Frankincense is the dried resin of Boswellia trees, used for thousands of years as incense and in traditional medicine. Today it is taken as a supplement for joint pain and inflammatory conditions, and used as an essential oil. The joint evidence is the most interesting part of it.
What is Frankincense?
Frankincense is the hardened resin tapped from Boswellia trees — chiefly Boswellia serrata in India, and Boswellia sacra and carterii in Arabia and the Horn of Africa. Cut the bark and the tree exudes a milky sap that hardens into pale “tears”.
It is sold as resin for burning, as an essential oil distilled from the resin, and as standardised extracts in capsules — often labelled Boswellia serrata extract rather than frankincense.
It is a herbal supplement and aromatic product, not a registered medicine, so it does not appear in the South African Medicine Price Registry.
The compounds of interest are the boswellic acids, particularly AKBA (acetyl-11-keto-β-boswellic acid). These inhibit 5-lipoxygenase, an enzyme in a different inflammatory pathway from the one NSAIDs block. That mechanism is genuine and reasonably well characterised, and it is why boswellia has attracted more serious research than most herbal remedies.
An important distinction: the essential oil is distilled and contains the volatile aromatic compounds. Boswellic acids are not volatile, so they are largely absent from the essential oil. The oil smells of frankincense; it is not the anti-inflammatory preparation. If you are taking it for joints, you need a standardised oral extract, not the oil.
What is Frankincense commonly used for?
- Osteoarthritis, particularly knee osteoarthritis — the best-supported use.
- Rheumatoid arthritis, as an adjunct.
- Inflammatory bowel disease, where small studies have looked at ulcerative colitis and Crohn’s.
- Asthma, on the same anti-inflammatory rationale.
- General inflammatory conditions and joint pain.
- Aromatherapy and meditation, burning the resin or diffusing the oil — its oldest use by far.
- Skincare, in oils and creams.
- Religious and ceremonial use, across many traditions.
Where the evidence stands, honestly:
Osteoarthritis is where it is strongest. Several randomised trials of standardised Boswellia serrata extract in knee osteoarthritis have shown improvements in pain and function, with reviews finding it more effective than placebo. The trials are mostly small, several are industry-funded, and durations are short — so it is promising and worth trying, not established. Even so, that is a considerably better position than most herbal supplements occupy.
Inflammatory bowel disease and asthma have small, encouraging studies and no firm conclusion.
Most other claims rest on tradition and laboratory work.
What it is not is a replacement for treatment of inflammatory arthritis. Rheumatoid and psoriatic arthritis damage joints permanently if uncontrolled, and what prevents that is disease-modifying treatment — methotrexate, sulfasalazine or a biologic. A supplement that eases pain while joint damage accumulates is a poor trade, and the damage is silent.
Who commonly looks for Frankincense and why
- People with osteoarthritis, looking for something to add or something gentler than NSAIDs.
- People who cannot take anti-inflammatories because of stomach, kidney or heart problems — a substantial group, and the one for whom the osteoarthritis evidence is most relevant.
- People with rheumatoid arthritis, seeking an adjunct.
- People with inflammatory bowel disease.
- People interested in aromatherapy, or using it in meditation and religious practice.
- People using it in skincare.
- People sold expensive essential oil blends with therapeutic claims — for whom the oil-versus-extract distinction above is the useful thing to know.
What to check on the label before taking Frankincense
- Whether it is a standardised extract. Look for Boswellia serrata extract with a stated boswellic acid percentage, ideally including AKBA. “Frankincense powder” without standardisation tells you nothing.
- The dose per capsule, and how it compares with trial doses — typically several hundred milligrams of standardised extract daily, often divided.
- Whether it is oil or extract. For joints you want the oral extract. The essential oil contains little or no boswellic acid.
- Whether it is a blend with other herbs, each carrying its own interactions.
- Third-party testing, particularly for heavy metals — resins and plant extracts can concentrate contaminants.
- The manufacturer, with a contactable South African distributor.
- For essential oil: that it is intended for topical or diffuser use, and never for swallowing. Essential oils are concentrated and are not taken internally without expert direction.
Safety, interactions and when to seek professional advice
Oral boswellia extract is generally well tolerated in trials. Reported effects include nausea, acid reflux, diarrhoea, abdominal discomfort and occasionally skin rash.
Speak to a doctor or pharmacist before taking it if you:
- Take warfarin or another blood thinner, or anti-inflammatories — boswellia may affect platelet function and bleeding risk.
- Take medicines processed by liver enzymes, since boswellic acids can affect some of these — including immunosuppressants and some cancer treatments.
- Are pregnant or breastfeeding. Avoid it — frankincense has traditionally been used to stimulate menstruation, and safety in pregnancy is not established.
- Have an autoimmune condition and take immunosuppressants.
- Are due for surgery — stop it beforehand because of the bleeding consideration.
- Have liver disease.
- Are giving it to a child.
For the essential oil specifically:
- Always dilute it in a carrier oil before applying to skin. Undiluted essential oils cause irritation and sensitisation.
- Patch test before wider use.
- Do not swallow it.
- Keep it away from eyes and mucous membranes, and out of reach of children — essential oils are dangerous if swallowed by a child.
- Ventilate when diffusing, and take care around people with asthma, where aerosols and smoke can trigger symptoms.
- Burning resin produces smoke. In an unventilated room that is a genuine respiratory irritant, particularly for children, older people and anyone with lung disease.
Stop and seek advice for persistent stomach upset, a rash, unusual bruising or bleeding, or yellowing of the skin or eyes.
See a doctor rather than self-treating if joints are swollen, hot, stiff for more than 30 minutes in the morning, or if several joints are affected symmetrically — that pattern suggests inflammatory arthritis needing proper treatment, not a supplement. Also for any joint that is hot, red and very painful with fever, which needs urgent assessment.
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Frequently asked questions
What is frankincense used for? As a supplement, mainly for osteoarthritis and inflammatory joint pain. It is also used as incense, in aromatherapy and in skincare.
Does it actually work for arthritis? For knee osteoarthritis, several trials of standardised Boswellia serrata extract have shown better pain and function than placebo. The studies are small and short, so it is promising rather than proven — but that is stronger evidence than most herbal supplements have.
Is the essential oil the same as the supplement? No, and this matters. Boswellic acids are not volatile, so they are largely absent from the distilled oil. For joints you need a standardised oral extract.
What should I look for on the label? Boswellia serrata extract with a stated boswellic acid percentage, ideally including AKBA, and a dose comparable to those used in trials.
Can I take it with my arthritis medicine? Ask first, particularly if you take blood thinners or anti-inflammatories. And it does not replace disease-modifying treatment in rheumatoid arthritis.
Can I use it in pregnancy? Avoid it. Frankincense has traditionally been used to stimulate menstruation and its safety in pregnancy is not established.
Can I swallow the essential oil? No. Essential oils are concentrated and are not taken internally without expert direction. Keep them away from children.
Is burning the resin safe indoors? Ventilate the room. The smoke is a respiratory irritant, particularly for children, older people and anyone with asthma or lung disease.