Incense

Frankincense, also known by its Latin name Frankincense and the names Frankincense and Bosewellia, is the natural resin (olibanum) of the frankincense shrub. A distinction is made between the Indian frankincense frankincense serrata and the Arabian frankincense sacra. To obtain the resin, the bark of the trees is scratched, the plant sap that emerges solidifies in the air and forms red-yellowish or brownish grains (1, 2). At normal temperatures, these grains are almost odorless, but when burned they produce a strong aromatic scent. Frankincense cannot be harvested in any quantity.

The plant only thrives in the most extraordinary regions of the world, where hostile desert and rain-bearing mountains meet - its growing conditions are therefore extremely demanding! Today, most frankincense is produced in Oman, Yemen and Somalia. Frankincense is an ancient natural remedy that is also used in spiritual ceremonies. Frankincense has always been used to relieve pain and inflammation, heal joints, improve circulation and much more. Modern science supports many of the traditional uses and reveals other potential benefits.

Traditional uses of frankincense

Frankincense was sacrificed to the oriental gods as long as 7000 years ago. The Egyptians also used frankincense for embalming, as an incense and, above all, for disinfectant purposes. Since ancient times, frankincense has been used in Africa, China, India and the Middle East to prevent and treat a range of diseases, including chronic inflammatory diseases (3). The resin of this plant is traditionally used to treat rheumatoid arthritis and other inflammatory diseases such as Crohn's disease (1). Frankincense serrata, - the incense plant - is one of the most highly valued medicinal plants in the field of Ayurvedic medicine.

In this ancient Indian system of medicine, it was and is used as an anti-inflammatory, arthritis-relieving and pain-relieving agent (4). In traditional Chinese medicine, the frankincense resin of B. carterii is used to improve circulation and relieve pain (3). Frankincense is traditionally used for colic and flatulence. In addition, frankincense is sometimes applied to the skin as an ingredient in hand creams. The essential oil of frankincense is applied to the skin and inhaled as a painkiller. Modern medicine and pharmacology supports some of the anti-arthritis effects, anti-inflammatory effects, pain-relieving effects and liver-protective effects of the frankincense plant (4).

The primary active compounds in frankincense

The four primary boswellic acids found in frankincense resin are responsible for inhibiting pro-inflammatory enzymes (3):

• β-boswellic acid (BA)
• Acetyl-β-boswellic acid (ABA)
• 11-keto-β-boswellic acid (KBA)
• 3-O-acetyl-11-keto-β-boswellic acid (AKBA)

KBA is the most potent anti-inflammatory component of the resin and selectively blocks leukotriene biosynthesis by inhibiting 5-lipoxygenase activity (2). Inflammation in the body is also caused by a specific enzyme (5-lipoxygenase). This enzyme triggers the formation of so-called leukotrienes. Leukotrienes are substances that the body produces during inflammation and are responsible for maintaining chronic inflammation. Clinical studies indicate that the boswellic acids extracted from the resin of the frankincense tree have a strong anti-inflammatory effect on chronic inflammations such as rheumatism and polyarthritis. AKBA has shown the potential to be effective against a large number of inflammatory diseases such as arthritis, bronchial asthma, chronic colitis, ulcerative colitis, Crohn's disease and cancer (3). In addition to boswellic acids, triterpenic acids isolated from frankincense resin (tircuallic acid, lupeolinic acid and roburic acid) also have anti-inflammatory effects (5).

Potential health benefits

Frankincense could relieve osteoarthritis symptoms

In two clinical trials involving a total of 135 osteoarthritis patients, a specific frankincense extract (5-loxin, 100 mg or 250 mg daily for three months) relieved joint pain and significantly improved overall joint functionality. Patients reported significant improvements after only seven days of treatment with the higher of the two doses (6, 7). In addition, different frankincense extracts were able to relieve pain and improve knee function in three studies involving 145 osteoarthritis patients (8, 9, 10). In studies with rats and mice suffering from joint disease, boswellic acid reduced swelling and showed anti-arthritis effects (4).

Frankincense could alleviate symptoms of inflammatory bowel disease

The wound-healing, anti-ulcer and anti-diarrheal properties of frankincense have been valued in the field of traditional medicine for centuries (1, 12). A frankincense serrata oleo-gum extract (BSE) exhibits antioxidant activity and protects the intestinal barrier from damage caused by inflammation (13). This extract was effective in treating 30 patients with chronic colitis with minimal side effects (13). In another study, frankincense serrata resin (350 mg, three times daily for six weeks) improved ulcerative colitis symptoms by 80 to 82% (15). In studies conducted with rats, frankincense showed anti-inflammatory and antioxidant effects, inhibited inflammation in acute colitis and prevented diarrhea (16, 17, 18). However, another study found no benefits of frankincense over a placebo in patients with Crohn's disease - another form of irritable bowel syndrome (19).

Frankincense has skin-protecting effects

A cream containing boswellic acid applied to the face led to significant improvements in photoaging, rough skin and fine wrinkles in a study of 15 women, while improving skin elasticity and reducing sebum production (20). In another study, a frankincense extract (twice daily for 5 weeks) reduced skin redness and irritation caused by radiation therapy. At the same time, this ointment reduced the need for cortisone cream by 60% compared to a placebo (21). In 59 patients with psoriasis, dandruff or skin irritation, the same product soothed the skin and improved symptoms in 50 to 70% of cases (22).

Frankincense could help with breast pain and lumps in the breast

A combination of boswellic acid, betaine and myoinositol relieved breast pain and reduced benign breast lumps in a study of 76 women. The same treatment also reduced the density of the tissue by 60% (23). In another study of 64 younger women, the same combination of active ingredients reduced the volume of benign breast lumps by an average of 18% (compared to 6% with a placebo) (24).

Frankincense could reduce swelling of the brain

In a study of 44 patients with brain tumors, frankincense serrata (4200 mg per day) reduced swelling associated with radiation with a success rate of 60% (compared to 26% with a placebo (25). Administration of 3,600 mg of frankincense extract per day 7 days before surgery reduced the amount of fluid around the tumor by 70% in 8 of 12 patients with brain tumors. Signs of brain damage decreased during treatment (26). In another study, an ethanol extract of frankincense serrata resin reduced swelling of the brain by 22 to 48%. However, crucial details such as the number of subjects in this study are not available (27). The use of frankincense for this indication is still purely experimental and requires strict medical supervision.

Frankincense could alleviate asthma

Frankincense is traditionally valued for its effects on the respiratory system and is used in inhalation solutions, baths and massages to treat coughs, colds, bronchitis and asthma (28). The boswellic acid contained in frankincense is responsible for inhibiting leukotriene biosynthesis and could therefore prevent or reduce inflammation in many chronic diseases such as asthma (29). Frankincense serrata resin improved symptoms of bronchial asthma such as difficulty breathing, wheezing sounds from the lungs and the number of asthma attacks in a study of 40 patients (29).

Frankincense could promote gum health

In a study of 75 girls, extracts and powders of frankincense prevented plaque-induced gingivitis (30).

Frankincense could improve cognitive function

Frankincense is traditionally used to improve learning ability and memory (3). Frankincense papyrifera produced significant improvements in spatial visual memory in 80 patients with multiple sclerosis, but had no effect on verbal memory and speed of information processing (31). Frankincense serrata improved cognition in a study of 38 patients with nerve damage, but did not improve general condition (32). Young rats whose mothers had been treated with frankincense during pregnancy showed improved cognition and an increased volume of hippocampal neurons (33).

In rats with epilepsy, a frankincense extract improved learning ability and eliminated the negative effects of seizures on cognitive function (34). In mice with brain damage, incensol acetate isolated from frankincense resin inhibited brain degeneration and improved cognitive performance (35, 36). Despite the promising preliminary results, further studies are needed to investigate the positive effects of frankincense on cognitive function.

Frankincense could be helpful for diabetes

Frankincense serrata significantly increased blood HDL cholesterol levels after 6 weeks in a clinical study of 69 diabetic patients, while reducing total cholesterol levels, LDL cholesterol levels, fructosamine (sugar) levels and liver enzyme levels (37). In diabetic rats, oral administration of frankincense glabra and frankincense serrata reduced blood glucose levels, cholesterol levels and triglyceride levels and prevented liver and kidney complications (38, 39, 40). In animal models of type 1 diabetes, frankincense extract prevented an increase in blood glucose levels and destruction of pancreatic islet cells (40).

Frankincense could relieve pain

Frankincense serrata increased the pain stimulus threshold and pain tolerance in 12 healthy volunteers (41). In the mouse model, frankincense serrata has also shown pain-relieving effects (42).

Frankincense could relieve headaches

Oral administration of frankincense serrata reduced the intensity and frequency of headaches in four patients with chronic cluster headaches (43). However, this study lacked a control group and the number of subjects was tiny, which is why this study does not allow any really meaningful conclusions to be drawn.

Frankincense could alleviate anxiety and depression

Incensol acetate, a component of frankincense resin, showed anxiolytic and antidepressant effects in a study with mice (44, 45).

Frankincense could have liver-protective effects

Scientists investigated the potential of frankincense serrata extract to prevent liver damage in an animal study (46). Rats suffering from non-alcoholic fatty liver disease and treated with boswellic acid showed increased insulin sensitivity and improved liver function (47). In mice with fibrosis associated with hepatitis, the combined administration of frankincense and sage extracts improved the course of the disease (48). In a study conducted with mice, the eggs of the parasite Schistosoma were used to induce inflammation of the liver. However, frankincense extracts were able to significantly reduce these changes (49).

Frankincense could have anti-cancer effects

In several studies carried out with mice, frankincense serrata and boswellic acids were able to inhibit the growth and metastasis of the following types of cancer (50, 51, 52, 53, 54):

• Colorectal cancer
• stomach cancer
• breast cancer

In test tubes, frankincense and its components were able to kill different types of cancer cells, but this does not necessarily imply the same anti-cancer effects in living organisms (55, 56, 57, 58, 59, 60). All of these results come from studies conducted with animals or cells, so further human studies are needed to draw conclusions about the potential effects in humans. Until then, frankincense supplements should never be used as a substitute for traditional cancer treatment.

Frankincense could promote heart health

Frankincense carteri showed mild cardioprotective and antioxidant effects in animals that had suffered a heart attack (61). In two studies conducted with rats, frankincense also showed blood-thinning effects (62, 63). In another study conducted with rats, β-boswellic acid prevented blood clots and protected blood vessels from injury (64).

Frankincense could protect against microbial infections

Frankincense carterii and frankincense dalziellii showed an effect in the test tube against various microorganisms such as fungi and gram-positive and gram-negative bacterial strains (11, 65).

Viruses

Frankincense serrata resin showed antiviral activity in the laboratory against the mosquito-borne chikungunya virus and the vesicular stomatitis virus (66).

Bacteria

Boswellic acid (AKBA) prevented and reduced biofilm formation by Staphylococcus aureus and Staphylococcus epidermidis bacteria (67). AKBA also showed an inhibitory effect on various caries pathogens tested (68).

Protozoa

Diterpenes in frankincense have been shown to be active against sleeping sickness-inducing Trypanosoma brucei and malaria-causing Plasmodium falciparum (69).

Fungi

Different species of frankincense (frankincense carteri and frankincense papyrifera) were able to fight fungi and frankincense rivae showed the strongest activity against Candida albicans (70).

Frankincense side effects

Frankincense has not shown any serious side effects in studies and is considered safe. Possible side effects are harmless and include (15, 3):

• Nausea
• abdominal pain
• heartburn
• itching
• Skin irritation when applied to the skin

Frankincense has an amazingly low toxicity and can even be used as a food additive in the USA. It is even safe and harmless for pregnant and breastfeeding women in the amounts found in food, while the safety of therapeutic doses for this group of people has not yet been evaluated. An oral toxicity study with repeated oral doses (90 days) of frankincense serrata was conducted in rats and frankincense was found to be relatively safe even at doses of 500 to 1000 mg per kilogram of body weight (71, 72). In a routine toxicity study, frankincense resin and AKBA have shown moderate to low toxicity on the skin (73).

Precautions and warnings

Pregnancy and lactation: Not enough is known about the use of frankincense during pregnancy and lactation. For this reason, pregnant and breastfeeding women should avoid frankincense.

Interactions

At the present time there is no information on interactions of frankincense with medications or supplements.

Dosage

Frankincense is generally taken in the form of tablets, capsules or bark infusion (4). The recommended dosage for inflammatory or asthmatic conditions is 300 to 400 mg of a standardized extract (containing 60% boswellic acid) three times daily (3). Several studies have noted that frankincense has very poor bioavailability and absorption (74, 75, 66). According to some studies, plasma levels of boswellic acid were only measurable when taken orally with a high-fat meal (76).

References

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258268/
2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664784/
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924999/
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309643/
5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074212/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974165/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575633/
8. http://www.ncbi.nlm.nih.gov/pubmed/12622457
9. http://www.ncbi.nlm.nih.gov/pubmed/26076376
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198257/
11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945480/
12. http://www.ncbi.nlm.nih.gov/pubmed/18424019
13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425476/
14. http://www.ncbi.nlm.nih.gov/pubmed/11488449
15. http://www.ncbi.nlm.nih.gov/pubmed/9049593
16. http://www.ncbi.nlm.nih.gov/pubmed/24619538
17. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751779/
18. http://www.ncbi.nlm.nih.gov/pubmed/11355324
19. http://www.ncbi.nlm.nih.gov/pubmed/20848527
20. http://www.ncbi.nlm.nih.gov/pubmed/20136919
21. https://www.ncbi.nlm.nih.gov/pubmed/25967706
22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235203/
23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839963/
24. http://www.ncbi.nlm.nih.gov/pubmed/27212181
25. http://onlinelibrary.wiley.com/enhanced/doi/10.1002/cncr.25945/
26. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.476.3479&rep=rep1&type=pdf
27. https://patents.google.com/patent/US5919821A/en
28. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924999/#ref21
29. http://www.ncbi.nlm.nih.gov/pubmed/9810030
30. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304380/
31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240932/
32. http://www.ncbi.nlm.nih.gov/pubmed/24088189
33. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877965/
34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318003/
35. http://jcb.sagepub.com/content/28/7/1341.long
36. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294134/
37. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929136/
38. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941871/
39. http://www.ncbi.nlm.nih.gov/pubmed/17877290
40. http://www.ncbi.nlm.nih.gov/pubmed/21831620
41. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175880/
42. http://www.ncbi.nlm.nih.gov/pubmed/25312172
43. http://www.ncbi.nlm.nih.gov/pubmed/22767962
44. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493463/
45. http://www.ncbi.nlm.nih.gov/pubmed/23015543
46. http://www.ncbi.nlm.nih.gov/pubmed/16751123
47. http://www.ncbi.nlm.nih.gov/pubmed/25708949
48. http://www.ncbi.nlm.nih.gov/pubmed/23111960
49. http://www.ncbi.nlm.nih.gov/pubmed/23271565
50. http://www.ncbi.nlm.nih.gov/pubmed/24647155
51. http://www.ncbi.nlm.nih.gov/pubmed/23500016
52. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246525/
53. http://www.ncbi.nlm.nih.gov/pubmed/21513768
54. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082612/
55. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538159/
56. http://www.ncbi.nlm.nih.gov/pubmed/26514509
57. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142179/
58. http://www.ncbi.nlm.nih.gov/pubmed/12507932
59. http://www.ncbi.nlm.nih.gov/pubmed/24908637
60. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510738/
61. http://www.ncbi.nlm.nih.gov/pubmed/24856757
62. http://www.ncbi.nlm.nih.gov/pubmed/21771654
63. http://www.ncbi.nlm.nih.gov/pubmed/26117531
64. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4611516/
65. http://www.ncbi.nlm.nih.gov/pubmed/11677023
66. http://www.ncbi.nlm.nih.gov/pubmed/26611396
67. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066120/
68. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201914/
69. http://www.ncbi.nlm.nih.gov/pubmed/21157686
70. http://www.ncbi.nlm.nih.gov/pubmed/17970299
71. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532773/
72. http://www.ncbi.nlm.nih.gov/pubmed/19679457
73. http://www.ncbi.nlm.nih.gov/pubmed/18304763
74. http://www.ncbi.nlm.nih.gov/pubmed/25714728
75. http://www.ncbi.nlm.nih.gov/pubmed/21553931
76. http://www.ncbi.nlm.nih.gov/pubmed/15643550