ASK DR. BAUGHAN                                                  August 1, 1998

MAMA MIA, SAY IT AIN’T SO

It is a periodic, but inevitable, discouraging aspect of medicine to have a fondly held health belief shot down, or at least wounded.  Does garlic help lower cholesterol?  I liked to think so.  There have been a few studies that suggested it might.  It helped me rationalize garlic-breath in the afternoon when I ate pasta for lunch.

But alas, in the June 17, 1998 issue of the Journal of the American Medical Association comes a report from the Department of Clinical Pharmacology at the University of Bonn in Germany.  No Italian would dare do such a study.  In their lipid research clinic, they had 25 patients with high cholesterol levels take 5mg of a garlic preparation twice a day for 12 weeks.  This is roughly equal to eating 4-5 gm of fresh garlic cloves per day.  They noted no change in cholesterol blood levels, cholesterol absorption, or cholesterol production in the body. 

They used a steam-distilled commercially available garlic-oil preparation after reviewing other studies done with garlic and finding that those that claimed the best results usually used an oil preparation instead of powdered garlic source.  The dose was actually higher than other studies that had claimed benefit with the equivalent of 1.8 to 2.7 gm per day of fresh garlic.  So it seemed they genuinely tried to give garlic a fair chance to do its stuff.  Although the number of patients involved was small, they were studied thoroughly enough and long enough that some positive effect should have been found if it were consistently potent.

So is the “garlic is good for your heart” theory dead, or just wounded?  Wounded, I would say.  This cannot be considered the ultimate study for all people.  Are there individual and ethnic differences in garlic and cholesterol metabolism?  Possibly.  Is there any evidence of harm in trying garlic?  None other than the smell.  Like oatmeal, it may work for some people, but not consistently.  Might it have some other beneficial effect on the heart, unrelated to cholesterol?  Maybe.  This study did not attempt to address those questions?

At a recent conference devoted to heart disease risk modification, much of the conference was devoted to cholesterol reduction, with some attention to controlling hypertension and stopping smoking.  When I specifically asked the panel of speakers, they all acknowledged that there was abundant evidence that psychosocial distress (depression, unhappy relationships, unrewarding jobs, other significant stresses) was far more significant in determining the outcome of someone with heart disease than cholesterol or the other “physical” factors.  What we do not yet know is whether intervening or changing those factors can improve outcomes in the same way that lowering cholesterol, blood pressure and stopping smoking can. We still have much to learn in how the different factors interplay to affect our hearts.  In the meantime, enjoy garlic for garlic’s sake.  The best thing for our hearts may be to enjoy life to the fullest, and how can you fully enjoy life without garlic?