Assessing the Israeli Public Adoption of Nutritional Supplements, Including Frankincense, in COVID-19 Management: Patterns, Perceptions, and Efficacy

Abstract The COVID-19 pandemic has increased public reliance on natural treatments, particularly in regions with strong cultural ties to herbal medicine or limited access to conventional healthcare. Globally, surveys have reported heightened use of plant-based remedies and dietary supplements, perceived as safe and effective. In Israel, this trend was evident within an integrative healthcare system that combines conventional and complementary medicine. The public demonstrated significant interest in herbal remedies and supplements to boost immunity and manage pandemic-induced stress. Natural compounds with anti-inflammatory and antiviral properties offer potential pharmacological benefits, warranting clinical investigation. However, restrictive trial criteria hinder broader applicability of findings. To address this gap, we evaluated the effects of bioactive dietary supplements on COVID-19 severity and duration through an online survey. Among respondents, Boswellia emerged as the most popular supplement. Disease duration in Boswellia users was significantly reduced (11.8± 7.1 days) compared to untreated cases or those taking other supplements (18.0±9.7 days). Known as frankincense, Boswellia’s gum resin has traditionally been used for its anti-inflammatory properties. Its bioactive compounds, boswellic acids and incensole acetate, inhibit cytokines like TNF α , IL-1 β , and IL-6, implicated in COVID-19-related cytokine storms and ARDS. Preliminary clinical and laboratory studies suggest Boswellia’s potential as an anti-inflammatory and antiviral agent. Laboratory experiments corroborated these findings, demonstrating that Boswellia extract (100 µg/mL) significantly reduced Coronavirus RNA levels (~8500-fold) in cell cultures infected with 229e virus, as measured by qPCR. Boswellia extracts also decreased viral RNA levels by up to 75% without adverse effects on cell viability and inhibited TMPRSS2 activity, a key protease for viral entry. These findings underscore Boswellia’s therapeutic potential, combining anti-inflammatory and antiviral mechanisms, and support further investigation into its use as a complementary treatment for COVID-19.