Journal of the Royal College of Physicians of London 1994;
28(1)
Garlic supplements may have an important role to play in the
treatment of hypercholesterolaemia. To determine the effect of
garlic on serum lipids and lipoproteins relative to placebo and
other lipid lowering agents, a systematic review, including meta-
analysis, was undertaken of published and unpublished randomized
controlled trials of garlic preparations of at least four weeks
duration.
Studies were identified by a search of MEDLINE and the
ALTERNATIVE MEDICINE electronic databases, from references listed
in primary and review articles, and through direct contact with
garlic manufacturers. Sixteen trials, with data from 952
subjects, were included in the analyses.
Many of the trials had methodological shortcomings. The pooled
mean difference in the absolute change (from baseline to final
measurement in mmol/l) of total serum cholesterol, triglycerides,
and high-density lipoprotein (HDL)-cholesterol was compared
between subjects treated with garlic therapy against those
treated with placebo or other agents. The mean difference in
reduction of total cholesterol between garlic-treated subjects
and those receiving placebo (or avoiding garlic in their diet)
was -0.77 mmol/l (95% CI: -0.65, -0.89 mmol/l). These changes
represent a 12% reduction with garlic therapy beyond the final
levels achieved with placebo alone.
The reduction was evident after one month of therapy and
persisted for at least six months. In the dried garlic powders,
in which the allicin content is standardized, there was no
significant difference in the size of the reduction across the
dose range of 600-900 mg daily. Dried garlic powder preparations
also significantly lowered serum triglyceride by 0.31 mmol/l
compared to placebo (95% CI: -0.14, -0.49). HDL-cholesterol was
non-significantly lowered by 0.04 mmol/l (95% CI: -0.11, 0.03
mmol l). Side effects from garlic therapy, other than odor, were
rare.
In conclusion, use of garlic therapy, either as dried garlic
preparations (in doses as low as 600 mg per day) or as fresh,
high allicin yielding garlic (10-20 g per day) appears
significantly to reduce total serum cholesterol over a 1-3 month
period. However, more rigorously designed and analyzed trials are
needed.