The techniques employed by modern surgeons represent some of the greatest advances of the past fifty years. The skills of these surgeons have allowed them to save many lives, repair deformed or broken bones, remove cancerous tumors, transplant diseased organs and replace clogged arteries. What is more, these procedures have been made considerably easier to perform by parallel advances in anesthesiology. Sophisticated new anesthetic and analgesic (pain-killing) drugs have taken a process that was once excruciatingly painful and made it relatively easy to tolerate.
But despite these advances, surgery of any type is a form of injury. No matter how precise or careful the incision, it still involves cutting through living tissue. Sometimes bones must be deliberately cracked or sensitive organs must be manipulated in a way that can damage their ability to function. Surgery can also induce chemical injury. The anesthetic drugs used to numb body parts or induce a generalized coma-like state, along with the medications that temporarily relax or paralyze muscles, can be hard on the liver, which detoxifies these drugs after their work is done. Postoperative problems such as hemorrhages, blood clots and infections are also a concern.
Could botanical medicines and nutritional supplements have something to offer people undergoing surgical procedures? Considering that specific nutrients are known to play an integral role in the physiology of healing and repair, it’s a reasonable assumption that providing them in adequate quantities could assist in the recovery process. Research has clearly shown that poorly nourished patients take longer to heal after surgery. Yet supplements of zinc, vitamin C, bioflavonoids and the amino acid arginine can actually improve wound healing and speed up overall recovery.
Certain herbs may provide even more comprehensive benefits. For example, echinacea (Echinacea spp.) and gotu kola (Centella asiatica) have both been shown in clinical studies to enhance wound healing. Bromelain, a mixture of enzymes from pineapple stems, helps decrease swelling and inflammation after surgery or trauma. Many medical doctors in Germany use these supplements. Doctors in China commonly prescribe Asian ginseng (Panax ginseng) to help their patients recover from the stress of surgery.
Ginkgo (Ginkgo biloba), another botanical from China, is a potent antioxidant that can help neutralize the deluge of free radicals generated by the trauma of surgery. Ginkgo also enhances circulation in the brain and the extremities. This makes it potentially useful to anyone convalescing from injury, especially when they must spend long periods of time resting in bed.
Garlic (Allium sativum) has many properties that could make it helpful after surgery. In addition to being an antioxidant, it helps prevent infections and assists the liver in detoxification. Other hepatoprotectants such as milk thistle (Silybum marianum) are also useful postoperatively. As an antioxidant that also increases levels of glutathione—a potent detoxifying substance—the herb can help the liver recover from the toxic damage that may occur after exposure to general anesthetics and other medications.
Over the years, I have been consulted by many patients preparing for surgical procedures. They often wanted to know if they could take something that would help them to tolerate the surgery better and heal faster afterward, with less pain and inflammation. Based on the scientific literature, I have frequently suggested various combinations of the herbs listed above, along with extra vitamins and minerals. I have usually suggested starting the herbs and extra nutrients at least a week before the surgery to help build up the body’s defense mechanisms. It has consistently been my experience that patients who followed these recommendations have tolerated the surgical procedures much better and recovered faster.
Given my very positive experience with herbs in this context, you can imagine my great surprise on finding that the American Society of Anesthesiologists (ASA) had issued a warning that patients should stop taking “all herbal preparations” starting two to three weeks before any elective surgery. This warning, initially issued in October 1999 by Charles McLeskey, M.D., of Texas A&M University, specifically mentioned the need to avoid ginkgo, American ginseng (Panax quinquefolius), Asian ginseng, garlic, St. John’s wort (Hypericum perforatum), feverfew (Tanacetum parthenium), ginger (Zingiber officinale) and kava (Piper methysticum). While I don’t doubt the positive intentions of McLeskey or the ASA, I am concerned that such a negative blanket recommendation could end up doing more harm than good.
This bias consists of the assumption that herbs are nothing more than nostrums—archaic remnants of folk medicine that are probably harmful, can potentially interact with medications, and are unlikely to have any therapeutic benefits. In fact, Jessica Leak, M.D., of the M. D. Anderson Cancer Center in Houston, Texas, and co-author of a patient education pamphlet from the ASA has stated, “Many patients mistakenly believe that since herbal products are labeled ‘natural,’ they must be safe. This inaccurate and dangerous assumption can put them at unnecessary risk.”
On one hand, it may be true that “natural” is not synonymous with “safe.” On the other hand, what the ASA has not stated is that “synthetic” is not synonymous with “safe,” either. In fact, synthetic drugs are much more likely to be toxic than herbs. Even when prescription medicines are used correctly, they have been found to cause a relatively high incidence of side effects, including death. By comparison, the incidence of side effects from correctly used herbal medicines is extremely low.
I do believe that it is crucial for people getting surgery to inform their anesthesiologist of any supplements they’ve been taking regularly, presuming the anesthesiologist will know what to do with the information. If the anesthesiologist responds in an antagonistic manner and tells the patient to immediately stop all supplements, without reviewing the pros and cons of each one, a situation is created that may ultimately backfire. Michael Zeligs, M.D., a practicing anesthesiologist in Boulder, Colorado, says, “Safer anesthesia and surgery requires better information, not a generalized ban on herbal medicines. Botanical medicines, including herbs or extracts, must be evaluated individually, just like prescription medicines.”
For example, reports that ginkgo, ginger, feverfew, and garlic put a patient at great risk for hemorrhage (this is the rationale behind avoiding them preoperatively) are vastly exaggerated, in my opinion. By making platelets slightly less sticky, these herbs do appear to influence the formation of blood clots. But the effect is minor at best and has only been reported in an extremely small percentage of people taking these herbs.
Ginseng is another victim of misinformation. Several articles state that ginseng can raise blood pressure and increase the risk of bleeding, yet the actual evidence that this occurs with significant frequency is sketchy. However, it may be one of the best available herbs for improving stamina postoperatively.
In contrast, it is clear that concentrated formulas of St. John’s wort can interfere with the metabolism of numerous drugs. It should probably be completely avoided for at least a week prior to surgery. Ephedra (Ephedra sinica) can significantly raise blood pressure and heart rate and is also best avoided in this context. But the role of kava is not so clear. It could potentiate the effect of tranquilizers used during surgery and should be avoided in the immediate preoperative period (one to two days beforehand); however, it also has pain-killing and muscle-relaxant properties that could be used postoperatively to help wean patients off toxic analgesics.
Because all of these herbs have multiple potential benefits, wouldn’t it be worth exploring a way to use them intelligently? What if they could be incorporated into an expanding toolbox of agents that included synthetic drugs, herbs, and nutritional supplements? I believe that such peaceful coexistence from an integrated approach could make surgical procedures safer, less traumatic, and less debilitating. In Zeligs’s words, “In reasonable amounts, supplementing nutritional essentials—vitamins, minerals, and amino acids—makes sense in getting ready for surgery.”
Robert Rountree, M.D., is a physician in private practice in Boulder, Colorado, where he practices integrative medicine. He is co-author of Smart Medicine for a Healthier Child (Avery, 1994) and Immunotics (Putnam, 2000) and is an Herb Research Foundation advisory board member.
Nightshades and anesthesia
Anesthesiologists have long been aware that some patients take longer to wake up and start moving again after surgery. Research conducted by Jonathan Moss, M.D., at the University of Chicago, appears to have identified one of the factors that may account for this. Laboratory experiments showed that a group of compounds isolated from nightshade plants, called solanaceous glycoalkaloids (SGAs), can inhibit two enzymes involved in breaking down anesthetic drugs. The effect of inhibiting these enzymes is that anesthetics are not easily cleared from the bloodstream and patients experience prolonged paralysis postoperatively. Human studies have found that when people consume these nightshade-family members (including potatoes and tomatoes), more than 80 percent of the SGAs are still in the bloodstream twenty-four hours later. If this effect is confirmed by more extensive clinical research, its potential impact would be far greater than that of medicinal herbs, which are consumed by a much smaller percentage of the population.
Source: American Medical News, January 25, 1999, pp. 45–47.