A randomized factorial study of the effects of long-term garlic and
micronutrient supplementation and of 2-wk antibiotic treatment for
Helicobacter pylori infection on serum cholesterol and
Lian Zhang, Mitchell H Gail, Yu-que Wang, Linda Morris Brown, Kai-feng Pan, Jun-ling Ma, Harunobu Amagase,
Wei-cheng You, and Roxana Moslehi
micronutrient supplementation on total, HDL, and LDL cholesterol
in disease-free persons.
Objective: We aimed to assess the effects of long-term supplemen-
tation with garlic and micronutrients and of short-term amoxicillin
in a rural Chinese population.
Design: We conducted a randomized, double-blind, placebo-
controlled, 2 ? 2 ? 2 and 2 ? 2 factorial study of precancerous
gastric lesions in 3411 subjects in Linqu County, Shandong Prov-
ince, China. Thirty-four subjects were randomly selected from each
effects on total, HDL, and LDL cholesterol after 2-wk twice-daily
treatment with 1 g amoxicillin and 20 mg omeprazole and supple-
mentation throughout the study with 1) 2 capsules twice daily, each
oil, or 2) twice-daily micronutrient capsules containing 250 mg
vitamin C, 100 IU vitamin E, and 37.5 mg selenium.
Results: Regressions adjusted for covariates indicated increases of
0.22 mmol total cholesterol/L (P ? 0.01) and 0.19 mmol LDL/L
Conclusions: In this rural Chinese population with low meat intake
and moderate cholesterol concentrations, long-term garlic supple-
mentation had no effect on lipid profiles, whereas micronutrient
in total and LDL-cholesterol concentrations at 7.3 y.
Am J Clin
pylori antibiotic therapy, China
Cholesterol, blood lipids, garlic supplementa-
High concentrations of total and LDL cholesterol and low
cular disease (CVD) (1). Garlic or garlic extracts have been
recommended for treatment or prevention (or both) of CVD (2),
as well as for other hyperlipidemia-related disorders (3). Some
controlled trials indicate that garlic reduces total cholesterol and
serum triacylglycerols and elevates HDL concentrations. How-
confined to patients with hypercholesterolemia or CVD (4). A
effect of garlic powder on total, LDL, or HDL cholesterol (5),
which leaves much uncertainty as to its effects in the general
on the effects of long-term supplementation with vitamins and
conflicting (see Discussion).
In 1995, the National Cancer Institute (NCI) and the Beijing
Institute for Cancer Research (BICR) initiated a randomized,
double-blind, placebo-controlled factorial trial, the Shandong
the prevalence of advanced precancerous gastric lesions and
gastric cancer. Those treatments were amoxicillin and omepra-
zole [only in subjects with Helicobacter pylori (HP) infection],
dietary supplementation with vitamins E and C and selenium,
and dietary supplementation with steam-distilled garlic oil and
aged 35–64 y (n ? 4010) residing in 13 villages selected at
in 1994 and were invited to participate in the SIT (Figure 1).
KP, JM, and WY); the Biostatistics Branch, Division of Cancer Epidemiol-
ogy and Genetics, National Cancer Institute, Bethesda, MD (MHG, LMB,
and RM); and Wakunaga of America Co Ltd, Mission Viejo, CA (HA).
2Supported by contract no. NO1-CP-71103 from the National Cancer
Institute and by the Intramural Research Program of the National Cancer
Institute, National Institutes of Health, Department of Health and Human
Services. Wakunaga of American Co Ltd, Sino-American Shanghai Squibb
in this study.
and Genetics, National Cancer Institute, National Institutes of Health, 6120
Executive Boulevard, EPS 8047, Rockville, MD 20852. E-mail:
Received January 13, 2006.
Accepted for publication June 8, 2006.
Am J Clin Nutr 2006;84:912–9. Printed in USA. © 2006 American Society for Nutrition
by guest on June 5, 2013
term supplementation with vitamins E and C and selenium than
CVD mortality was found. Thus, our data do not support the use
of this garlic preparation or of vitamin E or C or selenium sup-
plementation to lower serum concentrations of total or LDL
cholesterol or to increase concentrations of HDL cholesterol in
persons in this rural Chinese population. Although the meat in-
take in this population was substantially lower than that in the
5% lower. Thus, these findings may provide better guidance for
the general US population than do studies of subjects with CVD
or elevated cholesterol.
providing technical assistance.
LZ, MHG, LMB, HA, WY, and RM contributed to the conception of the
responsible for the laboratory analyses; MG and RM conducted the data
analysis; RM drafted the manuscript and was responsible for final editing of
America Co, Ltd. None of the other authors had a personal or financial
conflict of interest.
Bethesda, MD: National Institutes of Health, 1994.
2. Banerjee S, Maulik S. Effect of garlic on cardiovascular disorders; a
review. Nutr J 2002;1:1–14.
3. Alder R, Lookinland S, Berry JA, et al. A systematic review of the
4. Stevinson C, Pittler M, Ernst E, et al. Garlic for treating hypercholes-
terolemia. Ann Intern Med 2000;133:420–9.
powder tablets on serum lipids, blood pressure and arterial stiffness in
normo-lipidaemic volunteers: a randomized, double-blind, placebo-
controlled trial. Br J Nutr 2004;92:701–6.
6. Gail M, You WC, Chang YS, et al. Factorial trial of three interventions
to reduce the progression of precancerous gastric lesions in Shandong
China: design issues and initial data. Control Clin Trials 1998;19:352–
China: supplementation with specific vitamin/mineral combinations,
cancer incidence, and disease-specific mortality in the general popula-
tion. J Natl Cancer Inst 1993;85:1483–92.
progression of precancerous gastric lesions: compliance, serum micro-
nutrients and S-allyl cysteine levels and toxicity. Eur J Cancer Prev
9. You WC, Brown LM, Zhang L, et al. A randomized factorial trial of
Helicobacter pylori treatment and 7.3-year vitamin and garlic supple-
Province, China. J Natl Cancer Inst 2006;98:974–83.
10. Rifai N, Warnick GR. Quality specifications and the assessment of the
biochemical risk of atherosclerosis. Clin Chim Acta 2004;345:55–64.
11. Mader FH. Treatment of hyperlipidaemia with garlic-powder tablets.
Evidence from the German Association of General Practitioners’ mul-
ticentric placebo-controlled double-blind study. Arzneimittelforschung
12. DA Santos Os, Grunwald J. Effect of garlic powder tablets on blood
study. Br J Clin Res 1993;4:27–44.
13. Saradeth T, Seidl S, Resch K, et al. Does garlic alter the lipid pattern in
normal volunteers? Phytomedicine 1994;1:183–5.
14. Wang S, Qian F. Geriatric cardiology. Beijing, China: People’s Health
Publishing House, 1998.
15. Carroll M, Lacher D, Sorlie P, et al. Trends in serum lipids and lipopro-
teins of adults, 1960–2002. JAMA 2005;294:1773–81.
16. Spigelski D, Jones PJ. Efficacy of garlic supplementation in lowering
serum cholesterol levels. Nutr Rev 2001;59:236–41.
17. Hercberg S, Bertrais S, Czernichow S, et al. Alterations of the lipid
profile after 7.5 years of low-dose antioxidant supplementation in the
SU. VI.MAX study. Lipids 2005;40:335–42.
18. Howard DR, Rundell CA, Batsakis JG. Vitamin E does not modify
HDL-Cholesterol. Am J Clin Pathol 1982;77:86–9.
19. Hallfrisch J, Singh VN, Muller C, et al. High plasma vitamin C associ-
ated with increased plasma LDL and HDL cholesterol. Am J Clin Nutr
20. Jacques PF. Relationships of vitamin C status to cholesterol and blood
pressure. Ann N Y Acad Sci 1992;669:205–14.
21. Elwood PC, Hughes RE, Hurley RJ. Ascorbic acid and serum choles-
terol. Lancet 1970;2:1197 (letter).
cular disease: a critical review of epidemiologic and clinical trial data.
Ann Intern Med 1995;123:860–72.
23. Lee I, Cook N, Gaziano J, et al. Vitamin E in the primary prevention of
cardiovascular disease and cancer. JAMA 2005;294:56–65.
25. Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supple-
26. Hercberg S, Galan P, Preziosi P, et al. The SU. VI.MAX study. Arch
Intern Med 2005;164:2335–42.
infection and eradication on blood lipids and fibrinogen. Aliment Phar-
macol Ther 2002;16:577–87.
GARLIC, MICRONUTRIENTS, ANTIBIOTICS, AND LIPIDS
by guest on June 5, 2013