Journal of Nutrition,Fasting and Health

Journal of Nutrition,Fasting and Health

Garlic Supplementation and Exercise-Induced Immunomodulation: A Narrative Review of Synergistic Mechanisms and Clinical Implications

Document Type : Review Article

Author
Department of Physical Education and Sport Sciences, ET.C., Islamic Azad University, Tehran, Iran.
10.22038/jnfh.2026.94586.1621
Abstract
Garlic (Allium sativum) has been suggested as a natural immunomodulator, especially regarding exercise-induced immune system modulation. Due to its bioactive sulfur compounds, such as allicin, diallyl sulfides, and S-allylcysteine, garlic has been shown to have strong antioxidant and anti-inflammatory properties. The purpose of this narrative review was to assess the individual and combined effects of garlic supplement administration and exercise training on the immune system, focusing on molecular mechanisms and clinical results. A thorough literature search was performed in the PubMed, Scopus, Web of Science, and Persian databases (SID, MagIran) for articles published between 2000 and March 2025. Human and animal studies examining immunological parameters, such as immune cell activity, cytokines, immunoglobulins, oxidative stress markers, and infection rates, were qualitatively analyzed. Findings suggest that moderate garlic consumption (600-1200 mg/day of standardized garlic extract or equivalent) in combination with regular moderate to vigorous exercise may have a synergistic effect on the immune system. These immune system adaptations occur through Nrf2/ARE pathway activation, increased hydrogen sulfide production, NF-κB signalling inhibition, and gut-immune axis modulation. These results include increased NK cell and T lymphocyte activity, increased secretory IgA levels, improved antioxidant status, and decreased inflammatory markers (IL-6, TNF-α, CRP, and MDA), as well as a diminished post-exercise “open window” period. However, overuse or long-term unsupervised consumption may result in gastrointestinal side effects or adverse interactions, especially among patients taking anticoagulants. Garlic supplementation in combination with structured exercise regimens appears to be a promising approach for immune system modulation.
Keywords
Subjects

1.                 Tesfaye A. Revealing the therapeutic uses of garlic (Allium sativum) and its potential for drug discovery. ScientificWorldJournal. 2021; 2021:8817288.
2.                 Farazandeh Nia D, Hosseini M, Riyahi Malayeri S, Daneshjoo A. Effect of eight weeks of swimming training with garlic intake on serum levels of IL-10 and TNF-α in obese male rats. Jundishapur Sci Med J. 2018; 16(6):665–71.
3.                 El-Saadony MT, Saad AM, Korma SA, Salem HM, Abd El-Mageed TA, Alkafaas SS, et al. Garlic bioactive substances and their therapeutic applications for improving human health: a comprehensive review. Front Immunol. 2024; 15:1277074.
4.                 Tabe H, Abbassi Daloii A, Ziaolhagh SJ, Barari AR. The effect of aerobic training and garlic supplementation on heart tissue structure in obese rats. J Anim Physiol Dev. 2021; 14(3):73–84.
5.                 Khatami Saravi L, Abdi A, Barari AR. Protective effect of aerobic training along with garlic on lipocalin-2 and IL-1β in obese women with high blood pressure. J Nutr Sci Food Technol. 2020; 15(1):25–34.
6.                 Boostani M, Rezaei Nasab H. Comparison of the effect of six weeks of continuous and interval training on some indicators of immune system in healthy non-athlete males. Jundishapur Sci Med J. 2017; 16(1):25–34.
7.                 Niknam S. The role of nutrition in strengthening the immune system. J Public Health. 2022.
8.                 Akbarpour Beni M, Omidi M. Effect of short-term garlic supplementation on CD4 and CD8 factors in young karate athletes after intense exercise session. CMJA. 2018; 7(4):2041–51.
9.                 Percival T. The effect of garlic supplementation on immune function and the severity of cold and influenza. Med Sci J. 2021.
10.              Mirabo M. The effect of garlic extract on immune cells in rats. J Pharm Res. 2023.
11.              Janeway CA, Travers P, Walport M, Shlomchik MJ. Immunobiology: the immune system in health and disease. Garland Science; 2005.
12.              Medzhitov R, Janeway CA. Innate immunity. N Engl J Med. 2000; 343(5):338–44.
13.              Abbas AK, Lichtman AH, Pillai S. Cellular and molecular immunology. Elsevier; 2014.
14.              Garlic. Health Encyclopedia. Rochester, NY: University of Rochester Medical Center.
15.              Block E. The chemistry of garlic and onions. Sci Am. 1985; 252(3):114–9.
16.              Ried K. The effect of garlic on exercise performance: a systematic review. Sports. 2013.
17.              Ichikawa M, Ryu K, Yoshida J. Antioxidant effects of tetrahydro-beta-carboline derivatives identified in aged garlic extract. 2002; 57–72.
18.              Ryu K, Ide N, Matsuura H, Itakura Y. N alpha-(1-deoxy-D-fructos-1-yl)-L-arginine, an antioxidant compound identified in aged garlic extract. J Nutr. 2001; 131(3 Suppl):972S–6S.
19.              Javed H, Khan MM, Khan A, Vaibhav K, Ahmad A, Khuwaja G, et al. S-allyl cysteine attenuates oxidative stress associated cognitive impairment and neurodegeneration in mouse model of streptozotocin-induced experimental dementia of Alzheimer's type. Brain Res. 2011; 1389:133–42.
20.              Saravanan G, Ponmurugan P. Ameliorative potential of S-allyl cysteine on oxidative stress in STZ induced diabetic rats. Chem Biol Interact. 2011; 189(1–2):100–6.
21.              Samavati Sharif MA, Afshari A, Siavoshy H, Keshvary M. The effect of two exercise trainings on some of immune system markers in adolescent athletes. J Pract Stud Biosci Sport. 2017; 4(8):55–65.
22.              Nieman DC. Exercise, nutrition, and immune function. Sports Med. 2000; 30(4):307–17.
23.              Akbarpour Beni M, Omidi M. Effect of short-term garlic supplementation on CD4 and CD8 factors in young karate athletes after intense exercise session. CMJA. 2018; 7(4):2041–51.
24.              Ried K, Toben C, Fakler P. Garlic for the prevention of cardiovascular disease. J Nutr Immunol. 2020; 27(2):125–36.
25.              Farazandeh Nia D, Hosseini M, Riyahi Malayeri S, Daneshjoo A. Effect of eight weeks of swimming training with garlic intake on serum levels of IL-10 and TNF-α in obese male rats. Jundishapur Sci Med J. 2017; 16(6):665–71.
26.              Ried K, Toben C, Fakler P. Effects of garlic supplements on inflammatory markers and immune cell activity. J Nutr Immunol. 2020.
27.              Pedersen BK, Jensen M. Impact of garlic consumption and exercise program on immune response. Med Sci Sports Exerc. 2019.
28.              Science Reports. Investigating the effects of garlic supplementation on immunoglobulins and mucosal immune response in athletes. Sci Rep. 2021.
29.              Su QS, Tian Y, Zhang JG, et al. Effects of allicin supplementation on plasma markers of exercise-induced muscle damage, IL-6 and antioxidant capacity. Eur J Appl Physiol. 2008; 103(3):275–83.
30.              Gholami F, Naderi A. Acute garlic supplementation ameliorates exercise-induced lipid peroxidation in sedentary individuals. Int J Health Sci. 2020; 6(1).
31.              Johnson R, Smith A, Brown T. Effects of garlic supplementation on immune system performance. J Sports Med. 2020.
32.              Thompson L, Miller J, Davis K. Impact of garlic on athletic performance. J Nutr. 2018.
33.              Williams P, Taylor S, White J. Garlic and drug interactions. Clin Nutr. 2019.
34.              Shukla MJA, et al. Garlic: a review of its medicinal effects and the potential benefits for immune system. J Clin Med Res. 2013; 5(1):55–62.
35.              Akhtar KF, et al. Health benefits of garlic: a review. J Intercult Ethnopharmacol. 2016; 5(2):223–9.
36.              Vollaard NB, Shearman JP, Cooper CE. Exercise-induced oxidative stress: myths, realities and physiological relevance. Sports Med. 2005; 35(12):1045–52.
37.              Powers SK, Nelson WB, Hudson MB. Exercise-induced oxidative stress in humans: cause and consequences. Free Radic Biol Med. 2011; 51(5):942–50.
38.              Banni S, Day BW, Evans RW, et al. Liquid chromatographic-mass spectrometric analysis of conjugated diene fatty acids in a partially hydrogenated fat. J Am Oil Chem Soc. 1994; 71(12):1321–5.
39.              Armstrong RB, Ogilvie RW, Schwane JA. Eccentric exercise-induced injury to rat skeletal muscle. J Appl Physiol Respir Environ Exerc Physiol. 1983; 54(1):80–93.
40.              Kim HJ, Lee YH, Kim CK. Biomarkers of muscle and cartilage damage and inflammation during a 200 km run. Eur J Appl Physiol. 2007; 99(4):443–7.
41.              Takarada Y. Evaluation of muscle damage after a rugby match with special reference to tackle plays. Br J Sports Med. 2003; 37(5):416–9.
42.              Aoi W, Naito Y, Takanami Y, et al. Oxidative stress and delayed-onset muscle damage after exercise. Free Radic Biol Med. 2004; 37(4):480–7.
43.              Thirumalai T, Therasa SV, Elumalai EK, et al. Hypoglycemic effect of Brassica juncea (seeds) on streptozotocin-induced diabetic male albino rat. Asian Pac J Trop Biomed. 2011; 1(4):323–5.
44.              Tsao JP, Liu CC, Wang HF, et al. Oral resveratrol supplementation attenuates exercise-induced interleukin-6 but not oxidative stress after a high intensity cycling challenge in adults. Int J Med Sci. 2021; 18(10):2137–45.
45.              Tsao JP, Bernard JR, Hsu HC, et al. Short-term oral quercetin supplementation improves post-exercise insulin sensitivity, antioxidant capacity and enhances subsequent cycling time to exhaustion in healthy adults: a pilot study. Front Nutr. 2022; 9:875319.
46.              Nagae S, Ushijima M, Hatono S, et al. Pharmacokinetics of the garlic compound S-allylcysteine. Planta Med. 1994; 60(3):214–7.
47.              Wang X, Liu R, Yang Y, et al. Isolation, purification and identification of antioxidants in an aqueous aged garlic extract. Food Chem. 2015; 187:37–43.
48.              Yamaji K, Sarker KP, Abeyama K, et al. Anti-atherogenic effects of an egg yolk-enriched garlic supplement. Int J Food Sci Nutr. 2004; 55(1):61–6.
49.              Török B, Belágyi J, Rietz B, Jacob R. Effectiveness of garlic on the radical activity in radical generating systems. Arzneimittelforschung. 1994; 44(5):608–11.
50.              Borek C. Antioxidant health effects of aged garlic extract. J Nutr. 2001; 131(3):1010S–5S.
51.              Farhana A, Lappin SL. Biochemistry, lactate dehydrogenase. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
52.              Ide N, Lau BH. Garlic compounds minimize intracellular oxidative stress and inhibit nuclear factor-kappa B activation. J Nutr. 2001; 131(3 Suppl):1020S–6S.
53.              Moosavian SP, Paknahad Z, Habibagahi Z. A randomized, double-blind, placebo-controlled clinical trial, evaluating the garlic supplement effects on some serum biomarkers of oxidative stress, and quality of life in women with rheumatoid arthritis. Int J Clin Pract. 2020; 74(7):e13498.
54.              Moosavian SP, Arab A, Paknahad Z, Moradi S. The effects of garlic supplementation on oxidative stress markers: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2020; 50:102385.
55.              Tsao JP, Bernard JR. Garlic supplementation attenuates cycling exercise-induced oxidative inflammation but fails to improve time trial performance in healthy adults. Int J Sport Nutr Exerc Metab. 2023; 20(1):2206809.
56.              Nieman DC. Potential impact of diet and exercise on immune function. J Nutr. 2000; 130(3):640S–4S.
57.              Maughan RJ, Burke LM. Sports nutrition: a handbook for the athlete. Haynes Publications; 2012.
58.              Anwar F, Ashraf M. Garlic (Allium sativum L.): a review of the health benefits. Afr J Tradit Complement Altern Med. 2012; 9(4):509–17.
59.              Azam F, Anwar MJ, Kahfi J, Almahmoud SA, Emwas AH. Cracking the sulfur code: garlic bioactive molecules as multi-target blueprints for drug discovery. Pharmaceuticals (Basel). 2025; 18(11):1766.
60.              Jadhav A, Jagtap S, Vyavahare S, Sharbidre A, Kunchiraman B. Reviewing the potential of probiotics, prebiotics and synbiotics: advancements in treatment of ulcerative colitis. Front Cell Infect Microbiol. 2023; 13:1268041.
 
 

Articles in Press, Accepted Manuscript
Available Online from 28 September 2026

  • Receive Date 12 February 2026
  • Revise Date 15 August 2026
  • Accept Date 27 September 2026