JAMA: Herb Use May Interfere with Surgery

JAMA: Herb Use May Interfere with Surgery

CHICAGO--In the July 11 Journal of the American Medical Association (JAMA) (286:208-16, 2001), researchers found that certain herbs may interfere with surgery. According to a review conducted by researchers led by Michael Ang-Lee from the University of Chicago, echinacea, ephedra, garlic, ginkgo, ginseng, kava, St. John's wort and valerian were all found to be causes of concern during surgery. This story was picked up by major media outlets across the country.

Researchers conducted a keyword search using the terms "herbal medicine," "phytotherapy" and "alternative medicine" in their search for articles, which were published between 1966 and 2000 and found in the MEDLINE and Cochrane Collaboration databases. Researchers then extracted information regarding dietary supplements' safety and pharmacodynamic (the effects of a supplement on a human) and pharmacokinetic (how the body processes a supplement) properties.

According to this review, researchers concluded that complications occur during surgery because of the anti-clotting attributes of garlic, ginkgo and ginseng; the "cardiovascular instability" of ephedra; and the onset of hypoglycemia from ginseng. Additionally, herb-drug interactions between kava and valerian may heighten the effects of anesthesia. And, as it has been stated in other studies, St. John's wort may increase the absorption rate of various prescriptive drugs.

The authors concluded that physicians should be aware of the effects of these herbs on their patients and be proactive by asking their patients pre-surgery if they are taking any herbs. This study can be found on the JAMA site(http://jama.ama-assn.org).

The Council for Responsible Nutrition (CRN) stated in a press release that this review "provides a useful resource to the professional health-care community."

"Dialogue and open-mindedness must be a two-way street, however," said John Cordaro, president and chief executive officer of CRN. "Physicians should know what supplements their patients take and understand the science behind those supplements, especially if prescription medications or surgery are likely options or necessities for those patients." CRN added that it plans to hold an industry roundtable to discuss possible label warnings about these interactions for dietary supplements.

Not everyone in the industry wholeheartedly agreed with the study's results. "Most of the emphasis in this study was placed on the deleterious effects of herbal products while not fully acknowledging their benefits," said Phillip Harvey, Ph.D., the National Nutritional Food Association's (NNFA) director of science and quality assurance. "The number of examples cited by the researchers of harmful herbal effects during surgery was limited, in some cases to a single patient ... [Overall, it] is important for patients to feel comfortable in discussing any health-related matter with their physician without concern about being patronized," he added.