Boswellic Acids

• Potent anti-inflammatory effects
• Joint health support
• Neuroprotective properties
• Immune system modulation

• Respiratory health support
• Digestive system support
• Skin health improvement
• Cognitive function support
• Anticancer potential
• Liver protection

Boswellic acids exert their biological effects through a complex array of molecular mechanisms, with their anti-inflammatory properties being the most extensively studied. The primary active compounds include β-boswellic acid, acetyl-β-boswellic acid, 11-keto-β-boswellic acid, and acetyl-11-keto-β-boswellic acid (AKBA), with AKBA generally considered the most potent. The most significant anti-inflammatory mechanism of boswellic acids is their selective inhibition of 5-lipoxygenase (5-LOX), a key enzyme in the biosynthesis of leukotrienes from arachidonic acid. Unlike conventional non-steroidal anti-inflammatory drugs (NSAIDs) that primarily inhibit cyclooxygenase (COX) enzymes, boswellic acids specifically target the 5-LOX pathway, reducing the production of pro-inflammatory leukotrienes, particularly leukotriene B4 (LTB4).

This selective inhibition occurs through direct binding to the enzyme or its activator, 5-lipoxygenase-activating protein (FLAP), with AKBA showing the highest affinity. This mechanism is particularly relevant for inflammatory conditions where leukotrienes play a significant role, such as asthma, inflammatory bowel disease, and certain types of arthritis. Beyond 5-LOX inhibition, boswellic acids modulate multiple inflammatory signaling pathways. They inhibit the activation of nuclear factor-kappa B (NF-κB), a master regulator of inflammation, by preventing the phosphorylation and degradation of inhibitory kappa B (IκB).

This results in reduced expression of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6). Boswellic acids also downregulate the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), further contributing to their anti-inflammatory effects. In the context of joint health, boswellic acids inhibit the activity of matrix metalloproteinases (MMPs), enzymes that degrade cartilage and connective tissue. They specifically reduce the expression of MMP-3 and MMP-13 in chondrocytes and synovial fibroblasts, helping to preserve joint structure and function.

Additionally, boswellic acids inhibit the infiltration of leukocytes into inflamed tissues and reduce the release of elastase from activated neutrophils, which can damage joint tissues. The immunomodulatory effects of boswellic acids involve regulation of both innate and adaptive immune responses. They influence T-cell differentiation, promoting a shift from pro-inflammatory Th1 and Th17 responses toward anti-inflammatory Th2 and regulatory T-cell (Treg) responses. This immunomodulatory effect is particularly relevant for autoimmune conditions and chronic inflammatory disorders.

Boswellic acids also inhibit complement activation, specifically targeting the classical and alternative complement pathways, which contributes to their anti-inflammatory properties. For respiratory health, boswellic acids reduce bronchial inflammation through multiple mechanisms. Beyond leukotriene inhibition, they decrease the infiltration of inflammatory cells into the airways and reduce mucus hypersecretion. They also exhibit bronchodilatory effects by relaxing bronchial smooth muscle, potentially through calcium channel modulation.

In the context of digestive health, boswellic acids protect the gastric mucosa by maintaining the integrity of the mucosal barrier and increasing mucin production. They reduce intestinal inflammation by modulating the gut microbiota composition and enhancing the intestinal barrier function. These effects are particularly relevant for inflammatory bowel conditions like Crohn’s disease and ulcerative colitis. The neuroprotective properties of boswellic acids stem from their ability to reduce neuroinflammation and oxidative stress in the central nervous system.

They inhibit microglial activation and the subsequent release of pro-inflammatory mediators and reactive oxygen species. Boswellic acids also promote the expression of neurotrophic factors such as brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), supporting neuronal survival and function. For skin health, boswellic acids inhibit the activity of human leukocyte elastase (HLE), an enzyme that degrades elastin and contributes to skin aging. They also reduce the expression of pro-inflammatory mediators in keratinocytes and fibroblasts, helping to alleviate inflammatory skin conditions.

The anticancer potential of boswellic acids involves multiple mechanisms. They induce apoptosis (programmed cell death) in various cancer cell lines through both intrinsic (mitochondrial) and extrinsic (death receptor) pathways. Boswellic acids inhibit topoisomerase I and II, enzymes essential for DNA replication in rapidly dividing cells. They also suppress angiogenesis (formation of new blood vessels) by inhibiting vascular endothelial growth factor (VEGF) expression and signaling.

Additionally, boswellic acids inhibit the activity of urokinase-type plasminogen activator (uPA), reducing the invasive and metastatic potential of cancer cells. For liver protection, boswellic acids reduce oxidative stress by enhancing the activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase. They also inhibit the activation of hepatic stellate cells, which play a central role in liver fibrosis. These hepatoprotective effects are particularly relevant for conditions involving liver inflammation and fibrosis.

Boswellic acid dosages vary depending on the extract standardization, specific condition being treated, and individual factors. For standardized Boswellia serrata extracts (typically standardized to 60-65% boswellic acids or 30% AKBA), common dosages range from 300-1200 mg daily, divided into 2-3 doses. Higher potency extracts with increased AKBA content may be effective at lower doses. For enhanced absorption formulations like phytosomes or liposomal delivery systems, dosages are typically 30-50% lower than standard extracts

while maintaining efficacy.

Boswellic acids demonstrate relatively poor oral bioavailability, which is a significant limitation to their therapeutic potential. The absorption of boswellic acids is estimated to be between 15-30% of the administered dose, with considerable variation between different boswellic acid compounds. Acetyl-11-keto-β-boswellic acid (AKBA), often considered the most potent compound, ironically shows the poorest absorption (approximately 15%), while β-boswellic acid and acetyl-β-boswellic acid demonstrate somewhat better absorption rates (20-30%). This limited bioavailability is primarily attributed to their lipophilic nature and poor water solubility, which hinders dissolution in the gastrointestinal fluids.

After oral administration, peak plasma concentrations of boswellic acids are typically reached within 4-5 hours, indicating relatively slow absorption. The compounds undergo extensive first-pass metabolism in the liver, where they are primarily conjugated with glucuronic acid and sulfate, further reducing the systemic availability of free, unconjugated compounds. Studies indicate that only about 10-20% of the absorbed boswellic acids remain in their free, active form after hepatic metabolism. The plasma half-life of boswellic acids ranges from 5-8 hours, necessitating multiple daily dosing for sustained therapeutic effects.

Consuming boswellic acid supplements with a fat-containing meal increases absorption by 30-60% by stimulating bile release and improving solubilization, Phytosome technology, which incorporates boswellic acids into phospholipid complexes, has been shown to increase bioavailability by 3-4 times compared to standard extracts, Liposomal delivery systems can enhance bioavailability by up to 3 times by improving solubility and cellular uptake, Nano-emulsified formulations increase the surface area of boswellic acid particles, enhancing dissolution and absorption rates by up to 200%, Combining with piperine (black pepper extract) may enhance absorption by inhibiting certain detoxification enzymes, potentially increasing bioavailability by 30-50%, Lecithin-based delivery systems improve the solubility and absorption of boswellic acids through enhanced micelle formation, Solid dispersion techniques using hydrophilic carriers like polyethylene glycol or hydroxypropyl methylcellulose can improve dissolution rates and bioavailability, Self-emulsifying drug delivery systems (SEDDS) that form micro or nanoemulsions in the gastrointestinal tract can significantly enhance absorption, Enteric-coated formulations protect boswellic acids from degradation in the stomach and deliver them directly to the intestines where absorption is more favorable, Casperome® (a patented delivery form using phospholipid technology) has demonstrated up to 4 times greater plasma levels compared to standard extracts

For optimal absorption, take boswellic acid supplements with a fat-containing meal rather than on an empty stomach. The presence of dietary fats stimulates bile release, which helps solubilize these lipophilic compounds and enhance their absorption. For inflammatory conditions like arthritis, consistent blood levels are important, so dividing the daily dose into 2-3 administrations (typically morning, midday, and evening) is recommended rather than taking a single large dose. For digestive conditions like inflammatory bowel disease, taking the supplement 30-60 minutes before meals may provide more direct contact with the intestinal mucosa.

When using multiple doses throughout the day, space them evenly (e.g., every 8 hours for a three-times-daily regimen) to maintain consistent blood levels of active compounds. For enhanced formulations with improved bioavailability (like phytosomes or liposomal preparations), twice-daily dosing may be sufficient due to better absorption and potentially longer half-life. When using boswellic acids for respiratory conditions, taking the last dose of the day in the evening may help reduce nighttime symptoms. For individuals using boswellic acids alongside conventional medications, separating the doses by at least 2 hours may reduce the potential for interactions, particularly with drugs that undergo similar metabolic pathways.

Long-term, consistent use is typically required for optimal benefits, with many conditions showing progressive improvement over 4-8 weeks of regular supplementation.

• Mild gastrointestinal discomfort (nausea, abdominal pain, diarrhea)
• Acid reflux or heartburn, particularly with higher doses
• Allergic skin reactions (rare, primarily in individuals with known sensitivity to Boswellia or related plants)
• Headache (uncommon)
• Dizziness (rare)
• Nausea (typically mild and transient)
• Appetite changes (both increased and decreased appetite have been reported)
• Mild diarrhea (more common with higher doses)
• Skin rash (rare)
• Temporary increase in liver enzymes (rare, typically not clinically significant)
• Mild blood-thinning effects (generally not clinically significant at standard doses)

• Known allergy or hypersensitivity to Boswellia or plants in the Burseraceae family
• Pregnancy and breastfeeding (due to insufficient safety data)
• Scheduled surgery (discontinue at least 2 weeks before due to potential mild anticoagulant effects)
• Severe liver disease (due to limited data on safety in this population)
• Severe kidney disease (due to limited data on safety in this population)
• Active gastric or duodenal ulcers (may potentially exacerbate symptoms)
• Autoimmune conditions (theoretical concern due to immunomodulatory effects, though often used beneficially in these conditions under supervision)

• Anticoagulant and antiplatelet medications (warfarin, aspirin, clopidogrel) – potential for additive effects and increased bleeding risk, though generally mild
• Immunosuppressant medications – potential interference with therapeutic effects due to boswellic acids’ immunomodulatory properties
• Medications metabolized by cytochrome P450 enzymes (particularly CYP3A4, CYP2C9, and CYP2C19) – may affect drug metabolism, though clinical significance is generally low
• Anti-inflammatory medications (NSAIDs, corticosteroids) – generally safe to combine but may allow for dose reduction of conventional medications
• Antidiabetic medications – may enhance hypoglycemic effects, requiring monitoring of blood glucose levels
• Antacids – may reduce absorption of boswellic acids if taken simultaneously
• Lipid-lowering medications – potential additive effects on cholesterol levels, generally beneficial but warranting monitoring
• Chemotherapeutic agents – potential interactions, both beneficial (enhanced efficacy) and adverse (altered metabolism), requiring professional supervision

For standardized Boswellia serrata extracts (containing 60-65% boswellic acids), most research suggests that doses up to 1500 mg daily are generally safe for most adults when used short-term (up to 6 months). For long-term use (beyond 6 months), a more conservative upper limit of 1000 mg daily is recommended to minimize the risk of side effects. For extracts standardized to higher AKBA content (30% or more), the upper limit is proportionally lower, typically around 1000 mg daily for short-term use and 750 mg daily for long-term use. Higher doses increase the risk of gastrointestinal side effects without necessarily improving therapeutic outcomes.

For individuals with sensitive digestive systems, starting with lower doses (300-500 mg daily) and gradually increasing as tolerated is recommended. For enhanced absorption formulations (phytosomes, liposomal delivery systems), the upper limit should be reduced by approximately 30-50% due to increased bioavailability.

In the United States, Boswellia serrata extract and boswellic acids are regulated as dietary supplements under the Dietary Supplement Health and Education Act (DSHEA) of 1994. This means they can be marketed without prior FDA approval as long as no specific health claims are made regarding the treatment, prevention, or cure of diseases. Manufacturers are required to ensure their products are safe before marketing and must notify the FDA of any serious adverse events reported by consumers. The FDA has not approved Boswellia or boswellic acids as drugs for any specific indication, and they cannot be marketed with therapeutic claims for treating specific conditions.

Boswellia resin (frankincense) is generally recognized as safe (GRAS) for use as a food flavoring agent under 21 CFR 182.20, though this applies to small amounts used for flavoring rather than the concentrated extracts used in supplements. The FDA has issued warning letters to some companies making drug claims for Boswellia products, particularly those claiming to treat specific diseases like arthritis, asthma, or inflammatory bowel disease.

Eu: In the European Union, Boswellia serrata extract is regulated under the Traditional Herbal Medicinal Products Directive (2004/24/EC) in several member states. The European Medicines Agency (EMA) has established a community herbal monograph for Boswellia serrata, recognizing its traditional use for the relief of minor joint discomfort and for the symptomatic treatment of minor inflammations of the skin. This allows products meeting specific quality and labeling requirements to be registered as traditional herbal medicinal products in EU member states. For food supplements, Boswellia extracts must comply with the Food Supplements Directive 2002/46/EC and Regulation (EC) No 1924/2006 on nutrition and health claims. The European Food Safety Authority (EFSA) has evaluated several health claims for Boswellia serrata but has not approved any specific health claims due to insufficient scientific evidence meeting their standards for substantiation.

Canada: Health Canada has included Boswellia serrata in the Natural Health Products Ingredients Database with a medicinal ingredient monograph. It is approved for use in Natural Health Products (NHPs) with specific guidelines for dosage, contraindications, and warnings. Approved uses include: 1) To help relieve joint pain associated with osteoarthritis of the knee, 2) To help support the health of joints, and 3) To provide antioxidants for the maintenance of good health. Boswellia products must have a Natural Product Number (NPN) to be legally sold in Canada as natural health products. Health Canada has established specific quality requirements for Boswellia products, including standardization parameters for boswellic acid content.

Australia: The Therapeutic Goods Administration (TGA) in Australia regulates Boswellia serrata extract as a listed complementary medicine when used for therapeutic purposes. Products containing Boswellia must be included in the Australian Register of Therapeutic Goods (ARTG) before they can be marketed. The TGA recognizes several traditional and evidence-based indications for Boswellia, including for relief of mild joint pain and inflammation. Specific quality standards must be met, including identification and quantification of key boswellic acids. The TGA has approved certain specific formulations of Boswellia for more targeted health claims based on submitted evidence.

Medium to high, depending on standardization and delivery system

For standard Boswellia serrata extract (typically standardized to 60-65% boswellic acids), the cost ranges from $0.30 to $0.80 per effective daily dose (300-500 mg, three times daily). For higher potency extracts standardized to 30% AKBA, the cost ranges from $0.60 to $1.20 per effective daily dose. Enhanced absorption formulations like phytosomes or liposomal delivery systems typically cost $1.00 to $2.50 per effective daily dose, though

they may require lower total amounts due to improved bioavailability. Proprietary formulations with clinical research backing (such as 5-Loxin® or Aflapin®) generally cost $1.50 to $3.00 per effective daily dose.

Boswellic acid supplements offer good value for specific applications, particularly for inflammatory conditions like osteoarthritis and inflammatory bowel disease. When compared to conventional non-steroidal anti-inflammatory drugs (NSAIDs), boswellic acids provide comparable relief for many individuals with osteoarthritis at a similar or lower monthly cost, with the added benefit of fewer side effects with long-term use. This improved safety profile represents significant value, particularly for individuals who experience gastrointestinal side effects from NSAIDs or who require long-term anti-inflammatory support. For inflammatory bowel conditions, boswellic acids represent a moderate-value option compared to prescription medications, offering a lower cost but typically less potent effects than biologics or immunomodulators.

They may provide best value as complementary therapy alongside conventional treatments, potentially allowing for reduced doses of more expensive medications. The wide variation in product quality significantly impacts cost-efficiency. Low-cost products often contain minimal levels of active compounds or use inferior extraction methods, potentially providing little therapeutic benefit despite the lower price point. Standardized extracts with verified boswellic acid content, particularly those with higher AKBA levels, generally provide better value despite higher upfront costs.

Enhanced absorption formulations (phytosomes, liposomal delivery systems) represent good value despite their premium price, as the improved bioavailability means more active compounds reach the target tissues. These formulations may allow for lower total doses and potentially faster results, improving the overall cost-efficiency. For preventative use or mild inflammation, standard extracts offer reasonable value, while for more severe conditions, the enhanced absorption formulations or proprietary blends with clinical research backing may provide better cost-efficiency despite higher prices. When considering the full economic impact, boswellic acid supplements may offer indirect cost savings by potentially reducing the need for other medications, decreasing healthcare visits for inflammatory conditions, and minimizing lost productivity due to inflammatory pain or discomfort.

Properly stored boswellic acid extracts typically maintain their potency for 2-3 years from the date of production, though this varies by formulation and storage conditions. Standardized extracts in capsule or tablet form generally have a shelf life of 2-3 years when stored according to manufacturer recommendations. Raw Boswellia resin has remarkable stability and can maintain its properties for 5+ years when stored properly, which explains its historical use in long-distance trade. Liquid extracts and tinctures have a shorter shelf life of approximately 1-2 years once opened, due to potential oxidation and microbial contamination.

Enhanced delivery formulations like phytosomes may have slightly shorter shelf lives (1.5-2 years) due to the potential degradation of the phospholipid components. Boswellic acids themselves are relatively stable compounds compared to many other plant constituents, with β-boswellic acid and AKBA showing particular stability under proper storage conditions.

Store boswellic acid products in cool, dry places away from direct sunlight and heat sources, ideally at temperatures between 15-25°C (59-77°F). Capsules and tablets should be kept in their original containers with desiccant packets if provided to protect from moisture. For liquid extracts and tinctures, tightly seal containers after each use to prevent oxidation and evaporation of volatile compounds. Refrigeration is not necessary for most boswellic acid products and may actually cause condensation issues if containers are repeatedly moved between refrigerated and room temperature environments.

Avoid storing near strong-smelling substances as some volatile components in Boswellia extracts may absorb other odors or release their own aroma into nearby products. If transferring products to another container, use dark glass rather than plastic, as some compounds in Boswellia extracts may interact with certain plastics over time. For raw resin, store in airtight glass containers away from heat sources to prevent the volatile components from evaporating and the resin from becoming brittle. Avoid frequent temperature fluctuations, which can cause degradation through repeated expansion and contraction of the product.

Exposure to oxygen – Causes oxidation of boswellic acids and other compounds, gradually reducing their biological activity. This is particularly relevant for liquid extracts and opened containers of capsules or tablets., Light exposure – Particularly UV light, which can degrade boswellic acids and other compounds in the extract. This is why dark glass containers are preferred for storage., Heat – Temperatures above 30°C (86°F) accelerate degradation of boswellic acids and may cause melting or softening of resin-based products. Prolonged heat exposure can also lead to polymerization of certain compounds in the extract., Moisture – Promotes hydrolysis of acetyl groups in acetylated boswellic acids (like AKBA), potentially reducing their potency. Moisture also increases the risk of microbial contamination, particularly in powdered extracts and capsules., Microbial contamination – Can lead to breakdown of active compounds and production of potentially harmful metabolites, particularly in liquid extracts with insufficient preservatives., pH extremes – Boswellic acids are most stable at slightly acidic to neutral pH (5-7). Strongly acidic or alkaline environments can accelerate degradation through various chemical reactions, including hydrolysis of acetyl groups., Enzymatic activity – Residual enzymes from the plant material can continue to catalyze degradation reactions if not properly inactivated during processing., Metal ions – Particularly iron and copper, which can catalyze oxidation reactions of various compounds in Boswellia extracts, accelerating degradation. Contact with metal containers should be avoided., Improper formulation – Incompatible excipients or inadequate stabilizers in the formulation can lead to accelerated degradation of boswellic acids.

Synthesis Methods

Natural Sources

Quality Considerations

Boswellia resin, commonly known as frankincense or olibanum, has one of the most ancient and revered histories of medicinal use, spanning over 5,000 years across multiple civilizations. While the specific boswellic acids were not identified until modern times, the resin containing these compounds has been a cornerstone of traditional medicine systems. In ancient Mesopotamia, some of the earliest recorded medicinal uses of Boswellia resin date back to around 3000 BCE. Sumerian and Babylonian texts mention the use of frankincense for treating wounds, inflammation, and various digestive ailments.

The resin was often burned as incense, with the smoke believed to have purifying and healing properties when inhaled, particularly for respiratory conditions. In ancient Egypt, frankincense was considered sacred and was extensively documented in medical papyri from as early as 1500 BCE. The Ebers Papyrus, one of the oldest and most important medical papyri, mentions frankincense as a remedy for wounds, inflammation, hemoptysis (coughing up blood), throat infections, and as a fumigant to prevent disease. Egyptians also used frankincense in embalming practices, recognizing its preservative properties.

Ancient Indian Ayurvedic medicine, dating back to at least 1000 BCE, incorporated Boswellia serrata (known as ‘Shallaki’ or ‘Salai guggal’) as a key medicinal herb. Ayurvedic texts describe its use for arthritis (particularly Sandhivata or osteoarthritis), inflammatory conditions, pain management, wound healing, and respiratory disorders. It was classified as having ‘Kapha-Vata balancing’ properties, making it particularly valuable for conditions characterized by inflammation, pain, and swelling. Traditional Chinese Medicine, while not native to the Boswellia species, incorporated imported frankincense (known as ‘Ru Xiang’) from at least the 7th century CE.

It was primarily used to ‘activate blood circulation,’ reduce swelling, alleviate pain, and treat traumatic injuries. Chinese medical texts particularly noted its effectiveness for arthritis, menstrual pain, and chest congestion. In ancient Greece and Rome, frankincense was both a valuable trade commodity and a medicinal substance. Hippocrates, Dioscorides, and Galen all documented its medicinal uses, particularly for treating wounds, inflammation, digestive disorders, and respiratory conditions.

Dioscorides’ De Materia Medica (1st century CE) specifically recommended frankincense for cleaning wounds, treating hemoptysis, and as an ingredient in plasters for inflammation. In the Middle East and North Africa, where several Boswellia species are native, traditional Arabic medicine (Unani) incorporated frankincense for treating inflammatory conditions, digestive disorders, respiratory ailments, and skin diseases. The influential Persian physician Avicenna (980-1037 CE) included detailed accounts of frankincense’s medicinal properties in his Canon of Medicine. In traditional African medicine, particularly in regions where Boswellia species grow naturally (Ethiopia, Somalia, Sudan), the resin has been used for centuries to treat infections, inflammatory conditions, fever, and pain.

Local healers would prepare infusions, pastes, or burn the resin for various therapeutic applications. The religious and spiritual significance of frankincense has been intertwined with its medicinal use throughout history. Its mention in ancient religious texts, including the Bible, and its use in religious ceremonies across multiple faiths reflects the high value placed on this substance. This spiritual dimension often complemented its medicinal applications, with healing rituals involving frankincense addressing both physical and spiritual aspects of wellbeing.

The modern scientific understanding of boswellic acids as the primary active compounds in Boswellia resin began in the early 20th century, with significant advances in the 1970s and 1980s when specific boswellic acids were isolated and characterized. This scientific validation of traditional uses has led to standardized extracts focused specifically on boswellic acid content, representing a shift from whole resin preparations to more targeted supplementation. Contemporary interest in boswellic acids has been driven by research confirming their anti-inflammatory mechanisms, particularly 5-lipoxygenase inhibition, which provides scientific rationale for many of the traditional uses of frankincense in inflammatory conditions. This bridge between ancient wisdom and modern pharmacology has established boswellic acids as one of the more thoroughly researched plant-derived compounds with applications spanning both traditional and contemporary medicine.

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. doi:10.1186/s12906-020-02985-6, Abdel-Tawab, M., et al. (2011). Boswellia serrata: an overall assessment of in vitro, preclinical, pharmacokinetic and clinical data. Clinical Pharmacokinetics, 50(6), 349-369. doi:10.2165/11586800-000000000-00000, Cameron, M., et al. (2014). Herbal therapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews, (11), CD002948. doi:10.1002/14651858.CD002948.pub2, Liu, Z., et al. (2019). The efficacy and safety of herbal medicine for rheumatoid arthritis: A systematic review and meta-analysis of randomized controlled trials. Phytomedicine, 57, 27-42. doi:10.1016/j.phymed.2018.12.002

Evaluation of Boswellia serrata extract in patients with mild to moderate ulcerative colitis (ClinicalTrials.gov Identifier: NCT03453892), Efficacy and safety of Boswellia serrata extract in patients with knee osteoarthritis: A randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04193566), Boswellia serrata extract for the treatment of mild cognitive impairment: A randomized controlled trial (EudraCT Number: 2020-001456-18), Effects of Boswellia serrata extract on inflammatory biomarkers in patients with rheumatoid arthritis (ISRCTN Registry: ISRCTN15937589), Comparative efficacy of different Boswellia formulations for osteoarthritis: A multi-arm randomized controlled trial (ClinicalTrials.gov Identifier: NCT04523389)