Kerry Bone’s recommendations for Standard Process and/or
MediHerb product dosages are sometimes different than the doses that
appear on the product labels. Please refer to the product labels or to
the product descriptions found in the product catalogs for the
Standard Process and MediHerb dosage recommendations.
Herbal Insights for
Joint Health
Kerry Bone Co-Founder and Director Research & Development MediHerb Adjunct Associate Professor University of New England, Australia
Boswellia: A Rational Therapy for Joint Health A 2010 review noted the following effects of
Boswellia or boswellic acids from in vitro and in vivo experiments: • Inhibition of 5-LOX, but only minor activity on
PGE production • Downregulation of TNF- by inhibition of NF-B • Inhibition of IL-1 production • Inhibition of C3-convertase of the complement
system Particularly active are 11-keto--boswellic acid
(KBA) and acetyl-11-keto--boswellic acid (AKBA) Ammon HP. Phytomedicine 2010; 17(11): 862-867
Boswellia: The Clinical Evidence
The clinical evidence for Boswellia in Joint Health is good
In particular, there are suggestions from some trials that Boswellia therapy might be joint health modifying
These health-modifying effects should be no surprise given the broad range of its effects that are relevant to joint health
There are 4 key randomised, controlled clinical trials. Some of the results are striking
Boswellia: The Clinical Evidence A placebo-controlled, crossover trial in 30 patients
found that 8 weeks of Boswellia extract (1000 mg/day, 40% boswellic acids) significantly (p<0.001) effective1
Another trial in 66 patients found that Boswellia extract (1000 mg/day, 40% boswellic acids) was as effective as conventional therapy over 6 months2
1 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
2 Sontakke S, Thawani V, Pimpalkhute S et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee-a randomized double blind placebo controlled trial. Indian J Pharmacology 2007; 39(1): 27-29
Boswellia: The Clinical Evidence
However, while Boswellia had a slower onset of action (about 1 month), its effect persisted after discontinuation of therapy
This suggests it could be joint health modifying
In a 2008 trial, 75 patients received either two doses of a specialised Boswellia extract (100 or 280 mg/day of a AKBA-enriched extract) or a placebo for 90 days1
1 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: R85
Boswellia: The Clinical Evidence Benefits were faster in the higher dose group (as
early as 7 days) and significantly better than placebo and MMP-3 in synovial fluid was significantly and substantially reduced in both Boswellia groups
A 2010 trial compared the specialised extract above at 100 mg/day with 100 mg/day of a similar extract (but with enhanced bioavailability) and a placebo over 90 days in 60 patients with knee challenges1
Clinical results were remarkable in patients taking the enhanced extract (p<0.0001)
1 Sengupta K, Krishnaraju AV, Vishal AA et al. Comparative efficacy and tolerability of 5-Loxin and AflapinAgainst osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study, Int J Med Sci 2010; 7(6): 366-377
Boswellia Bioavailability
Optimising Pharmacokinetics
In a randomised, open, single-dose, two-way crossover study, 12 healthy male volunteers received 786 mg of Boswellia extract either with or without a standard high-fat meal1
Plasma concentrations of boswellic acids were measured up to 60 hours after the oral dosing
1 Sterk V, Buchele B, Simmet T. Planta Med, 2004; 70(12): 1155-1160
Boswellia Bioavailability
Optimising Pharmacokinetics
Administration in conjunction with a high-fat meal led to a substantial improvement in the bioavailability of the boswellic acids
For example, the maximum concentration for AKBA was 6.0 ng/mL for the fasted conditions versus 28.8 ng/mL with food
This means that Boswellia is best taken with meals, especially those containing some animal or vegetable fat
Boswellia Complex
Each tablet contains:
Boswellia serrata (Boswellia) extract 1.9 g equivalent to dry gum oleoresin standardised to contain boswellic acids 180 mg
Curcuma longa (Turmeric) extract 2.0 g equivalent to dry rhizome standardised to contain curcuminoids 70.4 mg
Apium graveolens (Celery) extract 1.0 g equivalent to dry fruit
Zingiber officinale (Ginger) extract 300 mg equivalent to dry rhizome
Dosage: 1 tablet 2 to 4 times per day
Willow Bark
What is It?
Many Willow Bark species are used especially Salix alba, S. daphnoides and S. purpurea
They all contain derivatives of salicylic acid, mainly salicin
Clinical trials have found that a high potency Willow Bark extract standardised for salicin has significant activity, but with fewer side effects than conventional therapy
In fact it acts quite differently to conventional therapy
Willow Bark
A Large-Scale Study
A large-scale study found that Willow Bark when tested in a clinical setting had a superior safety and efficacy profile compared to conventional therapy
Presented at a Berlin conference 2004 and involved 922 physicians and 4,731 patients in Germany1
1 Werner G, Scheithe K. Congress Phytopharmaka and Phytotherapy. Berlin, February 26-28, 2004
Willow Bark
A Large-Scale Study
Over 6 to 8 weeks, patients with joint challenges and discomfort took various doses of Willow Bark extract (an average of around 3 tablets per day) and rated their discomfort from 1 to 10 (with 10 representing the highest intensity)
Most of the patients had previously been taking conventional therapy, but had generally discontinued these because of either a lack of efficacy or side effects
Willow Bark: Clinical Trials
A Large-Scale Study
During the observation period, only 15.5% needed supplementary support in addition to their Willow Bark
Average discomfort reduced from 6.4 to 3.7 points in the first 4 weeks of treatment and had fallen further to 2.7 after 8 weeks, with 97% of patients reporting a reduction in discomfort and 18% reporting no discomfort at all
Side effects were judged as minor and occurred in only 1.3% of patients
MediHerb Saligesic
A high potency Willow Bark extract in tablet form phytoequivalent to the extract proven in clinical trials
Each tablet contains 400 mg of extract with 60 mg of salicin, corresponding to 8 g of bark
Dose is 2 to 4 tablets per day
Nutrition and Joint Health
Low dietary vitamin C intake was associated with increased risk of progression, but not incidence of knee joint challenges
Suboptimal selenium intake has been linked to worsening musculoskeletal challenge
A low dietary intake and serum level of vitamin D was associated with progression of knee joint challenges, other results have been controversial
No relationship has been found for dietary vitamins E, B1, B6, niacin and folate
Zhang Y, Jordan JM. Clin Geriatr Med 2010; 26(3): 355-369
Cheung PP, Gossec L, Dougados M. Best Pract Res Clin Rheumatol 2010; 24(1): 81-92
Garlic and Joint Health
Previous slides propose that microcirculatory and CV factors may predispose to joint challenge
This was supported by a UK study in female twins that found a strong protective effect on radiographic hip challenge for “Allium” consumption (Odds Ratio 0.70)
Non-citrus fruit was also protective (OR 0.56)
Williams FM, Skinner J, Spector TD et al. Dietary garlic and hip osteoarthritis: evidence of a protective effect and putative mechanism of action. BMC Musculoskelet Disord 2010; 11: 280
Herbs for Joint Health
Therapeutic Strategy: Goals, Actions and Herbs
The herbal approach regards joint health not as a focal joint issue, but a systemic challenge. Emphasis is placed on an alkaline-forming diet
Herbs which make the body more alkaline are a key part of the support of joint health, and the main herb in this category is Celery Seed. This is considered to increase the excretion of acidic metabolites in the urine
Another herb used for joint health in this category is Dandelion Leaves
Herbs for Joint Health
Therapeutic Strategy: Goals, Actions and Herbs
Depuratives, which are believed to aid in the clearance of metabolic waste from the body, are often recommended. These include Burdock and Yellow Dock, but the key herb is Nettle Leaf which has recently been found to also have joint supporting properties
Bladderwrack is used for overweight patients with joint challenge because of its thyroid-supporting activity, but may also have other effects
Herbs for Joint Health
Therapeutic Strategy: Goals, Actions and Herbs St John’s Wort is used where nerve involvement
is present. Because of its positive effect on the nervous system, particularly in support of mood, it can also help to compensate for negative psychosocial factors and improve sleep quality
Joint supporting herbs are often used and these include Boswellia, Ginger and Turmeric. Herbs which may modify cytokines and other processes, eg Rehmannia, Bupleurum and Boswellia and those working on NFB like Feverfew should be considered
Herbs for Joint Health
Therapeutic Strategy: Goals, Actions and Herbs
Willow Bark is the key joint discomfort supporting herb
The importance of improving the circulation to challenged joints has long been recognised. Garlic, Ginkgo and Celery Seed are considered key herbs
Herbs to benefit the microcirculation are also relevant, such as Grape Seed and Pine Bark extracts (sources of OPCs), Bilberry, Gotu Kola and Ginkgo
Gotu Kola should be considered as a long-term management to improve viability of chondrocytes
Herbs for Joint Health
Example Tablet Therapy
Core Support
Boswellia Complex tablets (3 to 4 per day) with a possible loading dose
Additional Support (as required)
Saligesic tablets (2 to 4 per day) especially if discomfort is a substantial feature
Herbs for Joint Health
Additional Support (as required)
Herbs for circulation, especially Garlic tablets (1 to 2 per day) and Ginkgo Forte tablets (2 to 3 per day) or HerbaVital tablets (2 to 3 per day) if there are general symptoms of circulatory challenge
St John’s Wort tablets (3 to 4 per day) if nerve discomfort is present
Gotu Kola 1:1 liquid (4 mL 1 to 2 times per day) to support the body’s natural repair and healing process or Gotu Kola Complex tablets (3 to 4 per day)
Herbs for Joint Health
Example Liquid Formula
Celery Seed 1:2 35 mL
Nettle Leaf 1:2 35 mL
Ginger 1:2 10 mL
Turmeric 1:1 30 mL
110 mL
Dosage: 8 mL with water twice per day
Case History
A Case of Small Joint Challenge
This challenge can be very difficult to manage and is quite stubborn, presumably because of its hereditary aspect
The following 58-year-old female patient had significant challenge on all of her fingers, with marked stiffness and moderate discomfort
Case History
The patient was initially prescribed the following liquid:
Ginger 1:2 15 mL
Celery Seed 1:2 50 mL
Nettle Leaf 1:2 35 mL
100 mL
Dosage: 8 mL with water twice per day
Boswellia Complex tablets at 2 per day were also included
Case History
Progress was initially steady but not dramatic
In the following 6 months 2 Saligesic tablets per day were added and the patient reported a big improvement in her discomfort and stiffness, despite being more active than usual