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What we now about Garlic

Scientific Name: Garlic

Other Names: Allium, Allium sativum, Rustic Treacle, Stinking Rose

Who is this for?

Note: Much of garlic's reputation is based on observation and tradition. While numerous animal and human studies have been carried out to test garlic's effectiveness for a wide range of health conditions, many of the studies have been small and short in duration. Not all of the studies used standardized garlic products or similar dosing regimens. Therefore, many of the study results are unreliable. However, taking garlic appears to have few if any serious negative effects and it may be a useful addition to conventional treatments for certain conditions.

In the United States, oral garlic supplements are sold mainly to reduce high cholesterol and high blood pressure. Garlic's possible positive effect on cholesterol levels — as seen in multiple small studies done mostly in the 1970s and 1980s — has not been substantiated by more recent research. However, garlic does seem to be better than placebo (sugar pills with no medical effectiveness) for lowering high blood levels of total cholesterol and triglycerides. Garlic does not lower blood cholesterol to the same extent achieved by dietary changes plus prescription drugs known as HMG-CoA reductase inhibitors (HMGs), Also called statins, HMGs include Lipitor, Lescol, lovastatin, Pravachol, and Zocor. In general, these medications in combination with low-fat diets may produce a 28% to 60% reduction in total cholesterol. Garlic may be responsible for cholesterol reductions in the 6% to 12% range. Additionally, several studies appear to show that garlic's cholesterol-lowering effects may be only short-term. Lower cholesterol seen after one month of treatment, may return to near pre-treatment levels after 6 to 12 months of garlic therapy. One study of 30 children with an inherited type of high cholesterol known as familial hypercholesterolemia found no effect from garlic on their cholesterol levels.

While garlic also appears to have a small effect on lowering blood pressure, overall results from a number of studies were generally not considered to be significant. On average, individuals who participated in several small clinical trials of a powdered garlic product had blood pressure reductions of 5% to 7% more than other participants who took an inactive placebo. It is believed that garlic may relax blood vessels, causing them to widen and allowing blood to flow more easily. In addition, the thickness of the blood may be reduced by taking garlic, which may block the body's production of thromboxane, a chemical involved in blood clotting and blood vessel tightening.

Garlic has been proved to reduce the stickiness of platelets. Platelets are blood components that are partly responsible for forming atherosclerotic plaques — the cholesterol-associated deposits that can block arteries. In several studies conducted in laboratory animals garlic appeared to stop or delay the formation of atherosclerotic plaques. Two separate human studies that each lasted for four years, also showed that existing plaques were reduced in size by garlic supplementation.

Some garlic preparations have also been promoted for boosting immune function. Garlic has been shown in laboratory research to increase blood levels of at least two enzymes that have antioxidant properties. Antioxidants are thought to protect body cells from damage caused by a chemical process called oxidation. In one study, seven people living with AIDS showed improvements in natural immune function after 12 weeks of garlic supplementation. No further human studies have been published to support these results, although some animal research seems to confirm them. Extensive research, conducted mostly in Asia, has related high intakes of raw and/or cooked garlic and similar plant foods with a lower incidence of colorectal, esophageal, and stomach cancers. One five-year observational study that followed more than 40,000 U. S. women between the ages of 55 and 69, also found that the women who used a lot of garlic in food preparation were less likely to have colon cancer than the women who did not cook with garlic. However, a study conducted over a three-year period in the Netherlands, did not show a reduction in breast, colon, lung, or rectal cancers among people who consumed garlic as compared with those who did not. Much more research is needed to determine whether garlic can protect against prostate cancer.

Garlic has long been known to be anti-infective. Laboratory studies show that it kills or damages a wide range of bacteria, fungi, protozoans, and viruses. The blood levels needed to control or kill most internal infective agents, however, may be too high to achieve by taking garlic orally. It may be effective, though, for controlling infective agents on the skin's surface. Several studies carried out in humans show that a compound extracted from garlic is effective and safe for application on fungal infections such as athlete's foot and ringworm in many areas of the world, garlic oil is also applied to repel biting insects.

When should I be careful taking it?

Garlic may interfere with blood clotting. Therefore, individuals who have hemophilia or other bleeding disorders should avoid eating or using large amounts of garlic.

Precautions

Because the chemicals in garlic may cause stomach irritation, individuals with stomach ulcers or sensitive stomachs should be careful about eating or swallowing garlic.

Individuals who are allergic to other members of the lily family of plants, which also includes onions and flowers such as crocus, hyacinth, lilies, and tulips; may also be sensitive to garlic. For susceptible individuals, touching garlic plants or taking garlic supplements may result in allergic responses such as upset stomach or skin rash.

Garlic is known to enter both amniotic fluid (the liquid that surrounds a developing fetus) and breast milk. Although the taste and smell of these liquids may change, no negative effects have been reported for the fetus or infant whose mother uses garlic supplements.

What side effects should I watch for?

No major side effects have been reported with the use of garlic in recommended amounts for food or as an herbal remedy. However, garlic does reduce the blood's ability to clot, so ingesting large amounts of it may cause excessive bleeding in combination with anticoagulant or antiplatelet drugs.

Some cases of asthma have been reported in people who process garlic. Other case reports attribute allergic symptoms such as irritated eyes, runny nose, and itching skin to working with large amounts of garlic for extended times. In very rare instances, garlic allergy is thought to have caused sudden and serious swelling, shortness of breath, and loss of consciousness.

Fresh garlic applied to the skin could result in blistering, chemical burns, or dermatitis. The chemicals that give garlic its smell may also irritate or burn the skin, especially when fresh garlic is allowed to stay on the skin for prolonged periods of time or when it is covered with a waterproof barrier such as a plastic bandage. Cases of serious burns have been reported by individuals who have no known sensitivities to garlic.

Other side effects associated with the oral use of garlic include:

  • Breath and/or body odor
  • Diarrhea
  • Gas
  • Heartburn
  • Mouth irritation
  • Nausea
  • Stomach upset
  • Vomiting

What interactions should I watch for?

Prescription Drugs

In studies and case reports, garlic has been shown to increase the time blood needs to clot. When it is taken with "blood thinners" — antiplatelet or anticoagulant drugs, the effect of the drug may be increased, resulting in uncontrolled bleeding.

  • Antiplatelet drugs include Plavix and Ticlid
  • Anticoagulants include heparin and warfarin

When garlic was given to healthy volunteers who were also taking a type of antiviral drug (a protease inhibitor named Fortovase); blood levels of the drug were reduced by about half, making it less effective for controlling HIV. Although garlic's possible effects on other antiviral drugs are unknown, individuals taking any type of antiviral therapy should avoid taking very large amounts of garlic.

A few small studies done in the 1970s seemed to show that garlic reduced blood sugar in laboratory animals. Although no additional studies have documented these results, people taking oral medications or insulin for diabetes should check with their doctors before taking large amounts of garlic.

Because garlic is broken down by certain enzymes in the liver, excessively large amounts of it possibly may interfere with the use of prescription drugs that are processed by the same enzymes. Some of these drugs are:

  • Allergy drugs such as Allegra
  • Antifungal drugs such as itraconazole and ketoconazole
  • Cancer drugs such as etoposide, paclitaxel, vinblastine, or vincristine
  • Drugs for high cholesterol such as lovastatin, Pravachol, and Zocor
  • Oral contraceptives

Non-prescription Drugs

Garlic can reduce the ability of blood to clot after an injury. Aspirin can also delay clotting, so large amounts of garlic should not be taken orally at the same time aspirin is being taken.

Both garlic and acetaminophen are processed by the same set of enzymes in the liver. When they are taken together, large amounts of garlic may interfere with the breakdown of acetaminophen. As a result too much acetaminophen may stay in the blood.

Herbals

Theoretically, if garlic is used with other herbs that affect blood clotting, bleeding may occur. Some of the most common herbal products that might inhibit blood clotting are:

  • Danshen
  • Devil's Claw
  • Ginger
  • Gingko
  • Ginseng
  • Horse Chestnut
  • Papain
  • Red Clover

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.

Should I take it?

Garlic was highly prized in the ancient world—both for flavoring and for medicine. Believed to have originated in eastern Asia, it is now grown and used in nearly every country. It belongs to the same family of aromatic plants as chives, leeks, and onions; flowers such as lilies are also related to garlic. Depending on the species of garlic, plants may be as tall as 3 feet or as small as about half a foot. All garlic plants have long, thin, grass-like leaves that surround a central stem. After white, pink, purple, or reddish flowers bloom during the summer and early fall, a large underground bulb develops. Although the leaves are used as food in some areas of the world, the bulb is the part most used for flavoring and medicines.

Although garlic contains many different chemicals, the sulfur compounds and volatile oils that give garlic its strong smell also account for much of its medicinal value. Also called essential oils, volatile oils possess the characteristic smell and taste of the plant. Volatile oils usually evaporate quickly at room temperature.

Dosage and Administration

Around the world, supplemental garlic is sold in a number of different forms — including capsules, concentrates, extracts, liquids, powders, raw garlic bulbs, and tablets. Fresh garlic juice and syrups made from fresh garlic are used more for medicine in Europe and Asia than in the United States. Some garlic products are aged to reduce odor or to allow the formation of additional chemical compounds. Some reliable evidence suggests that heat may reduce some or all of garlic's effectiveness, so preparations that are manufactured without being heated may retain more of the chemicals that are thought to be beneficial.

In this country, garlic preparations are most available as capsules or tablets made from dried garlic powder or as aged garlic extract. Made by crushing garlic and letting it mature in a cool place for up to 20 months, aged garlic extract has fewer irritating, odor-causing chemicals than fresh garlic. Either dried or aged garlic products are marketed in several strengths and in multiple combinations with other herbal ingredients such as echinacea or ginkgo biloba. Garlic preparations should be standardized to contain between 0.5% and 1.3% of alliin, one of the sulfur compounds in it. Standardization by the manufacturer should assure the same amount of active ingredient in every batch of the commercial preparation. Standardization of herbal products is not required by the U.S. Food and Drug Administration (FDA), so not every product will contain the same amounts of active ingredients.

The recommended supplemental dose of garlic is 600mg to 900mg daily, usually taken in three or four doses during the day. If you choose to take a garlic supplement, follow the directions for the product that you are using. Virtually no limits are placed on the consumption of dietary garlic, however—with reported continual daily amounts of several ounces being common among Asian cultures whose members regularly consume garlic plants as a vegetable.

Fresh garlic varies in the amounts of active ingredients it contains depending on the location and conditions in which it is grown and the way it was processed and stored. For those who prefer using it, one-half to three cloves of raw garlic can be chewed up to three times a day. Cooking may destroy some of the medicinally effective chemicals in garlic, so garlic used in seasoning foods may not be as beneficial to health as commercial supplements or raw garlic.

Summary

Some limited clinical evidence seems to show that garlic taken orally can help moderately to reduce high cholesterol and high blood pressure. Less evidence supports its effectiveness in preventing heart disease, enhancing immune function, and protecting against some types of cancer.

Risks

Garlic in recommended amounts seems to have few risks. People who have bleeding disorders or who take medications to thin the blood, should be aware that taking large amounts of garlic may further reduce the blood's ability to clot.

Side Effects

In the amounts used in food or recommended medicinal doses, garlic has few side effects. Large amounts, however, have been associated with irritated mouth or stomach. A few people may have asthma or rash from handling the garlic plants for a long time or in large amounts. If it is left in contact with the skin for extended periods of time, garlic may cause irritation or burns.

Interactions

If it is taken at the same time as drugs or other herbs that "thin the blood"' very large amounts of garlic taken by mouth could increase the amount of time that blood needs to clot. Garlic in high amounts may interfere with some antiviral and antidiabetic medications, as well as with other drugs, such as acetaminophen, that are broken down by the same liver enzymes as garlic. It may increase the activity of drugs that lower blood sugar.

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