Boswellia (Frankincense)

📜 Historical Use

Boswellia serrata is described by NCCIH as a branching tree native to the mountainous regions of Northern Africa, India, and the Middle East, and the material in question is its gum resin. That resin is the frankincense of the ancient incense trade, which is why one plant reaches a modern shopper under two quite different names: a standardised capsule for joints, and an essential oil for aromatherapy. The therapeutic history is Ayurvedic. NCCIH records that boswellia has traditionally been used in Ayurveda practices to improve arthritis, reduce inflammation and pain, and relieve symptoms of some respiratory and cardiovascular diseases and other disorders. MSKCC gives a compatible and slightly wider list, noting it is used widely in Ayurveda for treating arthritis, ulcerative colitis, coughs, sores, wound healing, and asthma. The modern marketing has narrowed that inheritance rather than departed from it: NCCIH describes boswellia extracts sold today as dietary supplements to reduce inflammation and support joint health, mobility, and digestive health. Unusually for this database, the traditional indications and the conditions with the most clinical study - osteoarthritis, asthma, ulcerative colitis - are broadly the same ones.

📊 What the Research Shows

NCCIH states the conclusion in one line: there is not enough high-quality evidence to determine whether boswellia is useful for any health condition. That includes the use it is sold for. On osteoarthritis, NCCIH says several studies have shown taking boswellia orally may help reduce inflammation and pain associated with osteoarthritis, but larger, higher quality studies are needed, and it describes the evidence for topical application as insufficient. On asthma, a few small studies suggest oral boswellia may reduce asthma symptoms, but NCCIH says there is not enough rigorous evidence to determine whether it is a useful treatment, and warns against substituting it for prescribed asthma treatment. There is no evidence that boswellia can prevent or treat COVID-19. MSKCC is more positive in places and more specific about failures. It reports that boswellia extracts were found useful in patients with osteoarthritis, that evidence supports symptom reduction in bronchial asthma and ulcerative colitis, that musculoskeletal pain relief was comparable to acetaminophen in study conditions, and that symptoms improved in tendinopathy and in oral aphthous lesions. Against that, MSKCC records no significant benefit in maintaining remission in patients with Crohn disease, and says the effect on collagenous colitis remains unclear. MSKCC also summarises preliminary oncology supportive-care work, which is outside the scope of this page and is not a treatment claim.

Take 300-500mg standardized extract (AKBA) 2-3 times daily with food.

May cause mild stomach upset. Do not use if pregnant.

⚠️ What happens if taken in excess:

Generally well-tolerated, but high doses (>3600mg/day) may cause nausea, diarrhea, acid reflux, and skin rashes. Very rarely, excessive use has been associated with liver damage. High doses may enhance blood-thinning effects. Topical overuse of frankincense essential oil can cause chemical burns and dermatitis.

NCCIH names no specific drug interaction for boswellia at all; its guidance is the generic instruction to tell your health care provider about any herbal product, which on its own is not enough to act on. MSKCC is specific, and the important one is bleeding. Boswellia extracts can inhibit platelet aggregation and may increase the risk of bleeding when used with anticoagulant and antiplatelet drugs, with warfarin named as the example requiring a physician conversation; the mechanism MSKCC gives for that antiplatelet effect is inhibition of clotting factors Xa and XIa. Anyone on warfarin, a direct oral anticoagulant, clopidogrel, or daily aspirin should treat that as the deciding fact about this supplement, and surgery is the obvious second context, although neither source read this session states a stop-before-surgery interval. Two transporter effects are reported with explicit uncertainty attached. MSKCC says 11-keto-beta-boswellic acid and AKBA modulated the activity of OATP1B3 and MRP2 in vitro, with clinical relevance unknown, and that boswellia extract and keto-boswellic acids inhibit P-glycoprotein in vitro and may affect the transport of drugs mediated by that protein, with clinical significance undetermined. P-glycoprotein carries digoxin, apixaban, rivaroxaban and many other substrates, so that signal is worth flagging even unconfirmed. Neither source reports cytochrome P450 data for boswellia.

1. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee — Kimmatkar N et al Phytomedicine (2003)[PubMed ↗]