Garlic- The King of all herbs?

Recently, I was criticized and mocked in social media for my opinions regarding the evidence-based beneficial effects of garlic consumption by a “Savior complex” self-proclaimed “Real Doctor” who has no documented natural medicine experience or training and has openly admitted to writing 50 prescriptions a day! This wannabe Youtube starlet has 11 years-experience as a physician yet somehow claims 18-20 years-experience as a doctor while being only 35 years old?! Did they become a Doctor as a teenager?! Is there some type of time machine involved?

Masquerading as an expert in all things medicine does not make it a reality any more than it did for Doogie Howser.

As so often happens these days, this untrained criticism was done without presenting any single shred of supporting scientific evidence in their self-serving quest for “views”, “likes” and “followers”. If a doctor offers their opinions, ESPECIALLY in areas where they have no credentialed training or certifications, they should at a very minimum be capable enough to show scientific studies to support their opinions. This should be an easy task for someone consistently promoting themselves as a “Real Doctor”. Show people the science! Most societies view physicians as “all-knowing” and “experts” when they speak, so it’s really frustrating when we have a self-proclaimed “Real Doctor” making groundless, unfounded, baseless, unsubstantiated and unscientific claims in social media on their quest for fame, relevance, adoration and legitimacy. Show us the science, not opinions!

Untrained opinions are NOT legitimate evidence. Shaking your head dismissively does not debunk established medical science or make it disappear. Acting superior to others does not make it so if you do not have the capacity to show even the most basic of scientific evidence. Bad opinions pollute good science. Saying that you are correcting incorrect medical advice by criticizing evidence-based clinical nutrition practices so you can try and be a celebrity is foolish and potentially dangerous because innocent people get fooled into thinking the self proclaimed “Real Doctor” knows what they’re talking about. Sharing untrained and unscientific medical or scientific opinions without demonstrating ANY medical or scientific evidence to support them as a doctor is as worthless as a chocolate frying pan and potentially dangerous to the public.

Apparently, the self-proclaimed “Real Doctor” is unable to find studies about garlic because nowadays the extensive scientific studies and reports are being put in wacky places like medical journals, research databases, government websites, science textbooks, libraries and even continuing medical education courses, just to name a few. They’re put in places where those of us who are looking to be better doctors actually look for them, find them and learn from them. There really is no excuse in this era for Doctors to remain ignorant about beneficial nutrition practices with the abundance of evidence that is readily and easily available to everyone.

Do you know as much as your doctor about nutrition?

For example, the U.S. National Library of Medicine PUBMED database of the U.S. National Center for Biotechnology Information, is an excellent source for ANYONE to learn about peer-reviewed studies demonstrating scientific evidence for natural plants and even foods and it’s FREE. You don’t need to be a “Real Doctor” to access it. The database contains over 8,000 study abstracts on garlic as of the writing of this article. Go there and have a look. We medical doctors are not the gatekeepers to scientific knowledge. Anyone can learn about the world we live in and the wondrous aspects of something like garlic by reading the peer-reviewed literature. Click the link below:

https://pubmed.ncbi.nlm.nih.gov/?term=Allium+sativum

I do not believe any legitimate physician or self-proclaimed “Real Doctor” should flatly ignore over 8,000 study abstracts on a subject and consider themselves someone that should be offering “expert” opinions. Untrained opinions are not evidence. As physicians, we should be compelled and committed to continue learning and growing in our knowledge as healers and capable enough to demonstrate the evidence behind our beliefs.

Dr. David Sackett, widely regarded as the “father of evidence-based medicine” was quoted a few years ago in the BMJ by his very close friend Dr. Richard Horton, the Editor of the BMJ in his article, “Thoughts for new medical students at a new medical school” (1).

“Half of what you’ll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half—so the most important thing to learn is how to learn on your own”. -Dr. David Sackett (1)

I choose to continue learning day after day because the body of knowledge in science does not stop growing. I study and investigate constantly to improve my knowledge and craft as a physician.

“The purpose of science is to extend the validated body of knowledge, which inherently is expected to challenge and even controvert deeply held beliefs.” -Dr. Martin Makary, M.D., M.P.H., Professor of Surgery at Johns Hopkins University School of Medicine (2)

I don’t know everything when it comes to medicine. I choose to continue learning to be a better doctor. I’m never satisfied with what I know. There is always something new to learn and discover.

“You should be working against all of the knowledge you have received because it is insufficient.” (3) – Dr. Juan Pascual, M.D., Ph.D., Professor in four Departments at the University of Texas Southwestern Medical Center at Dallas.

If a doctor stops learning and studying, how effective can they be just a handful of years after medical school?

“The half-life of knowledge in highly specialized clinical arenas cannot endure a shelf life of more than three years, at which point a clinician can become useless at best and dangerous at worst.” – Dr. Steven Z. Kussin (4)

I choose to learn daily and promote evidence-based medicine, NOT opinion-based medicine or pharmaceutical marketing-based schemes being promoted as medicine. Instead of writing 50 prescriptions a day, why not look for better ways?

“The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.” -Dr. David Sackett (5)

If that “Real Doctor”/ “Savior Complex”/ wannabe Youtube starlet would spend as much time researching science as they do making mediocre social media videos criticizing evidence-based medicine in their quest for validation, fame and relevance, they might actually be able to speak intelligently about science instead of being one of the world’s finest textbook examples of the Dunning Kreuger effect in action.

The “Savior complex” doctor should also get a license to practice medicine in the Philippines if they want to help Filipinos and actually show evidence of their alleged “medical missions” instead of videos of them walking around pranking Filipinos about their ability to speak English. If Filipinos want the opinions of a “Savior complex” doctor, they’ll ask. Colonial mentality is alive and well and being exploited.

“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough.” -Dr. David Sackett (5)

I choose to follow the lead of Dr. Sackett and be a good doctor by using the best available external evidence from systematic research, such as 8,000 study abstracts about garlic! So, once again I’ll debunk more of the unscientific disinformation and propaganda being spun by others in social media and demonstrate why the scientific basis for garlic recommendations is substantial evidence-based medicine. You debunk bad and unscientific ideas by showing science not ignorantly spewing untrained and unscientific opinions. 😊

To Garlic!

Journal of the National Medical Association– “Garlic is the best example of the philosophy that your medicine should be your food, and your food should be your medicine.” (6)

A cursory review of the scientific literature shows that garlic has a significant role to play in preventing or treating well over 150 health conditions. Instead of ignorantly dismissing the massive body of evidence for a powerful food such as garlic, it is critically important that we look at the overwhelming abundance and totality of confirmatory studies which continue to echo the same beneficial conclusions which are grounded in solid scientific evidence. Let’s look at some science!

Journal of the National Medical Association– “No other substance, either natural or synthetic, can match garlic’s proven therapeutic versatility and effectiveness.” (6)

“At present, there are no known toxic compounds in garlic and its extracts.” (7)

The actions of garlic are numerous and briefly noted below.

Historical

Garlic (Allium sativum) is one of the most ancient medicinal plants and among the oldest of all cultivated plants. It is believed to have originated from central Asia over 6,000 years ago. Garlic-based remedies were functioning in India some 5,000 years ago and its inclusion in Chinese medicine started 3,000 years ago. It has been used as a spice, food & folklore medicine and is the world’s most widely researched medicinal plant (8, 9, 10). The compound that produces much of the activity of garlic is allicin, which is released when intact cells of a garlic clove are cut or crushed. (11)

The Ebers papyrus is an Egyptian medical document dating to about 1550 B.C. It includes 22 therapeutic formulations that mention garlic as an effective remedy for a variety of ailments including heart problems, headache, bites, worms and tumors (12).

An ancient Egyptian mummy dated from the 24th century BC (4,400 years ago) was found at the base of the Great Pyramid buried with garlic. (13)

In Pharaoh Tutankhamun’s (14th century BC) tomb, several bulbs of garlic were found perfectly preserved, which shows how important it was in everyday life. (9)

The ancient Egyptians fed their pyramid building workers garlic to make them strong and capable of doing more work. (9) The ancient Greek historian Herodotus (14) wrote: “There is an inscription in Egyptian characters on the Pyramid which records the quantity of radishes, onions, and garlic consumed by the laborers who constructed it; and I perfectly well remember that the interpreter who read the writing to me said that the money expended in this way was 1,600 talents of silver.”

The Israelites developed a great fondness for garlic during that time. After they left Egypt some 3,500 years ago with Moses and trekked across the Sinai wilderness, it was written: “How we remember the fish that we used to eat in Egypt for nothing, the cucumbers and the watermelons and the leeks and the onions and the garlic!” (Numbers 11:4, 5)

Excavations of ancient Greek temples have unearthed garlic, and the palace of Knossos in Crete, dating to 1400–1800 BC, contained well-preserved garlic when it was excavated (9).

The ancient Greek physician Hippocrates (circa. 460-370 BC), widely regarded as the father of Medicine prescribed garlic for a wide range of conditions and illnesses. Hippocrates promoted the use of garlic for treating respiratory problems, pulmonary complaints, parasites, poor digestion, fatigue and for abdominal growths, particularly uterine. (15, 16)

Aristotle and Aristophanes also recommended garlic for its medicinal effects (12).

Dioscorides, chief physician to the Roman army in the first century A.D., prescribed garlic as a vermifuge, or expeller of intestinal worms (12). Soldiers were also reported to chew garlic before battles for strength. (17)

There is also evidence that during the earliest Olympics, which originated in Greece, garlic was fed to the athletes as a stimulant before they competed to improve performance (12, 17, 18, 19).

“French priests consumed liberal quantities of garlic during the bubonic plague and had a much higher survival rate than their English counterparts.” (6)

From 1720-1722 garlic was successfully used to save the Marseille population from the last western European outbreak of the bubonic plague (20, 21).

At the time when antibiotics and other pharmacy products did not exist, a bulb of garlic itself represented a whole pharmacy industry due to the broad spectrum of effects.

In India garlic has long served as an antiseptic lotion for washing wounds and ulcers (12).

Nobel Laureate Albert Schweitzer made use of garlic in Africa for the treatment of amoebic dysentery (6, 12).

“Since ancient times, folk doctors have used garlic to prevent and treat a variety of ailments, including heart problems, headaches, worms and tumors. Before antibiotics, battlefield doctors used garlic to prevent gangrene, and Albert Schweitzer used it as an antiseptic in his jungle hospital.” (22)

During the World Wars, Britain, Germany, and Russia used garlic for treating battlefield infections with much success. (6) The spread of infections were inhibited by garlic paste being applied directly to wounds. (23) “In the late war it was widely employed for the control of suppuration of wounds. It was externally applied in ointments and lotions, and as an antiseptic, to disperse hard swellings, also pounded and employed as a poultice for scrofulous sores.” (24)

“For over 5000 years, garlic has acquired a worldwide reputation in folklore as a formidable prophylactic and therapeutic medicinal agent. More than three thousand publications in this century have confirmed the efficacy of this herb in the prevention and treatment of a variety of diseases, acknowledging and validating the traditional uses.” (25)

THE IMMUNE BOOSTING EFFECTS OF GARLIC

“Evidence to date suggests that garlic may become known as one of the grand conductors of the body’s immune symphony.” (6)

“Immune dysfunction plays an important role in the development and progress of several diseases, we critically examined immunoregulation by garlic extracts and compounds isolated, which can contribute to the treatment and prevention of pathologies such as obesity, metabolic syndrome, cardiovascular disorders, gastric ulcer, and even cancer. We concluded that A. sativum (Garlic) modulates cytokine secretion and that such modulation may provide a mechanism of action for many of their therapeutic effects.” (26)

The King Saud University Saudi Pharmaceutical Journal article titled “Natural cures for breast cancer treatment”, states;

“Studies have shown that the number of suppressor T cells is increased by garlic and converts the lymphocytes in that form which is cytotoxic to cancerous cells. Metastases are prevented by altering the adhesion and attachment of cancerous cells, circulating in the blood vessels. Harmful effects of carcinogens to DNA are prevented by ripened garlic extract; it improves the immune system of the body, increases the removal of carcinogens from the body, and enhances the detoxifying enzyme’s activity…Complications of chemotherapy and radiotherapy could be lessened with garlic extract.” (27)

“Garlic and its compounds are the crucial immunomodulators that can stimulate the immune system against various diseases…In conclusion, garlic has an excellent efficacy to enhance the immune system against various diseases and act as a potent immunomodulatory substance.” (28)

Current evidence demonstrates that garlic acts as an immune booster by actively strengthening the host immune system within the tumor microenvironment against the immunosuppressive activity of an emerging tumor, some relevant literature has been summarized in Table 1. (29)

Table 1
Selected studies on the immunomodulatory (Immune Boosting) effects of garlic.

Functional Component	Concentration	Experimental System	Reported Effect	Ref.
Ajoene	5-40 μM	Human leukemic cells	Induction of apoptosis by stimulation of peroxide production and NFκB activation	(30)
AGE	500 mg daily for 6 months	Inoperable colorectal, liver or pancreatic cancer patients	Increase in NK cell number and activity	(31)
DAS, DADS, AMS	5 x 20 mg daily	BALB/c mice	Enhanced number of white blood cells and antibody titre	(32)
Fresh garlic	2g (once or daily for 7 days)	Healthy human volunteers	Increase in plasma NO and IFNα levels	(33)
Garlic extract	0.1-10 μg/ml	Whole blood and PBMCs	Decreased production of IL12, TNFα, IL1α, IL6, IL8, IFNγ, IL2; increase of IL10	(34)
Garlic extract	10-1000 μg/ml	Normal placental and preeclamptic explants	Inhibition of IL6 and TNFα production; IL10 increase (10μg/ml garlic extract) or IL10 decrease (1000μg/ml garlic extract)	(35)
Garlic powder extract DADS	10-100 mg/l 1-100 μmol/l	LPS-induced human whole blood	Reduction of NFκB activity and production of IL1β and TNFα	(36)
DAS DADS AMS	1-10 μM 0.1-0.5 μM 2-20 μM	LPS-stimulated RAW 264.7 macrophages	Reduction of iNOS expression and NO production; Reduction of COX2 expression and PGE2 release (only DAS)	(37)
AGE SAC	0.1-5 g/l 0.1-20 mmol/l	Ox-LDL induced injury in endothelial cells	Prevention of membrane damage, loss of cell viability and lipid peroxidation by prevention of intracellular GSH depletion and NFκB activation	(38)
Alliin	0.05-3 μg/ml	LPS-induced PMBCs	Increase in IL1β and TNFα; Decrease in IL6 production	(39)
DADS, DATS	50-400 μM	LPS-stimulated RAW 264.7 macrophages	Reduction of iNOS expression, NO and peroxide production; Inhibition of NFκB activation	(40)
Ajoene Allicin	IC50 2.5-5 μM IC50 15-20 μM	LPS-stimulated RAW 264.7 macrophages	Reduction of iNOS expression and NO accumulation	(41)
DAS DADS AMS	1-10 μM 0.1-0.2 μM 2-20 μM	LPS-stimulated RAW 264.7 macrophages	Inhibition of TNFα, IL1β, IL6, IL10 production; Inhibition of NO and prostaglandin PGE2 release Inhibition of TNFα, IL10 and NO release; Increase of IL1β and IL6 Inhibition of TNFα, Increase of IL10, Decrease of NO release	(42)
Ajoene	IC50 2.4-3.4 μM	LPS-stimulated RAW 264.7 macrophages	Inhibition of COX2 enzyme activity and PGE2 release	(43)
Aqueous Garlic Extract (AGE)	9.25, 18.5, 37, 74, 148 mg/ml	Leishmania major promastigotes (MRHO/IR/75/ER) added to an in-vitro cultured J774 cell line	Our finding confirms Ghazanfari’s data suggesting that garlic extract contains an immunomodulator, which modulates cytokine patterns towards a Th1-type response and the development of an effective cell-mediated response.	(44)

_{From: Schäfer G, Kaschula CH. The immunomodulation and anti-inflammatory effects of garlic organosulfur compounds in cancer chemoprevention. Anticancer Agents Med Chem. 2014;14(2):233-240. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915757/}

“The data presented here…provide evidence for the antileukemic activity of the garlic compound ajoene and thus support the contention of a benefit of garlic intake in cancer prevention and treatment. “ (30)

“Administering AGE (Aged Garlic Extract)…caused improvements in the NK cell activity in patients with advanced cancer of the digestive system…and AGE is considered safe to administer to patients with advanced cancer.” (31)

“The use of garlic and onions as dietary constituents andmedicinals for many disorders dates back to early civilizations. Some of these sulphur compounds werefound to be useful anticancer agents…These results are suggestive of an immunostimulating effect of sulphurcompounds.” (32)

“Garlic is used for different medicinal purposes ranging from cardiovascular diseases to diabetes and has been reported to enhance immunocompetence. It can also suppress inflammatory cytokines…Consumption of garlic resulted in stimulated synthesis of NO (nitric oxide) and, in turn, IFN-alpha (interferon-a) in humans, which could be beneficial in viral or proliferative diseases.” (33)

“Garlic extract induced a variety of immunomodulatory activities on leukocyte cytokine production. Leukocyte Th1 and inflammatory cytokine production was reduced significantly in the presence of garlic extract, revealing a potential therapeutic use in inflammatory conditions such as IBD.” (Inflammatory Bowel Disease) (34)

“Garlic is a sulphur-rich phytomedicine with a long history of therapeutic use. It has been shown to be usefulas an antiplatelet, antihypertensive, antifungal, anticancer, antioxidant, hypolipidaemic and hypoglycaemic…The potential role for garlic as a therapeutic agent for preeclampsia is broadened by its well-documented antihypertensive effect…We thus conclude that garlic may have an immunomodulatory effect on normal and preeclamptic placentas.” (35)

“To date, antithrombotic, lipid-lowering, antitumoral and antioxidant properties of garlic have been demonstrated…these results suggest that garlic modulates inflammatory cytokines, leading to an overall reduction of NF-kB (Nuclear factor kappa-light-chain-enhancer of activated B cells) activity in a human cell model.” (36)

“Our data suggest that AGE (Aged Garlic Extract) and its main compound, SAC (S-allylcysteine), may be useful for prevention of atherosclerosis.” (38)

“It is concluded that alliin in vitro exerts an immunomodulatory effect on certain functions of the peripheral blood cells.” (39)

Immunomodulatory

“We can demonstrate that allicin and ajoene, two compounds present in crushed garlic, are able to reduce the expression of iNOS (Inducible nitric oxide synthase), an enzyme induced by an inflammatory environment and which was shown to promote peroxynitrite formation in atherosclerotic lesions” (41)

“Epidemiological studies provide background support for the beneficial health properties of garlic, known by humans for centuries, by correlating Allium vegetable intake with reduced cancer risk. Accumulating evidence has shown DATS (Diallyl trisulfide, a bioactive compound derived from Allium vegetables) to regulate several cancer-related pathways including cell cycle arrest, apoptosis, chemical detoxification, invasion, migration, and angiogenesis.” (45)

“Recent data show that garlic-derived products modulate cell-signaling pathways in a fashion that controls the unwanted proliferation of cells thereby imparting strong cancer chemopreventive as well as cancer therapeutic effects.” (46)

“The immunomodulatory properties of garlic were elucidated in terms of shifting the cytokine response to a Th1-type pattern and therefore causing the protective response.” (47)

“We found that Aged Garlic Extract (AGE) could be a significant immuno-potentiator, and could exhibit anti-tumor activities through immune modulation.” (48)

“Anti-cancer activity of garlic is due to high amount of organic sulfides and polysulfide’s. Mechanism behind anti-tumor activity stimulating the lymphocytes and macrophages is that they kill the cancerous cells and interferes with tumor cells metabolism.” (27)

AGE (Aged Garlic Extract) is demonstrated to modulate the number and the activity of NK (Natural Killer) cells in patients with various advanced cancers (31) and also increases NK activities against different cancerous cell lines (48). Moreover, in healthy subjects, AGE increases the NK cell population (49). Therefore, garlic acts as a proliferation stimulator for this cell type. (50)

“A randomized, double-blind, placebo-controlled parallel intervention study recruited 120 healthy subjects (60 per group) to determine the effect of aged garlic extract supplementation (2.56 g/d) on immune cell proliferation and cold and flu symptoms.” (49)

RESULTS- “AGE supplementation reduced the severity of cold and flu symptoms…” (49)

“These findings provide evidence to support another avenue of anticancer/chemopreventative properties attributable to garlic constituents through immunomodulation.” (50)

NK (Natural Killer) Cells and T cells

Natural killer (NK) cells are effector lymphocytes of the innate immune system that control several types of tumors and microbial infections by limiting their spread and subsequent tissue damage. (51, 52) Natural killer cells represent the human body’s first line of defense against tumor cells and infectious pathogens and play a key role in tumor immune surveillance. (53)

Natural killer (NK) cells are potent anti-tumor and anti-microbial cells equipped with a vast array of receptors that recognize tumor cells and other pathogens. The anti-tumor properties of NK cells have attracted a high level of interest in biomedicine since their discovery in the 1970’s. The vast array of activating and inhibitory receptors on their surface equips NK cells with the capacity to recognize and kill a high variety of targets. (54) Studies suggest that NK cells develop long-lived and highly-specific memories to a variety of targets. (55) Immunologists have long been fascinated by the ability of NK cells to selectively detect and kill cancerous or virus infected cells, while tolerating healthy self-tissue (56, 57, 58, 59).

Natural killer (NK) cells constantly travel and survey the body for stressed and abnormal cells just like police out on patrol looking for bad guys. The signals that they receive through various cell surface receptors controls their activation and ability to target abnormal cells and produce cytokines. (60) The Natural killer (NK) cells possess the ability to recognize and kill unwanted cells without any prior sensitization just like little Terminators. (53)

Each NK cell is thought to reach exhaustion after killing about four target cells (61).

Low (Natural Killer) NK cell levels have been associated with an increased risk of death in breast cancer (62). Additionally, reduced NK cell activity increased the risk of metastasis by 350% in a separate study (63, 64)

The role of Garlic in immune function

University of Cincinnati– “Garlic contains compounds that help the immune system fight germs in a variety of ways by stimulating cells important to fighting disease and helping to regulate the immune system. It helps boost the production of virus-fighting T-cells and can reduce the amount of stress hormones your body produces which can help keep your immune system functioning at full strength.” (65)

“Our results indicate that F4 (a protein from aged garlic extract) is a very efficient immunopotentiator and may be used for immunotherapy.” (66)

Garlic antitumor activities have been shown both in vitro and in vivo. Studies have reported that garlic increases both the function AND frequency of NK (Natural Killer) cells (31, 66, 67, 68).

“The anticancer efects of garlic are being extensively documented and most of these effects have been attributed to the organosulfur compounds such as diallyl sulfde, diallyl disulfde, diallyl trisulfde, S-allylcysteine, or S-allylmercaptocysteine.” (68)

“Garlic’s role as an immune-system modulator and biologic-response modifier is indicated by the enhancement of NK-cell activity, macrophages, and cytotoxic T-cell activity.” (6)

“Garlic appears to enhance the functioning of the immune system by stimulating certain cell types, such as macrophages, lymphocytes, natural killer (NK) cells, dendritic cells, and eosinophils, by mechanisms including modulation of cytokine secretion, immunoglobulin production, phagocytosis, and macrophage activation.” (26)

“15 children aged 3–15 years were given a preparation of dry garlic in tablets…Statistically significant improvement of T lymphocytes function (p=0.005), evaluated by the blastic transformation method, as well as the improvement of children clinical condition were obtained.” (69)

“Garlic preparations have been found to exert an immunopotentiating effect by stimulating natural killer cell activity (70).” (11)

“Studies have shown that the number of suppressor T cells is increased by garlic and converts the lymphocytes in that form which is cytotoxic to cancerous cells. Metastases are prevented by altering the adhesion and attachment of cancerous cells, circulating in the blood vessels. Harmful effects of carcinogens to DNA are prevented by ripened garlic extract; it improves the immune system of the body, increases the removal of carcinogens from the body, and enhances the detoxifying enzyme’s activity.” (27)

“The action of garlic has been attributed to stimulating immune effector cells including T-cell and natural killer cells.” (71)

“Garlic could be useful in preventing the suppression of immune response associated with increased risk of malignancy as it stimulates the proliferation of lymphocytes, macrophage phagocytosis, stimulates the release of interleukin-2, tumor necrosis factor-alpha and interferon-gamma, and enhances natural killer cells.” (10)

“It has been found that garlic protein fraction has a stimulatory effect on lymphocyte, Natural Killer (NK) cells, and macrophages cytotoxicity (37, 66).” (68)

Garlic is demonstrated to enhance the proliferation AND frequency of lymphocytes (72, 73), and is also reported to normalize CD4+/CD8+ T cell ratio (increased T CD4+ and decreased TCD8+) (74). Other published reports have shown that garlic exhibits antiangiogenic as well as antiproliferative effects on tumor cells (68, 75, 76).

“The mechanisms of cancer chemopreventive agents include direct action on cancer cells through suppression of proliferation or induction of apoptosis, and indirect action (i.e., micro-environmental factors) through inhibition of angiogenesis and potentiation of immunologic reaction.” (76)

Research conducted on patients suffering from liver, pancreatic, or colon cancer, who were treated with aged garlic extract (AGE), demonstrated a significant increase of both NK cell number and NK cell activity. (60)

“Aged garlic extract (AGE) has manifold biological activities including immunomodulative and antioxidative effects…both the number of NK cells and the NK cell activity increased significantly in the AGE group…The study showed that administering AGE to patients with advanced cancer of the digestive system improved NK cell activity.” (31)

Garlic extract has also been shown to also increase NK cell cytotoxicity in addition to stimulating NK cell quantities (31, 77, 78).

Preliminary studies have shown that humans fed garlic and cold-aged, whole-clove preparations daily for three weeks had natural killer (NK) cells that destroyed 140 to 160 percent more K562 lymphoma cells than controls in vitro. (6)

There are scores of studies demonstrating the biological effects of garlic or its compounds on immune cell activation and proliferation. A small snapshot of some relevant literature is summarized below in Table 2. (68)

Table 2.

Garlic products	The biological effect on immune cell proliferation	Ref.
Garlic consumption	Enhancement of cells account in bone marrow Increasing lymphocyte proliferation in vivo in the absence of a mitogen Enhancement in lymphocyte proliferation in the spleen and thymus of rats from the garlic fed relative to the control group	(32) (79 )
Protein fraction	Stimulatory effect on lymphocyte and NK and macrophages cytotoxicity	(31, (66)
Extract and protein fraction	A dose-dependent augmentation of oxidative burst of macrophages An enhancement of T cell proliferation in splenocytes stimulated with PHA	(80)
Proteins from raw garlic extract	Mitogenic activity towards human peripheral blood lymphocytes, murine splenocytes, and thymocytes	(81)
Protein fraction of fresh garlic	Activating peripheral blood T lymphocyte and enlarged CD8+ T cell proliferation	(82)
Aged extract consumption	Increasing its proliferation of γδT cell population in healthy humans	(49)
Diallyl trisulfide (DATS)	Dual effect (inhibition and augmentation) on T lymphocyte proliferation in mice	(83, 84)
Ajoenes and alliin	Selective inhibition of proliferative response of human peripheral blood cells to lectins	(85)

_{Select studies showing biological effects of garlic or its compounds on immune cell activation and proliferation.

From: Moutia, Mouna et al. “In Vitro and In Vivo Immunomodulator Activities of Allium sativum L.” Evidence-based complementary and alternative medicine : eCAM vol. 2018 4984659. 12 Jun. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020507/}

“Garlic contains numerous compounds that have the potential to influence immunity. Immune cells, especially innate immune cells, are responsible for the inflammation necessary to kill pathogens. Two innate lymphocytes, γδ-T and natural killer (NK) cells, appear to be susceptible to diet modification.” (86)

In this study of 120 people, aged garlic extract reduced the severity of colds and the flu. It increased the number of immune cells (T cells and NK cells), boosting the immune system while lowering inflammatory proteins (cytokines). (49)

“AGE (Aged Garlic Extract) supplementation reduced the severity of cold and flu symptoms and this was associated with changes in NK and gd-T cell function, a reduction in inflammatory cytokine secretion and improved thiol status.” (49)

“The antiviral activity of garlic has long been intimated by habitual consumers of garlic who rarely have colds or become victims of influenza epidemics.” (6)

Garlic in the form of garlic extract or garlic powder, has been shown to increase natural killer cells (87). Other anti-carcinogenic properties of garlic include reduced infection-induced carcinogenesis, and the induction of apoptosis (48, 88). (64)

There are numerous studies demonstrating the effects of garlic or its compounds on immune system cytokine expression and production. Some of the relevant literature is briefly summarized below in Table 3. (68)

Table 3.
Selected studies demonstrating Garlic effects on cytokine expression and production

Garlic products	Reported biological effect	Ref.
Allicin	Inhibiting Th1 proinflammatory cytokines An inhibitory effect on NF-κB activation A negative effect on human T cell migration	(34) (89, 90) (91)
Garlic oil gavage (force feeding)	In rats: At low doses, enhancement of T cell response towards the Th1 type. At high doses, it triggered the Th2 type	(92)
Oral garlic consumption	Favoring a Th2 response via inducing an increased IL-4 production in spleen lymphocytes of the treated rats	(93)
Aged garlic extract	Alteration in normal cytokine production to a Th1 response in mice IL-10 upregulation in peripheral blood monocytes Decreasing IL-12 production	(94) (34, 95)
Garlic extracts	Increasing production of IFN-γ and IL-4 and reducing IL-2 production in Peyer’s patches of mice intestine Inhibition of IL-17 expression in treated human PBMCs	(96) (97)
Garlic powder extracts	Reducing proinflammatory cytokine like IL-1β and TNF-α, without changing IL-10 level human whole blood	(36)

_{From: Moutia, Mouna et al. “In Vitro and In Vivo Immunomodulator Activities of Allium sativum L.” Evidence-based complementary and alternative medicine : eCAM vol. 2018 4984659. 12 Jun. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020507/}

“Inclusion of garlic and its products in diets specially designed to provide immunonutrition in patients suffering from cancer and other maladies could impart a beneficial impact…the potential health benefits of garlic have supported its centuries old use as an immune booster.” (10)

“Healthful properties of garlic are legion and over a thousand scientific reports enumerated its functional activities which include free radical scavenging activities, immune stimulation, curing cardiovascular diseases, anti-cancer, and anti-infectious properties” (98, 99, 100, 101, 102, 103). (10)

“Seven genes related to immunity and/or cancer were upregulated in whole blood 3 h after RCG (Raw Crushed Garlic) consumption, and 5 of these genes were also upregulated in the monocytic cell line Mono Mac 6 when treated with garlic extract. The upregulated genes have a variety of functions, including roles in xenobiotic metabolism, inflammation, B cell and T cell development, apoptosis, and tumorigenesis.” (104)

WebMD- “Garlic: An Immunity-Boosting Superstar” (105)

“Garlic seems to increase the immune system functions. It stimulates macrophages, lymphocytes, NK cells, DC and eosinophils, by mechanisms including modulation of cytokine secretion, immunoglobulin synthesis, phagocytosis and macrophage activation.” (106)

“Significant increases in CD4 + and CD8 + T cells were observed following a short-term garlic extract supplementation.” (106)

Garlic, the immune system and Cancer

In 1909, Paul Ehrlich formulated the hypothesis that host defense may prevent neoplastic (Cancer) cells from developing into tumors (107). He wrote: “in the enormously complicated course of fetal and post-fetal development, aberrant cells become unusually common. Fortunately, in the majority of people, they remain completely latent thanks to the organism’s positive mechanisms.” (107). He understood that it was the immune system keeping cancer at bay.

Later, Lewis Thomas and Nobel Laureate Sir Frank Macfarlane Burnet proposed the concept of immunological surveillance of cancer starting more than six decades ago (108, 109, 110, 111). Immunological surveillance is the monitoring process of the immune system to detect and destroy virally infected and cancerous cells in the body. This is also known as immunosurveillance.

The theory of immunosurveillance remained somewhat controversial until a seminal scientific article appeared in Nature, back in 2001 entitled “IFN-gamma and lymphocytes prevent primary tumor development and shape tumor immunogenicity”. This groundbreaking article was authored by Robert D. Schreiber, Ph.D., and his colleagues at Washington University School of Medicine in collaboration with Lloyd J. Old, M.D., of the Ludwig Institute for Cancer Research and Memorial Sloan-Kettering Cancer Center. The experimental evidence presented in their paper clearly and unambiguously showed that the immune system can and often does prevent tumors from developing, and thus plays a strong protective role against cancer. (112)

“The toxic effect of garlic indirectly plays an important role in the death of cancer cells. Another key role in the prevention of cancers is garlic’s effect on the immune system. Macrophage activity, NK as well as the cytokine tumor necrosis factor (TNF), were all shown to have increased activity after administration of garlic and this resulted in an increase in antitumor response.” (71)

Garlic is known to have antitumor properties, owing to its content of a wide variety of organic sulfides and polysulfides. Garlic is reported to enhance immune function by stimulating lymphocytes and macrophages to destroy cancer cells; garlic is also reported to disrupt the metabolism of tumor cells. Various studies have shown that garlic can slow the development of bladder, skin, stomach, and colon cancers (113, 114, 115, 116). (11)

“Organosulfur compounds (OSC) from garlic can suppress proliferation of cancer cells in culture and in vivo.” (10)

“Of the many beneficial actions of garlic, inhibition of the growth of cancer is perhaps the most remarkable (76).” (10)

“Raw garlic extract was found to be the most effective and highly specific anticancer drug when compared with 33 raw vegetable extracts against different cancer cells without affecting the non-cancerous cells.” (117, 118)

“The growth rate of cancer cells is reduced by garlic, with cell cycle blockade that occurs particularly in the G2/M phase. Apoptosis is stimulated by garlic” (119) (120) (121)

Protective effects of garlic against cancer might be due to its ability to block the activation and formation of cancer-causing substances and enhance DNA repair, attenuation of ROS formation, reduction or inhibition of cell proliferation, or induction of cell death and instruction of efficient antitumor immunity (122, 123, 124, 125) (68).

“AGE (Aged Garlic Extract) would be a good chemopreventive agent for colorectal cancer because of its antiproliferative action on colorectal carcinoma cells and inhibitory activity on angiogenesis.” (76)

Numerous studies have concluded that organosulfur compounds such as DAS, DADS, and DATS act by arresting the cell cycle of cancerous cells. (126) (Diallyl sulfide (DAS), diallyl disulfide (DADS), and diallyl trisulfide (DATS) are organosulfur compounds derived from garlic.)

“Research over the years has revealed that naturally occurring OSCs (organosulfur compounds) target multiple pathways to inhibit growth of cancer cells, which include impairment of carcinogen metabolism, cell cycle arrest, induction of apoptosis, and inhibition of angiogenesis.” (126)

“Garlic has a variety of anti-tumor effects, including tumor cell growth inhibition and chemopreventive effects.” (121)

There is an ever-increasing number of studies demonstrating the effects of garlic and its various preparations & components against cancers. A brief excerpt of some relevant literature is briefly summarized below in Table 4. (10)

Table 4.
Selected studies regarding Garlic and its various preparation/components against cancers.

Functional garlic components	Cancer type and mechanisms of action	Ref.
DAS	Skin cancer; Recovers DNA strand breaks	(127)
DAS, DADS, DATS	Brain tumors; Human glioblastoma T98G and U87MG cells	(128)
DADS	Prostate cancer; Influence histone acetylation to induce apoptosis	(129)
Thiacremonone	Colon cancer; Modulating of NF-kappaB	(130)
DATS	Prostate cancer; ROS generation and regulating Bax/Bak proteins	(131)
High garlic use:; SAMC	Decreases the incidence of prostate cancer	(132)
DAS	Skin papilloma; Reduce numbers and sizes of tumors	(133)
DADS	Human nasopharyngeal carcinoma; S-phase block of the cell cycle	(134)
DATS	Prostate cancer; Apoptosis	(135)
S-allylcysteine (SAC)	Apoptosis in prostate cancer Decrease Bcl-2 and increased caspase-3	(136)
DADS	Human gastric cancer MGC803 cells	(137)
DATS	Colon cancer Induction of apoptosis	(138)
Garlic, DAS	Skin cancer, Regulation of p21/ras protein expression	(139)
DADS	Lungs carcinoma Increase of intracellular ROS	(140)
S-allyl mercaptocysteine	Colon cancer cells (Mitosis and Apoptosis	(141)
DADS	Esophagus epidermoid carcinoma Inhibition of gene expression	(142)
Allicin	Gastric epithelial cells Caspase-independent apoptotic	(143)
Aged garlic extract	Prevent early stages of colorectal cancer	(144)
Ajoene	Melanoma (Skin cancer); anti-proliferating & block the expression of α4β1 integrin	(145)
DADS	Bladder cancer; Induced apoptosis undergo caspase-3 activity	(146)
DAS	Colon cancer; Inhibition of arylamine N-acetyltransferase activity	(147)
Allylsulfide; SAC	transplantable tumors	(88)
Garlic extract	Colon cancer; enzyme modulation, and apoptosis	(148)
Ajoene	Skin tumor; suppressed skin tumor formation	(149)
SAC, SAMC	Colon cancer; antiproliferative inhibited progression at G2/M	(150)

_{From: Butt MS, Sultan MT, Butt MS, Iqbal J. Garlic: nature’s protection against physiological threats. Crit Rev Food Sci Nutr. 2009 Jun;49(6):538-51. http://wealthandhealth.ltd.uk/articles/Garlic%20Nature’s%20Protection%20Against%20Physiological%20Threats.pdf}

“Previous researches have showed allicin and its metabolites do a vital role in the killing of multiple cancers and the inhibition of the cancer progression.” (151)

“The use of garlic and garlic-based extracts has been linked to decreased incidence of cancer in epidemiological studies…The beneficial effects of garlic have been known for centuries, and our understanding of the molecular mechanisms that underlay these effects is steadily increasing. Here, we show that a homemade garlic extract has anti-cancer activities both in vitro and in vivo, and that the activity is stable for more than six months if stored in a freezer.” (152)

Garlic contains DADS (diallyl disulfide, a natural constituent of Allium sativum, garlic), which has been shown to reduce migration and invasion of human colon cancer, in part, mediated by attenuation of signaling pathways involving NF-κB, phosphatidylinositide 3-kinases, mitogen-activated protein kinases and p38 (153). These effects are consistent throughout the literature, where DADS has shown ability to inhibit growth of diverse cancer cell types such as HT-29 (154), MG-63 (155), HCT-15 (human colon tumor cells), SK MEL-2 (skin) and A549 (lung) (156). DADS can also act to suppress CCL2–CCR2 signaling, impede monocyte recruitment, and inhibit metastasis in vivo (157), a very effective therapeutic approach for treatment of human cancer (158, 159). (50)

“Garlic-derived organosulfur compounds, including allicin, ajoene, DAS, DADS, DATS, and SAMC, have been found to induce apoptosis when added to various cancer cell lines.” (160)

I believe the evidence clearly demonstrates that Garlic is the best food for cancer patients. The real question is why doesn’t every doctor recommend it?

Garlic & Cancer prevention

The U.S. National Cancer Institute initiated the Designer Food Program to determine which foods played an important role in cancer prevention (161). They concluded that garlic may be the most potent food having cancer preventive properties. (121)

Journal of The National Medical Association– “The incidence of major diseases associated with hyperlipemia, such as cancer, diabetes mellitus, and thromboembolic disorders, could be reduced with regular consumption of garlic. Hyperlipemia (High Cholesterol) is the underlying pathophysiology of the number one killer, atherosclerotic coronary artery heart disease.” (6)

“Garlic has been investigated extensively for health benefits, resulting in more than 1000 publications over the last decade alone, and it is considered one of the best disease-preventive foods, based on its potent and varied effects.” (162)

Multiple recent studies have linked garlic intake with protective effects against a range of cancers. (163, 164, 165). (152)

“The present hospital-based case-control study was carried out among Iranian women with newly diagnosed BC (Breast Cancer) in northwest Iran. To the best of our knowledge, the present investigation is the first to examine the potential effects of Allium vegetables such as onion, garlic, and leek on the risk of BC. Our main findings suggested that the consumption of garlic and leek was significantly associated with a lower risk of BC.” (163)

“Garlic intake appears to be associated with reduced risk of gastric cancer.” (164)

“Protective association between intake of raw garlic and lung cancer has been observed with a dose-response pattern, suggesting that garlic may potentially serve as a chemopreventive agent for lung cancer.” (165)

“Garlic exhibits hypolipidemic, antiplatelet, and procirculatory effects. It prevents cold and flu symptoms through immune enhancement and demonstrates anticancer and chemopreventive activities.” (162)

The chemoprotective actions of garlic are well recognized in several epidemiological studies, and it’s been convincingly demonstrated that people who regularly consume large amounts of garlic (∼20 grams or more per day) are at significantly reduced risk for colorectal, stomach, lung and esophageal cancers (17, 113, 166, 167, 168, 169, 170).

“The results of the current study suggest that raw garlic consumption is associated with reduced risk of lung cancer in a Chinese population.” (171)

“Epidemiological and animal studies have shown that consumption of garlic and its allyl sulfur compounds reduces the incidence of cancer of the stomach, colon, breast and cervix.” (172)

A prospective study of 42,000 Iowa women aged 55–69 y revealed that garlic consumption was inversely associated with cancer risk. Risk of cancer in the distal colon was 50% lower in women with the highest consumption of garlic than that of women who did not consume garlic (168). (11)

A recent population-based, case-control study conducted in Shanghai, China, examined the association between the risk of prostate cancer and the intake of Allium vegetables such as Garlic. This study concluded that men with a high intake of total Allium vegetables (>10 g/day) had a statistically significantly lower risk of prostate cancer than those with low intake (27).

“Our population-based, case–control study of the risk of prostate cancer in Chinese men identified a reduced risk associated with consumption of allium vegetables, especially garlic and scallions, that was independent of intake of other dietary items.” (173)

Scientists at the National Cancer Institute have concluded from their collaborative studies with Chinese scientists that the occurrence of stomach cancer is inversely related with the consumption of garlic, onion, and other Allium species (169). In northern China, where garlic production is high, people have the lowest mortality from stomach cancer in all of China. (11)

“Overall, evidence shows that Allium vegetables, mainly garlic and related organic allyl sulfur components, have cancer-preventive effects.” (174)

Garlic & Cardiovascular Diseases

The known health benefits of Allium vegetables and their constituents include cardiovascular protective effects, stimulation of immune function, reduction of blood glucose level, radioprotection, improvement of memory loss, protection against microbial, viral and fungal infections, as well as anticancer effects. (98)

The known medicinal benefits of garlic and other Allium vegetables and their constituents include lowering of serum cholesterol level, inhibition of platelet aggregation and increased fibrinolysis (175, 176), stimulation of immune function through activation of macrophages and induction of T-cell proliferation. (98)

Journal of The National Medical Association– “Some diseases that have been treated successfully with garlic include thromboembolic disorders, hypertension, hyperlipemia (High Cholesterol), heavy-metal toxicity, and various infections-some of the major killers of our times.” (6)

“This study using a meta-analysis demonstrated that garlic can reduce the level of TC (Total Cholesterol) and LDL (Low-Density Lipoprotein) instead of HDL (High-Density Lipoprotein) and TG (Triglyceride), indicating the ability of anti-hyperlipidemia. Thus, it is recommended that people with high blood lipids can eat more garlic.” (177)

Researchers in Kuwait found that daily ingestion of 3 g garlic for 6 months resulted in an 80% decrease in serum thromboxane B2 and a 20% decrease in coronary heart disease in middle-aged men (178). (11)

“The evidence presented in this paper supports the many beneficial health effects attributable to AGE and SAC (Aged Garlic Extract contains S-allylcysteine SAC), as they are able to reduce the risk of stroke and neurodegenerative damage.” (120).

“The wealth of scientific literature supports the proposal that garlic consumption have significant effects on lowering blood pressure, prevention of atherosclerosis, reduction of serum cholesterol and triglyceride, inhibition of platelet aggregation, and increasing fibrinolytic activity” (179) (121).

“Garlic can reduce lipid profile as well as glucose parameters and be therapeutically effective in patients suffering from cardiovascular diseases and diabetes.” (180)

“Garlic preparations may be viewed as a general heart and cardiovascular tonic with cholesterol-regulating properties and might be considered as an alternative option with a higher safety profile than conventional cholesterol-lowering medications for patients with slightly elevated cholesterol.” (181)

“Regular use of garlic can be effective in reducing the risk of heart attack and stroke because it lowers total- and LDL-cholesterol and triacylglycerol concentrations without affecting HDL-cholesterol concentrations” (181, 182) (11).

Dr. Karin Ried of The University of Adelaide and the Australian National Institute of Integrative Medicine reported that garlic supplements can reduce cholesterol in those with elevated levels by 8 per cent (183). This 8 per cent reduction is significant as it is associated with a 38 per cent decrease in the risk of coronary events for those 50 years of age and older (184, 185).

“In conclusion, garlic has the potential to improve cardiovascular health on several levels. First, there is consistent evidence that garlic supplements lower blood pressure in hypertensive individuals. Second, there is strong evidence that garlic modulates cholesterol concentrations when slightly elevated. Third, garlic has several immune system–enhancing properties that directly and indirectly benefit cardiovascular health.” (183)

“Current data confirms that garlic supplement plays positive and sustained roles in blood glucose, total cholesterol, and high/low density lipoprotein regulation in the management of T2DM (type 2 diabetes mellitus).” (186)

“The present study has demonstrated significant hypoglycemic and hypolipidemic effects of garlic when added with standard antidiabetic agent.” (187)

Journal of The National Medical Association- “The incidence of major diseases associated with hyperlipemia, such as cancer, diabetes mellitus, and thromboembolic disorders, could be reduced with regular consumption of garlic. Hyperlipemia (High Cholesterol) is the underlying pathophysiology of the number one killer, atherosclerotic coronary artery heart disease.” (6)

The ability of Garlic to lower serum cholesterol is long known (188, 189, 190, 191, 192).

A garlic component known as S-methylcysteine sulfoxide (SMCS), has been shown to reduce serum blood cholesterol AND the severity of atherosclerosis (181, 189, 190). Garlic has long been demonstrated to have protective effects against stroke, coronary thrombosis (193, 194), atherosclerosis (195), platelet aggregation (196, 197, 198, 199, 200), in addition to infections and vascular disorders (194).

“Garlic can minimize the risk of certain types of cancers and can help lower blood cholesterol levels and can reduce the tendency for blood to clot.” Dr. Robert Lin, Ph.D. (22)

“It can be concluded that administration of garlic should not be avoided; on the contrary, its intake should be as much as possible since it underlies human health.” (20)

Garlic & Hypertension

Garlic is shown to decrease platelet aggregation. This means that garlic does not allow your blood cells to easily stick together, instead allowing them to move more freely through your system.

“A total of seven randomized, placebo-controlled trials were identified. Compared with the placebo, this meta-analysis revealed a significant lowering effect of garlic on both systolic BP (Blood Pressure) (WMD: -6.71 mmHg; 95% CI: -12.44 to -0.99; P = 0.02) and diastolic BP (Blood Pressure) (WMD: -4.79 mmHg; 95% CI: -6.60 to -2.99; P < 0.00001)… The present review suggests that garlic is an effective and safe approach for hypertension.” (201)

“Garlic appears to have the largest impact on resting blood pressure. The meta-analyses available report average reductions in SBP e with from 6 to 8 mmHg and DBP from 4 to 7 mmHg, at a dosage of 300-600 mg/d.” (202)

Journal of The National Medical Association- “Some diseases that have been treated successfully with garlic include thromboembolic disorders, hypertension, hyperlipemia, heavy-metal toxicity, and various infections-some of the major killers of our times.” (6)

Garlic & Atherosclerosis

This study involved 55 patients, aged 40 to 75 years, who had been diagnosed with metabolic syndrome. Following evaluation, the participants were given either a placebo or a dose of 2,400 milligrams of Aged Garlic Extract every day. In the end, researchers found those who took the Aged Garlic Extract had slowed total plaque accumulation by 80%, reduced soft plaque and demonstrated regression. (203)

“The current study demonstrates that aged garlic extract supplemented with vitamins B6 and B12, folic acid and L-arginine was associated with not only decreased CAC (Coronary Artery Calcium) progression but also with concomitant improvement in vascular function following 1 year of treatment of asymptomatic intermediate risk patients.” (204)

“Aged garlic extract with supplement (AGE-S) significantly reduces coronary artery calcium (CAC).” (205)

“Despite the small study size, patients given AGE (Aged Garlic Extract) demonstrated a significant slowing of the accumulation of coronary artery calcification during this randomized, placebo-controlled trial.” (206)

“These experiments clearly proved that garlic extract strongly inhibits Ca2+ binding to HS-PG. In consequence, the formation of the ternary HS-PG/LDL/Ca2+ complex, initially responsible for the ‘nanoplaque’ composition and ultimately for the arteriosclerotic plaque generation, is decisively blunted.” (207)

“Continuous intake of high-dose garlic powder dragées reduced significantly the increase in arteriosclerotic plaque volume by 5–18% or even effected a slight regression within the observational period of 48 months…These results substantiated that not only a preventive but possibly also a curative role in arteriosclerosis therapy (plaque regression) may be ascribed to garlic remedies.” (208)

From The World Health Organization website

“Most research findings support the proposal that garlic consumption has a significant protective effect against atherosclerosis.” (209)

“Garlic preparations have revealed promising effects for many health conditions, including hyperlipidemia, hypertension, obesity, atherosclerosis, cancer, diabetes, ulcers and even infection.” (210)

Garlic and Type-2 Diabetes

A meta-analysis was performed on 768 patients with type 2 diabetes mellitus in nine randomized controlled trials. The result showed that garlic supplementation significantly reduced fructosamine and glycosylated hemoglobin. This study demonstrated that garlic supplements were effective in the management of type 2 diabetes mellitus.

“The present study has demonstrated significant hypoglycemic and hypolipidemic effects of garlic when added with standard antidiabetic agent.” (187)

“Garlic can reduce lipid profile as well as glucose parameters and be therapeutically effective in patients suffering from cardiovascular diseases and diabetes.” (180)

Journal of The National Medical Association- “The incidence of major diseases associated with hyperlipemia, such as cancer, diabetes mellitus, and thromboembolic disorders, could be reduced with regular consumption of garlic.” (6)

Garlic Protects against clotting

“These results show that garlic and onion can be taken frequently in low doses without any side effects, and can still produce a significant antithrombotic effect.” (211)

“Aqueous extracts of onion, garlic and ginger inhibited platelet aggregation induced by several aggregation agents, including arachidonate (AA), in a dose-dependent manner.” (212)

Garlic Antibacterial properties

“Garlic has the broadest spectrum of any antimicrobial substance that we know of — it is antibacterial, antifungal, antiparasitic, antiprotozoan and antiviral.” (213)

Laboratory investigations show that garlic juice diluted to one part in 125,000 inhibits the growth of bacteria of the genera Staphylacoccus, Streptococcus, Vibrio (including V.cholerae) and Bacillus (including B. typhosus, B. dysenteriae and B. enteritidis) (12).

“The antimicrobial activity of garlic is attributed to allicin activity that was reported toward a wide variety of microorganisms including antibiotic-resistant, Gram-positive and Gram-negative bacteria such as Shigella, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus mutans, S. faecalis, S. pyogenes, Salmonella enterica, Klebsiella aerogenes, Vibrio, Mycobacteria, Proteus vulgaris, and Enterococcus faecalis.” (117)

The wound healing properties of garlic were used by soldiers during World War II. The spread of infections were inhibited by garlic paste being applied directly to wounds. (23)

“In the late war it was widely employed for the control of suppuration of wounds. It was externally applied in ointments and lotions, and as an antiseptic, to disperse hard swellings, also pounded and employed as a poultice for scrofulous sores.” (24)

Garlic & Detoxification

“It has been shown that garlic and its major components can ameliorate the toxicity of different agents in brain, kidney, blood, liver, embryo, spleen, pancreas, heart, reproductive system in part through radical scavenging, antioxidant effect, reducing lipid peroxidation, anti‐inflammatory, chelating agent, cytoprotective activities, increase protein synthesis in damaged tissues, suppressing apoptosis, modulation of p53, phosphoinositide 3‐kinase, Akt, nuclear factor (erythroid‐derived 2)‐like 2, antioxidant responsive element, p38 MAPK, inducible nitric oxide synthase, cyclooxygenase‐2, cytosolic phospholipases A2, cleaved‐caspase‐9, cleaved‐caspase‐3 Bcl‐2, Bcl‐2‐associated X, peroxisome proliferator‐activated receptor gamma, NF‐jB, nuclear factor‐kappaB signaling pathways and cytochrome P450 enzymes.” (214)

“Garlic has been shown to be effective in the treatment of lead, mercury, cadmium, and arsenic poisoning.” (6)

Journal of The National Medical Association– “Some diseases that have been treated successfully with garlic include thromboembolic disorders, hypertension, hyperlipemia, heavy-metal toxicity, and various infections-some of the major killers of our times.” (6)

How can one substance do so many things?

The same doctor criticized me for recommending one plant for various disorders claiming that such a thing is foolish. How can one substance do so many things? What about Aspirin?

Aspirin is such a substance (which came from a plant!). In addition to its pain relieving and anti-arthritic effects, aspirin exhibits many other pharmacological effects including blood thinning, reduction of platelet aggregation, prevention of preeclampsia (an hypertensive disorder during pregnancy), and anticancer effects. (126)

Let’s look at the history of Aspirin. The ancient Egyptians used willow bark as a remedy for aches and pains. Hippocrates, the Greek physician and father of modern medicine wrote that willow leaves and bark relieved pain and fevers. It wasn’t until thousands of years later that people began to isolate the key ingredients of aspirin. An 18th-century clergyman, Edward Stone, rediscovered aspirin when he wrote a report of how a preparation of powdered willow bark seemed to benefit 50 patients with ague and other maladies. (215) The active ingredient of willow bark, salicylic acid, was first isolated by Johann Andreas Buchner in 1827 and 2 years later French Pharmacist Henri Leroux managed to obtain about 30 g of purified salicin from 1.5 kg of bark. (216, 217)

In 1897, chemists from Bayer produced a stable acetylated salicylate from salicylic acid derived from the meadowsweet plant rather than willow bark. The compound named aspirin was a contraction of the two words acetyl and Spirsäure—or salicylic acid. Aspirin was marketed by Bayer and enjoyed enormous success in the early nineteenth century for the treatment of pain, rheumatic fever and inflammatory diseases such as rheumatoid arthritis (217) even though the mechanisms by which it worked were virtually unknown. In other words, they didn’t know why it worked, it just did. It enjoyed tremendous success and became a critical part of clinical practice because of testimonials, not because of the knowledge of the scientific mechanisms involved, which weren’t well known until over 70 years later!

There’s MORE about Garlic!

Methicillin Resistant Staphylococcus Aureus (20,000 U.S. deaths per year, est.)

“Garlic, well known for its natural antibiotic properties, contains an ingredient that has been shown to effectively kill methicillin-resistant Staphylococcus aureus (MRSA), a virulent microbe that wreaks havoc in skin and soft-tissue wounds, several studies have shown.” –Chicago Tribune (218)

“These data suggest that these agents could provide anti-bacterial, anti-inflammatory, anti-coagulant and anti-oxidative functions against MRSA infection in diabetic individuals.” (219)

“The present study demonstrated that liquid and cream formulations containing allicin are active against S. aureus, including MRSA strains, showing both high and low levels of resistance to mupirocin.” (220)

“Garlic is a powerful antifungal, and, if you combine it with other thrush home remedies, it will likely cure your infection. Make sure you consult your doctor as soon as you notice the first symptoms, and stick to the prescribed treatment plan. This way, you’ll get rid of your infection quick and painlessly.”- Thrush Treatment Center (221)

Candidiasis in the mouth also known as thrush or oropharyngeal candidiasis

“These data demonstrate activity of FGE (Fresh Garlic Extract) against C. albicans in its planktonic, adherent, and sessile phases.” (222)

“The ubiquitous opportunistic pathogen C. albicans is sensitive to garlic; resistance to the broad spectrum of active principles present is unlikely so that its anticandidal effects may provide an important alternative route to chemotherapy…The antimicrobial properties of garlic can be exploited as an effective alternative to those of more common pharmaceutical preparations. A broad range of effects, in particular the observed antifungal properties, is now being investigated.” (223)

“These results further confirm that some garlic components possess significant anticandidal properties and that AA (Allyl Alcohol), a metabolic breakdown product of allicin, plays a major role in the inhibition of growth of C. albicans.” (224)

“In a randomized trial of 56 patients, topical application of garlic paste for 14 days was found to be as effective as that of clotrimazole solution in suppressing clinical signs of oral candidiasis.” (225)

Denture stomatitis (DS) is the most common form of chronic oral candidiasis.

“Considering the efficacy of garlic and lack of side effects for this compound and also regarding the nystatin-associated complications, garlic extract can be introduced as a substitution for standard treatment in DS (Denture Stomatitis).” (226)

Garlic was also reported to exhibit antifungal effects on two other species, the air-borne pathogen Botrytis cinerea and Trichoderma harzianum (24).

Pseudomonas Aerigonosima (2,700 U.S. deaths per year, est.)

“Oral treatment with garlic significantly lowered renal bacterial counts…” (227)

“Garlic juice had significant activity, with bactericidal action in dilutions ranging up to 1:128 of the original juice.” (228)

“The garlic treatment initially provoked a higher degree of inflammation, and significantly improved clearing of the infecting bacteria.” (229)

This study demonstrated how diallyl disulfide (DADS) from garlic oil can inhibit Pseudomonas aeruginosa. “Based on RNA and proteome high-throughput sequencing analysis, following DADS treatment, all key genes of the three QS systems (las, rhl, and pqs) of P. aeruginosa PAO1 were inhibited and thus the virulence factors (including exoprotease LasA, elastase LasB, pyocyanin biosynthesis, and biofilm formation) regulated by these three QS systems were also inhibited.” (230)

Cytomegalovirus Infections

“Clinical use of GE (Garlic Extract) against HCMV infection should be persistent and the prophylactic use of GE is preferable in immunocompromised patients.” (231)

“Allitridin (diallyl trisulfide), a main effective compound of Allium sativum (garlic), was previously shown to inhibit the expression of immediate-early antigens and viral proliferation of human cytomegalovirus (HCMV) in vitro.” (232)

“Allitridin (the main effective compound of garlic) can inhibit HCMV, IEA (Immediate Early Antigens) expression in vitro remarkably which is probably one of the major mechanisms of Allitridin anti-HCMV activity.” (233)

“This study indicated that allitridin (the main effective compound of garlic) has anti-HCMV activity and the mechanism is associated with suppression of ie (immediate early) gene transcription.” (234)

The amazing pharmacologic versatility of garlic is best reflected by its antiviral, antifungal, antiprotozoan, antiparasitic, and antibacterial activity. (6)

Mycotoxin-associated aflatoxicosis

“Garlic extract was found to be the most effective in the prevention of aflatoxin-induced toxicity and free radical generation in rats.” (235)

“These results indicate the usefulness of antioxidant food additives in ameliorating aflatoxin-induced mutagenicity and carcinogenicity.” (236)

“Dietary spices can be used to effectively control the level of AFB1 in food preparations…Among the studied spices, garlic showed the maximum (61.7%) degradation of AFB1 (aflatoxin B1).” (237)

“Aflatoxicosis is a disease generated as the consequence of aflatoxin contamination in foods and feeds. Garlic (Allium sativum Linn.), is a natural spice known to reduce the toxicity of aflatoxins in poultry.” (238)

“AGE (Aged Garlic Extract) may offer a natural source of antifungal agent against A. flavus. Its medicinal value is comparable to the present day antibiotics…AGE appears to have clinical and public health importance.” (239)

Helicobacter Pylori infection

“Our study, supports the hypothesis derived from in vitro studies that Allicin can be used in HP eradication.” (240)

“Raw garlic has anti-bacterial effects against H. pylori residing in the stomach and may be prescribed along with routine drugs for the treatment of gastric H. pylori infection.” (241)

“We have demonstrated in vitro that H. pylori is susceptible to garlic extract at a fairly moderate concentration. Even some antibiotic-resistant H. pylori strains are susceptible to garlic. Clinical trials are necessary to explore the possibility of using garlic as a low-cost remedy for eradicating H. pylori.” (242)

“In this study, ﬁve isolates of H. pylori were resistant to more than one antibiotic, but they were inhibited very well with the garlic juice…The antibacterial eﬀect of aqueous extract of garlic on all H. pylori clinical isolates was conﬁrmed.” (243)

Candida infection

“In this study, allicin, an allyl sulphur compound from garlic, was shown to enhance significantly the effect of AmB (Amphotericin B) against Candida albicans in vitro and in vivo.” (244)

“Garlic’s antifungal, antibiotic and perhaps anticancer effects are well-accepted world over because of the many scientific literature supporting these effects.” (71)

“Some of the breakdown products of allicin, the main parent antifungal compound in garlic, have been investigated for their general antimicrobial, anticancer and anticholesterol properties, and it appears that there is a common mode of action that underlies these activities. It appears that these small molecules have the ability to cross cell membranes and combine with sulfur-containing molecular groups in amino acids and proteins, thus interfering with cell metabolism. It has been suggested that the reason human cells are not poisoned by allicin derivatives is that they contain glutathione, a sulfur-containing amino acid that combines with the allicin derivative, thus preventing cell damage. In addition to their biochemical mechanism, these derivatives appear to stimulate cellular immunity, an important ability lacking in conventional antifungal chemotherapy. These derivatives appear to be safe, cheap, wide-spectrum and immunostimulatory, as well as possibly synergistic with conventional antifungal therapy, making them ideal candidates for investigation into their use as prophylactic antifungal agents.” (245)

“The antimicrobial effects of aqueous garlic extract (AGE) against 133 multidrug-resistant gram-positive and gram-negative bacterial isolates, including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Salmonella typhi, Pseudomonas aeruginosa, Escherichia coli, Shigella spp., and Proteus spp., and against 10 Candida spp. were studied…The results of this study support the use of garlic in health products and herbal remedies in Nigeria.” (246)

“Allicin and garlic extract as natural products can be used for medical purposes due to their antifungal activity and availability.” (247)

“Randomized clinical trials utilizing a variety of commercial garlic preparations revealed a prophylactic effect of garlic in the prevention and treatment of a number of viral infections in human including the common cold and flu, viral induced hepatitis and warts.” (21)

“The antiviral activity of garlic has long been intimated by habitual consumers of garlic who rarely have colds or become victims of influenza epidemics.” (6)

Klebseilla infection

“Garlic (Allium sativum) and ginger (Zingiber officinale) used in the present study were purchased from the local market of Lahore, Pakistan…garlic aqueous extract exhibited highest antibacterial activity against all tested bacteria.” (248)

“Garlic has been confirmed to be effective against gram-positive, gram-negative, and acid-fast bacteria including Salmonella, Escherichia coli, Pseudomonas, Proteus, Staphylococcus aureus, Klebsiella, Micrococcus, Bacillus subtilis, Clostridium, Mycobacterium, and Helicobacter.” (249)

“Use of garlic as a herbal medicine, and its antibiotic use, can be effective in reducing infections and decreasing antibiotic resistance in the community.” (249)

“Considering the results, FGE (Fresh Garlic Extract) demonstrated a unique antibacterial activity against clinical pathogenic bacteria; either in the planktonic or biofilm forms; in both in-vitro and in-vivo models without observed toxic effects. This supports its potential use as a prophylactic and/or therapeutic lock agent against biofilm-associated infections caused by MDR bacteria.” (250)

“The extensive research strongly indicates that garlic organosulfur compounds exhibit strong antibacterial activity against a wide range of bacteria including MDR strains…The organosulfur compounds have the potential to make a huge impact on human health by decreasing the mortality associated with bacterial infections.” (251)

“Garlic juice had significant activity, with bactericidal action in dilutions ranging up to 1:128 of the original juice.” (228)

Vibrio infection

“To our knowledge, this study is the first to show the success in using plants or plant products to inhibit and kill pathogenic v. (Vibrio) cholerae in a food model.” (252)

“The garlic extracts showed antibacterial activity against all the V. cholerae strains tested, irrespective of their origin, multidrug resistance and virulence…Thus, the Garlic extract harnesses the potential to control infection of multidrug resistant V. cholerae, especially in outbreak like situations in remote and underdeveloped areas where drug supply itself is a challenge.” (253)

“The virulence of vibrio parahaemolyticus is initially attributed to the production of a thermostable direct hemolysin (TDH)…Garlic essential oil showed to be effective against bacterial growth and production of TDH toxin. Its potential application in food systems may be suggested.” (254)

“The antibacterial activities of GO (Garlic Oil) and GO sulfides were substantial against several pathogenic species, some of which are significant causes of food poisoning, so that further exploration of the potential of GO in enteric disease control is warranted.” (255)

“The results indicated that Lawsonia inermis, Saraca indica, Syzygium cumini, Terminalia belerica, Allium sativum, and Datura stramonium served as broad-spectrum vibriocidal agents.” (256)

Cryptosporidium

This human trial conducted in China revealed the efficacy of garlic preparation in controlling Cryptosporidium parvum diarrhea in AIDS patients with weakened immune systems.

“Because of the lack of effective current therapies for Crypto-sporidium parvum diarrhea, the use of high-dose garlic concentrates appears to be a feasible therapeutic regimen to consider for HIV+ patients with CD4 counts less than 100.” (257)

Mycobacterium Tuberculosis

[23] “This study demonstrated that the garlic extract has showed its effectiveness against clinical isolates of MDR M. tuberculosis. It is worthwhile to utilize garlic as natural supplement with other standard ATT (Anti-Tubercular Treatment).” (258)

From 1946- “Garlic is one of the well-known remedies for tuberculosis, according to the indigenous Ayurvedic and Unani systems of medicine.” (259)

“In this study we were able to confirm their quantitative determination of the concentration required to inhibit M. tuberculosis and to establish evidence of the inhibitory nature of garlic extract on 16 other species of mycobacteria.” (260)

Group B Streptococcus Infection

“Garlic kills GBS (Group B Streptococcus), but because no profit can be made from its use, no research exists on the use of garlic to prevent GBS in newborns.” (261)

“Aqueous allicin is bactericidal against GBS isolates and maintains activity in a novel gel formulation.” (262)

“Eight patients with confirmed symptomatic vaginal GBS of 6 months to 4 years duration, not resolved by course(s) of oral antibiotics, presented to our practice over 4 year period…The women all successfully resolved the symptoms by using half a freshly cut clove of garlic inserted vaginally at night and removed in the morning, for 3 to 6 weeks followed by maintenance doses of once every 2-4 days.” (263)

Beneficially decreases brown adipose tissue, increases white adipose tissue around heart muscle.

“AGE-S (Aged garlic extract with supplement) is associated with increase in bEAT/wEAT (brown Epicardial Adipose Tissue/white Epicardial Adipose Tissue) ratio, reduction of homocysteine and lack of progression of CAC (Coronary Artery Calcium).” (205)

“This study shows that AGE+S (Aged garlic extract with supplements) is associated with favorable effects on reducing the progression rate of adipose tissue volumes.” (264)

ICU Patients

“Based on the results of our study, in people with weakened immune systems and in people with high incidence of opportunistic infections, it is necessary to strengthen their body’s immune system stimulants before dealing with these infectious agents, and to cause decrease in the diseases in the susceptible people. It was suggested that garlic supplementation has shown to be effective in patients admitted to intensive care units and those who are highly susceptible to nosocomial infection, and it can be used for the prevention of septicemia and urinary tract infections.” (249)

This is by no means a comprehensive overview of the mountain of studies showing the benefits of garlic and there are numerous areas I didn’t touch upon at all. I believe that Garlic is one of the most amazing foods ever created and this opinion is clearly supported by the peer-reviewed science. The next time someone wants to give advice to you because they claim to be a “real doctor”, just ask them to show you the science. If they can’t, are they really an “expert”? If recommending a superfood such a garlic with over 8,000 study abstracts to support it is, “The worst “doctor” advice in the Philippines”, then please tell me what food is better for a cancer patient than garlic and please provide peer-reviewed evidence to support your claim. I’m willing to learn.

To your health,

Dr. Farrah

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