Natural Arthritis remedies: Boswellia

Boswellia, also known as Indian Frankincense, is a traditional ayurvedic medicine that has been used for all sorts of conditions from coughs and sores to snakebites and colic, and of course, it has also been used as treatment for arthritis pain, as well. But does it really work? And is there any basis for it working at all?

Generally speaking, these are the critical questions that you must always ask when you are considering taking supplements, like Boswellia, along with added questions of safety and interactions with any current medications/medical conditions that you may be taking, so it's important to always consult with your physician.

It appears that in the case of Boswellia, the answer seems to be that it may in fact, be helpful to some degree with alleviation arthritis pain, even though unlike most arthritis treatments (like NSAIDS for instance, Boswella is neither an anti-pyretic (helps reduce fever) or an analgesic (helps reduce pain topically like a mentholated cream).

Boswellic acid, which is the major constituent, seems to have an anti-inflammatory effect, inhibiting the production of several inflammatory cytokines such as NF-KB and TNF-alpha, which are powerful cytokines that can produce fever, cell death, and sepsis. Likewise, Boswella may help reduce the production of inflammatory molecules called eicosinoids by inhibiting enzyme called 5-lipoxygenase. This may help relieve the pain of osteoarthritis, (1) as eiconosoids modification can be helpful in lessening the pain from arthritis. This is what Omega-3 fatty acids are thought to do, that is they help modify the eiconsoids metabolism/milieu so it is more generally anti-inflammatory.

Still, some skepticism should be applied, if not liberally, as other studies have been less enthusiastic in proclaiming a pain relieving effect. (2) In this study, ASU's (which are derived from soybean and avocado oil) have been shown to be much more effective in the treatment of arthritis pain, which is what I typically recommend for most patients, along with several other supplements and dietary strategies, to help attempt to naturally relieve some of the symptoms of arthritis.

Is Boswella then right for you? Hard to say, really. Although it does not appear to be harmful, it may not be all that helpful compared to some of the other more well known and well-studied supplements available, such as chondroitin, MSM, and glucosamine.  That being said, it may be worthwhile to consider this supplement (under your doctor's supervision is always preferable) if these other more well known supplements fail to help relieve the pain you have.

References: 

Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin(R) for treatment of osteoarthritis of the knee. Arthritis Res Ther. Jul 30 2008;10(4):R85.

Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. Jul 2007;21(7):675-683.

Supplements for arthritis

If you have pain, especially in your hands, and you have been told it's not carpal tunnel syndrome, but rather what you have is arthritis, there are several things that you can do. If it's really bad, surgery is an option. If it's only moderately bad, then a steroid injection can help, but if you are like the majority of patients that I see on a daily basis, then you are neither a candidate for surgery or steroids. 

Most doctors will then put you in the 'not much to do right now' category, and see you when the condition gets worse. But the fact is, when you have pain, most people would like to do something before it actually gets worse, and one of the roads that I recommend to patients is supplements. 

Now, I always say, supplements are only one aspect, that is, one road to take. The others are things like exercise, diet, and ergonomic modfications, but the fact is, supplements do help, and they can help a lot. 

I have written about this before in my other blog, but the information is constantly changing, as new products are coming out and new scientific knowledge is being discovered. 

Here is a update:

The most well known supplements today are:

1. Glucosamine is a supplement which is thought to decrease inflammation in the articular cartilage (the cartilage of joints that move, or articulate, like your knee and thumb, for instance) and it also seems to help prevent degradation of the articular cartilage. Glucosamine is a pre-cursor to molecules known as  glycosaminoglycans, which are part protein and part sugar molecule. GAG's are also known as mucopolysaccharides, and  they are important to joint health because they provide both the lubricating fluid and the cushioning aspect of the joint itself. If you think of it in terms of a car, it's like having the oil for your pistons and shock-absorbers. Studies have shown that Glucosamine appears to effective in helping treat osteoarthritis, and as a result, it is still a popular supplement which I recommend to all of my patients. 
2. Chondroitin sulfate is also a GAG, but it contains sulfur in its structure, which makes it unique. Sulfur is a very important micronutrient for a wide variety of procesess in the body, and it can help a great deal in relieving joint pain. (I have written about it before) In fact, many spa and mineral springs that have been in use for hundreds (and sometimes thousands) of years, have very high sulfur content in their water, suggesting that although the ancients may have not known the exact process by which they were deriving benefits from mineral springs, they were certainly observing results, which is probably one of the reasons why they were (and are in many cases, still) so popular. Chondroitin sulfate is thought to reduce some of the expression of anti-inflammatory substances within the joint thereby relieving joint pain.
3. A combination of glucosamine and chondroitin sulfate.  Although I discussed each of these supplements separately, it is important to note that these supplements are often sold together in combination, and this is because the combination is thought to work synergistically to help alleviate joint pain.
4. A special 'supplement' that deserves mention within this blog is hyaluronic acid, which like Glucosamine and Chondrotion sulfate which can be taken in supplement form, but now is more commonly given alone in the form a joint injection called Synvisc (but there are many other similar brands available). I give Synvisc injections for thumb arthritis pain quite frequently, but it is important to note that since this drug is still under patent, and can be rather expensive. You want to make sure that your insurance plan covers it, and if not, then you can often negotiate a payment plan with affordable rates with your doctor. 
5. Omega 3 fatty acids are essential fatty acids (mostly obtained from fish sources) which are important for a wide variety of function within the body, especially in the development and maintenance and health of neural tissue, but they also help a great deal with joint pain, as they tend to be anti-inflammatory.  Krill oil supplements  appear to be exceptionally helpful for joint pain when combined with hyaluronic acid, as they contain a natural anti-oxidant called astaxanthin, which helps prevent the Omega-3 fatty acids from going rancid, which they frequently do, if they are cheap or not used within a reasonable time frame. Likewise, astaxanthin may have some significant benefits as an anti-oxidant in itself. In either cases, krill oil may be a better choice when choosing Omega-3 supplements, and can help reduce chronic inflammation and joint pain.
6. A relatively new supplement called ASU, has become very popular over the last several years, and has been shown to help alleviate joint very effrectively for many people. ASU stands for avocado and soybean unsaponifiable fractions. It works in many of the same ways that glucosamine and chondroitin do, and can be added to glucosamine and chondroitin to help reduce pain. In regards to its overall safety, in 2002, the Cochrane Review, an independent health organization based in Oxford, England, examined herbal therapies for OA and found conclusive evidence concerning ASU. Specifically, a 2003 study published in the Journal of Rheumatology reported ASU inhibited not only the breakdown of cartilage but also promoted repair within the joint. The French government has tracked ASU’s safety record for more than 15 years and has yet to find any significant problems.