“Let food be thy medicine” -
Hippocrates
The Greek physician undoubtedly had naturally occurring substances in mind when he came up with this aphorism; the packaged foods and supplements we now pick up in supermarkets and pharmacies were a long way in the future.
Now we have labels such as medical foods, nutraceuticals and dietary supplements to cover the range of products – natural and manufactured – that could be used to follow Hippocrates’ advice.
In the US a clear distinction is made between these labels: dietary supplements are intended to enhance wellness among healthy adults and consist of vitamins, minerals, and/or herbs.
Nutraceuticals are nutrients, foods or parts of foods that provide health benefits and combat disease.
Like dietary supplements and nutraceuticals, medical foods are composed of combinations of vitamins and minerals but they are formulated specifically to manage nutritional deficiencies that affect disease progression.
Specific formulations
While many nutrients contained in medical foods are also commonly taken as supplements, medical foods contain specific formulations designed to manage the course of a disease.
European and Irish legislation is less prescriptive. Food supplements are defined as “foodstuffs the purpose of which is to supplement the normal diet and which are concentrated sources of nutrients or other substances with a nutritional or physiological effect, alone or in combination, marketed in dose form . . .”
And the 2007 statutory instrument giving effect to European legislation in this area defines nutrients as either vitamins or minerals.
Who regulates food supplements and nutrients in Ireland? The Food Safety Authority of Ireland (FSAI) is the national body with responsibility for the enforcement of food safety legislation. Vitamins, minerals and other substances sold as food supplements are regulated as food unless the product is considered a medicine.
However, food supplements with vitamin and mineral levels at or above prescription levels are considered medicinal products and come under the remit of the Irish Medicines Board (IMB).
Maximum levels for vitamins and minerals in food supplements are currently being established at European level and will be regulated under food legislation.
Herbal supplements are regulated under food legislation unless the product contains a herbal substance which is subject to medicinal control, in which case it is controlled by the IMB.
Confused? I have to admit I am. Perhaps some examples may help. If you are fond of a probiotic yoghurt in the morning or you like margarine with a cholesterol-lowering additive, then you are consuming a nutraceutical. It is a hybrid of a food laced with an additive that is associated with a health benefit. Nutraceuticals are also referred to as “functional foods”.
If you are taking a multivitamin pill such as Pharmaton as a general pick-me-up, then you are taking a food supplement containing vitamins such as A, B, C and E as well as minerals including iron, copper and magnesium.
On the other hand, if you have been told you have a certain type of anaemia (megaloblastic), and you are prescribed folic acid (vitamin B9) supplements then, at least according to the North American way of thinking, you are taking a medical food. Or if your child is diagnosed with an inborn error of metabolism such as phenylketonuria (PKU), they will be prescribed medical food in the form of large neutral amino acids.
Herbal supplements
A typical herbal supplement that comes under the umbrella of the IMB is St John's Wort. Also known as hypericum, it is an effective anti-depressant but also interacts with a number of prescribed medicines.
It is considered a medicine and must be prescribed by a medical practitioner.
When taking vitamin and mineral supplements, it’s important not to exceed the recommended daily dose.
mhouston@irishtimes.com
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