INSIGHTS-JOURNAL OF

HEALTH AND REHABILITATION

Comparison of Nutraceuticals Use and Outcomes in COVID-19

Patients Vs Non-COVID-19 Population
Original Research

Anza Ahmad*1, Ahmad Ibne Yousaf2, Neelam Bibi3, Momina Akram4, Maida Khalid5, Faiza Jamshaid6, Azzah Khadim Hussain7, Saleha Hameed7
1
Department of Pharmacy Practice, Akhter Saeed College of Pharmaceutical Sciences, Lahore, Pakistan
2
School of Human Nutrition & Dietetics / Academic Officer, Minhaj University Lahore.
3
Department of Pharmacy, University of the Punjab, Lahore.
4
Clinical Pharmacy, College of Pharmaceutical Sciences, Akhtar Saeed Medical College, Lahore, Pakistan.
5
Department of Pharmacy, Evercare Hospital Lahore, Pakistan.
6
Margalla College of Pharmacy, Margalla Institute of Health Sciences.
7
School of Human Nutrition and Dietetics, Minhaj University Lahore
Corresponding Author: Anza Ahmad, anzaahmad77@gmail.com

Conflict of Interest: None Grant Support & Financial Support: None Publication Date: 20-12-2024

ABSTRACT
Background: Nutraceuticals, representing a synergy between nutrition and pharmaceuticals, are gaining traction due to
increasing awareness of their health benefits. As dietary supplements become integrated into pharmacological treatments, their
role in managing health conditions, including COVID-19, is of significant interest.
Objective: This study aims to explore the use of nutraceuticals among individuals who have recovered from COVID-19
compared to those who have never contracted the virus, focusing on the patterns of usage and associated side effects.

Methods: A cross-sectional online survey was conducted from April to June 2023, targeting a diverse population of COVID-19
survivors and non-infected individuals. The survey captured data on demographics, vaccination status, nutraceutical use, and
any adverse effects experienced. A total of 250 participants were recruited to provide a broad perspective on the dietary
supplementation habits among these groups.

Results: Of the total participants, 65.1% (n=163) were non-COVID-19 individuals, and 34.9% (n=87) had recovered from
COVID-19. Nutraceuticals were more commonly used by non-COVID-19 individuals, with multivitamins and folates being the
most frequently consumed supplements. Notably, 77% of non-COVID-19 individuals reported side effects, predominantly an
unpleasant taste, compared to 23% of COVID-19 survivors experiencing similar issues.

Conclusion: The findings indicate a higher utilization of nutraceuticals among non-COVID-19 individuals, with multivitamins
and folates being predominant. Side effects were more prevalent in non-COVID-19 participants. Future research should further
investigate the specific benefits and risks of nutraceuticals to better understand their role in health management and recovery
post-COVID-19.

Keywords: COVID-19, Dietary Supplements, Folates, Multivitamins, Nutraceuticals, Side Effects, Survey Studies.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 405
INSIGHTS-JOURNAL OF
HEALTH AND REHABILITATION

INTRODUCTION
COVID-19, officially termed coronavirus disease has rapidly emerged as a predominant global health crisis due to the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2). Manifesting symptoms akin to flu, the disease primarily challenges public health
with its potential for severe respiratory complications and the lingering aftermath in recovered patients, often referred to as "post-COVID
syndrome" (1). This condition is characterized by a spectrum of symptoms including fatigue, cognitive disruptions termed "brain fog,"
difficulty in breathing, and joint pain, which markedly diminish the quality of life and impede daily functions (2). As the pandemic has
unfolded, about 40% of adults in the United States have been infected with the virus at some point, with nearly one in five experiencing
persistent symptoms, underscoring the virus's long-term impact on public health (2). This scenario has not only intensified the burden
on healthcare systems but has also shifted the focus towards integrative approaches combining modern medicine with dietary
modifications to manage and mitigate the diverse manifestations of the disease.
In response to this health crisis, the role of nutraceuticals—products derived from food sources with extra health benefits—has gained
significant attention. These products are increasingly viewed as a pivotal component of dietary strategies aimed at enhancing immune
responses and managing symptoms associated with chronic diseases, including COVID-19 (3). Nutraceuticals such as zinc, vitamin D,
vitamin C, and selenium play critical roles in strengthening the immune system, which is paramount in combating COVID-19 and
minimizing the risk of severe outcomes (1, 3, 8). Zinc, for example, is essential for immune function and has antiviral properties that
are particularly effective against respiratory illnesses. Zinc supplementation has been found to reduce the duration of cold-like
symptoms, which are similar to those experienced by many COVID-19 patients (8). Similarly, vitamin D plays a crucial role in immune
modulation and reducing inflammation, making it vital for protecting against respiratory tract infections that can be severe in COVID-
19 cases (8).
Moreover, the antioxidant properties of vitamin C support immune cell function, helping to prevent and treat upper respiratory infections,
thereby offering a dual function in both prevention and recovery phases of the disease (8). Selenium, a micronutrient found in various
foods, enhances antioxidant defense in the lungs, which is crucial for managing the inflammatory responses typical of COVID-19 (8).
The emerging research not only supports the beneficial impacts of these nutraceuticals in managing COVID-19 symptoms but also
highlights their broader potential in addressing post-COVID conditions that affect a significant portion of the population. These
conditions often involve prolonged fatigue, joint pain, and neurological symptoms, which can be ameliorated through targeted nutritional
support (1, 8). In addition to these micronutrients, compounds like curcumin and piperine have also demonstrated significant anti-
inflammatory and antioxidant properties. Curcumin, for instance, has shown potential in blocking the entry and replication of viruses at
the cellular level, while piperine, extracted from black pepper, has been effective in reducing inflammation, a common complication in
severe COVID-19 cases (8).
Table: Nutraceuticals and Their Health Benefits in Supporting Immunity and Combating Infections
NUTRACEUTICALS USES
Zinc Antiviral and antioxidant properties
Speeds healing process
Vitamin D Defend against respiratory infections
Vitamin C Prevent infections
Aids immune system
Selenium Boosts innate immunity
Improves lung antioxidant state
Piperine Decrease the production of pro inflammatory cytokines
Iron Lowers inflammation and enhancing the immune response
Probiotics Promote production of immunoglobulins
Vitamin E Promote T Cells proliferation
Curcumin Boosts production of antioxidant enzymes

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 406
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

The integration of nutraceuticals into daily dietary practices not only supports the management of existing health conditions but also
acts as a preventive measure against the development of new symptoms or the exacerbation of existing ones. The dietary approaches
such as the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet have been proven to positively influence
overall health outcomes, particularly in reducing high blood pressure, a common comorbidity in COVID-19 patients (5). This
comprehensive approach to health maintenance through dietary and supplemental interventions reflects a shift towards a more holistic
understanding of health and disease management. It acknowledges the complex interplay between diet, immunity, and disease outcomes
and underscores the importance of nutritional strategies in the broader context of health care and disease prevention. As the global
community continues to grapple with COVID-19 and its consequences, the role of nutraceuticals is increasingly recognized as part of a
multifaceted strategy to enhance immune resilience and improve long-term health outcomes. This approach not only helps in managing
the immediate challenges posed by the pandemic but also contributes to the ongoing efforts to improve public health in the face of
evolving viral threats. Emerging from Wuhan, China, in December 2019, COVID-19 has been identified as a global pandemic by the
World Health Organization, with a wide range of symptoms from mild respiratory issues to severe acute conditions (11). The response
to the pandemic has been swift, with significant research into the virus's biology, transmission, and potential treatments. Despite these
efforts, the pandemic has significantly impacted mental health, increasing the prevalence of psychological distress across various
demographics worldwide (12).
The long-term health complications for COVID-19 survivors, often termed 'Long COVID', include persistent symptoms such as
breathlessness, fatigue, and neurological impairments, which highlight the virus's capacity to affect health well beyond initial recovery
(13). This post-recovery phase can significantly reduce quality of life, impeding the return to pre-disease daily activities and thus
becoming a focal point for ongoing medical research and healthcare support. The concept of nutraceuticals, introduced by Stephen
DeFelice in 1979, has gained prominence in this context. Defined as food or food components that provide medicinal benefits,
nutraceuticals offer a complementary approach in the fight against COVID-19 by potentially enhancing the immune response and
ameliorating symptoms associated with the virus (14). Nutraceuticals range from isolated nutrients like vitamins and minerals to more
complex herbal products and diets, all aimed at disease prevention and health promotion. Given the nutritional deficiencies observed in
severely ill COVID-19 patients, which often exacerbate the disease's progression, there is a significant emphasis on the nutritional
management of patients. For instance, interventions such as the intravenous administration of milk proteins, vitamins, and minerals have
been explored to mitigate the effects of reduced food intake due to anorexia or severe inflammatory responses in hospitalized patients
(15). The biological underpinnings of such nutritional interventions are supported by substantial evidence indicating the antiviral and
immunomodulatory properties of various nutraceuticals. For example, compounds like luteolin and quercetin have shown promise in
inhibiting the SARS-CoV-2 virus through different mechanisms, such as binding to viral proteins and disrupting their function (16, 21,
24). This has extended the potential utility of nutraceuticals beyond mere nutritional supplementation to that of a tactical component in
managing viral infections, including COVID-19.
Table: Nutraceuticals with potential benefits for COVID-19 patients are given in the table.
SR Molecule Target Type of Study/Techniques Used Results
1 Luteolin SARS-CoV S2 Frontal-affinity chromatography-mass Luteolin inhibited SARS-CoV
protein spectrometry, HIV-luc/SARS infection in a dose-dependent manner.
pseudotype virus assay, MTT assay EC50: 10.6 μM, CC50: 0.155 mM,
with wild-type SARS-CoV LD50 in mice: 232.2 mg/kg.
2 Quercetin SARS-CoV S2 HIV-luc/SARS pseudotype virus assay EC50: 83.4 μM, CC50: 3.32 mM.
protein
3 GCG SARS-CoV Expression of recombinant 3CLPro in 91% inhibition at 200 μM. IC50: 47
(gallocatechin 3CLPro Pichia pastoris and its inhibition, μM. Binding energy: –14 kcal/mol.
gallate) Molecular docking
4 EGCG SARS-CoV Expression of recombinant 3CLPro in 85% inhibition at 200 μM. IC50: 73
3CLPro Pichia pastoris and its inhibition, μM. Binding energy: –11.7 kcal/mol.
Molecular docking
5 Resveratrol MERS-CoV NP MTT assay using Vero-E6 cell line, Effective in the 125–250 μM range on
Nucleocapsid protein staining viral titre and viral RNA amount.
Inhibits caspase 3 cleavage.
6 Hesperetin SARS-CoV Cell-free and cell-based cleavage IC50: 60 μM (cell-free assay), IC50:
3CLPro assays 8.3 μM (cell-based assay), CC50: 2718
μM.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 407
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

Moreover, the immune system's role in combating COVID-19 cannot be overstated. Nutraceuticals contribute to immune support by
supplying bioactive ingredients like probiotics, polysaturated fatty acids, and phytoconstituents with known immunomodulatory
properties. These components not only support the body's natural defenses but also help manage inflammation, a critical aspect of severe
COVID-19 cases characterized by cytokine storms and hyperinflammation (17). Respiratory health remains a primary concern in the
management of COVID-19, given the virus's target of the respiratory system. Nutraceuticals such as vitamins C and E play critical roles
in maintaining respiratory integrity and function. Their antioxidant properties help mitigate oxidative stress, a common pathway through
which the virus exacerbates lung damage (19, 20).

Figure 1: Micronutrient regulation of individual response in SARS-CoV-2 infection.

Nutritional support is thus a critical pillar in the management and recovery of COVID-19 patients. Ensuring adequate intake of key
micronutrients like vitamins A, C, D, and essential minerals can fortify the immune system and potentially reduce the severity of the
infection. The role of these micronutrients in immune function has been well-documented, underscoring their importance in a balanced
diet (22, 26). The objective rationale behind integrating nutraceuticals into COVID-19 management is grounded in both their preventive
and therapeutic potentials. As the pandemic continues to evolve, with new variants emerging, the role of nutrition and dietary
supplements becomes ever more critical in supporting immune function and overall health resilience. This approach not only aims to
mitigate the immediate effects of the virus but also addresses the long-term health consequences faced by COVID-19 survivors. As we
advance in our understanding of COVID-19 and its broad impacts, the integration of nutraceuticals into therapeutic regimens offers a
promising adjunct to conventional medical treatments. By enhancing immune defenses and supporting recovery, nutraceuticals embody
a proactive approach to health maintenance and disease prevention in the face of ongoing and future viral threats. This strategy aligns
with a broader perspective on health care that emphasizes preventive care and holistic management as foundational to combating not
only COVID-19 but also other potential viral epidemics.
METHODS
The study was ethically approved by the Ethical Committee of Akhtar Saeed College of Pharmaceutical Sciences, Lahore, ensuring
adherence to research ethics throughout the process. No incentives were offered, and informed written consent was obtained from all
participants, guaranteeing the authenticity and voluntary nature of their participation. The research did not involve any deceptive
practices. Conducted over three months from April to June 2023 in Pakistan, the study aimed to assess the utilization of nutraceuticals
among individuals who had recovered from COVID-19, as well as those who had not contracted the virus. It included survivors of all
ages, with a focus on both COVID-19 and non-COVID-19 populations who utilized dietary supplements. Participants were recruited
using convenience sampling through various platforms such as WhatsApp, Facebook, and threads where the online survey link was
shared. To ensure a comprehensive analysis, only fully completed surveys were included, with incomplete responses being excluded
from the study.
The sample size, calculated using the Raosoft Calculator®, was determined to be 250 participants, factoring in a 95% confidence level
and a margin of error of ±2.52%. To accommodate a potential dropout rate of 10%, the target was initially set to gather 300 responses.
The actual data collection was facilitated through an online questionnaire distributed across multiple social media platforms, including
Instagram and Twitter, ensuring a broad reach. The inclusion criteria specified that participants were to be divided into three age groups:
20-40, 40-60, and over 60 years. Eligibility was limited to those who were either COVID-19 positive or negative but were consuming

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 408
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

any form of dietary supplements. Exclusion criteria ruled out anyone under the age of 18, those not using dietary supplements, and any
duplicate responses.
The questionnaire was meticulously developed to ensure clarity and relevance to the study's objectives. Initially drafted after a thorough
review of the existing literature on nutraceutical use among both patient groups, the questionnaire underwent a pre-test to validate its
effectiveness. Following approval from a supervisory body, the questionnaire was made available to participants through Google Forms
in English. It comprised 18 questions divided into two sections; the first section collected demographic data and the second detailed the
nutraceutical consumption patterns, including type, dosage, duration, and any side effects experienced by the respondents. Statistical
analysis was performed using the IBM SPSS software, version 26.0. Descriptive statistics, such as frequencies and percentages, were
utilized to analyze the collected data, providing insights into the patterns and impacts of nutraceutical use among the surveyed
populations. It is important to note that while the study employed convenience sampling, which may limit the generalizability of the
findings, this method was suitable given the practical constraints and the specific nature of the population studied.

RESULTS
In the recent study conducted over three months, a total of 250 participants were approached to examine the use of nutraceuticals among
individuals who had recovered from COVID-19, and those who had not contracted the virus. The demographic distribution revealed a
predominant participation of females, constituting 77% of the total sample. The majority of the participants were non-COVID-19
survivors, making up 63.5% of the sample, while the average age primarily ranged between 20 to 40 years, accounting for 94.4% of the
participants. Notably, 89.6% of the participants reported being vaccinated.
Table: Frequency Distribution of Socio-demographic Variables Among COVID and Non-COVID Patients.
Demographics N COVID-19 Non- COVID-19 P value
Gender
Male 55 (22%) 17 (30.9) 38 (69.1%) 0.451
Female 195 (77%) 71 (36.4%) 124 (63.6%)
Age
20-40 236 (94.4%) 81 (34.3%) 155 (65.7%) 0.272
40-60 13 (5.2%) 6 (46.2%) 7 (53.8%)
>60 16 (4%) 1 (100%) 0 (0%)
Nationality
Pakistani 246 (98.4%) 85 (34.6%) 161 (65.4%) 0.172
Non-Pakistani 4 (1.6%) 3 (75%) 1 (25%)
Socio-economic status
Upper 27 (10.8%) 14 (51.9%) 13 (48.1%)
Middle 220 (88%) 74 (33.6%) 146 (66.4%) 0.076
Lower 3 (1.2%) 0 (0%) 3 (100%)
Data presented as frequency (%); p-value from chi-squared tests.
The socioeconomic status showed that 88% of the participants belonged to the middle class, while COVID-19 incidence was higher
among upper-class participants, with no cases reported among the lower-class participants. In terms of nationality, 98.4% of the
participants were Pakistani. When analyzing nutraceutical usage, 58.5% of non-COVID-19 patients reported using nutraceuticals
compared to 41.5% of COVID-19 patients. This difference was statistically significant. Chronic illnesses were less prevalent among
non-COVID-19 participants at 68.2%, whereas 63% of COVID-19 participants suffered from chronic conditions, predominantly
diabetes.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 409
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

Table: Frequency Distribution of Variables with Regards to COVID-19 & Non-COVID-19 Patients.
VARIABLE N COVID-19 NON- COVID-19 P -VALUE
Have you used any nutraceuticals? 0.016*
Yes 142 (56.8%) 59 (41.5%) 83 (58.5%)
No 108 (43.2%) 29 (26.9%) 79 (73.1%)

Chronic illness 0.001*

Yes 27 (10.8%) 17 (63%) 10 (37%)
No 223 (89.2%) 71 (31.8%) 152 (68.2%)
If yes 0.027*
Asthma 6 (2.4%) 3 (50%) 3 (50%)
Diabetes 3 (1.2%) 3 (100%) 0 (0%)
Hypertension 10 (4%) 6 (60%) 4 (40%)
Other 5 (2%) 3 (60%) 2 (40%)
Dietary supplements used:
Probiotic 13 (5.2%) 5 (38.5%) 8 (61.5%) 0.80
Multivitamins 148 (59.2%) 61 (41.5%) 86 (58.5%) 0.013*
Folate 9 (3.6%) 4 (44.4%) 5 (55.6%) 0.554
Vitamin B- complex 13 (5.2%) 5 (38.5%) 8 (61.5%) 0.382
Zinc 7 (2.8%) 2 (28.6%) 5 (71.4%) 0.710
Omega 3 2 (0.8%) 1 (33.3%) 2 (66.7%) 0.946
Other 57 (22.8%) 9 (15.5%) 49 (84.5%) <0.001
Who suggested you take nutritional
supplements?
Pharmacist
70 (28.0%) 11 (15.7%) 59 (84.3%) <0.001
Physician
87 (34.8%) 41 (47.1%) 46 (52.9%)
Relative
17 (6.8%) 9 (52.9%) 8 (47.1%)
Self-medication
76 (30.4%) 27 (35.5%) 49 (64.5%)
Dose of nutraceuticals per day. 0.659
One time/day 183 (73.2%) 64 (35%) 119 (65%)
Two times/day 30 (12%) 13 (43.3%) 17 (56.7%)
Once a week 32 (12.8%) 10 (31.3%) 22 (68.8%)
Twice a week 5 (2%) 1 (20%) 4 (80%)

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 410
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

How long did you continue taking

nutraceuticals?
1-2 week
102 (40.8%) 44 (43.1%) 58 (56.9%) 0.106
1month
100 (40%) 29 (29%) 71 (71%)
2-3month
26 (10.4%) 10 (38.5%) 16 (61.5%)
more than 3 months
22 (8.8%) 5 (22.7%) 17 (77.3%)
After taking nutraceuticals did you suffer
any other complications?
Yes
26 (10.4%) 11 (42.3%) 15 (57.7%) 0.42
No
224 (89.6%) 77 (34.4%) 147 (65.6%)
Have you noticed any of these symptoms
while taking nutraceuticals?
Nausea
34 (13.6%) 12 (35.3%) 22 (64.7%) 0.990
Vomiting
6 (2.4%) 3 (50%) 3 (50%) 0.292
Diarrhea
15 (6%) 3 (20%) 12 (80%) 0.204
Headache
64 (25.6%) 18 (28.1%) 46 (71.9%) 0.169
Unpleasant taste
91 (36.4%) 37 (40.7%) 54 (59.3%) 0.172
GI disturbance
40 (16%) 15 (37.5%) 25 (62.5%) 0.740
Did you feel after taking nutraceuticals
your body weight increased?
Yes
55 (22%) 17 (30.9%) 38 (69.1%) 0.443
No
189 (75.6%) 70 (37%) 119 (63%)
How satisfied are you with the benefits of
using nutritional supplements?
Very satisfied
27 (10.8%) 13 (48.1%) 14 (51.9%) 0.395
Satisfied
127 (50.8%) 44 (34.6%) 83 (65.4%)
Neutral
86 (34.4%) 29 (33.7%) 57 (66.3%)
Dissatisfied
8 (3.2%) 1 (12.5%) 7 (87.5%)
Very dissatisfied
2(0.8%) 1 (50%) 1 (50%)
Data presented as frequency (%); p-value from chi-squared tests.
The types of nutraceuticals consumed varied, with multivitamins being the most commonly used supplement, followed by other types
such as probiotics, folate, vitamin B-complex, zinc, and omega-3. Nutraceuticals were predominantly recommended by pharmacists,
especially for non-COVID-19 patients, who also reported higher levels of satisfaction with the benefits of these supplements.
Complications from nutraceutical use were more frequently reported by COVID-19 patients at 42.3%. Among all participants, there was
a notable perception of increased body weight after using nutraceuticals, especially among non-COVID-19 patients. Despite the
thorough collection of demographic and nutraceutical usage data, the study did not delve into the specific impact of nutraceuticals on
the health outcomes of COVID-19 versus non-COVID-19 patients, which could provide more direct insights into their efficacy and
safety.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 411
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

DISCUSSION
The findings of this study provide valuable insights into the use of nutraceuticals and dietary supplements among individuals affected
by and recovered from COVID-19 as well as those uninfected. Nutritional supplementation, known for its potential to boost the immune
system and protect against acute respiratory viral infections, has been widely discussed. However, there remains a notable gap in clinical
evidence supporting the efficacy of these supplements for preventing or treating COVID-19 or other chronic illnesses (27). This research
revealed a higher prevalence of nutraceutical consumption among non-COVID-19 participants, particularly those aged 20-40, which
aligns with patterns observed during the COVID-19 pandemic where increased supplement use was reported in similar demographic
groups in other studies, such as one conducted in Lithuania (28). The predominant use of multivitamins, often under physician
supervision, underscores a proactive approach towards health maintenance during the pandemic period. This is consistent with emerging
evidence suggesting potential therapeutic applications of specific supplements like zinc, vitamin C, and omega-3 fatty acids in the
context of COVID-19 (27).
Despite the positive reception and usage patterns observed, this study also highlighted some challenges associated with supplement
consumption. The majority of participants reported an unpleasant taste as a side effect, which may detract from the usability and
acceptability of these products. This sensory attribute of supplements, noted in both COVID-19 and non-COVID-19 groups, suggests a
need for improved formulation to enhance patient compliance. Interestingly, while a significant portion of participants followed
healthcare professional advice in supplement use, contrasting findings from another study indicated that only a minority consulted
healthcare experts, with many relying on advice from social media or family (29). This disparity points to the potential influence of
cultural and regional differences in health-related behaviors.
Participants in this study expressed satisfaction with the use of nutritional supplements, reflecting a widespread belief in their protective
and immune-boosting properties, a sentiment also observed in recent studies conducted in the Middle East (30). Such perceptions may
drive the continued use of these products beyond the pandemic, suggesting a long-term trend towards self-managed health care practices.
Several limitations were identified in the study, including the unbalanced representation between COVID-19 and non-COVID-19
patients and reliance on a cross-sectional survey design which restricts the ability to establish causal relationships. The small sample
size and geographical concentration limit the generalizability of the findings. Additionally, the use of an online survey may have
introduced bias through self-reported data, potentially affecting the accuracy of the results. Future research should aim to address these
limitations by incorporating a larger, more diverse population and longitudinal study designs to better understand the long-term effects
and efficacy of nutraceutical use. Collecting data on the quantity and frequency of supplement intake could also provide deeper insights
into consumption patterns and their health outcomes.
CONCLUSION
This study has highlighted the differential patterns of nutraceutical use among COVID-19 and non-COVID-19 patients, revealing a
higher prevalence of use and satisfaction among those not affected by COVID-19. These non-COVID-19 participants also reported a
greater incidence of side effects, particularly the unpleasant taste associated with these supplements. The role of physicians in guiding

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 412
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

the use of nutraceuticals emerged as significant, underscoring the importance of professional oversight in the administration of these
products. The findings underscore the potential of certain nutritional supplements, which merit further investigation to validate their
efficacy and safety in broader therapeutic contexts. Ultimately, this study contributes to the ongoing dialogue on the role of dietary
supplements in health management, suggesting avenues for future research to explore their full potential in enhancing well-being among
diverse patient populations.
Author Contribution
Anza Ahmad Conceptualization, Methodology, Formal Analysis, Writing - Original Draft, Validation, Supervision
Ahmad Ibne Yousaf Methodology, Investigation, Data Curation, Writing - Review & Editing
Neelam Bibi Investigation, Data Curation, Formal Analysis, Software
Momina Akram Software, Validation, Writing - Original Draft
Maida Khalid Formal Analysis, Writing - Review & Editing
Faiza Jamshaid Writing - Review & Editing, Assistance with Data Curation
Azzah Khadim Hussain Formal Analysis, Writing - Review & Editing
Saleha Hameed Writing - Review & Editing, Assistance with Data Curation

REFERENCES
1. Catalano, A., Iacopetta, D., Ceramella, J., Maio, A. C. D., Basile, G., Giuzio, F., . . . Sinicropi, M. S. (2022). Are nutraceuticals
effective in COVID-19 and post-COVID prevention and treatment? Foods, 11(18), 2884.
2. Gaylis, N. B., Kreychman, I., Sagliani, J., Mograbi, J., & Gabet, Y. (2022). The results of a unique dietary supplement
(nutraceutical formulation) used to treat the symptoms of long-haul COVID. Frontiers in Nutrition, 9, 2565.
3. Ghaffari, S., & Roshanravan, N. (2020). The role of nutraceuticals in prevention and treatment of hypertension: An updated
review of the literature. Food Research International, 128, 108749.
4. Al Mijan, M., & Lim, B. O. (2018). Diets, functional foods, and nutraceuticals as alternative therapies for inflammatory bowel
disease: Present status and future trends. World journal of gastroenterology, 24(25), 2673.
5. Sirtori, C. R., Arnoldi, A., & Cicero, A. F. (2015). Nutraceuticals for blood pressure control. Annals of Medicine, 47(6), 447-
456.
6. Pearson, K. (2018). Nutraceuticals and skin health: key benefits and protective properties. Journal of Aesthetic Nursing,
7(Sup1), 35-40.
7. Adelaja, A. O., & Schilling, B. J. (1999). Nutraceuticals: blurring the line between food and drugs in the twenty-first century.
Choices, 14(4), 35-39.
8. Mrityunjaya, M., Pavithra, V., Neelam, R., Janhavi, P., Halami, P., & Ravindra, P. (2020). Immune-boosting, antioxidant and
anti-inflammatory food supplements targeting pathogenesis of COVID-19. Frontiers in immunology, 11, 2337.
9. Tosato, M., Ciciarello, F., Zazzara, M. B., Pais, C., Savera, G., Picca, A., . . . Marzetti, E. (2022). Nutraceuticals and dietary
supplements for older adults with long COVID-19. Clinics in Geriatric Medicine, 38(3), 565-591.
10. Anand, S., & Bharadvaja, N. (2022). Potential benefits of nutraceuticals for oxidative stress management. Revista Brasileira
de Farmacognosia, 32(2), 211-220.
11. Sanyaolu, A., Okorie, C., Marinkovic, A., Patidar, R., Younis, K., Desai, P., . . . Altaf, M. (2020). Comorbidity and its impact
on patients with COVID-19. SN comprehensive clinical medicine, 2, 1069-1076.
12. Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M., Gill, H., Phan, L., . . . Majeed, A. (2020). Impact of COVID-19 pandemic on mental
health in the general population: A systematic review. Journal of affective disorders, 277, 55-64.
13. Gaber, T. A. K., Ashish, A., & Unsworth, A. (2021). Persistent post-covid symptoms in healthcare workers. Occupational
Medicine, 71(3), 144-146.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 413
Volume 2 Issue 2: Nutraceutical Use in COVID and Non-COVID Populations
Ahmad A et al.

14. Kumar, C., Kumar, S., Prabu, S., & Suriyaprakash, T. (2012). Nutraceuticals and their medicinal importance. International
Journal of Health & Allied Sciences, 1(2), 47-47.
15. Dubey, A. K., Chaudhry, S. K., Singh, H. B., Gupta, V. K., & Kaushik, A. (2022). Perspectives on nano-nutraceuticals to manage
pre and post COVID-19 infections. Biotechnology Reports, 33, e00712.
16. Savant, S., Srinivasan, S., & Kruthiventi, A. K. (2021). Potential nutraceuticals for COVID-19. Nutrition and Dietary
Supplements, 25-51.
17. Basak, S., & Gokhale, J. (2022). Immunity boosting nutraceuticals: Current trends and challenges. Journal of food biochemistry,
46(3), e13902.
18. Chavda, V. P., Patel, A. B., & Vaghasiya, D. D. (2022). SARS‐CoV‐2 variants and vulnerability at the global level. Journal of
medical virology, 94(7), 2986-3005.
19. Jain, S. K., & Flinn, C. Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Diseases (COPD).
20. Pisoschi, A. M., Pop, A., Iordache, F., Stanca, L., Geicu, O. I., Bilteanu, L., & Serban, A. I. (2022). Antioxidant, anti-
inflammatory and immunomodulatory roles of vitamins in COVID-19 therapy. European Journal of Medicinal Chemistry, 232,
114175.
21. Arancibia‐Hernández, Y. L., Aranda‐Rivera, A. K., Cruz‐Gregorio, A., & Pedraza‐Chaverri, J. (2022). Antioxidant/anti‐
inflammatory effect of Mg2+ in coronavirus disease 2019 (COVID‐19). Reviews in Medical Virology, 32(5), e2348.
22. Hakamifard, A., Soltani, R., Maghsoudi, A., Rismanbaf, A., Aalinezhad, M., Tarrahi, M. J., . . . Dolatshahi, K. (2021). The
effect of vitamin E and vitamin C in patients with COVID-19 pneumonia; a randomized controlled clinical trial.
Immunopathologia Persa, 8(1), e8-e8.
23. Semo, B.-w., & Frissa, S. M. (2020). The mental health impact of the COVID-19 pandemic: implications for sub-Saharan
Africa. Psychology research and behavior management, 713-720.
24. Makkar, R., Behl, T., Bungau, S., Zengin, G., Mehta, V., Kumar, A., . . . Arora, S. (2020). Nutraceuticals in neurological
disorders. International journal of molecular sciences, 21(12), 4424.
25. Paudel, K. R., Patel, V., Vishwas, S., Gupta, S., Sharma, S., Chan, Y., . . . Panth, N. (2022). Nutraceuticals and COVID‐19: A
mechanistic approach toward attenuating the disease complications. Journal of food biochemistry, 46(12), e14445.
26. Renata, R.-B. N., Arely, G.-R. A., Gabriela, L.-M. A., & Esther, M.-L. M. (2023). Immunomodulatory role of microelements
in COVID-19 outcome: a relationship with nutritional status. Biological Trace Element Research, 201(4), 1596-1614.
27. Lordan, R., Rando, H. M., & Greene, C. S. (2021). Dietary supplements and nutraceuticals under investigation for COVID-19
prevention and treatment. Msystems, 6(3), 10.1128/msystems. 00122-00121.
28. Arlauskas, R., Austys, D., & Stukas, R. (2022). COVID-19 Pandemic and Consumption of Dietary Supplements among Adult
Residents of Lithuania. International Journal of Environmental Research and Public Health, 19(15), 9591.
29. Delompré, T., Guichard, E., Briand, L., & Salles, C. (2019). Taste perception of nutrients found in nutritional supplements: A
review. Nutrients, 11(9), 2050.
30. Radwan, H., Hasan, H., Jaafar, Z., Abbas, N., Saif, E. R., Al Kitbi, M., . . . Naja, F. (2022). Diets and dietary supplements used
during the COVID-19 pandemic in the United Arab Emirates: a cross-sectional survey. Saudi Pharmaceutical Journal, 30(4),
421-432.
31. Mukattash, T. L., Alkhalidy, H., Alzu'bi, B., Abu-Farha, R., Itani, R., Karout, S., . . . Jarab, A. (2022). Dietary supplements
intake during the second wave of COVID-19 pandemic: A multinational Middle Eastern study. European Journal of Integrative
Medicine, 49, 102102.
32. Mahmood, N. A., Hassan, M. R., Ahmad, S., Mohd Nawi, H., Pang, N. T. P., Syed Abdul Rahim, S. S., & Jeffree, M. S. (2020).
Nutraceutical Use among Patients with Chronic Disease Attending Outpatient Clinics in a Tertiary Hospital. Evidence-Based
Complementary and Alternative Medicine, 2020.
33. Sahebnasagh, A., Saghafi, F., Avan, R., Khoshi, A., Khataminia, M., Safdari, M., . . . Nabavi, S. M. (2020). The prophylaxis
and treatment potential of supplements for COVID-19. European journal of pharmacology, 887, 173530.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
© 2024 et al. Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 414