Uttam Maharjan

Some months ago, the Department of Drug Administration issued a public notice prohibiting doctors from prescribing food supplements for their patients and instructing suppliers and pharmacies not to supply, distribute and sell such food supplements. The notice was issued in view of a growing trend of prescribing food supplements for patients, whether necessary or not. Food supplements, also called dietary or nutritional supplements, are not drugs. But in Nepal, food supplements are imported as food items but used as supplementary drugs (they are prescribed in addition to required drugs).

Balanced diet
Food supplements are helpful in overcoming nutritional deficiencies. So vitamins, multivitamins, omega 3, calcium and so on are prescribed by doctors as food supplements. They fulfil the requirements for carbohydrates, minerals, iron, herbs and other nutrients and come in capsule, pill, tablet or liquid form. But the thing is a balanced diet can fulfil all these nutritional requirements. That is why, dieticians argue against food supplements, saying that they cannot replace a balanced diet. They reason that food supplements are just food items and not drugs and so they cannot cure, or mitigate the severity of diseases. This is the reason they recommend including fruit and vegetables in a diet even if food supplements are being taken. They, however, say that food supplements may be resorted to only when people cannot afford nutritious food or their diet does not provide required nutrition for them or they become weak for lack of nutritious food.
Food supplements may be required for certain individuals, when they cannot get nutrition from their regular diet. Old people, long-hospitalised patients, women of child-bearing age, people on specific medications, stressful people or people with irregular eating habits may require food supplements. But again, such food supplements need to be taken on the recommendation of doctors or dieticians. Consuming food supplements haphazardly may be harmful. This may affect eating habits, lifestyles and sleep. Antioxidants in food supplements like vitamin C and vitamin E can affect the effectiveness of some cancer chemotherapy drugs. Use of vitamin B6 in high doses for a long time can cause neural damage. Likewise, excessive use of vitamin E can cause haemorrhage.
Demand for food supplements has been rising in the country. There are over 10,000 kinds of food supplements. The import bill for food supplements runs into seven or eight billion rupees annually and is growing by 20 per cent annually. Most of the food supplements (95 per cent) are imported from India and the rest come from China, Australia, Thailand and other countries. With food supplements having a huge market, doctors, suppliers and pharmacies are promoting the consumption of food supplements. In some cases, even medical representatives, who are concerned with drugs and surgical products, are also found involved in the food supplement promotion campaign.
Food supplements are under the purview of the Food Technology and Quality Control Department. So they are in the category of food items. They are also imported as such. But they are used as supplements to drugs as if they were to be taken together to enhance the effectiveness of medical treatment. That is why the Department of Drug Administration has stepped into the jurisdiction of the Food Technology and Quality Control Department. There are no grounds to prove that food supplements are of high quality, effective and safe. Some food supplements being used in the country are also in the prohibitory list of the Gazette. Moreover, the Food Technology and Quality Control Department does not conduct quality tests on the food supplements imported from abroad.
There is lack of awareness of food supplements among people. Some people even request their doctors to prescribe food supplements in addition to required drugs in the hope that that they can regain strength, recover quickly and become healthy again. On the other hand, some doctors themselves prescribe food supplements. As such, use of food supplements has been rising rapidly even if they were banned by the Department of Drug Administration 27 years ago. Use of both drugs and food supplements increases the economic burden on patients. Oftentimes, the cost of food supplements exceeds that of drugs. But who cares?

Quality tests
The time has come to distinguish between drugs and food supplements. The Department of Drug Administration should be persistent in its notice regarding regulating the import, distribution and sale of food supplements. However, it will not be judicious to completely ban food supplements. Some food supplements may be actually required for some individuals. But the Department of Drug Administration should completely ban the food supplements not registered with it. Further, quality tests should be mandatorily conducted on food supplements to ensure that they are nutritive and safe. The practice of haphazardly prescribing or selling food supplements must come to an end.
People, who must use food supplements besides required drugs, should be advised to use only authentic food supplements on the recommendation of doctors or dieticians. A public awareness campaign also needs to be launched across the country so that the general public can be familiar with food supplements and their benefits and harmful effects. Everyone likes to be healthy but it is not prudent to deceive patients by prescribing unnecessary things. After all, doctors should abide by the Hippocratic oath.

(Maharjan has been regularly writing on contemporary issues for this daily since 2000 and can be reached at uttam.maharjan1964@gmail.com)