Thread by @theliverdr

1/This is absolute nonsense of a tweet from senior doc, endangering public
This is proof that docs too are poor in analyzing scientific evidence, lack expertise in reading a scientific paper
Also bcoz #CardioTwitter aint doing anything abt it, #LiverTwitter is doing it pro-bono!

2/First the study:
This is from 2016
No standard treatment arm
No sample calculation for 4 groups
Excluded vegetarians
No detail on non-vegetarian diet of 8wk follow-up
Only previous 3d diet recall/ physical activity done
No proof that participants actually consumed garlic..

3/..the use of other medications in among study participants are also not mentioned especially with respect to diabetes, hypertension and hypothyroidism
The authors did not actually look at any proper cardiac outcomes, except measure fibrinogen level - this is cherry picking..

4/..The biggest issue is mentioned by the authors of the study themselves
"our study cannot suggest appropriate doses of garlic and lemon juice for people with hyperlipidemia"
If they didnt have a predefined dose that is known to work, then how could they actually do this study?

5/..which means, this shud have been a dose finding study instead of an efficacy trial & so, the study methods and the subsequent analyses are all actually futile.

Which means, this study is garbage level quality, which the doctor missed.

Now about blatant errors in study..

6/The study is meddled with poor sentence constructs, grammatical errors &
some WILD claims - without diet changes or exercises & just by consuming garlic and some lime juice, patients significantly lost weight
- this is absurd and this stinks of data manipulation
And now..

7/..the blatant misinformation.
The good doc also showed a "metanalysis" showing garlic was useful in lipid lowering.
But this was cherry picked to fit his narrative,
from a large body of evidence which says garlic has
NO -->DOUBTFUL value in lipid management.
Lets dig in..

8/Latest 2022 update on garlic effects on cardiac risk factors showed garlic studies wer poor in methodology & inconsistent
Hence no recommendations can be made
They also state dietary modification, NOT garlic use was more imp in positive study outcomes
pubmed.ncbi.nlm.nih.gov/35348024/

9/Another metanalysis (2021) showed that garlic MAY reduce total cholesterol, but wasnt conclusive bcoz studies included were non-standardized & garlic did nothing to other lipid parameters.
Basically it was a dud treatment, for those with heart disease
pubmed.ncbi.nlm.nih.gov/34627133/

10/ In fact the ONLY good, well controlled, well-designed,
LONG-TERM study ON GARLIC and cholesterol,
by garlic EXPERTS showed that garlic was absolutely USELESS in lipid lowering
And this was from 2007!
med.stanford.edu/news/all-news/…

11/Decades back clinical scientists who work on garlic use for cholesterol had this to say:

Garlic is a dead issue, confirms Dr. Sidney Alexander, director of lipid clinic at Lahey Clinic Medical Center in Burlington, Mass. “No one recommends it anymore.”
abcnews.go.com/Health/story?i…

12/ Mix of imaginary doses of garlic and lime is NOT the substitute for statins in patients with heart disease

Garlic has many plant chemicals that interact with OTHER medicines heart patients may be taking and can reduce or increase their levels too lpi.oregonstate.edu/mic/food-bever…

13/
So going back to first tweet - what are options for patients with high cholesterol who cannot tolerate or develop side effects to statins?

Here they are & they DONT feature a lame cocktail of lime and garlic.

Medical science is easy to understand, if you know how to look 🙏