Q&A with Dr. Bonakdar – DNI/DSI Webcast

Question: What are the expected resources that practitioners should ask for from supplement companies? For example, are there protocols or white sheets?

Dr. Bonakdar: When interacting with supplement companies that are educating physicians similar to a pharmaceutical company, ask about the evidence. For example, if they are talking about supplement X, ask them what is the research for its use in various scenarios?

Look for clinically-tested brands as much as possible. If it's a SAM-e for depression, can they give me the information on what population it was used on, how severe was the condition, how long did it take to work, and at what dose?

Those are all the things that you can take back to your patient and say, "Okay, Mrs. Jones, you are non-responsive to specific prescription medication, and we're at the appropriate dose. We talked about other options, or you failed other options, so this might be an appropriate time for us to consider another option. Based on what I've been told by the manufacturer and the research they provided, I can recommend this brand, this dosage, and I would expect it to begin working at this point." That's what you can do from an efficacy standpoint.

Look and ask manufacturers for their safety record. Ask for quality assurances, how the product is manufactured (make sure they have paperwork that it's not adulterated), it doesn't have heavy metals in it, and it passes the GMP [good manufacturing practices] specs. Those are very appropriate questions to ask.

You don't need to ask for it in every single scenario, for every single supplement, because that's time consuming. But if it's a new company, a new formulation, something you don't know about, you really have to think about the safety of the patient that's going to be ingesting that. Ask both about safety and get information about efficacy. In some cases, companies do a great job and other companies don't have much information. Lean towards the evidence when figuring out additional treatments for your patients.

Question: What are some reputable supplement companies that you have vetted and recommend?

Dr. Bonakdar: Each practitioner needs to find what's available in their area. It may depend on the area of the country. The AAFP does not definitely make any recommendations in this area. Don’t go out of your way to say, "brand A is better than brand B." It has a lot to do with the patients you're seeing and the conditions that may be most prevalent.

Vet the manufacturers and do whatever you can to see if there is reputable information on safety and efficacy. If you feel comfortable recommending brands to your patient, then go the next step to look at dosage and how long to take the supplement. Potential interactions and side effects need to be considered, because a lot of agents are powerful, just like prescription medications. Tell your patient what to expect and for what length of time they can expect to take it