Boswellia (Boswellia serrata)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
3-O-acetyl-11-keto-beta-boswellic acid (AKBA), 11-keto-beta-boswellic acid, acetyl-11-keto-beta-boswellic acid (AKBA), African elemi (Boswellia frereana), Afrikanischer Weihrauch (German), Afrikanischer Weihrauch-Baum (German), Afrikanischer Weihrauchbaum (German), albero dell'incenso (Italian), alpha-boswellic acid, Arabian incense (Bakhour), árbol del incienso (Spanish), arbre à encens (French), arbre à encens d'Afrique (French), arbre à encens de l'Inde (French), bakhor (Arabic), beta-boswellic acid, Bible frankincense, Bible incense (Boswellia carterii), birdwood, bosvelliia kartera (Russian), bosvelliia mil'chataia (Russian), Boswellia carterii, Boswellia dalziellii, Boswellia frereana, Boswellia ovalifoliolata, Boswellia papyrifera, Boswellia sacra, Boswellia serrata, Boswellia serrata gum resins, boswellic acids, boswellic acid acetate, boswellie (French), BSB108, Burseraceae (family), carterii, dhup, diterpenes, elephant-tree, fan hun shu (Chinese), frankincense, Frankincense der Weihrauch (German), furankinsensu (Japanese), gajabhakshya (Sanskrit), guggals, H15®, Indiai tömjénfa (Hungarian), Indian frankincense, Indian olibanum tree, indish incense, Indischer Weihrauch (German), kundur luban (Hindi), magher (Arabic), Mexican bursera, mirafur (Somali), mogar (Arabic), monoterpenes, moxor (Somalia), mughur (Arabic), nopane (Boswellia), ogaden etan (Amharic), oleogum resins, oleo-resin, olibán (Spanish), olibano (Italian), olibanum, pentacyclic triterpenic acids, pentacyclic triterpenoid, røgelsestræ (Danish), rökelseträd (Swedish), ru xiang (Chinese), ru xiang shu (Chinese), saagjas viirukipuu (Estonian), sacra, salai (Hindi), salai gugaal (Hindi), salai guggal (Hindi), salai guggulu (Sanskrit), sallai guggul (Hindi), Sallaki®, sanlaki (Thai), S-compound®, sesquiterpenes, shallaki (Sanskrit), Sudanese frankincense, triterpenoids, ubani (Swahili), Weihrauchbaum (German), Weihrauchpflanze (German), wierookboom (Dutch), wierookboom soort (Dutch), yagar (Somalia), ye ru xiang shu (Chinese), yigaar (Somalia).
Extracts from resins of Boswellia species have been used for years in African countries and in Ayurvedic medicine in India for the treatment of a variety of diseases. Resin extracts from the Boswellia serrata tree have been found to have anti-inflammatory effects. Animal and laboratory studies suggest possible efficacy for inflammatory conditions such as inflammatory bowel disease, rheumatoid arthritis, and osteoarthritis, although high-quality human data are lacking. Initial human evidence suggests the efficacy of Boswellia as a therapy for asthma (but not for the relief of acute asthma symptoms). Studies have shown anticancer, antibacterial, and antifungal effects.
As opposed to nonsteroidal anti-inflammatory drugs (NSAIDs), long-term use of Boswellia has demonstrated minimal side effects, although its safety has not been well studied in humans. Gastrointestinal side effects and liver toxicity have been reported in humans and in animals, respectively.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Boswellia has been proposed as a potential therapy for chronic asthma. Future studies are needed to assess the long-term efficacy and safety of Boswellia and to compare the effectiveness of Boswellia to standard therapies. Boswellia should not be used for the relief of acute asthma symptoms.
Boswellia has been used as a cancer treatment, specifically for brain tumors or swelling caused by such tumors. However, there are not enough human data to support this use over standard therapies. Additional research is needed in this area. Cancers should be treated by a medical oncologist.
Due to its potential anti-inflammatory properties, Boswellia has been suggested as a possible treatment for ulcerative colitis. At this time, however, only a limited number of human trials have evaluated this use of Boswellia, with inconclusive results. Additional research is needed in this area.
Boswellia has been noted to possess anti-inflammatory properties. However, limited human data exist. Additional research is needed before a conclusion can be made.
Due to its potential anti-inflammatory properties, Boswellia has been suggested as a possible treatment for osteoarthritis. Further research is needed in this area.
Due to its potential anti-inflammatory properties, Boswellia has been suggested as a possible treatment for rheumatoid arthritis (RA). However, data are conflicting, and sometimes combination products have been used. Additional research, including research on the use of Boswellia alone, is needed before a conclusion can be made.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Acne, amenorrhea (lack of menstrual period), analgesic (pain reliever), antibacterial, antifungal, anti-inflammatory, antioxidant, antiseptic, astringent, autoimmune diseases (encephalomyelitis), belching, bladder inflammation, blood purification, boils, breast cysts, bruises, bursitis, cancer, cancer (quality of life), carminative (digestion aid), cervical spondylosis, chemopreventive, chronic obstructive pulmonary disease (COPD), cicatrizant (scar formation), cystitis, digestive, diuretic, dyspepsia (upset stomach), emmenagogue (induces menstruation), expectorant, gas, genital area infections, hepatitis (hepatitis C), hyperlipidemia (high blood lipids), immunostimulant, infections, insect repellant, insomnia, leukemia, multiple sclerosis, nephritis, pain, parasitic infections (trypanosomiasis), peptic ulcer disease, pimples, sedative, sexually transmitted diseases (STDs), skin ulcers/sores, stomach ulcers, stomach upset, syphilis, tendonitis, toxin-induced liver damage, upper respiratory infections, uterine infections, varicose veins, wound healing, wrinkle prevention.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (over 18 years old)
For asthma, 300 milligrams of Boswellia powdered gum resin capsules has been taken by mouth three times daily for six weeks; and 400 milligrams has been taken three times daily for an unknown length of time.
For brain tumors, a maximum of 126 milligrams of standardized Boswellia serrata gum resin H15® per kilogram of body weight has been taken by mouth daily for a median of nine months.
For colitis, 350-400 milligrams of an extract, standardized to 37.5% boswellic acids per dose, has been taken by mouth three times daily for six weeks.
For Crohn's disease, 1,200 milligrams of standardized Boswellia serrata gum resin H15® has been taken by mouth three times daily for up to eight weeks.
For osteoarthritis, 333 milligrams of Boswellia serrata extract (standardized to 40% total boswellic acid) has been taken by mouth three times daily for eight weeks; two capsules of Articulin-F® (a combination formula containing 100 milligrams of Boswellia serrata, 450 milligrams of Withania somnifera, 50 milligrams of Curcuma longa, and 50 milligrams of zinc complex) has been taken by mouth three times daily after meals for 90 days; and 50 and 125 milligrams of 5-Loxin® has been taken by mouth twice daily for 90 days.
For rheumatoid arthritis, 400 milligrams of standardized Boswellia serrata gum resin H15® has been taken by mouth three times daily; two capsules of Articulin-F® (a combination formula containing 100 milligrams of Boswellia serrata, 450 milligrams of Withania somnifera, 50 milligrams of Curcuma longa, and 50 milligrams of zinc complex) have been taken by mouth three times daily; up to 3,600 milligrams of H15® has been taken by mouth for 12 weeks; and two tablets of RA-1® (an herbal mixture of Boswellia serrata, Withania somnifera (ashwagandha), Zingiber officinale (ginger), and Curcuma longa (turmeric)) (444 milligrams daily) have been taken by mouth three times daily for 16 weeks.
Children (under 18 years old)
Safety, efficacy, and dosing have not been systematically studied. Some experts believe that regular use of Boswellia may mask the symptoms of asthma in children and may delay diagnosis. Use in children should be supervised by a qualified healthcare professional.
A maximum of 126 milligrams of standardized Boswellia serrata gum resin H15® per kilogram of body weight has been taken by mouth daily for approximately nine months, for intracranial swelling associated with brain tumors.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Avoid in individuals with a known allergy or hypersensitivity to Boswellia, its constituents, or members in the Burseraceae family. Allergic contact dermatitis has been associated with the use of a naturopathic cream containing Boswellia serrata extract.
Side Effects and Warnings
Boswellia is likely safe when consumed in amounts normally found in foods (maximum levels of 0.001% in meat products).
Dermatitis (itchy, inflamed skin) has been reported in clinical trials using Articulin-F®, a combination product containing gum resin from Boswellia serrata, as well as Withania somnifera (ashwagandha), Curcuma longa (turmeric), and zinc complex. However, it is not clear if Boswellia alone is responsible for these effects.
Gastrointestinal side effects, including mild stomach upset, abdominal fullness, diarrhea, nausea, epigastric pain, abdominal cramps, and a bezoar, have been reported.
Use cautiously in children, due to a lack of safety and efficacy data.
Use cautiously in patients with pre-existing gastritis or gastroesophageal reflux disease (GERD), as reflux and stomach pain have been associated with the use of Boswellia.
Use cautiously in patients taking lipid-lowering or lipid-soluble medications or supplements, as the gum resin of Boswellia has been reported to lower cholesterol and triglyceride levels.
Boswellia may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients taking any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Use cautiously in patients with impaired liver function or liver damage, or those taking agents that damage the liver, as liver damage with pronounced liver enlargement and steatosis is possible with high doses of Boswellia.
Use cautiously in patients with lung disorders and those taking drugs, herbs, or supplements to treat these conditions, as oleoresin of Boswellia may theoretically cause harmful changes in lung tissue.
Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery.
Use cautiously in patients with autoimmune diseases, and those taking drugs, herbs, or supplements to treat these conditions, as Boswellia may stimulate the immune system.
Use cautiously if breastfeeding, due to a lack of safety data. Consult a qualified healthcare professional before use.
Avoid during pregnancy, as Boswellia may induce menstruation and abortion.
Avoid in individuals with known allergy or hypersensitivity to Boswellia, its constituents, or members of the family Burseraceae. Allergic contact dermatitis has been associated with the use of a naturopathic cream containing Boswellia serrata extract.
Pregnancy & Breastfeeding
Avoid during pregnancy, as Boswellia may induce menstruation and abortion.
Safety of Boswellia during pregnancy has not been systematically studied and therefore cannot be recommended.
Use cautiously if breastfeeding, due to a lack of safety data. Consult a qualified healthcare professional before use.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Boswellia may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.
Boswellia may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients taking any medication should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Theoretically, Boswellia may act additively with analgesics (pain relievers), antiarthritic agents, antibiotics, anticancer agents, antifungals, anti-inflammatory agents, cholesterol- and triglyceride-lowering agents, drugs that cause liver damage, immunosuppressants, leukotriene receptor antagonists (such as zafirlukast (Accolate®) and montelukast (Singulair®)), and tumor necrosis factor (TNF)-blocking agents.
Interactions with Herbs & Supplements
Boswellia may increase the amount of drowsiness caused by some herbs or supplements.
Boswellia may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may change in the blood. It may also alter the effects that other herbs or supplements potentially may have on the cytochrome P450 system.
Theoretically, Boswellia may act additively with analgesics (pain relievers), antiarthritic agents, antibacterials, anticancer agents, antifungals, anti-inflammatory agents, antimicrobials, cholesterol- and triglyceride-lowering agents, chondroitin sulfate, glucosamine, glycosaminoglycans (GAGs), herbs and supplements that cause liver damage, high-fat meals, and immunomodulators.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16. View Abstract
Basch E, Boon H, Davies-Heerema T, et al. Boswellia: An Evidence-based Systematic Review by the Natural Standard Research Collaboration. J Herb Pharmacother. 2004;4(3):63-83. View Abstract
Chande N, McDonald JW, MacDonald JK. Interventions for treating collagenous colitis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003575. View Abstract
Chande, N., McDonald, J. W., and MacDonald, J. K. Interventions for treating collagenous colitis. Cochrane.Database.Syst.Rev. 2008;(2):CD003575. View Abstract
Chopra A, Lavin P, Patwardhan B, et al. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol. 2000;27(6):1365-1372. View Abstract
Clarke, J. O. and Mullin, G. E. A review of complementary and alternative approaches to immunomodulation. Nutr.Clin.Pract. 2008;23(1):49-62. View Abstract
Ernst, E. Frankincense: systematic review. BMJ 2008;337:a2813. View Abstract
Gayathri B, Manjula N, Vinaykumar KS, et al. Pure compound from Boswellia serrata extract exhibits anti-inflammatory property in human PBMCs and mouse macrophages through inhibition of TNFalpha, IL-1beta, NO and MAP kinases. Int Immunopharmacol. 2007;7(4):473-482. View Abstract
Gerhardt H, Seifert F, Buvari P, et al. [Therapy of active Crohn disease with Boswellia serrata extract H 15]. Z.Gastroenterol. 2001;39(1):11-17. View Abstract
Gupta I, Parihar A, Malhotra P, et al. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med 2001;67(5):391-395. View Abstract
Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Phytomedicine. 2003;10(1):3-7. View Abstract
Madisch, A., Miehlke, S., Eichele, O., Mrwa, J., Bethke, B., Kuhlisch, E., Bastlein, E., Wilhelms, G., Morgner, A., Wigginghaus, B., and Stolte, M. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. Int.J Colorectal Dis. 2007;22(12):1445-1451. View Abstract
Sengupta, K., Alluri, K. V., Satish, A. R., Mishra, S., Golakoti, T., Sarma, K. V., Dey, D., and Raychaudhuri, S. P. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther 2008;10(4):R85. View Abstract
Shah, S. A., Rathod, I. S., Suhagia, B. N., Patel, D. A., Parmar, V. K., Shah, B. K., and Vaishnavi, V. M. Estimation of boswellic acids from market formulations of Boswellia serrata extract and 11-keto beta-boswellic acid in human plasma by high-performance thin-layer chromatography. J Chromatogr B Analyt.Technol Biomed Life Sci 4-1-2007;848(2):232-238. View Abstract
Slonim AE, Grovit M, Bulone L. Effect of exclusion diet with nutraceutical therapy in juvenile Crohn's disease. J Am Coll Nutr 2009;28(3):277-85. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017