What to Know About Herbs and Surgery

If you’re like about 60 million other Americans, you use an herbal supplement for health benefits. It could be echinacea to avoid a cold or gingko to improve your memory. On the surface, using these products sounds like a good idea. They are considered “natural” and are sold in pharmacies and health stores, so you might think that they must be safe.

Unfortunately, natural doesn’t necessarily mean safe. The FDA doesn’t regulate herbal supplements the same way it does prescription and over-the-counter (OTC) drugs. The standards of safety are not the same. That could be a problem for you, especially if you need to have surgery.

The American Society of Anesthesiologists, among other health organizations, recommends that all herbal supplements be stopped two to three weeks before surgery. That's because these herbs can have side effects that could make surgery more dangerous for you.

Herbs as medicine

The use of plants as medicines goes back to ancient times. The Egyptians used aloe vera to prolong life. The Bushmen of the Kalahari in Africa have used the flowering cactus hoodia for centuries to ward off hunger. In India and China herbal medicines are important parts of medical practice.

Many of the medications we rely on every day, including digitalis, aspirin, morphine and even some important cancer drugs, are based on plants. The problem is that when you take an herbal supplement that has not been tested or regulated for safety by the FDA, you don't really know what you are getting.

Herbs can have unexpected side effects, and for many herbal supplements all the active ingredients may not be known. Since most of these products have not been studied in large, controlled research trials, their safety and their effectiveness aren’t reliably known.

The problem with herbs and surgery

Taking herbs in the weeks before surgery could cause a negative reaction with anesthesia drugs or prolonged bleeding during and after surgery. This is especially dangerous because many people taking herbal supplements don't tell their surgeon or anesthesiologist about them.

An article published in the Journal of the American Medical Association listed these eight common herbal supplements in particular that could be a problem if you need to have surgery:

Echinacea. This herb comes from the purple cornflower and is taken for colds, infections, arthritis and ulcers. If you have liver disease and you have anesthesia while taking echinacea, you could end up with liver damage.
Ephedra. Also called ma-huang, this herb from the plant ephedra sinica is used for asthma and to suppress appetite. When combined with some anesthesia drugs, it can cause high blood pressure and abnormal heart rhythms.
Garlic. Garlic supplements are used to lower blood pressure and cholesterol. Garlic can increase the effects of medications used to control blood sugar, blood thinners and some OTC pain relievers, and it can increase bleeding during or after surgery.
Ginkgo. Ginkgo biloba is used to improve memory, but it may cause prolonged bleeding during or after surgery and make the sedation effects of anesthesia last longer.
Ginseng. Ginseng is commonly used for an energy boost or to lower blood sugar levels. During surgery ginseng may cause high blood pressure and a rapid heart rate.
Kava. Kava comes from the piper methysticum plant and is used for muscle relaxation and to calm the nerves. It may be dangerous for people having surgery because of its interactions with other drugs and because it may cause liver damage.
St. John's wort. Also known as goatweed, this herb is taken to relieve depression and anxiety. During a surgical procedure, St. John's wort may interfere with some anesthesia drugs and make it harder for you recover from the effects of anesthesia.
Valerian. This herb from the plant valeriana officinalis is used to relieve anxiety. It may increase the effects of anesthesia and make it more difficult to wake up after surgery. It may also cause irregular heart rhythms.

Other herbal supplements that may increase bleeding include feverfew, ginger and saw palmetto. Herbal supplements that could interfere with your blood pressure during surgery include goldenseed, licorice and milk thistle.

Remember that herbal supplements are not FDA-approved medications. They may have many benefits, but they don't have the same reliability and safety as prescription medications and OTC drugs.

The best advice is to avoid self-medication and to talk with your health care provider about all OTC drugs and herbal supplements you’re taking. If you have any surgery scheduled in your future, have this discussion as soon as possible.