Long Covid: how a dietitian can help - a personal and professional perspective.
Updated: Apr 12, 2021
It’s important to remember that everyone recovers after illness at different rates. This certainly applies to anyone suffering from Long Covid.
Symptoms can include but are not limited to:
· Loss of smell and taste
· Shortness of breath
· Chest pain
· Joint pain
· Brain fog, dizziness and headaches
· Nausea, diarrhoea and other gut issues
A very common symptom is poor appetite which can be caused by loss of smell or as a result of fatigue. This can have a significant impact on nutritional intake and diet quality.
The loss of smell and taste was the main reason I lost my appetite. I could only eat cereal in the first few weeks, as I found the crunchy texture and sweeter taste more appealing. I knew this was better than not eating anything at all, however I recognised that it was important to optimise my diet as soon as possible to aid recovery.
My fatigue was also intense for the first 3 months and I couldn’t do any cooking for myself. I was lucky my husband was able to do the shopping and prepare my meals for me. Eating a full meal without feeling fatigued or experiencing nausea wasn’t uncommon.
Fatigue/ Improving energy levels
It's important to try to keep your energy as balanced as possible. Ready meals can be helpful when you are feeling fatigued. If you choose carefully they can provide vital nutrition, when otherwise you may not eat at all. If you do have good days, batch cooking meals like stews or soups can take the pressure off. Sitting down when peeling vegetables can help preserve energy and reduce crashes. Accepting help from family, neighbours or friends is also really important. Further information on managing fatigue and pacing is available here: Fatigue | Your COVID Recovery.
It can be difficult to eat when you are short of breath. You may also have a dry mouth. This can lead to problems chewing and swallowing. Maintaining oral hygiene is crucial, as is adequate hydration. When we are ill we may forget to drink enough. Our fluid requirements may also be higher if we have a temperature. Eating little and often will prevent needing to eat larger portions at mealtimes which can make us feel worse. Softer moist food is often tolerated better.
Gut health/ Supporting gut issues
Many individuals have found that their gut health has been affected by Covid-19 and recent research suggested that the compostion of gut bacteria can be altered following infection. A healthy gut is important for immune health so making sure you are optimising this is crucial. Having good amounts of fibre and fluid in the diet will help prevent constipation. Opting for a variety of fibre containing foods such as fruit, vegetables, wholegrains, beans and pulses can be tricky when appetite is poor or you are struggling with diarrhoea. More complex gut issues will need addressing on an individual level.
If you have an ongoing poor appetite then you may need to increase your calorie intake. If you have lost weight (e.g. more than 10%) or are losing weight rapidly you may need more personalised advice. Speak to your GP about seeing an NHS dietitian or book a consultation with a freelance dietitian. You may find swapping your dairy or dairy alternatives to full fat versions may help. Drinking milk or smoothies can be an easy way to increase nutrients between meals. Little and often can be a useful approach when you don’t feel like eating normal-sized meals.
Taste and smell
Trying new flavours or foods you didn’t like before might surprise you. Bland foods might be better if you are feeling nauseated like toast or rice, particularly if you have an upset stomach. Cold or room temperature foods may be more appealing than hot foods. You may need to add extra sauces to meals at the table. Extra flavouring with herbs when cooking may be required. Some individuals may need to look into smell training if this is a particular problem for them. Research has shown that this can be helpful. Further information on smell and smell training can be found here Smell Training – Fifth Sense.
Many in the Long Covid community have been reporting weight gain due to inactivity. You may need to make dietary adjustments to prevent significant weight gain whilst ensuring an adequate intake of nutrients is achieved. A dietitian can help support you with this. It is important to remember that whilst weight gain is not advised when you are recovering either is rapid weight loss.
Diet quality for supporting the immune system
Ensuring you are having a good overall diet will help support the immune system. This means having enough good quality protein and important micronutrients. These include vitamin A, B6, B12, folate, Vitamin C, D and E. Minerals such as iron, zinc, copper and selenium are also vital for our immune health. If you are struggling with getting an optimal amount of these nutrients then you many need a supplement but ideally getting it from food is best.
There has been a lot of discussion around histamine intolerance and Long Covid symptoms. Histamine is a chemical that is both made by the body and found in certain foods. It is an inflammatory substance produced by cells during an infection. It is estimated that approximately 1% of the population in the world has histamine intolerance (1).
Histamine intolerance can cause symptoms such as diarrhoea, headache, asthma, rhinitis, hypotension, arrhythmia, hives, itching, flushing, and other conditions (1). These are similar to those being reported in Long Covid. There have been some reports in the Long Covid community that following a low histamine diet has helped SOME individuals with their symptoms. However, we haven't got the scientific evidence to say that this is an effective treatment that will help everyone. There is studies taking place to determine this. To date, there is no reliable test to diagnose histamine intolerance. Diagnosis is usually made through history and a three-step dietary adjustment (2).
A low histamine diet can be restrictive and time-consuming. It includes eliminating certain fruit and vegetables, fermented foods, certain fish, nuts, and certain dairy products to name a few. Unfortunately, there is very little evidence directly linking histamine intolerance and Long Covid however if you are embarking on a low histamine diet due to the lack of other available treatments consider working with a registered dietitian to ensure a balanced diet with adequate nutrients is being achieved.
A dietitian can help guide you through individual symptoms and suggest adjustments to help you manage them better.
1. Laura Maintz & Natalija Novak, Histamine and histamine intolerance, The American Journal of Clinical Nutrition 2007, May, Volume 85, Issue 5 Pages 1185–1196 Available at: https://doi.org/10.1093/ajcn/85.5.1185
2. Reese, I., Ballmer-Weber, B., Beyer, K. et al. German guideline for the management of adverse reactions to ingested histamine. Allergo J Int 2017, 26, 72–79 Available at: https://doi.org/10.1007/s40629-017-0011-5