The current debate regarding the role of nutrition in the treatment of HIV/Aids – fuelled by the likes of vitamin entrepreneur Dr Matthias Rath and the South African health ministry – is reaching boiling point.
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But in the midst of the controversy, thousands and thousands of people living with HIV/Aids are trying to make sense of mixed messages, desperately wanting to improve their quality of life.
"It may help to bear one thing in mind – namely that sound nutrition has not cured HIV/Aids in the developed world, and that it is not going to cure the disease in the developing world either," Prof Demetre Labadarios, Head of the University of Stellenbosch's Department of Human Nutrition, was recently quoted as saying in the Tygerland, a publication of the university's Faculty of Health Sciences.
The role of malnutrition
Experts, like Labadarios, know that malnutrition is a fatal condition. "Malnutrition affects virtually every organ system in the body and the consequences are fatal on a large scale worldwide on a daily basis, affecting all age groups and populations," he says.
It is also well known that disease, in general and more specifically HIV/Aids, which is not adequately treated, exacerbates malnutrition.
But while sound nutrition can prevent and cure malnutrition, it cannot cure disease, Labadarios says. "The underlying disease needs to be treated."
Sound nutrition can, however, alter the course of disease in the long run – but only in as much as "buying us time" and allowing the medicinal therapy to cure the disease, Labadarios says. That is if the disease is curable, of course.
The supplement controversy
The question of whether vitamin and mineral supplements are beneficial is an important one – especially in the context of the recent Rath controversy.
If one takes a look at research conducted over the years, there is little doubt that vitamin and mineral supplements are beneficial in terms of infection, especially when micronutrient requirements are increased and body stores are depleted.
But boosting one's vitamin and mineral intake is not a cure to infection. "Micronutrient supplements are best taken as an addition to the daily dietary intake, which serves to promote nutritional adequacy, specifically in individuals who are nutritionally deprived," he says.
In the case of HIV/Aids, the purpose of these supplements is to prevent micronutrient deficiencies and their complications.
"We know for instance that good nutrition, which includes micronutrient supplements, is very helpful in the treatment of a patient with tuberculosis, provided the patient is also compliant with the concurrent prescribed drug treatment for tuberculosis," reads a fact sheet compiled by the Nutrition Information Centre of the University of Stellenbosch (NICUS).
"We also know very well that failure to take the drug treatment for tuberculosis makes the disease fatal eventually. Similarly, HIV infection also overwhelms the body's defence mechanisms eventually, and in the long-term cannot be brought under control without medicinal treatment," the fact sheet states.
What this means is that good nutrition and micronutrient supplements can indeed afford benefits to people living with HIV/Aids, but not in terms of curing the disease. Instead, it only helps in terms of preventing malnutrition and nutrient-deficiency-associated complications.
Should one take supplements?
Experts believe that HIV-infected patients must exercise caution when using micronutrient supplements.
People often take excessive vitamin and mineral doses in the belief that if "a little is good, a bit more will be better". However, this practice is not supported by clinical research. And, in certain circumstances, high dosages of vitamins and minerals could be harmful.
In view of these facts, NICUS recommends the following:
Micronutrient supplementation is only useful in combination with an adequate and well-balanced diet and can never replace the need for adequate food intake.
There is no documented evidence that any specific food of any description, on its own, can alter the course of the disease or for that matter be effective in the treatment of malnutrition.
Multivitamin supplements should not exceed two to three times the recommended daily allowance (RDA) until such time that more data and experience becomes available.
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