Boswellia serrata (also known as Indian Frankincense, or olibanum) is a relatively small tree that is native to much of the arid regions of India. In traditional use the tree trunk is tapped, releasing a gummy sap or "oleoresin," called a "guggal" in Ayurvedic tradition of medicine. Any resin that is collected in this manner is called a guggal. It is from this naming convention from which the traditional name, "salai guggal" comes.

The oleoresin contain essential oils, terpenoids and boswellic acids. It is the boswellic acids that are believed to be the active components.¹ In several studies these boswellic acids have been found to have anti-inflammatory activity similar to that of the non-steroidal anti-inflammatory drugs (NSAIDs) used in conventional medicine.^2,3 However, unlike NSAIDs, boswellia does not seem to cause stomach irritation or ulceration.⁴ In fact, one small study found that boswellia may actually be helpful in the treatment of ulcerative colitis. ⁵

Boswellia has been used in Indian Ayurvedic medicine for centuries, perhaps millennia by some accounts.⁶ While boswellia has had many benefits attributed to it in that time, it is boswellia's uses as an anti-inflammatory, anti-arthritic, and analgesic that have garnered the most attention in Western medicine. After previous studies had found boswellia more effective than placebo, the Indian government funded research on boswellia in a comparison study against a type of NSAID know as a selective Cyclooxygenase 2 (COX-2) inhibitor.⁷ Selective COX-2 inhibitors are the latest class of anti-inflammatory drugs that have been found to high effective, but which most have more recently been shown to cause serious cardiac risk.

The researchers in this study stated in conclusion that "in terms of safety, efficacy and duration of action, the present study shows that [Boswellia serrata extract] was superior to valdecoxib, except for the slower onset of action compared to valdecoxib."⁸

Bromelain

Bromelain is a group of enzymes extracted primarily from the stem of a pineapple, a member of the bromeliad (Bromeliaceae) family of plants. While bromelain is also in the delicious flesh of the pineapple it is only available in low levels, but don't let that stop you from enjoying a pineapple! While some enzymes cannot survive in the stomach, bromelain seems to survive with little problem.⁹

Bromelain reportedly reduces the swelling from sports injuries, post-operational surgery, allergic rhinitis, and traumatic injury. It also reduces knee pain and ulcerative colitis among it's long list of uses.^10,11,12,13 The mechanism by which it works seems to be related to its constituents' ability to inhibit platelet aggregation and it may be able to alter leukocyte response and activation.¹¹ Bromelain is activated by magnesium and two of the other compounds in this formulation, trypsin and rutin, appear to work synergistically to accentuate its effects, specifically in regard to reduced knee and hip pain associated with the normal age-related deterioration of the joints. ^11,14,15,16

Curcumin is the active constituent in the spice turmeric that gives the spice, and the many "curry" dishes which it flavors, their distinctive taste and strong yellow color. The use of turmeric in Indian culture has taken on almost mystical properties, perhaps due in part to its many uses in Ayurvedic Medicine. In this tradition, curcumin, by way of turmeric, is used for a wide variety of stomach ailments, headache, liver and gallbladder ailments, respiratory infections, cancer and inflammation.^20,24 (To be clear, we only mean this as a factual statement, that is, turmeric is presently used for these purposes in Ayurvedic Medicine, whether or not such use is justified.)

Curcumin's method of action seems to be multi-fold. First it is an antioxidant and as such it helps to protect against the damaging effects of free radicals.^17,18 Second, it stimulates the body to naturally produce more histamine-lowering cortisone.¹⁹ Curcumin also appears to protect the liver from toxic compounds, which in turn, may improve general health. ²¹ It also seems to inhibit platelet clumping, which may reduce arterial scaring and reduce swelling due to blunt force injuries.^{20, 22} (And on this point, be sure to read the cautionary notice below.) But the most important aspect of curcumin is its apparent ability to inhibit mediators of inflammation, such as cyclooxygenase-2 (COX-2), lipooxygenase (LOX).^24,25,26 The combined effect of these mechanism makes curcumin a very potent anti-inflammatory substance that several studies have indicated reduces inflammation due to multiple causes and also reduces the pain and swelling associated with arthritis. ^27,28,29

Quercetin & Rutin

Quercetin is a flavonoid and antioxidant that natural occurs in many plants including apples, citrus fruit and buckwheat. Quercetin is commonly used for a number of issues ranging from high cholesterol to allergic rhinitis to peptic ulcers.⁴⁰ As different as those ailments may seem, there may be one common underlying cause which links them together, and that is inflammation. Preliminary research indicates that quercetin may be effective in reducing inflammation by inhibiting inflammatory agents such as histamine, leukotrienes and prostaglandins. It may also slow COX-2 production.^40,43,45,48 Direct study of the effects of quercetin and other flavonoids on allergic rhinitis appear favorable.^44,51 This is likely due to its histamine & leukotriene modulating effect. It is this modulation of inflammation-inducing compounds that likely yields quercetin's overall effect. Rutin is the most common form of quercetin.⁴⁰

Trypsin

Trypsin is a proteolytic enzyme, a class of enzymes that degrade protein, like bromelain. It appears as though trypsin may work synergistically in combination with bromelain and rutin to reduce the pain and swelling associated with normal age-related deterioration of joints.^14,52

The ingredients in this product, and thus this product itself, exhibit(s) anti-platelet aggregation properties. Therefore, it should not be used in conjunction with other products that exhibit similar properties, including angelica, clove, danshen, garlic, ginkgo biloba, panax ginseng, red clover and willow.

Concomitant use of this product with the following drugs might increase the risk of bleeding due to decreased platelet aggregation: aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), Phenprocoumon (a warfarin-related anticoagulant used in Europe) and others.

Research suggests that ginger (contained in this product) may increase insulin levels, and thus theoretically, it may have an additive effect with antidiabetes drugs and produce a hypoglycemic effect. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others.

Theoretically, ginger may have an additive effect with Calcium Channel Blockers which could produce a hypotensive effects and calcium-channel-blocking effects. Calcium channel blockers include nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), and others.

Theoretically, excessive doses of ginger can interfere and increase or worsen the following conditions: bleeding conditions, diabetes, certain heart conditions (as it has negative inotropic and chronotropic activity).

When used concomitantly with tetracycline antibiotics, Bromelain increases plasma and urine tetracyline levels. Therefore this product should not be taken with tetracycline antibiotics.

Quercetin might competitively inhibit quinolone antibiotics, and therefore this product should not be taken with quinolone antibiotics.

Zinc inhibits bromelain activity, and thus zinc should not be taken with this product.

This list is not intended to be comprehensive. As with all dietary supplements, discuss the use of this product with your pharmacist and health care practitioner prior to use.