The H.E.R.B.A.L. Guide: Dietary Supplement Resources for the Clinician by Robert A. Bonakdar (ed). Philadelphia, PA: Lippincott Williams & Wilkins; 2010. Paperback; 401 pages. ISBN-13: 978-0-7817-8268-5. $59.95.

Navigating the arena of dietary supplements can be a daunting task, even for those who work in the industry, much less those in the healthcare professions. Because a large segment of the population uses dietary supplements as part of its daily healthcare routine, it is important for clinicians to be knowledgeable in this area in order to guide patients toward making more informed decisions. Fortunately, Robert Alan Bonakdar, MD—a physician and Director of Pain Management at the Scripps Center for Integrative Medicine in La Jolla, CA and, for 10 years, the co-director of Scripps’ annual conference on evidence-based dietary supplements—has compiled an excellent resource for clinicians to guide patients who are integrating dietary supplements into their lifestyles, and to answer common questions that a patient may have. The book, The H.E.R.B.A.L. Guide: Dietary Supplement Resources for the Clinician, offers a comprehensive overview of the supplement arena, including clinical management, efficacy, regulation, safety, adverse event reporting, resources and education, and case studies. The book also provides a reference guide that lists dosages for conditions that have been clinically studied. The goal of the book is to provide a framework for the discussion of evidence-based dietary supplements and a foundation of knowledge and resources to facilitate discussion with a patient.

Dr. Bonakdar assembled this book in response to the discomfort he felt from lack of information available when responding to patient concerns regarding dietary supplements. The guiding principal of the book and important steps in patient care are summarized in Section 1 by the mnemonic acronym “H.E.R.B.A.L.”, which stands for: (1) Hear the patient out, (2) Educate the patient, (3) Record,

(4) Be aware of reactions/interactions, (5) Agree to discuss, and (6) Learn. In general, doctor-patient communication regarding supplements is often poor from the viewpoints of both the physician and his or her patients. The H.E.R.B.A.L. acronym was developed to capture and reinforce the key steps in a discussion on dietary supplements. It is a starting point to systematically put the pieces of the dietary supplement puzzle together.

The successive sections provide information on how to implement the “H.E.R.B.A.L” concept in the clinic. Section 2 (“Understanding Dietary Supplements”) describes what constitutes a dietary supplement, prevalence of use, and the legal implications of prescribing supplements. Section 3 supplies an overview of regulation of supplements implemented by the US Food and Drug Administration (FDA), including the Dietary and Supplement Health and Education Act (DSHEA), Nutrition Labeling and Education Act (NLEA), Good Manufacturing Practices (GMPs), and adverse event reporting. This section is important because consumers and physicians tend to be misinformed regarding the extent of supplement regulation and how it differs from that of over-the-counter and prescription medications. In addition, this section covers—from an international perspective—the regulation of dietary supplements and the role of trade associations and the industry in general to improve standards for dietary supplements.

Section 4 discusses how to address safety with regards to adverse effects, reactions, and interactions of supplements. The safety aspect is often misunderstood and mishandled in the clinic due to the lack of information available on this topic. Given the recent implementation of FDA regulations regarding reporting of serious adverse events, one important chapter of this section proffers guidance on how to report these events. In order for adverse event reporting to be useful, clinicians need to be provided with reporting guidelines so that they capture all relevant information that can be used to determine the safety of dietary supplements.

Section 5 provides guidance on how to evaluate clinical studies using dietary supplements, which is an important skill for surveying the literature for efficacy of these products. Section 6, titled “Clinical Management,” outlines the role of various healthcare providers with regard to supplements, including physicians, pharmacists, dietitians, nurses, naturopathic physicians, and Traditional Chinese Medicine practitioners. Section 7 then summarizes available resources to help clinicians best address their patients’ needs. It also suggests educational programs to prepare the clinicians of tomorrow to address the areas of dietary supplement discussion, education, and management.

Section 8 provides case studies that demonstrate how to apply guided care with dietary supplements and how they can be practically incorporated into sometimes complex patient scenarios. The book closes with Section 9, a guide that includes a brief sampling of the most typical initial choices for dietary supplements based on available level of efficacy and safety. This section provides formulation, dosing, and brand names utilized in clinical trials. It is designed to be a quick reference for the busy clinician who has a patient with a particular condition in need of additional options. Unfortunately, several of the clinically studied proprietary extracts that are listed in this book, such as those produced by Zeller AG, Lichtwer Pharma, Alk Abello, or Schwabe, may be difficult to obtain in certain markets given that some of these products appear to be available only in Europe. For example, the homepage for the allergy supplement Grazax® (www.grazax.com), supplied by Alk Abello, indicates that this product is only offered in European countries.

Included in The H.E.R.B.A.L. Guide: Dietary Supplement Resources for the Clinician is a password that allows access to an online version of the full text of this book and a list of links to important resources (www.herbalguideforclinicians.com). This provides a convenient way to access resources compiled in the book. Although Bonakdar targets his information toward clinicians, anyone interested in learning more about dietary supplements stands to gain from reading this guide. Other references may discuss many of these topics in more detail. However, Dr. Bonakdar arranges them into one easily understood reference that can serve as a starting point.

—Donna Webster, PhD Manager, Product Science, Safety and Compliance Herbalife International of America, Inc. Torrance, CA