What is long COVID?
What is long COVID?
This post was written by Megan Nippers, Specialist COVID rehab dietitian.
Long COVID describes the persistence of COVID-19 symptoms after 12 weeks or more of the initial infection. Long COVID affects people in many ways. Patients often describe their symptoms as coming and going in waves; relapsing, and then improving. Strikingly, long COVID appears to affect not one, but almost every part of the body, or body systems.
What are the symptoms of long COVID?
The symptoms and severity of long COVID are wide ranging, varying from one person to the next. However, the most common presentations include:
fatigue,
limited exercise tolerance,
breathlessness,
body pain,
anxiety,
depression,
brain fog/lethargy,
loss of appetite,
weight loss or gain
Do I have long COVID?
Many of the symptoms of long COVID overlap with other underlying health conditions. It is therefore important to not simply assume symptoms are due to long COVID. First ensure that any other underlying medical conditions have been ruled out. Thyroid function, vitamin D levels, iron levels, and blood sugars (HbA1c) can all be tested with a simple blood test. New gastric symptoms may require a blood test to rule out coeliac disease or a colonoscopy. It is recommended to start by keeping a log of symptoms and speaking to your GP.
What can I do to help my symptoms?
Gastric symptoms
For managing gastrointestinal symptoms, many of the dietary recommendations are based on those provided for patients with IBS. This includes a regular meal pattern, fibre manipulation, keeping well hydrated, reducing high fat/spicy foods, stress management and reducing alcohol.
More information on the dietary management of IBS can be found in a previous blog post written here.
Fatigue
Include low glycaemic index (GI) starchy carbohydrates as these provide a slower release of energy. Oats, wholegrain bread, brown pasta, skin on potatoes, bulgur wheat, barley, couscous, and/or quinoa are all great examples.
Taste/smell changes
The majority and sensitivity of taste comes from smell. Therefore, issues with taste may in fact not be a taste issue at all, but instead it could be to do with changes to smell. Absent smell training can be a great place to start to help improve taste and smell. Smell training, which is sometimes known as olfactory training works by stimulating your olfactory nerve. This nerve runs between the brain and the upper nasal cavity. Smell training is actively smelling the same four scents every day. The originally recommended smells are rose, lemon, clove, and eucalyptus.
The low histamine diet
Trialling a low histamine diet is something that has gained popularity on some long COVID forums. A low histamine diet reduces intake of histamine containing foods. The theory is that those with histamine intolerance have a reduced ability to break down ingested histamine.
This diet is extremely difficult to navigate, there is a lack of agreement on the types of foods that are low histamine, and there is no test to identify histamine intolerance. This diet is therefore not routinely recommended for the treatment of long COVID.
Instead, it is recommended to eat a Mediterranean style diet. This diet is often referred to as the anti-inflammatory diet and for good reason, as it has many proven health benefits. The key points to follow a Mediterranean diet are:
Base your meals on wholegrain starchy carbohydrates such as potatoes, brown bread, brown rice, and wholemeal pasta as they are a good source of energy and fibre. Fibre rich foods are often low GI which may help with fatigue.
Beans, pulses, fish, eggs, and meat are good sources of protein, vitamins, and minerals. Protein will help maintain muscle mass and can help with satiety.
Milk, cheese, and yoghurt are a source of protein and some vitamins such as vitamin A, D, and B12. They’re also an important source of calcium, which helps keep bones healthy. If choosing dairy alternatives, ensure you select versions that are fortified with calcium.
Aim for at least five portions of a variety of fruit and vegetables each day for vitamins, minerals, and fibre. Whether fresh, frozen, tinned or dried; they all count. Vitamins and minerals can help your immune system work to the best of its ability which is especially important during recovery.
Choose unsaturated oils and spreads in small amounts. Aim for Omega 3-rich food, such as oily fish, twice a week, flaxseeds and/or walnuts.
Drink plenty of fluids, especially water, aiming for a minimum of 2 litres every day. Fruit juice and smoothies also count, but limit these to no more than 150ml per day.
For more information on why a low histamine diet is not recommended for long COVID, and guidance on a Mediterranean diet please follow the links below.
https://www.bda.uk.com/resource/low-histamine-diets-and-long-covid.html
https://www.bda.uk.com/resource/heart-health.html
Supplements
The only supplement currently recommended for recovery from COVID is vitamin D. Vitamin D is a fat-soluble vitamin that regulates the levels of calcium and phosphate in the body. It is vital for musculoskeletal health.
In the UK, 80–90% of vitamin D is derived from skin exposure to ultraviolet B radiation from sunlight, with the remaining 10–20% being derived from dietary sources. No matter how balanced your diet, you cannot get enough vitamin D from food alone. A vast majority of the population will be deficient in vitamin D.
It is recommended for all adults to take 10ug (400iu) of vitamin D every day. Vitamin D is stored in the body, so if you are struggling to remember to take a daily dose you may want to take 25ug (1000iu) 3 times per week.
If you are taking any other vitamins, it is important to know your limits and check if they interact with any additional medications. More is not necessarily better. High dose vitamins may cause additional symptoms and can sometimes work against certain medications. For example, Vitamin C, magnesium, and calcium can all cause gastric symptoms, whilst vitamin K works against anticoagulants such as warfarin. Finally, Vitamin A should not be taken by anyone trying to conceive, and it can also increase risk of fractures in older adults.
For further information on recommended doses of vitamins and minerals please visit https://www.nhs.uk/conditions/vitamins-and-minerals/
References
Abscent.org. 2022. Smell Training. [online] Available at: <https://abscent.org/learn-us/smell-training> [Accessed 16 February 2022].
Your COVID recovery. 2022. Taste and smell changes. [online] Available at: <https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/taste-and-smell/> [Accessed 16 February 2022].
NHS.uk. 2022. Long-term effects of coronavirus (long COVID). [online] Available at: <https://www.nhs.uk/conditions/coronavirus-covid-19/long-term-effects-of-coronavirus-long-covid/> [Accessed 16 February 2022].
British Dietetic association. 2022. Low histamine diets and long COVID. [ebook] p.2. Available at: <https://www.bda.uk.com/resource/low-histamine-diets-and-long-covid.html> [Accessed 16 February 2022].
Nhs.uk. 2022. Vitamins and minerals. [online] Available at: <https://www.nhs.uk/conditions/vitamins-and-minerals/> [Accessed 16 February 2022].
British Dietetic association. Food Fact Sheet heart health. [ebook] p.2. Available at: <https://www.bda.uk.com/resourceDetail/printPdf/?resource=heart-health.html> [Accessed 16 February 2022].
National Institute for Health and Care Excellence (NICE) (2022) Vitamin deficiency in adults. Available at: < https://cks.nice.org.uk/topics/vitamin-d-deficiency-in-adults/.html> [Accessed 16 February 2022].
Huiberts, L. and Smoulders, K., 2021. Effects of vitamin D on mood and sleep in the healthy population: Interpretations from the serotonergic pathway. Sleep Medicine Reviews, 55.
Talks, N. and Plymouth, U., 2022. Nutrition and COVID-19 Recovery – a series of talks. [online] University of Plymouth. Available at: <https://www.plymouth.ac.uk/research/dietetics-and-health/covid-knowledge-hub/nutrition-and-covid-19-recovery-talks> [Accessed 18 February 2022].