Which supplements to stop before surgery, and when.

If you take supplements, expect your surgical team to ask about them. Many ask patients to stop dietary supplements for a period before surgery, commonly one to three weeks. This article explains why, how long the pause usually lasts, which supplements show up most often on hospital stop lists, and how the pause fits into the Recovery Laboratories protocol.

Why surgical teams ask you to pause supplements

The U.S. Food and Drug Administration puts it plainly: “If you’re planning a surgery, be aware that some dietary supplements can interact in a harmful way with medications you need to take before, after, or during that surgery.” The same FDA consumer update notes that your health care professional may ask you to stop taking dietary supplements “two or three weeks before the procedure to avoid potentially dangerous changes in heart rate, blood pressure, or bleeding risk.”

The American College of Surgeons lists herbal supplements alongside blood-thinning medications and notes that “some supplements can affect blood clotting” and may “interact with other drugs you are taking.” UT Southwestern Medical Center adds that “some supplements and medications can cause issues with anesthesia,” and that ingredient amounts can vary from product to product, which makes their effects harder to predict.

The reasons come down to three things:

• Bleeding and clotting during and after surgery
• Heart rate and blood pressure in the operating room
• Interactions with anesthesia and the other medications used around surgery

How long before surgery to stop supplements

The window varies by hospital, surgeon, and procedure. UT Southwestern asks patients to skip common supplements “at least seven days before surgery,” and some for one to two weeks. The FDA describes two or three weeks. Most guidance falls between one and three weeks. Your surgeon sets the date, and their instructions come first.

The Recovery Laboratories protocol builds in a three-week pause before surgery, the longest of the common windows, unless your surgeon gives you different dates.

Supplements that often appear on stop lists

No single list covers everyone, and these lists are not complete. Here is what three major sources name, with the reason each one gives.

UT Southwestern Medical Center names ten supplements to pause at least seven days before surgery:

• Garlic, ginkgo, ginseng, and vitamin E, for bleeding risk
• CBD oil, where preliminary studies suggest a bleeding risk
• Ephedra, which can cause high blood pressure and an erratic heart rate during surgery
• Kava, St. John’s wort, and valerian, which can interfere with anesthesia or prolong its effects
• Echinacea, which UT Southwestern notes can harm the liver

The American College of Surgeons names ginkgo biloba, vitamin E, feverfew, garlic, ginger, ginseng, omega-3 fatty acids, fish oil, St. John’s wort, and turmeric among herbs to discuss with your surgical team.

UCLA Health lists echinacea, ephedra, feverfew, fish oil, garlic, ginkgo biloba, ginger, green tea, kava kava, St. John’s wort, valerian, vitamin E, and large doses of vitamin C.

If something you take is not on these lists, that does not mean it is fine to continue. Bring everything to your surgical team and let them decide.

What to ask at your pre-op visit

The FDA’s advice is simple: “Every time you visit a health care professional’s office, bring a list of all the dietary supplements and medications you are currently taking.” Then ask:

• Which of these should I stop, and on what date?
• Are there any I should keep taking through surgery?
• When can I restart each one after surgery?
• Can I have the stop and restart dates in writing?

For a fuller script, see Talking to your surgeon about supplements.

When to restart after surgery

Restart only when your surgical team says you can. Ask for the restart date at the same visit as the stop date, since it is the question people most often forget. In the Recovery Laboratories protocol, the Acute phase starts when your surgical team clears you to resume supplements, not automatically on the day of surgery.

How the pause fits the protocol

The Recovery Laboratories protocol has six phases. Prepare runs until three weeks before surgery. Pause covers the final three weeks, with nothing to take unless your surgeon tells you otherwise. Acute begins when you are cleared to restart, and Tissue repair, Remodeling, and Maintenance follow. If you take any of our formulas in the Prepare phase, put them on your list for your surgeon too.

Sources

• U.S. Food and Drug Administration, “Mixing Medications and Dietary Supplements Can Endanger Your Health”
• American College of Surgeons, “Medication and Surgery: Before Your Operation”
• UT Southwestern Medical Center, “10 supplements and certain medications to pause before surgery” (2022)
• UCLA Health, “Medications to Avoid Before Surgery”