Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr Ang-Lee and colleagues1 presented a series of recommendations for managing
the use of herbal medicines prior to surgery. I am concerned about several
of their conclusions.
First, I disagree with their recommendation that garlic be avoided 7
days prior to surgery. This conclusion was apparently based on 1 case report
of an octogenarian who developed a spontaneous epidural hematoma following
chronic ingestion of massive quantities of raw garlic cloves, as well as in
vitro studies of isolated constituents of garlic. Results of in vitro experiments
generally do not accurately reflect the effect of the phytochemicals that
actually reach the bloodstream. Furthermore, they are usually conducted using
concentrations that are several orders of magnitude higher than those achieved
with oral ingestion.
Betz JM. Use of Herbal Medications Before Surgery. JAMA. 2001;286(20):2542-2544. doi:10.1001/jama.286.20.2542