Borago Officinalis
Also known as: Borage, starflower, bee bush, borage oil, Borago officinalis
Overview
Borago officinalis, commonly known as borage or starflower, is an annual herb native to the Mediterranean region, now cultivated worldwide. Its seeds are primarily used to extract borage oil, which is rich in gamma-linolenic acid (GLA), a polyunsaturated fatty acid. The flowers and leaves are also used in traditional medicine and cuisine, with flower extracts showing antioxidant properties. Borage oil is primarily marketed for inflammatory skin conditions like eczema, atopic dermatitis, and cyclic mastalgia (breast pain). While generally considered safe for short-term use, borage contains trace amounts of pyrrolizidine alkaloids (PAs), which pose a theoretical risk of hepatotoxicity, especially with long-term use or in susceptible individuals. Research on borage oil for dermatological conditions and mastalgia is moderate, with emerging studies on flower extracts for antioxidant and neuroprotective effects. Most human trials are small, and high-quality, long-term randomized controlled trials are limited.
Benefits
Borage oil has shown significant benefits in reducing the severity of cyclic mastalgia (breast pain) and improving related quality-of-life measures. A 90-day randomized controlled trial involving 60 participants demonstrated that borage oil significantly reduced pain scores and improved aspects like work, sleep, and sexual activity impact (all p < 0.01). Patient and physician global assessments also indicated significant improvement. These reductions were both statistically and clinically significant, with improvements observed within 45 days and sustained at 90 days. The strength of evidence for this benefit is moderate, based on a single-center RCT. Borage flower extracts exhibit robust in vitro antioxidant activity, with high ORAC values comparable to other edible flowers. However, the clinical relevance of these antioxidant effects in humans is not yet clear. Limited human data suggests potential anti-inflammatory or immunomodulatory effects, such as a study reporting borage syrup reducing TNF-α and ICU stay in COVID-19 patients, but this finding requires replication and further research. Currently, strong evidence for benefits in populations other than women with cyclic mastalgia is lacking.
How it works
The primary mechanism of action for borage oil is attributed to its high gamma-linolenic acid (GLA) content. Once ingested, GLA is metabolized into dihomo-γ-linolenic acid (DGLA), which serves as a precursor to anti-inflammatory prostaglandins, particularly prostaglandin E1 (PGE1). This pathway helps modulate inflammatory and immune responses within the body, potentially explaining its effects in conditions like cyclic mastalgia. The antioxidants present in borage flower extracts, such as polyphenols, are believed to protect against oxidative stress by scavenging free radicals and potentially influencing antioxidant enzyme systems. Borage oil's GLA is well absorbed, contributing to its systemic effects. The bioavailability of antioxidants from borage flowers in humans, however, is not well characterized. The interaction with body systems primarily involves the modulation of lipid metabolism and inflammatory cascades.
Side effects
Borage is generally well tolerated for short-term use, but long-term safety is less clear due to the presence of trace pyrrolizidine alkaloids (PAs). Common side effects, though not well quantified in clinical trials, can include gastrointestinal discomfort, headache, and allergic reactions. More serious, albeit rare, side effects include theoretical hepatotoxicity due to PAs. While case reports of liver toxicity exist for PA-containing herbs, a systematic review found no confirmed cases directly linked to borage, suggesting its PA content is much lower than more toxic plants like comfrey. However, the theoretical risk of liver damage, especially with prolonged high doses or in susceptible individuals, cannot be entirely dismissed. Borage may interact with certain medications, particularly CYP3A4 inducers (e.g., carbamazepine), potentially increasing the formation of toxic metabolites. Contraindications include pregnancy, lactation (due to theoretical PA risk to the fetus/infant), and individuals with pre-existing liver disease. It should also be avoided in children due to limited safety data and PA concerns. It is crucial to use PA-free or PA-reduced borage oil products to minimize risks.
Dosage
The minimum effective dose for borage oil is not definitively established, but typical dosages used in studies and recommended for general use range from 1 to 3 grams of borage oil per day. This dosage usually provides between 240 and 720 mg of gamma-linolenic acid (GLA). For conditions like cyclic mastalgia, a dosage within this range has shown efficacy. There is no established dosage for borage flower extracts. The maximum safe dose for borage oil is not defined, and prolonged high doses should be avoided due to the theoretical risk associated with pyrrolizidine alkaloids (PAs). Daily dosing is common, with no strong evidence suggesting specific timing for optimal effects. It is highly recommended to use PA-free or PA-reduced borage oil products to mitigate safety concerns. Raw plant material should be avoided. GLA absorption from borage oil is generally enhanced when taken with meals. No specific cofactors are required for its efficacy.
FAQs
Is borage oil effective for eczema?
Evidence for borage oil's effectiveness in treating eczema is limited and inconsistent. It is not considered a first-line treatment, and more research is needed to confirm its benefits for this condition.
Is borage safe for long-term use?
Short-term use of borage oil appears generally safe. However, long-term safety is uncertain due to the presence of trace pyrrolizidine alkaloids (PAs), which carry a theoretical risk of liver toxicity.
Can borage interact with medications?
Yes, borage may interact with certain medications, particularly those that induce the CYP3A4 enzyme, such as carbamazepine. This interaction could potentially increase the formation of toxic metabolites.
What results can I expect from borage oil?
For cyclic mastalgia, you might expect moderate reductions in pain and improved quality of life over 1 to 3 months of consistent use. For other uses, the evidence for significant results is currently weak.
What is a common misconception about borage?
A common misconception is confusing borage with comfrey, another herb rich in pyrrolizidine alkaloids (PAs) with known hepatotoxicity. While borage contains PAs, its content is much lower, but caution is still advised.
Research Sources
- https://www.scirp.org/journal/paperinformation?paperid=56886 – This randomized controlled trial (n=60) investigated the effect of borage oil on cyclic mastalgia. It found that borage oil significantly reduced pain severity and improved quality of life measures over 90 days, with improvements noted by 45 days. The study suggests borage oil as a beneficial treatment for cyclic mastalgia.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9312273/ – This in vitro study evaluated the antioxidant activity of borage flower extracts, finding high ORAC values comparable to other edible flowers. It provides mechanistic evidence for borage's antioxidant properties but lacks human clinical data on its efficacy in vivo.
- https://pubmed.ncbi.nlm.nih.gov/32105669/ – This systematic review assessed the safety of borage, particularly concerning pyrrolizidine alkaloids (PAs). It concluded that while a theoretical risk of hepatotoxicity exists due to PAs, confirmed cases directly linked to borage are very limited, distinguishing it from more toxic PA-rich herbs like comfrey.
- https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.975937/full – This study reported that borage syrup reduced TNF-α levels and shortened ICU stay in COVID-19 patients. While suggesting potential anti-inflammatory and immunomodulatory effects, this finding is preliminary and requires replication in larger, controlled trials to confirm clinical significance.
- https://www.webmd.com/vitamins/ai/ingredientmono-596/borage – This source provides a general overview of borage, its uses, potential side effects, and interactions. It highlights the primary uses for skin conditions and mastalgia, while also cautioning about the presence of pyrrolizidine alkaloids and potential drug interactions, particularly with CYP3A4 inducers.
- http://naturalingredient.org/wp/wp-content/uploads/157573-Pieszak-et-al.pdf – This document discusses the chemical composition of borage, emphasizing its richness in gamma-linolenic acid (GLA), polyunsaturated fatty acids, carotenoids, and vitamin E. It also notes the presence of minor pyrrolizidine alkaloids, providing a comprehensive chemical profile relevant to its therapeutic effects and safety considerations.
