Taking supplements before or during surgery

I advise my patients who are planning surgery to quit supplements and any natural product — even natural teas — at least a week or 10 days before surgery.

Natural products are biologically active and could adversely affect your surgery and its outcome. Excessive bleeding is a big concern. I do not think that we really know to what extent supplements and natural products can play a detrimental role before, during or after surgery, but why would you take the risk? Here are some commonly used natural products that you should be very cautious about when going for surgery:

(I have taken these lists from NaturalDataBase.com- a very reliable source of information about nutritional supplements and herbs. Their work is very impressive. This is not hearsay data, but from a team of skilled pharmacists and other professionals.) These lists just give you an idea of what might occur. DO NOT assume that if you do not see your supplement or herb here that you are home free. No way!

Commonly used natural medicines that might affect platelet aggregation (Meaning the ability of your blood to clot.)

• Andrographis – Based on in vitro and animal data
• Black tea – Caffeine in black tea can have antiplatelet effects based on in vitro data
• Boldo – Documented interaction between boldo and warfarin
• Chondroitin – Documented interaction between chondroitin and warfarin
• Danshen – Documented interaction between danshen and warfarin
• Dong quai – Documented interaction between dong quai and warfarin
• Fenugreek – Documented interaction between fenugreek and warfarin
• Fish oil – High doses associated with antiplatelet effects
• Garlic – Antiplatelet effects; however, conflicting data about whether garlic causes a clinically significant interaction with warfarin
• Ginger – Antiplatelet effects; however, conflicting data about whether ginger causes a clinically significant interaction with warfarin
• Ginkgo – Documented reports of surgical complications in patients taking ginkgo
• Glucosamine – Documented interaction between glucosamine and warfarin
• Green tea – Caffeine in green tea can have antiplatelet effects based on in vitro data
• Guarana – Caffeine in guarana can have antiplatelet effects based on in vitro data
• Horse chestnut – Active constituents thought to have antiplatelet activity
• Policosanol – Based on clinical research
• Resveratrol – Based on in vitro data
• Saw palmetto – Based on anecdotal evidence
• Vitamin E – High doses associated with antiplatelet effects

Commonly used natural medicines that might cause CNS depression(This means depression of your central nervous system.)

• German chamomile – Mild sedative effects
• Hops – Mild sedative effects; usually used in combination with other sedative products
• Kava – Documented report of additive effects with benzodiazepines; also linked to numerous reports of hepatotoxicity
• L-tryptophan – Clinical research showing sedative effects; documented reports of additive effects with CNS depressants; also affects serotonin levels
• Lavender – Mild sedative effects; animal models suggest additive effects with CNS depressants
• Lemon balm – Mild sedative effects; clinical research suggesting sedative effects
• Melatonin – Clinical research suggesting sedative effects
• Passionflower – Mild sedative effects; animal models suggest additive effects with CNS depressants
• Skullcap – Large doses might cause significant sedation
• Theanine – Mild sedative effects, possibly due to GABA inhibition
• Valerian – Clinical research suggesting sedative effects

Commonly used natural medicines that might affect blood glucose (blood sugar)

• Agaricus mushroom – Research suggests it lowers blood glucose by reducing insulin resistance.
• Alpha-lipoic acid – Clinical research suggesting hypoglycemic effects
• American ginseng – Clinical research suggesting hypoglycemic effects
• Banaba – Clinical research suggesting hypoglycemic effects
• Bitter melon – Clinical research suggesting hypoglycemic effects
• Cassia cinnamon – Research suggests that it potentiates insulin action
• Chromium – Reduces blood glucose through insulin sensitizing effects
• Fenugreek – Clinical research suggesting hypoglycemic effects
• Glucomannan – Clinical research suggesting hypoglycemic effects
• Gymnema – Clinical research suggesting hypoglycemic effects
• Panax ginseng – Clinical research suggesting hypoglycemic effects
• Prickly pear cactus – Clinical research suggesting hypoglycemic effects
• Vanadium – Clinical research suggesting hypoglycemic effects

Commonly used natural medicines that might affect blood pressure

• Andrographis – Preliminary evidence of hypotensive (low blood pressure) effects
• Coenzyme Q10 – Clinical research suggesting modest hypotensive (low blood pressure) effects
• Horny goat weed – Preliminary evidence of hypotensive (low blood pressure) effects
• Garlic – Prelimimary evidence of modest blood pressure lowering effects
• L-arginine – Clinical research suggesting modest hypotensive (low blood pressure)effects
• Licorice – Mineralocorticoid effects can increase blood pressure when used in high doses
• Pycnogenol – Preliminary evidence of modest blood pressure lowering
• Theanine – Decreases blood pressure in animal models

There are supplements that can stimulate such as bitter orange, caffeine (mate, guarana and cola nut) and DMMA (dimethyamlamine). They too should be stopped and I would want to know why you are taking them as well, if I were your physician.

These can adversely affect metabolism and should be stopped before surgery as well:

• Bitter orange
• Cat’s claw
• Danshen
• Devil’s claw
• Evodia
• Feverfew
• German chamomile
• Ginkgo
• Goldenseal
• Grapefruit
• Hu Zhang
• Indole-3-carbinol
• Ipriflavone
• Kava
• Quercetin
• Red clover
• Schisandra
• Siberian ginseng
• Valeria

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