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Efficacy and Safety of Curcumin and Curcuma longa Extract in the Treatment of Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trial.
Zeng, L, Yang, T, Yang, K, Yu, G, Li, J, Xiang, W, Chen, H
Frontiers in immunology. 2022;13:891822
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Arthritic disease is a chronic inflammatory condition affecting one or more joints. Over 100 different forms of arthritis have been identified. Despite their different causes (i.e. degenerative, autoimmune), they share common symptoms such as joint pain, swelling, stiffness, and reduced mobility, which can be disabling in many cases. Drug treatment focuses mainly on limiting the progression of the disease, reducing joint inflammation and managing pain. However, these drugs are associated with many side effects. The rhizome of Curcuma longa (CL), also known as turmeric, has longstanding use as an anti-inflammatory in traditional Asian medicines. Research has affirmed its anti-inflammatory and immunosuppressive properties. Evidence from multiple clinical trials suggests that curcumin, one of the active compounds of CL, can reduce the subjective experience of pain in some conditions and can also improve the symptoms and inflammation associated with arthritis. Hence this systematic review sought to evaluate the efficacy and safety of CL-extract in 5 types of arthritis (including Ankylosing Spondylitis, Rheumatoid Arthritis, Osteoarthritis, Juvenile idiopathic arthritis and gout). The review included 29 randomized controlled trials involving 2396 participants, with dosages ranging from 120 mg to 1500 mg for a period of 4-36 weeks. Overall, curcumin and CL extract appeared to improve inflammation and pain levels in arthritic subjects whilst demonstrating safety with no increases in adverse effects. CL and its active constituents appeared to favourably change immune and inflammatory responses, as well as serum uric acid levels in the reviewed forms of arthritis. However, due to the small sample numbers in the trials and some lower quality studies, the authors advocate to interpret the results with caution until more solid evidence is available.
Abstract
Background: Modern pharmacological research found that the chemical components of Curcuma longa L. are mainly curcumin and turmeric volatile oil. Several recent randomized controlled trials (RCT) have shown that curcumin improves symptoms and inflammation in patients with arthritis. Methods: Pubmed, Cochran Library, CNKI, and other databases were searched to collect the randomized controlled trials (RCTs). Then, the risk of bias of RCTs were assessed and data of RCTs were extracted. Finally, RevMan 5.3 was utilized for meta-analysis. Results: Twenty-nine (29) RCTs involving 2396 participants and 5 types of arthritis were included. The arthritis included Ankylosing Spondylitis (AS), Rheumatoid Arthritis (RA), Osteoarthritis (OA), Juvenile idiopathic arthritis (JIA) and gout/hyperuricemia. Curcumin and Curcuma longa Extract were administered in doses ranging from 120 mg to 1500 mg for a duration of 4-36 weeks. In general, Curcumin and Curcuma longa Extract showed safety in all studies and improved the severity of inflammation and pain levels in these arthritis patients. However, more RCTs are needed in the future to elucidate the effect of Curcumin and Curcuma longa Extract supplementation in patients with arthritis, including RA, OA, AS and JIA. Conclusion: Curcumin and Curcuma longa Extract may improve symptoms and inflammation levels in people with arthritis. However, due to the low quality and small quantity of RCTs, the conclusions need to be interpreted carefully.
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Implementation science for dietitians: The 'what, why and how' using multiple case studies.
Young, AM, Hickman, I, Campbell, K, Wilkinson, SA
Nutrition & dietetics: the journal of the Dietitians Association of Australia. 2021;78(3):276-285
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Dietetics is a science-based profession. To advance healthcare delivery, it is the mastery of implementation science that may hold the key to this profession. The aim of this study was to demonstrate the use of implementation science practice in nutrition and dietetics, and identify commonalities and differences in application and experience, and key enablers to the process, with the goal of assisting, informing and inspiring use of implementation science amongst dietitians. This study is a multiple case study approach which consisted of three case studies. The three case studies provided worked examples of how implementation science can be used by dietitians to implement evidence-based practices. Results show that cross-case analysis identified that diverse implementation theories, models and frameworks were used to identify key constructs as barriers and enablers, to plan for implementation and to guide the selection of implementation strategies. Authors conclude that there is a need for the dietetics profession to embrace implementation science as a foundation science and invest in education, training and mentoring to ensure dietetics can continue to claim to be an evidence-based science.
Abstract
AIM: Implementation science theories, models and frameworks help to address evidence-practice gaps, which have increasing importance for dietetic practice. This paper aims to provide dietitians with insight into how implementation science can be applied to practice, using multiple 'real-life' case studies. METHODS Three case studies were purposively selected across areas of dietetics practice to demonstrate application of commonly-used implementation theories, models and frameworks. Reflections from the authors were provided in response to a structured set of questions outlining how the theoretical approach was selected and used, and considerations for future application. Within and cross-case analysis was undertaken. RESULTS Dietitians used diverse implementation theories, models and frameworks to identify barriers and enablers, to plan for implementation, and to guide the selection of implementation strategies. Implementation theory was used to evaluate the implementation process in one case study. Cross-case analysis identified that mentoring by those with implementation expertise, multidisciplinary implementation teams, and leadership and investment in research and translation at an organisational and departmental level as key enablers. CONCLUSIONS This paper offers dietitians insight into how implementation science can be applied to improve the uptake of evidence-based practices within nutrition and dietetics, and suggests that there needs to be investment in implementation science as a foundation science within nutrition and dietetics, including education, training and mentoring for dietitians.
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Assessment of causal association between thyroid function and lipid metabolism: a Mendelian randomization study.
Wang, JJ, Zhuang, ZH, Shao, CL, Yu, CQ, Wang, WY, Zhang, K, Meng, XB, Gao, J, Tian, J, Zheng, JL, et al
Chinese medical journal. 2021;134(9):1064-1069
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Obesity, dyslipidaemia, and metabolic syndrome are major risk factors for cardiovascular disease, however, effect of thyroid dysfunction on dyslipidaemia and cardiovascular disease is largely unknown. This study used mendelian randomisation (MR), where a genetic variant is used as an instrumental variable to detect the causal effects of exposure to disease. This study used two sample MR analyses to find out whether clinical thyroid function measures show a causal relationship with the changes in lipid levels. The results showed a significant association between the elevated thyrotropin (TSH) level and increased total cholesterol. Also, there was a significant correlation between the free triiodothyronine (FT3): free thyroxine (FT4) ratio and total cholesterol and low-density lipoprotein (LDL). Further robust studies are required to confirm the results and investigate the causal effect of thyroid hormone dysregulation and cardiometabolic diseases due to the limitations of this study. However, healthcare professionals can use the results of this study to understand the importance of the pituitary-thyroid-cardiac axis in lipid metabolism and its impact on cardiometabolic health.
Abstract
BACKGROUND Thyroid dysfunction is associated with cardiovascular diseases. However, the role of thyroid function in lipid metabolism remains partly unknown. The present study aimed to investigate the causal association between thyroid function and serum lipid metabolism via a genetic analysis termed Mendelian randomization (MR). METHODS The MR approach uses a genetic variant as the instrumental variable in epidemiological studies to mimic a randomized controlled trial. A two-sample MR was performed to assess the causal association, using summary statistics from the Atrial Fibrillation Genetics Consortium (n = 537,409) and the Global Lipids Genetics Consortium (n = 188,577). The clinical measures of thyroid function include thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels, FT3:FT4 ratio and concentration of thyroid peroxidase antibodies (TPOAb). The serum lipid metabolism traits include total cholesterol (TC) and triglycerides, high-density lipoprotein, and low-density lipoprotein (LDL) levels. The MR estimate and MR inverse variance-weighted method were used to assess the association between thyroid function and serum lipid metabolism. RESULTS The results demonstrated that increased TSH levels were significantly associated with higher TC (β = 0.052, P = 0.002) and LDL (β = 0.041, P = 0.018) levels. In addition, the FT3:FT4 ratio was significantly associated with TC (β = 0.240, P = 0.033) and LDL (β = 0.025, P = 0.027) levels. However, no significant differences were observed between genetically predicted FT4 and TPOAb and serum lipids. CONCLUSION Taken together, the results of the present study suggest an association between thyroid function and serum lipid metabolism, highlighting the importance of the pituitary-thyroid-cardiac axis in dyslipidemia susceptibility.
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Effects of Plant-Based Diets on Weight Status: A Systematic Review.
Tran, E, Dale, HF, Jensen, C, Lied, GA
Diabetes, metabolic syndrome and obesity : targets and therapy. 2020;13:3433-3448
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Being overweight or obese is a huge risk factor for many detrimental conditions. It is estimated that around one-third of the world’s population will be overweight or obese by 2025. Hence there is a need to look at dietary strategies in the prevention and treatment of overweight and obesity. Plant-based diets have always existed, however interest in the topic has increased recently and more research is being done on the health-related effects of different plant-based diets. There are many reasons why someone might convert to a plant-based diet, possible health benefits such as weight management are among the most common. The purpose of this review was to evaluate intervention studies assessing the effects of different plant-based diets on body mass index and weight. The results suggest that plant-based diets may improve weight status in some patient groups. It should be noted that only one study out of the 19 included in the review had normal weight, clinically healthy participants. The study populations for the rest were overweight, obese or had type 2 diabetes. Future research should aim to include a representative study population and apply study diets without dietary restrictions.
Abstract
There is an increasing number of people who convert to a plant-based diet. The desire for health benefits, including weight management, is often a contributing factor behind this dietary choice. The purpose of this review was to evaluate intervention studies assessing the effects of different plant-based diets on body mass index and weight. A literature search was conducted in PubMed until December 2019. Twenty-two publications from 19 studies were included. The majority of them were randomized controlled trials comparing a low-fat vegan diet to an omnivore diet in participants with overweight, type 2 diabetes mellitus and/or cardiovascular disease. All studies reported weight reductions, of which seven revealed significant differences, and four revealed non-significant differences between the intervention and the control groups. The results suggest that plant-based diets may improve weight status in some patient groups. Due to restrictions in fat intake in many studies, followed by reduced energy intake, the effects of the different interventions differ depending on the specific plant-based diets investigated. Future research should aim to include a representative study population and apply study diets without dietary restrictions.
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Examining Weight Bias among Practicing Canadian Family Physicians.
Alberga, AS, Nutter, S, MacInnis, C, Ellard, JH, Russell-Mayhew, S
Obesity facts. 2019;12(6):632-638
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Weight bias represents negative attitudes and beliefs about individuals because of their weight. The aim of this study was to examine: a. weight bias in a national sample of family physicians in Canada, b. the relationships between weight bias, attitudes about treating patients with obesity, and how people with obesity are perceived as a burden to the public healthcare system. A probability sample of 400 currently practicing family physicians completed the survey by phone or online. Results show that most respondents were white (63.3%) men (61.3%) aged 45 years or older. The average total score of explicit weight bias was 2.95 (1.17) evaluated on a 7-point Likert scale. Furthermore, although weight bias was not present in the majority of the sample, it was present among some physicians. Authors conclude that future work is needed to investigate weight bias reduction techniques targeted at physicians.
Abstract
OBJECTIVES The aim of this study was to examine the attitudes of practicing Canadian family physicians about individuals with obesity, their healthcare treatment, and perceptions of obesity treatment in the public healthcare system. METHOD A national sample of Canadian practicing family physicians (n = 400) completed the survey. Participants completed measures of explicit weight bias, attitudes towards treating patients with obesity, and perceptions that people with obesity increase demand on the public healthcare system. RESULTS Responses consistent with weight bias were not observed overall but were demonstrated in a sizeable minority of respondents. Many physicians also reported feeling frustrated with patients with obesity and agreed that people with obesity increase demand on the public healthcare system. Male physicians had more negative attitudes than females. More negative attitudes towards treating patients with obesity were associated with greater perceptions of them as a public health demand. CONCLUSION Results suggest that negative attitudes towards patients with obesity exist among some family physicians in Canada. It remains to be determined if physicians develop weight bias partly because they blame individuals for their obesity and its increased demand on the Canadian public healthcare system. More research is needed to better understand causes and consequences of weight bias among health professionals and make efforts towards its reduction in healthcare.
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Non-Nutritive Sweeteners and Their Implications on the Development of Metabolic Syndrome.
Liauchonak, I, Qorri, B, Dawoud, F, Riat, Y, Szewczuk, MR
Nutrients. 2019;11(3)
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Artificial sweeteners, such as aspartame, neotame, saccharin, sucralose, and stevia are widely promoted as low-calorie alternatives to sugar and are known as non-nutritive sweeteners (NNS). Generally, they have been considered as a healthy option to replace sugars, but data is emerging that they may influence obesity and metabolic syndrome (METs) and contribute to the development of type II diabetes. These non-nutritive sweeteners can be thousands of times sweeter than sugar and have been widely adopted by the food industry to help reduce calories, and promote weight loss and diabetic products. It is believed that 25% of children and 41% of adults consume low-calorie sweeteners regularly, with the beverage industry relying heavily on them. However, it is now been shown that these sweeteners can cause imbalances to gut bacteria and interact with taste receptors and insulin signalling. These findings mean that artificial sweeteners may trigger the same hormonal response as sugar by releasing insulin and overtime lead to insulin resistance, obesity, and overall metabolic syndrome. Finally, there is evidence that our body develops a learned response to sweeteners which paradoxically leads to weight gain.
Abstract
Individuals widely use non-nutritive sweeteners (NNS) in attempts to lower their overall daily caloric intake, lose weight, and sustain a healthy diet. There are insufficient scientific data that support the safety of consuming NNS. However, recent studies have suggested that NNS consumption can induce gut microbiota dysbiosis and promote glucose intolerance in healthy individuals that may result in the development of type 2 diabetes mellitus (T2DM). This sequence of events may result in changes in the gut microbiota composition through microRNA (miRNA)-mediated changes. The mechanism(s) by which miRNAs alter gene expression of different bacterial species provides a link between the consumption of NNS and the development of metabolic changes. Another potential mechanism that connects NNS to metabolic changes is the molecular crosstalk between the insulin receptor (IR) and G protein-coupled receptors (GPCRs). Here, we aim to highlight the role of NNS in obesity and discuss IR-GPCR crosstalk and miRNA-mediated changes, in the manipulation of the gut microbiota composition and T2DM pathogenesis.
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Effects of Vitamin D Supplementation During Pregnancy on Birth Size: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Maugeri, A, Barchitta, M, Blanco, I, Agodi, A
Nutrients. 2019;11(2)
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Vitamin D deficiency may affect mother and neonatal outcomes, increasing the risk of pregnancy complications, preterm birth, low birth weight (LBW), small for gestational age (SGA), and poor offspring health. This systematic review and meta-analysis evaluates the effects of oral vitamin D supplementation during pregnancy on foetal growth and incidence of LBW and SGA births. 13 randomised controlled trials (RCTs), published between 1980 and 2016, were included in the meta-analysis, including in total 2016 newborns (1184 from mothers in the intervention groups and 832 from controls). Dosages ranged from 200-4000 IU for daily intakes and 35000 IU to 600000 IU for single or intermittent administration. Whilst there was no evidence for publication bias (e.g. an over-reporting of positive outcomes), overall, the quality of the reviewed studies varied from very low (head circumference) to moderate (birth weight, birth length, LBW, and SGA). All studies evaluating the effect of vitamin D supplementation on blood 25-hydroxyvitamin D (OHD) levels showed that intervention significantly increased 25-OHD concentration in both mothers and infants. The meta-analysis showed that vitamin D supplementation significantly increased birth weight and length, independent of dosage and whether vitamin D was administered daily or in single/intermittent high dosages. Head circumference was increased in a non-dose dependent way with daily but not with single/intermittent vitamin D supplementation. Effects on all three parameters were seen when vitamin D was supplemented alone, but not in combination with other nutrients. Both, risk of LBW and SGA, were also significantly reduced with vitamin D supplementation.
Abstract
During pregnancy, vitamin D supplementation may be a feasible strategy to help prevent low birthweight (LBW) and small for gestational age (SGA) births. However, evidence from randomized controlled trials (RCTs) is inconclusive, probably due to heterogeneity in study design and type of intervention. A systematic literature search in the PubMed-Medline, EMBASE, and Cochrane Central Register of Controlled Trials databases was carried out to evaluate the effects of oral vitamin D supplementation during pregnancy on birthweight, birth length, head circumference, LBW, and SGA. The fixed-effects or random-effects models were used to calculate mean difference (MD), risk ratio (RR), and 95% Confidence Interval (CI). On a total of 13 RCTs, maternal vitamin D supplementation had a positive effect on birthweight (12 RCTs; MD = 103.17 g, 95% CI 62.29⁻144.04 g), length (6 RCTs; MD = 0.22 cm, 95% CI 0.11⁻0.33 cm), and head circumference (6 RCTs; MD:0.19 cm, 95% CI 0.13⁻0.24 cm). In line with these findings, we also demonstrated that maternal vitamin D supplementation reduced the risk of LBW (3 RCTs; RR = 0.40, 95% CI 0.22⁻0.74) and SGA (5 RCTS; RR = 0.69, 95% CI 0.51⁻0.92). The present systematic review and meta-analysis confirmed the well-established effect of maternal vitamin D supplementation on birth size. However, further research is required to better define risks and benefits associated with such interventions and the potential implications for public health.
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Is waist-to-height ratio the best predictive indicator of hypertension incidence? A cohort study.
Rezende, AC, Souza, LG, Jardim, TV, Perillo, NB, Araújo, YCL, de Souza, SG, Sousa, ALL, Moreira, HG, de Souza, WKSB, do Rosário Gondim Peixoto, M, et al
BMC public health. 2018;18(1):281
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A variety of methods of measuring body fat are used as tools to predict the risk of developing certain lifestyle-related diseases such as high blood pressure. It is not yet clear which of these methods is the most accurate. The aim of this study was to evaluate and compare the effectiveness of using different measures of body fat to predict high blood pressure. The study was performed in Brazil. Adult volunteers with normal blood pressure were assessed for body fat using waist-to-height ratio (WHtR), body mass index (BMI) and waist circumference (WC), and then followed-up 13 years later to find out whether they had developed high blood pressure. 44% of the participants developed high blood pressure during the study period. BMI, WC and WHtR were all associated with the risk of high blood pressure and had similar accuracy in predicting the disease. However, the associations were only significant for women. The cut-off points for predicting high blood pressure agreed with current recommendations, except for the WC in men. The results suggest that both overall obesity (BMI) and central obesity (WC and WHtR) indicators can be used in this population to evaluate the risk of developing high blood pressure.
Abstract
BACKGROUND The best anthropometric indicator to verify the association between obesity and hypertension (HTN) has not been established. We conducted this study to evaluate and compare the discriminatory power of waist-to-height ratio (WHtR) in relation to body mass index (BMI) and waist circumference (WC) in predicting HTN after 13 years of follow-up. METHODS This study was an observational prospective cohort study performed in the city of Firminópolis, in Brazilian's midwest. The cohort baseline (phase 1) was initiated in 2002 with the evaluation of a representative sample of the normotensive population (≥ 18 years of age). The incidence of HTN was evaluated as the outcome (phase 2). Sociodemographic, dietary and lifestyle variables were used to adjust proportional hazards models and evaluate risk of HTN according to anthropometric indices. The areas under the receiver operating characteristic (ROC) curves were used to compare the predictive capacity of these indices. The best HTN predictor cut-offs were obtained based on sensitivity and specificity. RESULTS A total of 471 patients with a mean age of 38.9 ± 12.3 years were included in phase 1. The mean follow-up was 13.2 years, and 207 subjects developed HTN. BMI, WC and WHtR were associated with risk of HTN incidence and had similar power in predicting the disease. However, the associations were only significant for women. The cut-off points with a better HTN predictive capacity were in agreement with current recommendations, except for the WC in men. CONCLUSIONS The results suggest that both overall obesity (BMI) and central obesity (WC and WHtR) anthropometric indicators can be used in this population to evaluate the risk of developing hypertension.
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Sugar-Sweetened Beverage Consumption in Relation to Obesity and Metabolic Syndrome among Korean Adults: A Cross-Sectional Study from the 2012⁻2016 Korean National Health and Nutrition Examination Survey (KNHANES).
Shin, S, Kim, SA, Ha, J, Lim, K
Nutrients. 2018;10(10)
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Obesity and Metabolic Syndrome (MetS) in Korea has increased significantly in the last decade and dietary factors, including the consumption of sugar sweetened drinks, is considered one of the key drivers. Soft drinks, soda coffee, fruit juices, sports drinks and sweetened rice drinks are popular beverages in Asia. Consumption of these is a major source of sugar intake for the Korean population. This study analysed data from over 12,112 participants of the Korean National Health and Nutrition Examination Survey (KNHANES) to see if the consumption of sugar sweetened beverages was causally linked to obesity and MetS. Food questionnaires were used in the original study to assess which foods and drinks the participants consumed during a 1-year period. Within the study group the number of participants with obesity was 34.9% and MetS was 26.7% respectively. They found that the participants who regularly consumed >4 sugar sweetened beverages per week consumed more calories on average than those who did not drink these beverages. In men, it was linked to higher blood pressure and blood glucose levels whilst in women it linked to a higher body mass index (BMI), increased waist circumference, and elevated cholesterol. Overall drinking 1 sugar sweetened beverage per day increased the risks of obesity in women by 59% and MetS by 61% whilst in men it increased the prevalence of obesity by 41% and MetS by 7%. Therefore drinking sugar sweetened beverages increases the risk of both obesity and MetS.
Abstract
It is well known that the consumption of sugar-sweetened beverages (SSBs) increases the risk of developing obesity and metabolic syndrome (MetS). However, there are not many studies investigating the link between SSBs and increased incidences of diseases in the Asian population, and in particular, in Korea. We explored the association of SSB consumption with the risk of developing obesity and MetS among Korean adults (12,112 participants from the 2012⁻2016 Korean National Health and Nutrition Examination Survey). We calculated the total SSB consumption frequency by counting each beverage item, including soda beverages, fruit juices, and sweetened rice drinks. Obesity was defined as a body mass index ≥25 kg/m², and MetS was defined using the National Cholesterol Education Program, Adult Treatment Panel III. A survey logistic regression analyses was conducted to examine the association of SSB consumption with obesity and MetS, adjusting for related confounders such as age, energy intake, household income, education, alcohol drinking, smoking status, and physical activity. The SSB consumption was positively associated with an increased risk of the prevalence for obesity (Odd ratio (OR): 1.60; 95% confidence interval (CI): 1.23⁻2.09; p for trend = 0.0009) and MetS (OR: 1.61; 95% CI: 1.20⁻2.16; p for trend = 0.0003) among women. In men, SSB consumption only contributed to a higher prevalence of obesity (OR: 1.38; 95% CI: 1.11⁻1.72; p for trend = 0.0041). In conclusion, increased consumption of SSBs was closely linked with a higher prevalence of obesity and MetS in the Korean population.
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A novel boswellic acids delivery form (Casperome®) in the management of musculoskeletal disorders: a review.
Riva, A, Allegrini, P, Franceschi, F, Togni, S, Giacomelli, L, Eggenhoffner, R
European review for medical and pharmacological sciences. 2017;21(22):5258-5263
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Musculoskeletal conditions, including osteoarthritis, inflammatory arthritis, musculoskeletal injuries, gout and metabolic bone disease, are the most common cause of chronic disability worldwide. Treatment with analgesic and/or anti-inflammatory medication carries a significant risk of side effects. Botanical extracts are also commonly used for the management of musculoskeletal disorders, and in addition to having less side effects they may have a beneficial effect on the course of the disease. This review focuses on the use of boswellic acids (BA, from Frankincense, Boswellia serrata and Boswellia carterii) in the treatment of musculoskeletal conditions. In pre-clinical experiments, BAs have been shown to be anti-inflammatory and improve antioxidant status. In several clinical trials BSE was superior to placebo in reducing pain and increasing functionality in osteoarthritis. BSE are poorly absorbed, and both clinical and pre-clinical research has shown that a combination of BAs with lecithin (Casperome®) enhances absorption and bioavailability. Casperome® has been investigated in a number of clinical trials and has been shown to be of benefit in tendinopathies (inflammation of the elbow and Achilles tendon), radiculopathies (pinched nerves), sprained ankles and sports injuries. The authors conclude that Casperome® is a promising remedy as part of an integrated approach to musculoskeletal disorders.
Abstract
Standard pharmacological treatment of musculoskeletal conditions is often associated with relevant side effects. Botanical preparations endowed with a good tolerability profile, therefore, could have a role in the management of these disorders. Among different natural products, Boswellia serrata extracts have long been used for the treatment of musculoskeletal disorders, given their marked anti-inflammatory activity and their ability to promote tissue regeneration. However, standard preparations of Boswellia serrata show overall modest pharmacokinetic properties, a limitation which may ultimately lead to reduced efficacy. In an effort to improve the pharmacokinetic properties, Casperome®, a lecithin-based formulation of Boswellia serrata extract representing the whole natural bouquet, has been developed. This formulation was effective in the treatment of Achilles tendonitis, epicondylitis, radiculopathies, ankle sprains and sport injuries as shown in several clinical studies, the majority of which with a randomized design and all evaluating a number of well-recognized parameters of efficacy for the therapy of musculoskeletal disorder. All studies were consistent in showing a prompt decrease of pain and improvement of functionality of the affected area after supplementation with Casperome®, without any relevant adverse effect. Remarkably, these symptomatic improvements were paralleled by reduced plasmatic levels of inflammatory markers and by a diminished need for rescue analgesics. On these bases, Casperome® may have a role in the treatment of musculoskeletal disorders. Clinical studies in other similar conditions (e.g., osteoarthritis) appear warranted to further investigate the efficacy of this botanical product in more specific settings.