What is Boswellia?
Boswellia extracts are taken from the resin (a thick, sticky organic substance) of the tree Boswellia serrata, which is native to the Arabian peninsula, Somalia, Ethiopia, and India. It has been used in a variety of different folk medicines for inflammatory, gastrointestinal, and respiratory conditions.[1][9][10][11]
Boswellia has also been called frankincense, from the Old French term franc encens, which means “pure and noble high-quality incense”.[11] It has been used in funeral ceremonies and religious rituals in the Catholic church.[11]
What are Boswellia’s main benefits?
The most evidence for Boswellia is in osteoarthritis, where it generally has large effect sizes, but the evidence is of low quality.[1][4][12][8]
There is some overall weak evidence in support of Boswellia for neurological concerns (traumatic brain injury,[6] stroke recovery,[7] and memory in older adults[13]), and burns (from fire[14] and cancer radiation[10]). Additionally, there is scant evidence for acute diarrhea[9] and chronic asthma in adults.[15]
How does Boswellia work?
Boswellia resin contains such compounds such as boswellic acids (mainly acetyl-keto-boswellic acid) which inhibits inflammatory cytokines and enzymes such as C-reactive protein, TNF-ɑ, 5-lipoxygenase, and matrix metalloproteinases, which may play a role in the cartilage degradation and inflammation of osteoarthritis.[1][18][19][12]
Dosage information
Formulation:
Boswellia has most often been studied as an oral capsule.[1] Some studies have used concentrations of 12.5%–20% of boswellic acids.[2][1]
In one study where Boswellia was used topically, it was specified that the formulation was 40% boswellic acids.[3]
Range of dosages studied:
Boswellia has been most often studied at dosages of 100–250 mg/day of the Aflapin and 5-Loxin formulations.[1][4] Nonproprietary extracts have been studied at higher dosages, between 1,000 and 2,400 mg/day.[3][5][6][7]
Effective dosages:
Osteoarthritis
Often older adults (ages 50–65): 100–250 mg/day of oral capsules for 3 months.[1][4][8]
Special considerations: The formulations Aflapin and 5-Loxin have most often been studied. In a 2024 meta-analysis, subgroup analyses found Aflapin to have greater improvements in pain, functioning, and stiffness scores compared to a placebo.[1]
Traumatic brain injury and stroke recovery
Adults (average age of 36): 1,200–2,400 mg/day of a Boswellia extract for 3 months.[6][7]
Special considerations: Participants with a traumatic brain injury had an average time of 13 months since their injury.[6] In another trial, where Boswellia was used within 24 hours of hospital admission after a traumatic brain injury, there was no effect.[5]
Frequently asked questions
Boswellia extracts are taken from the resin (a thick, sticky organic substance) of the tree Boswellia serrata, which is native to the Arabian peninsula, Somalia, Ethiopia, and India. It has been used in a variety of different folk medicines for inflammatory, gastrointestinal, and respiratory conditions.[1][9][10][11]
Boswellia has also been called frankincense, from the Old French term franc encens, which means “pure and noble high-quality incense”.[11] It has been used in funeral ceremonies and religious rituals in the Catholic church.[11]
The most evidence for Boswellia is in osteoarthritis, where it generally has large effect sizes, but the evidence is of low quality.[1][4][12][8]
There is some overall weak evidence in support of Boswellia for neurological concerns (traumatic brain injury,[6] stroke recovery,[7] and memory in older adults[13]), and burns (from fire[14] and cancer radiation[10]). Additionally, there is scant evidence for acute diarrhea[9] and chronic asthma in adults.[15]
Meta-analyses of randomized controlled trials (RCTs) from 2015 to 2024 have consistently found that Boswellia improved pain, function, and stiffness (as evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index, or WOMAC) in osteoarthritis (OA). The effect sizes in each meta-analysis are large, but the quality of the evidence is often low.[1][4][12][8][16][20]
When looking at recent evidence from higher quality trials, the findings are promising: A 2024 meta-analysis examined 9 RCTs, of which 8 were graded as being of good quality, and found improvements in pain, stiffness, and function compared to a placebo,[1] and the improvements in pain and function were clinically significant.[21] Similarly, in a 2014 Cochrane review, the researchers found clinically significant effects on pain but not on function (though this finding was of borderline statistical significance) in 5 RCTs.[16]
Additionally, one meta-analysis was noteworthy in that in addition to the usual comparator of a placebo or an inactive control, Boswellia also improved outcomes compared to valdecoxib, an NSAID medication that can reduce pain and inflammation. However there were only 2 RCTs in this meta-analysis, and the evidence quality was rated as low.[20]
Unfortunately, many of the studies of Boswellia examined other interventions such as curcumin (another anti-inflammatory) as well, which contributes to the low quality of evidence in these studies.[1]
All of these studies considered, there is a reasonable level of evidence to suggest that Boswellia might improve pain, stiffness, and function in OA.
In traumatic brain injury (TBI) Boswellia has had inconsistent evidence, as it improved cognitive assessments after 3 months of supplementation in one randomized controlled trial (RCT),[6] but not after 6 weeks of supplementation in a randomized crossover trial.[5] Besides the difference in the durations of supplementation, the participants in the RCT had had a TBI 3 months to 3 years previously, versus the participants in the crossover trial who were given Boswellia (or a placebo) within 24 hours of admission to the hospital.
Similar to the crossover trial, Boswellia was given to the participants in an RCT within 72 hours of having a stroke. However, in this study Boswellia improved neurological function and reduced inflammatory markers (e.g., TNF-ɑ) after only 1 month of supplementation.[7]
In another trial that examined a 1-month duration of supplementation, a supplement containing Boswellia and lemon balm improved memory scores in older adults.[13] However, because the dose of Boswellia was only 27 mg, it is less likely that Boswellia had an effect, and lemon balm might have effects on memory as well.[22][23]
Ultimately, Boswellia might improve cognitive health after a neurological injury, but confidence in this effect is low.
In a 2015 randomized controlled trial (RCT) that examined radiation burns from breast cancer treatment, topical Boswellia reduced skin redness and medication (cortisone) use and reduced skin damage severity, although not quite significantly (p-value=0.07), compared to a placebo.[10]
In a 2023 RCT examining 2nd-degree burns from fire, the healing time with topical Boswellia was similar to medication (1% silver sulfadiazine), though confidence is reduced in this finding because the medication group had worse (i.e., a higher percentage of their body covered with) burns.[14]
Boswellia resin contains such compounds such as boswellic acids (mainly acetyl-keto-boswellic acid) which inhibits inflammatory cytokines and enzymes such as C-reactive protein, TNF-ɑ, 5-lipoxygenase, and matrix metalloproteinases, which may play a role in the cartilage degradation and inflammation of osteoarthritis.[1][18][19][12]
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