One of your patients mentions to you during a regular appointment that his family physician did a lipid panel recently and his LDL and total cholesterol were elevated.  He really does not want to take a statin drug, and asks you what supplements might help lower cholesterol.  Where might you check quickly to give this patient some sound advice?  If you said Natural Standard Database, pat yourself on the back.  Natural Standard Database is a peer-reviewed, authoritative source for information on complementary and integrative therapies.  It is actually composed of 10 different databases:  Herbs, Supplements, & Functional Foods, Health & Wellness, Comparative Effectiveness, Charts & Tables, Medical Conditions, Sports Medicine, Genomics & Proteomics, Environment & Global Health, and Animal Health.  Its editorial board and group of writers are academics and researchers from a broad array of health disciplines, including chiropractic. Research teams gather data from clinical trials on each particular therapy or supplement and apply the CONSORT grading system for the evidence (Fig 1), and documentation is included for each entry.  Natural Standard does not receive funding from any pharmaceutical or supplement companies, so there is less likelihood of bias in its results.  

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Figure 1

You can search across all databases at once for a particular term or enter a single database and use the alphabetic listing of topics to find your search term.  For example, entering “artichoke” in the search box on the home page (Fig. 1) and pressing the magnifying glass takes you to the page below.  (Fig. 2).

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Figure 2

This gives you a list of entries for the term “artichoke” across all relevant databases, and clicking on each respective link takes you to the pertinent information.  If you would simply want information on the supplement, you could click on the “Foods, Herbs, & Supplements” database from the pull-down menu “Databases” near the top of the home page (Fig. 1) and use the alphabetic listing to get to the monograph on the substance. (Fig. 3)

For your very first use in a session, you are first presented with a “Terms of Use” screen.  It does not require a log-in, but you must click “I Accept” in order to gain access to any information.  For subsequent searches in the same session, that screen will not appear.  As shown in Figure 2, the user is given several options on the results screen.  Intended for clinicians, the Professional Monograph gives the clinical description of the supplement, its uses and accompanying strength of evidence, dosing instructions, contraindications, interactions with other drugs and supplements, adverse effects, mechanism of action, accompanying evidence, and rating scale for the evidence.  The Bottom Line Monograph is also intended for clinicians, but is in an abbreviated form for quick reference.  It does not include the detailed rating of the various studies, and condenses the other categories.  It could also be used as patient information for certain, more well-informed patients.  The Flashcard is intended for patient information, is written in simpler, easier-to-understand language, and does not include the references.

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Figure 3

A category that coordinates with the Herbs & Supplements is the Brand Name database.  Those brand-name supplements that have been identified have an entry in alphabetical order to let the user know the manufacturer and the exact composition of that supplement.  In other words, you can find out exactly what Red Bull or Luna bars contain.  Each of the functional ingredients in the list is linked to its associated monograph, which in turn lets the reader know how that ingredient affects the body’s function.

One of the handier databases for a clinician is the database of Comparative Effectiveness, which presents the user with an alphabetical listing of conditions.  Clicking on any condition takes you to a table of various therapies identified for that condition rated by strength of evidence.  This is a very useful, concise way to get information on treatments for specific conditions based on strength of evidence.  (See Fig. 4)  Clicking on any therapy takes you to the description of that therapy and its various uses.

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Figure 4

The final part of Natural Standard to highlight is under the pull-down link “Checkers” near the top of the screen.  There is a Symptom Checker which allows the user to check off various symptoms in the left column, and the program suggests possible conditions those symptoms might indicate in the right column.  This can be done by body system, or by a listing of symptoms in alphabetical order.  Along with this is an Interaction Checker, which advises the user of interactions between supplements, between supplements and prescription drugs, and both with foods.  You can scroll the comprehensive listing or choose from four different categories: supplement, generic over-the-counter (OTC), brand name products, and brand name drugs.  Selecting any from the list yields a list of substances that interact with the selected substance, lab tests that might be affected, and known allergies. (See Fig. 5)

Combine all these features with links to a blog containing recent news items on health topics, podcasts and open-access webinars from various experts in complementary health care, as well as several types of interactive medical calculators, and you can see that the Natural Standard database is one to keep in your toolkit of evidence-based resources.

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Figure 5