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There is insufficient reliable information available about the effectiveness of black alder.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alzheimer disease. Although there has been interest in using oral black currant berry for Alzheimer disease, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Atopic dermatitis (eczema). Topical black currant seed oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in children aged 2-18 years with atopic dermatitis shows that using a specific cream containing black currant seed oil, sunflower oil, and balloon vine (Defensil), with added dexpanthenol and ceramide, twice daily for 4 weeks, improves atopic dermatitis severity scores similarly to urea 5% cream. About 38% of patients had a 50% improvement in severity score with the combination cream, compared with 35% with urea cream (105538).
• Colic. Although there has been interest in using oral black currant leaf for colic, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Common cold. Although there has been interest in using oral black currant berry for common cold, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Cough. Although there has been interest in using oral black currant leaf for cough, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Diarrhea. Although there has been interest in using oral black currant leaf for diarrhea, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Dry eye. Oral black currant has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in adults with dry eye disease shows that taking a specific combination product containing black currant 100 mg, L-carnitine 50 mg, elderberry fruit extract 300 mg, zinc 10 mg, and Eleutherococcus root 50 mg (Meramirt CM) orally once daily improves dry eye symptom scores when compared with no intervention. Contrast sensitivity scores also improved when compared with baseline in the treated group, but not in the control group (111295). It is unclear if this effect is due to black currant, other ingredients, or the combination.
• Dysmenorrhea. Although there has been interest in using oral black currant seed oil for dysmenorrhea, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Glaucoma. It is unclear if oral black currant is beneficial in patients with glaucoma. Details: Preliminary clinical research in adults with glaucoma shows that taking black currant anthocyanins 50 mg orally daily for 4 weeks decreases intraocular pressure (IOP) by 1.5 mmHg when compared with placebo (93696). However, other preliminary clinical research in patients with open-angle glaucoma shows that taking black currant anthocyanins 50 mg orally daily along with standard medications for glaucoma for 24 months does not improve IOP when compared with placebo (93695). Preliminary subgroup analyses suggest that patients taking one or less antiglaucoma medications, but not more than one, may benefit the most from black currant (93695,93696).
• Gout. Although there has been interest in using oral black currant leaf for gout, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Hyperlipidemia. It is unclear if oral black currant seed oil is beneficial in patients with hyperlipidemia. Details: Preliminary clinical research in adults with hyperlipidemia shows that taking black currant seed oil 18 grams orally twice daily for 6 weeks reduces total cholesterol by about 16%, reduces triglycerides by about 34%, and increases high-density lipoprotein (HDL) cholesterol by about 35% when compared with baseline (17638). However, the validity of this study is limited by the lack of a comparator group.
• Hypertension. It is unclear if oral black currant seed oil is beneficial in patients with hypertension. Details: Preliminary clinical research in males with borderline hypertension shows that taking black currant seed oil 6 grams orally daily for 8 weeks does not reduce blood pressure when compared with safflower oil 6 grams daily. However, when stress is induced by a mental arithmetic exercise, black currant seed oil appears to induce a 40% reduction in systolic and diastolic blood pressure elevations in these patients (35994).
• Influenza. Although there has been interest in using oral black currant berry for influenza, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Insect bite. Although there has been interest in using topical black currant leaf for insect bite, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Japanese cedar pollinosis. It is unclear if oral black currant extract is beneficial in patients with Japanese cedar pollinosis. Details: Preliminary clinical research in patients with Japanese cedar pollinosis shows that taking a black currant polysaccharide extract 540 mg orally twice daily for 8 weeks does not improve nasal symptom scores or swelling when compared with placebo (17635).
• Liver disease. Although there has been interest in using oral black currant leaf for liver disease, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Menopausal symptoms. Although there has been interest in using oral black currant seed oil for menopausal symptoms, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Muscle fatigue. It is unclear if oral black currant juice extract is beneficial in patients with muscle fatigue. Details: Preliminary clinical research in office workers shows that black currant juice extract, containing 10.83% anthocyanins, taken once orally and dosed as anthocyanins 17 mg/kg, reduces muscle stiffness scores after typing for 30 minutes when compared with placebo (17633).
• Osteoarthritis. Although there has been interest in using oral black currant leaf for osteoarthritis, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Peripheral arterial disease (PAD). Although there has been interest in using oral black currant juice for PAD, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Premenstrual syndrome (PMS). Although there has been interest in using oral black currant seed oil for PMS, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Rheumatoid arthritis (RA). It is unclear if oral black currant seed oil is beneficial in patients with RA. Details: A small clinical study in patients with RA shows that taking black currant seed oil 10.5 grams orally daily for 24 weeks reduces tenderness scores when compared with placebo (35990).
• Rhinosinusitis. Oral black currant has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients over 12 years of age with chronic sinusitis shows that taking a combination product containing black currant, Boswellia serrata, bromelain, and vitamin D (Flogostop Forte, Humana Italia) with inhaled corticosteroids daily for 30 days reduces rhinorrhea, hyperemia of mucosa, and local inflammation when compared with inhaled corticosteroids alone (111501). It is unclear if these findings are due to black currant, other ingredients, or the combination.
• Seizures. Although there has been interest in using oral black currant leaf for seizures, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Upper respiratory tract infection (URTI). Although there has been interest in using oral black currant berry for URTIs, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Urinary tract infections (UTIs). Although there has been interest in using oral black currant leaf for UTIs, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Venous insufficiency. Although there has been interest in using oral black currant for venous insufficiency, there is insufficient reliable information about the clinical effects of black currant for this purpose.
• Wound healing. Although there has been interest in using topical black currant leaf for wound healing, there is insufficient reliable information about the clinical effects of black currant for this purpose. More evidence is needed to rate black currant for these uses.

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POSSIBLY EFFECTIVE

• Burns. Topical cream containing sea buckthorn seems to improve burn healing. Details: Clinical research in patients with second-degree burn injuries shows that topical application of sea buckthorn 40% cream once daily reduces healing time by about 4.5 days when compared with a specific cream containing silver sulfadiazine 1% (Flamexin, Sina Daru) (106091).

POSSIBLY INEFFECTIVE

• Atopic dermatitis (eczema). Neither oral nor topical sea buckthorn products seem to be beneficial for atopic dermatitis. Details: Preliminary clinical research shows that taking sea buckthorn seed and pulp oils 5 grams daily orally for 4 months may improve the severity of atopic dermatitis when compared to pretreatment; however, treatment with the same dose of sea buckthorn seed oil does not have this effect, and the effect of sea buckthorn pulp oil does not appear to be significantly different than placebo (74021). Additionally, applying sea buckthorn 10% or 20% cream topically for 4 weeks does not seem to reduce the severity of atopic dermatitis when compared with placebo in patients with mild-to-moderate atopic dermatitis (74091).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Although there is interest in using topical sea buckthorn for acne, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Aging skin. Although there is interest in using oral or topical sea buckthorn for aging skin, there is insufficient reliable information about the clinical effects of sea buckthorn for this purpose.
• Asthma. Although there is interest in using oral sea buckthorn for asthma, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Cancer. Although there is interest in using oral sea buckthorn for reducing morbidity related to cancer and side effects related to chemotherapy, there is insufficient reliable information about the clinical effects of sea buckthorn for these uses.
• Cirrhosis. It is unclear if oral sea buckthorn is beneficial for patients with cirrhosis. Details: Preliminary clinical research shows that taking sea buckthorn extract 15 grams three times daily for 6 months might reduce liver enzymes and markers of liver inflammation in patients with cirrhosis when compared with a control group taking vitamin B complex (16694).
• Common cold. It is unclear if oral sea buckthorn is beneficial for preventing or treating the common cold. Details: Clinical research in healthy volunteers shows that consuming sea buckthorn berries 28 grams daily in frozen puree for 90 days does not reduce the risk of developing the common cold or reduce the duration of symptoms of the common cold when compared with placebo (16692).
• Diabetes. Although there is interest in using oral sea buckthorn for diabetes, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Dry eye. It is unclear if oral or topical sea buckthorn is beneficial for dry eye. Details: Preliminary clinical research in adults with dry eye shows that taking a specific sea buckthorn seed and pulp oil product (Omega-7, Aromtech Ltd.) 1 gram orally twice daily for 3 months reduces subjective assessments of eye redness and burning and reduces tear film osmolarity when compared with placebo (17406,74069). Preliminary clinical research also shows that using an eyelid spray containing sea buckthorn seed oil 0.4% and sodium hyaluronate 0.02% (Aromtech Ltd., and Finnsusp Ltd.) four times daily for 1.5 months reduces symptoms of dryness and watering by a small amount when compared to a control spray. However, there was no effect on feelings of grittiness, burning, redness, or other symptoms (102845).
• Dry skin. Although there is interest in using topical sea buckthorn for dry skin, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Dyslipidemia. It is unclear if oral sea buckthorn is beneficial for hyperlipidemia. Details: Some clinical research shows that sea buckthorn berries and extracts can improve the lipid profile in people with hyperlipidemia and/or nonalcoholic fatty liver disease (NAFLD). In a meta-analysis of 11 studies from China and Finland, consuming sea buckthorn berries or extracts for between 12 days and 4 months decreased total cholesterol and low-density lipoprotein (LDL) cholesterol by about 24 mg/dL and triglycerides by about 41 mg/dL and increased high-density lipoprotein (HDL) cholesterol by about 10 mg/dL when compared with baseline or a control group (96555). The sea buckthorn doses and formulations used in these studies were not identified. Additionally, a very small clinical study in females aged 50-61 with hypercholesterolemia shows that drinking sea buckhorn juice (ZAMIO, Ltd) 100% 50 mL daily for 8 weeks modestly improves HDL by about 2 mg/dL and LDL by 10 mg/dL, but does not impact total cholesterol or triglycerides when compared to baseline (112171). However, the validity of these findings is limited by the lack of a comparator group. In contrast, clinical research in patients with hypercholesterolemia shows that taking sea buckthorn puree 30 grams three times daily for 90 days does not improve lipid markers or blood pressure when compared with placebo (106090).
• Dyspepsia. It is unclear if oral sea buckthorn is beneficial for dyspepsia. Details: Preliminary clinical research shows that taking sea buckthorn dry emulsion (prepared with the fruit juice and oil) daily for 8 weeks increases levels of the appetite regulators leptin and neuropeptide Y, which tend to be lower in children with functional dyspepsia; however, sea buckthorn does not appear to improve gastric emptying rates in these patients. Doses were administered according to age: 2.5 grams twice daily for children aged 1-3 years, 5 grams twice daily for children aged 4-6 years old, and 7.5 grams twice daily for children aged 7 years (94800).
• Gout. Although there is interest in using oral sea buckthorn for gout, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Hypertension. It is unclear if oral sea buckthorn is beneficial for hypertension. Details: A meta-analysis of preliminary clinical research in patients with essential hypertension shows that taking sea buckthorn flavones 10-30 mg three times daily for 1-8 months reduces systolic and diastolic blood pressure to a similar extent as calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors (74090).
• Impaired glucose tolerance (prediabetes). It is unclear if oral sea buckthorn is beneficial for prediabetes. Details: A small clinical trial in patients with impaired glucose tolerance shows that taking sea buckthorn fruit puree 90 mL daily in three divided doses for 5 weeks modestly reduces fasting levels of blood glucose when compared with taking placebo. There was no effect on postprandial glucose levels or blood pressure (106088).
• Kidney failure. It is unclear if oral sea buckthorn oil is beneficial for patients on hemodialysis. Details: Preliminary clinical research shows that taking sea buckthorn oil 2 grams daily for 8 weeks does not improve levels of urea, creatinine, or calcium, reduce markers of inflammation, or improve salivary flow rate when compared with placebo in patients with chronic kidney disease (CKD) who are receiving hemodialysis (94798).
• Melasma. Although there is interest in using topical sea buckthorn for melasma, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Nephrotic syndrome. It is unclear if oral sea buckthorn is beneficial for nephrotic syndrome. Details: Preliminary clinical research in patients with idiopathic nephrotic syndrome shows that taking hydroalcoholic extract of sea buckthorn 350 mg orally twice daily for 3 months in addition to standard therapy reduces edema, anorexia, and the extent of proteinuria when compared to baseline. It is unclear if the effects of sea buckthorn plus standard therapy are significantly better than the effects of standard therapy alone (94799).
• Obesity. It is unclear if oral sea buckthorn is beneficial for obesity. Details: Preliminary clinical research shows that taking sea buckthorn berries, berry oil, or phenolic alcoholic extract does not reduce body weight in overweight or obese females, although it seems to reduce low-density lipoprotein (LDL) cholesterol (35463,94796).
• Peptic ulcers. Although there is interest in using oral sea buckthorn for peptic ulcers, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Psoriasis. It is unclear if topical sea buckthorn is beneficial for psoriasis. Details: One small clinical study in patients with previously untreated psoriasis shows that topically applying an unknown amount of sea buckthorn fruit extract suspended in corn oil twice daily for 8 weeks reduces the severity of psoriasis lesions when compared with corn oil alone (102844).
• Radiation dermatitis. Although there is interest in using topical sea buckthorn for radiation dermatitis, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Rheumatoid arthritis (RA). Although there is interest in using oral sea buckthorn for RA, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Sunburn. Although there is interest in using topical sea buckthorn for sunburn prevention, there is insufficient reliable information about the clinical effects of sea buckthorn for this condition.
• Vaginal atrophy. It is unclear if oral or intravaginal sea buckthorn is beneficial for vaginal atrophy. Details: Preliminary clinical research shows that taking 3 grams of sea buckthorn oil daily for 3 months does not improve vaginal dryness, itching, burning, pH, or elasticity when compared with placebo in postmenopausal individuals with vaginal atrophy (94797). Topical sea buckthorn oil has also been evaluated, in combination with other ingredients. Clinical research in adults with postmenopausal vulvovaginal atrophy shows that intravaginal application of a specific gel (Meclon Idra Alfasigma, Giellepi) containing sea buckthorn oil, aloe vera, 18-beta-glycyrrhetic acid, hyaluronic acid, and glycogen modestly improves sexual function and reduces vaginal pain, dyspareunia, and symptoms such as vaginal dryness, itching, and burning when compared with a placebo gel. The gel was used daily for 14 days and then twice weekly for 60 days after a 2-week washout (106089). It is unclear if these benefits are due to sea buckthorn oil, other ingredients, or the combination.
• Wound healing. Although there is interest in using topical sea buckthorn for healing of pressure ulcers, skin ulcers, or other wounds, there is insufficient reliable information about the clinical effects of sea buckthorn for this purpose.
• Wrinkled skin. Oral sea buckthorn oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in people with facial photodamage and severe fine wrinkling shows that taking a specific combination product (GliSODin Skin Nutrients Advanced Anti-Aging Formula, Isocell North America Inc.) as one capsule orally three times daily for 90 days, in addition to applying tazarotene 0.1% cream, improves the appearance of wrinkles, hyperpigmentation, and photodamage when compared with using tazarotene 0.1% cream alone. Three capsules of this product contain sea buckthorn berry oil 200 mg, krill oil 600 mg, zinc 10 mg, vitamin D 400 IU, cacao bean extract 100 mg, hyaluronic acid 30 mg, red clover flower isoflavones 30 mg, and a specific proprietary ingredient called GliSODin 500 mg (91778). It is not clear if these effects are due to sea buckthorn, the other ingredients, or the combination. More evidence is needed to rate sea buckthorn for these uses.

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There is insufficient reliable information available about the safety of black alder.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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LIKELY SAFE ...when used orally and appropriately. Black currant juice, leaves, and flowers have Generally Recognized As Safe (GRAS) status in the US (4912). Black currant juice up to 3000 mL daily for up to 3 weeks (17636,35987), black currant extracts 1080 mg daily for 8 weeks (17635,93695), and black currant seed oil products up to 10.5 grams daily for 24 weeks (4016,17634,17638,35990) have also been used safely in clinical research. There is insufficient reliable information about the safety of black currant when used topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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LIKELY SAFE ...when sea buckthorn fruit is consumed as food. Sea buckthorn fruit is used in jams, jellies, pies, juices, and sauces (9898).

POSSIBLY SAFE ...when sea buckthorn fruit or fruit extract is used orally and appropriately for medicinal purposes. The oil extract of the fruit and seed have been used with apparent safety in doses of up to 2 grams daily for up to 3 months (16692,17406). ...when sea buckthorn fruit is used topically and appropriately. A cream containing sea buckthorn fruit 40% daily has been used with apparent safety for up to 13 days (106091). There is insufficient reliable information available about the safety of sea buckthorn leaf or leaf extracts when used orally or topically.

CHILDREN: POSSIBLY SAFE
when used orally and appropriately for medicinal purposes. Sea buckthorn dry emulsion (prepared with the fruit juice and oil) 5-15 grams daily for 8 weeks has been used with apparent safety in children 1-7 years of age (94800).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, black currant seed oil might increase the risk of bleeding if used in combination with anticoagulant or antiplatelet drugs.  Details Gamma-linolenic acid (GLA), a constituent of black currant seed oil, appears to have antiplatelet effects (1979,35995).

PHENOTHIAZINES Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, black currant seed oil might increase the risk of seizure in patients receiving phenothiazines.  Details Black currant seed oil contains gamma-linolenic acid (GLA). There is some concern that taking supplements containing GLA might cause seizures, or lower the seizure threshold, when taken with phenothiazines, although there is no evidence that black currant seed oil causes seizures (88187). In one report, three patients with schizophrenia who had received phenothiazines developed EEG changes suggestive of temporal lobe epilepsy after starting treatment with GLA, although none experienced an actual seizure (21013). In another report, two patients with schizophrenia who were stabilized on phenothiazines developed seizures when evening primrose 4 grams daily, which contains GLA, was added. One of these patients had a prior history of seizures (21010).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, sea buckthorn may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.  Details Clinical research suggests that sea buckthorn fruit extracts can inhibit platelet aggregation and adhesion to collagen and fibrinogen (10208,96554).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking sea buckthorn with antihypertensive drugs might increase the risk of hypotension.  Details Taking sea buckthorn appears to reduce blood pressure in some patients (74090).

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...None reported.

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General ...Orally, black currant is generally well-tolerated. Topically, there is a limited amount of information on the adverse effects of black currant.

Gastrointestinal ...Of 2154 patients with hyperlipidemia taking black currant seed oil 1. 8 grams twice daily for 6 weeks, 8 reports of mild diarrhea were considered related to the supplement. These adverse reactions were reported 2-10 days after beginning treatment with black currant seed oil (17638).

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General ...Orally, sea buckthorn is well tolerated. Topically, sea buckthorn fruit seems to be well tolerated.
Most Common Adverse Effects:
Topically: Irritation and rash.

Dermatologic ...Orally, high doses of sea buckthorn may cause yellow staining of the skin. One case of generalized yellow skin has been reported for a patient who consumed sea buckthorn 100 grams daily for 6 months (74072). Topically, sea buckthorn oil has been associated with dryness, irritation, redness, and rash (74077,102845). Rash occurred in 4% of patients in one clinical study (74077). When used intravaginally, severe burning and itching have been reported rarely (106089).

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