Boswellia is often advertised as a supplement for an "athlete's healthy joints". But what exactly has been proven, and what is merely extrapolation from studies in people with arthritis? The editorial team analyzed the available clinical work and assessed how strong the evidence base is for active people.
Why athletes are interested in boswellia
Intense training is inevitably accompanied by microtrauma of muscles, tendons and articular cartilage. In response, local inflammation develops, which is part of normal adaptation but under excessive load can turn into chronic pain. That is why athletes look for means that will help control pain without regularly taking NSAIDs.
Non-steroidal anti-inflammatory drugs are effective, but their long-term use is associated with the risk of damage to the stomach lining, kidneys and cardiovascular system. There are also data that regular use of NSAIDs may affect tissue adaptation to load. Therefore natural alternatives with a different mechanism of action attract considerable interest.
Boswellia looks attractive precisely because of its mechanism: boswellic acids inhibit 5-lipoxygenase rather than cyclooxygenases, as most painkillers do. Theoretically this makes it possible to reduce inflammatory mediators without the stomach problems typical of NSAIDs.
However, an attractive mechanism does not yet guarantee practical benefit. For a responsible conclusion one must consider who the studies were conducted on, which indicators were measured and how large the effect was.
Osteoarthritis: the strongest part of the evidence base
Most randomized controlled trials of boswellia have been conducted on patients with osteoarthritis of the knee - mostly middle-aged and older people. Kimmatkar and colleagues (2003), in a double-blind crossover study, reported reduced pain and swelling and improved knee mobility with the extract.
Sengupta and colleagues (2008) evaluated the AKBA-enriched extract 5-Loxin at doses of 100 and 250 mg per day over 90 days. Both doses outperformed placebo on the WOMAC index, and the higher dose gave a greater effect. Later the same group studied Aflapin, where improvement was recorded as early as the first weeks (Vishal et al., 2011).
The meta-analysis by Yu and colleagues (2020), which combined several randomized studies, showed a statistically significant reduction in pain and stiffness and improved function compared with controls. At the same time, the authors emphasized the small samples, short duration and risk of bias in some of the work - particularly those funded by extract manufacturers.
Thus, if an athlete has diagnosed degenerative joint changes - which is not uncommon among veterans of weightlifting, running or team sports - the available data provide grounds to consider boswellia as an adjunct. But for young healthy athletes these studies are not directly applicable.
Recovery and muscle soreness: what is known
There are very few studies of boswellia specifically on healthy trained people. There are no large randomized trials that would measure delayed-onset muscle soreness (DOMS), muscle-damage markers such as creatine kinase, or strength recovery after eccentric loads compared with placebo.
Some small studies evaluated combination products in which boswellia was only one of the components alongside curcumin, ginger or other extracts. In such cases it is impossible to isolate the contribution of boswellia itself, so the editorial team does not consider this work as evidence of the efficacy of the individual substance.
The consensus of the International Olympic Committee on dietary supplements (Maughan et al., 2018) does not include boswellia among the agents with a reliably proven effect on performance or recovery. This does not mean there is no effect - only that it has not been confirmed by studies of adequate quality.
It is also worth considering that moderate inflammation after training is a signal for adaptation. Theoretically, aggressive suppression of inflammation could weaken the training effect, as is discussed with regard to NSAIDs, although for boswellia there are no data either way.
How to assess the quality of evidence
The editorial team suggests looking at each study through a few simple questions. Who was it conducted on: arthritis patients or athletes? Which product was used: raw resin or a standardized extract with a known AKBA content? How many participants were there and how long did the observation last?
| Criterion | Typical situation with boswellia | What it means |
|---|---|---|
| Population | Mostly patients with osteoarthritis | Hard to transfer to healthy athletes |
| Product | Various patented extracts | The result of one extract does not guarantee the action of another |
| Sample size | Dozens, rarely hundreds of participants | High risk of chance results |
| Duration | From a few weeks to 3-6 months | No data on multi-year use |
| Funding | Often the extract manufacturer | Possible conflict of interest |
Another nuance is the choice of endpoints. In osteoarthritis studies, subjective pain is assessed on scales that are sensitive to the placebo effect. Objective indicators - for example, cartilage structure on MRI - were rarely measured.
Finally, reproducibility is important. Results obtained by one group of researchers with one extract require confirmation by independent teams. For boswellia such independent verification is so far limited.
For all these reasons we rate the evidence base for joint pain as "moderate" and for sports performance and recovery as "insufficient".
- Who was studied:mostly middle-aged and older patients with osteoarthritis.
- What was studied:various patented extracts with different AKBA content.
- What was measured:mostly subjective pain and function on scales.
Practical conclusions for active people
If you have chronic joint pain due to osteoarthritis, boswellia may be a reasonable addition to the main plan - adjusting loads, strength exercises, weight control - after consulting a doctor. The doses studied range from 100-250 mg of AKBA-enriched extracts to about 1 g of standardized extract per day.
Do not expect quick pain relief: in most studies the effect built up over several weeks. It makes sense to evaluate the result no earlier than after 4-8 weeks of regular use.
For a young athlete without a diagnosis who wants to "speed up recovery", there is little scientific basis for taking boswellia today. Sleep, sufficient protein and calories, and sensible load planning will give a much greater effect.
If you compete in events with doping control, choose products with independent certification for the absence of prohibited impurities: boswellia itself is not banned, but the risk of supplement contamination exists.
Editorial conclusions
The evidence base for boswellia is strongest for osteoarthritis of the knee: standardized extracts moderately reduce pain and stiffness compared with placebo.
For healthy athletes - with regard to recovery, muscle soreness, strength or endurance - there are practically no high-quality studies, so expectations should be modest.
The results depend heavily on the specific extract, and a significant part of the research was funded by manufacturers, which calls for cautious interpretation.
We also recommend reading our articles "Boswellia: what it is and how it works", "How to take Boswellia: dosage, timing, duration" and "What to combine Boswellia with".
References
- Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee – a randomized double blind placebo controlled trial. Phytomedicine. 2003;10(1):3–7.
- Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther. 2008;10(4):R85.
- Vishal AA, Mishra A, Raychaudhuri SP. A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of Aflapin in subjects with osteoarthritis of knee. Int J Med Sci. 2011;8(7):615–622.
- 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.
- Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439–455.
- Ammon HPT. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100–1116.
- 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.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
