Nutrition care for the patient with long COVID

Since the COVID-19 virus first swept across the world, nutrition recommendations have evolved with a better understanding of the virus. Initial specifics for nutrition care for those with critical illness have expanded to meet many of the nutrition requirements generated from this illness. Research remains ongoing in those with long COVID.

While we have evidence-based guidelines for different comorbidities, long COVID itself remains a bit of a challenge, and this includes the best approach with medical nutrition therapy. Read on for the most recent research on long COVID and how a registered dietitian nutritionist can be most effective in helping to care for this group of patients.

What is long COVID?

Long COVID or post-COVID is described as residual symptoms that are experienced more than three months after an initial positive test. In patients that have tested positive for COVID-19, one study suggested that almost 57% of individuals had one or more symptoms for at least a six-month duration. Symptoms can be triggered from a mild or more serious illness and vary from fatigue, intermittent fevers, chest pain, difficulty with breathing, brain “fog” or difficulty concentrating, depression, digestive issues, a rash, or muscle and joint pain among other issues.

Experts suggest that individuals who were more critically ill or have other co-morbidities are more likely to experience long COVID symptoms. However, research remains ongoing as even some with mild infections can attest to the undesirable side effects of long COVID. Unfortunately, at this time, there is no test to officially diagnose someone with long COVID and as many as 1 in 5 adults in the United States who previously tested positive may still notice lingering symptoms months later.

Nutrition concerns with long COVID

With the vast number of potential symptoms for the patient struggling with long COVID, determining the best approach for nutrition can be a struggle. In fact, present evidence-based nutrition therapy in this area remains limited because of the ongoing research. Instead, management tends to focus on an individualized approach to overall health.

The goals with this type of counseling include preventing or improving malnutrition, optimizing oral intake, and overcoming nutrition barriers to any of the symptoms that might accompany long COVID. Thinking more along the lines of a trial-and-error type diet and individualized approach with this group of patients, consider some of the following suggestions as potential areas of discussion.

Finding the right weight balance. In many cases, especially with more serious illness, unintentional weight loss was a side effect simply because of disease impact making it difficult for the patient to eat. On the other hand, obesity has been identified as one of the higher risk factors for long COVID, especially in women. Aiming for and maintaining a healthy weight is encouraged for those with long-COVID. In addition, this can also be helpful for any other comorbidities present.

Following a healthy diet. The impact of diet on long COVID comes more from an understanding of other inflammatory disease states. Certain foods are associated with increased inflammation and oxidative stress. Reduction of these foods can potentially play a role in reducing these undesired side effects in the body. Think inclusion of lean protein sources, omega-3 fatty acids, and different complex carbohydrates.

Overcoming taste changes. Depending on the patient, loss of taste may be a short or long-term effect of COVID-19.  A treatment plan to overcome this symptom can be tough, especially with stronger food aversions to foods or food groups that taste “off”. Ensuring that zinc levels are not deficient is a first step. Also, work with the patient to find foods they better tolerate and, as able, gradually have them try and add different foods.

Trying more plant-based foods. While the individual doesn’t need to cut out all animal-based foods from their diet, incorporating more plant-based sources may be beneficial. This approach is based off the anti-inflammatory effect of these foods. Encourage your patient to aim for a variety of whole grains and different colors of fruits and vegetables.

Simple suggestions with chronic fatigue. Of the different symptoms of long COVID, fatigue can easily be one of the most challenging. Trying to plan and cook meals with limited energy often becomes too much and quick-fix, more processed meals may be the alternative. If the individual has a support system who can provide meals and snacks, this may be the best option to encourage a more well-rounded diet. If not, education should center on simple recipes for meals and snacks, healthy suggestions for premade choices, and consideration of grocery pick-up or delivery to help conserve energy.

Balancing multiple co-morbidities. In those with long COVID symptoms, many may also struggle with other disease states including cardiovascular disease, diabetes, chronic kidney disease, and obesity in addition to others. Trying to balance nutrition care for long COVID symptoms in addition to nutrition goals with these disease states is needed. This approach should also be easily incorporated with their lifestyle and physical capabilities.

Patient application

As more information and research becomes available, nutrition recommendations will continue to be adapted to better meet the needs of the growing population of individuals with long COVID. Meanwhile, offering different suggestions based on patient symptoms can help support overall nutrition status in these patients and quality of life.

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References:

Barrea L, Grant W, Frias-Toral E, et al. Dietary recommendations for post-covid-19 syndrome. Nutrients. 2022;14:1305. doi: 10.3390/nu14061305

Centers for Disease Control and Prevention. Long COVID or Post-COVID Conditions. Available at https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed November 22, 2022.

Centers for Disease Control and Prevention. Nearly One in Five American Adults Who Have Had COVID-19 Still Have “Long COVID”. Available at https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm. Accessed November 30, 2022.

Taquet M, Dercon Q, Luciano S, Geddes JR, Husain M, Harrison PJ. Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med. 2021;28;18(9):e1003773. doi: 10.1371/journal.pmed.1003773.