Frankincense Simply Explained

1. What Is Frankincense (Boswellia)?

Frankincense is the resin of trees of the genus Boswellia. These trees belong to the family Burseraceae. The resin has long been used as incense. In Ayurvedic and traditional medicine of India and the Middle East, it is a common remedy. In studies, an extract from the resin is usually tested. This extract is standardized to its content of boswellic acids.

2. Where Is It Found, and What Is It Made From?

Frankincense comes in various forms: resin in pieces, powder, extract with a stated content of boswellic acids, capsules or tablets, ointments and oils for external use, as well as essential oil. The resin is obtained by cutting into the bark of the trees. The exuding sap hardens in the air into resin lumps. The trees grow in dry regions of India, Africa and the Arabian Peninsula. Boswellia serrata comes from India, Boswellia sacra from the Arabian Peninsula. Most of the resin comes from wild populations.

3. What Does Frankincense (Boswellia) Do? What Research Shows

Joints and Musculoskeletal System

For knee osteoarthritis, several studies showed improvements in pain, stiffness and function 12671519. A questionnaire on pain, stiffness and everyday life (WOMAC) also turned out better 1519. The walking distance in six minutes increased 1923. In two studies with a sham treatment (placebo), images of the knee under Boswellia extract showed more cartilage and a wider joint space 23 or fewer bone spurs 36. A meta-analysis (combined evaluation of many studies) on dietary supplements found short-term pain relief for Boswellia 10. However, most studies are small and short; larger and longer studies are still pending.

Inflammatory Processes

In knee osteoarthritis, an inflammatory marker in the blood (CRP) decreased more under Boswellia extracts than under a sham treatment (placebo) 1523. Also after stroke and in COVID-19, inflammatory substances in the blood decreased under boswellic acids 2446. In Parkinson's disease, several inflammatory substances in the blood decreased compared with the start of the study 32. A mixture of methylsulfonylmethane and boswellic acids lowered pain and the consumption of anti-inflammatory drugs similarly to glucosamine 17. It remains open how closely the lowered inflammatory markers are related to the benefit in complaints.

Gut

A review saw evidence of efficacy in Crohn's disease, mostly from small individual studies 9. A study in which participants were assigned to a treatment by lot examined people with Crohn's disease in a quiet phase. It found no difference in how many remained in remission or how long it took until a relapse 18. In irritable bowel syndrome, participants under a Boswellia extract needed additional medication less often than under the usual treatment 28. In acute diarrhea, adults with a Boswellia extract recovered faster than with a sham treatment 35. A mixture of turmeric and frankincense, together with a special diet, relieved bloating and abdominal pain more than the diet alone 2934. The intestinal studies are mostly small.

Skin

A review reports on studies with frankincense in psoriasis and eczema 8. In second-degree burns, wounds healed under a preparation of Boswellia carteri about as quickly as under a silver sulfadiazine cream 33. A cream with boswellic acids made facial skin aged by the sun smoother and more elastic and reduced skin sebum, more than the cream without the active ingredient 4041. The skin studies are small and tested very different preparations.

Respiratory Tract

A meta-analysis of herbal asthma remedies cited a single study with boswellia as evidence of better lung function 14. In moderate COVID-19, oxygen saturation rose more with a syrup containing boswellic acids than with placebo, and the hospital stay was shorter 37. A mixture of Boswellia serrata and Aegle marmelos extract improved asthma symptoms and emotional function more than placebo 43. In a study without randomization, participants received a capsule with three plants: frankincense, turmeric and licorice. With this mixture, an inflammatory substance in the blood fell more than with a sham treatment 45. The respiratory studies tested almost only mixtures with other plants; it remains unclear how much frankincense contributes on its own.

Tolerability and Safety

Several controlled studies (with a comparison group) predominantly show no differences from placebo or comparison treatments in adverse events 1263639. In people with brain tumors undergoing radiation, some had mild gastrointestinal complaints under boswellia extract 38. Laboratory values such as blood count, serum chemistry and urine parameters also remained without abnormalities 2325273031. Tolerability was mainly investigated for extracts and capsules with resin. For essential oil and ointments, such investigations are still pending.

Other Investigations

Orally disintegrating tablets with frankincense extract made small wounds in the mouth (aphthae) shrink faster and relieved their pain more than a sham treatment 42. In heavy menstrual bleeding, frankincense oleoresin in addition to ibuprofen improved quality of life more than placebo 20. A mixture of Boswellia and turmeric extract relieved chronic low back pain more than placebo 21.

4. How Was Frankincense (Boswellia) Taken in the Studies?

In the studies, participants mostly took extracts as capsules or tablets. These extracts had a stated content of boswellic acids and mostly came from Boswellia serrata 1519. For the skin, creams with boswellic acids 404144 and a preparation of Boswellia carteri for burn wounds 33 were investigated. During a prostate biopsy, anxiety decreased under frankincense scent, but not in the placebo group; the pain was less than expected 16.

5. Is Frankincense (Boswellia) Safe? Side Effects in the Studies

Resin, extract and essential oil are not the same; each result applies only to the form tested. Preparations with other plants such as turmeric or ginger are mixtures; their result does not apply to frankincense alone. For essential oil, ointments and non-standardized resin preparations, larger studies are still pending.

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