Derived from the resinous sap of boswellia trees, frankincense has an extensive historical background, tracing back thousands of years as a prized substance with multifaceted significance. Throughout time, it has been revered across various cultures for its exceptional therapeutic properties. From sacred religious rituals to traditional medicine practices, frankincense has enhanced well-being. In this article, we delve into the diverse therapeutic uses of frankincense that have made it a popular natural remedy throughout history. (6)

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Botanical and Historical Context

Frankincense, a resin obtained from the trees of the genus Boswellia, holds significant historical and botanical importance. The boswellia tree, native to the arid regions of the Middle East, northern Africa, and the Indian subcontinent, is the primary source of frankincense resin. The resin is extracted from the bark of these trees, particularly from species like Boswellia sacra, Boswellia carterii, Boswellia frereana, and Boswellia serrata. (20) 

The boswellia tree is well-adapted to thrive in warm, dry climates. It is a small to medium-sized deciduous tree known for its papery peeling bark and pinnate leaves. The green tree's compound leaves grow in clusters at the tips of the branches. When cut, the tree bark produces a fragrant resin known as frankincense, which has been highly valued for its aromatic and medicinal properties. (8) 

Historically, frankincense has held immense cultural, religious, and medicinal significance, making it a valuable natural resource in various parts of the world. Ancient Egyptians used frankincense during religious ceremonies. In Christian tradition, frankincense was one of the three gifts offered to the infant Jesus. The resin is also mentioned frequently in the Jewish Pentateuch. Roman author Pliny the Elder mentioned frankincense as an antidote to hemlock poisoning. Boswellia extract is used in traditional Ayurvedic medicine to treat inflammatory disorders, such as asthma and arthritis. (5, 6) 

Phytochemistry: What Are The Active Components of Frankincense?

The frankincense gum resin is harvested by cutting or pulling away the bark of the boswellia tree. Boswellic acids have been identified as the active compounds in this resin, responsible for the extract's potent anti-inflammatory properties. The four primary boswellic acids extracted from frankincense are β-boswellic acid (BA), acetyl-β-boswellic acid (ABA), 11-keto-β-boswellic acid (KBA), and 3-O-acetyl-11-keto-β-boswellic acid (AKBA). The gum resin also contains essential oils, phenyl propanoids,  terpenoids, flavonoids, and other phenolic compounds (2). (20) 

Boswellia serrata extracts are commonly standardized to contain 30-65% boswellic acids (6). Chemically, boswellic acids have a very similar structure to steroids. One of the fundamental mechanisms through which boswellic acids exert their anti-inflammatory effects is by inhibiting the enzyme 5-lipoxygenase. This enzyme is involved in the production of leukotrienes, which are inflammatory mediators. By inhibiting 5-lipoxygenase, boswellic acids reduce the formation of leukotrienes, thereby decreasing inflammation. (20) 

Top Therapeutic Uses of Frankincense

Given its ability to block the synthesis of leukotrienes and, therefore, inhibit inflammation, frankincense has been proven effective in treating various inflammatory diseases. We will discuss the therapeutic application of Boswellia serrata extract in detail below. 

1. Frankincense for Joint Health and Arthritis

Frankincense has been widely studied for its therapeutic potential in promoting joint health and managing arthritis. Clinical studies have provided evidence supporting its effectiveness in these areas. Several clinical trials have investigated the use of oral frankincense supplements or extracts in patients with osteoarthritis. In these trials, patients taking frankincense supplements have reported significant improvements in joint function, reduced pain, and decreased stiffness compared to those in control groups. These studies have also shown that Boswellia serrata extracts do not have toxic side effects at higher doses, making them a safe alternative or complementary therapy to conventional arthritis medications. (32) 

One clinical study also investigated the topical use of frankincense oil in treating adults with osteoarthritis of the knee. Researchers concluded that applying the oil to the affected knee three times daily for four weeks reduces pain and improves joint flexibility, stiffness, and function.

Frankincense has also been found to be a safe and effective therapeutic option for treating joint inflammation associated with rheumatoid arthritis. In one trial, researchers administered 400-1,200 mg of H15®, a standardized frankincense extract, to over 260 patients for 1-6 months. Compared to placebo, patients taking H15® experienced reductions in pain, swelling, morning stiffness, need for nonsteroidal anti-inflammatory drugs (NSAIDs), and erythrocyte sedimentation rates. Patients using frankincense also reported improved general health and well-being. 

2. Frankincense for Asthma and Respiratory Health

Traditional medicine has used frankincense to treat bronchitis and asthma for centuries. Research suggests that boswellic acids prevent the production of leukotrienes and mast cells, which are responsible for causing the inflammatory response within the airways and the constriction of bronchial muscles during asthma attacks. Some research also suggests that frankincense may suppress allergic airway inflammation by inhibiting Th2-mediated cytokines, which mediate inflammation and excess mucus secretion in asthma.

Clinical studies examining the impact of frankincense on asthma have reported encouraging results that support its traditional use in this capacity. In one study, patients who took 500 mg of boswellia extract daily in addition to their standard asthma treatment were able to reduce their use of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA). 

Another placebo-controlled, double-blind study demonstrated that 70% of patients receiving 300 mg of boswellia gum resin orally three times daily for six weeks showed reduced signs and symptoms of asthma, improved lung function, and decreased levels of inflammation at the end of the trial. 

3. Frankincense for Digestive Health

Frankincense's anti-inflammatory properties also promote optimal gut health and function. 

Clinical studies suggest that an oral Boswellia serrata extract may improve symptoms of irritable bowel syndrome (IBS). Two trials, conducted in 2017 and 2019, have investigated the therapeutic effects of a specific lecithin-based delivery form of Boswellia serrata extract called Casperome®. Positive clinical outcomes associated with Casperome® supplementation in both studies included improved abdominal pain, bowel movements, gas, and cramps. Additionally, patients in the Casperome®-supplemented groups required less medical attention and experienced a lower incidence of side effects compared to those treated with hyoscine butylbromide or papaverine hydrochloride and belladonna extract. (4, 28) 

Frankincense is also commonly recommended by integrative practitioners for treating inflammatory gastrointestinal conditions. Boswellia serrata extract has been studied extensively in treating ailments such as inflammatory bowel disease (IBD) and microscopic colitis. Trials have shown that frankincense is as effective as conventional pharmaceutical options mesalamine and sulfasalazine in reducing symptoms of ulcerative colitis and Crohn's disease (17, 19). Another clinical trial shows that taking Boswellia serrata extract 400 mg three times daily for six weeks increases the clinical remission rate by 64% compared to placebo in patients with collagenous microscopic colitis.

4. Frankincense for Brain Health

In traditional medicine, it is believed that frankincense improves learning and memory, and it is used to support cognitive health in the elderly population (20). In modern medicine, frankincense has emerged as a promising natural remedy with therapeutic applications in supporting cognitive function during stroke and traumatic brain injury (TBI) recovery. Preliminary evidence suggests that boswellic acids can improve clinical outcomes in the early phases of stroke recovery; oral administration of boswellic acids enhanced the efficacy of aspirin and clopidogrel on neurological function in patients recovering from recent ischemic stroke. Another clinical study in patients suffering from TBI three months to three years prior concluded that Boswellia serrata extract dosed 400 mg three times daily for three months improves cognitive function tests assessing processing speed, memory, and overall cognitive function. 

5. Frankincense for Skin Conditions

Frankincense, used topically in skincare products, may offer therapeutic advantages in a dermatological context. Small clinical studies suggest that the anti-inflammatory properties of boswellic acids improve symptoms of aging skin by reducing fine surface lines, tactile roughness, and photo-aging scores. Patients also experienced improved skin elasticity and increased deposition of collagenous and elastic fibers. (11, 26).

Potential Side Effects of Frankincense and Considerations

While frankincense is generally considered safe for topical and oral use when used as directed, there are a few potential side effects and considerations to remember. Some individuals may experience mild skin irritation, redness, or rash when applying frankincense oil or products directly to the skin. It is advisable to perform a patch test before using it extensively, especially for individuals with sensitive skin. When used orally, there have been rare reports of gastrointestinal discomfort, such as stomach pain, acid reflux, or nausea. (7, 9) 

For pregnant and breastfeeding patients, Boswellia serrata is likely safe when used orally in amounts commonly found in foods. However, because there is insufficient evidence regarding the safety when used in higher doses, it is recommended to avoid frankincense supplementation in these populations. (10) 

Boswellia extracts can inhibit platelet aggregation and may increase the risk of bleeding when used with blood-thinning medications (7).

As with any dietary or herbal supplement, it is always recommended to consult healthcare experts, such as doctors or dermatologists, before incorporating frankincense products into one's skincare or wellness routine. Medical experts can provide personalized advice, considering individual health conditions, medications, and potential allergies. They can help determine the appropriate dosage, application method, and overall suitability of frankincense for specific individuals, ensuring its safe and effective use.

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Summary

Frankincense, the gum resin derived from boswellia trees, offers a wide array of therapeutic applications owing to its potent anti-inflammatory properties. Its effectiveness in promoting joint health, easing respiratory issues, supporting cognitive function, and preventing skin aging has been demonstrated in clinical studies. It is crucial to exercise caution and seek professional advice before incorporating frankincense into healthcare routines, especially in cases of allergies, interactions with medications, or specific health concerns. Continued research is essential to unlock the full potential of frankincense across diverse medical fields, ensuring its judicious use and maximizing its medicinal impact.