Boswellia Serrata: Natural Remedy for Joint Pain

Today we will talk about Boswellia Serrata, a plant traditionally used for its anti-inflammatory properties, an excellent resource to reduce joint ailments

What is Boswellia Serrata

Boswellia serrata, Olibano or Indian incense tree is a tree of oriental origin, native to the country of India, which is characterised by its interesting health properties thanks to its content of boswellic acids.

Figure I. Trees of the Boswellia plant with their respective resins and methanol extracts (a); main acids (b).

What is Boswellic Acid?

Boswellic acids are pentacyclic triterpenes naturally produced by Boswellia trees, which have shown positive effects in the prevention and treatment of numerous diseases.

Although there are more than 25 species of the genus Boswellia, the resin produced by the species B. Serrata is one that appears to have a steer density and variety of boswellic acids in its composition.

There are many types of boswellic acids with different triterpene configurations, but of all of them highlight the presence and known effects of two:

1. The 11-keto-β-boswellic acid (KBA)
2. The 3-O-acetil-11-keto-β-Boswellic acid (AKBA)

How does the Boswellia Serrata work?

Boswellia serrata is characterized by a marked anti-inflammatory profile, which has been researched for its potential to treat illnesses such as arthritis rheumatoid, neuroinflammation and neurodegeneration, asthma, atherosclerosis, inflammatory bowel, liver, kidney, pulmonary, cardiac…

The theoretical potential is incredible.

The mechanisms of action known and appearing to be more relevant by boswellic acids appear to be:

These mechanisms have been observed in in vitro models and we do not know the true relevance of them, however, the main target of action seems to be:

Figure II. Leukotriene biosynthesis path and stage of the inhibition process by the AKBA.

This inhibition would block the synthesis of leukotriene, molecules strongly associated with the development of chronic inflammatory processes that can negatively affect health.

In fact, this mechanism has been linked to the subsequent blocking of the activation of inflammatory factors such as ICAM, TNF-a and IL-1b, which increase the expression of matrix metalloproteinase (MMPs), enzymes vacuolated to the progression of osteoarthritis by the degradation of the protein structures of the cartilage, and the cartilage matrix of the joints.

Figure III. Different pharmacological action targets to mitigate the degradation of joint cartilage. The AKBA acts where it says “5-LOX”.

This is why research on the effects of the use of Boswellia Serrata has focused especially on these effects on joints.

Nothing more? No!

Boswellic acid impact a large number of molecular targets that modulate myriad metabolic transcription paths.

Figure IV. Molecular action targets of boswellic acids .

But the effects of their actions on these targets are unknown or we do not know what their actual clinical magnitude is in human models.

Boswellia serrata has shown potential to cope with a myriad of diseases, including various types of cancer.

Figure V. Possible pathological conditions that are positively influenced by the use of Boswellia serrata extracts.

Unfortunately, in many cases, the effects observed in vitro are not extrapolable to humans, as they are one of the first steps of the process of validation of the effectiveness of a compound.

Figure VI. Hierarchy of scientific evidence.

What We Know in Humans

For now, what we know with some precision is the beneficial effect of Boswellia serrata (its boswellic acids, mainly AKBA) on the improvement of the structure and the joint function in pathological inflammation pictures.

That is, it is a promising food supplement for joint inflammation control.

We can see how trials like Majeed et al. (2019) demonstrate improvements in the structure of articular, especially the knees, where applying X-ray imaging techniques a decrease in joint calcification and a noticeable restoration of the space of the bone intersection by regeneration of the joint cartilage can be observed.

Figure VII. Changes in after 4 months of use of Boswellia serrata extract in two patients with osteoarthritis in the knee.

This is consistent with what is observed by Liu et al. (2017) in its systematic review with meta-analysis on the most useful non-pharmacological compounds for the management of osteoarthritis:

Figure VIII. Effects of the use of different non-pharmacological therapies on joint pain, to the left indicates positive effects. Highlighted is Boswellia serrata extract.

Extract of Boswellia serrata stands out when assessing the decrease in joint pain here:

Figure IX. Effects of the use of different non-pharmacological therapies on physical function, to the left indicates positive effects. Highlighted is Boswellia serrata extract.

Along with improving motor function, it can increase the ROM without pain and increase the mechanical stress tolerated by the joint.

As can be seen, only 3 human RCTs studies were included in the meta-analysis, as Boswellia serrata is still a potential phytotherapeutic treatment which has seen an uptake in interest very recently.

The mechanisms it exhibits are very promising in the management of joint inflammation, for now the evidence in humans is not left behind when it comes to demonstrating the effects proposed in mechanistic trials.

Figure X. Anti-inflammatory mechanisms of action of boswellic acids contained in Boswellia serrata extract that exhibit positive effects on joint protection.

Anything to keep in mind with Boswellia Serrata?

Extract of the report by Liu et al. (2018):

Regarding precautions or potential damage

Regarding interactions

Bibliographic references

1. Bertocchi, M., Isani, G., Medici, F., Andreani, G., Usca, I. T., Roncada, P., … Bernardini, C. (2018). Anti-inflammatory activity of Boswellia serrata extracts: An in vitro study on porcine aortic endothelial cells. Oxidative Medicine and Cellular Longevity, 2018, 2504305.
2. Liu, X., Eyles, J., McLachlan, A. J., & Mobasheri, A. (2018). Which supplements can I recommend to my osteoarthritis patients? Rheumatology (United Kingdom), 57(suppl_4), iv75–iv87.
3. Liu, X., Machado, G. C., Eyles, J. P., Ravi, V., & Hunter, D. J. (2018). Dietary supplements for treating osteoarthritis: A systematic review and meta-Analysis. British Journal of Sports Medicine, 52(3), 167–175.
4. Majeed, M., Majeed, S., Narayanan, N. K., & Nagabhushanam, K. (2019). A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytotherapy Research, 33(5), 1457–1468.
5. Merolla, G., & Cerciello, S. (2017). Conservative and Postoperative Coanalgesic Therapy for Upper Limb Tendinopathy Using Dietary Supplements. In R. R. Watson & S. B. T.-N. M. of P. in the A. P. Zibadi (Eds.), Nutritional Modulators of Pain in the Aging Population (pp. 235–243).
6. Roy, N. K., Parama, D., Banik, K., Bordoloi, D., Devi, A. K., Thakur, K. K., … Kunnumakkara, A. B. (2019). An update on pharmacological potential of boswellic acids against chronic diseases. International Journal of Molecular Sciences, 20(17).

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