Who should not take Boswellia
Boswellia is among the supplements with a generally favorable safety profile, but 'natural' does not mean 'suitable for everyone'. There are conditions and situations in which its use should be postponed or agreed with a doctor. The editors have systematized the contraindications and precautions, drawing on clinical data and review sources.
Absolute restrictions
An absolute contraindication is a confirmed allergy to boswellia or other components of the product. If contact with frankincense - in the form of an ointment, essential oil or smoke - previously caused a rash, itching or swelling, you should not take the supplement internally.
People allergic to other plant resins, in particular myrrh from the same Burseraceae family, should also be cautious because of possible cross-sensitivity. In such cases it is advisable to consult an allergist.
The same category can include people who previously developed signs of liver damage while taking boswellia supplements. Taking it again in such a situation is unacceptable.
Finally, you should not take products whose composition is not fully disclosed: if you cannot verify exactly what and in what dose is in the capsule, you also cannot assess the risks.
Pregnancy, lactation and children
The safety of boswellia during pregnancy and breastfeeding has not been studied in controlled trials. In traditional medicine there are mentions of a possible effect of the resin on pelvic blood circulation, although there is no scientific confirmation of this. In the absence of data, the general principle of caution means avoiding the supplement.
The same applies to the period of pregnancy planning, if a woman is taking any supplements without agreeing them with an obstetrician-gynecologist. It is better to discuss with your doctor the full list of products you use.
As for children and adolescents, clinical data are very scarce. Individual studies in inflammatory bowel disease or asthma in childhood do not provide grounds for independent use. Children may be given the supplement only as prescribed by a doctor.
For young athletes who complain of joint or tendon pain, examination comes first: during growth such symptoms may be a manifestation of apophysitis or other conditions that require adjusting the load rather than supplements.
Conditions that require caution
There are a number of conditions in which use is possible only after consulting a doctor. The editors have summarized them in a table.
| Condition | Why caution is needed | Recommendation |
|---|---|---|
| Liver disease | Isolated reports of hepatotoxicity of boswellia supplements | Only with a hepatologist's consent, with monitoring of liver function tests |
| Gastritis, peptic ulcer disease, GERD | The most common side effects are gastrointestinal | Take with food, monitor, consult a gastroenterologist |
| Autoimmune diseases | Possible effect on immune processes, interaction with therapy | Discuss with a rheumatologist or another treating physician |
| Blood clotting disorders | Theoretical effect on platelet aggregation, data are contradictory | Avoid without a doctor's approval |
| Planned surgery | Uncertain effect on bleeding and anesthesia | Inform the surgeon; usually discontinue in advance |
It is especially important not to replace prescribed treatment for chronic inflammatory diseases - rheumatoid arthritis, Crohn's disease, ulcerative colitis, asthma - with boswellia. Although boswellia has been studied in these conditions (for example, Gerhardt et al., 2001; Gupta et al., 1998), the evidence is insufficient to replace standard therapy.
Stopping baseline medications on your own in favor of a supplement can lead to a flare-up of the disease with serious consequences. If you are interested in boswellia as an addition, discuss it with your doctor.
Taking medications and interactions
Laboratory studies have shown that boswellia extracts can inhibit some cytochrome P450 enzymes (Frank and Unger, 2006) and also affect transport proteins. In humans the clinical significance of these effects has not been established, but theoretically changes in drug concentrations are possible.
The greatest attention should be paid to drugs with a narrow therapeutic window, where even a small change in concentration matters. These include some anticoagulants, immunosuppressants after transplantation, antiepileptic drugs, and certain antiarrhythmic drugs.
- Anticoagulants and antiplatelet agents - a theoretical risk of enhanced action and bleeding.
- Immunosuppressants - possible changes in metabolism and an effect on the immune response.
- NSAIDs - summation of gastrointestinal side effects, difficulty in assessing the effect.
- Any drugs with a narrow therapeutic window - a risk of changes in concentration.
Practical rule: if you take prescription drugs on an ongoing basis, tell your doctor or pharmacist of your intention to start taking boswellia, even if you consider the supplement harmless.
Sport and special situations
Boswellia itself is not on the WADA Prohibited List. However, for athletes subject to doping control there is a risk of supplement contamination with prohibited substances, which the IOC consensus on dietary supplements warns about (Maughan et al., 2018). So it is worth choosing products with independent certification.
People preparing for elective surgical interventions, in particular arthroscopy or joint replacement, should inform the surgeon and anesthesiologist about all supplements. They are usually advised to discontinue them in advance.
If joint pain is accompanied by swelling, redness, fever or arose after an injury, diagnosis is needed. A supplement must not mask symptoms that require treatment.
Elderly people who take many drugs at once are especially sensitive to interactions. For them, consulting a doctor before starting is especially important.
Editors' conclusions
Boswellia should not be taken if you are allergic to it or to related resins, during pregnancy and breastfeeding, and children should take it only as prescribed by a doctor.
People with liver diseases, gastrointestinal tract diseases, autoimmune conditions, blood clotting disorders, and before surgery need a prior consultation.
Special attention is required for the combination with anticoagulants, immunosuppressants and other drugs with a narrow therapeutic window.
We also recommend reading our articles 'Side effects of Boswellia', 'How to take Boswellia: dosage, timing, duration' and 'Boswellia: what it is and how it works'.
References
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Boswellia. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases.
- Frank A, Unger M. Analysis of frankincense from various Boswellia species with inhibitory activity on human drug metabolising cytochrome P450 enzymes using liquid chromatography mass spectrometry after automated on-line extraction. J Chromatogr A. 2006;1112(1–2):255–262.
- 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.
- Gupta I, Gupta V, Parihar A, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res. 1998;3(11):511–514.
- Ammon HPT. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100–1116.
- 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.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
