Herbs and Surgery: An Unsavory Mix

By Terry Mason, healthAtoZ contributing writer

You're scheduled for surgery. Perhaps you're having your wisdom teeth removed, a hysterectomy or gall bladder surgery. You want to be as healthy as possible beforehand. So, you follow your doctor's advice. You exercise and rest when you're supposed to and take your medicines exactly as prescribed. You're even taking your usual herbal supplements for reassurance. You're doing everything you can, right?

Maybe not. Before surgery, your doctor probably didn't ask if you routinely take herbal supplements. Most do not, even though taking herbal medicines before surgery can interfere with your recovery from surgery in some surprising ways.

In a study reported in the Journal of the American Medical Association (JAMA), researchers Michael K. Ang-Lee, M.D., Jonathan Moss, M.D., and Chun-Su Yuan, M.D. found a host of potential dangers mixing herbs and traditional medicines often used in surgery.

The doctors examined eight of the most common herbs used in the United States. In fact, these herbs make up at least half of all herbs used in this country. They are echinacea, ephedra, garlic, ginkgo, ginseng, kava, St. John's Wort and valerian.

"Since many herbal preparations are a mixture of many different herbs, patients should bring herb bottles with them to all their pre-surgery appointments," recommends Yuan, an author of the JAMA article and an assistant professor in the Department of Anesthesia & Critical Care and Clinical Pharmacology at the University of Chicago. This would include appointments with your general doctor, surgeon and your anesthesiologist.

As a precaution, consumers also are wise to stop taking any herbs for at least a week before any surgical procedure.

The American Botanical Council estimates that 30 percent of all adults in the United States use some type of herbal supplement or preparation to treat common ailments such as colds, allergies, heartburn, headaches and insomnia.

Yuan wants consumers to be better educated about the potential dangers of taking herbs pre-surgery. "Both physicians and patients should be more aware of the herb-drug interaction issue," Yuan says. Here is a quick look at just some of the problems found when mixing herbal preparations with surgery:

This herb often is used for preventing or treating viral, bacterial or fungal infections. Because some people can be allergic to echinacea, those with allergies or asthma should be cautious of using this supplement at any time. This also is true for people with pre-existing liver conditions. Echinacea may diminish the effectiveness of immunosuppressant drugs so people who are having any kind of organ transplant should avoid taking echinacea for several weeks before surgery.

Ephedra

This herb promotes weight loss and increases energy. Ephedra is known to increase blood pressure in some people. A rise in blood pressure during surgery could lead to danger, at worst a heart attack or stroke. Ephedrine can persist for an entire day in your blood stream, so don't take this herb for a few days prior to surgery.

Garlic inhibits your platelet's ability to aggregate, or clot. This means it can become harder to stop any bleeding. It's a good idea not to take any kind of garlic herbal preparation for at least a week before surgery.

Ginkgo

This herb is taken for a number of conditions, including improving mental alertness, reducing dizziness caused by altitude sickness or vertigo and erectile dysfunction. Ginkgo also inhibits the platelet-activating factor, part of the normal blood-clotting process. This effect can make it harder for your body to heal after surgery. Stop taking ginkgo at least 36 hours before surgery.

Ginseng

Ginseng is thought to protect the body against stress. Unfortunately, it also may lower the glucose (sugar) in your blood. This could be a serious problem for a person with diabetes and could even cause a dangerous blood sugar drop in people without diabetes. It's a good idea to stop taking ginseng a week before surgery.

Kava commonly is used to treat anxiety. Kava may act as a sedative and might interfere with traditional sedatives given during surgery or shortly after surgery. Kava could interfere with the anesthetic medication that you receive during surgery. Try to discontinue kava at least 24 hours before your surgery.

This herb is widely used to treat mild to moderate depression. St. John's Wort also can increase the metabolism of medications. This may interfere with drugs used in organ transplants or anyone who may need to take an anticoagulation medicine after surgery to stop bleeding. It is a good idea to discontinue St. John's Wort at least five days prior to surgery.

This herb is used to calm anxiety and promote sleep. Because valerian may have some addictive qualities, it is a good idea to taper use for several weeks before surgery.

Simple advice to make your surgery safer:

• Even if your doctor or pharmacist does not ask specifically if you use herbal preparations, tell them.



• Before surgery, show your doctor any prescription medications, herbal preparations and over-the-counter medicines you take routinely. Ask if you should stop taking any of your medications or herbs before surgery.



• Because your doctor may not know about herbal preparations, you may want to err on the safe side and stop taking herbal preparations for a week before surgery.

Related Articles What Is Alternative Medicine? Herbalism

External Sources American Botanical Council National Institute of Environmental Health Sciences National Center for Complementary and Alternative Medicine Journal of the American Medical Association, JAMA 2001;286:208-216.

This article was reviewed April 2004, by Dennis C. Policastro, M.D., FACP, FACEP, Residency Program Director, Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA.

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