Vitamins and Herbs

What are herbs?
Herbs include flowering plants, shrubs, trees, moss, fern, algae, seaweed or fungus. In most cultures, including Western culture, herbs are used not only as a part of the treatment of disease, but also in the enhancement of life, physically, emotionally and spiritually. Plant parts, including flowers, fruits, leaves, twigs, bark, roots or seeds, are all considered usable.

What are dietary supplements?
Dietary supplements are taken by mouth and intended to supplement the diet. They may include vitamins, minerals, herbs or other botanicals, amino acids and substances such as enzymes, organ tissues, glandulars and metabolites.

Are herbs also medicines?
Until the 1930s, medical schools taught that plant drugs (or herbs) were the primary medicines available. Since that time, patented pharmaceuticals (prescription or over-the-counter medications) have replaced herbs which were either found to be too weak or unsafe.

If they are “natural” they must be safe, right?
No, natural doesn’t necessarily mean safe. Sometimes there can be other unintended reactions. Herbal and dietary products have chemical properties just as manufactured drugs do. Like anything that we eat or apply to our skin, there can be side effects.

One of the major problems with many of the products on the market today is that the amount and purity of their active ingredients vary greatly from product to product. In many cases, you do not always know how much of the natural substance you are really getting in each dose or if other ingredients have been added.

Do I need to tell my doctor about all of the herbal products and other supplements that I take?
Yes, it is absolutely essential that you tell your doctor about any treatments that you are using. These include the use of herbal medicines, vitamins, nutritional supplements or any other prescribed or over-the-counter drugs. Many of the popular herbal products on the market can cause harmful side effects or interact with your other medicines.

One of the primary concerns when it comes to taking herbs prior to surgery is the risk of excessive bleeding. Several herbs are known to have anti-clotting properties and these anti-coagulant activities become even more pronounced when these herbs are combined with prescription anti-clotting medications.

Some of the most commonly used herbs linked to post-surgery bleeding are:
• Feverfew
• Garlic
• Ginger
• Ginkgo
• Vitamin E

Could herbal medicines and other dietary supplements affect my anesthesia if I need surgery?
Yes. Studies are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists, anticipating a possible reaction is better than reacting to an unexpected condition. Therefore it is very important to tell your doctor about everything you are taking before surgery.

The dangers of combining herbs and surgical anesthetics has not been extensively studied but at least a few herbs are known to prolong the effects of certain types of anesthesia. Herbs* with known sedative properties include:
• Kava-Kava
• St. John's Wort
• Valerian

The following herbs* may affect your blood pressure during or after surgery:
• Ephedra
• Ginseng
• Licorice

Some of the best-selling herbs* known to increase inflammation include:
• Ephedra
• Ginseng
• Licorice

*NOTE: We only list some examples here; there may be other herbs that could cause side effects.

How do I know if my medication will have a negative interaction with my prescription medicine?
There are no guarantees. We always recommend that you first talk to your physician and your local pharmacist before combining any of these agents with your prescription medication. You can also refer to the Physicians Desk Reference which lists information regarding the herb or vitamin and potential adverse reactions with certain prescriptions.

Summary
Many people facing surgery fail to disclose herbal supplement use out of fear of being ridiculed by their doctor. But the fact is, most doctors want to know about their patients' use of herbal supplements. Only your doctor is qualified to advise you on your risks of complications during and after surgery. Talk to your doctor for more information about the herbs you are using and learn more about any potential risks.

Resources about Dietary Supplements

Administration on Aging
Food and Drug Administration, Center for Food Safety and Applied Nutrition
National Institutes of Health, Office of Dietary Supplements
National Center for Complementary and Alternative Medicine
Office on Women's Health
Federal Trade Commission
U.S. Department of Agriculture, Food and Nutrition Information Center


American Association of Retired Persons (AARP)
American Dietetic Association
American Pharmacists Association
Food Marketing Institute
National Council on Patient Information and Education

FDA MedWatch
If you suspect that you have had a serious reaction to a dietary supplement, you and your doctor should report it to FDA MedWatch or call 1-800-FDA-1088.

References
American Society of Anesthesiologists
NIH Office of Dietary Supplements
Herbs, Surgery & Anesthesia: What patients must know about herbal supplements and anesthesia