Juniper, Boswellia serrata (Boswellia serrata)

Description

The Juniper or boswellia is a medium-sized tree of the birch family. It grows mainly in India, Africa and the Middle East. The compound, oddly pinnate leaves have serrated margins, to which the plant owes its species name. It produces small, white to yellowish flowers. The main product of the boswellia is resin, which is mainly known as an incense used in religious ceremonies, not only in Christian churches. It is collected from a cut on the tree trunk into special bamboo baskets (1).

History

The oldest use of frankincense resin was smoking and embalming. It was used for this purpose by the cultures of ancient India (for Hindu ceremonies), Egypt, Babylon, Persia, China, Greece and Rome, but it has also been shown to be used by the indigenous peoples of the Americas. Resin was burned by these peoples in sacrificial rituals and daily ceremonies, whether to ward off evil spirits, please the gods or honour the dead (1, 2).

In the context of phytotherapy, boswellia was widely used by Ayurveda, which is a traditional Indian system of medicine. Boswellia is mentioned in two of the three seminal works of Ayurveda that compiled the complete medical knowledge of the time – the Charaka (c. 700 BC) and the Sasruta (c. 600 BC). The physicians of the time used boswellia mainly for its anti-inflammatory effects, especially for the treatment of joint pain, but its use in dysentery, fever, shingles, cardiovascular diseases, respiratory inflammation, sore throat, irregular menstruation and liver support is also mentioned (1).

Active ingredients

Boswellia resin contains monoterpenes, diterpenes, triterpenes, tetracyclic triterpenic acids and four major pentacyclic triterpenic acids: beta-boswellic acid, acetyl-β-boswellic acid, 11-keto-β-boswellic acid and acetyl-11-keto-beta-boswellic acid. It is boswellic acids that are the most important constituents due to their potent anti-inflammatory effects (1). However, the proportion of each component and thus the quality of the incense can vary considerably. Although trees growing on dry, stony soils grow slowly and yield much less resin, the quality is higher. It is the boswellic acid content that is decisive for the therapeutic effects.

Healing effects

The traditional area of use of boswellia is mainly joint pain, whether caused by arthrosis or rheumatoid arthritis. This is mainly due to the anti-inflammatory action of this plant, specifically the boswellic acids contained in it. The principle of their action is epigenetic – these acids directly influence the activation of genes responsible for inflammatory processes through chemical reactions (gene methylation, histone acetylation, microRNA regulation) (3). However, epigenetic action and the associated anti-inflammatory effects are also responsible for positive effects in other diseases and disorders, from cancer to cardiovascular disease, asthma and skin ageing.

Osteoarthritis and arthritis

Probably the best known is the use of boswellia in the prevention and treatment of arthritis. This degenerative disease most commonly affects the large joints of the lower limbs, but can occur in any joint. It consists in the gradual disappearance of articular cartilage and, in the last stage, affects the surrounding bones, ligaments, menisci, etc. Epigenetics plays an important role in the development of arthrosis. All three major epigenetic mechanisms, i.e. gene methylation, histone acetylation and microRNA expression, are involved, and these influence, in particular, the differentiation of articular cartilage cells and the maintenance of joint homeostasis (3). In contrast, rheumatoid arthritis is an autoimmune disease in which the mechanism of inflammation plays an important role, the nature of which is also influenced by epigenetics. However, inflammation also occurs in the later stages of arthritis.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, are often used to treat inflammation (and relieve pain), but they have many side effects and are therefore not suitable for long-term use. They inhibit not only the function of the enzyme cyclooxygenase-2 (COX-2), which is involved in the production of the pro-inflammatory mediator prostaglandins, but also the enzyme COX-1, which is important, for example, for the proper function of the gastric mucosa (18). Long-term use of NSAIDs can therefore cause a number of gastrointestinal problems. Although these are usually mild, in some cases they can develop into serious problems such as ulcer disease or internal bleeding (19-21). Boswellia can relieve inflammation almost as effectively, but it is selective only for COX-2 and thus has no side effects. Its administration results in a significant reduction in the levels of inflammatory mediators, such as prostaglandins E2, and inhibition of pro-inflammatory cytokines (4).

Boswellia is effective in treating inflammation and swelling in both arthritis (14, 15) and arthritis (16). In the case of arthritis, for example, in one study, the majority of patients in the advanced stage of the disease experienced a significant reduction in pain and swelling, an increase in joint mobility, and an increase in the distance they were able to walk after eight weeks of use (14). Other research has shown a lower, but still statistically significant, reduction in symptoms and discomfort after only seven days of treatment (17)!

Boswellic acid is also effective in the treatment of pain as such, especially in the case of chronic pain that accompanies not only arthrosis and rheumatoid arthritis, but also other physical ailments (13).

Tumour diseases

Boswellic acid is one of the substances that are able to modulate gene methylation and thus suppress certain types of cancer, such as colorectal cancer. If these genes are methylated, they cannot fully develop their function, allowing cancer to develop. Boswellic acid is able to remove this methylation, thereby allowing them to function (5). It can also significantly reduce the incidence of the so-called ‘methylation’. It also reduces the risk of these polyps “degenerating” into cancer cells (25).

The combination of boswellic acid with curcumin, a dye present in turmeric, is particularly effective. Both of these substances regulate not only gene methylation, but also microRNA, which is a nucleic acid that does not encode any information but determines whether or not certain genes are expressed. As a result, both of these substances influence cell proliferation (the ability to multiply rapidly) and apoptosis (programmed cell death). In animal experiments with colorectal cancer, tumour growth was affected as early as the third day after the start of the boswellic acid/curcumin mixture. Both of these substances can also significantly increase the effectiveness of conventional treatment. In fact, up to half of colon cancer patients have a mutation in the P53 gene, which means that drugs targeting this gene do not work. But when a mixture of boswellic acid and curcumin was added, chemotherapy began to work (6, 7).

However, the list of tumour types for which boswellia may play a role is likely to be much broader. For example, it has been shown to have a significant effect in suppressing the activity of the enzyme lipoxygenase, which has an important function in the development of brain metastases and in patients suffering from breast cancer (8), and has also been confirmed to be effective in pancreatic (11) and gastric (12) cancers.

Inflammatory bowel disease

Thanks to its strong anti-inflammatory effects, boswellia is also very effective in the treatment of inflammatory bowel diseases such as ulcerative and collagenous colitis or Crohn’s disease. In these diseases, the inflammatory state is maintained by the enzyme 5-LOX, which is involved in the production of inflammatory mediators leukotrienes, and boswellia can significantly suppress the activity of 5-LOX (22-24, 48-49). Another important mechanism of action is the effect of boswellia on the so-called barrier function of the intestine, which is almost always disturbed in inflammatory bowel diseases, thus reducing the resistance of the intestine to the effects of inflammatory processes, as the possibility of pathogens and antigens crossing this barrier is reduced. (62)

A third reason why boswellia is effective in inflammatory diseases is its positive effect on the gut microbiome, which is almost always disrupted in patients with these diseases (63).

In one study, for example, 82% of the patients studied experienced a resolution of symptoms, whereas only 75% of the control group using the traditional drug sulfasalazine did (26).

Cardiovascular diseases

For many years, high cholesterol was considered the main cause of heart and blood vessel disease. In the last decade, however, a number of studies have pointed to the fact that inflammatory processes play a very important role. Thus, the fight against inflammation is becoming a key factor in cardiovascular health (27, 28).

Boswellic acid suppresses the expression of the gene responsible for the production of the pro-inflammatory cytokine TNF-alpha (28) and also inhibits the pro-inflammatory factor NF-kappa B, resulting in an incredible 50% reduction of atherosclerotic plaques (27).

In addition, chronic inflammation causes changes in platelet function, making platelets “stickier”, forming clumps on the walls of blood vessels, reducing their patency, and can cause heart attacks or strokes (29). At the same time, boswellic acid reduces this activation of platelets and reduces the clumping of platelets in blood vessels (30). It also reduces blood cholesterol levels by up to 48 % (31).

Asthma and allergies

Research has also confirmed the effectiveness of frankincense resin in asthma. It is able to inhibit the production of leukotrienes, which are substances released by white blood cells in inflammatory and allergic reactions, causing swelling, increasing mucus production and contributing to smooth muscle hypertrophy in asthma. In one study, for example, 70% of patients reported a significant reduction in a wide range of complaints after six weeks of treatment (9).

Boswellia also interferes with the activation of T-lymphocytes and dendritic cells, which are immune cells involved in the development of allergic reactions. All these mechanisms are involved not only in asthma but also in other types of allergies. In addition, Boswellia is one of the natural remedies that are very effective also in atopic eczema (50).

Brain function, memory, depression

Boswellia is used in traditional phytotherapy for memory disorders (32) and its positive effect on brain function has been confirmed by modern science. For example, it can effectively protect brain cells when damaged by stroke, again due to its anti-inflammatory action. Tissue destruction takes place not only during the stroke itself, but also in the days following the stroke, and inflammatory processes play an important role here too – if we are able to mitigate them, the consequences of the stroke are much less (33, 34). In addition, the negative changes that take place in the brain as a result of ageing are also inflammatory (35, 36).

Boswellia suppresses NF-kappaB function as well as the expression of genes responsible for the production of inflammatory mediators in brain injury (37). This phenomenon is particularly strong in the part of the brain called the hippocampus, which is the seat of our memory. Boswellic acid not only protects hippocampal cells but also promotes their growth (38-40). This incidentally refutes the persistent view that damaged brain tissue cannot regenerate.

In addition, Boswellia, by its action on the hippocampus, can also slow memory loss caused by aging (41) and even improve memory and with it the ability to learn and other brain functions (42, 43). Moreover, through the expression of v genes, it is able to induce changes in the hippocampus that can provide significant relief from depression (44).

Skin quality and ageing

Boswellic acid is also a very promising raw material for the cosmetic industry because it improves the elasticity of the skin, improves its protection from external influences and slows down the signs of skin aging. In one study, when women applied a cream containing boswellic acid to half of their face for 30 days, they experienced a noticeable softening, reduction in fine lines, improved skin elasticity and a reduction in sebum production. Moreover, this effect persisted for two months after the end of application (10).

Kidney problems

Chronic kidney diseases are usually characterized by an increased level of inflammatory processes in this organ, and therefore the use of natural anti-inflammatory substances is also useful. This is also true for boswellia. (53) In particular, the combination with curcumin has been shown to reduce inflammation in people with chronic kidney disease. (54)

Liver protection

Another organ that can benefit from the positive effects of boswellia is the liver. For example, it promotes the protection and regeneration of liver tissue and counteracts liver fibrosis, including fibrosis caused by toxic chemicals such as carbon tetrachloride or thioacetamide (58, 59).

Diabetes

Boswellia can be very useful in diabetes. For example, in one study, patients with type II diabetes experienced a significant reduction in blood sugar, glycated haemoglobin and triglycerides after just eight weeks of taking 250 g per day. (55)

So far, only animal studies suggest that boswellia might be effective in type I diabetes, an inflammatory autoimmune disease affecting the pancreas. When given to mice with this problem, it not only reduced the overall level of inflammation, but also reduced the penetration of lymphocytes, a type of immune cell, into the islets of Langerhans, the areas of the pancreas where insulin is produced. (57) It is the infiltration of lymphocytes into tissues that is one of the important mechanisms in the development of autoimmune diseases.

A very interesting study was then conducted on mice, which was artificially induced diabetes. Not only did they experience a significant drop in blood sugar levels when taking boswellia (as early as day 17 after starting treatment), but they also experienced much lower rates of kidney and liver damage, which are common complications of diabetes, compared to the control group. And the pregnant mice even had a reduced rate of spontaneous abortion and fetal damage.(56) This is very promising, because pregnant diabetic women are at significantly higher risk of both abortion and fetal damage than the healthy population. Although Boswellia is not recommended for use during pregnancy, it could be a good choice for stabilizing health before a planned pregnancy.

Use of

Laboratory studies suggest that boswellia may increase both the effects and toxicity of some drugs, especially those designed to treat cancer, asthma and elevated cholesterol (including natural ones such as garlic). It also improves the effectiveness of natural antifungals such as tea-tree and joint supplements such as chondroitin and glucosamine. Conversely, it reduces the effectiveness of non-steroidal antirheumatic drugs such as aspirin or ibuprofen, some antibiotics and sedatives. So if you are taking any medications, check with your doctor before taking boswellia (45).

Boswellia is not suitable in pregnancy as it can increase the risk of miscarriage and damage to the fetus, nor is it recommended when breastfeeding. In rare cases, allergic reactions have been reported after ingestion of boswellia (45).

The recommended dosage varies considerably in different systems, ranging from 150 to 500 mg 2-3 times a day (1, 46). Usually, lower doses are used as prevention and increased in case of problems. External use, for example in the form of creams, is also possible.

Possible combinations

Boswellia is a common ingredient in joint preparations, where it is often combined with collagen, glucosamine or chondroitin sulphate. Here, however, the content of boswellia or boswellic acids should be monitored – if the concentration is too low, its epigenetic effects will not be sufficiently apparent. But there are other useful combinations besides:

Boswellia + curcumin – this combination significantly improves the bioavailability of both substances, and at the same time both ingredients support their effectiveness because they act by slightly different mechanisms. This is especially true in the area of anti-inflammatory action. It is also suitable for arthritis, inflammatory bowel disease, cancer, chronic kidney problems and diabetes (47, 53).

Boswellia + Baikal coneflower – this combination of herbs also complements each other well and is characterised by its strong anti-inflammatory action. It has also been shown to be effective in Crohn’s disease (61).

Boswellia + ginger – here too the advantage of this combination is its strong anti-inflammatory action. In addition to joint pain, it is also used for kidney problems (60).