Boswellia sometimes known as Indian frankincense, is a resin herbal extract from the Boswellia tree. It is extracted from the bark and resin of the Indian Boswelia tree.
People have been using Boswellia in natural medicine practices for centuries believing that its anti-inflammatory effects mean that it may help with conditions, such as arthritis, inflammatory bowel disease, and asthma. It is predominantly promoted in musculoskeletal disorders such as osteoarthritis. But does it work in animals?
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What is the evidence in arthritis?
We have a mixture of studies that seek to investigate the use of Boswellia, in different formulations and dosages, in humans and animals.
In humans, one study found all patients receiving drug treatment reported decrease in knee pain, increased knee flexion and increased walking distance and the frequency of swelling in the knee joint was decreased. Radiologically (on X-ray) there was no change. The observed differences between drug treated and placebo being statistically significant, suggesting a real effect. The study believed that Boswellia was well tolerated by the subjects except for minor gastrointestinal adverse drug reactions.
This was also seen in a trial that revealed that Boswellia treatment significantly improved the physical function of the patients by reducing pain and stiffness compared with placebo. Radiographic assessments showed improved knee joint gap and reduced osteophytes (spur) confirming the efficacy. They also found that Boswellia reduced the serum levels of high-sensitive C-reactive protein; a potential inflammatory marker associated with osteoarthritis of the knee. In this trial, no serious adverse events were reported.
So far so good, but…
However, there can be different formulations and delivery agents for Boswellia; this can be consuming when knowing if the product is of decent quality. Supplements are generally a poorly regulated market, and product contents can vary from label claims.
In a study using a solid lipid Boswellia serrata particles (SLBSP) against a standardized Boswellia serrata gum extract (BSE) using two scoring systems, both types of the extract led to improvement. However, the most significant effect was observed in the need for rescue analgesics. (The need for participants to take extra pain relief because the pain is not manageable). One of the extracts (SLBSP) caused marked lowering of inflammatory hormone levels, while the other (BSE) led to a several fold increase. Both groups showed marked improvement in pain, but again, SLBSP was superior to BSE. So not all extracts are equally effective and some may actually be causing other problems.
The results seen can also, apparently, be very quick. In a fourth human study, Aflapin, Novel Boswellia Serrata Extract, conferred significant improvements in pain scores as early as five days of treatment. The study authors believed that the results affirmed that Aflapin is clinically efficacious, fast-acting, and safe in the management of osteoarthritis.
Looks awesome, doesn’t it?
So, given this small section of studies it would be easy to get ahead of ourselves. But when looking at evidence, and I mean really looking, assessing and critiquing it is important to assess the quality and grade of the evidence we have available.
Boswellia has also been assessed in a review in asthma (Chronic Therapy), Crohn’s Disease, Osteoarthritis, Rheumatoid Arthritis and Ulcerative Colitis. The review found that there were numerous medicinal claims made previously for Boswellia that lack sufficient evidence.
The studies we have available have incredibly low study groups. This means it can be difficult to draw robust conclusions that can be extrapolated to a larger population. Overall, the evidence we have available is still low grade.
What about in companion animals?
Interestingly Boswellia resin has been evaluated in 24 dogs in an open multi-center study. Improvement in clinical signs, lameness, and pain was found in 17 of 24 dogs. Again, although promising this is a very small study, more research is necessary to confirm that Boswellia would be a truly beneficial addition to a treatment plan. Inflammatory parameters were improved and improvement in body weight, decrease in ankle diameter and arthritic index were seen in rats.
Although it could produce benefits by relieving pain and reducing the clinical signs of OA in dogs. Evaluating the response to supplementation with Boswellia serrata alone is complicated due to the limited publication of studies and variations in the purity and compositions of the products used.
So, if it might work why not try?
Although in humans we know that it is possibly safe when used in recommended doses as an oral agent to treat arthritis, inflammatory bowel disease, and asthma. And it may also not elicit many negative side effects in our pets there are still a few important factors to consider.
1) Caregiver Placebo
Caregiver placebo is a phenomenon where a client/owner or ‘caregiver’ believes they are seeing a marked improvement of health and welfare due to the fact they are giving a treatment; when in fact there is no marked change in the health of the animal. This means that the animal is no better, but the owner believes they are.
In relation to supplements, this could seriously impact the animal’s welfare. And it can delay the use of treatments that will actually benefit the dog’s health and welfare. We already know that caregiver placebo is extremely prevalent amongst our clients (and veterinary professionals). In one study a caregiver placebo effect was seen 39.7% of the time for owners evaluating their dog’s lameness. This highlights the need to warn clients of this issue and educate them to allow them to assess their dog from an independent and objective viewpoint. You may give a treatment you believe will work, like Boswellia, and you may think you see a benefit to your pet, when they are in fact having no benefits from it.
2) Poorly spent finances
Of course, owners are at perfect liberty to use their finances as they see fit. However a recent report showed many owners are worried about veterinary costs. It is possible that the National Health Service in the UK has left many people ignorant as to the expense involved in health care. It is noteworthy that veterinary professionals are often subject to extensive abuse about the cost of veterinary services; yet the practitioners of alternative medicine also charge, quite substantially, for their service. If treatment and finances are directed towards non-evidence-based therapies this could mean that effective treatment is delayed, leaving the patient to deteriorate further. This in turn means more care and more expense. Sadly, in some cases, the owner may have spent precious finances on treatment that does not work, leaving little left for evidence-based treatment options.
As usual I will conclude without the answer, which is often the case in veterinary medicine. Boswellia is a promising supplement that may help a select few conditions in animals. But, and there is a big but, there is still very limited evidence to support its use. So, although it is unlikely to do a huge amount of harm to try, it is also not something I would be rushing to buy if I have limited finances to spend on my pet’s condition. We must not run before we can walk. And when it comes to Boswellia and our pets it could be something to consider as part of a multimodal treatment plan (using lots of different things/intervention to create a positive outcome). However, I would always be inclined to spend any precious finances first on treatment options with stronger evidence base.