Post-COVID Nutrition Care

Coronavirus (CoV) is a family of viruses that can cause respiratory, as well as gastrointestinal, illnesses. It was named due to its crown-like spikes on the outer surface. Viruses of the CoV family can cause a wide range of illness in humans, from common cold to severe ones like Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). In December 2019, a new strain of coronavirus was detected in Wuhan, China, which has now engulfed the world.

The disease can be mild or moderate, as well as severe, but in some cases, individuals may show no symptoms at all. However, majority of the time, this disease manifests various respiratory symptoms. The growing evidence shows that it can also affect our gastrointestinal system, where the symptoms usually develop during the course of illness and might persist even after the virus leaves the body. Digestive problems commonly associated with COVID-19 are lack of appetite, nausea or vomiting, diarrhea, and abdominal pain. People recovering from COVID-19 might experience other problems, such as constipation, bloating, acid reflux, colitis (intestinal inflammation), gastrointestinal bleeding, and worsening of irritable bowel disease (IBD). The mechanism behind persistent GI symptoms is the disruption of normal intestinal mucosa by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), and this could also compromise nutrient absorption.
The manifestation of these persistent GI-related symptoms, such as loss of appetite, amnesia, bloating, and gastritis affect the basic nutritional status indicators of an individual, that is, intake, digestion, and absorption. This very reason accounts for the need of nutritional rehabilitation during the recovery phase. Also, other symptoms, such as persistent fatigue, weakness, and shortness of breath, have been reported by individuals even after two-three months of being negative, nutrition rehabilitation is further more important during these days. For any reason, whether you have recently been reported negative, or when you have been negative for few months now, whether you experience long-term symptoms or not, nutritional care does assist your physiology towards faster recovery.

Nutritional Guidelines

The body requires more calories than usual during the recovery phase to get rid of the virus. Hence, inclusion of calorie-dense food in the diet is very crucial. Include whole grains like wheat, maize, buckwheat, millet, rice, potatoes, and cereals in your diet. Also, add nuts and seeds, such as almond, walnut, pistachios, dates, flaxseeds, etc. during your mid-morning/afternoon or evening snacks, as these are high in calories and maintain your energy requirements.

Proteins are important for strengthening immunity. They also help in overcoming the wear and tear of your body cells, which is common during infection. Proteins also replenishes the body strength, hence daily intake of 1 g of protein per kg body weight throughout the day on a regular basis can play a strong role in recovery. Dairy products, such as milk, paneer, yogurt, and poultry (eggs, chicken), as well as legumes and beans can suffice your protein requirements.

3. Vitamins and minerals
Along with protein, many vitamins play a crucial role in recovery with COVID- 19. Vitamin C, which is a potent antioxidant, and vitamin D, an important immune modulator, are important micronutrients to add up to your diet. Suffice your requirements of vitamin C through avocado, kiwis, pineapple, and other seasonal citrus fruits. Exposure of sunlight is important to maintain the dosage of vitamin D; if in any case you are deficient, supplementing it according to your doctor’s prescription is crucial. Along with these vitamins, other secondary vitamins that play an important role in strengthening the immune system are vitamin A, vitamin E, and B-complex. Aim for five servings of fresh and seasonal fruits and vegetables in a day, which can load up all your vitamin requirements.

Minerals like zinc and selenium are important nutrients to add in the diet due to their immune-modulating effects. Zinc modulates the immune cells positively, and also exerts anti-viral effects, hence, load up your zinc requirements through nuts and seeds, dairy products, eggs and meat products, and whole grains. Also, selenium works as an antioxidant and increases the activity of immune cells, decreasing the risk as well as severity. Some of the richest sources of selenium are poultry and dairy products, oats, green leafy vegetables like spinach, and lentils.

4. Omega- 3s
Omega 3s are anti-inflammatory in nature, and during the recovery phase it is crucial to load up this nutrient, as it reduces inflammation caused during the infection. Fatty fishes like salmon, mackerel, and tuna, nuts and seeds like walnut, flaxseeds, and chia seeds, as well as vegetable oil like sunflower oil and canola oil are the richest sources of Omega-3s.

5. Probiotics/Prebiotics
Foods rich in probiotic are essential for our body, as they contain good bacteria that helps to boost the digestive system, support nutrition (absorption and digestion), and strengthen the immune system. As COVID treatment involves consumption of high dosages of antibiotics, these antibiotics decrease the number of necessary bacteria in the digestive system to a large extent and cause gastrointestinal symptoms like abdominal pain, constipation, and bloating. Hence, it is important to add probiotic foods in the daily diet, because they increase the level of gut bacteria, thereby strengthening immunity. So, add fermented foods like tama, gundruk, and pickle, or kombucha, kimchi, and kefir as probiotics in your diet. Similarly, prebiotics are a form of dietary fiber that feeds on good bacteria of the gut and maintains its population. Add oats, asparagus, and banana as a prebiotic source in your diet.

6. Nitric oxide-rich diet
Nitric oxide, produced by nearly every type of cell in the human body, is one of the most important molecules for blood vessel health as well as the respiratory cycle. It is as vital as oxygen. Without it, oxygen is not delivered to our brain, muscles, and other organs. Nitric oxide relaxes the vessels and keeps them flexible, allowing them to dilate, boosting blood flow, and is involved in the respiratory cycle by helping red blood cells to release the oxygen they carry to the body’s tissues. Also, certain immune cells generate nitric oxide, which is important as a defense molecule against bacteria and other pathogens. For individuals experiencing persistent shortness of breath and fatigue, adding up foods rich in nitrates, which is eventually converted to nitric oxide inside the body, is beneficial to ease breathing and reduce fatigue. Beetroot, spinach, radish, mushroom, and broccoli are the richest source of nitrate that can be added to the diet for symptomatic relief.

The focus is on balanced and diverse diet as the key factor that helps during the recovery. However, a huge setback during the post-COVID phase, as mentioned above, is persistent symptoms, such as loss of smell and taste, as well as bloating and medication-induced nausea, which hamper the eating. While coping with nausea, try reducing the spices and eat plain bland foods. For dry mouth, sucking on mints and toffee can stimulate saliva production. As for loss of taste, eating strong flavored foods help, and for loss of smell, eating foods rich in vitamin A and alpha lipoic acid aid in recovery. Foods rich in alpha lipoic acid are rice bran, potato, spinach, broccoli, and peas, while food rich in vitamin A are organ meat, carrots, sweet potatoes, pumpkin, and many more.

Things to Remember about the Recovery Diet
• Always prioritize fresh produce like fruits, vegetables, and animal products over pre-packaged ones.
• Make sure you are fully hydrated.
• Make sure all your meals are freshly cooked at home and are made with less spices, instead of relying on outside foods.
• Ensure that all hygiene practices are followed while preparing the food.
• Focus on small, but more frequent meals, as eating large portions may be difficult during the initial phase of recovery from COVID-19 infection.
• Try adding soft, mashed food, or liquids, to begin with, as many COVID-19 patients experience difficulties swallowing during the recovery period.
• Any diet is ineffective without proper sleep and exercise, so get enough rest and start with smaller physical activities to get back in shape.

Sample Diet Plan

• Breakfast: oatmeal with nuts (almond-6, walnut-1 whole), fresh dates- 2 whole, 1 teaspoon flaxseed, and 1 boiled egg.
• Lunch: Rice, dal , green leafy vegetables, other vegetables like cruciferous, squashes, or pumpkin and salads (beetroot, carrots, cucumber), and chicken (4-5 pieces) or paneer or tofu (for vegetarians).
• Mid- afternoon: 1cup curd with fruit (1seasonal fruit)
• Snacks: mashed potatoes, tofu sautéed, suji halwa , buckwheat/ millet pancake, etc.
• Dinner: As in the morning, or jaulo.
• Bedtime: 1 glass milk.


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