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This comprehensive review examines the microbial ecology underlying garlic fermentation, the biochemical pathways that generate bioactive metabolites, and the mechanistic basis by which fermented garlic employed in the broader food fortification strategy or incorporated into fortified therapeutic food formulations targeting clinical malnutrition, may support nutritional recovery in the context of Environmental Enteric Dysfunction (EED), the dominant gut pathology underlying stunting and wasting in low- and middle-income countries (LMICs)