By Katie Chapmon, MS, RD
March of 2022 marks the two-year anniversary when the World Health Organization declared COVID-19 a global pandemic. By now, most everyone has been diagnosed with or known someone who has developed symptoms from the virus. Research is well-documented on the short-term manifestations of the virus including fever, shortness of breath, cough, fatigue, muscle and body aches, loss of taste or smell, and diarrhea to name a few (1). On the contrary, the duration of symptoms and potential long-term complications are not well understood as the virus spreads between both vaccinated and unvaccinated people. In fact, a large study estimated 80% of COVID-19 infected patients have developed one or more long-term symptoms lasting more than 2 weeks (2). Another study found 57% of patients had one or more long term COVID symptoms during a 6-month period and 36.55% experienced symptoms between 3 and 6 months (3). According to the Centers for Disease Control and Prevention, long COVID can be described as “conditions running from new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19” (4).
Long COVID has also been described as post-COVID conditions, PASC (post-acute sequelae of SARS-CoV-2), long haulers, or long-term COVID (5). Some symptoms of long COVID may include chronic fatigue and respiratory disease ranging from a cough and shortness of breath to excessive lung tissue damage. Blood clots in the arteries and veins due to inflammation and long-term reduced movement from the illness may also occur. An increase in heart failure and cardiac complications post-infection including myocarditis and irregular heartbeat and damage to the nervous system including headaches and difficulty concentrating or “brain fog” have also been seen (6). Anyone can experience long COVID, although this condition is less common in children and adolescents (4). Because little is known about long COVID, there are no definite recommendations for therapeutic treatments. but there are some nutritional modifications that may lessen symptoms if you are experiencing long COVID.
NUTRITIONAL RECOMMENDATIONS FOR LONG COVID
Those suffering from long COVID may be at an increased risk for nutritional deficiencies based on healing time and process. Overall, it is important to emphasize a healthy, balanced diet so nutrient deficiencies are minimized. Ensuring adequate protein intake to counter the loss of lean body mass and assist the body in recovery is vital. Protein recommendations are usually based upon someone’s body weight, typically 1.0-1.2 grams per kilogram7. On average, the goal would be between 80-100 grams per day. Of course, consult your physician or registered dietitian to receive personalized instructions on protein intake. This increased protein intake will further assist in strength gain and decreasing fatigue
Ways to increase your protein:
• Emphasize Protein at every meal
• Consume lean protein sources such as skinless chicken, turkey, or fish
• Opt to include plant-based protein sources such as legumes, tofu, and tempeh
• Increase dietary intake of eggs and high protein dairy such as Greek yogurt or cottage cheese
• Drink a protein supplement or a supplemental high protein food, such as those from HealthWise
Plant-based eating is another approach being assessed to treat long COVID patients. Because 70% of immune tissue is located within the gastrointestinal tract, fueling the gut microbiome through adequate fiber is encouraged (8). Additionally, the increased antioxidant consumed through plant-based eating assists the body in fighting against symptoms of long-COVID (9). Plant-based eating emphasizes the consumption of fruits, vegetables, nuts and seeds, whole grains, and legumes.
Enhance your diet through plant-based eating by:
• Emphasizing a colorful plate at each meal
• Consuming 5 cups of vegetables and 2 cups of fruit per day Switching from refined grains to whole grains
• Opting for plant-based protein sources such as legumes, tofu, and tempeh
SUPPLEMENTAL RECOMMENDATIONS
Like nutritional guidance, there are no definite recommendations in terms of supplemental guidelines for treatment of long COVID. Vitamin D supplementation may be beneficial in prevention of long COVID as patients with inadequate levels of Vitamin D may have an increased risk of severe outcomes (10). Vitamin D works as an antiviral and works with the immune system. Another vitamin to be considered is Vitamin C. Vitamin C has been shown to be effective in preventing pneumonia (11) and has been shown to improve symptoms of fatigue and assist in immune function in other acute and chronic conditions (12). Vitamin C’s effect on long COVID specifically still requires additional research.
Enhance your vitamin levels by:
• Increasing Vitamin D levels through more sun exposure
• Boosting Vitamin C levels by consuming more citrus fruits and cruciferous vegetables
• Consulting with your physician/ registered dietitian for oral supplementation for both Vitamin D and C
• Adding HealthWise Nature’s Multivitamin into your supplement routine containing 400 IU Vitamin D and 90 mg Vitamin C
Other potential supplements include omega-3 fatty acids and probiotics. Omega-3 fatty acids may assist in decreasing the inflammation, the amount of virus detected, and oxidative stress on the body. More research needs to be conducted to determine what levels of supplementation of omega-3 fatty acids may be beneficial for those with long COVID (13). As previously discussed, if you have a healthy gut microbiome, your symptoms and severity of the illness may improve as large amounts of immune system tissue is located in the gut, therefore, probiotic supplementation may be useful. A clinical trial in the UK explored potential benefits of probiotic supplementation in patients with symptoms of long COVID and researchers found that cough, fatigue, and gut symptoms improved following 30-day supplementation (14). Larger study groups and longer research duration may be necessary to provide further recommendations.
Practical supplement recommendations:
- Increase your consumption of fatty fish containing high levels of omega 3’s (salmon, tuna, sardines, etc.)
- Use quality omega-3 supplementation through fish oils or HealthWise Nature’s Essential Fatty Acids containing ALA, EPA, and DHA
- Expand your consumption of pre- and probiotic foods (fibrous and fermented foods)
- Look for a probiotic supplement that includes at least 10 billion CFUs and contains multiple strains of bacteria like Lactobacillus, Bifidobacterium or Saccharomyces boulardii
The long-term effects of COVID-19 are still not well understood. Additional research will be necessary to provide greater guidelines for nutrition and supplemental recommendations for those suffering from COVID symptoms past the two-week incubation period. Increasing your protein intake and emphasizing plant-based foods are likely to assist in symptom reduction, while Vitamin D, C, omega-3 and probiotic supplementation may also be advantageous. General recommendations for prevention and intervention of less severe COVID-19 illness and long COVID has been to emphasize consumption of a healthy, balanced diet. Those who consume a healthy, balanced diet have a reduced risk for chronic diseases like obesity, heart disease, and diabetes, which are all risk factors for developing COVID-19 (15, 16). Practicing healthy eating habits to improve your immune system has been the best nutrition recommendation during the pandemic, yet specific diet recommendations for long COVID continue to be explored.
References:
1. CDC – Symptoms of COVID-19 – https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html/. March 8, 2022.
2. Lopez-Leon, S., Wegman-Ostrosky, T., Perelman, C., Sepulveda, R., Rebolledo, P. A., Cuapio, A., & Villapol, S. (2021). More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Scientific reports, 11(1), 16144. https://doi.org/10.1038/s41598-021-95565-8
3. Taquet, M., Dercon, Q., Luciano, S., Geddes, J. R., Husain, M., & Harrison, P. J. (2021). Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS medicine, 18(9), e1003773. https://doi.org/10.1371/journal.pmed.1003773
4. CDC – Post-COVID Conditions – https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Flong-term-effects.html. March 8, 2022.
5. Johns Hopkins Medicine – COVID ‘Long Haulers’: Long-Term Effects of COVID-19 – https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19#:~:text=The%20National%20Institutes%20of%20Health,known%20as%20%E2%80%9Clong%20haulers.%E2%80%9D March 8, 2022.
6. SeyedAlinaghi, S., Afsahi, A. M., MohsseniPour, M., Behnezhad, F., Salehi, M. A., Barzegary, A., Mirzapour, P., Mehraeen, E., & Dadras, O. (2021). Late Complications of COVID-19; a Systematic Review of Current Evidence. Archives of academic emergency medicine, 9(1), e14. https://doi.org/10.22037/aaem.v9i1.1058
7. Weijs, P., Mogensen, K. M., Rawn, J. D., & Christopher, K. B. (2019). Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study. Journal of clinical medicine, 8(1), 43. https://doi.org/10.3390/jcm8010043
8. Vighi, G., Marcucci, F., Sensi, L., Di Cara, G., & Frati, F. (2008). Allergy and the gastrointestinal system. Clinical and experimental immunology, 153 Suppl 1(Suppl 1), 3–6. https://doi.org/10.1111/j.1365-2249.2008.03713.x
9. Storz M. A. (2021). Lifestyle Adjustments in Long-COVID Management: Potential Benefits of Plant-Based Diets. Current nutrition reports, 10(4), 352–363. https://doi.org/10.1007/s13668-021-00369-x
10. Kaya, M. O., Pamukçu, E., & Yakar, B. (2021). The role of vitamin D deficiency on COVID-19: a systematic review and meta-analysis of observational studies. Epidemiology and health, 43, e2021074. https://doi.org/10.4178/epih.e2021074
11. Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr. 2020;14:211–212. doi: 10.1016/j.dsx.2020.03.002.
12. Carr, A. C., & Gombart, A. F. (2022). Multi-Level Immune Support by Vitamins C and D during the SARS-CoV-2 Pandemic. Nutrients, 14(3), 689. https://doi.org/10.3390/nu14030689
13. Hathaway, D., Pandav, K., Patel, M., Riva-Moscoso, A., Singh, B. M., Patel, A., Min, Z. C., Singh-Makkar, S., Sana, M. K., Sanchez-Dopazo, R., Desir, R., Fahem, M., Manella, S., Rodriguez, I., Alvarez, A., & Abreu, R. (2020). Omega 3 Fatty Acids and COVID-19: A Comprehensive Review. Infection & chemotherapy, 52(4), 478–495. https://doi.org/10.3947/ic.2020.52.4.478
14. Thomas R, Aldous J, Forsyth R, Chater A, Williams M (2021) The Influence of a blend of Probiotic Lactobacillus and Prebiotic Inulin on the Duration and Severity of Symptoms among Individuals with Covid-19. Infect Dis Diag Treat 5: 182. DOI: 10.29011/2577-1515.100182
15. CDC – Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals – https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html. March 8, 2022.
16. CDC – Poor Nutrition – https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm#:~:text=A%20healthy%20diet%20helps%20children,2%20diabetes%2C%20and%20certain%20cancers. March 8, 2022. Subbaraman N. US health agency will invest $1 billion to investigate ‘long COVID.’ Nature. 2021;591(7850):356.
By Katie Chapmon, MS, RD
About the Author:
Katie Chapmon, MS, RD is a Registered Dietitian Nutritionist specializing in Bariatric Nutrition, GI Issues and Hormonal Health and with 10+ years of hands-on clinical experience for leading medical providers. She is the proud recipient of the 2010 Recognized Young Dietitian of the Year Award and 2018 Excellence in Weight Management Practice Award through the Academy of Nutrition and Dietetics.
She spent the first decade of her career as the lead dietitian for Kaiser Permanente Southern California. For the past several years, she has been working with industry partners and consumers to improve nutrition education within the field and maintains a virtual private practice. In April 2021, she launched Bariatric Nutrition Pro – to provide healthcare practitioners education to start (or continue!) their bariatric career with the confidence and knowledge to succeed.
She is a past Chair of the American Society of Metabolic and Bariatric Surgery Integrated Health Clinical Issues Committee and Chapter author of the 3rd Edition of the Academy of Nutrition and Dietetics Pocket Guide to Bariatric Surgery. She is a national speaker and enjoys time hiking and cooking in the kitchen. Katie also partners with Nutritional Resources (d/b/a HealthWise) for creation of educational content for weight management professionals.