Traditionally garlic has been used for a wide range of conditions, e.g., the common cold and other infections. Today, the main indication for garlic is hypercholesterolemia. A recent meta-analysis (9) included 13 placebo-controlled, double-blind RCTs with a total of 806 patients with hypercholesterolemia. The methodological quality of these studies was good (Jadad score 3-5). The results of the meta-analysis demonstrated a weighted mean difference of —15.7 mg/dL (95% CI = —25.6 to —5.7). For the most rigorous RCTs, the effect size was only —9.4 mg/dL and not any longer statistically significant. Our overall conclusion therefore was ''garlic is superior to placebo.. .but the effect is modest and of debatable clinical relevance'' (9).
No systematic review of the safety of garlic is currently available. The most frequent adverse effects are mild and transient; they include body odor, allergic reactions, nausea, heartburn, and flatulence. Garlic has antiplatelet activity and can therefore increase the effect of anticoagulants, which, in rare cases, has been associated with bleeding. For the same reason, it seems prudent to discontinue garlic medication several days before major surgery (7).
Despite the relatively small effect on total cholesterol the benefits of garlic may well outweigh its risk. This is true particularly because garlic has a range of further beneficial actions on the cardiovascular system, including effects on blood pressure, coagulation factors, and arterial compliance (7).
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