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Freeman M. Reconsidering the effects of monosodium glutamate: a literature. J Am Acad Nurse Pract. 2006 Oct;18(10):482-6.

PURPOSE: This article reviews the literature from the past 40 years of research related to monosodium glutamate (MSG) and its ability to trigger a migraine headache, induce an asthma exacerbation, or evoke a constellation of symptoms described as the "Chinese restaurant syndrome." DATA SOURCES: Literature retrieved by a search using PubMed, Medline, Lexis-Nexus, and Infotrac to review articles from the past 40 years. CONCLUSIONS: MSG has a widespread reputation for eliciting a variety of symptoms, ranging from headache to dry mouth to flushing. Since the first report of the so-called Chinese restaurant syndrome 40 years ago, clinical trials have failed to identify a consistent relationship between the consumption of MSG and the constellation of symptoms that comprise the syndrome. Furthermore, MSG has been described as a trigger for asthma and migraine headache exacerbations, but there are no consistent data to support this relationship. Although there have been reports of an MSG-sensitive subset of the population, this has not been demonstrated in placebo-controlled trials. IMPLICATIONS FOR PRACTICE: Despite a widespread belief that MSG can elicit a headache, among other symptoms, there are no consistent clinical data to support this claim. Findings from the literature indicate that there is no consistent evidence to suggest that individuals may be uniquely sensitive to MSG. Nurse practitioners should therefore concentrate their efforts on advising patients of the nutritional pitfalls of some Chinese restaurant meals and to seek more consistently documented etiologies for symptoms such as headache, xerostomia, or flushing.

Beyreuther K, Biesalski HK, Fernstrom JD, Grimm P, Hammes WP, Heinemann U,Kempski O, Stehle P, Steinhart H, Walker R. Consensus meeting: monosodium glutamate - an update. Eur J Clin Nutr. 2007 Mar;61(3):304-13. Epub 2006 Sep 6.

OBJECTIVE: Update of the Hohenheim consensus on monosodium glutamate from 1997: Summary and evaluation of recent knowledge with respect to physiology and safety of monosodium glutamate. DESIGN: Experts from a range of relevant disciplines received and considered a series of questions related to aspects of the topic. SETTING: University of Hohenheim, Stuttgart, Germany. METHOD: The experts met and discussed the questions and arrived at a consensus. CONCLUSION: Total intake of glutamate from food in European countries is generally stable and ranged from 5 to 12 g/day (free: ca. 1 g, protein-bound: ca. 10 g, added as flavor: ca. 0.4 g). L-Glutamate (GLU) from all sources is mainly used as energy fuel in enterocytes. A maximum intake of 6.000 [corrected] mg/kg body weight is regarded as safe. The general use of glutamate salts (monosodium-L-glutamate and others) as food additive can, thus, be regarded as harmless for the whole population. Even in unphysiologically high doses GLU will not trespass into fetal circulation. Further research work should, however, be done concerning the effects of high doses of a bolus supply at presence of an impaired blood brain barrier function. In situations with decreased appetite (e.g., elderly persons) palatability can be improved by low dose use of monosodium-L-glutamate.

Reus KE, Houben GF, Stam M, Dubois AE. [Food additives as a cause of medical symptoms: relationship shown between sulfites and asthma and anaphylaxis; results of a literature review. Ned Tijdschr Geneeskd. 2000 Sep 16;144(38):1836-9.

OBJECTIVE: To determine if a causal connection exists between food additives and various medical complaints. DESIGN: Literature study. METHOD: Medline over the period January 1966-January 1999 was searched for articles on the following substances not containing protein and lactose: monosodium glutamate (MSG), sulfites, azo-dyes (tartrazine, sunset yellow, azorubin, amarant, cochineal red), benzoates, sorbates, butylated hydroxyanisole/butylated hydroxytoluene (BHA/BHT), parabens, cinnamon and vanilla, in combination with key words regarding food and side effects. Of those studies purporting to demonstrate an effect, only double-blind randomized placebo-controlled studies with oral challenge were assessed further, unless the complaint was anaphylaxis. Of studies not demonstrating an effect the design was assessed. RESULTS: Only for sulfites as causative agents of asthma and anaphylaxis, methodologically adequate studies demonstrating a causal connection could be found. For azo-dyes, benzoates, MSG, sorbates and BHA/BHT, no link with medical symptoms was demonstrable. For parabens, cinnamon and vanilla there were insufficient or inadequate data to justify a conclusion.

Stevenson DD. Monosodium glutamate and asthma. J Nutr. 2000 Apr;130(4S Suppl):1067S-73S

Allen et al. (1987) conducted oral monosodium glutamate (MSG) challenges with 32 asthmatic volunteers and reported that 14 reacted to MSG. Another study by Moneret-Vautrin (1987) also reported MSG-induced asthma attacks in 2 of 30 asthmatic patients. Four additional studies have been conducted and none has confirmed the results of the above authors. These studies, by Schwartzstein et al. (1987), Germano (1991), Woods et al. (1998) and Woessner et al. (1999), challenged a total of 45 patients who gave a history of asthma attacks in oriental restaurants. None of these patients experienced asthmatic reactions after ingesting MSG (one-sided confidence interval of 0-0.066). Another 109 asthmatic patients, without a history of asthma in oriental restaurants, also did not react to ingestion of MSG (one-sided confidence interval of 0-0.027). With a confidence interval < 0.05 there is a >95% probability that MSG history-negative asthmatic patients are not sensitive to MSG. For the MSG history-positive asthmatics, 45 patients, in well-performed studies, underwent negative challenges to MSG, contrasting with two studies reporting positive challenges. Allen et al. (1987) and Moneret-Vautrin (1987), who reported positive MSG challenge results, performed studies with the following characteristics: 1) single blinded, conducted after discontinuing essential antiasthma medications; 2) used effort-dependent peak expiratory flow rate measurement of lung function; 3) added AM bronchodilators in some patients; 4) ignored wandering baselines on the placebo challenge days; and 5) conducted some challenges in the AM and some at night. In summary, the existence of MSG-induced asthma, even in history-positive patients, has not been established conclusively.

Geha RS, Beiser A, Ren C, Patterson R, Greenberger PA, Grammer LC, Ditto AM, Harris KE, Shaughnessy MA, Yarnold PR, Corren J, Saxon A.J Review of alleged reaction to monosodium glutamate and outcome of a multicenter double-blind placebo-controlled study.
Nutr. 2000 Apr;130(4S Suppl):1058S-62S.

Monosodium glutamate (MSG) has a long history of use in foods as a flavor enhancer. In the United States, the Food and Drug Administration has classified MSG as generally recognized as safe (GRAS). Nevertheless, there is an ongoing debate exists concerning whether MSG causes any of the alleged reactions. A complex of symptoms after ingestion of a Chinese meal was first described in 1968. MSG was suggested to trigger these symptoms, which were referred to collectively as Chinese Restaurant Syndrome. Numerous reports, most of them anecdotal, were published after the original observation. Since then, clinical studies have been performed by many groups, with varying degrees of rigor in experimental design ranging from uncontrolled open challenges to double-blind, placebo controlled (DBPC) studies. Challenges in subjects who reported adverse reactions to MSG have included relatively few subjects and have failed to show significant reactions to MSG. Results of surveys and of clinical challenges with MSG in the general population reveal no evidence of untoward effects. We recently conducted a multicenter DBPC challenge study in 130 subjects (the largest to date) to analyze the response of subjects who report symptoms from ingesting MSG. The results suggest that large doses of MSG given without food may elicit more symptoms than a placebo in individuals who believe that they react adversely to MSG. However, the frequency of the responses was low and the responses reported were inconsistent and were not reproducible. The responses were not observed when MSG was given with food.

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