***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 r and omized , 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 The effect of guar gum in capsule form on serum total cholesterol , triglycerides , and lipoprotein cholesterol ( very low-density lipoproteins , low-density lipoproteins , and high-density lipoproteins ) was studied in healthy volunteers in this double-blind study . Twenty-four subjects equally divided into treatment and placebo groups , received 9.0 g/day of guar and glucose in 600 mg identical capsules , respectively , for 4 wk under conditions of constant body weight and dietary stability . Guar significantly lowered serum total cholesterol ( 16.6 % p less than 0.05 ) and low-density lipoprotein cholesterol ( 25.6 % p less than 0.05 ) but had no significant effect ( p less than 0.05 ) on serum triglycerides , high-density lipoproteins and very low-density-lipoprotein cholesterol . No significant changes ( p greater than 0.05 ) were seen in blood lipids in the placebo group This study examined the effects of garlic and fish-oil supplementation ( alone and in combination ) on fasting serum lipids and lipoproteins in hypercholesterolemic subjects . After an initial run-in phase , 50 male subjects with moderate hypercholesterolemia were r and omly assigned for 12 wk to one of four groups : 1 ) 900 mg garlic placebo/d + 12 g oil placebo/d ; 2 ) 900 mg garlic/d + 12 g oil placebo/d ; 3 ) 900 mg garlic placebo/d + 12 g fish oil/d , providing 3.6 g n-3 fatty acids/d ; and 4 ) 900 mg garlic/d + 12 g fish oil/d . In the placebo group , mean serum total cholesterol , low-density-lipoprotein cholesterol ( LDL-C ) , and triacylglycerols were not significantly changed in relation to baseline . Mean group total cholesterol concentrations were significantly lower with garlic+fish oil ( -12.2 % ) and with garlic ( -11.5 % ) after 12 wk but not with fish oil alone .  Mean LDL-C concentrations were reduced with garlic+fish oil ( -9.5 % ) and with garlic ( -14.2 % ) but were raised with fish oil ( + 8.5 % ) . Mean triacylglycerol concentrations were reduced with garlic+fish oil ( -34.3 % ) and fish oil alone ( -37.3 % ) . The garlic groups ( with and without fish oil ) had significantly lower ratios of total cholesterol to high-density-lipoprotein cholesterol ( HDL-C ) and LDL-C to HDL-C. In summary , garlic supplementation significantly decreased both total cholesterol and LDL-C whereas fish-oil supplementation significantly decreased triacylglycerol concentrations and increased LDL-C concentrations in hypercholesterolemic men . The combination of garlic and fish oil reversed the moderate fish-oil-induced rise in LDL-C. Coadministration of garlic with fish oil was well-tolerated and had a beneficial effect on serum lipid and lipoprotein concentrations by providing a combined lowering of total cholesterol , LDL-C , and triacylglycerol concentrations as well as the ratios of total cholesterol to HDL-C and LDL-C to 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 The efficacy and tolerance of a garlic preparation ( Sapec , Kwai ) was investigated in a r and omized double-blind study vs. bezafibrate . This multi-centre study was conducted in 5 general medical practice s and involved 98 patients with primary hyperlipoproteinaemia . The daily doses of the active substances were 900 mg of garlic powder ( st and ardized as to 1.3 % alliin ) and 600 mg of bezafibrate , respectively . The pre-phase with placebo lasted 6 weeks , the treatment period covered 12 weeks . All patients were advised to observe a low-fat " step-1 diet " for the duration of the study . The 98 case report forms allowed the statistical evaluation of total cholesterol , HDL cholesterol and triglyceride levels for 94 patients , and of LDL cholesterol values for 92 patients . In the course of the treatment both study medications caused a statistically highly significant reduction in total cholesterol , in LDL cholesterol and triglycerides , and an increase in HDL cholesterol . However , there was no significant difference in the efficacies of both medication groups . Side effects were mentioned by 5 patients each in both treatment groups , none of which led to the withdrawal of the patients . Concerning the garlic preparation , there was no correlation between the perception of garlic odour and the influence on the cholesterol level OBJECTIVE To evaluate the antioxidant and hypocholesterolaemic effects of Terminalia arjuna tree bark ( a popular cardiotonic substance in Indian pharmacopoeia ) and to compare it with a known antioxidant , vitamin E , we performed a r and omized controlled trial . METHODS One hundred and five successive patients with coronary heart disease ( CHD ) presenting to our centre were recruited and using a Latin-square design divided into 3 groups of 35 each . The groups were matched for age , lifestyle and dietary variables , clinical diagnosis and drug treatment status . None of the patients was on lipid-lowering drugs . Supplemental vitamins were stopped for one month before study began and American Heart Association Step II dietary advice was given to all . At baseline , total cholesterol , triglycerides , HDL and LDL cholesterol and lipid peroxide estimated as thiobarbituric acid reactive substances ( TBARS ) were determined . Group I received placebo capsules ; Group II vitamin E capsules 400 units/day ; and Group III received finely pulverized T. arjuna tree bark-powder ( 500 mg ) in capsules daily . Lipids and lipid peroxide levels were determined at 30 days follow-up . RESULTS Response rate in various groups varied from 86 % to 91 % . No significant changes in total , HDL , LDL cholesterol and triglycerides levels were seen in Groups I and II ( paired t-test p > 0.05 ) . In Group III there was a significant decrease in total cholesterol ( -9.7 + /- 12.7 % ) , and LDL cholesterol ( -15.8 + /- 25.6 % ) ( paired t-test p < 0.01 ) . Lipid peroxide levels decreased significantly in both the treatment groups ( p < 0.01 ) . This decrease was more in vitamin E group ( -36.4 + /- 17.7 % ) as compared to the T. arjuna group ( -29.3 + /- 18.9 % ) . CONCLUSIONS Terminalia arjuna tree bark powder has significant antioxidant action that is comparable to vitamin E. In addition , it also has a significant hypocholesterolaemic effect The present study aim ed at investigating the cholesterol-lowering and side effects of garlic enteric coated tablets in comparison with placebo tablets . The study is a r and omized double-blinded crossover design involving 116 volunteers . However , 16 of them did not complete the study . The remaining 100 volunteers were divided into two groups : 45 were in the trial group and the remaining 55 in the control group . The volunteers in the trial group were asked to take garlic tablets in the first three months , placebo in the second three months and discontinue all tablets in the last three months , while the volunteers in the control group started with three months of placebo followed by three months of garlic tablets and ended up with three months of tablets discontinuity . The results showed that there were no significant differences in the total serum cholesterol levels between the two groups at the end of three months or six months of the study . Side effects included headache , itching and complaints of garlic smell . No serious side effects relating to liver , kidney functions or hematologic side effects were OBJECTIVE To determine whether garlic extract therapy is efficacious and safe in children with hypercholesterolemia . DESIGN R and omized , 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 clinical ly 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 
    Output:
    
Safety scores did not improve by decade .
Many studies received high quality scores and noted safety information and reported effectiveness or efficacy in a clear manner .
This finding was not consistent with other systematic review s that have found the highest reported efficacy/ effectiveness in studies of poorer quality .