Article

complementary medicine

Complementary, Holistic, and

Integrative Medicine: Garlic
Larissa Shamseer, BSc*,

Definition and Description

Theresa L. Charrois,

Allium sativum, commonly known as garlic, is a perennial plant native to central Asia that
now is farmed worldwide. It is a member of the Liliaceae family and also is called Russian
penicillin and allium. Intact, the plant is odorless; its pungency arises when garlic is
crushed, yielding the sulfur-containing, pharmacologically active component allicin.
Garlic was one of the earliest cultivated plants and has been used in many cultures for its
culinary and medicinal purposes. It has been used widely as a folk remedy to ward off the
common cold and flu. In the first century, Ayurvedic medicine claimed a role for garlic in
the prevention and treatment of heart disease (1) that has been studied by medical research
since the 1920s with intriguing and often mixed results. (2)(3) In traditional Chinese
medicine, garlic has been used as an antimicrobial and for fever prevention. Despite use in
many cultures for its purported pharmacologic effects, there is a gap in the literature
surrounding the pediatric use of garlic.

BScPharm, MSc*, Sunita

Vohra, MD, MSc*

Author Disclosure
Ms Shamseer and
Charrois did not
disclose any financial
relationships relevant
to this article. Dr
Vohra is an Alberta
Heritage Foundation
for Medical Research
Population Health
Investigator and
recipient of a
Canadian Institute of
Health Research New
Investigator Award.

Cardiovascular Effects
The cardiovascular effects of garlic are purported to include the lowering of lipids and
blood pressure and the reduction of platelet aggregation in adults. (4)(5)(6) McCrindle
and associates (7) examined the effects of a commercial garlic extract on lipids in children
(8 to 18 y of age) who had first-degree relatives afflicted with familial hypercholesterolemia
or premature atherosclerotic cardiovascular disease and a minimum fasting total cholesterol concentration higher than 185 mg/dL (4.8 mmol/L) in a double-blind, randomized, controlled trial (RCT). The extract was administered in 300-mg doses (containing
0.6 mg allicin) three times daily for 8 weeks. There were no significant improvements in
total fasting cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein
cholesterol, triglyceride, apolipoprotein B-100, homocysteine, or fibrinogen concentrations. A small significant increase (10%) in serum apolipoprotein A-I was observed,
although this was not a primary outcome of the study. Additional and larger studies are
needed to confirm this result as well as to explore the effects of garlic on blood pressure and
lipid concentrations in children at cardiovascular risk.

Antimicrobial Effects
Upper Respiratory Tract Infection
A Russian RCT compared the effects of 600-mg long-releasing garlic tablets with benzimidazole (a commercial parasiticide) and placebo to treat children ages 10 to 12 years who
had acute respiratory disease (ARD). (8) This double-blind RCT conducted over a
5-month period resulted in a 1.7-fold reduction in morbidity compared with placebo and
a 2.4-fold reduction versus dibazole (a benzimidazole-containing medication). The full
text of this study could not be obtained, which precluded notation of specific outcomes of
morbidity. The difference in morbidity between benzimidazole and placebo was not
significant. Thus, garlic in the form of these tablets appears to be more efficacious than
conventional or placebo treatment of ARD, but additional studies are needed.

Acute Otitis Media (AOM)

A double-blind, randomized, two-arm study examined the effect of two different ear drop
preparations on ear pain associated with AOM in 103 children ages 6 to 18 years. (9)
A naturopathic preparation containing four herbs, including garlic, in olive oil (actual
*Complementary and Alternative Research and Education (CARE) Program, Department of Pediatrics, University of Alberta,
Canada, on behalf of the American Academy of Pediatrics Provisional Section on Complementary, Holistic, and Integrative
Medicine.
Pediatrics in Review Vol.27 No.12 December 2006 e77

complementary medicine

garlic content was not reported) was compared with a

mixture of ametocaine and phenazone dissolved in dehydrated glycerin, a conventional eardrop that has proven
pain-relieving effects. Five drops of either treatment were
administered five times per day for 3 days.
Pain improved in all children regardless of treatment
assignment. (9) A single dose of acetaminophen was
administered once to all patients at the beginning of the
study, which makes it difficult to conclude whether early
reduction in pain was attributable to either eardrop
alone. In addition, garlic was only one of four herbs
present in the herbal drops, and any effects must be
attributed to the union of these herbs and not to garlic
specifically. Raw garlic should not be put in the ear
because of the risk of irritation.

Gastrointestinal Infection
Antimicrobial activities of garlic in children having gastrointestinal infection also have been studied. In one
observational study, an 8-g garlic infusion was administered for 5 days to children who had intestinal Ascaris
lumbricoides infection, but little efficacy was noted.
(10) In another study, 10 children infected with Hymenolepsiasis nana and 26 children infected with Giardia
lamblia (giardiasis) were studied. (11) Two garlic preparations were examined: crude garlic extract (5 mL extract diluted in 100 mL of water) administered in two
daily doses or commercially prepared capsules (0.6 mg)
administered two capsules at a time twice daily.
The authors reported that garlic was effective and safe
and shortened the duration of treatment, (11) but statistical analyses showing the significance of these results
were not provided. Clinical symptoms of hymenolepsiasis were reported to disappear completely within 3 days
of treatment with the crude extract, and clinical symptoms of giardiasis subsided whether treated with either
preparation after 1 day of treatment. The contradictory
results of garlics antimicrobial activity in these two studies indicate the necessity for additional, more rigorous
studies of this purported effect.

Warts
Silverberg conducted a prospective cohort study in
which five children (all 5 y of age) were treated with one
half clove of garlic applied to their warts nightly and
covered with a plaster. (12) Resolution was reported in
all children, with an initial response by 3.2 weeks (range,
2 to 4 wk) on average and completion of therapy in an
average of 9 weeks (range, 7 to 12 wk). This study needs
to be replicated in a larger RCT before additional recommendations on its use can be presented.
e78 Pediatrics in Review Vol.27 No.12 December 2006

Safety
The adverse effect of garlic reported most commonly is
its pungent smell, reflected in both breath and body
odors. (12) Less common adverse effects include indigestion and gastrointestinal upset, although these have
not been reported in pediatric studies. It also has been
suggested that garlic interacts with anticoagulant and
antiplatelet agents, potentiating their effects. There is no
evidence for this effect in children. In fact, the study of
garlic on cardiovascular effects in children (7) found no
effect on fibrinogen.
Burns or contact dermatitis are the most noted adverse effects of garlic used topically. Several studies have
reported this adverse event in children. Patients from 3
months to 6 years of age reportedly have experienced
second-degree burns after the topical application of raw,
crushed garlic. (13)(14)(15) In adults, allergic reactions
to garlic are hypothesized to occur due to garlics primary
allergens: allicin, diallyl disulfide, and allylpropyl disulfide. (16)

Pharmacologic Action
The pharmacologic actions of garlic are attributed primarily to its many sulfur-containing compounds. Allicin,
the major active and sulfur-containing constituent of
garlic, is not present until the herb is crushed, chopped,
or chewed. The crushing action brings the enzyme allinase into contact with the substrate alliin, which is converted into allicin. Allicin is unstable in an oil base, and
oil-based preparations are presumably less efficacious.
(17) Because allicin formation is inhibited by a low
gastrointestinal pH, enteric-coated preparations are believed to be more effective.

Administration/Dosage Forms
Data are insufficient to recommend precise pediatric
dosages. In the previously mentioned RCT of cardiovascular risk factors, 300 mg TID in the form of dehydrated
powder tablets was used and well-tolerated in children
8 to 18 years of age.

Summary
A paucity of good evidence supports the use of garlic in
children, but its safety window appears to be wide, making it relatively safe (Table). Additionally, RCTs in children who received standardized preparations are required to establish the true usefulness of garlic for
cardiovascular and infectious disease problems in pediatric populations. Finally, with the increasing diversity of
the western population, the use of traditional remedies
such as garlic may be encountered more frequently.

Randomized, doubleblind, placebocontrolled clinical

trial

Randomized, doubleblind, placebocontrolled clinical

trial
Randomized, doubleblind, two-arm
trial

Hypercholesterolemia
(7)

Acute Respiratory
Disease (8)

Not discussed

Giardiasis (11)

n5

n26

n10

n103, ages 6 to 18
y who had ear pain
associated with
acute otitis media
Not reported

n30, ages 8 to 18 y
with familial
hypercholesterolemia and fasting
total cholesterol
level >4.8 mmol/L
n156, ages 10 to
12 y

Population

*Unable to determine due to language limitations. Unable to retrieve full text of article.

Observational

Not discussed

Hymenolepiasis (11)

Warts (12)

Not discussed*

Ascariasis (10)

Acute Otitis Media

(9)

Study Type

Summary of the Effects of Garlic

Condition

Table.

Resolution within
3 to 9 wk

Clinical symptoms
resolved within
1 to 3 d

None

None

Clinical symptoms
resolved within
3d

None

Pain reduction (as

effective as
standard of care)

Decreased morbidity
(specific outcomes
not listed)

No significant effect
on risk factors

Outcome

None

None

Ametocaine and
phenazone
eardrops

Placebo and
benzimidazole

Placebo

300 mg 3/d of
garlic extract
for 8 wk

300 mg/d of
long-releasing
garlic tablets
for 5 mo
Five drops 3/d
of herbal
eardrops for
3d
8 g/d of garlic
infusion for
5d
1 mg/mL aqueous
extract 2/d
or two
(0.6 mg/mL)
capsules 2/d
1 mg/mL aqueous
extract 2/d
or two
(0.6 mg/mL1)
capsules 2/d
Brief application
of freshly cut
glove of garlic

Control

Intervention

None reported

None reported

None reported

None reported

None

None reported

Unpleasant body odor

Adverse Effects

complementary medicine

Pediatrics in Review Vol.27 No.12 December 2006 e79

complementary medicine

Pediatric health-care practitioners should inquire about

its use.

References
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736S740S
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161162
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