Health Care Professional Information

Scientific Name
Borago officinalis
Common Name

Bee plant, bee bread, borage seed oil, ox’s tongue, starflower oil

Clinical Summary

Oil derived from the plant. Recent studies have shown gamma-linoleic acid (GLA) from borage seed oil has some benefits in treating rheumatoid arthritis (7) (9). Studies on borage oil's effect on skin conditions, such as atopic eczema (11) (12) and infantile seborrheic dermatitis (5), yielded mixed results. Borage oil contains a pyrrolizidine alkaloid, amabiline, which is hepatotoxic. Risk of hepatic damage increases with length of exposure and cumulative dose consumed. Patients should use borage oil certified free of unsaturated pyrrolizidine alkaloids. Borage oil may be unsafe during pregnancy.

Purported Uses
  • Arthritis
  • Chest congestion
  • Cough
  • Depression
  • Infantile seborrheic dermatitis
  • Menopausal symptoms
Constituents
  • Alkaloids: Contains small amounts of many pyrrolizidine types, especially amabiline (hepatotoxin).
  • Fatty acids: Linoleic acid gamolenic acid (GLA), oleic and saturated fatty acids
  • Mucilages: Glucose, galactose and arabinose
  • Acids: Acetic, lactic, malic and silicic
  • Tannins
  • Saponins
    (1)
Mechanism of Action

The GLA from the borage seeds may have anti-inflammatory properties. GLA can be converted to the prostaglandin precursor dihomo-gama-linolenic acid (DGLA). DGLA can block the transformation of arachidonic acid to leukotrienes and other prostaglandins (10). GLA can increase cAMP level which suppresses the synthesis of tumor necrosis factor-alpha - an inflammatory mediator linked to rheumatoid arthritis (9). The mucilage constituent has an expectorant-like action and malic acid has a mild diuretic effect. The tannin constituent may have mild astringent and constipating actions.
(3)

Warnings

Borage contains small amounts of the alkaloid amabiline, which is hepatotoxic. Consumption of 1-2 g of borage seed oil daily can result in an intake of toxic unsaturated pyrrolizidine alkaloids (UPAs) approaching 10 ug. The German Federal Health Agency now specifies consumption of such products should be limited to no more than 1 ug of UPA daily. Borage oil products should be certified free of UPAs (meet criterion of no more than 0.5-1 ug/g).
(2)

Contraindications

Pregnancy: Preliminary studies suggest borage oil has a teratogenic effect and that its prostaglandin E agonist action may cause premature labor.
(9)

Adverse Reactions

Common: Constipation may occur after administration.
Rare: Hepatotoxicity has been reported following chronic administration.

Herb-Drug Interactions

Phenothiazines: Theoretically borage oil may lower the seizure threshold due to its gamma linoleic acid content. Seizures have been documented with evening primrose oil, but not borage oil.
Tricyclic antidepressants: Theoretically, may lower seizure threshold due to gamma linoleic acid content. Seizures have been documented with evening primrose oil, but not borage oil.
NSAIDS: Theoretically concomitant use with borage oil would decrease the effects of borage oil, as NSAIDS interfere with the synthesis of prostaglandin E.
(6) (9)

Literature Summary and Critique

Henz BM, et al. Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. Br J Dermatol 1999;140:685-8.
A double-blind, multicenter study of borage oil (23% GLA) in 167 adults with stable atopic eczema of moderate severity. Patients were randomized to take daily either 500 mg of borage oil-containing capsules or the bland lipid miglyol as a placebo over a 24-week period. Primary endpoint was amount of rescue medication (topical diflucortolone-21-valerate cream) used until response; secondary endpoint was clinical improvement. Patients taking borage oil experienced small but insignificant clinical improvements compared to placebo; a subgroup excluding noncompliant patients and those who failed to show increased erythrocyte dihomo-gamma-linolenic acid levels showed a significant benefit.

Leventhal LJ, et al. Treatment of rheumatoid arthritis with gammalinoleic acid. Ann Intern Med 1993;119:867-73.
A randomized, double-blind, placebo-controlled, 24-week trial of 37 patients with rheumatoid arthritis and active synovitis. The treatment group receiving gammalinoleic acid (GLA) 1.4 g experienced a 36% reduction in the number of tender joints and a 28% reduction in swollen joints. The placebo group did not show significant improvement in any measure. No significant adverse effects were reported.

Pullman-Mooar S, et al. Alteration of the cellular fatty acid profile and the production of eicosanoids in human monocytes by gamma-linolenic acid. Arthritis Rheum 1990;33:1526-33.
In an uncontrolled trial, borage seed oil 1.1 g was given to 7 healthy patients and seven patients with rheumatoid arthritis for 12 weeks. Eighty-five percent of the arthritic group experienced relief, possibly due to the GLA in the borage oil.

Dosage (Inside MSKCC Only)
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References
  1. Newell CA, et al. Herbal Medicine: A Guide for Healthcare Professionals. London: Pharmaceutical Press; 1996.
  2. Tyler V. Herbs of Choice, the Therapeutical Use of Phytomedicinals. Binghamton: Pharmaceutical Press; 1994.
  3. Peirce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press Inc; 1999. 270.
  4. Hoffman D. The Herb Users Guide: The Basic Skills of Medical Herbalism. Wellingborough: Thorsons, 1987.
  5. Tollesson A, Frithz A. Borage oil, an effective new treatment for infantile seborrhoeic dermatitis. Br J Derm 1993;129:95.
  6. Brinker F. Herb Contraindications and Drug Interactions, 3rd ed. Sandy (OR): Eclectic Medical Publications; 2001.
  7. Leventhal LJ, et al. Treatment of rheumatoid arthritis with gamma-linolenic acid. Ann Intern Med 1993;119:867-73.
  8. Pullman-Mooar S, et al. Alteration of the cellular fatty acid profile and the production of eicosanoids in human monocytes by gamma-linolenic acid. Arthritis Rheum 1990;22:1526-33.
  9. Kast RE. Borage oil reduction of rheumatoid arthritis activity may be medicated by increased cAMP that suppresses tumor necrosis factor-alpha. International Immunopharmacol 2001;2197-99.
  10. Belch JJ, Hill A. Evening primrose oil and borage oil in rheumatologic conditions. Am J Clin Nutr 2000;71(suppl):352S-6S.
  11. Henz BM, et al. Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. Br J Dermatology 1999;140:685-8.
  12. Takwale A, Tan E, Agarwal S, Barclay G, Ahmed I, Hotchkiss K, Thompson JR, Chapman T, Berth-Jones J. Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial. BMJ. 2003 Dec 13;327(7428):1385.

Consumer Information

How It Works

Bottom Line: Borage may be helpful in treating rheumatoid arthritis, but there is no evidence that it can treat menopausal symptoms, depression, dermatitis or other serious medical conditions.

Borage seeds contain oils that are probably responsible for its medicinal actions. These oils are known to contain the omega-6 fatty acid gamma-linolenic acid (GLA), which is also produced naturally in the body. Scientists have not figured out how exactly borage exerts its effects, but theorize that GLA has anti-inflammatory activity. Chronic inflammation is mediated in part by substances known as prostaglandins and leukotrienes, both by-products of metabolism of arachidonic acid, a fatty acid in cell membranes. GLA is able to reduce the formation of prostaglandins and leukotrienes by replacing arachidonic acid in cell membranes.

Borage also contains mucilage, a sticky mixture of plant sugars, which can act as an expectorant to produce phlegm in patients with coughs.

Purported Uses
  • To reduce inflammation and pain associated with arthritis
    A handful of small clinical trials support this use.
  • As an expectorant and to treat coughs
    Laboratory studies support this use, but there is no proof from clinical trials that borage can treat coughs.
  • To treat depression
    No scientific evidence supports this use.
  • To treat infantile seborrheic dermatitis
    Laboratory studies do not support this use.
  • To treat atopic dermatitis (eczema)
    One large clinical trial (described below) does not support this use.
  • To ease menopausal symptoms such as hot flashes, vaginal dryness, sleep disturbances, and mood swings
    No scientific evidence supports this use.
Research Evidence

Thus far, not many clinical trials have been performed with borage oil, and all have focused on small groups of patients.

Rheumatoid arthritis:
A randomized controlled trial studied the use of borage oil in 37 patients with rheumatoid arthritis and active synovitis. After 24 weeks, the group that received 1.4 g of gammalinoleic acid (GLA) daily had a significant reduction in the number of tender joints and swollen joints. The group that took a placebo pill every day did not show improvement, and some patients worsened. No side effects were reported. This small study supports the safety and efficacy of short-term use of GLA in treating rheumatoid arthritis, but patients should be aware that the safety of its long-term use is still not known.

In an uncontrolled trial, 1.1 g of borage seed oil was given to seven healthy patients and seven patients with rheumatoid arthritis for twelve weeks. Six of the seven patients with rheumatoid arthritis reported relief of their symptoms. Because this study is very small and lacks a placebo group (a group of patients with rheumatoid arthritis taking a placebo pill) to which the borage oil group's improvements can be compared, its results are not very reliable. Larger, controlled clinical trials should be conducted.

Atopic eczema:
A randomized, controlled trial examined the effectiveness of borage oil with a high concentration of GLA (23%) in 160 adults with atopic eczema. Patients were randomly assigned to take either 500 mg of borage oil capsules or placebo capsules for 24 weeks. Those taking borage oil showed a slight improvement in symptoms, but the change was not considered “significant” by scientific standards. This well-designed trial does not support the use of borage oil for adult atopic eczema.

Patient Warnings
  • This product is regulated by the F.D.A. as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
  • Borage oil products should be certified free of toxic compounds called unsaturated pyrrolizidine alkaloids (UPAs), at least no more than 0.5-1 microgram of UPAs per gram of borage oil. The German Federal Health Agency recommends that consumption of UPAs should be limited to no more than 1 microgram daily.
Do Not Take If
  • You are pregnant (Borage oil may cause birth defects and premature labor).
  • You are taking phenothiazines (In theory, the GLA in borage oil may lower patients' seizure threshold. Seizures have been reported in patients that have combined phenothiazines with evening primrose oil, which also contains GLA.)
  • You are taking tricyclic antidepressants (In theory, the GLA in borage oil may lower patients' seizure threshold. Seizures have been reported in patients that have combined tricyclic antidepressants with evening primrose oil, which also contains GLA.)
  • You are regularly taking NSAIDs (such as aspirin, AdvilTM, or cox-2 inhibitors) (In theory, NSAIDs can reduce the effects of borage oil).
Side Effects
  • Constipation
  • Liver damage has occurred in a few patients who took borage oil for prolonged periods of time.
Special Point

Borage oil products should not be used unless they are certified free of unsaturated pyrrolizidine alkaloids (UPAs) such as amabiline, which can damage the liver. Risk of liver damage increases with length of exposure and cumulative dose.

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