What does the research show about boswellia?

Boswellia

Three meta-analyses report less knee osteoarthritis pain and stiffness and better function than placebo, from small, low-quality trials. A Crohn's disease trial was stopped early with no difference from placebo. Single small trials report remission in collagenous colitis and less brain swelling during radiotherapy. Adverse events matched placebo, and one case report describes seizure with low sodium.

Add to Bio HackChecked 2026-11-09

Status: Dietary supplement in the US. Not approved by the FDA as a drug for any use.
Also called: Boswellia serrata, Indian frankincense, frankincense extract, salai guggul, boswellic acids, AKBA, 5-Loxin, Aflapin, Casperome, Boswelan
Taken for: joint pain, osteoarthritis, inflammation, gut inflammation, Crohn's disease, colitis, asthma, recovery

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help3

StrongShown to lower knee osteoarthritis pain and stiffness and improve function against control in adults, in mostly small, low-quality trials.
LimitedOne pilot trial found 4,200 mg a day cut brain swelling by more than 75% in 60% of patients against 26% on placebo during radiotherapy.
LimitedOne trial found a boswellic acid syrup lowered several inflammation markers more than placebo in mild to moderate COVID-19.

Reported risks1

LimitedCase reports: a woman who raised her dose to 1,000 mg a day had a seizure with low sodium after 3 weeks, which resolved after stopping.How often is not known

What people take it for, and what was found

Shown to help3

Strong

Knee osteoarthritis pain and function

Shown to lower knee osteoarthritis pain and stiffness and improve function against control in adults, in mostly small, low-quality trials.

The numbers and sources

Effect: In 7 trials (545 patients), boswellia lowered VAS pain (WMD -8.33, 95% CI -11.19 to -5.46) and WOMAC pain (WMD -14.22), stiffness (WMD -10.04) and function scores (WMD -10.75) against control [1]. A meta-analysis of 11 RCTs (1,009 patients) of curcuminoids and boswellia found both improved pain and function more than placebo [2]. A 2026 network meta-analysis of 20 RCTs (1,633 participants) found modified boswellia formulations improved WOMAC pain, stiffness and function [3].
Population: Adults with knee osteoarthritis, mostly mild to moderate [1][2][3].
Sources: [1], [2], [3]
Caveats: Study quality was low overall, and most trials had fewer than 100 participants. No RCT compared boswellia with approved NSAIDs [2]. The abstracts do not report trial funding.

Limited

Brain swelling during radiotherapy

One pilot trial found 4,200 mg a day cut brain swelling by more than 75% in 60% of patients against 26% on placebo during radiotherapy.

The numbers and sources

Effect: In 44 patients irradiated for brain tumors, 4,200 mg a day cut cerebral edema by more than 75% in 60% of patients against 26% on placebo (p 0.023). Dexamethasone dose, quality of life and cognition did not differ [6].
Population: 44 patients with primary or secondary brain tumors [6].
Sources: [6]
Caveats: A pilot trial. The authors note the edema result may reflect an additional antitumor effect [6].

Limited

Inflammation markers

One trial found a boswellic acid syrup lowered several inflammation markers more than placebo in mild to moderate COVID-19.

The numbers and sources

Effect: In patients with mild to moderate COVID-19, a boswellic acid syrup (Inflawell) for 14 days lowered serum IL-1α, IL-8, TNF-α and MCP-1 more than placebo. The abstract reports p values only, not the size of the changes [7].
Population: Patients with mild to moderate COVID-19. The abstract does not give the number randomized [7].
Sources: [7]
Caveats: One trial of one product during an acute infection. Blood markers, not symptoms or disease outcomes [7].

Mixed results1

Limited

Collagenous colitis

One very small trial in collagenous colitis found more remission than placebo per protocol, 63.6% against 26.7%, but not by intention to treat.

The numbers and sources

Effect: In 31 patients with chronic diarrhea from collagenous colitis, 400 mg three times a day for 6 weeks led to remission in 63.6% against 26.7% on placebo per protocol (p 0.04). By intention to treat, it was 43.8% against 26.7% (p 0.25). Histology and quality of life did not differ [5].
Population: 31 randomized, 26 analyzed per protocol [5].
Sources: [5]
Caveats: Very small. The intention-to-treat result was not significant [5].

Not shown to help1

Limited

Crohn's disease remission

One trial found boswellia did not keep more people with Crohn's disease in remission than placebo over 52 weeks, 59.9% against 55.3%.

The numbers and sources

Effect: In 82 patients with Crohn's disease in remission, a boswellia extract at 6 × 400 mg a day for up to 52 weeks kept 59.9% in remission against 55.3% on placebo (p 0.85). Time to relapse was 171 days against 185. Disease activity and inflammation markers did not differ [4].
Population: 82 randomized outpatients at 22 German centers, 66 analyzed [4].
Sources: [4]
Caveats: The trial was stopped early because the drug and placebo did not separate [4].

Doses studied

Osteoarthritis effects were reported with treatment of at least 4 weeks [1]. The Crohn's trial gave 2,400 mg a day (6 × 400 mg) [4], the colitis trial 1,200 mg a day (400 mg three times) [5], and the brain tumor trial 4,200 mg a day [6].

Risks

Reported risks1

LimitedHow often is not known

Low sodium and seizure at high dose

Case reports: a woman who raised her dose to 1,000 mg a day had a seizure with low sodium after 3 weeks, which resolved after stopping.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: A 38-year-old woman who raised her Boswellia serrata dose from 200 mg to 1,000 mg a day was admitted to intensive care after 3 weeks with a first generalized seizure. She had syndrome of inappropriate antidiuretic hormone secretion with low sodium and rhabdomyolysis. It resolved after treatment and stopping boswellia [9].
Population: One case report [9].
Sources: [9]
Caveats: A single case. She had a recent vaccination and existing neurological symptoms [9].

Checked, no increase found1

Moderate

Adverse events in trials

Adverse events were about as common on boswellia as on placebo in knee osteoarthritis and Crohn's trials, which were mostly small and short.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Safety outcomes did not differ from placebo across knee osteoarthritis RCTs [2], and adverse events did not differ significantly in the 2026 network meta-analysis [3]. In the 52-week Crohn's trial, no safety disadvantages against placebo were observed [4]. Six patients on 4,200 mg a day reported minor gastrointestinal discomfort, with no severe adverse events [6]. A systematic review of 7 trials noted no serious safety issues [8].
Population: Trial participants [2][3][4][6][8].
Sources: [2], [3], [4], [6], [8]
Caveats: Most trials were small and short [2].

Claims tested and not found

That boswellia keeps Crohn's disease in remission. Remission over 52 weeks did not differ from placebo [4].
That boswellia changes the colon lining in collagenous colitis. Histology did not differ from placebo after 6 weeks [5].

Sources

Yu G, Xiang W, Zhang T, et al. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complementary Medicine and Therapies. 2020. https://doi.org/10.1186/s12906-020-02985-6
Bannuru RR, Osani MC, Al-Eid F, et al. Efficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis. Seminars in Arthritis and Rheumatism. 2018. https://doi.org/10.1016/j.semarthrit.2018.03.001
Inprasit C, Bunyamahote S, Boonpattharatthiti K, et al. Evaluating the efficacy and safety of Curcuma longa, Boswellia serrata, and their mixed formulation in treating knee osteoarthritis: A systematic review and network meta-analysis. Complementary Therapies in Medicine. 2026. https://doi.org/10.1016/j.ctim.2025.103256
Holtmeier W, Zeuzem S, Preiss J, et al. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn's disease: good safety profile but lack of efficacy. Inflammatory Bowel Diseases. 2011. https://doi.org/10.1002/ibd.21345
Madisch A, Miehlke S, Eichele O, et al. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. International Journal of Colorectal Disease. 2007. https://doi.org/10.1007/s00384-007-0364-1
Kirste S, Treier M, Wehrle SJ, et al. Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors: a prospective, randomized, placebo-controlled, double-blind pilot trial. Cancer. 2011. https://doi.org/10.1002/cncr.25945
Barzin Tond S, Abolghasemi S, Khatami SH, et al. Boswellic Acids Reduce Systemic Inflammation in Patients with Moderate COVID-19 Through Modulation of NF-κB Pathway. Journal of Dietary Supplements. 2025. https://doi.org/10.1080/19390211.2025.2468484
Ernst E. Frankincense: systematic review. BMJ. 2008. https://doi.org/10.1136/bmj.a2813
Finsterer J. Boswellia serrata intoxication manifesting with syndrome of inappropriate antidiuretic hormone secretion, hyponatremia, seizure, and rhabdomyolysis. Critical Care Science. 2024. https://doi.org/10.62675/2965-2774.20240049-en

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