Wednesday, June 18, 2008

Borage seed oil effective against rheumatoid arthritis - Literature Review & Commentary

Thirty-seven patients with active rheumatoid arthritis were randomly assigned to receive, in double-blind fashion, 1.4 g/day of gamma-linolenic acid (GLA) from borage seed oil or a placebo (cotton seed oil) for 24 weeks. GLA reduced the number of tender joints by 36%, compared with a 30% increase in the placebo group (p = 0.02 for difference between groups); reduced (improved) the tender-joint score by 45%, compared with a 55% increase in the placebo group (p = 0.003); reduced the swollen-joint count by 28%, compared with a 48% increase in the placebo group (p = 0.02); and reduced (improved) the swollen-joint score by 41%, compared with a 40% increase in the placebo group (p = 0.01). GLA also produced significant improvements, compared with placebo, in global assessment by physician (p = 0.002) and pain (p = 0.01). The treatment was well tolerated, and no patient withdrew because of adverse reactions.

Comment: This study demonstrates that GLA from borage seed oil is an effective treatment for rheumatoid arthritis. The magnitude of the benefit (up to a 45% improvement) is impressive, particularly in light of the apparent absence of a placebo effect in this study (patients receiving the placebo tended to become worse). Some investigators have suggested that omega-6 fatty acids (among which GLA is included) are pro-inflammatory; whereas omega-3 fatty acids (such as those derived from fish oil) are anti-inflammatory. However, the results of this and other studies clearly show that one can achieve an anti-inflammatory effect with at least certain omega-6 fatty acids. Moreover, the size of the effect seen with borage seed oil seems to be greater than that obtained in studies using fish oil, although no head-to-head comparisons have been done. One might assume that combining fish oil and borage seed oil would be even more effective than borage alone. However, there is no clinical evidence to validate that assumpt ion, and it is equally plausible that fish oil might interfere with the beneficial effect of borage seed oil. Considering that many Americans appear to be deficient in omega-3 fatty acids, how should fatty acid supplementation be administered to patients with rheumatoid arthritis? Obviously, more research is needed; however, based on the available evidence, I often recommend a therapeutic dose of borage seed oil plus a relatively small amount of cod-liver oil (such as one teaspoon per day).