Have you noticed in the past couple of years how the herbal product counter at your local pharmacy has grown like a well-tended garden? Burgeoning public interest has resulted in a “mushrooming” choice of these products. A very well-researched and lucid review of popular herbal products can be found on-line, authored by M.J. McKeown, M.D., and Alexandra Andrews (www.cancerlynx.com/herbhealth.html.)

Many prescription medicines come from herbals. Unlike prescription medications, however, the herbal industry is under-regulated, so that harmful effects, dangerous interactions with other herbals or prescription medications, or risky sources may be omitted legally from the label or the insert. Regulations vary state to state. Unfortunately, all too often I find that patients either don’t realize the importance, or are gun-shy about sharing their use of these products. Remember, “natural” does not equal “safe.” Our “natural” world is a risky place.

The effects of herbal products may prove not only dangerous, but lethal, under anesthesia. That is why I am writing about them, and why the American Society of Anesthesiologists urges discontinuation of these products 2-3 weeks before surgery, along with these additional precautions: avoidance in pregnancy and nursing, checking health facts of a product with a professional, use only of a standardized dosing from a reputable manufacturer with contact, content, and production information clearly spelled out in the label/insert . The following are some of the more commonly used herbals.

ECHINACEA – short-term is touted to stimulate the immune system; long-term it ironically may hinder one’s immune system, and as a seed extract may harm the liver.

EPHEDRA – used as a stimulant (possibly for weight loss), can exhibit dangerous elevations of heart rate and blood pressure, heart inflammation and damage, depletion of catecholamines, and potentially fatal interactions with certain medications (eg. monoamine oxidase inhibitors).

Several common herbals may alter adversely the normal blood clotting pathways by its effect on platelets: FEVERFEW / GINGER / GINGKO / GARLIC (may also lower blood pressure), and lead to excessive bleeding.

One of the liver’s enzyme systems is C4P3A4. Although the precise outcome is unknown, those herbals which can interfere with the normal functioning of this system include LICORICE (which can also cause low potassium, high blood pressure, arrhythmias, and hormonal derangements), CHAMOMILE, GOLDENSEAL, and CAT’S CLAW.

KAVA,used to treat anxiety or as a sleep aid, may compound the effects of anesthesia dangerously, and therefore should be halted at least one day in advance of a general anesthetic. VALERIAN, another sleep aid, also works on a similar brain chemical pathway (GABA system). Sudden halting of its use can cause dangerous withdrawal symptoms – be sure to taper.

This listing of only the most commonly taken herbals in this country likely has you questioning if the healthful effects are “worth it.” The take-home message is that you owe it to yourself and to those you love to be forthright with your surgeon/anesthesiologist about your herbal product history, and to be completely free of these agents at least 2-3 weeks before an anesthetic/surgical procedure………end of sermon.