Paula Viñas
José de Felippe Junior

O Colesterol não é gordura é um álcool. Ele possuí uma estrutura esquéletica fundamental , chamada – ciclopentano perhidrofenantreno – que entra na constituição dos hormônis esteroides.

O colesterol está presente na dieta de todas as pessoas e ele pode ser absorvido lentamente no trato gastrointestinal, sem prévia digestão, passando diretamente para o sistema linfático. É altamewnte solúvel em gorduras e levemente hidrosolúvel, sendo capaz de formar esteres quando combinado com os ácidos graxos.

Formação do colesterol: Ao lado do colesterol absorvido diariamente pelo trato gastro intestinal , que é chamado de “colesterol exógeno” , uma grande quantidade de colesterol é gerado no interior das células do organismo , o “colesterol endógeno”. Praticamente todo colesterol endógeno que circula no plasma com as lipotroteínas é formado no fígado, porém todas as células do corpo fabricam colesterol para fazer parte da membrana celular e membrana das organelas celulares.

Colesterol exógeno: Gorduras saturadas da alimentação : carne de animais e seus derivados , carne bovina, carne suína, aves, frutos do mar, miúdos, gema de ovo, frios, embutidos , manteiga, queijos, creme de leite, chantily. As margarinas possuem gorduras trans e devem ser evitadas.

Normalmente o colesterol é necessário em muitas funções corporais complexas, incluindo a síntese do estrogênio, androgênio e progesterona , manutenção das células nervosas e constituição das membranas .

O colesterol é transportado no sangue ligado a lipoproteínas, cujas principais são a LDL-colesterol (colesterol ruim) e a HDL-colesterol (colesterol bom)

LDL-colesterol : Considerado o colesterol ruim, porque participa na formação da placa de gordura, obstruindo a artéria (aterosclerose): o LDL é facilmente oxidado pelos radicais livres de oxigênio e se deposita no endotélio. Percebendo a situação, os glóbulos brancos fagócitos se dirigem ao local para fagocitar a gordura, mas não possuem as enzimas certas para degradar o lipídeo, e acabam por se infiltrar nas paredes do vaso. A placa de gordura (ateroma), não consegue mais sair das paredes do vaso, acarretando a sua obstrução. Se a obstrução acontecer nas coronárias teremos a angina pectoris ou infarto do miocárdio. Se a obstrução acontecer vasos do cérebro teremos o acidente vascular cerebral isquêmico .

LDL aumentado não provoca dano algum. O perigo está no LDL oxidado , o que acontece nas situações de aumento de radicais livres no corpo: sobrecarga emocional, sobrecarga de trabalho, contaminação por metais tóxicos ( 40% da população de Saõ Paulo e 30% no Rio de Janeiro ), excesso de álcool, fumo, noites mal dormidas, sedentarismo, excesso de Sol, lâmpadas fluorescentes ( lesam a retina e provocam degeneração macular senil), agrotóxicos, edulcorantes, aspartame , excesso de ferro, etc.

Salientamos que 40 % dos infartos do miocardio acontecem com LDL normal ou até abaixo do normal , pois a obstrução coronaria é devida à oxidaçao do LDL esteja ele baixo ou normal.

HDL-colesterol : considerado o bom colesterol pois retira o colesterol das artérias e dos tecidos e o leva para o fígado, onde é metabolizado e reaproveitado. Portanto quanto maior a taxa de HDL mais se evita a aterosclerose.

Plantas que diminuem o colesterol

As plantas têm um efeito peculiar sobre o colesterol: diminuem a concentração plasmática e possuem efeito antioxidante, previnindo a oxidação do LDL. Como já salientamos, o importante é previnir a oxidaçaõ do LDL-colesterol e as plantas por viverem sob o Sol são ricas em antioxidantes, substâncias anti radical livre que as protegem justamente do Sol.

Alcachofra - Cynara scolymus

Reduz o colesterol e os triglicérides. Diminui as taxas de colesterol devido à ação nas enzimas hepáticas (20 mg de cinarina reduzem em 30% o colesterol)

Anti-hyperlipidemic sesquiterpenes and new sesquiterpene glycosides from the leaves of artichoke (Cynara scolymus L.): structure requirement and mode of action.
Bioorg Med Chem Lett. 2003 Jan 20;13(2):223-8.
Shimoda H, Ninomiya K, Nishida N, Yoshino T, Morikawa T, Matsuda H, Yoshikawa M.
Kyoto Pharmaceutical University, Misasagi, Yamashina-ku, Kyoto 607-8412, Japan.

The methanolic extract from the leaves of artichoke (Cynara scolymus L.) was found to suppress serum triglyceride elevation in olive oil-loaded mice. Through bioassay-guided separation, sesquiterpenes (cynaropicrin, aguerin B, and grosheimin) were isolated as the active components together with new sesquiterpene glycosides (cynarascolosides A, B, and C). The oxygen functional groups at the 3- and 8-positions and exo-methylene moiety in alpha-methylene-gamma-butyrolactone ring were found to be essential for the anti-hyperlipidemic activity of guaiane-type sesquiterpene. In addition, inhibition of gastric emptying was shown to be partly involved in anti-hyperlipidemic activity.

Herbs for serum cholesterol reduction: a systematic view.
J Fam Pract. 2003 Jun;52(6):468-78.
Thompson Coon JS, Ernst E.
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, United Kingdom. jo.thompson-coon@pms.ac.uk

OBJECTIVES: To systematically review the clinical evidence for herbal medicinal products in the treatment of hypercholesterolemia. STUDY DESIGN: A systematic review of randomized clinical trials of herbal medicinal products used to lower serum cholesterol. Systematic literature searches were conducted in 6 electronic data-bases. The reference lists of all papers and our files were searched for more relevant publications. Experts in the field and manufacturers of identified herbal medicinal products were contacted for published and unpublished data. No language restrictions were imposed. OUTCOMES MEASURED: All randomized clinical trials of serum cholesterol reduction, in which mono-preparations of herbal medicinal products were administered as supplements to human subjects, were included. RESULTS: Twenty-five randomized clinical trials involving 11 herbal medicinal products were identified. Guggul (Commiphora mukul), fenugreek (Trigonella foenum-graecum), red yeast rice, and artichoke (Cynara scolymus) have been most extensively studied and have demonstrated reductions in total serum cholesterol levels of between10% and 33%. The methodological quality as assessed by the Jadad score was less than 3 (maximum, 5) for 13 of the 25 trials. CONCLUSIONS: Many herbal medicinal products have potential hypocholesterolemic activity and encouraging safety profiles. However, only a limited amount of clinical research exists to support their efficacy. Further research is warranted to establish the value of these extracts in the treatment of hypercholesterolemia.

Amaranto (Amaranthus caudatus L.)

Efeito do Consumo de amaranto (Amaranthus caudatus L.) no metabolismo lipídico de coelhos hipercolesterolêmicos / Effect of amaranth consumption in the lipid metabolism of hypercholesterolemic rabbits.

Säo Paulo; 2000. 79 p.

Apresentada a Universidade de Säo Paulo. Faculdade de Saúde Pública. Departamento de Nutriçäo para obtenção do grau de Mestre

Plate, Andrea Yukie Arikawa

Avalia o efeito do consumo do amaranto na reduçäo da hipercolesterolemia de coelhos. Para tanto, 18 coelhos machos da raça New Zealand foram, inicialmente, alimentados com dieta indutora de hipercolesterolemia durante 45 dias. Após este período, os animais foram divididos em três grupos através de sorteio e cada grupo recebeu uma dieta diferente durante 21 dias: dieta de manutençäo, que foi utilizada como controle, dieta com óleo de amaranto e dieta com 50 por cento de extrusado de amaranto. Foram coletadas amostras de sangue dos animais no período inicial do experimento e após 45 dias de administraçäo da dieta indutora de hipercolesterolemia. A partir da introduçäo das três dietas experimentais, passou-se a coletar sangue dos animais a cada quatro dias, até o final do experimento. Näo foi observada diferença estatística entre as taxas de crescimento dos três grupos durante o experimento. O grupo de extrusado de amaranto apresentou reduçäo de 50 por cento e 55 por cento nos valores de colesterol plasmático total e LDL-C, respectivamente, enquanto que o grupo de óleo de amaranto apresentou reduçäo de 18 por cento e 21 por cento e o grupo controle, 14 por cento e 7 por cento. Com relaçäo aos triglicerídios e VLDL-C, os grupos do extrusado e do óleo de amaranto apresentaram valores mais baixos do que o grupo controle. Näo houve diferença estatisticamente significante entre os níveis de HDL-C dos animais dos três grupos. Conclui que o extrusado de amaranto possui efeito benéfico na reduçäo do colesterol plasmático total, VLDL-colesterol, triglicerídios e LDL-colesterol de coelhos hipercolesterolêmicos quando comparado com uma dieta controle (AU).

Alfafa

Effect of alfalfa meal in diets of laying quails on performance, egg quality and some serum parameters.

University of Erciyes, Faculty of Veterinary Medicine, Department of Animal Nutrition and Nutritional Diseases, Kayseri, Turkey. berrinkg@hotmail.com

Arch Anim Nutr;58(3):255-63, 2004 Jun.Güçlu BK; Iscan KM; Uyanik F; Eren M; Agca AC

This study was conducted to investigate the effects of increasing levels of alfalfa meal in the diet of laying quails on egg production, feed consumption, feed efficiency, egg quality, egg yolk cholesterol and selected serum parameters. In this study, 192, 10-week old quails (Coturnix coturnix japonica) were evenly distributed to four groups with four replicates of 12 quails each. The control group was fed a basal diet containing 0% alfalfa meal and the remaining groups received 3, 6 or 9% alfalfa meal for 12 weeks. Live weight, feed consumption, and egg production were recorded and feed efficiency were calculated. Eggs were examined for interior and exterior quality and egg yolk cholesterol content. At the end of the experiment, blood samples were collected and sera were analysed for serum Ca, inorganic P (P(i)), Mg, triglycerides and total cholesterol. Any level of alfalfa meal had no effect on live weight, egg production, feed consumption, feed efficiency, egg weight, and egg yolk index. Six percent and 9% alfalfa meal increased specific gravity of whole egg and eggshell thickness as well as serum P(i) levels. Nine percent alfalfa meal reduced serum triglycerides, total cholesterol levels and egg yolk cholesterol content. The results of this experiment indicated that addition of 9% alfalfa meal into the laying quail diet may improve eggshell quality and reduced serum triglycerides and serum and egg yolk cholesterol without any adverse effect on performance.

Curcuma (Curcuma domestica)

Lowering of lipid composition in aorta of guinea pigs by Curcuma domestica.

Department of Biomedical Sciences, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia. raha@medic.ukm.my

BMC Complement Altern Med;1(1):6, 2001.Ahmad-Raus RR; Abdul-Latif ES; Mohammad JJ

BACKGROUND: A short-term study was carried out using guinea pigs to determine the effects of Curcuma domestica on lipid composition in the serum and aorta. METHODS: Animals were given food pellets containing 4% (w/w) powdered rhizome of C. domestica in order to determine its effect on cholesterol, triglyceride and phospholipid levels in the aorta and serum. The animals were fed either a cholesterol free diet or a high cholesterol diet (2% cholesterol, w/w, in food pellet) in order to induce hypercholesterolemia. After five weeks of this diet treatment, blood and aorta were taken for biochemical analysis and histological studies. RESULTS: C. domestica in the diet showed no significant effect on the levels of cholesterol, triglyceride and phospholipid in the serum and aorta of the cholesterol free diet animals. However, addition of C. domestica to a high cholesterol diet counteracted increases in the levels of cholesterol, triglyceride and phospholipid in the aorta. Histology studies showed less cholesterol deposits in the aorta of high cholesterol diet animals given C. domestica compared to the high cholesterol diet animals not given C. domestica supplement. C. domestica also had a lowering effect on triglyceride level in the serum of high cholesterol diet animals but showed no effect on serum cholesterol and phospholipid levels. CONCLUSION: This study has shown that dietary intake of C. domestica decreased all lipid composition levels in the aorta and also the serum triglyceride level. In addition, C. domestica also reduced cholesterol deposition in the aorta of high cholesterol diet animals

Aipo

Effects of aqueous celery (Apium graveolens) extract on lipid parameters of rats fed a high fat diet.
Planta Med. 1995 Feb;61(1):18-21.
Tsi D, Das NP, Tan BK.
Department of Pharmacology, Faculty of Medicine, National University of Singapore.

The antihyperlipidemic property of aqueous celery extract was studied in rats. Two groups of Wistar rats were fed a high fat diet for eight weeks to induce hyperlipidemia. One group was supplemented with aqueous celery extract in the diet while the other group served as control. At the end of the experiment, a significant reduction was found in the serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) concentrations in the celery-treated rats. However, the concentration of hepatic TG was significantly higher in the celery-treated group than in the control group. Hepatic triacylglycerol lipase (HL) activity was found to be significantly lower in the celery-treated rats while the reverse was observed for the hepatic microsomal P450 content. Analysis of an ethereal extract of the aqueous extract of celery by thin layer chromatography (TLC) with two different solvent systems showed that the extract did not contain 3-n-butylphthalide (BuPh), a unique compound in celery that has previously been reported to have lipid-lowering action. Our study indicates that other active principle(s) could be responsible for the observed effects of aqueous celery extract on serum and hepatic lipid levels.

Yucca schidigera

Hypocholesterolemic property of Yucca schidigera and Quillaja saponaria extracts in human body.

Arch Pharm Res;26(12):1042-6, 2003 Dec Kim SW; Park SK; Kang SI; Kang HC; Oh HJ; Bae CY; Bae DH. Division of Endocrinology & Metabolism, Department of Medicine, Miz Medi Hospital, Seoul, Korea

Resumo: This study was undertaken to observe the effects of the blend of partially purified Yucca schidigera and Quillaja saponaria extracts on cholesterol levels in the human's blood and gastrointestinal functions, and to determine if a new cholesterol-lowering drug can be developed by the further purification of the extracts. Ultrafiltration and sequential diafiltration increased the amounts of steroidal saponin in aqueous yucca extract and terpenoid saponin in aqueous quillaja extract from 9.3% and 21.4% to 17.2% and 61.8%, respectively. Taking 0.9 mg of the blend (6:4, v:v) of the resulting filtrates a day for 4 weeks resulted in the decreases in total and LDL cholesterol levels in blood plasma of hyper-cholesterolemic patients with enhancement in gastrointestinal symptoms of patients.

Opuntia robusta

Regular ingestion of opuntia robusta lowers oxidation injury.

Prostaglandins Leukot Essent Fatty Acids;65(1):45-50, 2001 Jul. Budinsky A; Wolfram R; Oguogho A; Efthimiou Y; Stamatopoulos Y; Sinzinger H

Clinical Division of Oncology, University of Vienna, A-1090 Vienna, Austria.

Resumo: The influence of opuntia robusta (prickly pear), a traditionally used dietary nutrient against diabetes mellitus among the American Indian population, was examined in 15 young patients suffering from familial heterozygous isolated hypercholesterolemia. Oxidation injury was determined via 8-epi-PGF(2 alpha)in plasma, serum and urine. Daily consumption of 250 g broiled edible pulp of prickly pear had no influence on body weight and body fat composition. Total cholesterol was lowered (P<0.01) as was LDL-cholesterol (P<0.04). No significant changes were observed either in triglycerides or in HDL. Prickly pear induced a significant decrease in plasma (27.9+/-3.3-->25.6+/-3.2;P<0.03), serum (302.0+/-11.4-->283.2+/-14.5;P<0.0003) and urinary (355.9+/-18.4-->323.9+/-16;P<0.00002) 8-epi-PGF(2alpha)values. The findings on a decrease of 8-epi-PGF(2alpha)were more pronounced in females than in males, the highest significance being found in urine, while, in contrast, the effects on total- and LDL-cholesterol were more pronounced in males. A prerunning 4 weeks period of dietary counseling had no significant effect on either of the parameters examined. These findings indicate that the regular ingestion of opuntia robusta is able to significantly reduce in-vivo oxidation injury in a group of patients suffering from familial hypercholesterolemia. This traditional food of the American Indians thus may have a significant cardiovascular benefit.

Trigonella foenum-graecum

Hypoglycaemic effect of aqueous extract of the leaves of Trigonella foenum-graecum in healthy volunteers.

East Mediterr Health J;6(1):83-8, 2000 Jan. Abdel-Barry JA; Abdel-Hassan IA; Jawad AM; al-Hakiem MH

Department of Biochemistry, College of Medicine, University of Basra, Basra, Iraq.

Resumo: The safety and efficacy of Trigonella foenum-graecum extract was investigated using 20 male volunteers aged 20-30 years. They were randomly treated with either 40 mg/kg aqueous extract powder in 10 mL distilled water or 10 mL distilled water in which coffee simulated the extract. The extract significantly lowered blood glucose level by 13.4% 4 hours after ingestion. A significant change of 14.1% was observed in potassium levels. No significant alteration in serum cholesterol, total serum protein and blood urea occurred. Approximately one-third experienced feelings of hunger, frequency of micturition or dizziness during the 24 hours after ingestion. The aqueous extract effectively reduced blood glucose in normal subjects safely. Its hypokalaemic effect merits further investigation.

Ocimum sanctum and Ocimum album - Manjericão

Randomized placebo-controlled, single blind trial of holy basil leaves in patients with noninsulin-dependent diabetes mellitus.

Int J Clin Pharmacol Ther;34(9):406-9, 1996 Sep. Agrawal P; Rai V; Singh RB

Department of Home Science, Azad University of Agriculture and Technology, Kanpur, India. Resumo: Experimental studies on albino rats reported that leaf extract of (holy basil) had hypoglycemic effect. To explore further evidence we studied the effects of treatment with holy basil leaves on fasting and postprandial blood glucose and serum cholesterol levels in humans through randomized, placebo-controlled, crossover single blind trial. Results indicated a significant decrease in fasting and postprandial blood glucose levels during treatment with holy basil leaves compared to during treatment with placebo leaves. Fasting blood glucose fell by 21.0 mg/dl, confidence interval of difference -31.4 - (-)11.2 (p < 0.001), and postprandial blood glucose fell by 15.8 mg/dl, confidence interval -27.0 - (-)5.6 (p < 0.02). The lower values of glucose represented reductions of 17.6% and 7.3% in the levels of fasting and postprandial blood glucose, respectively. Urine glucose levels showed similar trend. Mean total cholesterol levels showed mild reduction during basil treatment period. The findings from this study suggest that basil leaves may be prescribed as adjunct to dietary therapy and drug treatment in mild to moderate NIDDM.

Ginseng

Ginseng therapy in non-insulin-dependent diabetic patients.

Diabetes Care;18(10):1373-5, 1995 Oct. Sotaniemi EA; Haapakoski E; Rautio A

Department of Internal Medicine, University of Oulu, Finland.

Resumo: OBJECTIVE: To investigate the effect of ginseng on newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) patients. RESEARCH DESIGN AND METHODS: In this double-blind placebo-controlled study, 36 NIDDM patients were treated for 8 weeks with ginseng (100 or 200 mg) or placebo. Efficacy was evaluated with psychophysical tests and measurements of glucose balance, serum lipids, aminoterminalpropeptide (PIIINP) concentration, and body weight. RESULTS: Ginseng therapy elevated mood, improved psychophysical performance, and reduced fasting blood glucose (FBG) and body weight. The 200-mg dose of ginseng improved glycated hemoglobin, serum PIIINP, and physical activity. Placebo reduced body weight and altered the serum lipid profile but did not alter FBG. CONCLUSIONS: Ginseng may be a useful therapeutic adjunct in the management of NIDDM.

Terminalia arjuna

Antianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease.

J Assoc Physicians India;42(4):287-9, 1994 Apr. Dwivedi S; Agarwal MP

Department of Medicine, UCMS, Delhi.Resumo: The effect of bark powder of Terminalia arjuna, an indigenous drug, on anginal frequency, blood pressure, body mass index, blood sugar, cholesterol and HDL-cholesterol was studied in 15 stable (Group A) and 5 unstable (Group B) angina patients before and 3 months after T. arjuna therapy. Tread mill test (TMT) and echocardiographic left ventricular ejection fraction was evaluated in some cases. There was 50% reduction in anginal episodes in Group A cases (P < 0.01). TMT performance improved from moderate to mild changes in 5 patients and one with mild changes became negative for ischemia. The time to the onset of angina and appearance of ST-T changes on TMT after T. arjuna was delayed significantly. However, in patients with unstable angina there was an insignificant reduction in anginal frequency. These patients also needed diltiazem, B-blockers and nitroglycerine in addition to T. arjuna. The drug lowered systolic blood pressure and body mass index to a significant level (p < 0.05) and increased HDL-cholesterol only slightly along with marginal improvement in left ventricular ejection fraction in stable angina patients. There were no deleterious effects on liver or kidney functions. Our results suggest that monotherapy with T. arjuna is fairly effective in patients with symptoms of stable angina pectoris. However, it has a limited role in unstable angina.

Mistura de ervas

Control of hyperglycaemia and hyperlipidaemia by plant product.

J Assoc Physicians India;42(1):33-5, 1994 Jan. Bhardwaj PK; Dasgupta DJ; Prashar BS; Kaushal SS

Department of Medicine, Indira Gandhi Medical College, Himachal Pradesh, India.

Resumo: A herbal powder consisting of Guargum, Methi, Tundika and Meshasringi was administered to thirty control and thirty NIDDM patients twice daily before principal meals for four weeks. Oral GTT showed improvement in both control and patient groups. Serum total and LDL cholesterol also fell significantly in both the groups after the trial period. Test meal of the herbal powder with D-Xylose excretion was otherwise normal. Follow up for upto two years did not reveal any long term side effect of the powder. This powder, therefore, can be effectively used to reduce postprandial blood glucose and LDL cholesterol in NIDDM patients as a long term measure.

Chá de ervas

Efficiency of the vegetative tea in diet therapy for patients with obesity associated with diabetes mellitus type 2

Vopr Pitan;72(4):12-6, 2003. Khrushcheva IuV; Mal'tsev GIu; Popova IuL; Vasil'ev AV

País de publicação: Russia

Resumo: The dynamic of glycemia, insulin, C-peptide, glycosylated hemoglobin, fructosamine, thyroid hormones, parameters of serum lipids, lipid peroxidation and system of antioxidant defense in 81 hospital patients and out-patients with obesity associated with diabetes mellitus type II was studied of influence of hypocaloric diet 9. Universal normalizing influence of hypocaloric diet 9 with vegetation tea was discovered on parameters of carbohydrate, lipid and oxidative metabolism and of patients clinical state of pateni. The additional criteria of evaluation of efficacy of food dietary supplements in complex treatment of patients with obesity associated with diabetes mellitus type II was offered on basis of study of influence vegetation tea on mechanisms of metabolic disorders in these patients.

Legumes

Effects of legume consumption on serum cholesterol, biliary lipids, and sterol metabolism in humans.

J Lipid Res;38(6):1120-8, 1997 Jun Duane WC.

Resumo: Legume consumption appears to lower serum cholesterol and to increase cholesterol saturation of bile, but the mechanisms of these effects have not been established. We studied nine human subjects on a metabolic ward during two randomly ordered 6-7 week periods: one during consumption of a control diet and the other during consumption of the same diet with 120 gm mixed legumes substituted for foods having equivalent calories, fat, protein, and carbohydrate. Mean serum LDL cholesterol was significantly lower during legume consumption (126 vs. 138 mg/dl, P = 0.039). Legume consumption significantly increased mean cholesterol saturation index of gallbladder bile from 1.07 to 1.26 (P = 0.016), largely because of an increase in hepatic secretion of cholesterol from a mean of 90.2 mumol/h to 100.8 mumol/h (P = 0.042). Fecal neutral sterol output was unaffected by legumes, but fecal acidic sterols increased from a mean of 861 to 1202 mumol/day (P = 0.002) during legume consumption. Mean sterol balance became significantly more negative during legume consumption (-2140 vs. -2700 mumol/day, P = 0.037) indicating an increase in cholesterol synthesis. Mean fractional absorption of bile acid was lower during legume consumption than (0.947 vs. 0.960, P = 0.003). These data suggest that legume consumption lower LDL cholesterol by partially interrupting the enterohepatic circulation of bile acids and increases cholesterol saturation of bile by increasing hepatic secretion of cholesterol.

Soja e ervilha

Effects of pea and soybean fibre on postprandial lipaemia and lipoproteins in healthy adults.

Eur J Clin Nutr;47(7):508-20, 1993 Jul. Dubois C; Cara L; Armand M; Borel P; Senft M; Portugal H; Pauli AM; Bernard PM; Lafont H; Lairon D

Resumo: To evaluate some possible mechanisms whereby total dietary fibre (TDF) may affect lipid metabolism in humans, six normolipidaemic males ingested on separate days a low-fibre test meal (2.8 g TDF) containing 70 g fat and 756 mg cholesterol, enriched with 10 g TDF in the form of either pea fibre or soybean fibre. Fasting and post-meal blood samples were obtained for 7 h and chylomicrons (CM) were isolated. Lipoproteins (VLDL+CM remnants, LDL, HDL) were isolated from the baseline samples and the samples of the 2-3 h triglyceride peaks. As compared to the postprandial response given by the control low-fibre test meal, adding fibre induced no change in serum glucose, insulin or Apo A1 and Apo B variations. The serum triglyceride response was not altered by adding fibres but the 2-3 h chylomicron triglyceride rise was increased (P < or = 0.05) by soybean fibre. VLDL+CM remnants, LDL and HDL triglyceride variations were unchanged with fibres. Cholesterolaemia decreased postprandially for 6 h, and was further lowered in the presence of pea fibre. This resulted from a marked decrease in serum esterified cholesterol. The chylomicron cholesterol and phospholipid rise was lowered in the presence of either fibre. The postprandial changes in the free cholesterol concentrations of the various lipoprotein classes were not altered by fibre whereas changes from baseline in esterified cholesterol concentrations were reduced by soybean fibre in LDL and amplified by soybean and pea fibres in HDL. The results obtained show that dietary fibre present in legumes may alter postprandial lipaemia and lipoproteins in humans to a variable extent. These effects could be related to some long-term metabolic effects.

Feijão

Extruded dry beans and serum lipoprotein and plasma haemostatic factors in hyperlipidaemic men.

Eur J Clin Nutr;54(5):373-9, 2000 May Oosthuizen W; Scholtz CS; Vorster HH; Jerling JC; Vermaak WJ. Nutrition Research Group, Department of Nutrition, Potchefstroom University for Christian Higher Education, Potchefstroom, South Africa. VGEWO@PUKNET.PUK.AC.ZA

Resumo: OBJECTIVE: To examine the effects of the inclusion of extruded dry beans in the diet on serum lipoprotein, plasma fibrinogen, plasma viscosity and plasminogen activator inhibitor 1 (PAI-1) levels. SUBJECTS AND STUDY DESIGN: Twenty-two free living hyperlipidaemic men participated in this randomised, controlled, cross-over study. The subjects were randomly assigned to one of two groups. After a run-in period of four weeks, during which subjects followed their normal diet with the exclusion of dry beans, group A had to include 110 g/day of extruded dry beans in the form of baked products for four weeks while group B continued with the run-in diet. A washout period of four weeks followed after which the experimental intervention was crossed-over. Anthropometric measurements, serum lipoproteins and haemostatic variables were measured with standard methods and dietary intakes were estimated with five-day dietary records at the beginning and end of each experimental period. RESULTS: Compliance was determined as 83.5% with a mean intake of 91. 9 g/day extruded dry beans. Extruded dry beans did not have significant effects on total serum cholesterol, low density lipoprotein cholesterol, triglycerides, apolipoprotein A or B, plasma fibrinogen and plasma viscosity concentrations. High density lipoprotein cholesterol concentrations decreased in both the dry bean and control periods. Lipoprotein (a) concentrations increased with intake of extruded dry beans, but this increase was probably not due to an independent effect of extruded dry beans. Plasminogen activator inhibitor 1 levels were significantly lower after the intake of extruded dry beans compared to the control period. CONCLUSIONS: The inclusion of 91.9 g extruded dry beans per day in the diet had no effects on serum lipoproteins, plasma fibrinogen and viscosity levels but decreased PAI-1 levels. Sponsorship: Dry Bean Producers Organisation (South Africa) and the Potchefstroom University for Christian Higher Education, Potchefstroom, South Africa.

Cardiovascular and renal benefits of dry bean and soybean intake.

Am J Clin Nutr;70(3 Suppl):464S-474S, 1999 Sep. Anderson JW; Smith BM; Washnock CS

Resumo: Dry beans and soybeans are nutrient-dense, fiber-rich, and are high-quality sources of protein. Protective and therapeutic effects of both dry bean and soybean intake have been documented. Studies show that dry bean intake has the potential to decrease serum cholesterol concentrations, improve many aspects of the diabetic state, and provide metabolic benefits that aid in weight control. Soybeans are a unique source of the isoflavones genistein and diadzein, which have numerous biological functions. Soybeans and soyfoods potentially have multifaceted health-promoting effects, including cholesterol reduction, improved vascular health, preserved bone mineral density, and reduction of menopausal symptoms. Soy appears to have salutary effects on renal function, although these effects are not well understood. Whereas populations consuming high intakes of soy have lower prevalences of certain cancers, definitive experimental data are insufficient to clarify a protective role of soy. The availability of legume products and resources is increasing, incorporating dry beans and soyfoods into the diet can be practical and enjoyable. With the shift toward a more plant-based diet, dry beans and soy will be potent tools in the treatment and prevention of chronic disease.

Fibras

Chronic and postprandial responses of plasma insulin, glucose and lipids in volunteers given dietary fibre supplements.

Br J Nutr;73(5):733-51, 1995 May. Frape DL; Jones AM

Resumo: We questioned whether a dietary fibre supplement known to lower fasting plasma cholesterol concentrations can also lower the postprandial plasma cholesterol, glucose and insulin concentrations when it is administered just before a meal. Two studies were conducted in healthy middle-aged volunteers of both sexes in whom the fasting plasma total cholesterol concentrations were above normal. In the first study the dietary fibre treatments (2.2 g) were psyllium and a psyllium-citrus pectin mixture to which the subjects (four males, eight females) had no prior exposure. Controls received no supplement. The meals were high-fat breakfasts and lunches. In the second study the dietary fibre (6 g) was from sugar-beet root and the reference control was alpha-cellulose (2 g); the meal was of glucose. The volunteers (eight males, eight females) had prior exposure to the fibre supplements three times daily for 3 weeks. After adjustments for fasting values and changes in haemodilution, the psyllium and psyllium-citrus pectin mixture in the first experiment had no significant effects on the postprandial measurements of plasma glucose, insulin:glucose ratio, total-, LDL- and HDL-cholesterol, and triacylglycerol. By contrast, the sugar-beet fibre in the second study significantly decreased the area under the glucose response curve by 6.9%, the area under the insulin response curve was lower by 9.6%, although not significantly, and the post-glucose meal HDL-cholesterol concentration was significantly (12%) higher. Additionally, the 3-week treatment with sugar-beet fibre significantly lowered the fasting total- and LDL-cholesterol concentrations, by 8.5% and 9.6% respectively. We conclude that low doses of psyllium and citrus pectin at breakfast and lunch have no effects on the postprandial plasma measurements, but that sugar-beet fibre taken daily for 3 weeks affects both fasting and postprandial plasma metabolites favourably in these individuals with mildly increased risk of ischaemic heart disease. Further, we observed that small changes in haemodilution occur after meals, as indicated by plasma albumin concentration and packed cell volume. Underemphasis of the dietary fibre effects may occur when postprandial haemodilution is not taken into account.

Soluble fiber and serum lipids: a literature review.

J Am Diet Assoc;94(4):425-36, 1994 Apr. Glore SR; Van Treeck D; Knehans AW; Guild M

Resumo: Although fiber has been increasingly recognized as an important dietary constituent, controversy and confusion still exist about the physiologic effects of fiber. Specifically, the independent ability of dietary fiber to lower serum lipid levels is controversial. The purpose of this article is to review available evidence regarding the impact of soluble fibers on serum lipid levels. Soluble fibers appear to have a greater potential to alter serum lipid levels than do insoluble fibers. Significant reduction in the level of serum total cholesterol by soluble fiber was found in 68 of the 77 (88%) human studies reviewed. Of the studies measuring low-density lipoprotein cholesterol, 41 of 49 (84%) reported significant reductions. No significant changes were reported in 43 of the 57 (75%) studies that reported high-density lipoprotein cholesterol and/or in 50 of the 58 (86%) studies that measured triglyceride levels.

Fibra - Ruibarbo

Cholesterol lowering effects of rhubarb stalk fiber in hypercholesterolemic men.

J Am Coll Nutr;16(6):600-604, 1997 Dec. Goel V; Ooraikul B; Basu TK

Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada.

Resumo: OBJECTIVE: The present study was undertaken to examine the lipid lowering effects of rhubarb fiber prepared by blanching and drying fresh rhubarb stalks. The new fiber source contained 74% dietary fiber, on dry weight basis, with 66% insoluble and 8% soluble fiber. DESIGN: Ten hypercholesterolemic men were assigned to consume 27 g of ground rhubarb stalk fiber per day for 4 weeks. The dietary intake in terms of total energy, lipid and cholesterol was kept unaltered during the study period. Changes in serum lipid profile were monitored by obtaining blood samples before and after the fiber intervention. RESULTS: Rhubarb fiber supplementation resulted in significant lowering of serum total cholesterol (8%) and low-density lipoprotein (LDL) cholesterol (9%), while high-density lipoprotein cholesterol (HDL) concentrations remained unchanged. The depressed total and LDL cholesterol levels returned to baseline after the fiber supplementation was withdrawn for 1 month. CONCLUSION: The rhubarb stalk fiber is effective in lowering serum cholesterol concentrations, especially LDL cholesterol, in hypercholesterolemic men. These results signify the potential use of underutilized rhubarb crop.

Fibra - Plantago Psyllium

Lipid- and glucose-lowering efficacy of Plantago Psyllium in type II diabetes.

J Diabetes Complications;12(5):273-8, 1998 Sep-Oct. Rodríguez-Morán M; Guerrero-Romero F; Lazcano-Burciaga G

Mexican Social Security Institute and Research Group on Diabetes and Chronic Illnesses, Durango.

Resumo: The beneficial effect of dietary fiber in the management of type II diabetes is still controversial and has not been totally demonstrated. The purpose of this study was to determine the plasma-lowering effects of 5 g t.i.d. of Plantago Psyllium, as an adjunct to dietary therapy, on lipid and glucose levels, in patients with type II diabetes. Patients were randomly selected from an outpatient clinic of primary care to participate in a double-blind placebo-controlled study in which Plantago Psyllium or placebo was given in combination with a low fat diet. One hundred twenty-five subjects were included in the study that consisted in a 6-week period of diet counseling followed by a 6-week treatment period. Fasting plasma glucose, total plasma cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured every 2 weeks. The test products (Psyllium or placebo) were supplied to subjects in identically labeled foil packets containing a 5-g dose of product, to consume three doses per day (of 5 g each one), before regular meals. There was an excellent tolerance to Psyllium, without significant adverse effects. No significant changes were observed in the patient's weight for both groups (not significant). Fasting plasma glucose, total cholesterol, LDL cholesterol, and triglycerides levels, showed a significant reduction (p < 0.05), whereas HDL cholesterol increased significantly (p < 0.01) following Psyllium treatment. Our results show that 5 g t.i.d. of Psyllium is useful, as an adjunct to dietary therapy, in patients with type II diabetes, to reduce plasma lipid and glucose levels, resolving the compliance conflict associated with the ingest of a great amount of fiber in customary diet.

Effect of Plantago ovata (psyllium) husk and seeds on sterol metabolism: studies in normal and ileostomy subjects.

Am J Clin Nutr;59(2):395-400, 1994 Feb. Gelissen IC; Brodie B; Eastwood MA

Resumo: The diet of six normal and five ileostomy subjects was supplemented with 10 g/d Plantago ovata psyllium husk for 3 wk while six normal and four ileostomy subjects received 10 g/d psyllium seed. Fecal and ileostomy output, sterol excretion, serum cholesterol, and triglycerides were measured before and after supplementation. The husk had no effect on cholesterol or triglyceride concentrations in either normal or ileostomy subjects. Total and high-density-lipoprotein-cholesterol concentrations were reduced on average by 6.4% and 9.3%, respectively, in the normal group after seed supplementation. No effect on fecal bile acid excretion in the normal subjects was found after both regimes. Ileostomy bile acids were increased (on average 25%) after seed supplementation, whereas no effect on cholesterol concentrations was found. These results suggest that psyllium seed might be more effective than the husk in reducing serum cholesterol, that this cholesterol-lowering effect is not mediated by increased fecal bile acid losses, and increased ileal losses of bile acids might be compensated for by enhanced reabsorption in the colon.

Alho

Garlic extract therapy in children with hypercholesterolemia.
Arch Pediatr Adolesc Med. 1998 Nov;152(11):1089-94.

McCrindle BW, Helden E, Conner WT.
Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada.

OBJECTIVE: To determine whether garlic extract therapy is efficacious and safe in children with hypercholesterolemia. DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: Specialized pediatric lipid disorders ambulatory clinic. PARTICIPANTS: Thirty pediatric patients, aged 8 to 18 years, who had familial hyperlipidemia and a minimum fasting total cholesterol level greater than 4.8 mmol/L (> 185 mg/dL). INTERVENTION: An 8-week course of a commercially available garlic extract (Kwai [Lichtwer Pharma, Berlin, Germany], 300 mg, 3 times a day) or an identical placebo. MAIN OUTCOME MEASURES: Absolute and relative changes in fasting lipid profile parameters. RESULTS: The groups were equivalent at baseline and compliance

was similar in the 2 groups (P = .45). There was no significant relative attributable effect of garlic extract on fasting total cholesterol (+0.6% [95% confidence interval, -5.8% to +6.9%1) or low-density lipoprotein cholesterol (-0.5% [95% confidence interval, -8.7% to +7.6%]). The lower limits of the confidence intervals did not include -10%, the minimum relative attributable effect believed to be clinically important. Likewise, no significant effect was seen on the levels of high-density lipoprotein, triglycerides, apolipoprotein B-100, lipoprotein (a), fibrinogen, homocysteine, or blood pressure. There was a small effect on apolipoprotein A-I (+10.0% [95% confidence interval, +1.2% to +16.5%] P=.03). There were no differences in adverse effects between groups. CONCLUSION: Garlic extract therapy has no significant effect on cardiovascular risk factors in pediatric patients with familial hyperlipidemia.

Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism: a randomized controlled trial.
Berthold HK, Sudhop T, von Bergmann K.
Department of Clinical Pharmacology, University of Bonn, Germany. berthold@uni-bonn.de

CONTEXT: Garlic-containing drugs have been used in the treatment of hypercholesterolemia even though their efficacy is not generally established. Little is known about the mechanisms of action of the possible effects on cholesterol in humans. OBJECTIVE: To estimate the hypocholesterolemic effect of garlic oil and to investigate the possible mechanism of action. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Outpatient lipid clinic. PATIENTS: We investigated 25 patients (mean age, 58 years) with moderate hypercholesterolemia. INTERVENTION: Steam-distilled garlic oil preparation (5 mg twice a day) vs placebo each for 12 weeks with wash-out periods of 4 weeks. MAIN OUTCOME MEASURES: Serum lipoprotein concentrations, cholesterol absorption, and cholesterol synthesis. RESULTS: Baseline lipoprotein profiles were (mean [SD]): total cholesterol, 7.53 (0.75) mmol/L (291 [29] mg/dL); low-density lipoprotein cholesterol (LDL-C), 5.35 (0.78) mmol/L (207 [30] mg/dL); high-density lipoprotein cholesterol (HDL-C), 1.50 (0.41) mmol/L (58 [16] mg/dL); and triglycerides, 1.45 (0.73) mmol/L (127 [64] mg/ dL). Lipoprotein levels were virtually unchanged at the end of both treatment periods (mean difference [95% confidence interval]): total cholesterol, 0.085 (-0.201 to 0.372) mmol/L (3.3 [-7.8 to 14.4] mg/dL), P=.54; LDL-C, 0.001 (-0.242 to 0.245) mmol/L (0.04 [-9.4 to 9.5] mg/dL), P=.99; HDL-C, 0.050 (-0.028 to 0.128) mmol/L (1.9 [-1.1 to 4.9] mg/dL), P=.20; triglycerides, 0.047 (-0.229 to 0.135) mmol/L (4.2 [-20.3 to 12.0]) mg/dL, P=.60. Cholesterol absorption (37.5% [10.5%] vs 38.3% [10.7%0], P=.58), cholesterol synthesis (12.7 [6.5] vs 13.4 [6.6] mg/kg of body weight per day, P=.64), mevalonic acid excretion (192 [66] vs 187 [66] microg/d, P=.78), and changes in the ratio of lathosterol to cholesterol in serum (4.4% [24.3%] vs 10.6% [21.1%], P=.62) were not different in garlic and placebo treatment. CONCLUSIONS: The commercial garlic oil preparation investigated had no influence on serum lipoproteins, cholesterol absorption, or cholesterol synthesis. Garlic therapy for treatment of hypercholesterolemia cannot be recommended on the basis of this study.

Garlic powder and plasma lipids and lipoproteins: a multicenter, randomized, placebo-controlled trial.
Arch Intern Med. 1998 Jun 8;158(11):1189-94.
Isaacsohn JL, Moser M, Stein EA, Dudley K, Davey JA, Liskov E, Black HR.
The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio, USA. ejlmarc@aol.com

BACKGROUND: Garlic powder tablets have been reported to lower serum cholesterol levels. There is widespread belief among the general public that garlic powder tablets aid in controlling cholesterol levels. However, much of the prior data demonstrating the cholesterol-lowering effect of garlic tablets involved studies that were inadequately controlled. OBJECTIVE: To determine the lipid-lowering effect of garlic powder tablets in patients with hypercholesterolemia. METHODS: This was a randomized, double-blind, placebo-controlled, 12-week, parallel treatment study carried out in 2 outpatient lipid clinics. Entry into the study after 8 weeks of diet stabilization required a mean low-density lipoprotein cholesterol level on 2 visits of 4.1 mmol/L (160 mg/dL) or lower and a triglyceride level of 4.0 mmol/L (350 mg/dL) or lower. The active treatment arm received tablets containing 300 mg of garlic powder (Kwai) 3 times per day, given with meals (total, 900 mg/d). This is equivalent to approximately 2.7 g or approximately 1 clove of fresh garlic per day. The placebo arm received an identical-looking tablet, also given 3 times per day with meals. The main outcome measures included levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol after 12 weeks of treatment. RESULTS: Twenty-eight patients (43% male; mean +/- SD age, 58 +/- 14 years) received garlic powder treatment and 22 (68% male; mean +/- SD age, 57 +/- 13 years) received placebo treatment. There were no significant lipid or lipoprotein changes in either the placebo- or garlic-treated groups and no significant difference between changes in the placebo-treated group compared with changes in the garlic-treated patients. CONCLUSION: Garlic powder (900 mg/d) treatment for 12 weeks was ineffective in lowering cholesterol levels in patients with hypercholesterolemia.

Food labeling: health claims; garlic, reduction of serum cholesterol, and the risk of cardiovascular disease in adults--FDA. Interim final rule.
Fed Regist. 1998 Jun 22;63(119):34110-2.

The Food and Drug Administration (FDA) is issuing an interim final rule to prohibit the use on foods of a claim relating to the relationship between garlic, decreased serum cholesterol, and the risk in adults of cardiovascular disease. This interim final rule is in response to a notification of a health claim submitted under section 303 of the FDA Modernization Act of 1997 (FDAMA). FDA has reviewed the statement that the petitioner submitted in that notification, and, in conformity with the requirements of FDAMA, the agency is prohibiting the claim because the statement submitted as the basis of the claim is not an "authoritative statement" of a scientific body, as required by FDAMA; therefore, section 303 of FDAMA, does not authorize use of this claim. As provided for in section 301 of FDAMA, this rule is effective immediately upon publication.

Modulation of lipid profile by fish oil and garlic combination.
J Natl Med Assoc. 1997 Oct;89(10):673-8.
Morcos NC.
Division of Cardiology, University of California, Irvine 92717, USA.

Fish consumption has been shown to influence epidemiology of heart disease, and garlic has been shown to influence triglyceride levels. This study was undertaken to evaluate the effect of fish oil and garlic combinations as a dietary supplement on the lipid subfractions. Forty consecutive subjects with lipid profile abnormalities were enrolled in a single-blind, placebo-controlled crossover study. Each subject received placebo for 1 month and fish oil (1800 mg of eicosapentanoic acid [EPA] + 1200 mg of docosahexanoic acid) with garlic powder (1200 mg) capsules daily for 1 month. Lipid fractionation was performed prior to study initiation, after the placebo period, and after the intervention period. Subjects all had cholesterol levels > 200. Subjects were instructed to maintain their usual diets. Supplementation for 1 month resulted in an 11% decrease in cholesterol, a 34% decrease in triglyceride, and a 10% decrease in low-density lipoprotein (LDL) levels, as well as a 19% decrease in cholesterol/high-density lipoprotein (HDL) risk. Although not significant, there was a trend toward increase in HDL. There was no significant placebo effect. These results suggest that in addition to the known anticoagulant and antioxidant properties of both fish oil and garlic, the combination causes favorable shifts in the lipid subfractions within 1 month. Triglycerides are affected to the largest extent. The cholesterol lowering and improvement in lipid/HDL risk ratios suggests that these combinations may have antiatherosclerotic properties and may protect against the development of coronary artery disease.

Efficacy of garlic supplementation in lowering serum cholesterol levels.
Nutr Rev. 2001 Jul;59(7):236-41.
Spigelski D, Jones PJ.
School of Dietetics and Human Nutrition, McGill University, Quebec, Canada.

Previous studies using garlic have found alterations on a number of cardiovascular disease (CVD) risk factors including blood pressure, plasma viscosity, platelet activity, and serum lipid levels. The latest clinical research suggests that consumption of garlic powder does not play a significant role in lowering plasma lipid levels when in conjunction with a low-fat, low-cholesterol diet. Additional well-controlled, long-term studies that explore dosage and preparation type are necessary to confirm the efficacy of garlic in lowering cholesterol levels and to fully understand garlic's potential role in CVD.

Cholesterol-lowering effect of garlic extracts and organosulfur compounds: human and animal studies.
J Nutr. 2001 Mar;131(3s):989S-93S.
Yeh YY, Liu L.
Department of Nutrition, The Pennsylvania State University, University Park, PA 16802, USA. yyy1@psu.edu

The medicinal use of garlic dates back thousands of years, but there was little scientific support of its therapeutic and pharmacologic properties until recently. In the past decade, the cancer-protective effects of garlic have been well established by epidemiologic studies and animal experiments. However, the cardiovascular-protective properties of garlic are less well understood. In particular, despite the reported hypocholesterolemic effect of garlic, the mechanism of the effect is unclear. In a recent randomized, double-blind, placebo-controlled intervention study, we showed that aged garlic extract (AGE) supplementation was effective in lowering plasma concentration of total cholesterol by 7% and LDL cholesterol by 10% in hypercholesterolemic men compared with subjects consuming a placebo. Supplementation of AGE in animal diets similarly reduced plasma concentrations of total cholesterol and triacylglycerol by 15 and 30%, respectively. In subsequent experiments using cultured rat hepatocytes, we found 44--87% inhibition of cholesterol synthesis by the water-extractable fraction (WEF), methanol-extractable fraction (MEF) and petroleum ether-extractable fraction (PEF) of fresh garlic, and Kyolic (liquid form of AGE). These observations suggested that hydrophilic and hydrophobic compounds of garlic are inhibitory to cholesterol synthesis. Because S-allylcysteine (SAC) alone was less potent than Kyolic, which contains SAC and other sulfur compounds, a maximal inhibition appears to require a concerted action of multiple compounds of garlic. In a series of experiments, we further characterized the inhibitory potency of individual water-soluble and lipid-soluble compounds of garlic. Among water-soluble compounds, SAC, S-ethylcysteine (SEC), and S-propylcysteine (SPC) inhibited cholesterol synthesis by 40--60% compared with 20--35% by gamma-glutamyl-S-allylcysteine (GSAC), gamma-glutamyl-S-methylcysteine (GSMC) and gamma-glutamyl-S-propylcysteine (GSPC). Lipid-soluble sulfur compounds (i.e., diallyl sulfide, diallyl disulfide, diallyl trisulfide, dipropyl sulfide and dipropyl trisulfide) at low concentrations (0.05--0.5 mol/L) slightly (10--15%) inhibited cholesterol synthesis but became highly cytotoxic at high concentrations (1.0--4.0 mol/L). All water-soluble compounds, except S-allylmercaptocysteine, were not cytotoxic, judging from the release of cellular lactate dehydrogenase into the culture medium. Taken together, the results of our studies indicate that the cholesterol-lowering effects of garlic extract, such as AGE, stem in part from inhibition of hepatic cholesterol synthesis by water-soluble sulfur compounds, especially SAC.

Suppression of LDL oxidation by garlic.
J Nutr. 2001 Mar;131(3s):985S-8S.
Lau BH.
Department of Microbiology and Molecular Genetics, School of Medicine, Loma Linda University, Loma Linda, CA 92350, USA.

It has been known for several decades that hypercholesterolemia is a major risk factor for atherosclerosis and that lowering of cholesterol can significantly reduce risk for cardiovascular diseases. More recently, oxidation of LDL has been recognized as playing an important role in the initiation and progression of atherosclerosis. Oxidized LDL, but not native LDL, promotes vascular dysfunction by exerting direct cytotoxicity toward endothelial cells, by increasing chemotactic properties for monocytes, by transforming macrophages to foam cells via scavenger-receptors and by enhancing the proliferation of various cell types, e.g., endothelial cells, monocytes and smooth muscle cells; all of these events are recognized as contributing to atherogenesis. In this paper, experimental evidence is presented that shows that several garlic compounds can effectively suppress LDL oxidation in vitro. Short-term supplementation of garlic in human subjects has demonstrated an increased resistance of LDL to oxidation. These data suggest that suppressed LDL oxidation may be one of the powerful mechanisms accounting for the antiatherosclerotic properties of garlic.

Garlic ameliorates hyperlipidemia in chronic aminonucleoside nephrosis.
Mol Cell Biochem. 2000 Aug;211(1-2):69-77.
Pedraza-Chaverri J, Medina-Campos ON, Granados-Silvestre MA, Maldonado PD, Olivares-Corichi IM, Hernandez-Pando R.
Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico.

Nephrotic syndrome (NS) is characterized by proteinuria, oxidative stress and endogenous hyperlipidemia. Hyperlipidemia and oxidative stress may be involved in coronary heart disease and the progression of renal damage in these patients. Garlic has been suggested to be beneficial in various disease states. Some of the beneficial effects of garlic may be secondary to its hypolipidemic and antioxidant properties. Therefore, the effect of a 2% garlic diet on acute and chronic experimental NS induced by puromycin aminonucleoside (PAN) was studied in this work. Acute NS was induced by a single injection of PAN to rats which were sacrificed 10 days later. Chronic NS was induced by repeated injections of PAN to rats which were sacrificed 84 days after the first injection. Garlic treatment was unable to modify proteinuria in either acute or chronic NS, and hypercholesterolemia and hypertriglyceridemia in acute NS. However, garlic treatment diminished significantly total-cholesterol, LDL-cholesterol and triglycerides, but not HDL-cholesterol in chronic NS. Garlic induced no change in the percentage of sclerotic glomeruli in chronic NS and a significative decrease on the percentage of sclerotic area of these glomeruli (33 +/- 3% in NS+Garlic group vs. 47 +/- 4% in NS group, p = 0.0126). The enhanced in vivo renal H2O2 production and the diminished renal Cu, Zn-SOD and catalase activities in acute NS, and the decreased renal catalase activity in chronic NS were not prevented by garlic treatment. These data indicate that garlic treatment ameliorates hyperlipidemia and renal damage in chronic NS which is unrelated to proteinuria or antioxidant enzymes.

Garlic powder, effect on plasma lipids, postprandial lipemia, low-density lipoprotein particle size, high-density lipoprotein subclass distribution and lipoprotein(a).
J Am Coll Cardiol. 2000 Feb;35(2):321-6. Superko HR, Krauss RM.
Cholesterol, Genetics and Heart Disease Institute, Berkeley Heart Lab, San Mateo, California 94402, USA.

OBJECTIVES: To test the hypothesis that a garlic supplement alters plasma lipoproteins, postprandial lipemia, low-density lipoprotein (LDL) size and high-density lipoprotein (HDL) subclass distribution differently in 50 moderately hypercholesterolemic subjects classified as LDL subclass pattern A or B. BACKGROUND: Garlic has been variably reported to reduce or not affect plasma cholesterol values. Low-density lipoprotein pattern B is a common inherited disorder of lipoprotein metabolism that has been shown to have a significantly greater response to several lipid lowering treatments including low fat diet when compared with LDL pattern A individuals. METHODS: A double blind, randomized, placebo controlled trial in an outpatient lipid research clinic was performed and included fifty moderately hypercholesterolemic subjects (mean LDL cholesterol = 166 +/- 22 mg/dl) classified as LDL subclass pattern A (predominantly large LDL, n = 22) or B (predominantly small LDL, n = 28). Following a two-month stabilization period, subjects were randomly assigned to a placebo or 300 mg three times a day of a standardized garlic tablet for three months. RESULTS: For all subjects, LDL pattern A and B subjects combined, garlic treatment for three months resulted in no significant change in total cholesterol, LDL cholesterol, HDL cholesterol, HDL subclass distribution, postprandial triglycerides, apolipoprotein B, lipoprotein (a) (Lp[a]), LDL peak particle diameter or LDL subclass distribution. There was no significant difference in response for the same parameters among subjects classified as LDL pattern A or B with the exception of significantly greater (p = 0.01) reduction in mean peak particle diameter in pattern A subjects treated with either garlic or placebo. There was no significant change in LDL subclass distribution. CONCLUSIONS: This investigation confirms that garlic therapy has no effect on major plasma lipoproteins and further, that it has no impact on HDL subclasses, Lp(a), apolipoprotein B, postprandial triglycerides or LDL subclass distribution. Garlic may have a greater effect on LDL particle diameter in LDL pattern A compared with pattern B subjects. This difference was not reflected in other plasma lipid measurements.

A systematic review of the effectiveness of garlic as an anti-hyperlipidemic agent.

J Am Acad Nurse Pract;15(3):120-9, 2003 Mar. Alder R; Lookinland S; Berry JA; Williams M

Resumo: PURPOSE: To 1) conduct a thorough search of the literature for randomized controlled trials (RCTs) addressing the efficacy of garlic as an antihyperlipidemic agent, 2) critically appraise those studies, and 3) make a recommendation for practicing health care professionals. DATA SOURCES: Two independent reviewers extracted data from the articles identified from several data bases, using the previously tested Boyack and Lookinland Methodological Quality Index (MQI) as the standard. RESULTS: Six of ten studies found garlic to be effective. The average drop in total cholesterol was 24.8 mg/dL (9.9%), LDL 15.3 mg/dL (11.4%), and triglycerides 38 mg/dL (9.9%). The overall average MQI score was 39.6% (18%-70%). Major shortcomings of many of the RCTs included short duration, lack of power analysis and intention to treat analysis, as well as lack of control of diet as a confounding variable. CONCLUSION/IMPLICATIONS: The low methodological quality of the studies make it difficult to recommend garlic as an antihyperlipidemic agent. Until larger RCTs of longer duration, which correct the existing methodological flaws, are designed and carried out, it is best not to recommend garlic be used to treat mild to moderate hyperlipidemia.

Reduction of cardiovascular risk in primary prophylaxy of coronary heart disease

Klin Med (Mosk);83(4):52-5, 2005. Sobenin IA; Prianishnikov VV; Kunnova LM; Radinovich EA; Orekhov AN . Trabalho da Federação Russa

Resumo: The purpose of the study was to evaluate the effects of Allicor, an Allium sativum (garlic) preparation with prolonged activity, on 10-year prognostic risk of coronary heart disease (CHD), acute myocardial infarction (MI) and sudden death in patients with elevated and high risk of CHD. 79 patients with elevated and high risk of CHD were included in a double blind randomized placebo-controlled study. They underwent multifactor evaluation of cardiovascular risk by algorithms based on the results of Framingham and Munster studies. Prolonged (12 months) administration of Allicor significantly reduced the multifactor risk, which was demonstrated by a 13.2% (p = 0.005) reduction of prognostic 10-year risk of CHD in men, and a 7.1% (p = 0.040) reduction of the same parameter in women. Prognostic 10-year risk of MI and sudden death in men was reduced by 26.1% (p = 0.025) and did not change significantly in women. In men the main factor of cardiovascular risk reduction was the decrease of cholesterol and low-density lipoprotein concentration by 23.5 +/- 6.6 mg/dl (p = 0.004), and in women - the increase of high-density lipoprotein level by 2.8 +/- 1.5 mg/dl (p = 0.040). The results of the study demonstrate that prolonged Allicor therapy can be applied to the large category of patients who are in need of atherosclerosis prevention.

Allicin release under simulated gastrointestinal conditions from garlic powder tablets employed in clinical trials on serum cholesterol.

Planta Med;67(1):13-8, 2001 Feb. Lawson LD; Wang ZJ; Papadimitriou D

Resumo: The failure of five recent clinical trials to show significant reduction in elevated serum cholesterol by a single brand of allicin-standardized garlic powder tablets is in contrast to many prior positive studies with the same brand. The hypocholesterolemic activity of garlic is mainly due to allicin, a compound that is produced by the acid-sensitive garlic enzyme, alliinase, only after tablet consumption. Therefore, the allicin-releasing ability of ten lots of these tablets--manufactured over the same years that the positive and negative clinical trials were conducted (1989-1997)--was determined under simulated gastrointestinal dissolution conditions, as defined by U.S. Pharmacopeia Method 724A. It was found that the older lots were more resistant to acid-disintegration (2.5 h vs. 1.3 h, P < 0.001) and that they released three times as much allicin (44% vs. 15 % of their potential, P < 0.001) as the newer lots. A second brand of tablets employed in a recent negative trial released no detectable amount of allicin, while a third set of tablets with high allicin release was used in a trial that gave positive effects. Hence, the persons involved in the recent negative clinical trials probably received considerably less allicin than did those in the older positive studies, possibly accounting for much of the discrepancy in the outcomes. In conclusion, clinical trials using garlic powder tablets to assess any effect of garlic that might be related to allicin, as most are, cannot be considered valid for garlic when the trial shows no effect, unless the expected allicin release from the tablets has at least been determined under standardized drug release conditions (USP 724A).

Garlic for treating hypercholesterolemia. A meta-analysis of randomized clinical trials.

Ann Intern Med;133(6):420-9, 2000 Sep 19. Stevinson C; Pittler MH; Ernst E

Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, United Kingdom.

Resumo: PURPOSE: To investigate the effect of garlic on total cholesterol level in persons with elevated levels by conducting a meta-analysis of randomized, double-blind, placebo-controlled trials. DATA SOURCES: Systematic literature searches were conducted on the MEDLINE, EMBASE, BIOSIS, Cochrane Library, AMED, and CISCOM databases. Manufacturers of commercial garlic preparations and experts in the field were asked about published or unpublished trials. STUDY SELECTION: Selected trials were required to state that they were randomized, double-blind, and placebo-controlled; use garlic monopreparations; include persons with mean total cholesterol levels of at least 5.17 mmol/L (200 mg/dL); and report total cholesterol level as an end point. There were no language restrictions. DATA EXTRACTION: Two reviewers, blinded to key identifiers of each paper, independently extracted data in a standardized manner and assessed methodologic quality by using the Jadad scale. Discrepancies were settled through discussion. DATA SYNTHESIS: In the 13 trials included in the meta-analysis, garlic reduced total cholesterol level from baseline significantly more than placebo (P < 0.01); the weighted mean difference was -0.41 mmol/L (95% CI, -0.66 to -0.15 mmol/L) (-15.7 mg/dL [CI, -25.6 to -5. 7 mg/dL]). Six diet-controlled trials with the highest scores for methodologic quality revealed a nonsignificant difference between garlic and placebo groups; the weighted mean difference was -0.11 mmol/L (CI, -0.30 to 0.08 mmol/L) (-4.3 mg/dL [CI, -11.7 to 3.1 mg/dL]). CONCLUSIONS: The available data suggest that garlic is superior to placebo in reducing total cholesterol levels. However, the size of the effect is modest, and the robustness of the effect is debatable. The use of garlic for hypercholesterolemia is therefore of questionable value.

Effect of allicin from garlic powder on serum lipids and blood pressure in rats fed with a high cholesterol diet.

Prostaglandins Leukot Essent Fatty Acids;62(4):253-9, 2000 Apr. Ali M; Al-Qattan KK; Al-Enezi F; Khanafer RM; Mustafa T

Department of Biological Sciences, Faculty of Science, Kuwait University, Safat. muslim@kuc01.kuniv.edu.kw

Resumo: The use of fresh aqueous garlic extract is known to be effective in reducing thromboxane formation by platelets in both in vivo and in vitro animal models of thrombosis. In the present study, we studied the effect of Lichtwer garlic powder (containing 1.3% alliin equivalent to 0.6% allicin) on the serum cholesterol, triglyceride, glucose, protein, and systolic blood pressure in rats fed with a high cholesterol diet. Experimental rats were fed a 2% high cholesterol diet with and without garlic powder for 6 weeks. Control rats were fed a normal diet. The aqueous garlic powder extract was given orally to rats on a daily basis. It was observed that cholesterol-fed animals had a significant increase in serum cholesterol compared to the control group of rats fed on a normal diet. However, when the rats were fed with a high cholesterol diet mixed with garlic powder, there was a significant reduction in their serum cholesterol levels compared with the group which were on a diet containing high cholesterol without garlic powder. Serum triglyceride levels were also significantly lowered by garlic powder when compared to control and high cholesterol diet group rats. The blood pressure of the high cholesterol diet animals was significantly higher compared to the animals receiving the control diet. The blood pressure of the animals receiving garlic powder and high cholesterol diet was significantly lower as compared to the high cholesterol and control diet group. No significant changes were observed in the serum glucose and protein in all of the rats. These results show that garlic is beneficial in reducing blood cholesterol, triglycerides levels and systolic blood pressure in hypercholesterolemic rats. Our experimental results show that garlic may beneficially affect two risk factors for atherosclerosis--hyperlipidemia and hypertension.

A comparative study on hypocholesterolaemic effect of allicin, whole germinated seeds of bengal gram and guggulipid of gum gugglu.

Phytother Res;14(3):200-2, 2000 May. Ghorai M; Mandal SC; Pal M; Pal SP; Saha BP

Department of Pharmaceutical Technology, Faculty of Engineering and Technology, Jadavpur University, Calcutta - 700032, India

Resumo: The daily use of allicin and whole germinated bengal gram seeds for 8 weeks led to a significant decrease in serum cholesterol levels in normal volunteers with no side effects. The standard reference, guggulipid therapy, significantly (p < 0.001) reduced the mean serum cholesterol level to 142.88 +/- 24.14 mg/100 mL from an initial status of 211.91 +/- 6.23 mg/100mL (32.36% +/- 12.48% fall). Allicin treatment significantly reduced the mean serum cholesterol level to 129.99 +/- 2.79 mg/100 mL from a pre-treatment value of 148.10 +/- 8. 81 mg/100mL, a fall of 13.36% +/- 4.64%. The serum cholesterol value was reduced to 135.62+/- 22.85 mg/100 mL from a pre-treatment value of 157.29 +/- 4.94 mg/100mL (17.15% +/- 9.94% fall) due to daily use of whole germinated bengal gram seeds. Hence the hypocholesterolaemic effects of allicin and whole germinated bengal gram seeds are comparable to the established standard reference, guggulipid. These two materials are herbal in origin and it is supposed to have a lesser risk-benefit ratio compared with other available synthetic drugs. The inclusion of these herbal products in the normal diet may be an alternative effective measure for hypercholesterolaemia.

Effect of garlic (Allium sativum) on blood lipids, blood sugar, fibrinogen and fibrinolytic activity in patients with coronary artery disease.

Prostaglandins Leukot Essent Fatty Acids;58(4):257-63, 1998 Apr. Bordia A; Verma SK; Srivastava KC Department of Medicine, RNT Medical College, Udaipur, India.

Resumo: Thirty patients with coronary artery disease (CAD) were administered garlic (study group) while another 30 patients received the placebo (control group). Various risk parameters were determined at 1.5 and 3 months of garlic administration. Garlic, administered in a daily dose of 2 x 2 capsules (each capsule containing ethyl acetate extract from 1 g peeled and crushed raw garlic), reduced significantly total serum cholesterol and triglycerides, and increased significantly HDL-cholesterol and fibrinolytic activity. There was no effect on the fibrinogen and glucose levels. In vitro effects of the garlic oil on platelet aggregation (PAg) and eicosanoid metabolism were examined; it inhibited PAg induced by several platelet agonists, and also platelet thromboxane formation. Two important paraffinic polysulphides - diallyl disulphide (DADS) and diallyl trisulphide (DATS) - derived from garlic and are usual constituents of garlic oil, showed antiplatelet activity, and also inhibited platelet thromboxane formation. In this respect DATS was more potent than DADS. The nature of inhibition of PAg by DATS was found to be reversible.

New pharmacological activities of garlic and its constituents

Nippon Yakurigaku Zasshi;110 Suppl 1:93P-97P, 1997 Oct. Sumiyoshi H

Wakunaga Pharmaceutical Co., Ltd., Hiroshima, Japan.

Resumo: According to the recent pharmacological findings, garlic is a preventive rather than therapeutic. Epidemiological studies in China, Italy and USA showed the inverse relationship between stomach and colon cancer incidences and dietary garlic intake. Anti-carcinogenic activities of garlic and its constituents including sulfides and S-allyl cysteine, have been demonstrated using several animal models. Garlic preparations has been also shown to lower serum cholesterol and triglyceride levels, which are major risk factors of cardiovascular diseases, through inhibition of their bio-synthesis in the liver, and to inhibit oxidation of low density lipoprotein. Furthermore, in vitro and in vivo studies have revealed that aged garlic extract stimulated immune functions, such as proliferation of lymphocyte, cytokine release, NK activity and phagocytosis. More recently, aged garlic extract has been demonstrated to prolong life span of senescence accelerated mice and prevent brain atrophy. Manufacturing processes significantly affect chemical constituents in garlic preparations. Different forms contain different phytochemicals and may have different effects and toxicities. For example, aged garlic extract inhibited t-BuOOH-induced oxidation, whereas raw garlic stimulated the oxidation. Although garlic has been used as a condiment and folklore for a long time, it has been noted to cause adverse reactions, such as stomach ulcer and anemia. Among the garlic preparations, only aged garlic extract has been proven to be safe through toxicological studies. Thus, aged garlic extract could be the most promising garlic preparation for disease prevention.

Effects of garlic on atherosclerosis.

Nutrition;13(7-8):656-63, 1997 Jul-Aug. Orekhov AN; Grünwald J

Institute of Experimental Cardiology, Cardiology Research Center of the Russian Academy of Medical Sciences, Moscow, Russia. Resumo: This review discusses the use of garlic and garlic preparations as agents for prevention and treatment of atherosclerosis and atherosclerosis-related diseases. Garlic indirectly effects atherosclerosis by reduction of hyperlipidemia, hypertension, and probably diabetes mellitus and prevents thrombus formation. In addition, in animal models, garlic causes direct antiatherogenic (preventive) and antiatherosclerotic (causing regression) effects at the level of artery wall. Garlic's direct effect on atherosclerosis may be explained by its capacity to reduce lipid content in arterial cells and to prevent intracellular lipid accumulation. This effect, in turn, is accompanied by other atherosclerotic manifestations, i.e., stimulation of cell proliferation and extracellular matrix synthesis. Clinical trials are currently being carried out to reveal the possible effect of garlic therapy on human atherosclerosis. Positive results of these trials may open a new era in the use of garlic for prevention and treatment of many atherosclerosis-related diseases.

A double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids.

Am J Clin Nutr;64(6):866-70, 1996 Dec. Steiner M; Khan AH; Holbert D; Lin RI

Resumo: A double-blind crossover study comparing the effect of aged garlic extract with a placebo on blood lipids was performed in a group of 41 moderately hypercholesterolemic men [cholesterol concentrations 5.7-7.5 mmol/L (220-290 mg/dL)]. After a 4-wk baseline period, during which the subjects were advised to adhere to a National Cholesterol Education Program Step I diet, they were started on 7.2 g aged garlic extract per day or an equivalent amount of placebo as a dietary supplement for a period of 6 mo, then switched to the other supplement for an additional 4 mo. Blood lipids, blood counts, thyroid and liver function measures, body weight, and blood pressure were followed over the entire study period. The major findings were a maximal reduction in total serum cholesterol of 6.1% or 7.0% in comparison with the average concentration during the placebo administration or baseline evaluation period, respectively. Low-density-lipoprotein cholesterol was also decreased by aged garlic extract, 4% when compared with average baseline values and 4.6% in comparison with placebo period concentrations. In addition, there was a 5.5% decrease in systolic blood pressure and a modest reduction of diastolic blood pressure in response to aged garlic extract. We conclude that dietary supplementation with aged garlic extract has beneficial effects on the lipid profile and blood pressure of moderately hypercholesterolemic subjects.

Garlic powder in the treatment of moderate hyperlipidaemia: a controlled trial and meta-analysis.

J R Coll Physicians Lond;30(4):329-34, 1996 Jul-Aug. Neil HA; Silagy CA; Lancaster T; Hodgeman J; Vos K; Moore JW; Jones L; Cahill J; Fowler GH

Resumo: OBJECTIVE: To determine the effect of 900 mg/day of dried garlic powder (standardised to 1.3% allicin) in reducing total cholesterol. DESIGN: Double-blind, randomised six-month parallel trial. SUBJECTS: 115 individuals with a repeat total cholesterol concentration of 6.0-8.5 mmol/l and low-density lipoprotein (LDL) cholesterol of 3.5 mmol/l or above after six weeks of dietary advice. INTERVENTION: The active treatment group received dried garlic tablets (standardised to 1.3% allicin) at a dosage of 300 mg three times daily. The control group received a matching placebo. OUTCOME MEASURES: Primary end-point: total cholesterol concentration; secondary end-points: concentrations of LDL and high-density lipoprotein cholesterol, apolipoproteins (apo) A1 and B, and triglycerides. RESULTS: There were no significant differences between the groups receiving garlic and placebo in the mean concentrations of serum lipids, lipoproteins or apo A1 or B, by analysis either on intention-to-treat or treatment received. In a meta-analysis which included the results from this trial, garlic was associated with a mean reduction in total cholesterol of -0.65 mmol/l (95% confidence intervals: -0.53 to -0.76). CONCLUSIONS: In this trial, garlic was less effective in reducing total cholesterol than suggested by previous meta-analyses. Possible explanations are publication bias, overestimation of treatment effects in trials with inadequate concealment of treatment allocation, or a type 2 error. We conclude that meta-analyses should be interpreted critically and with particular caution if the constituent trials are small.

Consumption of a garlic clove a day could be beneficial in preventing thrombosis.

Prostaglandins Leukot Essent Fatty Acids;53(3):211-2, 1995 Sep. Ali M; Thomson M

Department of Biochemistry, Faculty of Science, Kuwait University, Safat, Kuwait.

Resumo: The effect of the consumption of a fresh clove of garlic on platelet thromboxane production was examined. A group of male volunteers in the age range 40-50 years participated in the study. Each volunteer consumed one clove (approximately 3 g) of fresh garlic daily for a period of 16 weeks. Each participant served as his own control. Thromboxane B2 (TXB2, a stable metabolite of thromboxane A2), cholesterol and glucose were determined in serum obtained after blood clotting. After 26 weeks of garlic consumption, there was an approximately 20% reduction of serum cholesterol and about 80% reduction in serum thromboxane. No change in the level of serum glucose was observed. Thus, it appears that small amounts of fresh garlic consumed over a long period of time may be beneficial in the prevention of thrombosis.

On the effect of garlic on plasma lipids and lipoproteins in mild hypercholesterolaemia.

Atherosclerosis;113(2):219-25, 1995 Mar. Simons LA; Balasubramaniam S; von Konigsmark M; Parfitt A; Simons J; Peters W

Resumo: The ingestion of garlic has been reported to have many cardiovascular effects, including a reduction in plasma cholesterol concentration and the susceptibility of LDL to oxidation. A double-blind, placebo-controlled, randomised crossover study was conducted in subjects with mild to moderate hypercholesterolaemia who were subject to strict dietary supervision and assessment. After a baseline dietary period of 28 days, subjects took Kwai garlic powder tablets 300 mg three times daily or matching placebo for 12 weeks, followed by 28 days washout, followed by a 12 weeks crossover on the alternative preparation. In the analysis hypercholesterolaemia was defined as those subjects in the range 5.5-8.05 mmol/l. Three subjects were withdrawn, one allocated to garlic and complaining of garlic body odour, one using placebo having intercurrent health problems, and one with a baseline cholesterol below 5.5 mmol/l, yielding analysable results in 28 subjects. Comparing the period on garlic with that on placebo, there were no significant differences in plasma cholesterol, LDL cholesterol, HDL cholesterol, plasma triglycerides, lipoprotein(a) concentrations, or blood pressure. Mean LDL cholesterol concentration was 4.64 +/- 0.52 mmol/l on garlic and 4.60 +/- 0.59 mmol/l on placebo. There was no demonstrable effect of garlic on oxidisability of LDL, on the ratio of plasma lathosterol/cholesterol (a measure of cholesterol synthesis), nor on LDL receptor expression in lymphocytes. This study found no demonstrable effect of garlic ingestion on lipids and lipoproteins.

Garlic as a lipid lowering agent--a meta-analysis.

J R Coll Physicians Lond;28(1):39-45, 1994 Jan-Feb. Silagy C; Neil A

Resumo: Garlic supplements may have an important role to play in the treatment of hypercholesterolaemia. To determine the effect of garlic on serum lipids and lipoproteins relative to placebo and other lipid lowering agents, a systematic review, including meta-analysis, was undertaken of published and unpublished randomised controlled trials of garlic preparations of at least four weeks' duration. Studies were identified by a search of MEDLINE and the ALTERNATIVE MEDICINE electronic databases, from references listed in primary and review articles, and through direct contact with garlic manufacturers. Sixteen trials, with data from 952 subjects, were included in the analyses. Many of the trials had methodological shortcomings. The pooled mean difference in the absolute change (from baseline to final measurement in mmol/l) of total serum cholesterol, triglycerides, and high-density lipoprotein (HDL)-cholesterol was compared between subjects treated with garlic therapy against those treated with placebo or other agents. The mean difference in reduction of total cholesterol between garlic-treated subjects and those receiving placebo (or avoiding garlic in their diet) was -0.77 mmol/l (95% CI: -0.65, -0.89 mmol/l). These changes represent a 12% reduction with garlic therapy beyond the final levels achieved with placebo alone. The reduction was evident after one month of therapy and persisted for at least six months. In the dried garlic powders, in which the allicin content is standardised, there was no significant difference in the size of the reduction across the dose range of 600-900 mg daily. Dried garlic powder preparations also significantly lowered serum triglyceride by 0.31 mmol/l compared to placebo (95% CI: -0.14, -0.49).

Limitation of the deterioration of lipid parameters by a standardized garlic-ginkgo combination product. A multicenter placebo-controlled double-blind study.

Arzneimittelforschung;43(9):978-81, 1993 Sep. Kenzelmann R; Kade F

Institute for Clinical Research, Gümlingen Switzerland. Resumo: The efficacy of a garlic-ginkgo combination product (Allium plus) was analyzed in a randomized placebo-controlled double-blind study under extreme dietary conditions. The Christmas/New Year's season was chosen for this 2 months lasting investigation analyzing whether the known cholesterol lowering effect of garlic was even effective during the period of the year with the most cholesterol-rich meals. 43 patients with elevated total cholesterol levels ranging between 230-390 mg/dl completed the study. There were no significant changes of the total cholesterol values in both treatment groups. Nevertheless the analysis of improvement or deterioration of total cholesterol values revealed a clear difference between verum and placebo. 20% of the patients in the placebo group showed an improvement of their total cholesterol level, while there was a significant greater improvement rate of 35% in the verum group (p < 0.05). The responders of the verum group showed a reduction in the total cholesterol values from 298.5 +/- 53.8 to 293.0 +/- 56.4 mg/dl after 1 month and a total reduction of 10.4% after 2 months to 267.6 +/- 44.4 mg/dl. The difference after 2 months of treatment was significantly different from the starting value (p < 0.05). After the 2 months treatment phase there was a 2 weeks wash-out period. During this period the total cholesterol value returned to 293.5 +/- 90.1 mg/dl showing the effectiveness of garlic treatment, but indicating the need for a continuous long-term therapy.

Effect of garlic on total serum cholesterol. A meta-analysis.

Ann Intern Med;119(7 Pt 1):599-605, 1993 Oct 1. Warshafsky S; Kamer RS; Sivak SL

Resumo: OBJECTIVE: To assess the size and consistency of garlic's effect on total serum cholesterol in persons with cholesterol levels greater than 5.17 mmol/L (200 mg/dL). DATA SOURCES: Clinical trials were identified by a computerized literature search of MEDLINE and by an assessment of the bibliographies of published studies and reviews. STUDY SELECTION: Trials were selected if they were randomized and placebo-controlled and if at least 75% of their patients had cholesterol levels greater than 5.17 mmol/L (200 mg/dL). Studies were excluded if they did not provide enough data to compute effect size. Five of 28 studies were selected for review. DATA EXTRACTION: Details of study design, patient characteristics, interventions, duration of therapy, and cholesterol measurements were extracted by one author and were verified by another. DATA SYNTHESIS: Study quality was evaluated by multiple reviewers using a closed-ended questionnaire. Patients treated with garlic consistently showed a greater decrease in total cholesterol levels compared with those receiving placebo. Meta-analysis of homogeneous trials estimated a net cholesterol decrease attributable to garlic of 0.59 mmol/L (95% CI, 0.44 to 0.74) (23 mg/dL [CI, 17 to 29]) (P < 0.001). CONCLUSIONS: Meta-analysis of the controlled trials of garlic to reduce hypercholesterolemia showed a significant reduction in total cholesterol levels. The best available evidence suggests that garlic, in an amount approximating one half to one clove per day, decreased total serum cholesterol levels by about 9% in the groups of patients studied.

Multiple inhibitory effects of garlic extracts on cholesterol biosynthesis in hepatocytes.

Lipids;28(7):613-9, 1993 Jul. Gebhardt R

Physiologisch-Chemisches Institut, University of Tübingen, Germany.