台大醫院雲林分院 社區及家庭醫學部 彭仁奎 醫師 蒜頭的健康價值 院長、各位主任師長、雲林分院同仁 今天在這裏為大家報告社區醫學這幾年在雲林地區發展狀況 雲林地區社區醫學發展過去6年來在前院長謝博升教授及家醫科兩位主任的帶領，及其他師長(特別是劉文俊老師)的指導與協助下，才有今日的發展 台大醫院雲林分院 社區及家庭醫學部 彭仁奎 醫師

大蒜的藥理機轉 大蒜中主要衍生物是蒜苷(alliin)。 大蒜細胞被切碎或咀嚼，便會出現蒜酶 (alliinase) 將蒜苷轉變為蒜素(allicin)。 胃酸抑制alliinase 高溫抑制alliinase

蒜頭可以降低血脂肪 分析45篇臨床實驗： 服用8-12週蒜頭製品： 長期的療效(>6個月)並不明顯。 總膽固醇：降低 19.2 mg/dL 低密度膽固醇：降低 6.2 mg/dL 三酸甘油脂：降低 21.1 mg/dL 長期的療效(>6個月)並不明顯。 Arch Intern Med 2001;161:813-24

蒜頭可以降低血壓 針對11份臨床實驗 (RCT) 進行系統性分析： 針對高血壓患者： 針對沒有高血壓者：(統計意義不顯著) 收縮壓平均降低 8.4 mmHg 舒張壓平均降低 7.3 mmHg 針對沒有高血壓者：(統計意義不顯著) 收縮壓平均降低 2.3 mmHg 舒張壓平均降低 0.1 mmHg BMC Cardiovascular Disorder 2008;8:13

蒜頭可以降低血壓

蒜頭可能降低心血管疾病風險 抗血拴作用 Arch Intern Med 2001;161:813-24 血管硬化班塊縮小 Atherosclerosis 1999;144:237-49 降低動脈硬化程度 Circulation 1997;96:2649-55 <Plaque> In a randomized, double-blind, placebo-controlled clinical trial, the plaque volumes in both carotid and femoral arteries of 152 probationers were determined by B-mode ultrasound. Continuous intake of high-dose garlic powder dragees reduced significantly the increase in arteriosclerotic plaque volume by 5-18% or even effected a slight regression within the observational period of 48 months. Also the age-dependent representation of the plaque volume shows an increase between 50 and 80 years that is diminished under garlic treatment by 6-13% related to 4 years. It seems even more important that with garlic application the plaque volume in the whole collective remained practically constant within the age-span of 50-80 years. These results substantiated that not only a preventive but possibly also a curative role in arteriosclerosis therapy (plaque regression) may be ascribed to garlic remedies. <Artery stiffness> BACKGROUND: Epidemiological studies have suggested that garlic may have protective effects against cardiovascular diseases. We undertook this cross-sectional observational study to test the hypothesis that regular garlic intake would delay the stiffening of the aorta relating to aging. METHODS AND RESULTS: We studied healthy adults (n=101; age, 50 to 80 years) who were taking > or = 300 mg/d of standardized garlic powder for > or = 2 years and 101 age- and sex-matched control subjects. Pulse wave velocity (PWV) and pressure-standardized elastic vascular resistance (EVR) were used to measure the elastic properties of the aorta. Blood pressures, heart rate, and plasma lipid levels were similar in the two groups. PWV (8.3+/-1.46 versus 9.8+/-2.45 m/s; P<.0001) and EVR (0.63+/-0.21 versus 0.9+/-0.44 m2 x s(-2) x mm Hg(-1); P<.0001) were lower in the garlic group than in the control group. PWV showed significant positive correlation with age (garlic group, r=.44; control group, r=.52) and systolic blood pressure (SBP) (garlic group, r=.48; control group, r=.54). With any degree of increase in age or SBP, PWV increased less in the garlic group than in the control group (P<.0001). ANCOVA and multiple regression analyses demonstrated that age and SBP were the most important determinants of PWV and that the effect of garlic on PWV was independent of confounding factors. CONCLUSIONS: Chronic garlic powder intake attenuated age-related increases in aortic stiffness. These data strongly support the hypothesis that garlic intake had a protective effect on the elastic properties of the aorta related to aging in humans.

蒜頭的使用與腫瘤的風險 運用美國食品藥物管理局(FDA)實證醫學資料的綜合分析顯示： 蒜頭可能預防的癌症： 尚須探討、證據不足的部分： 結腸直腸癌、攝護腺癌、食道癌、喉癌、口腔癌、卵巢癌、腎細胞癌。 尚須探討、證據不足的部分： 胃癌、乳癌、肺癌、子宮內膜癌。 Am J Clin Nutr 2009;89:257-64 BACKGROUND: Interest in the potential benefits of allium vegetables, in particular, onion (Allium cepa) and garlic (Allium sativum), has its origin in antiquity, but the details of these benefits are still open to discussion. OBJECTIVE: We investigated the role of allium vegetables in the etiology of various neoplasms. Previous data are scanty and are based mainly on Chinese studies. DESIGN: Using data from an integrated network of Italian and Swiss case-control studies, we analyzed the relation between frequency of onion and garlic use and cancer at several sites. We calculated odds ratios (ORs) by using multivariate logistic regression models that were adjusted for energy intake and other major covariates. RESULTS: Consumption of onions varied between 0-14 and 0-22 portions/wk among cases and controls, respectively. The multivariate ORs for the highest category of onion and garlic intake were, respectively, 0.16 and 0.61 for cancer of the oral cavity and pharynx, 0.12 and 0.43 for esophageal cancer, 0.44 and 0.74 for colorectal cancer, 0.17 and 0.56 for laryngeal cancer, 0.75 and 0.90 for breast cancer, 0.27 and 0.78 for ovarian cancer, 0.29 and 0.81 for prostate cancer, and 0.62 and 0.69 for renal cell cancer. CONCLUSIONS: This uniquely large data set from southern European populations shows an inverse association between the frequency of use of allium vegetables and the risk of several common cancers. Allium vegetables are a favorable correlate of cancer risk in Europe.

十大死因中六項疾病與蒜頭有關係，蒜頭幾乎可以對抗國人十大死因的近六名 96年台灣十大死因 惡性腫瘤 心臟疾病 腦血管疾病 糖尿病 事故傷害 肺炎 慢性肝病及肝硬化 腎炎、腎徵候群及腎性病變 自殺 高血壓性疾病 十大死因中六項疾病與蒜頭有關係，蒜頭幾乎可以對抗國人十大死因的近六名

96年台灣十大癌症死因 肺癌 肝癌 結腸直腸癌 女性乳癌 胃癌 口腔癌 攝護腺癌 子宮頸癌 食道癌 胰臟癌 其他可能有相關之癌症： 喉癌、卵巢癌、腎細胞癌、子宮內膜癌

食用蒜頭的重點 服用量： 勿過量、勿空腹食用 手術前7-10天停止服用，以免影響凝血功能 新鮮蒜頭：每天4公克 (約2瓣) 蒜頭粉末 (含1.3%alliin)：300毫克，每天2-3次 勿過量、勿空腹食用 可能的副作用：呼吸異味與體味 少見的副作用：胃腸不適、脹氣 皮膚直接塗抹：注意局部刺激反應 手術前7-10天停止服用，以免影響凝血功能 Am Fam Physician 2005;72:103-6

結論 蒜頭非藥品，但有益健康。可能的好處： 蒜頭並非萬能。除了吃蒜頭，請多注意： 降血脂、降血壓、預防心血管疾病、預防癌症 參加[整合式篩檢] 或 [成人健檢] 糞便潛血檢查、口腔癌篩檢、高危險群定期追蹤 婦女：子宮頸抹片、乳房攝影(>50歲以上者) 戒菸、戒酒、戒檳榔、戒毒品 均衡飲食、多運動