NSAIDS—Is chronic use for arthritis worth the consequences?
Boswellia supplements fight pain without harmful side effects

American arthritis patients are eliminating non-steroidal anti-inflammatory drugs (NSAIDs) from their medicine cabinets in response to burgeoning evidence that Advil, Aleve and Celebrex increase risks of strokes, heart attacks and GI issues. Many are switching to clinically proven, side-effect-free natural painkillers like Boswellia (also known as Indian frankincense).

Chronic pain holds hostage 54 million Americans with osteoarthritis, rheumatoid arthritis and gout who require daily or near daily relief. Traditionally, that support is pursued in non-prescription or prescription pharmaceutical pills that all have harmful side effects.1

For centuries, nature has provided its own pharmacy for relief of pain, virtually without side effects. With a healthier future in mind, many Americans are now turning to natural alternatives, like Boswellia, an ancient herb proven in modern studies to equal and exceed the effectiveness of NSAIDS. Though there are many brands of over-the-counter (OTC) pain relievers available in generic form, there are two basic types:

  1. Acetaminophen (such as Tylenol) and

  2. NSAIDs, (such as aspirin (Bayer), ibuprofen (such as Motrin and Advil) and naproxen (such as Aleve).

Some NSAIDs are also sold by prescription, like Celebrex. In an analysis of 31 studies, ibuprofen increased the risk of heart attacks the most, and increased the risk of stroke threefold.1A

Americans take these painkillers to treat headaches, backaches and arthritis, often without realizing their dangerous side effects. In addition to non-aspirin NSAIDs that significantly increase the risk of strokes and heart attacks, these medicines cause stomach bleeding, ulcers, liver problems and asthma attacks and death. Long-term use increases all risks and can lead to kidney problems and potentially kidney failure.2

Reacting to mounting research that points to increased cardiovascular risk, the Food and Drug Administration (FDA) required stronger Boxed Warning wording in 2015 (updated from 2005 warnings) on outer packages for all non-aspirin prescription and non-prescription NSAID products.3

NSAIDS are not designed for chronic conditions requiring long term use

NSAID use is intended for mild to moderate pain with treatment limited to three days for fever and headaches and not more than ten days without a health care provider’s recommendation. Studies show heart and gastrointestinal risks are greater with long term use required to reduce inflammation for chronic pain conditions like osteoarthritis or rheumatoid arthritis.

The term non-steroidal distinguishes these drugs from steroids, which while having a similar eicosanoid-depressing, anti-inflammatory action, have a broad range of other effects. First used in 1960, the term served to distance these medications from steroids.

NSAIDs work by inhibiting the activity of COX-1 and/or COX-2 enzymes. In cells, they are involved in the synthesis of key biological mediators, namely prostaglandins, which are involved in inflammation and thromboxanes, which are involved in blood clotting. Most of these drugs are non-selective, meaning they inhibit the activity of both COX-1 and COX-2. Selective non-steroidal drugs inhibit only COX-2, which makes them easier on the stomach.

Led by over-the-counter medications like ibuprofen, naproxen and aspirin, more than 30 billion doses of NSAIDs are consumed every year in the United States alone. This widespread intake results in more than 100,000 hospitalizations annually for gastrointestinal complications, according to research in American Journal of Managed Care (AJMC).4

Clinical studies show Boswellia (frankincense) effectiveness equals NSAIDs

If you could achieve the relief you need safely, without total reliance on drugs, wouldn’t it be worth a try?

For centuries, nature has contained the answers for pain relief. There are many botanical and herbal substances that have proven effective and safe.

Boswellia (Indian frankincense) is a botanical substitute for NSAIDs. Its effectiveness has been recognized even in modern

medical circles. It has been the subject of numerous studies for various causes of pain, particularly for the joint discomfort and pain from arthritis.

Osteoarthritis is the most studied health issue for the use of Boswellia. In general, Boswellia-containing dietary supplements have been shown to reduce pain (by up to 30-65 percent), reduce knee joint swelling, increase walking distances, increase knee flexion, and increase overall activity levels. Boswellia for rheumatoid arthritis has been less studied, and while found helpful, is lacking significant positive results.

Double blind placebo-controlled trials using Boswellia serrata for osteoarthritis of the knee were published in Phytomedicine (2003) and the Indian Journal of Pharmacology (2006). Significant improvements in pain scores and physical function were reported for each study, including decreases in morning stiffness and decreased difficulty performing daily activities. There were.no radiological changes.5,6

Arthritis Foundation cites strong anti-inflammatory properties of Boswellia

Boswellia (frankincense) is a gummy resin derived from the Boswellia serrata tree, a large branching tree native to the area of India. The resin is extracted by tapping. The emission is then purified into a powder and standardized to acetyl-keto-boswellic acid (AKBA), which is considered a primary active component of the tree resin. It has been used as a traditional medicine for thousands of years to help modulate inflammatory response.7

The Arthritis Foundation acknowledges that the strong anti-inflammatory and analgesic properties of boswellic acids may also help prevent cartilage loss and inhibit the autoimmune process., They advocate frankincense as a potential therapy for rheumatoid arthritis (RA) in addition to osteoarthritis (OA).8

They cite two additional studies in 2008 that used frankincense/Boswellia as treatment for OA:

  • The first was a double blind, randomized, placebo-controlled trial published in Arthritis Research & Therapy where a supplement component called 5-Loxin (enriched with 30% AKBA) significantly improved OA pain and function within seven days and slowed cartilage damage after 3 months.9

  • The second was a systematic review published in the British Medical Journal (BMJ) which found Indian frankincense/Boswellia safe and effective for both OA and RA, though results of RA trials have been mixed.10

Additional studies support effectiveness of Boswellia in lieu of NSAIDS

In 2010, a double-blind randomized, placebo-controlled clinical study compared two derivative AKBA compounds from Boswellia serrata--5-Loxin and Aflapin--for 60 knee osteoarthritis patients who received either 100mg of the two mixtures or placebo for 30 days. Both Boswellia serrata preparations improved pain and physical function significantly. The study was published in the International Journal of Medical Sciences.10A

In May 2011, a research overview confirmed the potential anti-inflammatory properties of Boswellia serrata, published in the Indian Journal of Pharmaceutical Sciences. The resin extracts of the herb have been traditionally used for centuries to treat various chronic inflammatory diseases. The resin possesses four major boswellic acids. Of primary interest from the four is acetyl-11-keto-beta boswellic acid (AKBA). It is the most potent inhibitor of 5-lipoxygenase (5-LOX), an enzyme responsible for inflammation.11

In October 2011, results of a double-blind placebo-controlled study were published in the International Journal of Medical Sciences from a 30-day trial which assessed the effectiveness of AKBA boswellic acid in Aflapin for managing symptoms of osteoarthritis. There were 60 study participants who received either placebo or 100 mg Boswellia serrata, which was found to significantly improve pain and physical function in as few as 5 days.12

Choose carefully. Popular botanical supplements are sometimes contaminated

Boswellia is an herb. With millions of people using medicinal plants worldwide, the market of herbal supplements is witnessing a steady growth. Recent data indicate that in 2012, 17.9 percent of all U.S. adults used botanical supplements13 In Germany, 90 percent of the people use natural medicines at some time during their life and over 50 percent of the population has done so in other European countries.14,15

Thus, the global market for herbal dietary supplements or phytomedicines, estimated at approximately $60 billion U.S. in 2000, increased dramatically to over $100 billion U.S. by 2017.16

At the same time, episodes of contamination (with insecticides, pesticides, synthetic drugs, heavy metals) or adulteration (substituting one plant for another either purposefully or through misidentification) have been frequently reported, resulting in increased concerns about the safe, effectiveness and quality of herbal products.17

2016 survey finds lack of quality in some top-selling boswellia supplements

In consideration of the increasing popularity of frankincense as a substitute for NSAIDs, and the widely published quality problems associated with botanical dietary supplements, a survey was conducted for the first time on the quality of botanical dietary supplements containing the herb.

Six U.S. products representing 78% of the units sold and 11 European products representing 30% of the units sold were tested for their boswellic acid composition profile, label compliance, and claimed health benefits.

Twelve products out of seventeen (71%) did not disclose all relevant label information for the Boswellia extract (the species, part of plant used, and boswellic acid content). When tested, one product from Italy did not contain any of six characteristic boswellic acids at all, and one US product contained only traces, suggesting the absence of frankincense, or the use of inferior Boswellia frereana instead of serrata.

Three of the six U.S. products (50 percent) did not make declaration of the boswellic acids content and 41 per cent of the products tested overall did not comply with their label declarations. Survey authors said in addition that consumers could be misled by outdated literature or references to in vitro studies performed at dosages that can never be achieved in humans following oral administration.

The authors summarized: “This survey reveals that in spite of increased regulation on botanical dietary supplements, the problem of mislabeling still exists and needs to be addressed by the manufacturers, so that consumers get greater confidence in the botanical dietary supplements they use.”

Four of the six U.S. products were formulated for joint health issues. The survey was published in the international peer-reviewed journal Planta Medica in April 2016.18

Two ‘beyond organic’ trusted Boswellia supplements for pain and joint health

Clearly, Boswellia is a drug-free way to fight pain and improve joint comfort without depending upon NSAIDs. The AKBA standardized extract is considered the primary active component of the tree resin. Make sure from the label that AKBA is present whenever purchasing a Boswellia product.

Studies show that AKBA may prevent inflammation by inhibiting synthesis of pro-inflammatory substances and reduce pain and improve function in osteoarthritis of the knee.19

To avoid the side effects and lack of effectiveness of NSAIDs, two pain relief dietary supplements containing Boswellia serrata AKBA can be trusted for safety and efficacy:

  1. A pain relief complex substitute for NSAIDS. Contains 1000 mg per serving clinically-proven blend of Boswellia serrata AKBA (standardized to 40% boswellic acids), using a complementary, patented blend of 150 mg safflower extract. A pain reliever that provides flexibility and overall comfortable movement. Unlike NSAIDs, it is gentle on the stomach. It contains no aspirin, is gluten free, has no artificial flavors, sweeteners, colors or preservatives added.

  2. A joint health complex that contains 1500 mg vegetarian glucosamine blend that contains a unique, patent-pending fast-acting form of 100 mg Boswellia extract (AKBA) that has been shown in a clinical study to significantly improve joint comfort in as few as five days and supports long-term joint health.12, 20

Both products are treatment alternatives to NSAIDs for arthritis. They were introduced in 2003 by the leading natural nutrition company in the U.S., in business since 1956. They are obsessed with product purity (safety), potency and performance. They are 100% science-grounded. They voluntarily conduct clinical studies on their own products (not required in dietary supplement industry by current Good Manufacturing Practices (cGMP) FDA regulations. They conduct over 350 quality control tests on all raw ingredients. They are ‘beyond organic’. Their product portfolio is not inexpensive, but their consumers never worry about safety, contamination, label deviation, or efficacy. They are the gold standard in their industry.

Clinical study: one joint health Boswellia supplement knees leading brands

The Boswellia extract in the above joint health supplement works 28 percent faster than claimed by national leading brands. A 90-day clinical study compared vegetarian Advanced Joint Health Complex to best-selling Osteo Bi-Flex®, Nature Made® Triple Flex, and Schiff® Move Free®. Participants were asked to rate their level of comfort and ease of motion before and after taking joint health products. Results showed the Boswellia extract in New Advanced Joint Health Complex® scored significantly better than the Boswellia extract in Osteo Bi-Flex® in both categories—45 percent better joint comfort; 31 percent better ease of motion.12

The competing brands all contain chondroitin and glucosamine sourced from shellfish. Nature Made® also includes artificial colors, as of label comparisons updated June 12, 2017. These products are drug-free answers for those who worry about continued use of NSAIDs long-term.

The comparison of brands study was conducted July 15 2011.20


Sources/References

1 Arthritis by The Numbers, a .PDF Book of Facts and Trusted Figures, 2018 Edition, Arthritis Foundation;accessed 5-31-2018 https://www.arthritis.org/Documents/Sections/About-Arthritis/arthritis-facts-stats-figures.pdf
1A Study Common painkillers linked to increased risk of heart problems Source: BMJ/ScienceDaily, January 12, 2011 https://www.sciencedaily.com/releases/2011/01/110111184132.htm
2 Davis, J; Watson, S; Article, NSAIDS and the Risk of Heart Problems and Stroke, Arthritis Foundation, accessed online May 28, 2018. https://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/nsaids/nsaids-heart-attack-stroke-risk.php
3 Safety Announcement, FDA strengthens warning that non-aspirin NSAIDs can cause heart attacks or strokes, July 9, 2015. Accessed May 28, 2018. https://www.fda.gov/Drugs/DrugSafety/ucm451800.htm
4 Fine, M.,MD; Study, Quantifying the impact of NSAID-associated adverse events—Hidden Costs, journal AJMC, November 20, 2013 http://www.ajmc.com/journals/supplement/2013/a467_nov13_nsaid/a467_nov13_fine_s267?p=2
5 Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a random-ized double blind placebo controlled trial. Phytomedicine. 2003 Jan;10(1):3-7. PMID: 12622457.
6 Sontakke, S., Open, randomized, controlled clinical trial of Boswel-lia serrata extract as compared to prescription valdecoxib (Bextra, later re-moved from market) in osteoarthritis of knee: October, 31, 2006. Indian Journal of Pharmacology; 2007, Volume 39, Issue 1, Pgs 27-29 http://www.ijp-online.com/article.asp?issn=0253-7613;year=2007;volume=39;issue=1;spage=27;epage=29;aulast=Sontakke
7 Natural Arthritis Treatments, Arthritis Foundation, accessed online May 28, 2018 https://www.arthritis.org/living-with-arthritis/treatments/natural/
8 Indian Frankincense, Arthritis Foundation, accessed online May 28, 2018 https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/guide/indian-frankincense.php
9 Sengupta K, et al., study, Efficacy and safety of 5-Loxin AKBA Boswellia extract resin for treatment of osteoarthritis of knee, journal Arthritis Research & Therapy, July 30, 2008, https://doi.org/10.1186/ar2461
10 Ernst, E., study, Frankincense:systematic review, British Medical Journal (BMJ), BMJ 2008; 337:a2813December 18, 2008, https://doi.org/10.1136/bmj.a2813
10A Sengupta, K et al, study Comparative efficacy and tolerability of boswellic acids against osteoarthritis of the knee. International Journal of Medical Sciences, November 2010.
11 Siddiqui, M.Z. Overview: Boswellia serrata, a potential anti-inflammatory agent; Indian Journal of Pharmaceutical Sciences, May 2011; 73(3);255-52, PubMed PMID 22457547
12 Vishall, A et al. Study, Early efficacy of Aflapin in patients with osteoarthritis of the knee. International Journal of Medial Sciences, October 12, 2011.
13 Peregoy JA, Clarke TC, Jones LI, Stussman BJ, Nahin RL. Regional variation in use of complementary health approaches by U.S. adults. NCHS Data Brief 2014; 146: 1–8
14 World Health Organization. Traditional medicine. Media Centre Fact Sheet N°134. Available at http://www.who.int/ Accessed 5-31-2018
15 World Health Organization. National policy on traditional medicine and regulation on herbal medicine. Report of a WHO global survey. Geneva: World Health Organization; 2005
16 Global Industry Analyst, Inc. Report: Herbal supplements and remedies – global strategic business report. https://www.thieme-connect.com/products/ejournals/linkout/10.1055/s-0042-103497/id/RZ1001-4 Accessed 6-1-2018.
17 Moraes CDF, Still DW, Lum MR, Hirsch AM. DNA-based authentication of botanicals and plant-derived dietary supplements: where have we been and where are we going? Planta Med 2015; 81: 687–695
18 Meins, J et al, study introduction Survey on the Quality of Top-selling European and American botanical dietary supplements containing boswellic acids. journal , 2016 Apr; 82(6):573-9. doi: 10.1055/s-0042-103497. Epub 2016 Apr 7. https://www.ncbi.nlm.nih.gov/pubmed/27054914
19 Ingredient glossary, Boswellia, Health Resources website, Shaklee Corpora-tion, accessed June 1, 2018. http://healthresource.shaklee.com/Ingredients/boswellia/?pws=arthritisrelief.myshaklee.com
20 Product bulletin, New Advanced Joint Health Complex, Shaklee Corporation, http://www.shaklee.net/pws/library/products/20281_jointhealthbulletin.pdf


Health statements on this NSAIDS page have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease








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