Ingredient review —Boswellia serrata
What is it?
Description
Boswellia serrata is a branching tree and member of the Boswellia genus native to India, Northern Africa, and the Middle East. (43) Its active ingredient, known as boswellic acid (BA), is derived from the gum resin of Boswellia plants and has been traditionally used in Ayurvedic and Unani medicines. BA targets multiple physiological signal transduction cascades providing anti-inflammatory, expectorant, anti-septic, anxiolytic, anti-neurotic, analgesic, tranquilizing, and anti-bacterial properties. (37)
Six major α and β-boswellic acids have been identified, including:
- 3-acetyl-11-keto-β-boswellic acid (AKBA)
- 11-keto-β-boswellic acid (KBA)
- α-boswellic acid (αBA)
- β-boswellic acid (βBA)
- 3-acetyl-α-boswellic acid (AαBA)
- 3-acetyl-β-boswellic acid (AβBA) (15)
Of these BAs, AKBA and KBA possess the most powerful inhibitory effects on pro-inflammatory enzymes and on the production of inflammatory cytokines, which has led to their widespread therapeutic application in chronic inflammatory conditions. (24)(37)(43)
Not be confused with:
- Frankincense (olibanum resin/oil produced by Boswellia trees including Boswellia serrata, Boswellia carteri, Boswellia frereana, and Boswellia sacra) (14)
- Guggul (resin from Commiphora wightii, Commiphora mukul, Commiphora gileadensis, Boswellia serrata, Boswellia carterii, Boswellia sacra, Boswellia ovalifoliolata, Boswellia dalzielii, Boswellia frereana, and Boswellia thurifera) (28)
Main uses
Inflammatory disorders, including: musculoskeletal, gastrointestinal, respiratory, and dermal
Formulations
Form
Standardization
Non-formulated Boswellia serrata extracts
ApresFLEX®, Aflapin®
Boswellin®
Standardized to total BAs of >50% - AKBA: 30%, KBA: 1.5%, AβBA: 3.5%, and βBA: 7.5% (30)
BSE-18
Cap Wokvel™
H15 Gufic™, Sallaki™
Phytosome®
S. Compound™
Standardized to contain AKBA: 0.7%, KBA: 0.63%, and 1.5% AβBA/βBA (1)
Dosing & administration
Asthma
General outcomes from A-level evidence
No data currently available.
Dosing & administration
300 mg (S. Compound™) three times per day to adults for 6 weeks
Outcomes
dyspnea, rhonchi, number of attacks, erythrocyte sedimentation rate, and eosinophils
FEV1, FVC, and PEFR (18)
Class of evidence
c
Dosing & administration
500 mg (Casperome®) per day to adults for 4 weeks with ICS and LABAs
Outcomes
the number of concomitant inhalations required per day within 1 week of administration
Effects continue to reduce the frequency of needed concomitant therapy with each week (12)
Class of evidence
c
Chronic colitis
General outcomes from A-level evidence
No data currently available.
Dosing & administration
350 mg three times per day to adults for 6 weeks
Outcomes
Improved one or more parameters for stool properties, histopathology and scan microscopy, or blood parameters for Hb, Fe, Ca, P, proteins, total leukocytes and eosinophils to a similar extent to sulfasalazine therapy (19)
Class of evidence
c
Collagenous colitis (microscopic colitis)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
400 mg (80% boswellic acid) three times per day to adults for 6 weeks
Outcomes
chance of clinical remission (29)
Class of evidence
c
Crohn’s disease
General outcomes from A-level evidence
No data currently available.
Dosing & administration
1200 mg (H15 Gufic™) three times per day for 8 weeks
Outcomes
Crohn Disease Activity Index to the same extent as mesalazine (17)
Class of evidence
c
Diffuse axonal injury
General outcomes from A-level evidence
No data currently available.
Dosing & administration
360 mg (60% Boswellia serrata gum resin) three times per day to adolescents or adults for 6 weeks
Outcomes
cognitive ability for self-care score
No effect disability rating scale overall (32)
Class of evidence
c
Irritable bowel syndrome
General outcomes from A-level evidence
No data currently available.
Dosing & administration
250 mg (Casperome®) per day to adults for 1-6 months
Outcomes
Class of evidence
c
Joint pain
General outcomes from A-level evidence
No data currently available.
Dosing & administration
500 mg (Casperome®) per day for 5 days to athletes with knee pain, then 250 mg per day for 23 days adjunct with acetaminophen or NSAIDs
Outcomes
Compared with standard therapy alone:
VAS-pain score, number of px with pain on effort, joint effusion, structural damage, intramuscular hematomas, biomarkers of cartilage damage and inflammation (COMP and CRP, respectively), and hyperthermic area
pain-free walking distance (13)
Class of evidence
c
Dosing & administration
150 mg (FlexiQule®) three times per day to adults with joint pain in the hand for 2 weeks during a standard rehabilitation plan
Outcomes
pain, hyperthermic areas, erythrocyte sedimentation rate and need for NSAIDs or corticosteroids to control pain
hand function more quickly and effectively than standard rehabilitation alone (7)
Class of evidence
c
Knee osteoarthritis (OA)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
50-125 mg (5-Loxin®) twice per day for 3 months to adults with knee OA
Outcomes
Class of evidence
b
Dosing & administration
50 mg (Aflapin®) twice per day for 1-3 months to adults with knee OA
Class of evidence
b
Dosing & administration
333 mg (Cap Wokvel™) three times per day for 2-6 months to adults with knee OA
Class of evidence
b
Dosing & administration
170 mg (Boswellin®) twice per day for 4 months to adults with knee OA
Outcomes
pain & stiffness scores, serum hs-CRP, osteophytes (spur), and reductions in joint space from loss of articular cartilage
physical function and QoL scores (30)
Class of evidence
c
Radiotherapy-induced dermatitis
General outcomes from A-level evidence
No data currently available.
Dosing & administration
2% Boswellia topical cream in Phytosome® (Bosexil®) applied to skin twice per day immediately after radiation therapy and before bed to adults with breast cancer
Outcomes
erythema intensity grade and the proportion of patients using topical hydrocortisone therapy (47)
Class of evidence
c
Radiotherapy-related edema
General outcomes from A-level evidence
No data currently available.
Dosing & administration
1200-1400 mg (H15) three times per day to adults with cerebral tumors during radiotherapy
Outcomes
cerebral edema and may reduce need for steroids during brain irradiation (26)
Class of evidence
c
Dosing & administration
4500 mg (Monoselect AKBA™) per day to adults with Glioblastoma multiforme during radiochemotherapy with temozolomide for a max of 34 weeks
Outcomes
proportion of reduced or stabilized edema
use of steroids to treat cerebral edema (10)
Class of evidence
c
Rheumatoid arthritis (RA)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
400-1200 mg (H15®) two or three times per day to adults for 1-6 months
Outcomes
pain and swelling, erythrocyte sedimentation rate, morning stiffness, and need for NSAIDs
general health and well-being scores (11)
Class of evidence
b
Skin aging
General outcomes from A-level evidence
No data currently available.
Type II diabetes
General outcomes from A-level evidence
No data currently available.
Dosing & administration
250-400 mg (olibanum gum resin from Boswellia serrata) twice per day to adults on metformin for 8-12 weeks
Class of evidence
b
Dosing & administration
300 mg (gum resin from Boswellia serrata) three times per day to adults on oral hypoglycemic therapy for 6 weeks
Outcomes
total cholesterol, LDL-C fructosamine, SGPT and SGOT
HDL-C (2)
Class of evidence
c
Ulcerative colitis
General outcomes from A-level evidence
No data currently available.
Dosing & administration
250 mg (Casperome®) per day to adults for 4 weeks
Outcomes
GI pain & cramp intensity and frequency, frequency of diarrhea, feces with blood or mucus, bowel movements, need for medication, and medical attention (34)
Class of evidence
c
Dosing & administration
300 mg three times per day to adults for 6 weeks
Outcomes
Improves stool properties, histopathology and scan microscopy, and blood parameters for Hb, Fe, Ca, P, proteins, total leukocytes and eosinophils to a similar extent to sulfasalazine therapy (20)
Class of evidence
c
Adverse effects
Pharmacokinetics
Absorption
- Stable plasma levels are achieved after 30 hours. (42)
- All six major BAs may be found in the plasma, however the principle acid, AKBA, is not always detectable. All of the acids show high variability. (16)
- BAs have low intestinal absorption due to BAs lipophilic properties. (41) AKBA, AαBA, and AβBA have particularly low absorption as shown in rats. (1)(4)(15)(27)
- Bioavailability can be increased when consumed with fatty food (44)(46) or in soy lecithin formulations. (22)(36) Phosphatidylcholine or phospholipid formulations may also increase bioavailability as shown in rats. (23)(41)
Distribution
Metabolism
Excretion
- BAs have a half-life of approximately six hours. (42)
References
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