Natural Does Not Guarantee Risk-Free
Plants have been used for healing for thousands of years, and many modern medications have roots in plant-based compounds. Aloe vera, willow bark, foxglove, and sweet wormwood are just a few examples of plants that have influenced traditional and modern medicine.
Natural products can be part of a healthy lifestyle, but during surgery, clear communication matters. Sharing your supplement list helps your healthcare team reduce avoidable risks and support a safer recovery.
Today, many people use vitamins, minerals, herbs, teas, protein powders, tinctures, and other dietary supplements to support their health. Some people take echinacea for immune support, ginkgo for memory, turmeric for inflammation, magnesium for relaxation, or fish oil for heart health.
Supplements Commonly of Concern Prior to Surgery
The following supplements are often discussed because they may increase bleeding risk, affect anesthesia, change blood pressure or heart rhythm, alter blood sugar, or interact with medications used before, during, or after surgery.
Garlic Supplements
Garlic in normal food amounts is usually not the concern. The concern is concentrated garlic supplements, which may affect blood clotting and increase the risk of bleeding, especially when combined with blood thinners, aspirin, or certain anti-inflammatory medications.
Ginkgo Biloba
Ginkgo is often used for memory or circulation support. It may increase bleeding risk, especially when combined with anticoagulant or antiplatelet medications. NCCIH notes that taking ginkgo with warfarin has been associated with a higher risk of major bleeding.
Ginseng
Ginseng is commonly used for energy, stamina, or blood sugar support. Before surgery, it may be a concern because it can affect blood sugar, bleeding risk, blood pressure, and heart rate.
Turmeric (Curcumin)
Turmeric is widely used for inflammation and joint discomfort. In concentrated supplement form, turmeric may affect blood clotting or interact with medications. This is different from using small amounts of turmeric as a cooking spice.
Ginger Supplements
Ginger is often used for nausea or digestion. While ginger in food is generally not the same concern, concentrated ginger supplements may affect clotting in some people and should be reported to the surgical team.
Fish Oil (Omega-3 Supplements)
Fish oil and omega-3 supplements are often taken for heart, brain, or inflammation support. Research on bleeding risk has been mixed, but many surgeons still want to know about fish oil use before surgery because it may affect clotting in certain situations or when combined with other medications.
Vitamin E
Vitamin E has antioxidant properties, but higher-dose vitamin E supplements may affect blood clotting. This can be especially important for people also taking aspirin, warfarin, Eliquis, Xarelto, Plavix, or other blood-thinning medications.
St. John’s Wort
St. John’s wort is commonly used for mood support. It can change the way the liver processes many medications, including some drugs used for anesthesia, pain control, and recovery. Because of these interactions, it is especially important to tell the surgical team if you take it.
Kava
Kava is used for relaxation or anxiety. It may increase sedation and has been associated with liver safety concerns. It may also interact with anesthesia, sedatives, and pain medications.
Valerian
Valerian is often used for sleep or anxiety. It may increase the sedating effects of anesthesia and other medications. Abruptly stopping it after long-term use may also be an issue for some people, so patients should ask their healthcare provider how to stop it safely.
Echinacea
Echinacea is commonly used for immune support. It may interact with medications processed by the liver and may be a concern for people with liver conditions or those receiving certain medications around the time of surgery.
Feverfew
Feverfew is sometimes used for migraine prevention. It may increase bleeding risk and should be disclosed before surgery.
Black Cohosh
Black cohosh is often used for menopausal symptoms. It may affect the liver and may interact with medications used around surgery.
CBD, Cannabis Products, and Herbal Blends
CBD, marijuana, and some herbal blends may affect sedation, pain control, heart rate, blood pressure, and medication metabolism. The American College of Surgeons specifically recommends discussing marijuana and CBD products before surgery.
Ephedra (Ma Huang)
Ephedra was once used for weight loss, energy, and breathing issues. The FDA banned dietary supplements containing ephedrine alkaloids because of serious safety risks, including cardiovascular risks. It is illegal to market adulterated dietary supplements containing ephedrine alkaloids in the United States.
What About Vitamins Before Surgery?
Vitamins can also matter before surgery, especially when taken in high doses or combined with certain medications.
Vitamin E
Vitamin E is one of the most commonly discussed vitamins because it may slow clotting and increase bleeding risk in some situations.
Vitamin K
Vitamin K plays a role in blood clotting. For people taking warfarin, sudden changes in vitamin K intake can affect how the medication works. This does not mean everyone should stop vitamin K, but people taking blood thinners should ask their doctor what amount is appropriate.
Vitamin C
Vitamin C is important for tissue repair and immune function. It is not usually treated like a high-risk supplement for most surgeries, but high doses may not be appropriate for everyone, especially people with a history of kidney stones or certain medical conditions. It is still best to list it with all other supplements before surgery.
Multivitamins, Minerals, and Specialty Formulas
Multivitamins, minerals, and specialty formulas should also be listed. Some “daily” or “wellness” products contain herbs, green tea extract, turmeric, vitamin E, iodine, stimulants, or other ingredients that may matter before surgery.
Herbal Teas Count, Too
Many people forget that herbal teas can have medicinal effects. Chamomile, valerian, kava, licorice root, ginseng, ginger, turmeric, and other herbal teas may affect sedation, blood pressure, bleeding risk, or medication interactions in some people. The amount in tea is lower than in capsules or extracts, but it is still wise to mention herbal teas during the pre-surgery review.
Why Supplements Matter Before Surgery
Both the American College of Surgeons and the American Society of Anesthesiologists recommend that patients provide their surgical team with a complete list of all medications, including prescriptions, over-the-counter medications, vitamins, minerals, herbal medicines, and other supplements. A 2024 review in the Journal of Clinical Anesthesia notes that herbal medicines may interact with anesthesia and may affect bleeding, blood pressure, heart rhythm, sedation, liver metabolism, and blood sugar regulation.
Some products may need to be stopped or adjusted before surgery, but this should be guided by the surgical team, not guessed at home. This is especially important because many people do not think to mention “natural” products, herbal teas, tinctures, CBD products, or occasional supplements when asked about medication use. However, these products can still have real effects on the body.
The Safest Approach
Before any surgery or procedure involving anesthesia, give your surgeon, physician, anesthesiologist, and healthcare team a complete list of everything you take. Include prescription medications, over-the-counter medications, vitamins, minerals, herbs, teas, tinctures, protein powders, CBD/cannabis products, homeopathic products, and any supplements taken only “once in a while.”
Do not stop prescribed medications, blood thinners, diabetes medications, heart medications, or psychiatric medications without medical guidance. Some medications must be continued, adjusted, or stopped on a specific schedule.
For many elective surgeries, patients are commonly advised to stop herbal supplements about one to two weeks before surgery, but the safest timing depends on the product, the dose, the type of surgery, and the patient’s medical history. When in doubt, ask the surgical team early.
References
- American Society of Anesthesiologists – Supplements and Anesthesia
- American College of Surgeons – Medication and Surgery: Before Your Operation
- Journal of Clinical Anesthesia (2024) – Use of Herbal Medication in the Perioperative Period: Potential Adverse Drug Interactions
- National Center for Complementary and Integrative Health – How Medications and Supplements Can Interact
- U.S. Food & Drug Administration – Dietary Supplements
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