Boswellia Serrata supplement benefit for arthritis, dosage, side effects by Ray Sahelian, M.D.
 

Boswellia is an Ayurvedic plant that contains anti-inflammatory triterpenoids called boswellic acids. Boswellic acid and its derivatives have anti-carcinogenic, anti-tumor, and blood lipid lowering activities. Dried extracts of the resin of the Boswellia serrata tree have been used since antiquity in India to treat inflammatory conditions.

Mechanism of action
Boswellia reduces inflammation. It inhibits proinflammatory 5-lipoxygenase chemicals and blocks leukotriene synthesis. By doing so, boswellia may be helpful in medical conditions involved in inflammation.

Nature's Way Boswellia Extract , 65% Boswellic Acids

Boswellia Extract is standardized to 65% boswellic acids, with the researched clinical dose used to support joint health and mobility. Boswellia extract is concentrated from the specially processed resins and gums of the Boswellia serratta tree. The benefits of this herb are due to the presence of four triterpene acids, especially Beta boswellic acid. This Boswellia extract is carefully standardized to contain at least 65% boswellic acids.



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Supplement Facts:
Glucosamine sulfate, Chondroitin sulfate, MSM, CMO complex, Boswellia serrata extract, Curcumin, Cat's claw extract, Devil's claw extract, and Sea Cucumber

Potential Benefits of Boswellia Serrata supplements

Asthma
In a double-blind, placebo-controlled trial, the use of 300 mg of boswellia serrata 3 times daily led to improvement in signs and symptoms of asthma, including a reduction in asthma attacks.

Inflammatory bowel disease
In one study of 30 patients aged 18-48 with chronic colitis, 20 were given boswellia extract 300 mg 3 times a week for 6 weeks, and the other 10 were given sulfasalazine, 1 g three times a day. Of the 20 treated with boswellia, 14 went into remission, as did 4 of the 10 treated with the drug.   Patients were studied at the Department of Medicine, Medical College Jammu, J&K, India suffered from chronic colitis characterized by vague lower abdominal pain, bleeding per rectum with diarrhea and palpable tender descending and sigmoid colon. The inflammatory process in colitis is associated with increased formation of leukotrienes causing chemotaxis, chemokinesis, synthesis of superoxide radicals and release of lysosomal enzymes by phagocytes. The key enzyme for leukotriene biosynthesis is 5-lipoxygenase. Boswellic acids were found to be inhibitors of the enzyme 5-lipoxygenase. (see research update below)

Boswellia and osteoarthritis
Boswellia serrata has been studied in combination with other herbs. An Ayurvedic herbal combination of ashwagandha, boswellia serrata , and curcumin was evaluated in a randomized, double-blind, placebo controlled, cross-over study in patients with osteoarthritis. Treatment with this formulation produced a significant drop in severity of pain.

Q. You say on your web page "Osteoarthritis -- boswellia serrata has been studied in combination with other herbs (see research update below). An Ayurvedic herbal combination of ashwagandha, boswellia serrata, and curcumin was evaluated in a randomized, double-blind, placebo controlled, cross-over study in patients with osteoarthritis. Treatment with this formulation produced a significant drop in severity of pain." Do you have a reference for the study regarding boswellia pills and osteoarthritis? I looked on Pubmed and found a study that has these herbs plus ginger, or these three herbs plus zinc. But not just these three herbs. If you could provide a reference so I can track down this study I would really appreciate it.
   A. Here is the boswellia osteoarthritis study. Phytomedicine. 2003 Jan;10(1):3-7. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial.

Q. I am currently taking prednisone for arthritis symptoms (10 mg tab 1x daily). Would it be advisable to take boswellia supplement before I finish taking the prednisone. How effective is boswellia for joint problems? I have arthritis symptoms and lupus symptoms.
   A. Research with boswellia supplements as a treatment for osteoarthritis is not extensive but early results show some benefit. As to taking a boswellia supplement with prednisone or after, that is a decision you and your doctor would need to make.

Boswellia Dosage
No guidelines have been established as to the ideal dosage of boswellia serrata. One option is to take boswellia 300 to 500 mg 2 or 3 times a day of an extract standardized to contain 30 to 40% boswellic acids. The full effect may take several weeks.

Boswellia Serrata supplement Human Research Update
Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee -- a randomized double blind placebo controlled trial.
Phytomedicine. 2003 Jan;10(1):3-7.
Osteoarthritis is a common, chronic, progressive, skeletal, degenerative disorder, which commonly affects the knee joint. Boswellia serrata tree is commonly found in India. The therapeutic value of its gum has been known. It possesses good anti-inflammatory, anti-arthritic and analgesic activity. A randomized double blind placebo controlled crossover study was conducted to assess the efficacy, safety and tolerability of Boswellia serrata extract in 30 patients of osteoarthritis of knee, 15 each receiving active drug or placebo for eight weeks. After the first intervention, washout was given and then the groups were crossed over to receive the opposite intervention for eight weeks. All patients receiving boswellia reported decrease in knee pain, increased knee flexion and increased walking distance. The frequency of swelling in the knee joint was decreased. Radiologically there was no change. The observed differences between drug treated and placebo being statistically significant, are clinically relevant. Boswellia serrata extract was well tolerated by the subjects except for minor gastrointestinal symptoms. Boswellia serrata extract is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis.

Effects of gum resin of Boswellia serrata in patients with chronic colitis.
Planta Med. 2001 Jul;67(5):391-5.
Patients studied here suffered from chronic colitis characterized by vague lower abdominal pain, bleeding per rectum with diarrhoea and palpable tender descending and sigmoid colon. The inflammatory process in colitis is associated with increased formation of leukotrienes causing chemotaxis, chemokinesis, synthesis of superoxide radicals and release of lysosomal enzymes by phagocytes. The key enzyme for leukotriene biosynthesis is 5-lipoxygenase. Boswellic acids were found to be non-redox, non-competitive specific inhibitors of the enzyme 5-lipoxygenase. We studied the gum resin of Boswellia serrata for the treatment of this disease. Thirty patients, 17 males and 13 females in the age range of 18 to 48 years with chronic colitis were included in this study. Twenty patients were given a preparation of the gum resin of Boswellia serrata (900 mg daily divided in three doses for 6 weeks) and ten patients were given sulfasalazine (3 gm daily divided in three doses for 6 weeks) and served as controls. Out of 20 patients treated with Boswellia gum resin 18 patients showed an improvement in one or more of the parameters: including stool properties, histopathology as well as scanning electron microscopy, besides haemoglobin, serum iron, calcium, phosphorus, proteins, total leukocytes and eosinophils. In the control group 6 out of 10 patients showed similar results with the same parameters. Out of 20 patients treated with Boswellia gum resin 14 went into remission while in case of sulfasalazine remission rate was 4 out of 10. In conclusion, this study shows that a gum resin preparation from Boswellia serrata could be effective in the treatment of chronic colitis with minimal side effects.

Therapy of active Crohn disease with Boswellia serrata extract H 15]
Z Gastroenterol. 2001 Jan;39(1):11-7.
The purpose of this clinical trial was to compare efficacy and safety of the Boswellia serrata extract H15 with mesalazine for the treatment of active Crohn's disease. Randomised, double-blind, verum-controlled, parallel group comparison for which 102 Patients were randomised. The population included 44 patients treated with Boswellia and 39 patients treated with mesalazine. As primary outcome measure the change of the Crohn Disease Activity Index (CDAI) between the status of enrolment and end of therapy was chosen. Boswellia was tested on non-inferiority compared to standard treatment with mesalazine. The CDAI between the status of enrolment and end of therapy after treatment with Boswellia was reduced by 90 and after therapy with mesalazine by 53 scores. The difference between both treatments could not be proven to be statistically significant in favor to Boswellia for the primary outcome measure. The secondary efficacy endpoints confirm the assessment of the comparison of Boswellia and mesalazine. The proven tolerability of Boswellia completes the results of the shown clinical efficacy. The study confirms that therapy with Boswellia is not inferior to mesalazine. This can be interpreted as evidence for the efficacy of Boswellia according to the state of art in the treatment of active Crohn's disease with Boswellia serrata extract, since the efficacy of mesalazine for this indication has been approved by the health authorities. Considering both safety and efficacy of Boswellia serrata extract H15 it appears to be superior over mesalazine in terms of a benefit-risk-evaluation.

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 Nov 17;3(11):511-4.
The gum resin of Boswellia serrata, known in Indian Ayurvedic system of medicine as Salai guggal, contains boswellic acids, which have been shown to inhibit leukotriene biosynthesis. In a double-blind, placebo-controlled study forty patients, 23 males and 17 females in the age range of 18 - 75 years having mean duration of illness, bronchial asthma, of 9.58 +/- 6.07 years were treated with a preparation of Boswellia gum resin of 300 mg thrice daily for a period of 6 weeks. 70% of patients showed improvement of disease as evident by disappearance of physical symptoms and signs such as dyspnoea, rhonchi, number of attacks, increase in FEV subset1, FVC as well as decrease in eosinophilic count and ESR. In the control group of 40 patients 16 males and 24 females in the age range of 14-58 years were treated with lactose 300 mg thrice daily for 6 weeks. Only 27% of patients in the control group showed improvement. The data show a definite role of gum resin of Boswellia serrata in the treatment of bronchial asthma.  boswellia curcumin

Allergic contact dermatitis from Boswellia serrata extract in a naturopathic cream.
Contact Dermatitis. 2004 Aug;51(2):91-2. Department of Dermatology, Hospital de Cruces, Bilbao, Spain.

Animal Research
Dietary support with Boswellia resin in canine inflammatory joint and spinal disease.
Schweiz Arch Tierheilkd. 2004 Feb;146(2):71-9.
An open multi-centre veterinary clinical trial, comparing conditions before and after treatment with a herbal dietary supplement consisting of a natural resin extract of Boswellia serrata, was conducted by 10 practicing veterinarians in Switzerland. This traditional plant-based supplement is known for its anti-rheumatic and anti-inflammatory properties. 29 dogs with manifestations of chronic joint and spinal disease were enrolled. Osteoarthritis and degenerative conditions were confirmed radiologically in 25 of 29 cases. The Boswellia resin extract (BSB108, product of Bogar AG) was administered with the regular food at a dose of 400 mg/10 kg body weight once daily for 6 weeks. Already after two weeks of treatment, an overall efficacy of Boswellia  was evident in 71% of 24 eligible dogs. A statistically significant reduction of severity and resolution of typical clinical signs in individual animals, such as intermittent lameness, local pain and stiff gait, were reported after 6 weeks. Because quality and stability of the boswellia resin extract were ensured, these data suggest that a standardized preparation can be recommended as a herbal dietary supplement providing symptomatic support in canine osteoarthritic disease.

Laboratory Research
Pharmacokinetic study of 11-Keto beta-Boswellic acid.
Phytomedicine. 2004 Feb;11(2-3):255-60.
Boswellia serrata has been used in traditional medicine for treatment of inflammatory diseases since antiquity. However human kinetic studies are lacking for this. Twelve healthy adult men volunteers were given capsule Wok Vel containing 333 mg of Boswellia Serrata Extract, orally, after a seven days washout period. Elimination half life of nearly six hours suggests that the drug needs to be given orally at the interval of six hours. The plasma concentration will attain the steady state after approximately 30 hours. Boswellia serrata is a safe drug and well tolerated on oral administration. No adverse effects were seen with this drug when administered as single dose in 333 mg.

Immunomodulatory activity of boswellic acids of Boswellia serrata Roxb.
Indian J Exp Biol. 2003 Dec;41(12):1460-2.
Extract of gum resin of B. serrata containing 60% acetyl 11-keto beta boswellic acid (AKBA) along with other constituents such as 11-keto beta-boswellic acid (KBA), acetyl beta-boswellic acid and beta-boswellic acid has been evaluated for antianaphylactic and mast cell stabilizing activity using passive paw anaphylaxis and compound 48/80 induced degranulation of mast cell methods. The extract inhibited the passive paw anaphylaxis reaction in rats in dose-dependant manner (20, 40 and 80 mg/kg, po). However, the standard dexamethasone revealed maximum inhibition of edema as compared to the boswellia extract. A significant inhibition in the compound 48/80 induced degranulation of mast cells in dose-dependant manner (20, 40 and 80 mg/kg, po) was observed thus showing mast cell stabilizing activity. The standard disodium cromoglycate was found to demonstrate maximum per cent protection against degranulation as compared to the boswellia extract containing 60% AKBA. The results suggest promising anti-anaphylactic and mast cell stabilizing activity of the boswellia extract.

Cytostatic and apoptosis-inducing activity of boswellic acids toward malignant cell lines in vitro.
Anticancer Res. 2002 Sep-Oct;22(5):2853-62.
Boswellic acids from frankincense were indentified as the active compounds which inhibit leukotriene biosynthesis, 5-lipoxygenase and exert antiproliferative activity toward a variety of malignant cells. Because of the relevance for the clinical application, we tested the ethanolic extract of Boswellia serrata gum resin containing a defined amount of boswellic acids for its cytotoxic, cytostatic and apoptotic activity on five leukemia and two brain tumor  cell lines. The Boswellia serrata extract induced dose-dependent antiproliferative effects on all human malignant cells tested. The results of this study suggest the effectiveness of Boswellia serrata extract with defined content of boswellic acids.

Inhibitory activity of boswellic acids from Boswellia serrata against human leukemia HL-60 cells in culture.
Planta Med. 1998 May;64(4):328-31.
Four major triterpene acids including beta-boswellic acid were isolated from the gum resin of Boswellia serrata and examined for their in vitro antitumor activity. They inhibited the synthesis of DNA, RNA and protein in human leukemia HL-60 cells in a dose dependent manner.

Boswellia serrata extract emails
Q. I have read that boswellis supplement should be taken for no more than 8-12 weeks. Do you agree? I've started taking it recently for tendonitis at my bottom left knee. It helps reduce inflammation from IBS and upper respiratory problems I encounter.
   A. We have not come across long term human trials with boswellia to know its long term safety and how often breaks are needed. Plus, each person has a different medical condition, and the length of boswellia use could depend on the dosage used, and how potent a boswellia extract is being taken, and also what other medicines or herbs are being used at the same time.

Q. I was wondering if you have heard of dogs being given boswellia and Metacam. I give her Metacam in the evenings, and I was wondering if Boswellia could be given in the morning, as an adjunct for arthritis. Any anectodal information would be helpful and appreciated.
   A. I am not familiar with treating dogs with medicines or herbs, but we have had some owners say that their dog's arthritis seemed to improve with Joint Power Rx, although we don't have first had knowledge of this. Joint Power Rx has boswellia.

Q. What data is there regarding reaction(s) between Boswellia pills and Atacand (for HBP), Zetia, Wellbutrin, Celexa and Tylenol?
   A. Boswellia pills have not been studied in relation to these drugs, so little is known about interactions.

Q.  Is there anything definitive in the literature about the effects of boswellia on blood sugar? Is it safe for diabetics? I've read conflicting reports: boswellia can raise blood sugar; or can lower blood sugar.
   A. I can only find one rodent study regarding the influence of boswellia in reducing blood sugar and this was boswellia glabra rather than boswellia serrata. What happens in rodents may not necessarily happen in humans since the dosages that are used per body weight can be quite different.

Hypoglycemic and other related effects of Boswellia glabra in alloxan-induced diabetic rats.
Indian J Physiol Pharmacol. 2007 Jan-Mar. Kavitha JV, Rosario JF, Chandran J, Anbu P, Bakkiyanathan. LN College of Pharmacy, Bhopal.
The hypoglycemic effect of the aqueous extract of the leaves and roots of Boswellia glabra was examined using alloxan-induced diabetic rats. A single oral administration of Boswellia glabra leaf and root extract decreased the blood glucose level. The continued use of leaf and root extract for 28 days produced significant hypoglycemic effects; also there was a decrease in serum glucose, cholesterol, triglyceride, urea and creatinine levels and enzyme activities (alkaline phosphatase and glucose-6-phosphatase). Ultra structural studies of beta cell of alloxan-induced diabetic rats treated with root extract showed numerous granulated sacs in comparison to rats treated with leaf extract. Thus, rats treated with root extract showed less degranulated sacs and more number of filled secretory granules in comparison to diabetic rats. Thus the use of aqueous extract of Boswellia glabra increased the synthesis of secretory granules in the beta-cell.