Aspartame and Sudden Cardiac Death

Got this off rense.com. It's very long, but interesting as it relates to what many here have been saying about aspartame and free glutamate in general.

Here's the page:

[www.rense.com]


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Rense.com
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CDC Reports Sudden Cardiac
Death Nation's #1 Killer
From Betty Martini
Bettym19@mindspring.com
11-4-3

The Idaho Observer
October 2003

Biochemical evidence indicates aspartame behind this curious epidemic

Secretary of Defense Donald Rumsfeld's killing spree did not begin with the unjustified use of military force against Arabs whom he suspects of being terrorists. His murderous rampage began in 1981 when he used his political muscle to overcome science in the approval of the artificial sweetener aspartame. Since the approval of aspartame, millions of Americans have fallen victim to numerous chronic and degenerative diseases -- and death. The most shocking legacy of this dangerous excitotoxin is its relationship to incidents of sudden death among children and adults. Nearly half a million Americans are simply "dropping dead" each year. Though numerous medical journal reports, magazine and newspaper articles have acknowledged this fatal phenomenon, they stop short of explaining what is causing it. The evidence points to aspartame. There is only one way to tell for sure if aspartame is the culprit: Stop using this potentially fatal substance.

from Mission Possible

The CDC reports that Sudden Cardiac Death (SCD), the nation's #1 killer, prematurely ended the lives of 460,000 Americans in 1999. When the heart stops abruptly without warning, the diagnosis is SCD. It kills its victims within minutes. It is estimated that 95 percent of victims die before reaching the hospital. Often SCD happens to outwardly healthy people with no known heart problems such as high school, college and professional athletes and thousands of children.

New York State has mandated automatic external defibrillators (AEDs) be provided for all schools and athletic events on campus or off. Illinois passed a similar law. In California they talk of making defibrillators as common as fire extinguishers.

The Philadelphia Trial Lawyers Association donated 73 AEDS so all of their school gyms and playing fields will be equipped to fight this devastation.

The Philadelphia School District estimates 7,000-10,000 American children and youths die annually from SCD. Chief of Cardiology Victoria Vetter, MD, at Children's Hospital said, "I diagnose, treat and follow hundreds of children from the Philadelphia region with cardiac issues."

On 9/12 came the tragic report of 13 year old Emil Gadjev's collapse and death while playing soccer here in Atlanta.

Sudden Cardiac Death is not a "heart attack" or myocardial infarction caused by clogged arteries. It's an electrical problem in which the cardiac conduction system that generates the impulses regulating the heart suddenly puts out rapid or chaotic electrical impulses, or both. The heart ceases its rhythmic contractions, the brain is starved of oxygen and the victim loses consciousness in seconds.

Aspartame's biochemical route to SCD

Dr. James Bowen believes the evidence is pointing the finger at aspartame as the toxin responsible for sudden death in many of these instances. "The combination of aspartame consumption with the stresses of strenuous athletic competition lead to activation of the shock mechanism including the elaboration of arginine vasopressin in the hypothalamus. This results in cerebral edema, cardiac congestion and pulmonary edema in combination with severe potassium wastage which is a sure ticket to sudden death, especially in the face of the many damages inflicted by aspartame.

"Aspartame is already well known for causing neuroendocrine abnormalities such as serotonin elevations and suppression in various areas of the brain. Due to its phenylalanine isolate poisoning, which depletes dopamine, and hypothalamic damage from its extreme excitotoxic effect and resultant formaldehyde/formic acid poisoning especially focused in the hypothalamus, any biochemist could verify the direct effect of aspartame poisoning in producing the fatal aberrant shock mechanism in those exposed to it. The mere occurrence of severe athletic stress does not cause this to happen all by itself," Dr. Bowen reasoned.

Indeed, only in recent history is it mentioned that people have a habit of simply "dropping dead" from routine exertion.

Aspartame triggers an irregular heart rhythm and interacts with cardiac medication. It damages the cardiac conduction system and is a direct cause of sudden death. What Dr. Bowen is saying, of course, is that it's not just hitting their hearts but their hypothalamus and neuroendocrine systems as well.

Of interest is the report from The Telegraph in the UK regarding an investigation of why children, having mild seizures that normally don't cause death, die before they can get to a hospital. Dr. Bowen responded: "Sudden death during seizures is almost always from cardiac standstill due to arrhythmias. There are several ways that aspartame can cause this damage. Aspartame and methyl alcohol poisoning are noted for damaging myocardium as well as the cardiac conduction system itself.

"This kind of damage leads to susceptibility to irregular heartbeats, or arrhythmias. The aspartame and methyl alcohol poisoning cause immense damage to the mitochondria and to MtDNA which perpetuates the mitochondria damage. The myocardium and cardiac conduction system never get to rest. They are constantly at work pumping blood, therefore they are very highly concentrated in mitochondria to accommodate the metabolic needs of this tremendous work load.

"Therefore, mitochondrial damage is more highly reflected in the heart. Damaged mitochondria produce increased amounts of free radicals and other abnormal metabolite-producing arrhythmias.

"The person using NutraSweet may have a markedly decreased intake of mineral and vitamin co-enzyme factors which also sensitizes the heart to arrhythmias. Seizures always put unusual demands on the cardiorespiratory system and seizures due to NutraSweet occur more frequently and in spite of otherwise adequate anti-seizure medication. Aspartame creates unusual medical toxicity from the anti-seizure medication.

"It should be no surprise then that people are dropping dead from this aspect of aspartame toxicity."

CDC review

In Nov. 1984 the CDC compiled a report reviewing 213 of 592 cases of aspartame complaints. Some of these included cardiac arrest, seizures, disorientation, hyperactivity, extreme numbness, excitability, memory loss, loss of depth perception, liver impairment, severe mood swings and even DEATH. Frederick L. Trowbridge added an executive summary that conflicted with the information in the report by stating that the complaints were "generally of a mild nature."

Obviously experts and laypeople alike would disagree that such things as seizures, cardiac arrest and DEATH are "mild" problems.

Then the CDC put the summary on their web site [http://www.cdc.govwww.cdc.gov], and left off the investigation so the public would not get the real facts. But it is on www.dorway.com for anyone who wants to read the 146-page investigation.

When Mission Possible's Betty Martini asked the CDC why they allowed this phony summary, their only excuse was "Dr. Trowbridge is now retired."

The recent sudden death of John Ritter

The sudden death of John Ritter on Sept 12 stunned the nation. It was discussed on the news by Roy Flood, M.D., that he died from an undiagnosed dissection of the aorta. While we don't even know if Ritter used aspartame, Dr. Flood mentioned that this condition is usually triggered by having hypertension for several years and aspartame causes this "big time."

More biochemistry of an ignored epidemic

H. J. Roberts, M.D., F.A.C.P., F.C.C.P. is a world renowned Board Certified and Recertified Internist who declared Aspartame Disease to be a global plague and published the medical text, Aspartame Disease: An Ignored Epidemic, available at www.sunsentpress.com.

In Aspartame Disease: An Ignored Epidemic, Dr. Roberts discusses aspartame and hypertension: "Increased brain phenylalanine can elevate norepinephrine levels becoming clinically manifest as hypertension. A comparable phenomenon has been demonstrated in spontaneously hypertensive rats. Another plausible mechanism involves increased phenylalanine metabolites, especially dopamine, in the presence of excess insulin. Tourian (l985) demonstrated that insulin potentiates the synthesis of phenylalanine hydroxylase in tissue cultures."

He also says, "The documentation of essential hypertension in an insulin-resistant state associated with hyperinsulinemia (Ferrannini l987), but independent of obesity, is germane because many aspartame reactors have reactive hypoglycemia. Furthermore, phenylalanine increases insulin release. In the face of continued hyperinsulinemia, the down regulation of insulin receptors (and ensuing decreased insulin action), the increased reabsorption of sodium and sympathetic stimulation can exaggerate hypertension.

"Other clinical observations suggest a relationship between phenylalanine and tyramine. Severe hypertension may occur when increased tyramine (present in certain cheeses and alcoholic beverages) is consumed by persons taking monoamine oxidase inhibitors and cough/cold preparations or appetite suppressants that continue ephedrine, phenylephrine or phenylpropanolamine."

Ritter revisited

Two-thirds of the population is using aspartame and it's hard to avoid. So while we don't know at this point if John Ritter was consuming it, Dr. Bowen said: "The death of John Ritter highlights another possible ill resulting from the ingestion of aspartame. Aspartame is well recognized among its victims as causing connective tissue diseases in their body. Since much of the aorta consists of fibroelastic connective tissue it is logical to conclude that aspartame causes degeneration of the heart muscle."

He also said, "Aspartame really doesn't spare any structure or system in the body so its not logical to try and mentally isolate it to a few structures or a few systems of the body. In fact, the FDA identified 92 documented symptoms triggered by aspartame including death, the ultimate symptom."

Epidemic heart conditions in American children

The Atlanta Journal Constitution on 9/11 wrote: "Sudden death in high school athletes is a topic that has received a lot of attention recently." It mentioned some children have serious heart conditions that have not been diagnosed. Dr. Bowen remarked, "In many cases aspartame victims may have had pre-existent or congenital undiagnosed cardiac problems. The fatal abnormalities induced by NutraSweet would have a quicker and greater effect on these unfortunate individuals."

Sonny Bono

The article in the AJC discusses accidents that may have been caused by sudden cardiac arrest. It brings to mind the death of Sonny Bono who had an accident while skiing and hit a tree. The newspaper reported that Bono was not drinking alcohol, only a "Diet Coke."

Crashing into trees

Aspartame also causes confusion and disorientation, memory loss, etc. One pilot who asked that Mission Possible start an aviation division, said: "Dumb I am not but I couldn't make a decision on aspartame and crashed my plane into a tree."

And, yes, there are now defibrillators on planes.

Pilot Neill

American Airlines Pilot Neill was drinking a diet drink and died in flight. The captain landed the plane for the body to be removed and to get a new co-pilot. An unauthorized autopsy was requested by American Airlines but they refused to allow his widow to see the results.

Medical journals recognize "Rumsfeld's" disease*; refuse to identify its cause

The New England Journal of Medicine published the article "Magnitude of Left Ventricular Hypertrophy and Risk of Sudden Death in Hypertrophic Cardiomyopathy." Dr. Bowen said: "Yes, that is what aspartame does."

One article, "Cardiomyopathy and Its Relation to Exercise: Sudden Death in Athletes" www-unix.oit.umass.edu/`excs597k/carpender/sdathletes.htm says: "According to the Center for Disease Control in Atlanta 100,000 young athletes die each year from all cardio-vascular disorders, including cardiomyopathy, as a result of participation in sports."

This is twice as many as die in auto accidents. Of the 100,000 who die annually, 45,000 of them play basketball, not boxing or football.

The report in Science last year (that was discussed in the Atlanta Journal Constitution article), said 450,000 people each year are victims of sudden death.

An article back in 2001 by the Journal of Athletic Training reported: "In the U.S. each year, sudden cardiac arrest kills 350,000, which is approximately 1,000 people per day." ..... "The exact incidence of sudden cardiac arrest in athletes is unknown because no universal, standard surveillance method is used."

So the figures could even be greater.

Have a (diet) coke and a smile

President Bush had a fainting spell and claimed this was due to a pretzel.

Blackouts are common in aspartame victims and President Bush is constantly drinking Diet Coke.

An interesting article on Medscape is titled Syncope (fainting) as a predictor of sudden cardiac arrest. Kathy Fulford (now Mission Possible Camilla, Georgia) was certain she was dying and was having blackouts. One day she almost hit a car head on.

Her friend Darlene wanted to find out what was killing Kathy. Ten doctors were unable to diagnose the cause of her problems, mainly because the FDA, aspartame manufactures and professional organizations funded by the manufacturer push aspartame propaganda. She put her symptoms into a search engine and came to www.dorway.com.

She got off aspartame and her health problems disappeared.

Drop dead

Fulford said her neighbor, a 46 year old beautician, drank Diet Coke from the time she got up until she went to bed and her mind was going. She, too, had blackouts and was recently found dead on the floor -- another SCD victim.

***

* When people who consume aspartame become ill, the wide spectrum of symptoms are commonly referred to "aspartame disease" by those who understand the connection. Since Donald Rumsfeld can claim credit for aspartame's 1981 FDA approval, we believe its appropriate that the disease be renamed, "Rumsfled's disease."

The Idaho Observer
P.O. Box 457
Spirit Lake, Idaho 83869
Phone: 208-255-2307
Email: <mailto[email protected]>[email protected]
Web:
[idaho-observer.com]
[proliberty.com]



About Sudden Cardiac Death

Comment
From Daniel Fey
danfey@earthlink.net
11-4-3

I would like to make several points about heart disease and sudden cardiac death.

1) A study of 500 high school athletes revealed that one carbonated beverage a day increased the fracture rate from 200 to 500% depending upon the level of carbonation with coke being the worst offender. This is because carbonation destroys the body's ability to absorb minerals. This applies to Sudden Cardiac Death, too.

2) A study in Australia showed that giving magnesium to heart attack victims immediately markedly improved their conditions 41% of the time. This is because magnesium is essential in the body's manufacture of enzymes that tell the heart to beat. There are 300 of these magnesium heart related enzymes in the human heart. Drinking a carbonated beverage blocks the ability of the body to absorb magnesium.

3) Magnesium and Calcium are related in that the human body has one recptor for both minerals. This means that we need to balance our intake of calcium and magnesium. That is why health food stores often sell magnesium and calcium together in one tablet. Calcium makes it possible for the heart to physically beat. Every muscle contraction requires calcium. Carbonation also blocks the absorbtion of this mineral too, but sugar is also a problem for both of these minerals. Every heart beat requires calcium and magnesium.

4) The human body has at most 10 grams of sugar in the blood. If you look at the label of a coke or a cookie, then you will notice that eating or drinking will double, triple or even quadruple your blood sugar level. This alerts the body to mobilize insulin to reduce the blood sugar level by burning sugar only and ceasing the burning of fat and oxygen. This is why eating sugar makes people fat. The driving of insulin also relates to calcium as an imbalance in the blood draws calcium from the bones. Sugar destroys bones and teeth. It also creates imbalances in calcium and magnesium.

5) Another problem is the deficiency of vitamin E and selenium which are co-factors for each other. Vitamin E is a methyl donor (CH3). It is important in the phosphorylation cycle and allows the body to turn a waste product into a product that body builders pay many dollars for at health food stores. The FDA commissioned a study of vitamin E which excluded selenium, its co-factor so you would run out and buy drugs rather than eat food.

6) Copper is also important. A copper deficeincy can cause heart fibrilations, varicose veins and brain aneurysms. Copper shares the same receptor as zinc so these two should be taken together.

7) A better test than cholesterol is liposome A which is a glue like substance that allows the body to stick cholesterol to the arterial walls. The reason is a vitamin C deficiency. C plus protein makes collagen that supports the face and protects against wrinkles. But vitamin C also makes elastin which supports the arteries. So a C deficiency will cause the body to look for cholesterol to use to keep its arteries from collapsing. This requires that the body increase its production of liposome A which can be tested for. Of course it would be cheaper to get sufficient c and bioflavonoids in the diet.





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Kestra,

Interesting.......... and alarming. I remember Fran mentioneing a study she'd come across in some of the nortwestern Scottish islands which, if memory serves, discovered that 22% of Holtered schoolchildren had arrythmic activity. And we all know that school children LOVE (and are bombarded with commercial pressure to consume) crappy sweetened foodstuffs.

Mike F.

Thank you Kestra for sharing. Although, we don't consume aspartame, nor do we allow our children to, we know of many who do. We try to warn them, but sometimes it falls on deaf ears. My wife tried diet pop about 7 yrs ago, and noticed a funny feeling the first time, but on trying one the second time, she knew something was wrong. She said it was if she had been drugged. Her eyesight started to become unfocused and she felt like she was loosing her balance, as if she was going to pass out. That was the end of that.

Richard

For a more skeptical perspective on this subject go to the following link:

[www.snopes.com]

Though heart attacks have been the leading cause of death in the United States for decades, there is no correlation with consuming aspartame. Below is one of the papers that the CDC has written about aspartame:

[www.cdc.gov]

There are many fear mongers on the internet who enjoy warping the truth to scare people.

I can't say as I have read the information on CDS, but I do know plenty of the problems associated with Aspartame.

More than 1 million people in the modern world have had a documented toxic reaction to Aspartame. Most European Common Markets have banned the use of Aspartame in children's food.

Aspartame is more commonly known as NutraSweet here in America. It is in just about anthing "diet".

Aspartame is made of three compounds: aspartic acid, phenylalanine and methanol

Scarry enough, when NutraSweet is digested, it yields 10% methanol (wood alcohol). The wood alcohol (methanol) is widely distributed throughout the body including brain, muscle, fat and nervous tissue. It is then metabolized to FORMALDEHYDE (you know, embalming fluid!) which enters the cells and binds to the proteins and DNA (the genetic material).
(Methanol from fruit and alcoholic beverages does not convert to formaldehyde because of protective factors/chemicals in the foods).

To go even further, the formahldehyde then turns into formic acid, which in turn causes metabolic acidosis. (Formic acid is the poison found in the sting of fire ants!).

Only a very unwise or ignorant (ignorant in the sense of doesn't know about it at all) person would eat this stuff.

Some of the symptoms of aspartame poisoning include:

Headaches/Migraines, Dizziness, Seizures, Nausea, Numbness, Muscle spasms, Weight gain, Rashes, Depression, Fatigue, Irritability, Tachycardia, Insomnia, Vision Problems, Hearing Loss, Heart palpitations, Breathing difficulties, Anxiety attacks, Slurred Speech, Loss of taste, Tinnitus, Vertigo, Memory loss, Joint Pain

Because aspartame metabolizes into a poison and other dangerous chemicals (despite the claims of the manufacturer to the contrary), it is believed that it can trigger or worsen the following conditions:

Brain tumors, Arthritis, Multiple sclerosis, Epilepsy, Chronic faigue syndrome, Parkinson's Disease, Alzheimer's Disease, Mental retardation, Lymphoma, Birth defects, Fibromyalgia, Diabetes, Thyroid Disorders

Monsanto (just sold to a Japanese company) is the world's largest manufacturer of poisons (maker of Aspartame), not only of the citizens of the world but also of the environment. In 1995, Monsanto ranked 5th among US corporations in the EPA's Toxic Release Inventory, having discharged 37 million pounds of toxic chemicals into the air, land, water and underground.

A side note, when I need to get rid of ants, I buy nutrasweet and mix up a bowl of water/sugar/nutrasweet(equal) paste and it wipes out the entire colony in 2 days or so. And, guess what.... aspartame is sold to some pesticide companies as a key ingredient! That's gotta be good for you!

FWIW,
Joe

The problems with aspartame do not come from fear mongers. I grant you that some of the sites could be construed this way. But they are no more than the very angry reactions of people who have suffered first hand the terrible things it can do to you. What they want to do is to warn others so they don't have to suffer symptoms that get given labels such as MS or SADS. A lot of these so called modern diseases that are increasing every year are due to the chemicals in our diet, and that includes MSG which is a very close cousin of aspartame - they work on the same receptors.

The toxic effects of aspartame are very very real. The government and FDA stance is what you would expect from governments in the hands of multinationals. These are the people who pay for the governments and in the same breath keep themselves in business. And as they are multinationals hold the world in their hands and keep the multinational pharmaceutical companies in business to boot. Bring down the lies of the multinationals and you bring down the goovernment and the whole capatilist world. That; no-one will allow to happen at any cost. So it will continue to happen... You scratch my back and I'll scratch yours.......

The only way to stop this has to be consumer led. People need to learn the truth themselves and stop allowing themselves to be drip fed propoganda.

Fran

FWIW, Monsanto is the same company that got their attorney, Taylor, into the FDA, thanks to Clinton, just long enough to get the bovine growth hormone passed, for usage in dairy cattle. As soon as citizens became aware, Taylor quickly disappeared back to Monsanto. When two news reporters for FOX tried to tell the story of the effects of the BGH, they were fired, as Monsanto threatened to pull all advertising from the network. The story, needless to say, never aired. It was enough to make me buy only organic dairy for my children, even though I don't eat dairy. Don't these people have families????

Richard

Aspartame is the most frequently reported and has the highest number of yearly Adverse Effects reportings to the FDA than any other substance.

Make no mistake, it is a bad chemical with far-reaching problems. No one with any common sense would use aspartame anymore than they would drink formeldahyde... that's what aspartame metabolizes to.

This is not a fear monger talking.... the facts are out there. The FDA is in bed with Monsanto, always has been.

A totally innocuous and totally natural sweetener, Stevia, from the leaves of a plant has been known and used for years in Japan.

Monsanto got so nervous that Stevia might replace aspartame, that it influenced the FDA to ban the use of Stevia in commercial products here (like foods and beverages) and the FDA even went so far (1999) as to order the destruction of three books published by the distributor of Stevia. 2500 copies of three books were "burned." But 10,000 copies had already been sold...so the word was out inspite of the FDA.

The FDA says the product is safe when sold as a supplement, but not safe when marketed as a food additive.

Recently it was reported that Monsanto now has 55% of its employees working for the FDA. Guess the tail wags the dog here.

Now that Monsanto has been sold to the Japanese, I wonder if they will foist it on their own people as a healthy drink. That will be interesting.

Jackie

Richard,

You may be interested in an article I wrote a few years ago on the bovine growth hormone problem. Actually, I believe this was the first article to air the possibility of a serious problem in the making. You can find it at:

www.yourhealthbase.com/milk.html

Hans

What if you've been drinking diet sodas for years?? If you stop taking it in, can the damage (if there is any) be reversed?? Anyone know?

blessings,
MLM

Marshal,

I stopped drinking diet soda about a year ago, and I believe I have fared quite well and am healthier as a result, just one more thing removed from the sabatoging of my system. No doubt, to continue any poison or toxin in your body would be worse than continuing it because it's habit.

I would have to do some research to find you a concrete answer but I am sure there are those on this board that can provide you an answer more readily.

Joe

With all due respect, and believe me, all of you have mine, could someone please explain something to me here? The above quoted article speaks of sudden cardiac death in children, and arrhythmias in general in children, and wants to make the Aspertame link. "Seven thousand to ten thousand SCDs per year in children." Were those children all chubby and lived on diet coke? With the exception of anorexic teenageed girls, I don't think any children or adolescents drink diet drinks or will eat diet anything. My kids used to grab a sip of my coke and say "yuk, is this a diet coke?". John Ritter's sudden death from disecting aorta: my brother in law had a disecting aorta, and it's usually caused by an anneurism, which his was. He was lucky and it was detected and corrected. He has defecits, like a left ventricular ejection fraction of about 35%. The point is though, he is quite thin and never drank a diet drink or ate anything with Aspertame in his life. I think the article overreacts. It's like a conspiracy theory. Sonny Bono hit a tree; that happens. He was probably distracted by a squirrel, or girl watching.
I'm not ruling out that Searle/Monsto and the CDC are in bed together, that's a distinct possibility. It just seems to me that alot of unfounded, farfetched guesswork is coming into play here.

Just my opinion,
Pam

Hans,

Thank you for showing me what you had written. It was very interesting, and I'm hoping Canada is still resisting the pressures of the bullying tactics of Monsanto. Interesting that your article said that Japan had resisted the addition of BGH, yet they purchased Monsanto. Something smells a bit fishy in this change of ownership. Either there's a greater protection of hiding behind the skirts of international law, or Monsanto is recognizing the trend of awareness. I can't tell you how many times that the organic milks and creams are sold out in various grocery stores, when trying to purchase them.

Richard

Hi Pam

I do believe we have discussed the aspartame issue before. Aspartame is not just found in diet drinks anymore. It is in ALL lemonade and most fizzy drinks in the UK!! along with sugar - what for we have to ask ourselves. It is also in normal orange squash, toothkind ribena, apple squashes etc etc along with sugar, ALL chewing gum, in some toothpastes, yogurts etc etc.

I am thin, never been fat. Apsartame (and MSG) caused me to have bad arrhythmias which led to seizures with near death experiences. Avoidance has stopped them. I am not trying to scare tactic anyone. I agree they like to lay all the ills in the world at the door of aspartame, but the sad fact is that it is really bad and it is not the only one in normal diet. That other one is - yes you guessed it - MSG. The evidence of well meaning folks should not be dismissed because the FDA etc says it is safe.

And the neurotoxic effects can cause structural changes. It is possible for aspartame and MSG to cause an aneurysm through inflamation and eventual cell death - leading to loss of elasticity... I could go on and on....


Fran

Fran: Are you talking about drinks and foods that are not called "diet" food or drink? And another question to you off the subject of aspartame - do deli meats contain MSG?

Pam

Pam

I hope you see this. The answer to both your questions is YES and YES.

Yes aspartame is used in foods and drink that are not called diet - and deli foods especially meat are notoriously full of MSG.

Fran

Thanks Fran. Perhaps it's inescapable!!! I'm trying though.

Pam