The country’s top scientific body has called for ‘science-based evidence’ to clear up the ‘confused messages’ about the role of nutrition, traditional medicine and alternative remedies in HIV and TB treatment.
The Academy of Science of South Africa this week condemned the ‘dual system’ in this country where orthodox medicine was subjected to rigorous scientific tests to prove that it works, while traditional and alternative remedies were free to make all kinds of unproven claims.
The Academy’s recommendations were contained in a two-year study into the role of nutrition in HIV and TB that was released this week.
‘An effectively dual system of approval of medicinal claims has developed, in which orthodox medicine is evaluated with all the rigour of the regulatory environment, while traditional medicines and alternative therapies continue to claim efficacy without being properly evaluated by the responsible legal and regulatory institutions,’ said the Academy.
The Academy study was initiated in 2005 after repeated claims by Health Minister Manto Tshabalala-Msimang that garlic, beetroot, lemons and oil olive have a marked impact on improving people’s weak immune systems while antiretroviral drugs were toxic.
The Academy’s 15-person expert panel ‘unanimously’ supported the view that ‘specific antiretroviral agents are the only established direct weapon in the treatment of HIV infection itself’.
It also concluded that there is ‘no evidence and no biological reason to suspect that any diet, food, nutrient or non-nutrient (phytochemicals) or combinations of these can replace the proper use of orthodox drug treatment for either TB or HIV’.
However, it found there was ‘some evidence’ that good nutrition might slow the progression of HIV to AIDS, improve patients’ response to antiretrovirals, and reduce the side-effects of ARVs.
There was also evidence that if undernourished people at risk of getting TB were given nutritional support, this would reduce their risk of getting the disease.
However, the panel proclaimed itself ‘frankly appalled by the dearth of reliable and truly informative studies of the nutritional influences or interventions on the course and outcomes’ of the two diseases.
In this context, ‘the marketplace has been flooded with claims that various foodstuffs, food supplements and micronutrients can prevent, alleviate or cure HIV or TB, or strengthen the immune system,’ noted the Academy.
‘Senior community and political leaders have expressed concern about the potential toxicities of ARVs, while simultaneously promoting alternative nutritional therapies for the benefit or cure of HIV.
This had created ‘enormous confusion and lack of trust in orthodox health practitioners and in orthodox medicines’.
Healthworkers were also confused about what advice to give patients.
‘The panel cannot emphasize strongly enough that in the especially problematic context of HIV infection and active TB it is unethical and unacceptable to recommend any treatment for which there is no proof that it would be beneficial and no convincing proof that it would do no harm.’
The few pronouncements the panel could make indicated the complexity of how vitamins and minerals interact with the diseases.
For example, they found that Vitamin A supplements could increase the risk of pregnant and breastfeeding mothers transmitting HIV to their babies
However, multivitamin supplements (excluding vitamin A) reduced disease progression in HIV positive pregnant women.
Meanwhile, a few small trials showed that zinc supplements given to HIV positive children are safe and effective in reducing disease, but zinc may be harmful to HIV positive pregnant women.
The panel recommended that the nutritional care of people with HIV and TB should focus on ‘diversified diets including available, affordable and traditional foods’ as well as fortified foods and macro- and micronutrient supplements at safe levels.
‘Established, well-described steps and protocols should be followed in public health nutrition interventions and in the therapeutic nutritional care of patients,’ recommends the report.
The Department of Health said it noted the outcomes of the study which, ‘based only on review of available scientific literature – do not necessarily provide any new information that was unknown to the Department of Health’.
‘The findings of the study actually reaffirm the policy position of the Department. It confirms that in addition to the two infectious diseases – TB and HIV – South Africa is also facing a challenge of macronutrient deficiencies and/or micronutrient deficiencies,’ said health ministry spokesperson Sibani Mngadi. ‘ Health-e News Service.