Garlic

Bava Kamma 85a ~ Is Honey Bad For You?

בבא קמא פה,א 

כדתניא הרי שעבר על דברי רופא ואכל דבש או כל מיני מתיקה מפני שדבש וכל מיני מתיקה קשין למכה והעלה מכתו גרגותני יכול יהא חייב לרפאותו ת"ל רק

It was taught in a Braisa: If the victim of an assault disobeyed the advice of his doctor and ate honey or all types of sweets - and this violated his doctor's instructions because honey and all types of sweets are harmful for a wound - it could be thought that the assailant is still obligated to heal the victim. Therefore the Torah uses the word רק (only) to teach otherwise...(Bava Kamma 85a)

Secretions of the honey bee. From Israili, Z.  Antimicrobial Properties of Honey.    American Journal of Therapeutics    2014. 21; 304–323.

Secretions of the honey bee. From Israili, Z.  Antimicrobial Properties of Honey. American Journal of Therapeutics 2014. 21; 304–323.

Three days ago we studied the medical effects of garlic, and noted that although the Talmud praises it for its health effects, there is conflicting evidence as to its efficacy. Today, we turn to honey, which has been used as a medicine for at least the last 3,000 years.  It is therefore very surprising that in the culture that gave birth to the Talmud, honey was thought to be bad for your health.  As we will see, honey has some quite amazing therapeutic uses.

FROM WHERE DOES HONEY COME?

The honeybee is the only insect that produces food eaten by humans. Here is what happens: The female honeybees use their proboscis (a tube-like tongue) to up suck flower nectar and mix it with their saliva and enzymes. Then they store it in a honey sack. Back at the hive, the mixture is regurgitated into cells, dried to about 16% moisture, and stored as a primary food source. As you might expect, the content of the honey depends on a number of factors including the species of bee, the kind of flowers on which they fed, and the conditions in which the honey was stored.

Honey as an Antibiotic

In a recent review article that focuses on the antimicrobial properties of honey, Zafar Israili from the Emory School of Medicine noted that a large number of laboratory and clinical studies have confirmed the broad-spectrum antimicrobial properties of honey.  These include antibacterial, antifungal, antiviral, and antimycobacterial.  “Honey,” wrote Israili, “was found to be an effective topical treatment for ringworms, athlete’s foot, jock itch, nail fungus, and yeast infections and reported to be comparable to many over-the-counter antifungal preparations.” These properties are likely due to the honey’s acidity, osmotic effect, high sugar concentration, and the presence of chemicals like hydrogen peroxide, antioxidants, and lysozymes.  

Honey contains more than 600 compounds (you can see a list of them here), and the wound healing properties of honey are probably its oldest and best studied medicinal property.  It has been shown to aid wound healing in conditions such as chronic pressure sores, traumatic and diabetic wounds, diabetic foot ulcers, boils, burns, fistulas, necrotizing fasciitis, and a very nasty condition called Fournier’s gangrene. (That's necrosis of the scrotum. Yes, quite gross.) So in contrast to the advice of the talmudic doctors that "honey is bad for an injury", honey turns out to be rather good for wounds, especially when applied directly to them.  But honey isn't just good for wounds...

There is a large body of evidence to support the use of honey as a wound dressing for a wide range of types of wounds. Its antibacterial activity rapidly clears infection and protects wounds from becoming infected, and thus it provides a moist healing environment without the risk of bacterial growth occurring. It also rapidly debrides wounds and removes malodor.
— Molan, PC. The Evidence supporting the use of honey as a wound dressing. Lower Extremity Wounds 2006. 5 (1); 52.

Your Mother was correct

A 2012 study from physicians at the Sackler School of Medicine in Tel Aviv tested the effects of honey on nocturnal cough and sleep quality.  They enrolled 150 children age 1-5 years (and presumably, their tired and exasperated parents) and half an hour before bedtime, gave half of them “a single dose of 10g of eucalyptus honey, citrus honey, or labiatae honey,” and the other half a placebo. (In case you were wondering, as was I, as to what the placebo was, here’s the answer: date extract, “because its structure, brown color, and taste are similar to that of honey.” True enough.) What they found might change the way you treat your own cough this winter. Each of the three honey groups had a better response compared with the date extract, and no significant differences were found among the different types of honey. The authors concluded that honey may be preferable to cough and cold medications for childhood respiratory infections. 

The effect of different types of honey and date extract on cough frequency (I), cough severity (II), cough bothersome to child (III), the child’s sleep (IV), parent’s sleep (V), and combined symptoms score (VI). P <0.05 for the comparisons between group D and the other groups. A, eucalyptus honey; B, citrus honey; C, labiatae honey; D, silan date extract. From Cohen, AH. et al. Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-blind, Randomized, Placebo-Controlled Study.    Pediatrics    2012. 130 (3); 465-471.

The effect of different types of honey and date extract on cough frequency (I), cough severity (II), cough bothersome to child (III), the child’s sleep (IV), parent’s sleep (V), and combined symptoms score (VI). P <0.05 for the comparisons between group D and the other groups. A, eucalyptus honey; B, citrus honey; C, labiatae honey; D, silan date extract. From Cohen, AH. et al. Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-blind, Randomized, Placebo-Controlled Study. Pediatrics 2012. 130 (3); 465-471.

Honey as a Medicine for Pretty much everything

There are dozens of other medical conditions for which honey may be used. Here is what the review from Israili has to say:

Honey has been reported to be of benefit in a large number of human pathologies including allergy, asthma, bronchitis, common cold, flu, hay fever, nasal congestion, rhinitis, sinusitis, upper respiratory infections, sore throat, cough, fatigue, anxiety, migraine (stress related), cuts, lacerations, burns, wounds (venous, arterial, diabetic, malignant), pressure ulcers, malignant ulcers, perianal and gluteofemoral fistulas, bed sores, adult and neonatal postoperative infections, necrotizing fasciitis, pilonidal sinus, insect bites, infections (bacterial including antibiotic-resistant strains and fungal), septicemia, conjunctivitis and other eye diseases, endophthalmitis, acne, chronic seborrheic dermatitis, dandruff, eczema, psoriasis, inflammation, gingivitis, stomach ache, stomach ulcers, digestive disorders, constipation, vomiting, diarrhea, colitis, dehydration, diabetes, osteoporosis, insomnia, chronic fatigue syndrome, anemia, hypertension, immune disorders, multiple sclerosis, cardiovascular disease, hepatitis, tumors, cancer, and radiation/chemotherapy-induced oral mucositis.

You'd have to check the references and decide if the evidence supports claims like this. But in any event, this list is in startling contrast to the advice of physicians living during talmudic times, that those who were ill or injured should avoid honey.

The Koren Talmud on Honey - woops

In its otherwise excellent translation and commentary on the Talmud, the Koren Talmud has this to say in a footnote on today's daf:

Ingesting large quantities of sweet foods can cause a rise in blood sugar, which in turn can delay the healing of injuries. In addition, poor circulation caused by the fatty deposits in the arteries can limit the amount of oxygen and healing nutrients that reach a wound. Nerve damage, or neuropathy, causes numbness in the feet that prevents open wounds from healing. Moreover, when blood sugar levels are high, the immune system cannot effectively do its job of clearing away dead and damaged tissue and building new skin cells.

Oy.  This is a mess.  In the first place, in persons who are not diabetic, ingesting sweet foods will only cause a mild and very temporary rise in blood sugar. Second, fatty deposits are caused by cholesterol plaque build-up, and not by carbohydrates (which are sugars). Third, neuropathy has absolutely nothing to do with preventing wound healing.  That's caused mostly by a deficient microcirculation, which is often associated with a neuropathy, (for example in diabetics) but is not caused by it.  Finally, elevated blood sugars might effect the immune system, but again, this is only an issue for those whose diabetes is poorly controlled.

The Koren edition seems to be following a long tradition of getting it wrong when it comes to honey. In today's page of Talmud, honey is recorded as being harmful to your health, and the Koren Talmud tries, but fails, to give this belief a patina of scientific credibility.  But both are wrong.  In fact, you might want to put down that garlic so praised by the Talmud, and pick up some honey. That would be very good for you.

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Bava Kamma 82a ~ Is Garlic Good for You?

     בבא קמא עב, א

...עשרה תקנות תיקן עזרא...אוכלין שום בערב שבת... משום עונה דכתיב אשר פריו יתן בעתו וא"ר יהודה... זה המשמש מטתו מערב שבת  לערב שבת. ת"ר חמשה דברים נאמרו בשום משביע ומשחין ומצהיל פנים ומרבה הזרע והורג כנים שבבני מעיים וי"א מכניס אהבה ומוציא את הקנאה

Ezra made ten regultions...That they eat garlic on the eve of Shabbat, on account of the mitzvah to have sexual relations. As it is written [Psalms 1:3]: “He shall be like a tree…that yields its fruit in its proper time,” and Rav Yehuda taught….this verse refers to a person who has sexual intercourse on every eve of Shabbat. The rabbis taught that garlic has five qualities: It satiates and warms the body and brightens the face, it increases semen, and it kills parasites in the intestines. Others add that it instills love and so eliminates jealousy (Bava Kamma 82a)

Many, many years ago I watched a rabbi liberally rubbing garlic into matzah at his home as part of Friday night Shabbat dinner. I thought it was because he liked the taste.  I may have been wrong.

Today, the Talmud (Bava Kamma 82a) lists ten regulations enacted by Ezra when he led the return of the Jewish people from Babylonia to Israel. Some, like reading from the Torah on Mondays and Thursdays, you may have heard of. Others, never became quite so popular. Which brings us to enactment #5: to eat garlic on the eve of Shabbat. The Talmud explains why Ezra decreed (presumably to the men only) that garlic should be eaten on Friday night – because it increases male fertility and Friday night is the prescribed time to have intercourse.  So is the Talmud correct? Does garlic increase fertility? You’d be surprised…

The Medicinal Properties of Garlic

In a 2005 review article from Yeshiva University and the Albert Einstein College of Medicine, Ellen Tattleman noted that garlic has been used for medicinal purposes for thousands of years. Sanskrit records show that it has been in use as a medicine for at least 5,000 years, making the Chinese relative newcomers to the garlic industry, since they’ve only been using it for some 3,000 years. The Egyptians, Babylonians, Greeks, and Romans used garlic for healing purposes, and even the great Louis Pasteur noted garlic’s antibacterial activity, in 1858. In case you want to prepare this at home, it is the root bulb of the garlic plant (fresh, dehydrated, or as a steam-distilled oil) that you need to go for.  This bulb contains allicin which is formed when alliin, a sulfur-containing amino acid, comes into contact with the enzyme alliinase. This reaction happens whenever you chop, crush or chew raw garlic. The antimicrobial, lipid lowering, antioxidant, and anti-clotting effects that have been attributed to garlic are thought to be related to this allicin and other breakdown products. We will return to these medicinal properties later, but for now let’s focus on the effect of garlic on male fertility; after all, that’s what today’s page of Talmud discusses.

Garlic and Sperm Production - in Mice

There is conflicting evidence about the role of garlic on sperm production.  Some studies have shown that it impairs the Leydig and Sertoli cells that are part of the machinery of sperm production – if you are a rat. Other studies have shown that garlic, or rather the allicin that garlic produces, can protect the testes against toxins.  If you are a rat, being exposed to these testicular shriveling toxins. When it comes to the sperm themselves, again, the evidence is conflicting.  In mice, garlic has been shown both to increase and to decrease the production of sperm, and scientists have also noted conflicting results about the effect of garlic on testosterone levels.

In 2001 a group of Japanese researchers investigated the pharmacological activities of four garlic preparations, raw garlic juice, garlic powder, heated garlic juice and aged garlic extract, on testicular hypogonadism (hypospermatogenesis and impotence) induced by warm water treatment. The results showed that aged garlic extract at a 4 ml/kg  dose for a couple of weeks significantly enhanced spermatogenesis and improved impotence after warm water treatment of mice. In contrast, the other preparations were only slightly effective.  So perhaps infertile male mice should try garlic on Friday nights.

Overall, the effects of garlic on sperm production - on rodents -  are not clear.  A 2013 review in Andrologia of the impact of garlic on male fertility of concludes with these remarks:

In traditional oriental medicine, garlic has been used to improve male sexual dysfunction and to recover testicular functions. But in the literature, there are very few studies about the potential effects of garlic on spermatogenesis (about ten studies), and their results are contradictory. These discrepancies could be related to three main factors (i) the type of preparations, (ii) the way of administration [sic] and (iii) the dose.

Garlic and the Quality of Human Sperm

So much for mice and rats; what about the effect of garlic on human sperm production? It turns out that you can buy a combination antioxidant widely touted to improve male fertility. It is called Menevit, and among other substances, each capsule apparently contains 333 micrograms of garlic oil.   But a 2009 study from Australia found that after three-months of therapy with Menevit® there was no significant change in sperm concentration, motility or morphology, although it did produce a significant reduction in sperm DNA fragmentation. Which is confusing because the same team reported that infertile men treated with Menevit® for the same period of time had an improvement in the levels of sperm global DNA methylation, though whether that is a marker of anything important is not clear.  If you are confused, so are the experts. Here is what one expert review concluded, in the excitingly titled Male Infertility: Contemporary Clinical Approaches:


The present body of evidence surrounding the treatment of male factor infertility with antioxidants is difficult to critically interpret because of less than ideal study design (not screening for oxidative stress at enrollment, sperm quality as a primary endpoint instead of pregnancy and a lack of concurrent placebo controls). Furthermore, the use of a large number of different types and dosages of antioxidant and the lack of adequately powered studies to analyse pregnancy outcomes precludes definitive conclusions being made… Firm conclusions relating to antioxidant therapies ability to improve sperm concentration, motility and morphology is presently impossible due to the abundance of contradictory results and inadequately controlled studies.
 

are there Other Benefits of Garlic?

So the evidence that garlic does anything useful to sperm production is, um, not great. But what about the other widely touted health benefits of garlic? For example, some claim that garlic lowers your lipids and in a study published in the prestigious Journal of the American Medical Association, garlic appeared to be have a real, but modest effect on lowering cholesterol, when compared to placebo.  There is also a claim that garlic lowers your blood pressure. In a meta-analysis (which is an analysis of many trials lumped together) of 23 trials only three showed a statistically significant reduction in diastolic blood pressure and one showed a statistically significant reduction in systolic blood pressure (approximately 3 percent) in patients treated with garlic compared with placebo. There are claims that garlic can prevent cancer, and slow the onset of atherosclerosis. Here is a summary from my colleagues at the National Center for Complementary in Integrative Medicine, part of the National Institutes of Health:

  • Some evidence indicates that taking garlic can slightly lower blood cholesterol levels; studies have shown positive effects for short-term (1 to 3 months) use. However, an NCCIH-funded study on the safety and effectiveness of three garlic preparations (fresh garlic, dried powdered garlic tablets, and aged garlic extract tablets) for lowering blood cholesterol levels found no effect.
  • Preliminary research suggests that taking garlic may slow the development of atherosclerosis (hardening of the arteries), a condition that can lead to heart disease or stroke
  • Evidence suggests that taking garlic may slightly lower blood pressure, particularly in people with high blood pressure. 
  • Some studies suggest consuming garlic as a regular part of the diet may lower the risk of certain cancers. However, no clinical trials have examined this. A clinical trial on the long-term use of garlic supplements to prevent stomach cancer found no effect.

And if you are tempted to take a garlic containing pill, because "why not, it can't do any harm" please bear in mind that although it appears to be safe for most adults:

  • Side effects include breath and body odor, heartburn, upset stomach, and allergic reactions. These side effects are more common with raw garlic.
  • Garlic can thin the blood (reduce the ability of blood to clot) in a manner similar to aspirin. This effect may be a problem during or after surgery. So use garlic with caution if you are planning to have surgery or dental work, or if you have a bleeding disorder.
  • Garlic has been found to interfere with the effectiveness of  a drug used to treat HIV infection. Garlic may also interfere with other drugs, though this has not been well studied.

The more things change, the more they stay the same.

In today's page of Talmud it was claimed that garlic does many different things: "It satiates and warms the body and brightens the face, it increases semen, and it kills parasites in the intestines, and it instills love and so eliminates jealousy." How strange then to note that today the supposed health effects of garlic are widely touted.  Plus ça change, plus c'est la même chose.  

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