Philippine Health Secretary Francisco Duque III, on January 29, 2008, issued a circular, rescinding a previous one released in 2003, reinstating ampalaya (Momordica charantia) on the Department of Health’s list of “scientifically validated herbal medicinal plants.”
The reason cited for his decision was the “recent evidence on the clinical efficacy of ampalaya against diabetes mellitus.” The basis was the “clinical
trials conducted by scientists at the University of the Philippines in Manila and Los Baños which have found that leaves of ampalaya growing in Mt. Makiling are comparable to synthetic drugs for diabetes….Other studies have established that ampalaya fruits and seeds have medicinal properties.”
Not potent enough by itself
As we have written in this column on September 15, 2003 (The Brewing Bitter Controversy), “….while ampalaya has the property to lower blood sugar, eating ampalaya or taking any of those ampalaya preparations (capsules, tea, etc) being marketed as herbal alternative “cure” for diabetes, alone and by themselves (in lieu of prescription medications for diabetes), is not effective enough to adequately and safely treat diabetes.”
Announcing that ampalaya has been “scientifically validated herbal medicinal plants” is fine, but saying that the “ampalaya leaves are comparable to synthetic drugs for diabetes” is dangerously confusing to the lay persons. That statement should be qualified for public safety.
The 2003 circular
“Ampalaya…is not intended to treat, prevent, mitigate, cure or diagnose (diabetes) disease,” said Leticia B. Gutierrez, Director of the Philippine Bureau of Food and Drugs (BPAD) in her position paper released August 29, 2003. Then Health Secretary Manuel Dayrit on June 23rd issued Circular 196-A series of 2003 where he “strongly advised all concerned to cease, desist and discontinue any endorsement ampalaya an alternative treatment for diabetes mellitus.” I could not agree more with those two vital pronouncements which could save countless of lives.
Safe as an aid
While eating the sumptuous ampalaya vegetable and leaves can conceivably aid in the management of diabetes, using this alone, or taking ampalaya preparations alone, as an alternative method of treatment for diabetes, abandoning anti-diabetes medication prescribed by the physician, is most unsafe.
With the advent of these widely and irresponsibly advertised ampalaya pills and drinks “for diabetes,” there have been cases reported where diabetic patients unwittingly discontinued taking their prescription drugs and replaced them with ampalaya capsules, who went into coma, some of them dying. The ampalaya preparations were obviously not potent enough to control the diabetes.
Among those with pre-diabetes, people who are prone to develop the disease but who do not have the full-blown diabetes yet, physical exercises and dieting can significantly delay, and in some cases prevent, the onset of diabetes. It is conceivable that this pre-diabetic stage is where eating ampalaya regularly or using the ampalaya pills or tea as a part of the delaying regimen might be of real benefit in warding off the disease for as long as possible. But these so-called Ampalaya supplements could have deadly results when taken alone as a treatment for diabetes, abandoning prescribed medications to control the blood sugar level.
The Metformin wonder
Metformin (Brand names: Glucophage, Glucophage XR, Fortamet, and Glumetza) is an effective and widely used drug for the treatment of non-insulin dependent Type 2 diabetes mellitus. It controls blood sugar by making the body cells to be more sensitive to insulin, slowing the release of sugar from the liver, and by reducing the speed of absorption of sugar from food in the intestinal tract. Some studies have shown metformin to possibly improve longevity among its users. Future larger evidence-base clinical research, a global consortium, would be a welcome endeavor in this regard, since there are almost half a billion T2 diabetics around the world today, rising from 4.7 percent in 1980 to 8.5 percent in 2014, the prevalence rising rapidly among the middle-and-low income countries.
Legal liability
The manufacturers and distributors/vendors of these herbal and other food supplements with their implied claim of medical use or cure must be legally liable for any complications, adverse reactions or deaths caused, directly or indirectly by their claims and their products. Marketing misleading ads, half-truths, unproven claims, is criminal. The poor unsuspecting ignorant people are the obvious targets of the unscrupulous advertising that floods the world. This trillion business industry must held accountable for whatever harm they cause society, just like the tobacco industry.
Be first, do no harm
While it might be a bitter pill to swallow for some people, especially for the money0-hungry entrepreneurs marketing “food supplements,” we have to face the fact that ampalaya derivatives (pills, tea, etc.) have not been fully proven to be effective, by themselves, as sole treatment for diabetes, to warrant abandonment of the physician prescribed proprietary or generic drugs for diabetes. That is a fact the Department of Health and all health providers should accept. Furthermore, the DOH must explain and qualify its new circular as clearly as possible for public safety. Not to do so would be to trivialize and denigrate the sanctity of the healer’s precept of primum non nocere (first, do no harm) in treating living beings, the basic tenet of the Hippocratic Oath which all physicians took as they were sworn into the practice of medicine. Not doing so would also be a great disservice to the patients and a potential grave risk to people’s lives.
The message
The January 29, 2008 circular of the Department of Health should be carefully understood with all its medical subtleties. The fact is while ampalaya could be an aid in the treatment of diabetes, the ampalaya vegetable alone, and/or the ampalaya preparations being marketed as a treatment or “cure” for diabetes, alone and in themselves, are NOT effective enough to replace the anti-diabetic medications prescribed by the physician. Before using or shifting to this or any other herbal alternative, patients should first discuss this thoroughly with their attending physician. To do otherwise would be foolhardy and dangerous.
***
Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
