooth decay.

Her teeth were soft and discolored, with many destroyed by erosion. She usually sipped the beverage directly from a can or a bottle, and held the soda in her mouth before swallowing, Bassiouny said.

"She also mentioned that when doing so, she habitually leaned on her left side against the arm of the sofa while watching television," he said. The "massive" damage to the left side of her mouth bore this out and resulted in what is called a collapsed bite.

"None of the teeth affected by erosion were salvageable," Bassiouny said. The woman had to have all of her teeth removed and replaced with dentures.

Methamphetamine and crack are known to ravage the mouths of users, and the two drug abusers needed all of their teeth extracted.

Besides exposing teeth to damaging acid, these illegal drugs reduce the amount of saliva in the mouth, providing less opportunity for the acids to wash away. The drugs also cause systemic health problems that affect dental hygiene. Previous studies have linked "meth mouth" with rampant decay.

A group representing soft drink manufacturers said this case study should not be seen as an indictment of diet sodas generally.

"The woman referenced in this article did not receive dental health services for more than 20 years — two-thirds of her life," the American Beverage Association said in a statement. "To single out diet soda consumption as the unique factor in her tooth decay and erosion — and to compare it to that from illicit drug use — is irresponsible.

"The body of available science does not support that beverages are a unique factor in causing tooth decay or erosion," the group said. "However, we do know that brushing and flossing our teeth, along with making regular visits to the dentist, play a very important role in preventing them."

Dr. Eugene Antenucci, spokesman for the Academy of General Dentistry, said he was not surprised by Bassiouny's findings.

"From my experience, the damage that happens to people's mouths from cocaine or methamphetamine are degrees greater than what I see from soda, but I see a lot of damage from soda," said Antenucci, a dentist in Huntington, N.Y.

Damage from excessive soda consumption can cause "very deep brown stains, where it's actually eroded into the tooth, and the teeth are soft and leathery," he said.

Prevention is the best cure, Bassiouny said. How often you drink soda, how much you drink and how long it's in your mouth all are important factors. "You can help prevent it from happening by reducing any of those," he said.

Sugar-free soda is no better than regular soda when it comes to dental decay, Bassiouny added. "Both of them have the same drastic effect if they are consumed in the same frequency, the same amount and the same duration," he said.

Antenucci said people need to keep in mind that they are drinking something that is highly acidic when they pick up a soda.

"Knowing that, you limit it and understand that you need to clean your mouth afterward," he said. "Even simple water will wash away the acidity. And everyone should brush twice a day, if not more often."

Should people give up drinking soda? "You'd be better off if you didn't drink the soda," Antenucci said, "but in my mind there's not a reason for that extreme."
Source: www.everydayhealth.com/dental-health/0523/die

Have you ever wondered if people of certain weights buy certain drinks?


We have the answers, and they will surprise you. Using data obtained from EnergyFiend.com we’ve discovered that, out of the top 10 most popular caffeinated drinks, Mountain Dew drinkers are the heaviest, weighing in at an average of 165.73 lbs (75.2 kgs). Espresso coffee drinkers are the lightest at average of 156.35 pounds. There is no differentiation between male and female, or age. (Editor's note: If that were true, they must have only tested small men and large women.)

Pepsi, 7UP, A&W, Sunkist and Mtn Dew have come out with a six-pack of 8 ounce cans and Coke and Sprite reduced theirs to a eight-pack of 7.5 ounce cans. Interesting strategy since they can say their product only has 90 calories per serving while Pepsi and 7Up have 100 calories per can, which Coke and 7Up would be if they were in 8 ounce cans. (Editor's note: Actually not. Coke and Sprite, not 7Up would still be less calories at 96 for an 8 ounce can. Also note that you get a total of 60 ounces of Coke or Sprite from the 8-pack and only 48 ounces of product from 6-packs making Coke and Sprite fewer calories and more economical (.0644 cents/oz vs .0532 cents/oz..)

Sucralose - Safety and Information


Sucralose is a popular artificial sweetener, usually sold under the brand name Splenda. It's not poisonous; it doesn't cause cancer, and it isn't a pesticide. Sucralose does not break down in the body, and it doesn't release chlorine into your system.It's manufactured from sugar, but it's approximately 600 times sweeter than sugar, so very little is needed. Most sucralose passes through your digestive system without being absorbed. The small amount that's absorbed leaves the body through the urine.

How It's Made and Used

Sucralose is made by adding three chlorine atoms to each molecule of sucrose. This process makes the sugar indigestible, so the body doesn't recognize it as a carbohydrate. Since it isn't digested like sugar, the body isn't able to use it for energy, so no calories are consumed.Sucralose is already found in many products such as diet sodas, yogurt and breakfast cereal. Individually-sized yellow Splenda packets are found in most restaurants and coffee shops.Sucralose can be sprinkled on your cereal, in your coffee or used as an ingredient in cooking and baking. It's important to note that Splenda is a blend of sucralose and starches that have some calories - so Splenda has about 95 calories per cup.

Sucralose Safety

Don't let the chlorine scare you. Remember it's also found (as chloride) in table salt, lettuce and mushrooms. Twenty years of science has shown sucralose to be safe for humans to consume.

Sucralose has been used safely as an artificial sweetener for over 20 years. Canada was the first country to approve it for use in foods and beverages. The United States Food and Drug Administration (FDA) approved sucralose in 1998 after reviewing 110 scientific studies. It's approved for use by everyone including pregnant women and children.There are a few anecdotal reports of adverse reactions to sucralose, and some dubious websites claim it's a cause of several illnesses including thymus damage, which could affect the immune system. That claim is based on one laboratory study where young rats fed sucralose and low-calorie diets suffered from shrinking thymus glands. But that's a common response for rats when they're under stress due to weight loss for any reason. It isn't specific to sucralose consumption. And follow-up studies did not discover any evidence of immune system dysfunction.
Sources: International Food Information Council. "Everything You Need to Know About Sucralose." June 2004. Kille JW, Ford WC, McAnulty P, Tesh JM, Ross FW, Willoughby CR. "Sucralose: lack of effects on sperm glycolysis and reproduction in the rat." Food Chem Toxicol. 2000;38 Suppl 2:S19-29. Academy of Nutrition and Dietetics. "Facts About Sucralose." 2006. Academy of Nutrition and Dietetics. "Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners." J Am Diet Assoc. 2004 Feb;104(2):255-75.
Web Source:
nutrition.about.com/od/calories/p/splenda.htm?utm_source=cn_nl&utm_medium=email&utm_term=Health%20Channel%20Newsletter&utm_campaign=healthsl&utm_content=20150428

Aspartame Is a Safe Artificial Sweetener


Aspartame is an artificial sweetener usually sold under the brand names Equal or Nutrasweet. It's about 200 times sweeter than sugar, so very little is needed to sweeten foods. That's why using aspartame doesn't add any calories.The American Medical Association, the Academy of Nutrition and Dietetics, and the American Diabetes Association all consider aspartame safe when used as part of a healthy eating plan.

But that doesn't prevent people from worrying about it's possible side effects.

Science Indicates Aspartame is Safe

Some people just don't like the idea of artificial sweeteners, which is probably why the rumors are spread so easily. So first, let me point out that aspartame isn't poisonous, doesn't cause cancer, and it's not a pesticide. The sweetener has been blamed for causing brain tumors, leukemia, and many other ailments and has been the topic of urban legends for many years. No credible studies have found any relationships between aspartame and these diseases. In fact, it's been shown to be safe in more than 200 studies. I know there have been some studies that claim that it's dangerous. But most of them have been refuted, and others just don't match what happens in the body. It may help to understand that your body doesn't absorb aspartame -- it's broken down into two amino acids -- phenylalanine and aspartic acid -- plus a tiny bit of methanol, in your digestive tract. Those smaller molecules are absorbed and metabolized.

That means that studies that look at the direct effect of aspartame molecules on human cells are creating a situation that doesn't happen.

So What Does Happen?

Your body absorbs the phenylalanine and aspartic acid and adds them to the pool of amino acids that are already in your body. That's not dangerous, weird or unusual by any means.The methanol is absorbed and taken directly to the liver where it's converted to formaldehyde. That formaldehyde is changed to formic acid and eliminated in your urine.But it's the methanol that concerns people because formaldehyde is toxic in large amounts. But, the amount you get from eating foods that contain aspartame is pretty small. In fact, you'll wind up with more formaldehyde from the digestion and absorption of 100-percent fruit and vegetable juices than from the same amount of diet soda. There are two conditions that are associated with aspartame. One is phenylketonuria, or PKU. People with PKU can't metabolize phenylalanine, so it builds up in the body and becomes toxic. This disorder is diagnosed early in life -- it's not something you catch, nor is it something you develop by consuming aspartame. Also, some people find that consuming foods that contain aspartame can trigger their migraine headaches.

Okay, So It's Safe -- How Is It Used?

Aspartame virtually replaced saccharin as the sweetener of choice for diet sodas because it doesn't have the strong bitter aftertaste of saccharin. It's also used to sweeten powdered diet soft drinks, packaged desserts, yogurt and some vitamin and cold remedies .Aspartame does not hold up to heat so you can't use it as a sugar replacement for home baking or cooking. Sucralose is a better choice for your kitchen because it's heat-stable and can be used in most recipes that call for sugar.
Sources: Academy of Nutrition and Dietetics Evidence Analysis Library. "Relationship Between Aspartame, Methanol and Formaldehyde Explained." Accessed September 17, 2014. http://www.andeal.org/topic.cfm?cat=4089.Magnuson BA, Burdock GA, Doull J, Kroes RM, Marsh GM, Pariza MW, Spencer PS, Waddell WJ, Walker R, Williams GM. "Aspartame: a safety evaluation based on current use levels, regulations, and toxicological and epidemiological studies." Crit Rev Toxicol. 2007;37(8):629-727.Van den Eeden SK, Koepsell TD, Longstreth WT Jr, van Belle G, Daling JR, McKnight B. "Aspartame ingestion and headaches: a randomized crossover trial." Neurology. 1994 Oct;44(10):1787-93.
Web Source:
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