Garlic: food or medicine?

You’ve probably heard a lot about garlic. From fighting off vampires to protecting sailors from magic in The Odyssey, this plant has been wrapped up in folklore for a long time. That’s not all though; garlic was so important in Egypt that it was used as a form of currency. So, what’s all the fuss about?

Garlic (Allium sativum) originates from the southwest region of Asia and is a close relative of the onion, leek, and chives. China is the primary producer of garlic today, accounting for as much as 80% of the world’s supply (clearly we know where we’re going for our next trip now…); it is followed by India, South Korea, Russia, and the United States. Garlic has been in use for a long time and has been considered a vegetable, a spice, and even a superfood. It has also been well known for its healing effects meaning that it is also a medicinal plant. Though some important medicinal effects of garlic have been confirmed scientifically in clinical studies, some popular herbal healers have overstated its use by exaggerating its versatility and treating it as a panacea.

Garlic really started to gain attention in both the professional and public spheres when researchers running trials with animal and then later human subjects found that regular garlic consumption (about 2g per day) reduced the concentration of fats and cholesterol in the blood, which also proved to slow down the progression of atherosclerosis. Various studies have shown that garlic also has antibacterial and antifungal properties as well as lowering blood sugar levels and inhibiting platelet aggregation. What remains unclear, however, is which of these effects (if any) are enjoyed by those of us with a more mild level of garlic consumption. Claims about the natural antibiotic powers of garlic have also been greatly exaggerated. Studies on the matter have used a wide range of different garlic preparations (fresh, dry, powdered, extract, “fragrant” extract, etc.), and these differences make it difficult to compare the results from the various studies. That being said, an excellent overview of studies on the effects of garlic was published by the European Medicines Agency. Though at 75 pages it’s a bit overwhelming, this report is available for free to the public; you can find it at (klik)

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Garlic bulbs contain the compound alliin, which carries a long chemical name of S-(Z)-(2-propenyl)-L-cysteine-S-oxide (a bit of a mouthful). This compound is non-volatile and odorless. When you cut or crush garlic you damage the cellular tissue which then prompts the allinase enzyme to convert the odourless alliin into the volatile alicin (also known as allylthiosulphinate), which bears a distinctive odour and taste. From here, alicin can be transformed into allylisulfide, allylthiosulphonate, and allyltrisulfide (take a look at the picture to make things a bit clearer).

So where do we categorise garlic?

Food is defined by legislation as everything we eat except tobacco and medicines. It draws a pretty clear (though arbitrary) line with tobacco, but what classifies as medicine is much more complicated. As such, until medicine is defined, we can’t really grasp the definition of food. To make things even more complicated, there is also a specific category of foods known as food supplements (or nutritional supplements). Though they look similar to medicines (often in tablets and capsules), these products are not meant to prevent or treat disease. They serve to supplement various nutrients and other substances in our diets. That being said, many people (patients) go against their intended use and attempt to use them as a form of treatment. As we’ll see in a bit, some of these cases have even been brought to the highest European court.

Medicines and dietary supplements

Medications are used in treating illness. This, however, extends to include aspects of prevention, alleviation, and diagnosis as well. Based on legal definitions, medicinal product is “a product presented with treatment characteristics or which can be used for treatment.” If a product matches the definition for a medicine but ALSO matches the definition for another form of product then it has to be classified as a medicinal product. This explains the confusion with food supplements a bit better. Though they are grouped with foods, they border on being medicines. They are intended to compliment the usual diet (such as through additional vitamins, minerals, essential fatty acids and amino acids, fiber, and antioxidants) and legislation requires that each food supplement must indicate on the label that “The dietary supplement is not a substitute for a balanced and diverse diet.”
In considering the definitions for medicines and dietary supplements, we find two main ways in which we separate food (and thus food supplements) from medicine:

1) Presentation- In their labels, presentations, and advertisements, foods should not be attributed with preventative or healing properties as they pertain to human health and diseases. Even what would be considered an implication of such to the average consumer is prohibited for foods. 
2) Effects- Among medicinal products (regardless of presentation), the effects are meant to "restore, improve, or modify physiological functions through pharmacological, immunological, or metabolic action, or to determine diagnosis."

Though it would be nice if this would leave us an obvious boundary, it doesn’t. The line between “healing effects” and “nutritional and physiological effects” is not entirely clear. A garlic bulb is, of course, food. Even if the garlic is dried and powdered it is still a food. If you fill a capsule with garlic powder it is a food supplement, and thus still a food. However, if you have these capsules in a package with a label that says that the product will have effects such as lowering blood cholesterol or blood pressure levels or that it will prevent cardiovascular complications, then this product is a medicine. In this case, specific authorisation is needed before marketing can begin, and this will require scientific evidence of the product’s efficacy and safety. Procedures would need to be in place to ensure that all batches of the product contain an appropriate amount of the active substance in order to achieve therapeutic effects and that these substances will be stable through the shelf life of the product. The product would also need to come with the necessary warnings associated with use, such as dangerous interactions with other substances. All of the statements and evidence would then have to be verified by the competent authority.

Based on effects (the second point of our definition), garlic is somewhere between a food and a medicine. This leaves it up to the producer how to declare it, bringing presentation (the first point of our definition) into play. This applies to unprocessed garlic bulbs just as much as it does to capsules of garlic powder. If they are sold as a food, the method of cultivation, processing, and quality checks are much simpler, but the product cannot be marketed as medicinal. If the manufacturer decides to declare the product as a medicinal product, it is their duty to provide thorough documentation of the production and processing involving precise quality control. With this, it also gains the right to market the product as having medicinal effects.

Garlic dispute at the European Court of Justice

One manufacturer wanted to market garlic capsules on German market as a food supplement and thus did not mention therapeutic benefits. The competent authority for medicinal products in Germany, however, thought that the product was medicinal and therefore required the manufacturer to obtain market authorisation for a medicinal product. They decided that though the product did not indicate medicinal use, that the intended use of the capsule was indeed for treatment since German consumers are already aware of the therapeutic effects of garlic preparations. If we recall our definition, this is then a sufficient condition for the product to be considered a medicine. They also argued that marketing the product in an uncontrolled manner outside of pharmacies and without the appropriate warnings could pose a health risk to consumers. Patients taking anti-clotting medications (anticoagulants) can have the medication’s effects increased when also taking garlic products which could cause bleeding. On the other hand, those taking products designed for the treatment of HIV could see a decrease in the effectiveness of their medications if they were to consume garlic products simultaneously. Obviously neither of these scenarios is good. The manufacturer disagreed with the ruling and the dispute went to court. Eventually, it came to the European Court of Justice, which ruled in autumn on 2007 that the health risks were not so great as to justify restricting the free movement of the product. Germany thus had to allow the product to be marketed as a food supplement.

Culinary uses of garlic

With its sharp and distinctive taste and smell, garlic is primarily used as a spice in cooking. In food, the aroma can vary depending on how it is prepared. Japan and Korea take garlic a step further, making something called “black garlic.” This involves a nearly month-long process of fermentation at high temperatures. The garlic slowly begins to turn dark as a result of the formation of melanoidin. In Korea, this is added to energy drinks, while in Thailand you can find it in chocolate (that sounds like a must-try). In some parts of eastern Europe, young garlic is mixed with sugar, salt, and other spices and allowed to sit for a few weeks before being served as a starting dish.

Well, we are pretty sold on garlic! We hope you enjoyed this little foray into science, and hope to see you next time for another yummy vegan recipe.

Until then!

The Hungry Pumpkin Team (with garlic breath).