Don’t eat your veggies – Dayrit

Generations of children have always searched for reasons to dodge stern commands by parents to eat their veggies. They’ve finally found an ally, it seems, in no less than the Secretary of Health. Overturning decades of research on the benefits of ampalaya for diabetics, Manuel Dayrit recently branded the findings as folklore. Herbalists feel bitter. If the well-studied, widely-recommended bitter melon can incur the ire of a health chief, what more other medicinal plants that aren’t as popular?

Dayrit’s assertion caught the medical community by surprise. Sans consultation with colleagues who’ve been testing ampalaya medicinal values, he issued Circular 196-A s.2003 on June 23, "strongly advis(ing) all concerned to cease, desist and discontinue any endorsement of ampalaya as an alternative treatment of diabetes mellitus." The memo reversed Circular 168-A s.1995, long used by health workers as bible in promoting "safe, effective alternative medicines." Dayrit reclassified ampalaya efficacy from the old "scientifically-validated" to "folklorically-validated." Medical schools are at a loss. Ampalaya and nine other medicinal herbs – including lagundi for cough or fever, sambong as diuretic, guava as oral or skin antiseptic, and garlic to lower cholesterol – are part of the curriculum.

The health chief did not cite any scientific study to back up his order or to negate earlier studies on ampalaya. He merely adduced to "more recent developments," with no specifics. The one study he quoted even hailed the lowly ampalaya. He said it "showed a significant decrease in blood sugar concentration and improvement in glucose tolerance" in diabetics. But he quickly added that the sampling was too small – 27 patients – to establish ampalaya as truly beneficial as supplemental treatment.

Makers of ampalaya preparations were stunned. Aware that many patients are dropping diabetes medicines in favor of ampalaya pills and tea, they have been warning customers through labels and newspaper ads to never stop taking their prescriptions without doctors’ orders. They never expected Dayrit to exhort the entire medical community to instead drop ampalaya altogether.

Banded under the Chamber of Herbal Industries of the Philippines Inc. (CHIPI), the 15 supplement makers also were surprised that Dayrit’s circular "to all concerned" appeared to have been kept from them. They got hold of a copy only on Aug. 1 from a doctor who in turn got it from a drug detail man. They trooped to the office next door of assistant secretary Juanito Rubio who, as head of the Philippine Institute of Traditional and Alternative Health Care (PITAHC), was just as dumbfounded. He had not been asked by Dayrit for his insights on ampalaya.

Three days later in a convention on alternative medicine, CHIPI showed the order to Dr. Gemiliano Aligui of the Philippine Council for Health Research and Development, and former health chief Jaime Galvez Tan. Both couldn’t believe it. The Council, which includes the Departments of Health, Science and Technology, Education, Agriculture, Environment and Natural Resources, as well as nutritionists, doctors, educators and community workers, has done extensive research on ampalaya. Tan had promoted it during his tenure, as did predecessors Hilarion Ramiro and Juan Flavier. They, too, were never asked by Dayrit about their experiences.

CHIPI suspected big pharmaceutical firms to have lobbied for the attack. The first ampalaya supplement was registered with the Bureau of Food and Drugs (BFAD) only in Oct. 1999 and launched in Jan. 2000. It was an instant hit in a country where half the population suffers from diabetes, from which stems other ailments that cause half of male deaths. Patients and doctors found that ampalaya greatly relieves symptoms. Word spread even among overseas Filipinos, who started ordering boxes from relatives. The trade soon grew to P500 million a year for ampalaya pills and P300 million for tea, edging out diabetes drugs that patients began to ditch despite admonitions from makers and doctors. The 15 ampalaya brands now make up 16 percent of local sales of diabetes treatments.

CHIPI’s guess could have basis. Sometime in April four prominent doctors came up with an ampalaya alert: presidents Elizabeth Paz-Pacheco of the Philippine Society of Endocrinology and Metabolism, Rosa Allyn Sy of the Philippine Diabetes Association, Augusto Litonjua of the Philippine Center for Diabetes Education, and Ricardo Fernando of the Institute for Studies on Diabetes. "We do not consider ampalaya as part of the standard treatment of diabetics and therefore do not recommend its use," they declared. "Neither is ampalaya recommended for prevention of diabetes among healthy individuals at risk." For them, standard care for diabetics must be a low-fat, high-fiber diet; regular physical activity; weight loss if necessary; anti-diabetic drugs, as prescribed by the physician; periodic blood glucose monitoring; and prevention and treatment of complications.

"Before any substance is recommended for use in the treatment of diabetic patients, it must have undergone rigorous scientific testing in both experimental and clinical settings," they added. "It should have been proven by sound statistical analysis to be more effective than placebo, and just as importantly, to be free from side effects or toxicity."

Curiously, Fernando coauthored the study that Dayrit quoted in the circular. He wrote in the Philippine Journal of Internal Medicine (July 2001): "Ampalaya fruit prepared as a tea can be a useful dietary adjunct in the treatment of diabetes. It is well tolerated and safe, with minor gastrointestinal side effects, particularly increased bowel movement."

BFAD Director Leticia Barbara Gutierrez met with the diabetes experts on April 23. Later that day, she wrote to Dayrit recommending issuance of the circular against ampalaya, On Aug. 6, Leo Wassmer, executive vice president and CEO of the Pharmaceutical and Health Care Association of the Philippines, fired off a memo to member-firms: "As a result of our representations, (BFAD) conducted inquiries on the medical claims made by entities marketing ampalaya-based products." He informed them about Dayrit’s circular.

Rural health workers are crying that Dayrit’s order is anti-poor. But the doctors fear the danger of taking ampalaya preparations as diabetes treatments and not as mere food supplements.

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