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Potential Risk of Prolonged Gamma-linolenic Acid Use
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TO THE EDITOR:
The report by Leventhal and colleagues [1] did not address the potential risk of arachidonate accretion associated with prolonged use of γ-linolenic acid. Because elongase is more active than delta-5-desaturase, the dihomo-γ-linolenic acid content of tissue lipids is increased during administration of borage oil, and some of this is metabolized further to arachidonate. We found that 2 g/d of γ-linolenic acid given to previously obese women increased the arachidonate content of their serum phospholipids [2]. Gamma-linolenic acid given to obese Zucker rats increased adipose triglyceride arachidonate fivefold compared with controls and reduced their food intake [3]. Elevated dihomo-γ-linolenic acid in muscle phospholipids is associated with insulin resistance [4]. During relatively short periods of borage oil administration, the initial effects result from the increase in dihomo-γ-linolenic acid. With prolonged administration (for example, >1 year), slow accumulation of arachidonate will eventually enhance the tissue content of this inflammatory mediator, which could counteract the early therapeutic effects of borage oil. After γ-linolenic acid treatment is discontinued, the production of extra dihomo-γ-linolenic acid ceases, and the residual effects of enhanced tissue arachidonate could include exacerbation of the arthritis. Thus, it would be important to have data on serum or tissue fatty acids and to know whether symptoms rebounded in study patients after drug discontinuation and in its absence. Physicians and patients should be alerted that a tissue buildup of arachidonate might promote subsequent inflammation, thrombosis, and immunosuppression [5].
Stephen Phinney, MD, PhD
University of California, Davis; School of Medicine; Davis, CA 95616
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
