Boswellia, commonly known as frankincense, has been used in religious ceremonies and traditional medicine for thousands of years across Africa, China, India, and the Middle East. The resin is collected by making cuts in the bark of Boswellia trees, allowing the sticky substance to seep out and harden into tear-shaped lumps. If you’ve ever attended a high church service with incense wafting through the air, you’ve encountered boswellia’s aromatic cousin.

But beyond the ceremonial smoke, does boswellia actually do anything useful when you swallow it? I’ve gone through the clinical research to find out what the evidence actually supports, where the studies fall short, and who should probably skip this one entirely.

What is boswellia?

Boswellia is an oleogum resin extracted from trees in the Boswellia genus, part of the Burseraceae (torchwood) family. When the bark is cut, the tree produces this resin as a defence mechanism against infection and pests. The composition breaks down roughly as 5-9% essential oils, 20-23% polysaccharides, and about 60% resin.

The active compounds that researchers focus on are called boswellic acids. These include AKBA (acetyl-11-keto-β-boswellic acid), which appears to inhibit 5-lipoxygenase, an enzyme involved in inflammation. This mechanism is why boswellia keeps getting studied for inflammatory conditions.

Four species produce most of the commercially available boswellia:

Boswellia serrata from India (this is what most supplements contain)
Boswellia carterii from East Africa and China
Boswellia frereana from Northeast Africa
Boswellia sacra from the Middle East (the biblical frankincense)

The species matter because their chemical profiles differ somewhat, though most clinical research has focused on Boswellia serrata extract.

What does the evidence actually show?

I should be upfront: the research base for boswellia is thin. Most studies are small, many lack proper controls, and we don’t have the large-scale trials that would give us confidence about long-term safety and effectiveness. That said, there are three areas where the evidence is at least worth discussing.

1. Osteoarthritis pain and stiffness

Osteoarthritis is a degenerative joint condition where cartilage breaks down over time, causing pain, stiffness, and reduced mobility. It’s the most common form of arthritis, affecting millions of people as they age.

A systematic review and meta-analysis published in BMC Complementary Medicine and Therapies looked at seven randomised controlled trials involving 545 people with osteoarthritis [1]. The studies used Boswellia serrata extract at daily doses between 100-250mg for at least four weeks.

Compared to placebo or no treatment, boswellia reduced pain scores (measured by both VAS and WOMAC scales) and stiffness, and improved joint function. The effect sizes were modest but statistically significant.

The catch? Sample sizes were small, follow-up periods were short, and several studies had high risk of bias. The authors themselves noted that “more rigorous studies are needed” before drawing firm conclusions.

My honest assessment: if you have knee osteoarthritis and haven’t responded well to other approaches, a trial of boswellia extract probably isn’t unreasonable. But I wouldn’t expect dramatic results. The effects, if any, appear to be mild to moderate. For more severe arthritis, you’ll likely still need conventional treatments.

2. Chronic cluster headaches

Cluster headaches are brutal. They’re characterised by severe unilateral pain around the eye, typically lasting 15 minutes to 3 hours, often with tearing, nasal congestion, or facial sweating on the affected side. “Chronic” cluster headache means the attacks continue for a year or more with minimal remission.

The evidence here is limited to a single open-label case series of four patients with chronic cluster headaches who took boswellia extract (branded as Sallaki H15) [2]. All four reported reduced headache intensity and frequency.

Four patients. No placebo control. Open-label design where everyone knew what they were taking. This is about as preliminary as evidence gets.

I mention it because cluster headaches are notoriously difficult to treat, and sufferers are often desperate for anything that might help. But honestly, this evidence is too weak to recommend boswellia for this purpose. It’s a hypothesis-generating observation at best, not a treatment recommendation.

3. Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel condition that can affect any part of the digestive tract, though it most commonly involves the small intestine. Symptoms include abdominal pain, diarrhoea, weight loss, and fatigue. The inflammation often extends deep into the bowel wall, distinguishing it from ulcerative colitis which affects only the surface layer.

One randomised, double-blind controlled study compared boswellia extract to mesalazine (a standard anti-inflammatory drug for Crohn’s) in 102 patients [3]. The boswellia group showed comparable improvement in the Crohn’s Disease Activity Index.

This is interesting but not conclusive. The study compared boswellia to an active treatment rather than placebo, so we can’t say whether either treatment was better than doing nothing. And 102 patients split between two groups means each arm had about 50 people, which is quite small for detecting meaningful differences.

The study was also conducted in the 1990s, and Crohn’s treatment has evolved considerably since then. Whether boswellia would hold up against current standard treatments is unknown.

If you have Crohn’s disease, I would not recommend substituting boswellia for prescribed medications. The evidence is simply too thin. However, discussing it with your gastroenterologist as a possible adjunct therapy might be worthwhile if you’re interested.

Side effects

Boswellia has been used by humans for millennia, and when taken at typical supplement doses, it appears reasonably safe for most people. That said, side effects have been reported:

Stomach pain and nausea
Diarrhoea
Heartburn or acid reflux
Skin itching
Headache
Swelling
General weakness

These tend to be mild and reversible. The gastrointestinal symptoms (nausea, diarrhoea, heartburn) are the most commonly reported. If you experience persistent digestive upset, reducing the dose or stopping altogether usually resolves the issue.

A 2020 review in the Journal of Herbal Medicine noted that boswellia appears to have a good safety profile in short-term studies (up to 6 months), but long-term safety data are limited [4]. This is a common problem with herbal supplements: we have plenty of historical use but relatively little rigorous safety monitoring.

Who should avoid boswellia (5 contraindications)

1. Pregnant and breastfeeding women

There’s no good safety data on boswellia during pregnancy or breastfeeding. Animal studies haven’t shown obvious problems, but that’s not the same as demonstrating safety in humans. The traditional use of boswellia in some cultures during pregnancy doesn’t constitute evidence either, as it wouldn’t have been systematically tracked for subtle effects.

The conservative approach is to avoid it. If you’re pregnant or nursing, there are better-studied options for most conditions boswellia might address.

2. People with impaired liver or kidney function

Boswellia is metabolised primarily through the liver, and we don’t have studies specifically examining its safety in people with hepatic or renal impairment. Until such data exist, those with significant liver or kidney disease should probably steer clear.

This is particularly relevant if you’re already taking multiple medications that stress these organs, as adding another compound without clear benefit doesn’t make sense.

3. People taking anti-inflammatory or pain medications

Boswellia may interact with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin. The concern is that combining them could either enhance anti-inflammatory effects (increasing bleeding risk) or interfere with drug metabolism.

If you’re on regular NSAIDs, prescription anti-inflammatories, or anticoagulants, discuss boswellia with your doctor before starting. This isn’t necessarily a hard contraindication, but it does require medical supervision.

4. People with autoimmune conditions

This one is somewhat theoretical, but worth mentioning. Boswellia appears to have immunomodulatory effects, meaning it can influence immune function. In some circumstances, this might theoretically worsen autoimmune conditions where the immune system is already overactive.

Conditions in this category include multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis (despite the osteoarthritis benefits), and other immune-mediated diseases. The evidence for harm isn’t strong, but the potential for unexpected immune effects warrants caution.

Ironically, some autoimmune conditions involve inflammation that boswellia might theoretically help. The problem is that we don’t understand the effects well enough to predict who might benefit versus who might be harmed. When in doubt, consult your rheumatologist or immunologist.

5. People with known plant allergies

There’s at least one documented case of allergic contact dermatitis from topical boswellia cream application [5]. If you have multiple plant allergies or have reacted to similar tree resins, approach boswellia with caution.

Starting with a low dose and watching for reactions is sensible. Stop immediately if you develop rash, itching, swelling, or difficulty breathing.

How boswellia is typically used

Most supplements contain Boswellia serrata extract standardised to boswellic acid content (often 30-65% boswellic acids). Typical doses in studies have ranged from 100-400mg of extract daily, usually divided into two or three doses taken with food.

Some products combine boswellia with other ingredients like curcumin or glucosamine for joint health. Whether these combinations work better than either ingredient alone isn’t well established.

Effects, when they occur, may take several weeks to become noticeable. Unlike NSAIDs which work within hours, herbal anti-inflammatories tend to have slower onset. If you’re going to try boswellia, give it at least 4-6 weeks before deciding whether it’s helping.

The bottom line

Boswellia has modest evidence for helping with osteoarthritis symptoms, and weaker evidence for cluster headaches and Crohn’s disease. The studies are generally small and methodologically limited, so we shouldn’t overstate the case.

If you’re considering boswellia, my honest take:

For osteoarthritis: it might provide mild benefit, especially if you want to reduce NSAID use. Worth discussing with your doctor.
For cluster headaches: the evidence is too thin to recommend.
For Crohn’s disease: don’t substitute it for prescribed treatments, but ask your gastroenterologist if it might be a reasonable addition.

The safety profile appears decent for short-term use in healthy adults, but we lack long-term data. Avoid it if you’re pregnant, breastfeeding, have significant liver or kidney issues, take anti-inflammatory medications regularly, or have autoimmune conditions.

For related conditions, you might also want to read about interstitial cystitis and bladder spasms, which are sometimes managed with anti-inflammatory approaches. If you’re dealing with chronic pain conditions, the article on fish oil covers another commonly used anti-inflammatory supplement.

References

Yu G, Xiang W, Zhang T, et al. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020;20(1):225. PMID: 32680575
Lampl C, Haider B, Schweiger C. Long-term efficacy of Boswellia serrata in four patients with chronic cluster headache. Cephalalgia. 2012;32(9):719-722. PMID: 22767961
Gerhardt H, Seifert F, Buvari P, et al. Therapy of active Crohn disease with Boswellia serrata extract H 15. Z Gastroenterol. 2001;39(1):11-17. PMID: 11215357
Efferth T, Oesch F. Anti-inflammatory and anti-cancer activities of frankincense: Targets, treatments and toxicities. Semin Cancer Biol. 2022;80:39-57. PMID: 32956776
Mahajan G, Gupta S, Sharma S, et al. Allergic contact dermatitis to Boswellia serrata. Contact Dermatitis. 2017;77(6):407-408. PMID: 29143342
NHS. Complementary and alternative medicine. https://www.nhs.uk/conditions/complementary-and-alternative-medicine/ (Accessed January 2026)
Abdel-Tawab M, Werz O, Schubert-Zsilavecz M. Boswellia serrata: an overall assessment of in vitro, preclinical, pharmacokinetic and clinical data. Clin Pharmacokinet. 2011;50(6):349-369. PMID: 21553931