Indian Frankincense

Synonym(s): boswellia serrata, boswellic acid

Nutrient group: plant extracts & active ingredients

Sources and physiological effects

Dietary sources
The frankincense tree belongs to the balsamic shrub family and is comprised of various species. Indian frankincense (Boswellia serrata) is traditionally used in Indian ayurvedic medicine and is also listed in the European pharmacopoeia. The resin obtained by notching the trunk contains a broad spectrum of active substances, such as terpene alcohols and tetracyclic and pentacyclic triterpenes. The main active ingredients are boswellic acids, which belong to the latter group.
Physiological effects
Inflammation	Inhibition of leukotriene B activity, deactivation of proinflammatory TH1 cytokines and mediators such as IFNgamma and IL-12, deactivation of proinflammatory TH1 cytokines and mediators such as IFNgamma and IL-12.

Detailed information

Frankincense components

The resin of the Indian frankincense tree (Boswellia serrata) is characterized by a high content of essential oil. It contains boswellic acids, triterpene acids and terpene alcohols, which are used for pain therapy and rheumatic diseases due to their antiphlogistic, corticomimetic and immunomodulating effects. Especially in cases of inflammatory rheumatism, inflammatory degenerative diseases and intermittent joint inflammations frankincense has proven itself useful due to its pharmacologically active ingredients.

Anti-inflammatory and antiphlogistic effects

Frankincense is thought to suppress inflammatory cytokines such as leukotrienes¹ and inhibit COX-1 formation.² Studies suggest that the anti-inflammatory effects occur through the targeted deactivation of proinflammatory TH1 cytokines and mediators such as IFNgamma and IL-12.³

Frankincense and rheumatic diseases

Several clinical studies have demonstrated the efficacy of frankincense in the treatment of patients with chronic and rheumatoid arthritis.⁴ In patients with osteoarthritis of the knee, boswellia extracts significantly reduced pain and clinical parameters after 7 days⁵ and improved mobility.⁶The combination of Boswellia serrata and native collagen (type II) significantly reduced pain, stiffness and improved physical function in a study of 40 patients with knee osteoarthritis.⁷

Inflammatory diseases of the gastrointestinal tract

Frankincense also shows promising therapeutic results in other inflammatory processes. Clinical studies for the successful use in chronic colitis, ulcerative colitis and Crohn's disease are available. However, phytotherapeutics are only an an adjuvant treatment for these chronic inflammatory bowel diseases, since their etiology is likely in the automatic and autoimmune pathological area.⁸ Boswellic acids have a direct anti-inflammatory effect on the affected cells, which may be due to induced inhibition of leukotriene B activity.⁹

Frankincense in asthma treatment

In a German double-blind and placebo-controlled study, supplementation with 3 x 300 mg of frankincenses per day for 6 weeks was able to greatly improve clinical symptomes in 70%.¹⁰ However, follow-up studies are needed.

Systematic analysis of clinical frankincense studies

The systematic evaluation of 47 studies (1998-2008), including several randomized and placebo-controlled studies, shows that frankincense is an effective phytotherapeutic for the treatment of osteoarthritis, rheumatoid arthritis, Crohn's disease, ulcerative colitis and asthma. Most studies use between 600 mg and 3000 mg frankincense per day. Frankincense is well tolerated and has no known interactions with drugs.¹¹

Indications

Effect	Indication	Dosage
Physiological effects at a low intake	Complementary therapy for inflammatory diseases of rheumatic forms such as osteoarthritis, rheumatoid arthritis	1000 – 4000 mg/d
	Complementary treatment for muscle pain, spinal pain, stiffness of joints or muscles, swollen joints	1000 – 4000 mg/d
	For inflammations of the tendons, tendon sheaths and bursae	1000 – 4000 mg/d
	Adjuvant therapy for inflammatory diseases such as Crohn's disease or chronic colitis	1000 – 4000 mg/d
	As adjuvant therapy in asthma treatment	1000 – 4000 mg/d

Administration

General mode of administration
When	Incense should be taken with meals.
Side effects
No side effects are known to date.
Contraindications
Pregnancy and lactation (as no scientific evidence is available)

Interactions

Drug interactions
None	No interactions are known to date.
Nutrient interactions
None	No interactions are known to date.

References

¹ Ammon, H. P. 2016. Boswellic Acids and Their Role in Chronic Inflammatory Diseases. Adv Exp Med Biol. 928:291–327.
²Siemoneit, U. et al. 2008. Identification and functional analysis of cyclooxygenase-1 as a molecular target of boswellic acids. Biochem Pharmacol. 75(2):503-13. doi: 10.1016/j.bcp.2007.09.010.
³ Gayathri, B. et al. 2007. Pure compound from Boswellia serrata extract exhibits anti-inflammatory property in human PBMCs and mouse macrophages through inhibition of TNFα, IL-1β, NO and MAP kinases. Int Immunopharmacol. 7(4):473-82. doi: 10.1016/j.intimp.2006.12.003.
⁴ Etzel, R. 1996. Special extract of Boswellia serrata in the treatment of rheumatiod arthritis. Phytomedizin. 3:91-94.
⁵ Sengupta, K. et al. 2008. 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. 10(4):R85. doi: 10.1186/ar2461.
⁶Kimmatkar, N. et al. 2003. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee. Phytomedizin. 10(1):3-7.
⁷Jain, A. V., Jain, K. A., Vijayaraghavan, N. 2021. AflaB2® and osteoarthritis: a multicentric, observational, postmarketing surveillance study in Indian patients suffering from knee osteoarthritis. Int J Res Orthop. 7(1):110-115.
⁸ Wagner, H., Wiesenauer, M. Phytotherapie: Phytopharmaka und pflanzliche Homöopathika, 2. Auflage. Stuttgart: Wissenschaftliche Verlagsgesellschaft Stuttgart, 2003.
⁹ Anthoni, C. et al. 2006. Mechanism underlying the anti-inflammatory actions of boswellia acid derivates in experimental colitis. Am J Physiol gastrointest Liver Physiol. 290(6):G1131-7.
¹⁰ Gupta, I. et al. 1998. 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. 3(11):511-4.
¹¹ Ernst, E. 2008. Frankincense: systematic review. BMJ. 337:a2813. doi: 10.1136/bmj.a2813.

References Interactions:
¹ Stargrove, M. B. et al. Herb, Nutrient and Drug Interactions: Clinical Implications and Therapeutic Strategies, 1. Auflage. St. Louis, Missouri: Elsevier Health Sciences, 2008.
² Gröber, U. Mikronährstoffe: Metabolic Tuning –Prävention –Therapie, 3. Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2011.
³Gröber, U. Arzneimittel und Mikronährstoffe: Medikationsorientierte Supplementierung, 3. aktualisierte und erweiterte Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2014.