Risks and benefits of certain herbal supplements before surgery

Putting On the Breaks

You’re about to be wheeled into surgery and you have a thought: I wonder if my daily supplement use might impact the surgery?

You can assume it very likely will.

Herbs & plastic

When you think of plastic surgery, what state comes to mind? California? Probably. Ohio? Probably not.

And yet, a team from the Department of Plastic Surgery at Cleveland’s University Hospitals Case Medical Center recently provided a very useful study for any patient about to undergo surgery – whether it’s a quadruple bypass or a simple out-patient cosmetic procedure.

After UHCMC researchers conducted a review to assess the benefits and risks of widely used herbal supplements, they compiled this list of herbs that might be best to avoid in the two weeks prior to surgery:

  • For bleeding effects: gingko biloba, garlic, ginseng, dong quai, feverfew, fish oils
  • For drug interactions: echinacea, goldenseal, licorice, St. John’s wort, kava, valerian root
  • For cardiovascular effects: ephedra, garlic
  • For anesthetic effects: valerian root, St. John’s wort, kava
  • For photosensitivity effects: St. John’s wort, dong quai
  • For hypoglycemia effects: ginseng

The study discusses the usefulness as well as the potential surgical drawbacks of each of these herbs except one: fish oils. Obviously, fish oils are not herbs, but the authors don’t explain why they strayed outside the world of botanicals to include this item on their list.

Important warning

One of the drawbacks of the focus on herbs in the UHCMC study is that it might leave patients and doctors with the impression that vitamin use is of no concern before surgery. And that’s not the case.

In the e-Alert “C Saw,” (5/28/03), HSI Panelist Allan Spreen, M.D., explained how high levels of vitamin C complicate the anesthesia process.

Dr. Spreen: “Very high doses of C over time cause the body to ‘awaken’ dormant enzyme systems that more fully utilize high doses of the nutrient. For those people I tell them to TAPER the C over time, reaching nearly zero just before surgery (not weeks before). This is because such high doses are good enough detoxifiers that more anesthetic drugs may be necessary for the anesthesiologist to keep you under. BUT, the absolute INSTANT you tolerate oral intake, you jack the C back up to heroic levels.”

In addition, Dr. Spreen recommends that other supplements – including a good multi, along with vitamins E, A, and B- complex, selenium, NAC, alpha lipoic acid, milk thistle extract, zinc, and essential fatty acids – should be taken generously after surgery, provided your doctor agrees, of course.

And finally, in the e-Alert “Answering the Call” (4/7/05), you’ll find commentary from Dr. Spreen on five specific nutrients that have been shown to improve post-surgical outcome by boosting immune system function.

“Perioperative Risks and Benefits of Herbal Supplements in Aesthetic Surgery” Aesthetic Surgery Journal, Vol. 29, No. 2, March/April 2009
“Feds Investigate Conflict Charge Over Emory Prof” Craig Schneider, The Atlanta Journal-Constitution, 2/27/09, ajc.com
“Top Psychiatrist Didn’t Report Drug Makers’ Pay” Gardiner Harris, New York Times, 10/3/08, nytimes.com