14.1 Dietary Supplements, Herbal Medicines, and Functional Foods
Key Takeaways
RA 9711 defines a food supplement as a processed food that adds vitamins, minerals, herbs, amino acids, or other dietary substances, and it is not a replacement for drugs or meals.
The Traditional and Alternative Medicine Act of 1997 (RA 8423) created the Philippine Institute of Traditional and Alternative Health Care (PITAHC).
The DOH promotes ten herbal medicines, including lagundi for cough, sambong as a diuretic, akapulko for fungal skin infections, and ampalaya for mild diabetes.
Probiotics are live microorganisms that confer a health benefit in adequate amounts, while prebiotics such as inulin and fructooligosaccharides feed beneficial gut bacteria.
St. John's wort speeds the breakdown of many drugs, while ginkgo, garlic, and high-dose fish oil can increase bleeding risk with warfarin.
The table of specifications includes nutrition updates such as supplements, herbal products, and functional foods. Clients often ask about products promoted online, so examinees should know the regulations and evidence.
Food Supplements in Philippine Regulation
The FDA Act of 2009 (RA 9711) defines a food supplement as a processed food product meant to supplement the diet that contains one or more dietary ingredients such as vitamins, minerals, herbs or other botanicals, amino acids, or other dietary substances. It usually comes as capsules, tablets, liquids, gels, powders, or pills, and it is not represented as a conventional food, the sole item of a meal, or a replacement for drug products.
Key points for practice:
- Food supplements must be registered with the FDA before they are sold.
- They may not claim to cure, treat, or prevent disease. Registered food supplements carry a required Filipino-language advisory stating that the product is not a medicine and should not be used to treat any disease.
- Products with therapeutic claims are regulated as drugs (including traditionally used herbal medicines) and need drug registration.
- Advise clients to check FDA registration status, avoid products with miracle claims, and tell their physician about all supplements they take.
When supplements are appropriate: documented deficiency, increased needs (for example iron and folic acid in pregnancy, vitamin A supplementation in young children under DOH programs), restricted diets (vitamin B12 for vegans), malabsorption, and older adults with low vitamin D or B12 status.
Traditional and Herbal Medicine
The Traditional and Alternative Medicine Act of 1997 (RA 8423) created the Philippine Institute of Traditional and Alternative Health Care (PITAHC) to promote research on and development of traditional and alternative health care. The DOH promotes ten medicinal plants that have been studied for specific uses:
| Plant | Scientific name | Common use promoted |
|---|---|---|
| Lagundi | Vitex negundo | Cough and asthma |
| Sambong | Blumea balsamifera | Diuretic; help with kidney stones |
| Akapulko | Cassia alata (Senna alata) | Fungal skin infections |
| Ampalaya | Momordica charantia | Mild non-insulin-dependent diabetes |
| Bawang | Allium sativum | Lowering cholesterol |
| Bayabas | Psidium guajava | Wound washing; mouthwash; diarrhea |
| Niyog-niyogan | Quisqualis indica | Intestinal worms (ascariasis) |
| Tsaang gubat | Ehretia microphylla (Carmona retusa) | Stomach ache and diarrhea |
| Ulasimang bato (pansit-pansitan) | Peperomia pellucida | Lowering uric acid in gout |
| Yerba buena | Mentha species | Pain relief such as headache or toothache |
Herbal products can still cause side effects and interactions. Ampalaya can add to the glucose-lowering effect of diabetes drugs, and sambong's diuretic effect can matter in kidney or heart disease.
Herb-drug and food-drug interactions to know:
| Product | Interaction |
|---|---|
| St. John's wort | Induces liver enzymes (CYP3A4); lowers levels of oral contraceptives, cyclosporine, some antiretrovirals, and warfarin |
| Ginkgo, garlic supplements, high-dose fish oil, ginseng | May increase bleeding risk with warfarin or antiplatelet drugs |
| Grapefruit juice | Inhibits intestinal CYP3A4; raises levels of some statins and calcium channel blockers |
| Licorice root | Can raise blood pressure and lower potassium |
| Green leafy vegetables and vitamin K supplements | Change the effect of warfarin; keep intake consistent |
Functional Foods and Bioactive Components
Functional foods provide health benefits beyond basic nutrition. Health claims must be supported by evidence and approved by regulators.
| Component | Sources | Evidence-based effect |
|---|---|---|
| Probiotics | Yogurt and fermented milks with live cultures; some fermented foods | Live microorganisms that confer a health benefit in adequate amounts; strain-specific benefits such as reducing antibiotic-associated diarrhea |
| Prebiotics | Inulin, fructooligosaccharides (FOS), galactooligosaccharides (GOS); onions, garlic, bananas | Selectively fermented by beneficial gut bacteria; produce short-chain fatty acids |
| Synbiotics | Products combining probiotics and prebiotics | Combined effect on the gut microbiota |
| Beta-glucan | Oats, barley | Soluble fiber that lowers LDL cholesterol |
| Plant sterols and stanols | Fortified spreads and drinks | About 2 g/day lowers LDL cholesterol by roughly 8-10% |
| Omega-3 fatty acids (EPA, DHA) | Fatty fish such as sardines, tuna, mackerel (galunggong) | Lower triglycerides; support heart health |
| Lycopene | Tomatoes, watermelon, pink guava | Antioxidant carotenoid |
| Isoflavones | Soybeans, tofu, taho | Phytoestrogens; modest effects on menopausal symptoms |
| Sulforaphane | Broccoli, cabbage, pechay and other cruciferous vegetables | Studied for anticancer effects |
| Anthocyanins and flavonoids | Ube, duhat, berries, tea, cocoa | Antioxidant and anti-inflammatory activity |
Malunggay (moringa) is rich in vitamin A precursors, calcium, and iron and is widely promoted, including as a galactagogue for breastfeeding mothers. The evidence for increasing milk supply is limited, so frequent effective breastfeeding remains the main strategy.
Evaluating Supplement and Health Claims
Teach clients to ask:
- Who is making the claim, and do they sell the product?
- Is the evidence from controlled human trials or only testimonials and animal studies?
- Does the claim promise a cure or quick results?
- Is the product registered with the FDA, and does the label match the registration?
- Could it interact with the client's medicines or condition?
Caution
Never advise a client to stop prescribed medicine in favor of a supplement or herbal product. Refer questions about drug changes to the physician.
A client with diabetes takes metformin and wants to add an ampalaya capsule. What is the most appropriate advice?
Take it instead of metformin, because ampalaya is natural and has no side effects at all
Check its FDA registration and tell the doctor, since it may add to metformin's effect
Ampalaya has no effect on blood glucose and is harmless
Take double the label dose to stop metformin sooner
Which DOH-promoted herbal medicine is used mainly for cough and asthma?
Sambong
Akapulko
Lagundi
Niyog-niyogan
A woman taking oral contraceptives starts St. John's wort for low mood. What is the main concern?
It reduces contraceptive effectiveness by speeding drug breakdown
It increases the contraceptive dose and causes overdose
It blocks absorption of calcium from milk
It has no known interactions with prescribed drugs
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