Nutritional Recommendations for Covid-19 Patients

Nutrition is one of the important factors to help you overcome Covid-19. Nutrition helps to support and improve the ‘barrier’ to protect the body, such as immune cells, antibodies, skin, mucous membrane and stomach lining. A good diet requires proper energy balance with enough proteins, fat, carbohydrates, vitamins, minerals, probiotics fibres and water.

GENERAL PRINCIPLES

• Eat full 3 main meals, supplement nutrition for extra meals if you eat poorly (such as high-energy nutritious milk, soy milk, nut milk, yogurt, fruit smoothies, cakes, etc.) to ensure enough energy for your body.
• Eat a variety of different foods with different colours.
• Drink enough water (from 2 to 2.5 litres/day), drink slowly, small sips, even if not thirsty, avoid soft drinks but take instead fresh fruit juices which are rich in vitamin C to strengthen body resistance.
• You should consult your doctor about the diet if you suffer from a chronic disease such as diabetes, high blood pressure, bad cholesterol, liver or kidney disease.

Nutrients	Use	Food Source
Proteins	Indispensable to build immune cells and antibodies, participate in the body’s immune responses.	All meals of the day (breakfast, lunch, dinner) need protein. Eat a combination of foods rich in animal protein (such as fish, chicken, beef, eggs, milk etc.) and proteins from plants (from legumes, beans etc.)
Vitamin A and Beta-carotene	Maintains the integrity of the respiratory and gastrointestinal mucosa.	Animal liver, egg yolk. Milk, cheese. Papaya, carrot, sweet potato, pumpkin, orange, mango, broccoli, spinach etc.
Group B vitamins (B1, B6, folate, B12 etc.)	Help the body convert food into energy (metabolism), create new blood cells, and maintain healthy skin cells, brain cells, and other body tissues.	Organ meats (such as liver and kidney), eggs, nuts, seeds, whole grains, enriched grains, legumes, peas Milk, cheese.
Vitamin C	Strengthens immunity, fights against oxidants.	Fresh vegetables and fruits such as oranges, tangerines, grapefruit, guava, papaya, mango, apple, grapes, kiwi, tomato, cauliflower, radish, , bell pepper, spinach etc.
Vitamin D	Supports the immune, digestive, circulatory and nervous systems.	Skin needs to be exposed to sunlight for 15-30 minutes a day. Increase foods rich in vitamin D such as fish liver, egg yolks, fish and foods fortified with vitamin D (milk, cereals) etc.
Vitamin E	Promotes the development of immune organs.	Seeds such as sunflower seeds, soybean products, wheat, bean sprouts, sprouts, spinach etc.
Selenium	Strong antioxidant, helps strengthen the body’s ability to fight infections.	Brown rice, germinated rice, sprouted rice, fish, shrimp, seaweed etc.
Iron and zinc	Helps maintain the normal functioning of the immune system.	Poultry (chicken etc.), shellfish and seafood such as oysters, crabs,  etc. Animal liver and lean meat are also rich in easily absorbed iron.
Omega 3	Anti-inflammatory and improves the immune system.	Fish oil, cod liver oil, sardines, salmon, basa, halibut, herring, tuna, oysters, some nuts etc.
Flavonoids	Increases antioxidant capacity and strengthens the body’s immunity.	Spices such as basil, perilla, broccoli,  apple, green tea, ginger, garlic, turmeric, green leafy vegetables etc.
Probiotics live healthy microorganisms	Helps strengthen the body’s immune system.	Types of yogurt, some types of cheese, fermented soybeans (miso, natto) etc.
Beta-glucan	Immuno-modulator	Yeast, oat bran, barley, wheat, algae and some species of Ganoderma, mushroom etc.

For a healthy body and a good immune system, in addition to eating right, it is also necessary to have a proper exercise regimen. Patients can exercise regularly according to their health status, even at home. It is necessary to maintain a healthy lifestyle: get enough sleep, do not abuse alcohol, do not smoke, have an optimistic spirit. For patients with Covid-19 who have symptoms of loss of smell, taste, anorexia, or patients with chronic diseases, the issue of nutritional supplements needs special attention. At this time, you should consult a medical nutritionist or a dietician to receive specific supplementary instructions, specify alternative foods, supplements or provide nutrients by some more suitable method. It is important to help patients stay healthy and improve their immune system to overcome the disease.

NUTRITIONAL RECOMMENDATIONS FOR LONG COVID-19 PATIENTS

Long Covid refers to the effects of Covid-19 that last for weeks or months after the initial illness. Tips for eating when you are short of breath  Eating can be very challenging when you are short of breath so try to:

• Eat smaller portions of energy and protein-rich foods more frequently throughout the day;
• Select foods that are softer and moister, making them easier to chew and swallow;
• Enjoy your meal at your own pace.

Tips for managing a dry mouth  The use of nebulisers, inhalers, and oxygen therapy can all cause dry mouth. It can make chewing and swallowing foods difficult, and it can sometimes cause taste changes.

• Drink 6 to 8 cups of fluid per day (including nourishing fluids like milky drinks or juices).
• Add sauces such as gravy, mayonnaise, salad cream, and cheese sauce to foods, and choose moist dishes like stews.
• Suck sugar-free sweets or chew sugar-free gum to help saliva production.
• Rinse and gargle with water after using an inhaler to keep your mouth fresh.

If you are having difficulty swallowing, coughing regularly during meals, or your voice becomes  garbled, ask your healthcare professional to refer you to a speech and language therapist to check your swallowing and provide further advice.  Tips for managing changes to taste and smell  Changes in taste and smell are frequent Long Covid-19 symptoms that can make eating and drinking less pleasurable:

• Experiment with herbs, spices, pepper, chutneys, and pickles in cooking;
• If you dislike the strong flavour of hot foods, try cold foods instead;
• If you go off a particular food, try it again regularly as your tastes may continue to change. 

Tips for making the most of your food  It can be difficult to eat well when you’ve lost your appetite, try some of the suggestions below:

• Eat more of the foods that you enjoy at the times of day when you feel more like eating;
• Eat smaller meals with snacks and nourishing drinks (e.g. smoothies, soups, fruit juice, milkshakes or hot chocolate) in between;
• Avoid drinking before or during meals, as the liquid can fill you up;
• Add ingredients such as cream, cheese, butter, olive oil, cream cheese, milk powder, and ground almonds to foods like soups, stews, curries, scrambled eggs, vegetables, potatoes;
• Add honey, syrup, and jams to porridge, milky puddings, on bread, toast, or tea cakes;
• To make your regular milk more nutritious, whisk 2-4 tablespoons skimmed milk powder into a half-litre of milk;
• If you usually eat low fat, low sugar ‘diet’ foods and drinks, switch to non-diet ones (e.g. whole milk) and have some treats between meals or as a snack, such as a piece of cake, chocolate, a handful of nuts, or a biscuit.

To recover from Long Covid symptoms, you must also supplement with essential nutrients. Some vitamins (A, B6, B12, C, folate, and E) and trace elements (zinc, copper, selenium, and iron) have been shown to improve the immune system. These are best obtained through a well-balanced diet that includes:

• Milk and cheese – the source of vitamin A and B12
• Fish and oily fish – the source of vitamins A, B6, and B12 and Selenium
• Green leafy vegetables such as kale, spinach, and broccoli – the source of vitamins A and B6, folate, and iron
• Nuts and seeds – the source of vitamin E, copper, and iron
• Meat – the source of zinc, iron, selenium, and vitamins B6 and B12
• Fruits – the source of vitamin A and C.

Vitamin D also plays a role in the immune system and low levels have been associated with an increased risk of infection and respiratory diseases.

LOW-HISTAMINE DIET

The low-histamine diet has received some attention in Long Covid. Mast cell activation syndrome is thought to play a role in Long Covid, and mast cells release histamine, a chemical associated with inflammation. Because histamine can be found in some foods, a low histamine diet may be beneficial in the treatment of Long Covid. Here are some examples of high-histamine foods:

• Cured and aged meat
• Oily fish and shellfish
• Fermented dairy including aged cheese, yogurt, and kefir
• Eggs
• Deli chicken and turkey slices
• Some fruit and vegetables, spices, nuts and fermented foods.

However, this is only a theory at the moment, with no direct evidence to back it up. Furthermore, because the low-histamine diet is so restrictive, it is not appropriate for everyone and should only be tried for a limited time under the close supervision and support of a registered dietician. Oral Nutritional Supplements (ONS) should be used whenever possible to meet your calories needs, when dietary counselling and food fortification are not sufficient to increase dietary intake and reach nutritional goals. ONS shall provide at least 400 kcal/day including 30g or more of protein/day and shall be continued for at least one month. Efficacy and expected benefit of ONS shall be assessed once a month. FV doctors and nutritionists can provide advice on nutrition, design customised menu specifically for you that you can prepare and cook at home, advice about nutritional supplements and even organise meals prepared by FV Kitchen to be delivered to your home. You can book an appointment with doctors of FV Department of Nutrition & Dietetics, via phone number (028) 54 11 33 33, extension 1419.