An extensive analysis of all scientific research on the links between improved nutrition and the treatment of both HIV/AIDS and tuberculosis (TB) has found no evidence that healthier eating is any substitute for correctly-used medication.
The analysis was carried out by an expert panel appointed by South Africa’s Academy of Science of South Africa (ASSAf), an independent statutory body that advises the government.
Professor of nutrition Esté Vorster, director of the Africa Unit for Transdisciplinary Health Research at North-West University, said that malnutrition and poverty remained a contributing factor in many infections, including HIV/AIDS and tuberculosis. ''Neither poverty nor malnutrition is the cause of HIV/AIDS or tuberculosis,'' she emphasised.
''South Africans need to eat a healthy diet with a variety of daily fruit and vegetables. But if you've been tested for HIV/AIDS and you know your status, you need to also know that supplements cannot compensate for eating healthily. In the same way, eating healthily cannot compensate for anti-retroviral drugs when indicated by a doctor. For both HIV/AIDS and tuberculosis, we have to rely on the appropriate medical drugs,' she said.'
The analysis was deemed necessary because of widespread beliefs in South Africa that antiretroviral treatment was unnecessary if a person eats a healthy diet and that AIDS is caused, in part, by malnutrition. These beliefs have been promoted by Health Minister Manto Tshbalala Msimang, who has become notorious for her promotion of garlic, African potato and beetroot as vegetables that can delay the onset of AIDS.
She attracted ridicule at last year’s International AIDS Conference for requiring the South African government’s stand at the conference to display these vegetables, and has become widely known in the South African press as Dr Beetroot (link to cartoon).
The detailed report by a 15-member consensus panel of the prestigious Academy of Science of South Africa (ASSAf) has been given to government and is now available online.
''The panel has concluded that no food, no component made from food, and no food supplement has been identified in any credible study as an effective alternative to appropriate medication,'' said Wits professor and National Health Laboratory Services pathologist Barry Mendelow, a specialist in blood disorders who chaired the study.
''We need a well-nourished nation. But a well-fed population on its own is not going to resist HIV/AIDS without anti-retroviral drugs,'' panel member Dr Dan Ncayiyana, editor of the South African Medical Journal, said.
In October 2005, the Academy of Science of South Africa appointed the study panel, which included people such as Dr Mohamed Ali Dhansay of the Medical Research Council, Dr Clive Gray of the National Institute for Communicable Diseases and both Dr Helen Rees and Dr Francois Venter from the Reproductive Health and HIV Research Unit in Johannesburg.
The panel made a series of recommendations to government and other institutions on nutrition policy in relation to HIV/AIDS and TB in South Africa.
The implementation of the existing integrated nutrition programme of the Department of Health is should be evaluated and adequately resourced for implementation to address undernutrition in all vulnerable groups, but especially in women and very young children.
Resources should be directed to ensure food security based on locally available, affordable and traditional foods to vulnerable populations.
The nutritional care of people infected with HIV should focus on diversified diets including locally available, affordable and traditional foods, and should be complemented by appropriate, locally acceptable macronutrient supplements.
Everything possible should be done to promote and support adequate dietary intake of micronutrients at recommended (that is, INL98) levels, while recognising that this may not be sufficient to correct nutritional deficiencies in all HIV-infected individuals.
In situations where micronutrient deficiencies are endemic, these nutrients should be provided through food fortification or micronutrient supplements where available that contain at least 1-2 INL98s. HIV-infected women should be offered multivitamin supplementation at INL98 levels.
The nutritional care of individuals infected with TB should focus on adequate diversified diets including locally available, affordable and traditional foods. In addition, the use of appropriate, locally acceptable macronutrient supplements is recommended, especially for those patients who are demonstrably deficient in these nutrients. Nutritional interventions for patients with TB should extend to their close contacts and families.
The existing legislation and regulations should be enforced for all products claiming medicinal benefits with respect to HIV infection or active TB.
Government should identify accessible, scientifically valid ways to accelerate the investigation of promising traditional or herbal products.
An urgent national expert consultation should be convened to develop national guidelines for HIV-infected infant feeding. This should be aligned with the Paediatric Food-Based Dietary Guidelines for South Africa by the SA Nutrition Society.
More nutritionists and dietitians should be trained, employed and utilised in all programmes addressing HIV/AIDS and tuberculosis, and the nutritional knowledge of all health care workers in community, clinic and hospital settings should be improved and extended.