Borage

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Borage

Common Names

  • Bee plant
  • Bee bread
  • Borage seed oil
  • Ox's tongue
  • Starflower oil

For Patients & Caregivers

How It Works

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

Borage seed oil contains the omega-6 fatty acid known as gamma-linolenic acid. GLA is also produced naturally in the body and thought to have anti-inflammatory activity. Borage also contains mucilage, a sticky mixture of plant sugars, which can act as an expectorant to produce phlegm in patients with coughs. Borage has been promoted for rheumatoid arthritis, skin inflammation, diabetic nerve pain, menopausal symptoms, and gastrointestinal issues, but research shows only moderate support for its use to relieve rheumatoid arthritis symptoms.

Although it has been suggested as an alternative source of GLA to evening primrose oil, borage seed oil can have toxic effects on the liver and its chronic use should be avoided, especially by patients with liver disease or women who are pregnant or breastfeeding.

Purported Uses
  • ​To reduce inflammation and pain associated with arthritis
    Some clinical trials support this use.
  • As an expectorant and to treat coughs
    In a small study, a borage extract improved some asthma symptoms, including cough. Additional studies are needed.
  • To treat depression
    No scientific evidence supports this use.
  • To treat dermatitis
    Two clinical trials do not support its use for skin inflammation such as atopic dermatitis.
  • To ease menopausal symptoms
    No scientific evidence supports this use.
Patient Warnings
  • 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 or breastfeeding: Borage may cause birth defects, premature labor, or a blood disorder in infants known as blue baby syndrome.
  • You have liver disease: Borage oil may have small amounts of a compound that causes toxic liver effects.
  • You are taking drugs that can cause liver toxicity (eg, anabolic steroids, ketoconazole): Borage contains small amounts of compounds also known to be toxic to the liver. 
  • You are taking blood thinners (eg, warfarin): Borage may increase bleeding risk or the effects of these drugs.
  • You are regularly taking NSAIDs (aspirin, AdvilTM, or cox-2 inhibitors): In theory, NSAIDs can reduce the effects of borage oil.
Side Effects
  • Occasional headache, abdominal pain, nausea, belching, and loose stools.
  • Possible liver damage may occur if taking borage oil for prolonged periods of time.

Case reports

Continuous seizure activity: In an otherwise previously healthy 41-year-old woman, with short-term use (1 week) of borage oil.

Near-fatal poisoning, caused by mistaken plant identity: Borage was confused with the toxic plant foxglove, causing accidental poisoning in an otherwise healthy 58-year-old woman.

Blue baby syndrome: Multiple cases in Spain clearly linked this infant blood disorder to ingestion of borage, which was tested as a purée and is high in nitrates. Other factors that caused this syndrome included breastfeeding. Infants are unable to process large amounts of nitrates.

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.
  • Borage plants during non-flowering seasons can be easily confused with foxglove, which is toxic.
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For Healthcare Professionals

Scientific Name
Borago officinalis
Clinical Summary

Borage oil, derived from the seeds of the plant, is a rich source of gamma-linolenic acid (GLA) and linoleic acid (LA). In herbal and traditional medicine, borage oil has been used to induce sweating, as an expectorant and anti-inflammatory, to promote lactation, to stimulate adrenal function, and as an alternative source to evening primrose oil for obtaining GLA (13). It has also been promoted to treat rheumatoid arthritis, atopic dermatitis, diabetic neuropathy, menopause-related symptoms, and gastrointestinal disease (14) (15).

In vitro and in vivo studies suggest antimutagenic, cytotoxic, and chemopreventive effects (16) (33). In an animal model of senile osteoporosis, a diet rich in borage or fish oils reduced inflammation and improved bone parameters (17). Borage extract consumption improved markers of disease-induced cognitive dysfunction in Alzheimer’s models (18).

In humans, studies show that GLA from borage seed oil has some benefits in treating rheumatoid arthritis (RA) (7) (9). A long-term study evaluating fish and borage seed oils in RA patients at increased risk for cardiovascular disease suggest these may be useful to correct dyslipidemia when used either alone or in combination (19). Other analyses suggest moderate evidence of GLA-containing oils including borage oil for the relief of RA symptoms such as pain intensity and disability without increased adverse events, but adequate dose and treatment duration are unknown (20), and there was not enough available evidence to support their current use in RA management (21).

In a preliminary double-blind trial, a borage extract improved the clinical findings of moderate asthma, but not related inflammation (34). In patients with mild asthma, a combination of seed oils from borage and echium (a plant rich in linolenic acid) produced anti-inflammatory effects (24). In patients with early-stage type 2 diabetes or metabolic syndrome, this combined supplementation significantly lowered total and low-density lipoprotein (LDL) cholesterol levels (25).

Studies are mixed on the effect of borage oil for skin conditions such as atopic eczema (11) (12) and infantile seborrheic dermatitis (5). Several analyses indicate that neither evening primrose oil nor borage oil are effective in treating atopic eczema, with improvements being similar to respective placebos (22) (23).

Borage oil contains pyrrolizidine alkaloids that are hepatotoxic (26). 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 should not be used during pregnancy or when breastfeeding (27) (36).

Purported Uses
  • Arthritis
  • Chest congestion
  • Cough
  • Depression
  • Dermatitis
  • Menopausal symptoms
Mechanism of Action

The anti-inflammatory properties of borage oil have been attributed to its high GLA content (16). It also contains other fatty acids including linoleic, oleic, palmitic, stearic, eicosenoic, and erucic acids (28). 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 levels which suppress 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).

In vitro, a borage oil formulation demonstrated inhibitory effects on alpha-amylase, an enzyme that hydrolyzes 1,4-alpha-glucoside bonds in oligo- and polysaccharides, which is the first step in digestion of dietary starch and glycogen (29). In animal models, borage oil improved amyloid-beta-induced long-term potentiation disruption in the hippocampal dentate gyrus, providing a neuroprotective effect attributed to the scavenging of free radicals (18). Borage-enriched sunflower oil counteracted pro-inflammatory mechanisms and prevented senile osteoporosis, by inhibiting osteoblast-induced osteoclast formation (17).

In human studies, dietary supplementation with borage and echium seed oils produced anti-inflammatory effects in mild asthmatics by altering polyunsaturated fatty acid (PUFA) levels and by attenuating leukotriene production (24).

Although aerial parts of borage demonstrate affinity for the serotonin transporter, its toxicity profile precludes its further development as an herbal drug (30). Borage contains several minor constituents known as pyrrolizidine alkaloids which are hepatotoxic, including amabiline, supinine, lycopsamine, intermedine, acetyllycopsamine and acetylintermedine (26) (31). Borage oil also has teratogenic effects, and its prostaglandin E agonist action may cause premature labor (9).

Warnings

Borage contains small amounts of unsaturated pyrrolizidine alkaloids (UPAs) that are hepatotoxic. Consumption of 1–2 g of borage seed oil daily can result in a UPA intake approaching 10 ug. The German Federal Health Agency specified 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 (meeting the criterion of no more than 0.5-1 ug/g)  (2).

Contraindications

Liver disease: Patients with liver problems should avoid this product.

Pregnancy or breastfeeding: Borage may have teratogenic effects, or cause premature labor (9)  or infant methemoglobinemia (36).

Adverse Reactions

Occasional headache, abdominal pain, nausea, belching, and loose stools (20) (21).

Possible hepatotoxicity following chronic administration.

Case report
Status epilepticus: In an otherwise previously healthy 41-year-old woman with no family history of epilepsy, associated with borage oil ingested over 1 week (14).

Near-fatal poisoning, caused by mistaken plant identity: In an otherwise healthy 58-year-old woman. Borage was confused with foxglove (Digitalis spp.), which is toxic, causing this case of accidental ingested poisoning (35).

Diet-induced infant methemoglobinemia: Multiple cases from a long-term case-control study in Spain were clearly linked to borage, which are high in nitrates, and was tested as a purée. Other factors included breastfeeding and proximity between time of preparation and use (36).

Herb-Drug Interactions

Hepatotoxic drugs (eg, anabolic steroids, ketoconazole): Borage contains low concentrations of unsaturated pyrrolizidine alkaloids also known to cause hepatotoxic effects (13).
Anticoagulants (eg, warfarin): In a small study of humans on several months of supplementation with y-linoleic acid from evening primrose oil, a significant increase in bleeding time was observed in 9 of 12 patients (37). By extension, caution should be taken with borage for a potential interaction, as borage oil is approximately 25% GLA, while evening primrose oil is about 10% GLA (38).
Nonsteroidal anti-inflammatory drugs (NSAIDs): Theoretically, concomitant use would decrease the effects of borage oil, as NSAIDs interfere with prostaglandin E synthesis (9).

Dosage (OneMSK Only)
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, et al. 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.
  13. Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. Nov 9 1998;158(20):2200-2211.
  14. Al-Khamees WA, Schwartz MD, Alrashdi S, et al. Status epilepticus associated with borage oil ingestion. J Med Toxicol. Jun 2011;7(2):154-157.
  15. Leos-Rivas C, Verde-Star MJ, Torres LO, et al. In vitro amoebicidal activity of borage (Borago officinalis) extract on Entamoeba histolytica. J Med Food. Jul-Aug 2011;14(7-8):866-869.
  16. Tasset-Cuevas I, Fernandez-Bedmar Z, Lozano-Baena MD, et al. Protective effect of borage seed oil and gamma linolenic acid on DNA: in vivo and in vitro studies. PLoS One. 2013;8(2):e56986.
  17. Wauquier F, Barquissau V, Leotoing L, et al. Borage and fish oils lifelong supplementation decreases inflammation and improves bone health in a murine model of senile osteoporosis. Bone. Feb 2012;50(2):553-561.
  18. Zargooshnia S, Shahidi S, Ghahremanitamadon F, et al. The protective effect of Borago Officinalis extract on amyloid beta (25-35)-induced long term potentiation disruption in the dentate gyrus of male rats. Metab Brain Dis. Feb 2015;30(1):151-156.
  19. Olendzki BC, Leung K, Van Buskirk S, et al. Treatment of rheumatoid arthritis with marine and botanical oils: influence on serum lipids. Evid Based Complement Alternat Med. 2011;2011:827286.
  20. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2011(2):Cd002948.
  21. Macfarlane GJ, El-Metwally A, De Silva V, et al. Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. Rheumatology (Oxford). Sep 2011;50(9):1672-1683.
  22. Bamford JT, Ray S, Musekiwa A, et al. Oral evening primrose oil and borage oil for eczema. Cochrane Database Syst Rev. 2013;4:Cd004416.
  23. Madhok V, Futamura M, Thomas KS, et al. What’s new in atopic eczema? An analysis of systematic reviews published in 2012 and 2013. Part 2. Treatment and prevention. Clin Exp Dermatol. Jun 2015;40(4):349-354; quiz 354-345.
  24. Arm JP, Boyce JA, Wang L, et al. Impact of botanical oils on polyunsaturated fatty acid metabolism and leukotriene generation in mild asthmatics. Lipids Health Dis. 2013;12:141.
  25. Lee TC, Ivester P, Hester AG, et al. The impact of polyunsaturated fatty acid-based dietary supplements on disease biomarkers in a metabolic syndrome/diabetes population. Lipids Health Dis. 2014;13:196.
  26. Herrmann M, Joppe H, Schmaus G. Thesinine-4’-O-beta-D-glucoside the first glycosylated plant pyrrolizidine alkaloid from Borago officinalis. Phytochemistry. Jun 2002;60(4):399-402.
  27. Ernst E. Herbal medicinal products during pregnancy: are they safe? Bjog. Mar 2002;109(3):227-235.
  28. Asadi-Samani M, Bahmani M, Rafieian-Kopaei M. The chemical composition, botanical characteristic and biological activities of Borago officinalis: a review. Asian Pac J Trop Med. Sep 2014;7s1:S22-28.
  29. Marrelli M, Loizzo MR, Nicoletti M, et al. In vitro investigation of the potential health benefits of wild Mediterranean dietary plants as anti-obesity agents with alpha-amylase and pancreatic lipase inhibitory activities. J Sci Food Agric. Aug 2014;94(11):2217-2224.
  30. Jager AK, Gauguin B, Andersen J, et al. Screening of plants used in Danish folk medicine to treat depression and anxiety for affinity to the serotonin transporter and inhibition of MAO-A. J Ethnopharmacol. Feb 13 2013;145(3):822-825.
  31. Vacillotto G, Favretto D, Seraglia R, et al. A rapid and highly specific method to evaluate the presence of pyrrolizidine alkaloids in Borago officinalis seed oil. J Mass Spectrom. Oct 2013;48(10):1078-1082.
  32. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. Jul 1 2000;57(13):1221-1227; quiz 1228-1230.
  33. Lozano-Baena MD, Tasset I, Munoz-Serrano A, et al. Cancer Prevention and Health Benefices of Traditionally Consumed Borago officinalis Plants. Nutrients. Jan 18 2016;8(1).
  34. Mirsadraee M, Khashkhashi Moghaddam S, Saeedi P, et al. Effect of Borago Officinalis Extract on Moderate Persistent Asthma: A Phase two Randomized, Double Blind, Placebo-Controlled Clinical Trial. Tanaffos. 2016;15(3):168-174.
  35. Bonfanti L, Lippi G, Ciullo I, et al. In the kingdom of “tortelli” (ravioli-like pasta) plant poisoning is still a threat. A case report of near-fatal poisoning from Digitalis Purpurea accidentally confused with Borago Officinalis. Acta Biomed. Jan 16 2017;87(3):353-357.
  36. Martinez A, Sanchez-Valverde F, Gil F, et al. Methemoglobinemia induced by vegetable intake in infants in northern Spain. J Pediatr Gastroenterol Nutr. May 2013;56(5):573-577.
  37. Guivernau M, Meza N, Barja P, et al. Clinical and experimental study on the long-term effect of dietary gamma-linolenic acid on plasma lipids, platelet aggregation, thromboxane formation, and prostacyclin production. Prostaglandins Leukot Essent Fatty Acids. Nov 1994;51(5):311-316.
  38. Chung S, Kong S, Seong K, et al. Gamma-linolenic acid in borage oil reverses epidermal hyperproliferation in guinea pigs. J Nutr. Oct 2002;132(10):3090-3097.
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