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?
By definition, a dietary supplement is a product taken by mouth and intended to supplement the diet. These products may include: vitamins, minerals, herbs or other botanicals, amino acids and substances such as enzymes, organ tissues, glandulars and metabolites.

Are they medicines?
The term “drug” comes from the ancient word for “root.” Until the 1930s, medical schools taught that plant drugs were the primary medicines available. In general, since that time, patented pharmaceuticals (prescription or over the counter medications) have replaced the herbs or “roots,” which were either found too weak or unsafe. Like drugs or foods, medicinal plants (herbs) and dietary products (vitamins, minerals, amino acids) have many actions in the body.

If they are “natural” they must be safe, right?
No. Sometimes, even if you take an herb or supplement for one certain reason, there can be other unintended reactions. Natural doesn’t necessarily mean safe. Herbal and dietary products have chemical properties just as manufactured drugs do. Like anything that we ingest (eat) or apply (like a salve), there can be side effects. One of the major problems with many of the products on the market today is that the amount and the purity of their active ingredients vary so 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. Another problem is determining how much of each active ingredient is really safe, particularly over long term use. There are even case reports of contaminated herbs causing death. Studies are being done to see how herbals and supplements react with other medications.

More than 30% of people scheduled for surgery take at least one herbal supplement on a regular basis but most herb users facing surgery or other medical procedures don't disclose their use of herbs to their anesthesiologist, surgeon or referring physician. Unfortunately, withholding information about herbal supplement use prior to surgery can be very dangerous.

It's important to remember that herbs, and products that contain them, are generally packaged as dietary or nutritional supplements--not medicines--so herbal supplements will often not carry the same information as other medications. For example, there are often no warnings, dosage information or suggested usage instructions included with herbal supplements. As a result, many people incorrectly assume that a "natural" medicine is inherently safer than a pharmaceutical. This is not only untrue; it's an assumption that can be dangerous if a person is facing surgery.

Does the federal government make sure that herbs and other dietary supplements are safe?
Not really. The government regulates herbal medicines in the same way that it regulates food and nutritional Supplements, but herbs and other dietary supplements do not undergo the same strict research requirements as prescription drugs or over-the-counter medications (like aspirin). Whole plants cannot be patented (meaning that no one manufacturer has exclusive rights to an herb) and therefore, nonpharmaceutical companies that produce herbal products or dietary supplements are not obligated to do the same safety research that the Food and Drug Administration (FDA) requires for prescriptions or over the counter medications. If the FDA has reason to suspect that an herb or dietary supplement is unsafe, then the agency may require it be removed from the market. By law, however, the FDA cannot require testing of all herbal medicines and other dietary supplements before they are put on the shelf.

In what types of preparations are herbal medicines available?
Herbs are available in many forms, depending on the type of plant and its use. Some plants are best used fresh, but they are highly perishable. Dried, chopped or whole herbs can be steeped as teas (infusions) or simmered over low heat (decoctions). Some fresh and/or dried herbs are preserved in alcohol (tinctures), while others are better suited to vinegar extracts (acetracts), syrups, glycerites (in vegetable glycerine) or miels (in honey). Freeze-dried or herbal powders also come in bulk, tablet, capsule, paste or concentrate (4-6 times regular strength). Other ways to administer herbs may be by suppositories, creams, gels, liniments, oils, compresses, steams, aromatics (oils) or baths.

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 (but not limited to) 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. Anesthesiologists are conducting research to determine exactly how certain herbs and dietary supplements interact with certain anesthetics. They 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. So it is very important to tell your doctor about everything you are taking before surgery.
There are thousands of herbal products and dietary supplements currently on the market. Check with your doctor if you have any questions about the prescription or nonprescription medications that you are taking. 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. The list of herbs with known sedative properties (but not limited to) includes:
• Kava-Kava
• St. John's Wort
• Valerian

Both during and after surgery, a patient's blood pressure is closely monitored. Blood pressure can not only serve as a warning of potential problems; it can also be a serious health concern on its own. Herbs (but not limited to) that can raise blood pressure during and after surgery include:
• Ephedra
• Ginseng
• Licorice

How do I know if my medication will have negative interaction with my prescription medicine?
There are no guarantees. There is a site that has been developed by the well known Physicians Desk Reference you can refer to: http://www.pdrhealth.com/drugs/drugs-index.aspx. It has the capability of listing information regarding the herb or vitamin and potential adverse reactions with certain prescriptions. Research is ongoing so not all combinations are available. We always recommend that you talk to your physician and your local pharmacist before combining any of these agents with your prescription medication.

Another issue that often arises after surgery, even if the anesthetic was only used locally, is post-surgical swelling. Excessive inflammation can delay healing, increase scarring and increase a person's risk of infection so relieving inflammation is a primary focus of post-operative care. Some of the best-selling herbs that are known to increase inflammation (but not limited to) include:
• Echinacea
• Goldenseal
• Licorice

Summary
Used properly, herbs can aid post-surgical healing, help minimize scarring and act as mild pain relievers. Used improperly, though, herbs can cause unpredictable and life-threatening complications.

Many people facing surgery fail to disclose their herbal supplement use out of fear of being ridiculed by their doctor. 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 him or her for more information about the herbs you are using and learn more about the potential risks they bring.

Dietary Supplement Resources
Federal Government Agencies:
• Administration on Aging, DHHS: http://www.aoa.gov

• Food and Drug Administration, DHHS, Center for Food Safety and Applied Nutrition:
http://www.cfsan.fda.gov/~dms/supplmnt.html
http://www.cfsan.fda.gov/~dms/ds-savvy.html
http://www.cfsan.fda.gov/label.html

• National Institutes of Health, DHHS:
o Office of Dietary Supplements: http://dietary-supplements.info.nih.gov
o National Center for Complementary and Alternative Medicine (http://nccam.nih.gov) and Clearinghouse (1-888-624-6226)

• Office on Women's Health, DHHS: http://www.4woman.gov or 1-800-994-WOMAN

• Federal Trade Commission: http://www.ftc.gov

• U.S. Department of Agriculture, Food and Nutrition Information Center: http://www.nal.usda.gov/fnic

Others:
• American Association of Retired Persons (AARP): http://www.aarp.org
• American Dietetic Association: http://www.eatright.org
• American Pharmacists Association: http://www.pharmacyandyou.org
• Food Marketing Institute: http://www.fmi.org
• National Council on Patient Information and Education (NCPIE): http://www.talkaboutrx.org

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:
•  Phone: 1-800-FDA-1088
•  Fax: 1-800-FDA-0178
•  Internet: www.fda.gov/medwatch/how.htm

References:
http://ods.od.nih.gov/pubs/partnersbrochure.asp

The American Society of Anesthesiologists www.ASAhq.org

http://herbalmedicine.suite101.com/print_article.cfm/herbs_surgery_anesthesia

American Society of Anesthesiologists. (2000). What You Should Know About Herbal and Dietary Supplement Use and Anesthesia.

Kaye, A., Kaye, M., Hegazi, A., Sabar, R., Deaton, B., Powell, J., Hofbauer, R. (2002). Nutraceuticals: potential roles and potential risks for pain management. Pain Practice.

Sabine, A., Krieg, T., Davidson, J. (2007). Inflammation in Wound Repair: Molecular and Cellular Mechanisms. Journal of Investigative Dermatology.