Surgery: Surgery and Herbs - Do They Mix? Discover What You Need To Know Before You Go Under The Knife

I received an email from an NHR member called Sue recently, asking about some advice her mother had been given regarding her herbal supplement programme prior to undergoing surgery. Its a topic a lot of you have expressed similar concerns about over the years, so Sues letter presented the perfect opportunity to go over it in more detail. Heres what Sue had to say:

My mother is scheduled for hip replacement surgery soon. We have been strongly advised to stop ALL herbal supplements of any kind 1-2 weeks before surgery. One doctor has signs plastered all over his surgery with DANGER in bold letters, etc. When I asked why, they explained that it is because of a concern that herbal products thin the blood and can cause increased bleeding during surgery. I wonder if that is indeed true, or if its just a sneaky way for the medical profession to plant the thought that herbal approaches arent worthwhile...

Let me say at the outset that it is good to err on the side of caution and to stop taking any herbs you may be using except for a few exceptions one to two weeks before surgery.

The truth behind the warnings and scare tactics
Despite what mainstream practitioners would have you believe, not all herbs are harmful prior to surgery. The main concern expressed in the medical journals is that many herbs can increase the tendency to bleed. These fears have some rational basis when it comes to certain herbs like garlic and ginger, but the journal articles also mention herbs like feverfew, chamomile, and ginseng which have NEVER been connected to adverse bleeding.

But that doesnt seem to matter to most mainstream doctors. There seems to be a willingness to believe even the flimsiest of arguments, as long as theyre attacking herbs.

For example, when it comes to chamomile, part of the confusion might be due to the fact that it contains phytochemicals known as coumarins. Pharmacists not skilled in herbal medicine might be under the impression that chamomile is related to another coumarin-containing herb, sweet clover, which caused an uproar years ago when a herd of cattle fed spoiled sweet clover died of a strange bleeding disease. Notice I mentioned theyd eaten spoiled sweet clover. When the clover spoiled, it formed another phytochemical, which is what actually caused the bleeding (J Biol Chem 1941; 138: 513-527).

Eventually, researchers used this chemical to develop synthetic anticoagulant drugs. So coumarin itself really has nothing to do with bleeding risk, but thanks to its complicated history, many inexperienced pharmacists and doctors just assume coumarin is dangerous. Its really not especially not in the form of chamomile, which can have great healing effects. In fact, chamomile doesnt even contain coumarin itself, but two coumarin derivatives called herniarin and umbelliferone.

In an animal study, massive amounts of chamomile more than you would get in a years worth of chamomile tea produced no toxic effects at all and certainly no bleeding (Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, 2000, p 324). 

Two herbs you should definitely avoid taking prior to surgery
Garlic and ginger should definitely be stopped a full two weeks before surgery as theyve both been linked to causing bleeding after surgery. Its just as crucial to stop eating garlic and ginger before surgery, as it is to stop taking them in supplement form.

On the flip side of this coin, there are also some herbs that taken prior to and immediately after surgery can help protect and heal you. The main one is milk thistle. Anaesthetic drugs used during surgery are really hard on the liver, but milk thistle helps to protect this vital organ from stress and thereby speeds up recovery times. And it will not make the anaesthetic less effective in the process.

The bottom line is that the vast majority of herbs do not increase bleeding tendency and incorporating the right ones into your pre- and post-surgery supplement programme may actually go a long way in helping you recover more quickly and efficiently. A qualified herbalist will be able to advise you further, for more information contact the National Institute of Medical Herbalists on 01392 426022;
www.nimh.org.uk.

Obviously it is important to let your doctor and surgeon know what herbs in addition to what nutritional supplements and medication (both prescription and over-the-counter) you are taking as far in advance of the surgery as possible. Supplements like vitamin C and NAC should be stopped as they can interfere with the
anaesthetic and make you require more for it to have an effect. Plus, most patients are advised that any sort of aspirin therapy for heart health should be discontinued well before surgery to minimise bleeding.