Allium sativum L.

Last updated: 8 September 2016

Scientific Name

Allium sativum L.

Synonyms

Allium arenarium Sadler ex Rchb. [Invalid], Allium controversum Schrad. ex Willd., Allium longicuspis Regel, Allium ophioscorodon Link, Allium pekinense Prokh., Porrum ophioscorodon (Link) Rchb., Porrum sativum (L.) Rchb. [Illegitimate] [1]

Vernacular Name          

Malaysia Bawang putih [2], bawang china, bawang puteh [3]
English Garlic [2], cultivated garlic [3]
China Da suan, Hsiao suan, suan [3]
India Acanam, acanapanni, acunan, arishtha, arittam, attankal, awqariyo, belluli, cavukkiriya, chanam, corutca, cunam, diete, dirghapatraka, eripuntu, foam, gohari lusoon, grinjana, hana, ilacunam, irecan, jawari gadde, kalinkam, kayam, lacunam, lahsan, maha-ushadha, mileccakantakam, naharu, poondu, purunvar, raconakam, saum, tellagadda, ukkirakantam, vacikaram, venkaveli, yavaneshta, et al. [3]
Indonesia Bawang putih, bawang bodas (Sundanese) [2]; lasun putih [3]
Thailand Krathiam (General); hom-tiam (Northern) [2]
Laos Kath'ièm [2]
Philippines Bawang (Tagalog, Ilocano); ajos (Bisaya); ahus (Ibanag) [2]
Cambodia Khtüm sââ [2]
Vietnam Dai toan, hom kia, sluon, toi, t[or]I [3]
Tibet Sgog gcig, sgog skya, sgog-skyam [3]
Papua New Guinea Galik (Pidgin) [2]
Tanzania Kitunguu saumu, somu, thumu [3]
France Ail [2]

Geographical Distributions

Allium sativum probably originated from central Asia (Tien Shan), but nowhere truly wild; cultivated all over the world at latitudes of between 5-50 in both hemispheres. [2]

Botanical Description

A. sativum is a member of the Amaryllidaceae family. It is an erect herb, usually grown as an annual and up to 150 cm tall. The bulb is composed of (1-)4-15 lateral bulbs (cloves) and measures up to 7 cm in diametre. [2]

There are 4-10 leaves while the blades are flat or V-shaped in transverse section. [2]

The herb has one solid inflorescence stalk, and the inflorescence is composed solely of bulbils or of bulbils and flowers. The flowers are often rudimentary or absent, and with greenish-pink to purplish tepals. The stamens and style are shorter than tepals. [2]

The fruit is abortive and seedless. [2]

Cultivation

A. sativum prefers a slightly lower temperatures and a day length of at least 13 hours and it can be grown up to 2200 m altitude. It is grown during the dry season as too much rain will result in a high incidence of fungal diseases. It requires well-drained soils. [2]

Chemical Constituent

A. sativum has been reported to contain primarily sulfur containing compounds (e.g. alliin, diallylsulfides, S-allyl-cysteine, and ajoenes), enzymes (e.g. alliinase), glucosinolates, vitamin A, vitamin B, and vitamin C. [4][5]

Plant Part Used

Bulb [6]

Traditional Use

A. sativum or garlic has been traditionally used for flatulence. It also has been used internally as part of the mixture with other herbs for women after childbirth, treating various intestinal problems, diarrhoea, purge, vomiting, stomach pain, chronic colonic obstruction, improving appetite, correcting effects of gluttony, gastric stimulant, coughs, headaches, gouty pains, congestion of the liver, and various female complaints. Externally, it is used together with other herbs as a rubefacient and for orchitis. The pounded A. sativum used as a poultice for wounds and stings from scorpions and centipedes. It has been reported that garlic can be used for skin problems, to stimulate skin and prescibed for asthma. [6]

Preclinical Data

Pharmacology

Antimicrobial activity

Allicin and alliin from A. sativum  are reported to have anti-infective effects against bacteria and fungi [7][8][9]. Italso has been reported to exhibit antigiardial activity in vitro. [10]

A. sativum  has been reported in laboratory studies to inhibit Helicobacter pylori, a causative agent in peptic ulceration [11][12]. Research has reported that the enzyme allinase may be irreversibly inhibited by stomach acid and may fail to form adequate amounts of allicin or other thiosulfinates below pH 3.6. Recommending a quality garlic supplement is essential, and enteric coating may be advantageous [13][14].

Hepatoprotective activity

An aged A. sativum  product has been reported to have hepatoprotective properties [15]. It is suggested that the hepatoprotective effects of the garlic product are due primarily to the reduced glutathione-sparing properties of its constituents, most probably its organosulphur compounds. Diallyl sulfide compounds extracted from A. sativum  were reported useful in combination with doxorubicin to protect the liver from oxidative injuries due to the chemotherapy drug and to improve the clinical efficacy of doxorubicin [16]. The diallyl disulfides in garlic was reported to increase tissue activities of the phase II detoxification enzymes quinone reductase and glutathione transferase in laboratory animals [17]. Also, S-allylmercaptocysteine (SAMC), one of the water-soluble organosulfur compounds in ethanol extracts of garlic was reported to protect laboratory animals against acetaminophen-induced liver injury [18].  Another laboratory animal study reported that the use of a A. sativum  extract in chemical induced hepatocarcinogenesis significantly reduced the number and area of positive foci compared with placebo, suggesting strong supportive evidence for the anticarcinogenic activity of garlic [19]. Of further note, as reported in a few laboratory animal studies, there is the potential for very large amounts of allicin to damage liver tissue if absorbed [20][21].

Antihypertensive activity

A. sativum  use has been reported to be beneficial in hypertension in laboratory animals [22][23]. Studies have reported that garlic’s ability to lower blood pressure may in part be due to the decreased production of nitric oxide by the activation of inducible nitric oxide synthase [27]. However, a laboratory animal data has reported that pulmonary vasodilator responses to allicin are independent of the synthesis of nitric oxide, ATP-sensitive K+ channels, activation of cyclo-oxygenase enzyme, or changes in bronchomotor tone in the pulmonary vascular bed [26]. Other methods attributing to A. sativum ’s hypotensive qualities may include its anti-thrombotic activity [27].

Anticancer activity

A. sativum  and its components have been reported active against various cancers in vitro, including cancerous cell lines from the human bladder [28], certain hepatic cells lines [29], some breast cancer cell lines [30][31], prostate [32], and some colorectal and stomach cancers [33][34][35] among others.

The organosulfur components originating from garlic are reported to be responsible for the immune modulation [36]. Organosulfur compounds have been found in laboratory studies to inhibit carcinogen activation, boost phase 2 detoxifying processes, cause cell cycle arrest mostly in G2/M phase, stimulate the mitochondrial apoptotic pathway and increase acetylation of histones. A. sativum  -derived sulfur compounds influence also gap-junctional intercellular communication and participate in the development of multidrug resistance [37]

Antidiabetic activity

A. sativum  supplements have been used for centuries for blood sugar regulation. Laboratory and clinical studies support the use of A. sativum  in blood sugar regulation, including aged garlic and timed release supplements. Evidence suggests that A. sativum antioxidative, anti-inflammatory, and antiglycative properties are responsible for its role in preventing diabetes progression and the development of diabetes-related complications. [38]

An in vitro study found that aged A. sativum  inhibits formation of advanced glycation endproducts (AGEs), potentially decreasing AGEs associated diabetic complications. [39]

Toxicity

No toxicity is reported in recommended dosages [40]. It is recommended that very large doses of A. sativum  not be ingested over a long period of time [41].

Clinical Data

Clinical findings

Antimicrobial activity

A small clinical study found A. sativum  oil to be effective in treating dyspeptic patients with H. pylori infection [42]. A study reported no activity against H. pylori, but freshly chopped A. sativum  was used in the study, which can destroy necessary enzymes unless preserved appropriately [43].

Cardiovascular study

The benefits of A. sativum  on the cardiovascular system are one of the main reasons this supplement is so popular around the world. A. sativum  has been reported to lower total cholesterol, LDL cholesterol and triglycerides, and increases HDL cholesterol in laboratory studies and human trials, although results have been controversial. [44][45][46][47][48]

A. sativum  may be of benefit in the prevention of heart disease and atherosclerosis [49][50]. A. sativum  has been reported to  inhibit platelet aggregation and influence blood viscosity through its fibrinolytic activity [51][52][53][54]. This activity leads to the use of A. sativum  in the supportive treatment of cardiovascular disease (CVD) and CVD risk factors [55][56][57].  A human study of 13 normolipidemic patients reported that aged A. sativum  extract significantly inhibited both the total percentage and initial rate of platelet aggregation [58].

A comprehensive meta-analysis in 2001 assessed the impact of A. sativum  supplementation on cardiovascular risk factors. 45 randomized trials and 73 additional studies reporting adverse events were identified and assessed. Trials evaluating lipid outcomes were adjusted for any differences that existed in baseline characteristics. Compared with placebo, the effect on total cholesterol, low-density lipoprotein levels, and triglyceride levels of garlic preparations may lead to small improvements at 1 and 3 months. When evaluated at 6 months no improvements were noted. Also the evaluators noted no statistically significant changes in high-density lipoproteins. Significant reductions in platelet aggregation were reported, the effects on blood pressure outcomes were "mixed" and concerning glycemic-related outcomes, no effects were noted. However, the clinical significance of the trials evaluated was limited by the quality of the studies, the short duration of the studies and the lack of information regarding the garlic preparations used in the studies. [59]

Antihypercholestromia activity

A meta-analysis of randomized, double-blind, placebo-controlled trials of A. sativum utility in hypercholestrolemia was reported in 2000. In the 13 trials included in the report, the garlic supplements reduced total cholesterol level from the baseline significantly more than placebo, with a conclusion that the available data suggests that A. sativum  is superior to placebo in reducing total cholesterol levels. It was concluded, however, that the size of the effect is modest, and the robustness of the effect is debatable, and the use of garlic for hypercholesterolemia may be of questionable value. [60]

Reports of A. sativum  products having no effect on serum lipids has been seen in various studies, and remains a controversial issue [61][62][63][64][65]. Another analysis in 2009 Looked at MEDLINE, CINAHL and the Cochrane Database from the earliest published date through to November 2007 in order to identify randomized, placebo-controlled trials of A. sativum  that reported effects on total cholesterol (TC), triglyceride (TG) concentrations, LDL or HDL. 29 trials were included garlic was found to significantly reduce TC and TG but exhibited no significant effect on LDL or HDL. It was concluded that future studies should be conducted evaluating the impact of adjunctive A. sativum  therapy with fibrates or statins on TG concentrations. [66]

Several studies used A. sativum  oil to treat hypercholesterolemia, which is processed by heating to extreme temperatures. Changes can occur in the active constituents when exposed to cooking or other processing which can render the garlic product virtually ineffective [67]. Cooking is known to denature proteins and, therefore, may inactivate the enzyme (allinase) that is necessary in converting alliin into allicin, the major bio-active constituent in garlic. Powdered A. sativum  supplements can lose bioactivity due to organosulfur compounds and not be effective [68]. It is imperative to use standardized supplements, including timed release, enteric coated and aged garlic. Aged garlic extracts (AGE) have laboratory and human studies that have antioxidant activity by increasing superoxide dismutase, catalase, glutathione peroxidase, and glutathione levels, and inhibiting lipid peroxidation and inflammatory prostaglandins. AGE has been reported to have cardiovascular benefits by reducing cholesterol synthesis through ihibition of 3-hydroxy-3-methylglutaryl-CoA reductase (may have an additive effect with statins in its action,), inhibition of cholesterol, LDL oxidation, and platelet aggregation, inhibition of arterial plaque formation, decreasing homocysteine, lowering blood pressure, and increasing microcirculation, also important in diabetes related complications. AGE also may help prevent cognitive decline by protecting neurons from Abeta neurotoxicity and apoptosis, thereby preventing ischemia- or reperfusion-related neuronal death and improving learning and memory retention. More studies in humans are warranted [69].

Antihypertensive activity

A. sativum  use has been reported to be beneficial in hypertension in human subjects [70]. A meta-analysis in 1994 found that garlic supplements were clinically useful in treating mild hypertension, although the authors stated that further research should be performed in this area [71]. A 2008 systematic review and meta-analysis of randomized controlled trials reviewed the literature of using garlic for hypertension [72]. The conclusion of the analysis was that A. sativum  was superior to placebo in reducing systolic and diastolic blood pressure. A recent study reported that individuals whose blood pressures are on the lower side are more likely to consume more A. sativum  in their diets [73]

Several clinical studies out of Russia using a timed-released product found positive effects of A. sativum  on hypertension (both systolic and diastolic and to lower total cholesterol levels and also raise HDL. [74][75]

Immune support and anticancer

A. sativum  has been found to improve immunity in both laboratory and clinical studies. Aged A. sativum  has been reported in a clinical study to improve immunity of patients with advanced cancer (including colorectal, liver and pancreatic) by improving NK cell numbers and activity, thereby helping to improve the quality of life in these patients [76]. A. sativum  is also reported to stimulate macrophage and LAK cell activity, and to increase the production of IL-2, TNF, and interferon-gamma [77]. 

A. sativum  is reported in laboratory studies to detoxify chemical carcinogens and prevent carcinogenesis, along with directly inhibiting the growth of cancer cells [78][79]. A. sativum  is reported to inhibit nitrosamine formation, which has lead to it being studied in cancer therapy [80]. 

Several population studies show an association between increased intake of A. sativum  and reduced risk of certain cancers, including cancers of the stomach, colon, esophagus, pancreas, and breast. An analysis of data from seven population studies showed that the higher the amount of raw and cooked garlic consumed, the lower the risk of stomach and colorectal cancer [81][82].  A systematic review found that there is consistent scientific evidence of the A. sativum  protective effects against colorectal cancer [83].

A 2009 literature search using the Medline and EMBASE databases for the period 1955-2007 found there was no credible evidence to support a relation between A. sativum  intake and a reduced risk of gastric, breast, lung, or endometrial cancer, and there is very limited evidence supported a relation between garlic consumption and reduced risk of colon, prostate, esophageal, larynx, oral, ovary, or renal cell cancers. [84]

A Cochrane Database search in 2009 of randomized, controlled trials using A. sativum  in preventing and treating the common cold. Although the number of days of illness was lower in the garlic group compared with the placebo group, the number of days to recovery was similar in both groups. The authors concluded there is insufficient clinical trial evidence regarding the effects of A. sativum  in preventing or treating the common cold. [85]

Antioxidant activity

A. sativum  has been reported in laboratory and clinical studies to have antioxidant activity, A small clinical trial found that garlic significantly lowered plasma and erythrocyte pro-oxidant levels and to increased activities of some antioxidant enzymes, including glutathione peroxidase and superoxide dismutase [86]. The antioxidant activity of A. sativum  contributes to its positive health effects, including for cardiovascular disease, liver health, anti-cancer effects, sickle cell anemia, BPH, and others. [87][88][89][90]

Antidiabetic activity

A small clinical study found that timed release A. sativum  helps lower fasting blood sugar levels in patients with type 2 diabetes. [91]

A. sativum  may also help in the detoxification of heavy metals from the body, including lead. The mechanism of action appears to be that garlic protects the membranes of red blood cells against heavy metal ions by chelating the metal ions, allowing them to be excreted from the body. [92]

A Cochrane database review in 2006 found that there was insufficient evidence to recommend increased A. sativum  intake for preventing pre-eclampsia and its complications. [93]

Precautions

No documentation.

Side effects

Some individuals may experience GI distress or irritation when beginning use. [61]

Pregnancy/Breast Feeding

No documentation.

Age limitation

No documentation.

Adverse reaction

No documentation.

Interaction & Depletion

Interaction with drug

Antihypertensive medications

Studies have reported that A. sativum  may lower blood pressure which may alter the effects of these medications and possibly the dose needed for treatment. Use with caution. [49]

These drugs include amlodipine, bepridil, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine, verapamil, benazepril, captopril, enalapril, lisinopril, fosinopril,moexipril, quinapril, ramipril, trandolapril, perindopril erbumine, atenolol, esmolol, betaxolol, penbutolol, carteolol, bisoprolol, pindolol, metoprolol, timolol, sotalol, acebutolol, nadolol, propranolol, labetalol, carvedilol, methyldopa, clonidine, guanfacine, guanabenz, brimonidine tartrate, dipiprazole, levobunolol, levobetaxolol, metipranolol, reserpine, prazosin, terazosin, doxazosin meylate, guanadrel, guanethidine, isosorbide monohydrate, isosorbide dinitrate, nitroglycerin, hydralazine, minoxidil, papaverine, isoxsuprine, losartan, valsartan, eprosartan mesylate, telmisartan, candesartan cilexetil, irbesartan

Antihyperlipidemic medications

Studies have reported that A. sativum  may lower cholesterol levels which may alter the effects of these medications and possibly the dose needed for treatment. Use with caution. [45][57]

These drugs include atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, cholestyramine, colestipol, colesevelam, gemfibrozil, fenofibrate, clofibrate, niacin (nicotinic acid)

Anticoagulant medications

Aged A. sativum  extract has been reported to be safe in individuals taking anticoagulant medications. [94] Studies have reported that garlic affects the blood's clotting ability and may alter the effects of these medications and possibly the dose needed for treatment. Use with caution. [51][95]

These drugs include warfarin, heparin, dalteparin, tinzaparin, enoxaparin, danaparoid sodium, antithrombin III, lipirudin, argatroban, bivalirudin,

Antiplatelet medications 

Studies have reported that A. sativum affects the blood's clotting ability and may alter the effects of these medications and possibly the dose needed for treatment. Use with caution. [51][58][96]

These drugs include aspirin, dipyridamole, anagrelide, cilostazol, clopidogrel, ticlopidine, abciximab, tirofiban, eptifibatide

saquinavir

A study in healthy human volunteers has indicated that A. sativum supplements can decrease the blood levels of saquinavir, which may change the effects of this medication and possibly the dose needed for treatment. Inform your healthcare professional if using these two products. [97]

Interaction with other Herbs

No documentation.

Contraindications

No documentation.

Dosage

No documentation.

Poisonous Management

No documentation.

Line drawing

72

 

Figure 1: The line drawing of A. sativum [2]

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