Does Boswellia Help with Interstitial Cystitis?
In this month’s blog post I want to talk about Boswellia serrata, also known as Indian frankincense. There are several types of Boswellia, including sacra, papyrifera and dioscoridis, but in this post we will only concern ourselves with Boswellia serrata. Throughout this post you should therefore take all references to Boswellia to mean Boswellia serrata. For ease of both writing and reading, I will dispense with the italicised styling normally used for Latin plant names unless I am directly quoting other material. I am sorry if this offends any botanists!
When Boswellia serrata is used in medicine or food supplements, it is normally in the form of a gum-resin extract taken from the bark of the tree. This extract consists of several types of terpenes, but the most important active constituents are the four main boswellic acids: β-boswellic acid, acetyl-β-boswellic acid, 11-keto-β-boswellic acid and acetyl-11-keto-β-boswellic acid 1. If I refer to ‘boswellic acid’ without specifying a type, you should take this to mean a combination of all four types.
Now that we’ve got all that sorted, let’s start the blog properly!
Earlier this year we introduced a range of aloe vera powders to the Tiny Pioneer store and one of these, Blend No. 3, contains Boswellia serrata. I am very proud of this blend, because to my knowledge it is completely unique – I know of no other product that offers aloe vera, palmitoylethanolamide and Boswellia together. I might devote a separate blog to Blend No. 3 at some point, because in my opinion the different modes of action of the ingredients complement each other perfectly to offer fantastic anti-inflammatory potential. However, I must not get side tracked with that here – this post is about Boswellia only!
Although Boswellia has not been well studied in urinary issues, the way in which it works and the other conditions is has been studied in leads me to believe that it could be a very useful ingredient for addressing interstitial cystitis. I am obviously not the only one to think so as since I designed Blend No. 3, this study has been published examining the uro-protective effect of boswellic acids in rats with cyclophosphamide-induced cystitis. It showed that “boswellic acids, by their antioxidant and anti-inflammatory properties, negate the detrimental effects of cyclophosphamide on the bladder, suggesting boswellic acids as promising therapeutic alternatives for cystitis” 2. I try to avoid references to animal studies where possible, but so little research has been done into Boswellia and human urology that this is the most relevant study I can find on the matter.
Also published since Blend No. 3 was created is this study into the use of Boswellia and propolis rectal suppositories as a treatment for type III chronic prostatitis and chronic pelvic pain 3. It showed “significant symptomatic improvement in most patients”, which supports the idea that Boswellia might be useful in improving urinary symptoms in males with prostatitis. I feel quite pleased that both these studies have come out since Blend No. 3 was created, as I included Boswellia based only on what I knew about its mode of action and its application in other inflammatory conditions. It feels reassuring to know that people within the medical profession were having similar ideas and were conducting research that has subsequently validated my own thoughts!
Boswellic acid, in particular acetyl-11-keto-β-boswellic acid, inhibits the synthesis of 5-lipoxygenase (5-LO), a pro-inflammatory enzyme involved in the production of leukotrienes. Leukotrienes are inflammatory mediators that play a role in conditions including arthritis, inflammatory bowel disease, asthma and allergic rhinitis 4. One of the most potent pharmaceutical non-steroidal anti-inflammatory drugs, diclofenac, works in part by inhibiting leukotriene production 5. However, whereas diclofenac and other NSAIDs are known to accelerate joint damage by disrupting the production of glycosaminoglycans (those all-important GAG molecules again!), boswellic acids have been shown to reduce glycosaminoglycan degradation 1. Acetyl-11-keto-β-boswellic acid is also unique in that it inhibits 5-LO via non-competitive, non-redox mechanisms 6. This lessens the likelihood of side effects seen in redox drugs.
Boswellic acids also inhibit human leukocyte elastase, which is an enzyme involved in tissue degradation and inflammation, and acetylcholinesterase. Inhibitors of acetylcholinesterase have been linked to anti-inflammatory effects and reduced cytokine release 4. There is some research to suggest that boswellia acids might inhibit COX-1 formation and also prostaglandin E2 formation, further contributing to Boswellia’s anti-inflammatory properties 7, 8.
Theoretical modes of action are all very well, but how does Boswellia perform in the real world?
It certainly performs well in osteoarthritis, with this randomised, double-blind, placebo-controlled 120 day study into osteoarthritis of the knee concluding that “biologically active constituents of BSE [Boswellia serrata extract]…act synergistically to exert anti-inflammatory/anti-arthritic activity showing improvement in physical and functional ability and reducing the pain in stiffness” 9. A later meta-analysis of seven studies into osteoarthritis concluded that Boswellia and Boswellia extracts might be “a safe and effective treatment option for patients with OA [osteoarthritis]”. It was found that Boswellia and its extracts could relieve pain and stiffness and improve joint function. The recommended duration of treatment was at least four weeks 10.
A small randomised, double-blind, placebo-controlled, crossover study evaluated the pain-relieving qualities of Boswellia in 12 healthy volunteers. A mechanical pain model was used and Boswellia was found to significantly increase pain threshold and pain tolerance compared to placebo 11. This supports its use in arthritic conditions, as well as other inflammatory conditions – including interstitial cystitis – where pain is a factor.
Arthritic conditions are often treated with non-steroidal anti-inflammatory drugs, as mentioned above. One of the main side effects of NSAIDs is their gastrointestinal symptoms, which can include stomach ulcers and perforation, indigestion, diverticular bleeding and perforation, and flare-ups of inflammatory bowel disorders. Boswellic acids have been shown to protect against gastric ulcers in a rat study12 and have been proposed as a treatment for NSAID-induced peptic ulcers13.
Boswellia has proven applications in inflammatory bowel diseases. This randomised, double-blind, verum-controlled trial into 102 patients with active Crohn’s disease compared Boswellia serrata extract with mesalazine (a pharmaceutical medication). It found that Boswellia was not inferior to mesalazine and asserted that in terms of a risk-benefit evaluation was superior 14. A similar study into ulcerative colitis showed that 82% of patients treated with Boswellia serata gum resin at a dose of 350mg three times a day for six weeks went into remission, compared to 75% of those taking sulfasalazine 15.
A branded type of Boswellia called Casperome® has been shown to reduce the need for inhalation therapy when taken alongside existing medication in a study of 32 asthma sufferers16. This reinforces the findings of an earlier double-blind, placebo-controlled study into 40 asthma patients which showed 70% of those treated with Boswellia serrata gum resin experienced improvements of symptoms, compared to only 27% of those in the control group 17.
The anti-inflammatory and antioxidant properties of Boswellia mean it is also effective in Parkinson’s disease, Alzheimer’s disease and cancer. This article contains a whole host of references to Boswellia studies about these and other chronic diseases, should you be interested in finding out more 18.
Although there was no compelling research into interstitial cystitis or other urinary conditions when I was formulating Blend No. 3, I was very excited by the anti-inflammatory and gastro-protective qualities of Boswellia. I felt sure that these could be applied to the inflammation and pain of interstitial cystitis and prostatitis. I also believed the combination of aloe vera, palmitoylethanolamide and Boswellia would be of great interest to those with Crohn’s disease or ulcerative colitis. Often, people with interstitial cystitis have digestive issues as well (see this post about interstitial cystitis and leaky gut), so a product that might benefit both the urinary and digestive system seemed like a great idea.
Boswellia is not always very well absorbed, but the addition of aloe vera to Blend No. 3 along with the small amount of sunflower derived phosphatidylcholine present in the water-soluble palmitoylethanolamide might assist with absorption. Both aloe vera and palmitoylethanolamide have their own anti-inflammatory properties as you can read in this post about acemannan and this one about PEA for chronic pain.
I hope this post, although quite boring, has helped you to learn what a special and exciting ingredient Boswellia serrata is! I feel sure that in the coming years you will see it mentioned in interstitial cystitis and prostatitis forums more frequently, and that more studies will be conducted into its genitourinary applications. Just remember that you saw it here first!
Wishing you the best of health,
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- Siddiqui M. Z. (2011). Boswellia serrata, a potential antiinflammatory agent: an overview.Indian journal of pharmaceutical sciences, 73(3), 255–261.
- Fatima, M., et al. (2022). Boswellic Acids, Pentacyclic Triterpenes, Attenuate Oxidative Stress, and Bladder Tissue Damage in Cyclophosphamide-Induced Cystitis. ACS omega, 7(16), 13697–13703.
- Presicce, F., et al. Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome: An Italian prospective multicenter study. Asian Journal of Urology, Volume 9, Issue 2, 2022. Pages 139-145
- Ku, E. C., et al. (1985). The effects of diclofenac sodium on arachidonic acid metabolism. Seminars in arthritis and rheumatism, 15(2 Suppl 1), 36–41.
- Siemoneit, U., et al. (2008). Identification and functional analysis of cyclooxygenase-1 as a molecular target of boswellic acids. Biochemical pharmacology, 75(2), 503–513.
- Siemoneit, U., et al. (2011). Inhibition of microsomal prostaglandin E2 synthase-1 as a molecular basis for the anti-inflammatory actions of boswellic acids from frankincense. British journal of pharmacology, 162(1), 147–162.
- Majeed, M., et al. (2019). A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytotherapy research : PTR, 33(5), 1457–1468.
- Yu, G., et al. (2020). Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC complementary medicine and therapies, 20(1), 225.
- Prabhavathi, K., et al. (2014). A randomized, double blind, placebo controlled, cross over study to evaluate the analgesic activity of Boswellia serrata in healthy volunteers using mechanical pain model. Indian journal of pharmacology 46(5), 475–479.
- Singh, S., et al. (2008). The gastric ulcer protective effect of boswellic acids, a leukotriene inhibitor from Boswellia serrata, in rats. Phytomedicine : international journal of phytotherapy and phytopharmacology, 15(6-7), 408–415.
- Gerhardt, H., et al. (2001). Therapy of active Crohn disease with Boswellia serrata extract H 15. Zeitschrift fur Gastroenterologie, 39(1), 11–17.
- Gupta, I., et al. (1997). Effects of Boswellia serrata gum resin in patients with ulcerative colitis. European journal of medical research, 2(1), 37–43.
- Gupta, I., et al. (1998). Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. European journal of medical research, 3(11), 511–514.
- Roy, N. K., et al (2019). An Update on Pharmacological Potential of Boswellic Acids against Chronic Diseases. International journal of molecular sciences, 20(17), 4101.