Boswellia (Boswellia serrata)

Category

Herbs & Supplements

Synonyms

11-keto ß-boswellic acid, Acetyl-11-keto ß-boswellic acid (AKBA), African elemi (Boswellia frereana), Arabian incense (Bakhour), Bibal incense (Boswellia carterii), birdwood, Bosweilla, Boswellia carterii, Boswellia dalziellii, Boswellia frereana, Boswellia ovalifoliolata, Boswellia papyrifera, Boswellia sacra, Boswellia serrata, Boswellia serrata gum resins, BSB108, Burseraveae (family), carterii, dhup, frankincense, guggals, H15®, indish incense, Mexican bursera, nopane (Boswellia), oleogum resins, oleo-resin, olibanum, pentacyclic tritrepertinoid, S-compound®, sacra, salai guggal, sallai guggul, Sallaki®.

Background

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 chronic therapy for asthma (but not for the relief of acute asthma exacerbations). Further studies are warranted in this area.

As opposed to non-steroidal anti-inflammatory drugs (NSAIDs), long-term use of boswellia has not been shown to cause gastrointestinal irritation or ulceration, although adverse effects have not been well studied in humans.

Evidence

DISCLAIMER: 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.

Asthma (chronic therapy): Boswellia has been proposed as a potential chronic asthma therapy. Future studies are needed to assess the long-term efficacy and safety of boswellia and to compare the efficacy of boswellia to standard therapies. Boswellia should not be used for the relief of acute asthma exacerbations.
Grade: B

Brain tumors: Boswellia has been used as a cancer treatment but there is not enough human data to support this use over standard therapies. Cancer should be treated by a medical oncologist.
Grade: B

Crohn's disease: Boswellia has been noted to possess anti-inflammatory properties. However, limited human data exist, and there is inadequate evidence for or against using boswellia in the treatment of Crohn's disease.
Grade: C

Osteoarthritis: Due to boswellia's potential anti-inflammatory properties, boswellia has been suggested as a potential treatment for osteoarthritis. Further research is needed in this area.
Grade: C

Rheumatoid arthritis: Due to boswellia's potential anti-inflammatory properties, boswellia has been suggested as a potential treatment for rheumatoid arthritis (RA). However, data is conflicting and sometimes combination products have been used. Therefore, there is currently insufficient evidence to recommend for or against the use of boswellia for rheumatoid arthritis.
Grade: C

Ulcerative colitis: Due to boswellia's potential anti-inflammatory properties, boswellia has been suggested as a potential treatment for ulcerative colitis. At this time, however, only a limited number of human trials have evaluated this use of boswellia, with inconclusive results. Therefore, there is inadequate evidence for or against this use of boswellia.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. 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 healthcare provider. There may be other proposed uses that are not listed below.
Acne, amenorrhea (lack on 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, 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 cholesterol), immunostimulant, infections, insomnia, leukemia, multiple sclerosis, nephritis, parasitic infections (trypanosomiasis), pain, peptic ulcer disease, pimples, sedative, sexually transmitted diseases (STDs), skin ulcers/sores, stomach ulcers, stomach upset, syphilis, tendonitis, toxin-induced liver damage, tumors (meningioma), upper respiratory infections, uterine infections, varicose veins, wound healing, wrinkle prevention.

Dosing

Adults (over 18 years old)

There is no proven effective dose for boswellia. For asthma, 300 milligrams three times a day of boswellia powdered gum resin capsules (S-compound®) taken by mouth has been used. Another dose that has been taken is 400 milligrams three times daily (extract standardized to 37.5% boswellic acids per dose). For Crohn's disease, 1,200 milligrams three times daily of standardized Boswellia serrata gum resin H15® has been taken by mouth for up to eight weeks. For rheumatoid arthritis, 400 milligrams three times daily of standardized Boswellia serrata gum resin H15® has been taken by mouth. For ulcerative colitis, 350-400 milligrams three times daily (extract standardized to 37.5% boswellic acids per dose) has been taken by mouth.

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.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy to boswellia, its constituents, or members in the Burseraveae family. Allergic contact dermatitis has been associated with the use of a naturopathic cream containing Boswellia serrata extract.

Side Effects and Warnings

Boswellia is generally believed to be safe when used as directed, although safety and toxicity have not been well studied in humans. The most common complaints in trials have been nausea and acid reflux. A qualified healthcare professional, including a pharmacist, should be consulted prior to use.

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 would cause these effects.

Boswellia extract has been associated with mild gastrointestinal upset, abdominal fullness, epigastric pain, gastroesophageal reflux symptoms, diarrhea, and nausea. It is not clear to what extent these symptoms were related to the patients' underlying colitis or the boswellia specifically in some cases due to use of a combination product.

Pregnancy & Breastfeeding

Reports in the Indian literature suggest that resin from boswellia is an emmenagogue (promotes menstruation) and may induce abortion. Safety of boswellia during pregnancy has not been systematically studied, and therefore cannot be recommended.

Interactions

Interactions with Drugs

Boswellia may potentiate the actions of pharmaceutical leukotriene inhibitors such as zafrilukast (Accolate®) and montelukast (Singulair®), which are used in the treatment of asthma.

Theoretically, use with other anti-proliferative agents may increase effects or toxicity of boswellia.

The gum of boswellia may lower cholesterol and triglyceride levels and may increase the effects of lipid lowering agents. It may also bind to/impair absorption of lipid-soluble agents.

Non-steroidal anti-inflammatory drugs may interfere with the proposed benefits of boswellia in arthritis.

Boswellia may increase the effects of antifungals.

Boswellia may interact with immunomodulators, drugs broken down by the liver, antibiotics, fat soluble drugs, and sedatives.

Interactions with Herbs & Supplements

Boswellia may act additively with agents shown used in the treatment of osteoarthritis, such as glucosamine and chondroitin.

Theoretically, use with other anti-proliferative agents may increase effects or toxicity of boswellia.

Boswellia may increase the effects of antifungals.

The gum of boswellia has been reported to lower cholesterol and triglyceride levels in rats, and may increase the effects of lipid lowering agents, such as garlic.

Boswellia may interact with immunomodulators, herbs and supplements broken down by the liver, antibiotics, fat soluble drugs, chondroitin, glycosaminoglycans (GAGS), and sedatives.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Abrams, PharmD (University of Rhode Island); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Heather Boon, BScPhm, PhD (University of Toronto); Dilys Burke, BA (Natural Standard Research Collaboration); Theresa Davies-Heerema, PhD (Boston University); Ivo Foppa, MD, ScD (Harvard School of Public Health); Nicole Giese, MS (Natural Standard Research Collaboration); Michael Goble, BS, PharmD (Massachusetts College of Pharmacy); Sadaf Hashmi, MD, MPH (Natural Standard Research Collaboration); Jens Hasskarl, MD (Harvard Medical School); David Sollars, MAc, H.M.C. (New England School of Acupuncture); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: 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, Mack T, Singh GB, et al. Inhibition of leukotriene B4 formation in rat peritoneal neutrophils by an ethanolic extract of the gum resin exudate of Boswellia serrata. Planta Med 1991;57(3):203-207.

Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16.

Ammon HP. Salai Guggal - Boswellia serrata: from a herbal medicine to a non-redox inhibitor of leukotriene biosynthesis. Eur J Med Res. 5-24-1996;1(8):369-370.

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.

Chande N, McDonald JW, MacDonald JK. Interventions for treating collagenous colitis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003575.

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.

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.

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.

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 1998;3:1-5.

Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2(1):37-43.

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.

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.

Kulkarni RR, Patki PS, Jog VP, et al. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharm 1991;33(1-2):91-95.

Kulkarni RR, Patki PS, Jog VP, et al. Efficacy of an Ayurvedic formulation in rheumatoid arthritis: a double-blind, placebo-controlled, cross-over study. Indian J Pharm 1992;24:98-101.

Sander O, Herborn G, Rau R. [Is H15 (resin extract of Boswellia serrata, "incense") a useful supplement to established drug therapy of chronic polyarthritis? Results of a double-blind pilot study]. Z.Rheumatol 1998;57(1):11-16.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.