Potentially Dangerous Vitamins, Supplements & Foods AVOID Before & After Surgery
The following list of Vitamin and herbal supplements should be carefully avoided before and after surgery. Many of these traditional medicinal herbs are regularly used in alternative and homeopathic medicine, but have clearly demonstrated potentially dangerous drug-nutrient interactions for surgical patients and those on prescription blood thinners, anticoagulants and antiplatelet therapies.
Special Note for Patients Carefully Managing Vitamin K & Warfarin Coumadin Blood Clotting Interactions
- K-Neutral™ : No Vitamin K in Any NutraSafe Products
- No Compliance Requirement for Patients on Warfarin
- Start, Stop, or Miss NutraSafe Without Risk of Disrupting INR Levels
- Can be used near surgery, when other supplements not allowed
AVOID VITAMIN & HERBAL SUPPLEMENTS CONTAINING THESE INGREDIENTS BEFORE SURGERY OR AFTER PHYSICAL TRAUMA
Vitamin K (phylloquinone): Critical vitamin for coagulation. The “K” is derived from the original German word, koagulation, meaning the process of blood clot formation and coagulation. Vitamin K is found in dark green leafy vegetables and prepared foods using some types of plant oils. Warfarin decreases the ability of blood to clot by interrupting the normal metabolism of vitamin K (phylloquinone) in the liver. Patients should strive to take a consistent moderate dietary intake of Vitamin K in order to maintain a stable International Normalized Ratio (INR). No major changes to your diet should be made while on Warfarin.
“The foods you eat can affect how well Coumadin®/warfarin works for you. High amounts of vitamin K might work against Coumadin®/warfarin. Talk to your doctor about the amount of vitamin K that is right for you.” – US Dept of Health & Human Services, AHRQ
Bilberry (Vaccinium myrtillus): Contains compounds called anthacyonosides and flavonoids active in blood vessels and circulatory disorders. Bilberry can interact with blood platelets and may increase bleeding.
Coenzyme Q: May antagonize the drug warfarin and abnormal blood clotting.
Cranberry (Vaccinium macrocarpon): Cranberry juice can interact with warfarin / Coumadin®, so should be avoided when anticoagulant medications are prescribed.
Cayenne (Capsicum frutescens): Also known as red pepper, cayenne has been shown to affect blood pressure and lower cholesterol levels. Cayenne can affect platelets and blood clotting and overdoses have been known to cause significant drops in body temperature.
Dong Quai (Angelica sinensis): An ancient Chinese medicinal herb used for energy and to regulate female hormones. Dong Quai contains a coumarin- like molecule, which may increase anticoagulation medications and create bleeding problems.
Echinacea (Echinacea augustfolia): Often used to benefit immune function and respiratory infections. Echinacea may be detrimental to the liver (CYP3A4 enzyme) when general anesthetics and other surgical pain medications are used.
Feverfew (Tanacetum parthenium): Often used to treat migraine headaches. Conflicts with NSAIDs and it may also increase bleeding for patients on blood thinners.
Garlic (Allium satavum): Used in homeopathy to prevent atherosclerosis and lower cholesterol. Garlic may amplify the anticoagulant effects of Coumadin, warfarin and non-steroidal anti-inflammatory drugs (NSAIDs) causing abnormal bleeding time.
Ginger (Zingiber officinale): Used to activate the digestive system and as an anti-nausea therapy for vomiting, motion sickness, and morning sickness during pregnancy. Ginger may alter prothrombin clotting time and interfere with cardiac and anticoagulant medicines.
Ginkgo Biloba (Ginkgo biloba): An ancient herbal remedy claims to improve mental faculties, blood circulation and inhibit platelet aggregation. Ginkgo has significant blood thinning activity and can conflict with aspirin, warfarin and trazodone.
Ginseng (Panax quinquefolium / Panax ginseng): Ginseng is a powerful antioxidant and adaptogen, with claims to counter high-stress and enhance mental and physical performance. Ginseng acts as a blood thinner and can interact with cardiac, high blood pressure medicines and blood-glucose lowering medications.
Green Tea: Considered a healthful tea, but contains high amounts of Vitamin K and recommended by Mayo Clinic to be avoided by those on warfarin therapy.
Hawthorne (Crateagus laevigata): Hawthorne is claimed to benefit congestive heart failure, arteriosclerosis and abnormal heart rhythms, or arrhythmia. Hawthorne has been shown to alter the effects of cardiac medications digitalis (Lanoxin or Digoxin).
Kava Kava (Piper methysticum): Kava root claims to reduce stress and anxiety. Kava kava may alter the effects of pain medications, sedatives, antidepressants, antipsychotics and general anesthetics.
Licorice Root (Glycyrrhiza glabra): Often used for coughing and dermatology, licorice root may cause high blood pressure, low potassium levels and edema, or tissue swelling.
Ma Huang (Ephedra sinica): Also known as ephedra, this herb is used in weight loss and energy supplements, but was banned by the Food & Drug Administration (FDA) in 2003. Bitter orange is used as a substitute, and both have similar effects on the cardiovascular system including hypertension, rapid heart rate, cardiomyopathy (heart muscle inflammation) and abnormal heart rhythm (arrhythmia).
Melatonin: A hormone secreted by the pineal gland in the brain. It controls the body’s sleep-wake cycle, and is often used for sleeplessness and jet lag. Melatonin may alter the central nervous system effects of barbiturates and general anesthetics.
Papaya: The FDA categorizes papaya as ‘generally regarded as safe’. However, increases or decreases in INR for those starting or discontinuing papaya intake may put patients at increased risk for the adverse events, such as bleeding and stroke, that have been connected to INR results outside the patient’s target range.
Red Clover (Trifolium pratense): A rich source of isoflavones and used to treat a number of menopausal conditions. An active constituent in Red Clover includes coumarin derivatives, which may interfere with existing anticoagulant medications and cause abnormal blood clotting.
St. John’s Wort (Hypericum perforatum): An herbal supplement often used for mild to moderate depression and seasonal affective disorder (SAD). It can conflict with the medications theophylline, cyclosporine, warfarin, indinavir, digoxin, simvastatis, antiepileptics, immunosuppressants and selective serotonin reuptake inhibitors (SSRIs). Some data suggests that St. John’s Wort works like the antidepressants called monoamine oxidase (MAO) inhibitors, and it may interact with these drugs as well as anesthesia and pain medications.
Valerian (Valeriana officinalis): Valerian is used for insomnia, stress-related anxiety and nervous restlessness. Valerian may act as a sedative and may increase the effects of other anti-anxiety medications or prescription painkillers.
Vitamin E: May interact with aspirin for an additive blood thinning (antithrombotic ) effect. Important for wound healing and scar tissue healing so correct dosing and avoiding megadoses are important considerations.
Yohimbe (Corynanthe yohimbe): Touted as a natural “Viagra®”, yohimbe is claimed to act as a sexual stimulant and treatment for male impotence. Yohimbe may raise heart rate and blood pressure, and interact with anesthetics.
Foods containing medium to high amounts of Vitamin K:
Vegetables & Fruits such as:Kiwi.
Spinach & Kale
Turnip, collard, and mustard greens.
Parsley & Endive.
Meats, such as:Beef liver.
Other High Vitamin K Oils, Condiments, Foods:Mayonnaise.
Not comprehensive. For a more complete list: