- Indian frankincense
For Patients & Caregivers
How It Works
Boswellia may be helpful for some inflammatory conditions, such as arthritis. A few studies also suggest it may reduce radiation therapy side effects, but more studies are needed.
The gummy resin derived from the bark of Boswellia is widely used in Ayurvedic medicine. It contains the compound boswellic acid, which exhibits certain biological properties. In lab animals, boswellic acid inhibited an enzyme important to inflammation. A few clinical trials in patients with colitis and osteoarthritis have also shown anti-inflammatory effects. However, a study of boswellia for maintenance of Crohn’s disease remission showed no significant benefit.
Even though lab studies suggest compounds in boswellia have anticancer properties, it is not known whether these effects could occur in humans. Only a few clinical studies have been done that suggest boswellia may reduce inflammation or swelling caused by radiation therapy. More studies are needed to confirm such effects.
- To treat osteoarthritis Although a few studies suggest benefit, the evidence is insufficient. Larger well designed trials are needed.
- To treat asthma Boswellia reduced symptoms of bronchial asthma in a clinical trial, but more studies are needed to draw a conclusion.
- To treat colitis Studies in animals suggest that boswellia can reduce inflammation, but small preliminary trials in humans are mixed.
- To reduce inflammation Studies in animals and from clinical trials show that this herb can reduce certain inflammatory conditions.
- To treat cancer Even though lab studies suggest compounds in boswellia have anticancer properties, human studies to evaluate these effects have not been conducted.
- To reduce radiation therapy side effects Only a few studies have been done in humans that suggest boswellia may reduce inflammation or swelling due to radiation therapy. More studies are needed to confirm such effects.
Do Not Take If
- You are taking drugs that are substrates of P-Glycoprotein (P-Gp): Boswellia may affect how these drugs are absorbed or metabolized. Clinical significance has yet to be determined.
- You are using anticoagulant and/or antiplatelet drugs: Boswellia may increase risk of bleeding when used with these drugs. Clinical significance has yet to be determined.
- Allergic contact dermatitis was reported following use of a topical cream containing an extract of Boswellia serrata.
- A 17-year-old girl with celiac disease developed a gastric bezoar (accumulation of vegetable fiber, hair or other substances, in the stomach or small intestine) after excessive intake of olibanum (frankincense). Her symptoms, including abdominal pain and vomiting, improved after the bezoar was surgically removed.
For Healthcare Professionals
Boswellia serrata is a tree prevalent in India, the Middle East and North Africa. The gummy exudate or resin obtained by peeling away the bark is commonly known as frankincense or olibanum. Boswellia, also referred to as Indian frankincense, is used widely in Ayurveda for treating arthritis, ulcerative colitis, coughs, sores, wound healing, and asthma. It is marketed as a supplement to support and improve joint health and mobility.
The major component is boswellic acid (1), a 5-lipoxygenase inhibitor with anti-inflammatory and anti-arthritic effects (1) (2) (3). It also demonstrated cytotoxic (4) (5) (6) (7) and radio-enhancing properties (21), and prevented intestinal tumorigenesis in a murine model (26). Other animal studies suggest boswellia may improve cognitive impairment and insulin resistance (42). Essential oil of boswellia has been shown to have antimicrobial activities (24).
Small studies have shown beneficial effects of boswellia for bronchial asthma (8), ulcerative colitis (9), mild irritable bowel syndrome (38), and osteo-muscular pain (36). But evidence is unclear or negative on any benefits for collagenous colitis (12) (13) (14), with no significant benefit in maintaining Crohn’s disease remission (15). An enriched boswellic acid extract was reported useful in patients with osteoarthritis (11), and other studies report efficacy with formulations containing boswellia, Terminalia chebula, turmeric (39); and boswellic acid combined with curcumin (40). Larger well-designed studies are needed for clinical recommendation (41).
Other preliminary data suggest that boswellia may be effective in reducing cerebral edema in patients with brain tumors following radiotherapy (23); and in reducing radiochemotherapy-induced cerebral edema in patients with primary glioblastoma multiforme (43). A boswellia-based cream was found useful in preventing skin damage due to radiotherapy in breast cancer patients (32). Other data suggest that a combination of boswellic acid, betaine, and myo-inositol treatment may help to reduce mammary density, a risk factor for breast cancer (33).
Mechanism of Action
Boswellic acid, the major constituent of boswellia, is thought to contribute to most of the herb’s pharmacological activities. In vitro and animal studies show that anti-inflammatory activity occurs via inhibition of 5-lipoxygenase (2) (3) and cyclooxygenase-1 (35). It also inhibits nuclear transcription factor KappaB (NF-KappaB) signaling, markedly decreasing production of the key proinflammatory cytokine tumor necrosis factor (TNF-alpha) (17). Unlike other non-steroidal anti-inflammatory drugs, however, boswellic acid failed to show analgesic or antipyretic effects (16).
Research on cytotoxic effects of boswellic acid indicates that it induces p21 expression through a p53-independent pathway and causes apoptosis in glioma (4) (6) and leukemia (5) cell lines. A boswellia extract induced apoptosis in a cervical cancer cell line by inducing endoplasmic reticulum (ER) stress (18). Other apoptotic mechanisms include early generation of nitric oxide and reactive oxygen species that upregulated time-dependent expression of p53/p21/PUMA (19), inhibition of microsomal prostaglandin E synthase-1 (mPGES-1), and decreased prostaglandin (PGE2) levels and its downstream targets (37).
A semisynthetic analog of boswellic acid, 3-alpha-Butyryloxy-beta-boswellic acid, demonstrated significant growth inhibition in Ehrlich Ascitic Tumour (EAT), Ehrlich Ascitic Carcinoma (EAC) and Sarcoma-180 tumor models, via NF-KappaB downregulation and induction of poly (ADP-ribose) polymerase (PARP) cleavage (27). Acetyl-boswellic acids inhibited topoisomerases by competing with DNA for binding sites (20). Acetyl-11-keto-beta-boswellic acid (AKBA) inhibited human prostate tumor growth via inhibition of VEGFR2-induced angiogenesis (22). In vitro, antiplatelet effects of boswellia gum resin extracts are attributed to inhibition of clotting factors Xa and XIa. (34).
Generally well tolerated (15).
- Allergic contact dermatitis was reported following use of a topical cream containing an extract of Boswellia serrata (28).
- A 17-year-old girl with celiac disease developed a gastric bezoar (accumulation of vegetable fiber, hair or other substances, in the stomach or small intestine) after excessive intake of olibanum (frankincense). Her symptoms, including epigastric pain and vomiting, resolved after the bezoar was surgically removed (29).
- In IBS patients supplemented with Casperome®, mild stypsis was the only unwanted effect recorded (38).
- OATP1B3 (an anion transporter): Both 11-keto-beta-boswellic acid (KBA) and 3-acetyl-11-keto-beta-boswellic acid (AKBA) modulated the activity of OATP1B3, in vitro (30). Clinical relevance is not known.
- MRP2 (a multidrug resistant protein): Both 11-keto-beta-boswellic acid (KBA) and 3-acetyl-11-keto-beta-boswellic acid (AKBA) modulated the activity of MRP2, in vitro (30). Clinical relevance is not known.
- P-Glycoprotein (P-Gp): A Boswellia extract and keto-boswellic acids inhibit the activity of P-Glycoprotein in vitro, and may affect the transport of drugs mediated by this protein (31). Clinical significance has yet to be determined.
- Anticoagulant and/or antiplatelet drugs: Boswellia extracts can inhibit platelet aggregation and may increase risk of bleeding when used with these drugs (34). Clinical significance has yet to be determined.