Curcumin vs Boswellia: what to choose and for whom

Curcumin and boswellia are often advertised as “natural anti-inflammatories”, and it is hard for a buyer to work out which supplement to choose and whether to take both. Our editorial team offers a practical view: for which goals each has more data, how to choose a quality product, which doses were used in studies and who would do better to avoid these supplements.

Frame the task: joints, recovery or “prevention”

The most research on both curcumin and boswellia has been carried out in people with knee osteoarthritis. If your goal is to reduce chronic moderate knee pain with an established diagnosis, both supplements have some grounds for a trial course as an addition to exercise.

But if it is about recovery after training, the picture is different. For curcumin there is a series of small studies on delayed-onset muscle soreness, the results of which are inconsistent. For boswellia there is practically no sports data. In addition, it is worth remembering that moderate inflammation after a workout is part of adaptation, and constantly “quenching” it is not necessarily beneficial.

Taking them “for prevention” without a specific problem is the least justified scenario. For a healthy person with no symptoms these supplements are unlikely to give a measurable benefit, while the risks, though small, remain.

Finally, acute pain, injury, swelling or redness of a joint is a reason to see a doctor. Plant extracts do not treat injuries and do not replace diagnosis.

Whom curcumin may suit

Curcumin is a choice for those who want to try the supplement with the largest volume of clinical research among plant “anti-inflammatories”. The meta-analysis by Daily and colleagues (2016) points to a possible reduction of pain in arthritis, although the studies were small.

It may also interest people who train and want to try to reduce delayed-onset muscle soreness. Here, however, it is worth preparing for a modest and not guaranteed effect and not taking the supplement constantly without need.

The main condition is the right form. Ordinary turmeric as a spice or a cheap extract without improved absorption will give a minimal level of curcumin in the blood. Practically all the positive studies used standardised extracts or forms with improved bioavailability.

Curcumin is less appropriate for people who take many medications, especially anticoagulants, and for those who have liver or biliary-tract disease.

Whom boswellia may suit

Boswellia extract is an alternative for people with osteoarthritis for whom curcumin was not suitable or who want to try an agent with a different mechanism of action. Small randomised studies (Kimmatkar et al., 2003; Sengupta et al., 2008) showed a reduction in pain and an improvement in knee-joint function.

Since the main target of boswellic acids is 5-lipoxygenase, which is linked to the leukotriene branch of inflammation, boswellia has also been studied in inflammatory bowel disease and asthma. However, these directions have been studied even less, and you must not use the supplement on your own for such diagnoses: treatment is prescribed by a doctor.

For people who need to avoid an effect on the gallbladder, boswellia may be a more acceptable option than curcumin, although there is also little data on its long-term safety.

The combination of curcumin and boswellia is found in combined products. In theory the different mechanisms may complement each other, but there is so far little convincing independent research on the advantage of the combination.

• Osteoarthritis, a wish to try a supplement with a larger evidence base — curcumin in a bioavailable form.
• Curcumin intolerance, gallbladder problems — boswellia standardised for AKBA.
• Sports recovery — curcumin only, the effect is modest.

How to read the label and which doses were studied

For curcumin, look for an indication of curcuminoid content (often 95%) and the type of formula: with piperine, a phospholipid complex, a micellar or other form with improved absorption. In studies of standard extracts, 500 to 1500 mg of curcuminoids per day, split into several intakes, were often used; for forms with increased bioavailability the doses are usually lower.

For boswellia, standardisation for boswellic acids, in particular AKBA, is important. Studies used doses from 100–250 mg of AKBA-enriched extracts to about 1000 mg of standard extract per day. It is better to take it with food that contains fat.

Assess the result against clear criteria: pain intensity, morning stiffness, the distance you can walk without discomfort. If there is no change after 2–3 months, it is not worth continuing.

Avoid products with no stated standardisation and “proprietary blends” in which the amount of each component is not disclosed.

Who should better avoid them

People taking anticoagulants (warfarin, direct oral anticoagulants) or antiplatelet agents can start either supplement only after consulting a doctor. This also applies to those who have surgery planned.

In liver disease, curcumin — especially in forms with piperine or increased bioavailability — should be used with great caution: the LiverTox database describes cases of drug-induced liver injury linked to turmeric. Gallstone disease is another reason to avoid curcumin.

Piperine changes the metabolism of many drugs, so people on ongoing medication should choose forms without it or agree on intake with a doctor.

For pregnant and breastfeeding women these supplements are not recommended because of insufficient safety data. Children are also not indicated for them without a doctor's prescription.

Editorial conclusions

If you want to try a plant supplement for osteoarthritis, curcumin in a form with improved absorption has a somewhat broader evidence base, while boswellia standardised for AKBA is a sensible alternative with a different mechanism of action.

For sports recovery there is little data, and “preventive” intake without a specific goal is the least justified.

The main limitations are interactions with anticoagulants and liver and biliary-tract disease.

We also recommend reading “Curcumin or Boswellia: what's the difference”, our review of piperine and bioavailability and the article “Glucosamine vs MSM: what to choose and for whom”.

References

1. Daily JW, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food. 2016;19(8):717–729.
2. Hewlings SJ, Kalman DS. Curcumin: a review of its effects on human health. Foods. 2017;6(10):92.
3. Shoba G, Joy D, Joseph T, et al. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta Med. 1998;64(4):353–356.
4. Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee — a randomized double blind placebo controlled trial. Phytomedicine. 2003;10(1):3–7.
5. Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther. 2008;10(4):R85.
6. Siddiqui MZ. Boswellia serrata, a potential antiinflammatory agent: an overview. Indian J Pharm Sci. 2011;73(3):255–261.
7. National Institute of Diabetes and Digestive and Kidney Diseases. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Turmeric. Bethesda (MD): NIDDK.