• CAM-summaries
  • Alternative medical systems
  • Biologically-based practices
    • Boswellia
      • What is Boswellia?
      • How well does Boswellia work?
      • Is Boswellia safe?
      • Boswellia conclusions
    • Cannabinoids
    • Essiac
    • Galavit
    • Laetrile
    • Shark cartilage
    • Ukrain
    • Black cohosh
  • Diet & nutrition
  • Energy medicine
  • Manipulative & body-based practices
  • Mind-body medicine
• CAM systematic reviews
• CAM and the law
• Prevalence of CAM use

What is Boswellia?

Boswellia subspecies are branching trees (family: Burseraceae) found in India, Northern Africa and the Middle East (ref 1, 2). Frankincense is the hardened gum resin extruded from incisions in the trunk of several Boswellia species, including Boswellia carterii (African frankincense) and Boswellia serrata (Indian frankincense). The gummy oleo-resin is also known as olibanum (Boswellia carterii) and Salai Guggal (Boswellia serrata) (ref 3).
Medicinal dry extracts from the gummy resin are traded under names such as "H15 Ayurmedica" or "Olibanum" and referred to as "Boswellia extracts" throughout this summary. These products are sold as capsules or tablets for oral administration, usually with a content around 400 mg of Boswellia extract.

Boswellia resin is a multicomponent mixture and contains more than 200 different substances (ref 4), for instance: resin, long-chain sugar compounds, essential oils, proteins, and inorganic compounds (ref 5). Boswellic acids (BAs) have been identified as the putative active principle of the gum resin. BAs are pentacyclic triterpenes with different functional groups in position 3 and 11 of their carbon rings. The most important BAs are:

• α-Boswellic acid
• ß -Boswellic acid
• Acetyl-ß-Boswellic acid
• Acetyl-α-Boswellic acid
• 11-Keto-ß-Boswellic acid (KBA)
• Acetyl-11-ß-beta-Boswellic acid (AKBA).

Boswellia preparations vary naturally in terms of their content of the different Boswellic acids. Medicinal dry extracts are manufactured following standardised procedures to minimise sources of variation within the production process (ref 1). However, even in standardised phytopharmacons a natural variation occurs in both the already known pharmacologically active BAs and others so far not specified components with yet to be investigated effects.

So far, two studies have investigated the basic pharmacokinetics of Boswellia extracts in healthy male volunteers. Findings indicated a possible initial fast gastric resorption, followed by intestinal resorption (ref 6) depending on concomitant food intake (ref 7). Gastrointestinal resorption of BAs was increased when taken with a high-fat meal. The concentration peak was seen after approximately 4.5 hours. Elimination half time was 6 hours in the mean. However, elimination half time varied considerably with concomitant food intake with some BAs showing a prolonged elimination half life and another showing a shortened half life when taken with a high-fat meal. BAs were found to have a high volume of distribution, which indicates pooling in another compartment, for instance, body fat, or binding to a specific biological material/carrier.

History

Boswellia preparations have been used in Indian Ayurvedic medicine for the treatment of inflammatory diseases (ref 5). It was occasionally mentioned in European medical traditions from the Middle Ages to modern times, as well (ref 8). Current research is being conducted on the anti-inflammatory properties of Boswellia extracts and their use in chronic inflammatory diseases like Morbus Crohn or asthma bronchiale.

Claims

Boswellia products sold in Europe are very reserved in describing alleged efficacy and indications of Boswellia extracts. This might be due to the fact that Boswellia products are traded as "dietary supplements" and European Union (EU) law forbids medicinal claims for dietary supplements.

Complementary medicine internet sites describe Boswellia products as inhibitors of inflammation processes, with efficacy against perifocal edema of the brain. They are recommended for the treatment of brain edema as an alternative to glucocorticoids and are claimed to improve accompanying clinical conditions like headache, pareses, dysphasia/aphasia and the overall wellbeing (ref 9). Participants of internet forums and newsgroups for cancer patients regularly allege an antitumour activity for Boswellic extracts (ref 10).

The complementary use of Boswellia extracts is exclusively linked to brain tumours and edema in brain tumour patients.

Prevalence of use

There is no data on the prevalence of use of Boswellia products in tumour or brain tumour patients

Legal issues and providers

H 15 Ayurmedica is a registered Ayurvedic medication in India (Gufic, Mumbay, India). This medication also holds a partial license for Switzerland, but is not licensed within the EU. However, it can be imported to the EU for use in individual patients under specific circumstances and for use in clinical studies. Additionally, some companies sell Boswellia extracts as "dietary supplements" in the EU, however, the legal basis for this practice is questionable.
Licensed homeopathic remedies of Boswellia extracts are produced in varying potencies. Due to their minimal content of the original plant extract, they are not applicable for phytopharmaceutical use as evaluated in this summary.

Cost(s) and expenditures

Costs for Boswellia extracts amount to between 80-120 € per month (depending on the daily dose) when ordered via the internet (plus shipping).

References

1. Ennet D, Poetsch F, Schopka D: Indischer Weihrauch. Pharmazeutische Bewertung der Harzdroge und ihrer Zubereitungen. Deutsche Apotheker Zeitung 2000;140:1887-95.

2. http://www.naturaldatabase.com (accessed 13.06.2005)

3. Buvari PG: Wirksamkeit und Unbedenklichkeit der H15 Ayurmedica-Therapie bei chronisch-entzündlichen Erkrankungen. Med. Diss., Universität Heidelberg 2001.

4. Kreck C, Saller R: [Herbal drugs of foreign cultures and medical systems exemplified by Indian incense. Considerations regarding social and insurance medicine expert assessment]
Phytopharmaka fremder Kulturkreise beziehungsweise Medizinsysteme am Beispiel des indischen Weihrauchs. Überlegungen zur sozial- und versicherungsmedizinischen Begutachtung. Versicherungsmedizin 1999;51:122-7.

5. Ammon HPT: [Boswellic acids (components of frankincense) as the active principle in treatment of chronic inflammatory diseases] Boswelliasäuren (Inhaltsstoffe des Weihrauchs) als wirksame Prinzipien zur Behandlung chronisch entzündlicher Erkrankungen. Wien Med Wochenschr 2002;152:373-8.

6. Sharma S, Thawani V, Hingorani L, Shrivastava M, Bhate VR, Khiyani R: Pharmacokinetic study of 11-Keto Boswellic acid. Phytomedicine 2004;11:255-60.

7. Sterk V, Büchele B, Simmet T: Effect of food intake on the bioavailability of Boswellic acids from a herbal preparation in healthy volunteers. Planta Med 2004;70:1155-60.

8. Schrott E: Weihrauch. Mosaik, München 1998.

9. http://www.naturaldatabase.com (accessed 13.06.2005)

10. http://www.krebs-kompass.org (accessed 13.06.2005)