Boswellia

Purported Benefits, Side Effects & More
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Boswellia

Purported Benefits, Side Effects & More
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Boswellia

Common Names

  • Indian frankincense

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

Boswellia is an herbal extract made from the bark of the boswellia tree. It is also known as frankincense. The resin (sticky substance found in trees and plants) is used to make an extract.

Boswellia resin is used in Ayurvedic (traditional Indian) medicine. You can take boswellia in different ways, including taking it orally (by mouth) in a capsule, pill, or tablet, or using it as an oil that you can put on your body.

What are the potential uses and benefits?

Boswellia is used to:

  • Treat arthritis
  • Help with asthma
  • Treat colitis (inflammation of your colon)
  • Help with inflammation (swelling and redness)
  • Help reduce fluid cerebral edema (brain swelling) after radiotherapy, in patients with brain tumors
  • Help reduce skin damage due to radiotherapy, in breast cancer patients

It’s generally safe to use boswellia. However, talk with your healthcare providers before taking supplements. Herbal supplements can have higher amounts of boswellia compared to Ayurvedic formulas.

Supplements can also interact with some medications and affect how they work. For more information, read the “What else do I need to know?” section below.

What are the side effects?

Side effects of using boswellia may include:

  • Allergic skin reactions
What else do I need to know?
  • Talk to your doctor if you’re taking blood thinners such as warfarin (Coumadin®). Boswellia may increase your risk of bleeding if you take it with blood thinners.
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For Healthcare Professionals

Scientific Name
Boswellia serrata
Clinical Summary

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 is used widely in Ayurveda for treating arthritis, ulcerative colitis, coughs, sores, wound healing, and asthma. It is also available in supplemental forms to support joint health.

The bioactive compound in boswellia is boswellic acid (1), a 5-lipoxygenase inhibitor. It showed anti-inflammatory, anti-arthritic (1) (2) (3), cytotoxic (4) (5) (6) (7) and radio-enhancing effects (21), and prevented intestinal tumorigenesis in a murine model (26). Other animal models suggest boswellia may improve cognitive impairment and insulin resistance (42); and essential oil of boswellia showed antimicrobial property (24).

In clinical studies, boswellia extracts (11) (44) (52) (53) (55); a formulation containing boswellia, Terminalia chebula and turmeric (39); as well as boswellic acid combined with curcumin (40) were reported useful in patients with osteoarthritis although data are conflicting (48). Supplements containing boswellia were also alleviated symptoms of tendinopathy (45), were comparable to acetaminophen in reducing musculoskeletal pain (46), and reduced aromatase inhibitor-induced joint pain (54). Additional studies suggest benefits in patients with oral aphthous lesions (49), bronchial asthma (8), ulcerative colitis (9), mild irritable bowel syndrome (38) (50), knee pain (56) and osteo-muscular pain (36). Larger trials are needed to confirm these effects. As well, evidence is unclear, or negative, surrounding boswellia’s effectiveness against collagenous colitis (12) (13) (14), with no significant benefit in maintaining remission in patients with Crohn’s disease (15).

Preliminary findings suggest boswellia may be effective in reducing cerebral edema in patients with brain tumors following radio- and radiochemotherapy (23) (43), and topical use prevented radiation-induced skin damage in breast cancer patients (32). Also, boswellia formulations helped reduce mammary density, a risk factor for breast cancer (33), inhibited breast cancer proliferation (57), and decreased genitourinary pain in men with prostatitis-like symptoms (47).

Although similar in many functions, boswellia should not be confused with guggul or myrrh.

Purported Uses and Benefits
  • Arthritis
  • Asthma
  • Colitis
  • Inflammation
  • Radiation therapy side effects
Mechanism of Action

Boswellic acid, the major constituent of boswellia, is thought to contribute to many of the herb’s pharmacological activities. Preclinical studies show that anti-inflammatory activity occurs via inhibition of 5-lipoxygenase (2) (3) and cyclooxygenase-1 (35). Boswellic acid 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, it 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 cells 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). The antiplatelet effects of boswellia gum resin extracts are attributed to inhibition of clotting factors Xa and XIa. (34).

Adverse Reactions

Generally well tolerated (15).

Case reports

  • Allergic contact dermatitis: After using boswellia oil (51) and a topical cream containing a boswellia extract (28)
  • Gastric bezoar (accumulation of vegetable fiber, hair or other substances, in the stomach or small intestine): In a 17-year-old girl with celiac disease after excessive intake of frankincense. Her symptoms, which included epigastric pain and vomiting, resolved after surgical excision of the bezoar (29).
  • Mild stypsis: In IBS patients supplemented with Casperome®, a lecithin-based formulation of boswellia extract (38).
Herb-Drug Interactions
  • 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.
Dosage (OneMSK Only)
References
  1. Dahmen U, Gu YL, Dirsch O, et al. Boswellic acid, a potent antiinflammatory drug, inhibits rejection to the same extent as high dose steroids. Transplant Proc. Feb-Mar 2001;33(1-2):539-541.
  2. Safayhi H, Boden SE, Schweizer S, et al. Concentration-dependent potentiating and inhibitory effects of Boswellia extracts on 5-lipoxygenase product formation in stimulated PMNL. Planta Med. Mar 2000;66(2):110-113.
  3. Safayhi H, Mack T, Sabieraj J, et al. Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase. J Pharmacol Exp Ther. Jun 1992;261(3):1143-1146.
  4. Glaser T, Winter S, Groscurth P, et al. Boswellic acids and malignant glioma: induction of apoptosis but no modulation of drug sensitivity. Br J Cancer. May 1999;80(5-6):756-765.
  5. Jing Y, Nakajo S, Xia L, et al. Boswellic acid acetate induces differentiation and apoptosis in leukemia cell lines. Leuk Res. Jan 1999;23(1):43-50.
  6. Winking M, Sarikaya S, Rahmanian A, et al. Boswellic acids inhibit glioma growth: a new treatment option? J Neurooncol. 2000;46(2):97-103.
  7. Frank MB, Yang Q, Osban J, et al. Frankincense oil derived from Boswellia carteri induces tumor cell specific cytotoxicity. BMC Complement Altern Med. 2009 Mar 18;9:6.
  8. Gupta I, Gupta V, Parihar A, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res. Nov 17 1998;3(11):511-514.
  9. Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. Jan 1997;2(1):37-43.
  10. Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. Jul 2007;21(7):675-683.
  11. Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin(R) for treatment of osteoarthritis of the knee. Arthritis Res Ther. Jul 30 2008;10(4):R85.
  12. Kafil TS, Nguyen TM, Patton PH, et al. Interventions for treating collagenous colitis. Cochrane Database Syst Rev. Nov 11 2017;11:Cd003575.
  13. Madisch A, Miehlke S, Eichele O, et al. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. Int J Colorectal Dis. Dec 2007;22(12):1445-1451.
  14. Chande N, MacDonald JK, McDonald JW. Interventions for treating microscopic colitis: a Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Review Group systematic review of randomized trials. Am J Gastroenterol. 2009 Jan;104(1):235-41.
  15. Holtmeier W, Zeuzem S, PreiB, J, et al. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease. Inflamm Bowel Dis. 2011 Feb;17(2):573-82
  16. Singh GB, Atal CK. Pharmacology of an extract of salai guggal ex-Boswellia serrata, a new non-steroidal anti-inflammatory agent. Agents Actions. Jun 1986;18(3-4):407-412.
  17. Wang H, Syrovets T, Kess D, et al. Targeting NF-KB with a natural triterpenoid alleviates skin inflammation in a mouse model of psoriasis. J Immunol. Oct 2009;183(7):4755-63.
  18. Kim HR, Kim MS, Kwon DY, et al. Boswellia serrata-induced apoptosis is related with ER stress and calcium release. Genes Nutr. Feb 2008;2(4):371-374.
  19. Bhushan S, Malik F, Kumar A, et al. Activation of p53/p21/PUMA alliance and disruption of PI-3/Akt in multimodal targeting of apoptotic signaling cascades in cervical cancer cells by a pentacyclic triterpenediol from Boswellia serrata. Mol Carcinog. 2009 Dec;48(12):1093-108.
  20. Syrovets T, Buchele B, Gedig E, et al. Acetyl-boswellic acids are novel catalytic inhibitors of human topoisomerases I and IIalpha. Mol Pharmacol. Jul 2000;58(1):71-81.
  21. Conti S, Vexler A, Edry-Botzer L, et al. Combined acetyl-11-keto-beta-boswellic acid and radiation treatment inhibited glioblastoma tumor cells. PLoS One. 2018;13(7):e0198627.
  22. Pang X, Yi Z, Zhang X, et al. Acetyl-11-keto-beta-boswellic acid inhibits prostate tumor growth by suppressing vascular endothelial growth factor receptor 2-mediated angiogenesis. Cancer Res. 2009 Jul 15;69(14):5893-900.
  23. Kirste S, Treier M, Wehrle SJ, et al. Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors: A prospective, randomized, placebo-controlled, double-blind pilot trial. Cancer. 2011;117(16):3788-95.
  24. Camarda L, Dayton T, Di Stefano V, Pitonzo R, Schillaci D. Chemical composition and antimicrobial activity of some oleogum resin essential oils from Boswellia spp. (Burseraceae). Ann Chim. 2007 Sep;97(9):837-44.
  25. Mikhaeil BR, Maatooq GT, Badria FA, Amer MM. Chemistry and immunomodulatory activity of frankincense oil. Z Naturforsch C. 2003 Mar-Apr;58(3-4):230-8.
  26. Wang R, Wang Y, Gao Z, Qu X. The comparative study of acetyl-11-keto-beta-boswellic acid (AKBA) and aspirin in the prevention of intestinal adenomatous polyposis in APC(Min/+) mice. Drug Discov Ther. 2014 Feb;8(1):25-32.
  27. Qurishi Y, Hamid A, Sharma PR, et al. NF-κB down-regulation and PARP cleavage by novel 3-α-butyryloxy-β-boswellic acid results in cancer cell specific apoptosis and in vivo tumor regression. Anticancer Agents Med Chem. 2013 Jun;13(5):777-90.
  28. Acebo E, Ratón JA, Sautúa S, et al. Allergic contact dermatitis from Boswellia serrata extract in a naturopathic cream. Contact Dermatitis. 2004 Aug;51(2):91-2.
  29. El Fortia M, Badi H, Elalem Kh, Kadiki O, Topov Y. Olibanum bezoar: complication of a traditional popular medicine. East Mediterr Health J. 2006 Nov;12(6):927-9.
  30. Krüger P, Kanzer J, Hummel J, et al. Permeation of Boswellia extract in the Caco-2 model and possible interactions of its constituents KBA and AKBA with OATP1B3 and MRP2. Eur J Pharm Sci. 2009 Feb 15;36(2-3):275-84.
  31. Weber CC, Reising K, Müller WE, et al. Modulation of Pgp function by boswellic acids. Planta Med. 2006 May;72(6):507-13.
  32. Togni S, Maramaldi G, Bonetta A, Giacomelli L, Di Pierro F. Clinical evaluation of safety and efficacy of Boswellia-based cream for prevention of adjuvant radiotherapy skin damage in mammary carcinoma: a randomized placebo controlled trial. Eur Rev Med Pharmacol Sci. 2015 Apr;19(8):1338-44.
  33. Pasta V, Gullo G, Giuliani A, et al. An association of boswellia, betaine and myo-inositol (Eumastos(R)) in the treatment of mammographic breast density: a randomized, double-blind study. Eur Rev Med Pharmacol Sci. Nov 2015;19(22):4419-4426.
  34. Kokkiripati PK, Bhakshu LM, Marri S, et al. Gum resin of Boswellia serrata inhibited human monocytic (THP-1) cell activation and platelet aggregation. J Ethnopharmacol. 2011 Sep 1;137(1):893-901. 
  35. Siemoneit U, Hofmann B, Kather N, et al. Identification and functional analysis of cyclooxygenase-1 as a molecular target of boswellic acids. Biochem Pharmacol. 2008 Jan 15;75(2):503-13.
  36. Franceschi F, Togni S, Belcaro G, et al. A novel lecithin based delivery form of Boswellic acids (Casperome®) for the management of osteo-muscular pain: a registry study in young rugby players. Eur Rev Med Pharmacol Sci. 2016 Oct;20(19):4156-4161.
  37. Ranjbarnejad T, Saidijam M, Moradkhani S, Najafi R. Methanolic extract of Boswellia serrata exhibits anti-cancer activities by targeting microsomal prostaglandin E synthase-1 in human colon cancer cells. Prostaglandins Other Lipid Mediat. 2017 May 24;131:1-8.
  38. Belcaro G, Gizzi G, Pellegrini L, et al. Supplementation with a lecithin-based delivery form of Boswellia serrata extract (Casperome®) controls symptoms of mild irritable bowel syndrome. Eur Rev Med Pharmacol Sci. 2017 May;21(9):2249-2254.
  39. Karlapudi V, Prasad Mungara AVV, Sengupta K, Davis BA, Raychaudhuri SP. A Placebo-Controlled Double-Blind Study Demonstrates the Clinical Efficacy of a Novel Herbal Formulation for Relieving Joint Discomfort in Human Subjects with Osteoarthritis of Knee. J Med Food. 2018 May;21(5):511-520.
  40. Haroyan A, Mukuchyan V, Mkrtchyan N,  et al. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med. 2018 Jan 9;18(1):7.
  41. Bannuru RR, Osani MC, Al-Eid F, Wang C. Efficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis. Semin Arthritis Rheum. 2018 Dec;48(3):416-429.
  42. Gomaa AA, Makboul RM, Al-Mokhtar MA, et al. Polyphenol-rich Boswellia serrata gum prevents cognitive impairment and insulin resistance of diabetic rats through inhibition of GSK3beta activity, oxidative stress and pro-inflammatory cytokines. Biomed Pharmacother. Jan 2019;109:281-292.
  43. Di Pierro F, Simonetti G, Petruzzi A, et al. A novel lecithin-based delivery form of Boswellic acids as complementary treatment of radiochemotherapy-induced cerebral edema in patients with glioblastoma multiforme: a longitudinal pilot experience. J Neurosurg Sci. 2019 Jun;63(3):286-291.
  44. Yu G, Xiang W, Zhang T, Zeng L, Yang K, Li J. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020 Jul 17;20(1):225.
  45. Henrotin Y, Dierckxsens Y, Delisse G, Seidel L, Albert A. Curcuminoids and Boswellia serrata extracts combination decreases tendinopathy symptoms: findings from an open-label post-observational study. Curr Med Res Opin. 2020 Dec 21:1-20.
  46. Rudrappa GH, Chakravarthi PT, Benny IR. Efficacy of high-dissolution turmeric-sesame formulation for pain relief in adult subjects with acute musculoskeletal pain compared to acetaminophen: A randomized controlled study. Medicine (Baltimore). 2020 Jul 10;99(28):e20373.
  47. Sibona M, Destefanis P, Agnello M, et al. The association of Boswellia resin extract and propolis derived polyphenols can improve quality of life in patients affected by prostatitis-like symptoms. Arch Ital Urol Androl. 2020 Jan 14;91(4):251-255.
  48. Liu X, Robbins S, Eyles J, et al. Efficacy and safety of a supplement combination on hand pain among people with symptomatic hand osteoarthritis an internet-based, randomised clinical trial the RADIANT study. Osteoarthritis Cartilage. 2021 May;29(5):667-677.
  49. Soltani R, Saberi Z, Ghanadian SM, Taheri A, Entezarhojjat A. The effectiveness of olibanum orally disintegrating tablet in the treatment of oral aphthous ulcers: A randomized, double-blind, placebo-controlled clinical trial. J Res Med Sci. 2022 Jan 29;27:8.
  50. Giacosa A, Riva A, Petrangolini G, et al. Beneficial Effects on Abdominal Bloating with an Innovative Food-Grade Formulation of Curcuma longa and Boswellia serrata Extracts in Subjects with Irritable Bowel Syndrome and Small Bowel Dysbiosis. Nutrients. 2022 Jan 18;14(3):416.
  51. Buonomo M, Hylwa S. Allergic contact dermatitis from Boswellia carterii (frankincense) oil. Contact Dermatitis. 2021 Oct;85(4):465-467.
  52. Mohsenzadeh A, Karimifar M, Soltani R, Hajhashemi V. Evaluation of the effectiveness of topical oily solution containing frankincense extract in the treatment of knee osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. BMC Res Notes. 2023 Mar 4;16(1):28.
  53. Karlapudi V, Sunkara KB, Konda PR, Sarma KV, Rokkam MP. Efficacy and Safety of Aflapin®, a Novel Boswellia Serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study. J Am Nutr Assoc. 2023 Feb;42(2):159-168.
  54. Desideri I, Lucidi S, Francolini G, et al. Use of an alfa-lipoic, Methylsulfonylmethane, Boswellia serrata and Bromelain dietary supplement (OPERA®) for aromatase inhibitors-related arthralgia management (AIA): a prospective phase II trial (NCT04161833). Med Oncol. 2022 Jun 6;39(8):113.
  55. Dubey V, Kheni D, Sureja V. Efficacy evaluation of standardized Boswellia serrata extract (AflapinⓇ) in osteoarthritis: A systematic review and sub-group meta-analysis study.  Explore (NY). 2024 Feb 10:S1550-8307(24)00009-0.
  56. Pérez-Piñero S, Muñoz-Carrillo JC, Victoria-Montesinos D, et al. Efficacy of Boswellia serrata Extract and/or an Omega-3-Based Product for Improving Pain and Function in People Older Than 40 Years with Persistent Knee Pain: A Randomized Double-Blind Controlled Clinical Trial.  Nutrients. 2023 Sep 3;15(17):3848.
  57. Valente IVB, Garcia D, Abbott A, Spruill L, Siegel J, Forcucci J, Hanna G, Mukherjee R, Hamann M, Hilliard E, Lockett M, Cole DJ, Klauber-DeMore N. The anti-proliferative effects of a frankincense extract in a window of opportunity phase ia clinical trial for patients with breast cancer.  Breast Cancer Res Treat. 2024 Jan 9. 
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