World search for guidelines to eliminate vitamin charlatans
‘A money-making racket,’ is how AIDS doctor Janet Giddy describes the market of immune boosters, supplements and ‘miracle cures’ aimed at people living with HIV and AIDS.
‘Many of our patients are buying these alternative therapies even though most can’t afford to,’ says Dr Giddy, who is based at the internationally renowned Sinikithemba Clinic at Durban’s McCord Hospital.
‘We talk to our patients a lot about a healthy diet and give them multivitamins. But we tell those on antiretroviral drugs not to take immune boosters as they may interfere with the efficacy of the drugs.’
Dr Giddy is one of many doctors world-wide who despair at how salesmen manage to persuade many poor patients and their families to divert precious food money to vitamins and supplements.
Concerned about confusion over the nutritional needs of people living with HIV, the World Health Organisation (WHO) is hosting a consultation starting this Sunday in Durban with officials and researchers from 20 countries from eastern and southern Africa.
The consultation is part of a process to develop a ‘global strategy to address nutrition and HIV’ which will involve setting international standards as well as getting donors to include food as part of their HIV aid packages.
The Durban meeting will develop consensus on recommendations for immediate action and implementation by the represented countries. After the meeting, nutrition experts will meet to evaluate inputs and formulate recommendations to send to the WHO.
Similar meetings are being held throughout the world. Once recommendations from all continents have been collected, the WHO will issue international recommendations on wide range of issues including the fortification of food and how food supplements should be advertised and marketed.
Two years of preparation have gone into the consultative meetings, which started with the appointment in May 2003 of a WHO Technical Advisory Group on nutrition and HIV/AIDS.
‘We will discuss the scientific evidence, listen to researchers and see what the gaps are,’ says WHO scientist Dr Randa Saadeh, one of the scientific advisers to the Durban consultation.
There has been bitter debate in South Africa about HIV and nutrition over the past five years. This is mainly because some people, particularly so-called AIDS dissidents who do not believe that HIV exists, have chosen to advocate that good nutrition is an alternative to anti-retroviral (ARV) drugs.
Despite South Africa’s commitment to ARV drugs, Health Minister Dr Manto Tshabalala-Msimang often mentions that people can choose to eat her own concoction of beetroot, garlic and other foodstuffs, as well as traditional medicines, instead of ARVs.
Recently, a Dr Matthias Rath has formed an alliance with AIDS dissident Anthony Brink and certain traditional healers in the Western Cape to propagate supplements rather than ARVs.
In a series of advertisements since declared ‘misleading’ by the Advertising Authority, Rath claimed that the solution to HIV/AIDS ‘does not come from high-priced and toxic pharmaceutical drugs but from public education about the dramatic health benefits of vitamins and other natural therapies’.
Ironically, a month’s supply of Rath’s vitamin supplements, Vitacor Plus, which he describes as the foundation of his cellular health programme, costs around R185 whereas government can provide three ARV drugs for around R100.
The WHO and Joint United Nations Programme on AIDS (UNAIDS) have described Rath’s claims as ‘wrong’, ‘misleading, ‘dangerous’ and ‘unhelpful’.
‘All the scientific evidence we have available tells us that vitamins and supplements cannot take the place of the comprehensive treatment of HIV, including anti-retroviral therapy and prophylactic treatment to prevent opportunistic infections,’ says Dr Saadeh, who is part of WHO’s Nutrition for Health and Development programme in Geneva.
‘Good nutrition can help people living with HIV to live better and feel better and is an integral package of care for people with HIV,’ she stresses. ‘But there is no way that it can replace anti-retroviral therapy, which work to prevent the virus from replicating in the body.’
Although the consultation process is not yet over, Saadeh says there are already some proven guidelines for people living with HIV.
The starting point is a balanced, healthy diet, as opposed to micronutrient (vitamin and mineral) and food supplements.
‘People living with HIV who are asymptomatic need about 10% more energy [food] than those who are HIV negative to maintain their body weight and keep doing physical exercise, which is important for their wellbeing,’ says Saadeh.
Once a person shows symptoms of AIDS, they need to eat about 20 to 30% more food to maintain their body weight.
Children under five who have AIDS need 50 to 100% more energy to prevent the wasting usually associated with AIDS. In addition, these children need Vitamin A supplements every four to six months.
However, there is no evidence that piling on extra protein or fat is good for people with HIV, says Saadeh.
Pregnant and breastfeeding women with HIV are particularly vulnerable. From the moment the woman knows she is pregnant, the WHO advises folate-iron supplements twice a day to prevent anaemia. Thes women may also benefit from a micro-nutrient supplement.
Nutritionist Mamra Nsika, who works with mothers of children under five in poor communities, says that there is no substitute for food.
‘We nutritionists don’t believe in pills. Healthy food in the right proportions is the basic building block for our bodies. Vitamins can only ever supplement, not replace, food,’ she stresses.
Saadeh adds that whatever global nutritional strategy is developed, it is important that food security policies include all vulnerable people, not just those living with HIV.
E-mail Kerry Cullinan
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