- Bee plant
- Bee bread
- Borage seed oil
- Ox's tongue
- Starflower oil
For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
How It Works
Borage may be helpful for rheumatoid arthritis, but there is no evidence that it can treat other 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 that 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. Its chronic use should be avoided, especially by patients with liver disease or women who are pregnant or breastfeeding.
Purported Uses and Benefits
To relieve arthritis symptoms
Some clinical trials suggest borage oil may help reduce inflammation and pain associated with arthritis.
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.
- Borage oil products should be certified free of toxic compounds called unsaturated pyrrolizidine alkaloids (UPAs), with 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 oil 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.
- Occasional headache, abdominal pain, nausea, belching, and loose stools.
- Possible liver damage may occur if taking borage oil for prolonged periods of time.
Continuous seizure activity: In an otherwise previously healthy 41-year-old woman, with short-term use (1 week) of borage oil.
Near-fatal poisoning from 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.
- 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.
For Healthcare Professionals
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).
Preclinical 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 suggest that GLA from borage seed oil has some benefits in treating rheumatoid arthritis (RA) (7) (9). A long-term study of fish and borage seed oils either alone or in combination suggest these may be useful to correct dyslipidemia in RA patients at increased risk for cardiovascular disease (19). Other analyses suggest moderate evidence of GLA-containing oils for relief of RA pain and disability without increased adverse events, but dose and treatment duration are unknown (20) and there was not enough evidence to support their current use in RA management (21).
In a preliminary double-blind trial, a borage extract improved 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 LA, produced anti-inflammatory effects (24). In patients with early type 2 diabetes or metabolic syndrome, this combination also lowered total and LDL cholesterol levels (25). In a study of postmenopausal hypertensive women, short-term borage oil supplementation significantly reduced blood pressure and waist-to-hip ratio (39).
Studies are mixed on whether borage oil can help skin conditions such as atopic eczema (11) (12) and several analyses indicate that neither evening primrose nor borage oil are effective for this purpose, 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 and Benefits
Mechanism of Action
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 can block transformation of arachidonic acid to leukotrienes and other prostaglandins (10). GLA can increase cAMP levels which suppress synthesis of TNF-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, the first step in digesting 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 levels and attenuating leukotriene production (24). Individual genetic variation in fatty acid desaturase as a gene–diet interaction has been proposed to explain heterogeneity of anti-inflammatory effects in clinical trials. One study demonstrated that borage oil elevated serum GLA and DGLA in an rs174537 genotype-dependent manner, and further suggests that “one size fits all” supplementation may not be appropriate (40).
Although aerial parts of borage demonstrate affinity for the serotonin transporter, toxicity profiles preclude 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).
Borage contains small amounts of unsaturated pyrrolizidine alkaloids (UPAs) that are hepatotoxic (13). Consumption of 1–2 g of borage seed oil daily can result in a UPA intake approaching 10 mcg. 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).
Possible hepatotoxicity following chronic administration.
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).
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 GLA from evening primrose oil, 9 of 12 patients had a significant increase in bleeding time (37). By extension, caution should be taken as borage oil is approximately 25% GLA, while evening primrose oil is about 10% GLA (38).
NSAIDs: Theoretically, concomitant use would decrease the effects of borage oil, as NSAIDs interfere with prostaglandin E synthesis (9).