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Boswelia

Boswellia, commonly known as frankincense, has been used in traditional medicine for centuries. This review examines the scientific evidence for its therapeutic properties based on peer-reviewed research.

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Modified by Peter Jorgensen.

Botanical Classification and Common Names

The primary species studied for medicinal properties include Boswellia serrata (Indian frankincense or "Salai guggul"), Boswellia carterii (Somali frankincense), Boswellia sacra (Arabian frankincense), and Boswellia frereana (African frankincense). Though often collectively referred to as "frankincense," these species contain slightly different compositions of bioactive compounds. Olibanum is another common name used for the resin obtained from these trees.

It's important to note that Commiphora myrrha (myrrh) is sometimes confused with boswellia, though they are distinct plants from the same Burseraceae family with different chemical compositions and medicinal properties.

Active Compounds

The primary bioactive components in boswellia are boswellic acids, particularly 3-O-acetyl-11-keto-β-boswellic acid (AKBA), 11-keto-β-boswellic acid (KBA), β-boswellic acid (βBA), and acetyl-β-boswellic acid (AβBA). These compounds are primarily responsible for the anti-inflammatory effects through inhibition of 5-lipoxygenase (5-LOX) and other inflammatory pathways.

Evidence-Based Therapeutic Applications

• Osteoarthritis: Multiple clinical trials have demonstrated efficacy in reducing pain and improving function, with strongest evidence for knee osteoarthritis.
• Inflammatory Bowel Disease: Studies suggest benefits for both ulcerative colitis and Crohn's disease, with improvements in symptoms and maintenance of remission.
• Asthma: Clinical research shows reduced frequency of attacks and improved lung function parameters.
• Rheumatoid Arthritis: Moderate evidence for pain reduction and improved joint function.
• Brain Edema: Preliminary studies suggest potential reduction in peritumoral brain edema in patients with brain tumors.
• Psoriasis: Limited evidence suggests improvements in some patients.
• Cancer (adjunctive therapy): Preclinical research shows potential anti-cancer properties, though human evidence remains preliminary.
• Inflammatory conditions: General anti-inflammatory properties supported by multiple mechanisms of action.

Recommended Dosages

Based on clinical studies, effective dosages typically range from 300-1200 mg daily of boswellia extract, standardized to contain 30-65% boswellic acids. Most studies showing efficacy use formulations containing at least 30% AKBA. For specific conditions:

• Osteoarthritis: 100-250 mg of extract standardized to 30% AKBA, three times daily
• Inflammatory bowel disease: 300-400 mg three times daily of extract standardized to contain 37-65% boswellic acids
• Asthma: 300-400 mg three times daily of extract containing 60-65% boswellic acids
• Rheumatoid arthritis: 200-400 mg three times daily of standardized extract

Duration of treatment in most studies ranged from 4 weeks to 6 months, with benefits often observed after 2-4 weeks of consistent use.

Potential Side Effects and Safety Concerns

• Generally well-tolerated in clinical trials at recommended dosages
• Mild gastrointestinal symptoms (nausea, acid reflux, diarrhea)
• Allergic skin reactions (rare)
• Headache (uncommon)
• Potential drug interactions with anticoagulants/antiplatelets due to mild antiplatelet effects
• May interact with medications metabolized by CYP enzymes (theoretical concern)

No significant toxicity has been reported in human studies using recommended dosages. Limited data exist on long-term safety beyond 6 months of continuous use.

High Dose Studies and Knowledge Gaps

Limited research exists on doses exceeding 1500 mg daily of standardized extract. Animal toxicity studies suggest a wide safety margin, with no observed adverse effects at doses several times higher than those used therapeutically in humans. However, systematic dose-ranging studies in humans are lacking, particularly for long-term use.

Key knowledge gaps include: optimal standardization parameters for specific conditions, long-term safety data beyond 6-12 months, definitive bioavailability enhancement strategies, and pharmacokinetic interactions with common medications. Additionally, there is insufficient evidence regarding use during pregnancy or lactation, with most authorities recommending avoidance due to lack of safety data.

Commercial Pharmaceutical Products

• Shallaki® (Himalaya Pharmaceuticals): Standardized B. serrata extract for arthritis
• 5-Loxin® and AprèsFlex® (PLT Health Solutions): Patented AKBA-enriched boswellia extracts used in multiple pharmaceutical formulations
• Boswelya Plus: Standardized for use in inflammatory conditions
• Wokvel®: Clinical-grade boswellia extract used in osteoarthritis studies

These products are typically regulated as pharmaceuticals in some countries and as supplements in others, with specific formulations and standardization parameters.

Conclusion

Evidence supports boswellia's efficacy for several inflammatory conditions, particularly osteoarthritis, inflammatory bowel disease, and asthma. The strongest evidence exists for standardized extracts with verified boswellic acid content, particularly those with high AKBA concentrations. While generally safe at recommended dosages, more research is needed on optimal dosing, long-term safety, and specific formulations for various conditions.

References

Al-Harrasi, A., Csuk, R., Khan, A., & Hussain, J. (2019). Distribution of the anti-inflammatory and anti-depressant compounds: Incensole and incensole acetate in genus Boswellia. Phytochemistry, 161, 28-40.

Beghelli, D., Isani, G., Roncada, P., Andreani, G., Bistoni, O., Bertocchi, M., ... & Alunno, A. (2017). Antioxidant and ex vivo immune system regulatory properties of Boswellia serrata extracts. Oxidative medicine and cellular longevity, 2017(1), 7468064.

Cui, N., Li, M. J., Wang, Y. W., Meng, Q., Shi, Y. J., & Ding, Y. (2024). Boswellic acids: a review on its pharmacological properties, molecular mechanism and bioavailability. Tradit Med Res, 9(10), 60.

Gomaa, A. A., Farghaly, H. A., Abdel-Wadood, Y. A., & Gomaa, G. A. (2021). Potential therapeutic effects of boswellic acids/Boswellia serrata extract in the prevention and therapy of type 2 diabetes and Alzheimer’s disease. Naunyn-Schmiedeberg's Archives of Pharmacology, 394(11), 2167-2185.

Majeed, M., Majeed, S., Narayanan, N. K., & Nagabhushanam, K. (2019). A pilot, randomized, double‐blind, placebo‐controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytotherapy Research, 33(5), 1457-1468.

Rajabian, A., Sadeghnia, H., Fanoudi, S., & Hosseini, A. (2020). Genus Boswellia as a new candidate for neurodegenerative disorders. Iranian journal of basic medical sciences, 23(3), 277.

Trivedi, V. L., Soni, R., Dhyani, P., Sati, P., Tejada, S., Sureda, A., ... & Sharifi-Rad, J. (2023). Anti-cancer properties of boswellic acids: mechanism of action as anti-cancerous agent. Frontiers in pharmacology, 14, 1187181.

Yu, G., Xiang, W., Zhang, T., Zeng, L., Yang, K., & Li, J. (2020). Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC complementary medicine and therapies, 20, 1-16.