Evening Primrose Oil
Description
Evening primrose oil (EPO) has traditionally been used as an astringent, antibiotic, mucilaginous, expectorant, antitussive, and digestive stimulant. Modern use of this supplement focuses on its prostaglandin properties.
Evening primrose oil (EPO) is high in gammalinolenic acid (GLA), which is readily converted in the body to prostaglandin E1. Therefore, it is employed in the treatment of any and every condition for which prostaglandin could be beneficial.
Numbering among these conditions are: premenstrual syndrome, benign breast disease, cholesterol regulation, platelet aggregation, blood pressure regulation, obesity, atopic disease, multiple sclerosis, arthritis, rheumatism, alcoholism, mental disorders, and childhood hyperactivity.
Method of Action
Evening Primrose Oil is a rich source of GLA
The real value of evening primrose lies in the gammalinolenic acid (GLA) content of its oil. GLA is an important intermediary in the metabolic conversion of linoleic acid (technically, the cis-isomer) to prostaglandin E1. Essentially that pathway goes as follows: cis-linoleic acid -->gammalinolenic acid --> dihomo-gammalinolenic acid --> prostaglandin E1.
The normal diet is quite sufficient in linoleic acid, but the first step in its conversion to prostaglandin E1 can be easily blocked. Among the known blocking agents are: viruses, carcinogens, cholesterol, saturated fatty acids, trans fatty acids, alcohol, insufficient zinc or insulin, radiation, insufficient delta-6-desaturase, and the aging process.
Dietary GLA could therefore be extremely valuable since very few factors block the successive steps in the metabolic pathway.
Therapeutic Approaches
Just over a decade ago, established nutritionists were dismissing GLA (gamma-linolenic acid) with the words, 'there is no sound evidence that it improves health in any way'. Today, Evening Primrose Oil, whose main claim to fame is its GLA content, is prescribed regularly by medical practitioners for a range of disorders. Most, if not all, properties of evening primrose oil resemble and indeed can be attributed to the actions of prostaglandin E1. Among those effects already investigated are the following:
Alcoholism
As early as 1650, Nicholas Culpeper wrote that 'it opens obstructions of the liver and spleen, provokes urine, is good for the dropsy if infused in common drink.' Its medicinal properties were so comprehensive it became known as the 'King's Cure-all'.
Preliminary tests in humans show evening primrose oil (EPO) can make withdrawal from alcohol easier and can relieve post-drinking depression.
It is possible to use gamma-linolenic acid to counter the effects of alcohol abuse. Supplementation with Evening Primrose oil has been found to prevent hangovers, relieve withdrawal symptoms and post-drinking depression, reduce the body's tolerance of alcohol and tackle addiction, help repair liver damage and cut down the need for tranquilizers during withdrawal.
Brain and liver function improve more quickly in people who have stopped drinking if they take Evening Primrose Oil (study funded by Efamol). A study found alcoholics taking EPO for 24 weeks had significantly faster brain function than those who had not.
EPO had an even more remarkable effect on liver function. After only three weeks, patients taking EPO showed a significant improvement of liver function over those who did not take the supplement.
EPO had an even more remarkable effect on liver function. After only three weeks, patients taking Evening Primrose oil showed a significant improvement of liver function over those who did not take the supplement ( Glen in Horrobin, D. F., ed. 1990.)
This benefit also extends to offspring, as in FAS (fetal alcohol syndrome).
Antimicrobial activity
EPO has anti-tubercular activity as well as anti-microbial and antibacterial properties. It is active against Staphylococcus citrius, S. roseus, Pseudomonas pyocyanea, Streptococcus pyogenes, E. coli, Bacillus subtilis, Klebsiella aerogenes, Diplococcus pneumoniae and Salmonella typhi. For each of these organisms, the oil compared favorably with penicillin.
Wright reported that an enzymeused in the conversion of linoleic acid into gamma-linolenic acid )GLA) might actually be defective in atopic people Despite a sufficiency of linoleic acid they found that their subjects had very low levels of GLA and dihomo-gamma-linolenic acid (the derivative of GLA which is needed to form PGE 1), as well as another derivative, arachidonic acid.
In the trial, young people with atopic eczema were administered EPO, it was discovered, only 3 of them showed any GLA in their blood, even though over half had very high levels of linoleic acid.
After 12 weeks their GLA and dihomo-gamma-linolenic acid levels improved but they were still below normal. Doses of 8-12 capsules a day for much longer than 12 weeks was needed by people who had been deficient most of their lives.
Although EPO could not remedy the defect in the enzyme in question (delta-6-desaturase) it was able to bypass the conversion process from linoleic acid to GLA and thereby enabled the subsequent conversion processes to take place). In younger children the suggested dose is two to four capsules daily.
Arthritis
The usual treatment for rheumatoid arthritis is to administer nonsteroidal anti-inflammatory drugs (NSAID’s), such as aspirin. There may be unwanted side effects and they serve only to “mask”the underlying imbalance of prostaglandins.
Supplementation with gamma-linolenic acid (GLA)should be the treatment of first resort. And if the levels of PGE 1 increase those of PGE 2 automatically reduce. PGE 1 acts as a block in the production of PGE2s from arachidonic acid.
Prostaglandin E1 normalizes the behavior of T-lymphocytes, a variety of white blood cells which form a vital part of the body's defense mechanisms. In rheumatoid arthritis they go awry. Furthermore, PGE 1 inhibits the release of the lysosomal enzymes that cause such destruction to the bone and cartilage. Leukotrenes, another inflammatory substance produced from arachidonic acid, are also kept in check by PGE1.
Animal studies have demonstrated the potential of supplemental PGE 1 (through EPO) for treatment and encouraging results have also been reported in human patients, especially if supplementation is given in the early stages of the disease (Belch, J., in. Horrobin, D., ed. 1990).
In one trial fifty-two patients, all long-standing sufferers of arthritis taking NSAID’s were given either Evening Primrose oil or EPO plus fish oils. 60% of the patients were able to stop NSAID treatment, and another 25% were able to cut their dosage in half (Belch, J.,1986). There were no obvious differences between the group given EPO alone or in combination with fish oils.
A 1993 study conducted on 19 patients with rheumatoid arthritis reported that 1.4 g of GLA from Borage seed oil experienced a significant reduction to the signs and symptoms of the disease as compared to the placebo group. (Lawrence J., 1993.)
Atherosclerosis
In 1956 Sinclair sent a letter to the Lancet explaining how our modern degenerative diseases were caused by deficiencies of certain unsaturated fatty acids and errors in the body's mechanisms for processing these acids. Horrobin recounts Sinclair's work in: Omega-6 Essential Fatty Acids: Pathophysiology and Roles in Clinical Medicine.
Benign Breast Disease
EPO has been reported to improve symptoms of benign breast disease via the inhibition of prolactin, as with PMS.
Since a dietary deficiency of essential fatty acids may cause increased deposition of fibrous tissue, the cysts of benign breast disease may be in some way related.
Women experiencing cyclical breast problems were compared with others, suffering independently of their menstrual cycles.
Subjects were given either EPO or a placebo for 3months. There was no improvement in any of the women who received the placebo. Those who were given EPO found significant improvement in their condition but there were differences between the 'cyclical' group and the 'noncyclical' group.
The former reported that the tenderness and lumpiness of their breasts was much reduced. The second group noticed less tenderness but their breasts remained lumpy. The women were also given vitamin C. The dosage of EPO was two capsules three times a day. The researchers observed that the longer the treatment period the better the condition became. Treatment should be for at least 3 or 4 months (Pashby, N.L., et al., 1981).
Blood Pressure
Studies have shown EPO can lower high blood pressure levels.
Breast pain
Breast pain or mastalgia is a frequent complaint and it may represent various pathological conditions.
Some cases will modify or stop on oral contraception, or adapt to hormone replacement therapy. Those women still resistant to treatment may experience relief from evening primrose oil supplements, bromocriptine, danazol, some progestins, tamoxifen or GnRH analogues. Therapy of non cyclic breast pain is made according to the underlying pathology. If no substrate is present, treatment is the same as for cyclical mastalgia but the response is diminished (Genolet-PM; 1995).
Research into the possible benefits of supplementary GLA are encouraging but not, at this stage, conclusive.
Most of the investigations have taken place in the laboratory. They have clearly demonstrated that cancer cells treated with gamma-linolenic acid and dihomogamma-linolenic acid are killed off without affecting normal cells. One important study took place in South Africa. GLA extracted from EPO was administered to three different types of cancer cells taken from humans and mice. Cancer cell growth was reduced by up to seventy per cent (Diepenaar, 1982, Leary, 1982).
Animal experiments, involving transplantation of human breast cancer and melanoma into mice, demonstrate that high levels (4-8 g/day) can inhibit cancer growth. (Pritchard, G.A. & Mansel, R.E., Omega ). It seems PGE 1 keeps the cell membranes in good health and stimulates the T-cells.
In the laboratory it has been possible to replicate the conditions that give rise to malignant cells - such as radiation, chemicals, certain viruses, etc. The cells under observation underwent a change of 'behavior' and structure and were no longer able to convert linoleic acid into GLA and, from there, PGE 1. The administration of GLA and PGE 1 reversed these changes and the cells returned to normal (Bailey, J.M in. Snyder, F., ed 1977; Dunbar,1975; Horrobin, D.F.,1980; Horrobin, D. F., et al.,1979; Johnson, G.S, 1975; Puck, T.T.,1977;.)
Cholesterol
EPO effectively lowers serum cholesterol in animals and humans with high levels. This effect usually takes several weeks to achieve.
Studies have shown that essential fatty acids and their derivatives (which includes GLA) lower cholesterol levels, reduce the stickiness of blood platelets (preventing clumping), and keep down blood pressure (caused by the heart having to pump harder to squeeze the blood through narrow and hardened arteries) (Fleischman,A.I. et al, 1979; Hornstra, G., 1973; Sinclair, H, 1980a, 1980b.).
Indeed the very first human study to determine the efficacy of EPO was to investigate its cholesterol lowering effects by Leinweber & May in 1970 Bio Oil Research). Of 15 patients given (6 capsules) EPO for a period of 4 weeks, 3 dropped out, and 8 showed a decrease.
Diabetes
One study looked at the effect Essential Fatty Acids on patients who were non-insulin dependent were given 4g of EPO, 2.4 g of sardine oil and 200 mg of vitamin E for four weeks. The researchers observed that the levels of glucose, cholesterol and body weight decreased significantly. (Takahashi, R., et al,1993)
Another, study of human subjects recorded that diabetic neuropathy could be reversed through supplemental essential fatty acids and their derivatives. Dr. Keen conducted a study on 111 patients with diabetic neuropathy who were divided into two groups. On group was given 12 capsules of EPO per day and the other group received no supplementation at all. The patients on EPO showed significant improvement in their neurological symptoms. The researchers also concluded that GLA may help prevent deterioration. (Diabetes Care, 1993)
Hyperactivity (ADD: Attention Deficit Disorder)
Atopic children may also suffer from hyperactivity. In fact, many hyperactive children have been found to be atopic. Although the problem manifests itself as a behavioral one (violence, clumsiness, sleeplessness, poor concentration, disruptive) it is now recognised that the causes are probably connected with diet and a defective metabolic process in the child. It is more often found in boys than in girls.
The evidence that has been emerging (much of it is still unpublished) is that hyperactivity is linked to a deficiency of essential fatty acids and their derivatives (boys need three times as much EFAs as girls). This may be compounded by a diet which, as well as being low in EFAs, may include additives which the block the conversion of what linoleic acid there is into GLA. Other dietary 'culprits' may be salicylates which are naturally-occurring substances in certain fruits, such as apples, oranges, peaches, plums, apricots, and grapes, and wheat and milk which can produce exorphins in the gut which block prostaglandin E1 formation. The implications for behaviour can be understood when you realise that prostaglandins (the derivatives of GLA) are vital for the brain to function normally.
What may seem a mystery is why only one child in a family may be hyperactive when s/he is eating a diet identical to that of the other children. The answer would seem to be a possible defect in the child's own conversion processes. These processes are helped along by other nutrients in the diet and if there is a shortage of these as well then the processes are compromised further. Zinc, the B vitamins, and vitamin C are the most important of these.
The Hyperactive Children's Support Group recommends the following regime, in addition to making dietary adjustments by following the Feingold diet in which additives and salicylate-containing foods are eliminated.
· Children under 2 years: Contact the group direct for their recommendations as they need to be worked out for the individual child.
· Children 2 to 5 years: 2 EPO capsules of 500 mg per day (rub into the skin); 2 tablets daily of 250 mg vitamin C, 15 mg vitamin B3, 50 mg vitamin B6, 5mg zinc sulphate.
· Children 6 to 7 years: 3 EPO capsules of 500 mg daily (orally or rubbed into the skin); 3 tablets daily of 375 mg vitamin C, 22.5 mg vitamin B3, 75 mg vitamin B6, 7.5 mg zinc sulphate.
· Children 7 years up: 4 EPO capsules of 500 mg daily (orally or rubbed into the skin); 4 tablets daily of 500 mg vitamin C, 30 mg vitamin B3, 100 mg vitamin B6, 10 mg zinc sulphate. Dosage can gradually be increased to 6 Evening Primrose oil capsules daily.
Therapeutic Approaches cont'd
Multiple Sclerosis
One of the earliest diseases for which EPO was used is multiple sclerosis. When linoleic acid is given to patients with MS it reduces the frequency and severity of relapses.
Therefore, one could expect similar results from EPO. Early studies were not promising but they involved potentially serious procedural errors. Multiple sclerosis was one of the first disorders for which EPO was recommended.
There is no typical MS patient because the symptoms are so varied and are not consistent. Whilst some sufferers may be severely incapacitated, being unable to move or speak, others may experience it only mildly and be able to live a normal life. Further, the symptoms may come and go so that one week the sufferer may be disabled by it and the next week appear quite well. The most common symptoms are blurred vision, reduced mobility, tingling, numbness, and affected speech. If the condition worsens over the years paralysis may be an outcome. About one in a thousand people are afflicted and they are typically young adult women.
What is sure is that the levels of linoleic acid are low in the red blood cells, the plasma (in some MS patients), and in nerve tissues (Gul, S., 1970). Trials involving the administration of linoleic acid to suffers have demonstrated that the severity and frequency of relapses can be reduced (Millar,1973). Sunflower seed oil was the medium through which linoleic acid was given and for a while many MS sufferers increased their consumption of the oil.
However, when Field showed that gamma-linolenic acid, through EPO, was more effective than linoleic acid at normalizing the behavior of the white blood cells, lymphocytes, so that they stopped attacking the myelin coating in the brain (Field, E.,1975; Mertin, J., 1973.).
Apart from normalizing the function of the white blood cells, the T-suppressor lymphocytes which protect the body from being attacked by its own defense mechanisms, supplementary gamma-linolenic acid can bring about other beneficial effects for MS sufferers. It prevents platelet aggregation (it has been found that the platelets in the blood of someone with MS clump together abnormally); helps to reduce the abnormally large red blood cells, restores their mobility, and encourages better regulation of fluids passing through the cell membranes; strengthens the blood vessel walls so that leakage is prevented; acts as an anti-viral; improves the functioning of the nervous system; and ensures the correct balance of PGE 1s and PGE 2s. In fact, PGE 1, the derivative of gamma-linolenic acid, is the key component.
Obesity
In at least one study, human patients taking evening primrose oil were found to lose weight, but only if they were at least 10% over their ideal body weight. Patients within the 10% limits exhibited no loss of weight.
Conversely, in another trial EPO did not effect obesity in subjects (at least 20% above their ideal weight).
Platelet Aggregation
EPO decreases the tendency of the blood to clot.
Premenstrual Syndrome
In one study, 61% of the patients reported complete relief, 25% reported partial relief. The results were attributed to the ability of PgE 1 to inhibit the effects of prolactin, an agent though responsible for some of the symptoms of PMS.
In another study, EPO (Gamma Oil) was used with remarkable success. The symptoms of swollen abdomen and breast discomfort were eradicated in 95% of the women, irritability in 80%, depression in 74%, swollen fingers and ankles in 79%, and anxiety in 53%. The only two symptoms which persisted in more than half of the women were tiredness and headaches. A dosage of four 500 mg capsules was recommended morning and night for two weeks leading up to menstruation.
At the PMS clinic of St. Thomas' Hospital in London a trial was conducted involving 68 women who had severe symptoms. They were all treated with EPO. Some also received vitamin B6 (which is a 'co-factor' in the conversion process) and others, a vitamin/mineral supplement which contains not only B6 but other co-factors, too - vitamins B3, C and zinc. Some of the women who were given additional B6 had already tried supplementing with the vitamin alone, to no good effect. The results of the study showed that 61 per cent of the women experienced a 'very marked improvement'. Twenty-three per cent obtained 'partial relief'. fifteen per cent had 'no significant change' (Brush, in: Horrobin, D.F., ed 1982). The recommended dosage is four 500 mg capsules morning and night for two weeks leading up to menstruation.
Rheumatoid Arthritis
Fifty-two patients, all long-standing sufferers of arthritis taking non-steroidal anti-inflammatory (NSAID) drugs, were given either evening primrose oil (Efamol) or evening primrose oil plus fish oils (Efamol Marine). Sixty percent (60%) of the patients were able to withdraw completely from NSAID treatment, and another 25% were able to cut their NSAID dosage in half.
Skin conditions
EPO has been used successfully in patients with atopic eczema. A double blind cross-over study was used with the following dosages:
Adults: Group A - 2 capsules taken twice daily
Group B - 4 capsules taken twice daily
Group C - 6 capsules taken twice daily
Children: 2 to 4 capsules per day
Results indicated that there was significant clinical improvement in the EPO group, especially at the higher dosages( about 43%).
Psoriasis may be responsive to a combination of EPO and fish oils (Gamma Oil Marine). A preliminary study in Denmark has shown this to be so, and a more comprehensive study is currently underway.
Other uses
Native Americans used the seed pods to brew an infusion for wound-healing, leaf poultices to treat sprains and juice from its roots for coughs.
Research at the Efamol Institute in Nova Scotia has implicated EPO in the successful treatment of childhood hyperactivity and mental disorders such as schizophrenia. Much of that research is yet to be published.
Independent substantiation of the possible therapeutic role of EPO has been forthcoming.
Toxicity Factors
Evening primrose oil has a very low toxicity.
Possible Interactions
Veratrum alkaloids may potentiate the activity of evening primrose by up to 50%. The hypotensive effect of this herb may also be potentiated by anorectic drugs such as fenfluramine, whose effects are mediated by brainstem 5HT.
Evening primrose should not be used with methotrimeprazine, a potent CNS-depressant analgesic. Furthermore, colchicine may increase sensitivity or enhance the response to evening primrose. An associated condition would be epilepsy.
The topical application of this astringent herb, in conjunction with the acne product tretinoin (retinoic acid, vitamin A acid), may adversely affect the skin.
Additive effects may occur between the hypotensive property of evening primrose and that of dopamine receptor agonists, such as bromocriptine mesylate.
Due to the presence of blood serum platelet aggregation inhibitors, such as linolenic acid, evening primrose may potentiate the effects of anticoagulant drugs such as heparin.
In order to minimize central nervous system depression and possible synergism, evening primrose should not be taken by persons on procarbazine antineoplastic drugs.
EPO is commonly available in 250 mg capsules. These are usually taken in pairs twice a day and may be taken up to 4 times daily (a total of 4 gms).
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