Regular NHD contributor, Rebecca Gasche, RD, looks at the common symptoms of long COVID (which include loss of appetite and gastric problems) and considers the current thinking around nutrition and diet to help alleviate some of the problems patients are facing.

As we turn the corner into spring, with vaccinations being rolled out and restrictions gently lifting, there seems to be a feeling of hope simmering across the nation. The past 12 months have been tough on so many – from the key workers putting in extra hours, businesses closing, jobs ending and loved ones sadly lost.

There have been a total of over four million positive cases of COVID-19 and, sadly, over 120,000 deaths (true on 28/03/21).¹ But a stat you tend to hear less about is long COVID – it is not known exactly how many people are suffering with the effects but it is estimated to be growing above 60,000.²

NICE has published guidance on how to identify long COVID, stating that:

• recovery time is different for everyone, but for many people, symptoms will resolve by 12 weeks;
• the likelihood of developing ongoing symptomatic COVID-19 or post-COVID-19 syndrome is not thought to be linked to the severity of an individual’s acute COVID‑19 (including whether they were in hospital);
• if new or ongoing symptoms occur, they can change unpredictably, affecting a person in different ways at different times.³

There are a number of common symptoms linked with long COVID, including the following:

• Respiratory Breathlessness, cough
• Cardiovascular Chest tightness, chest pain, palpitations
• Generalised Fatigue, fever, pain
• Neurological Cognitive impairment ('brain fog', loss of concentration or memory issues), headache, sleep disturbance, peripheral neuropathy symptoms (pins and needles and numbness), dizziness, delirium (in older populations)
• Gastrointestinal Abdominal pain, nausea, diarrhoea, anorexia and reduced appetite (in older populations)
• Musculoskeletal Joint pain, muscle pain
• Psychological/psychiatric Depression, anxiety
• Ear, nose and throat Tinnitus, earache, sore throat, dizziness, loss of taste and/or smell
• Dermatological Skin rashes

The NICE guidance advises that patients experiencing long COVID should be referred to the appropriate multidisciplinary teams, depending on their symptoms, and notes that the core rehab team could include (but is not limited to) occupational therapists, physiotherapy, clinical psychology and psychiatry, and rehabilitation medicine.³

THE ROLE OF NUTRITION AND LONG COVID

As above, long-COVID can affect people in many different ways. The role of nutrition should not be underestimated, as a number of symptoms may be improved through appropriate nutritional therapy. I have picked out just a few examples to demonstrate this:

Gastrointestinal symptoms

• Altering fibre content in the diet may help with patients suffering with diarrhoea or constipation.
• Identify dietary triggers that could be contributing to altered bowel habits, abdominal discomfort or bloating.
• Plain, dry foods or flavours such as citrus or ginger can help with nausea.

Loss of appetite

• Fortify meals and snacks by adding cream, butter, grated cheese, dried milk powder to meals/sauces.
• Eat little and often.
• Include nourishing drinks between meals.

Fatigue

We know that nutrition can be vital in improving a patient’s symptoms of fatigue in other conditions, such as chronic fatigue syndrome (CFS) and, therefore, advice given to these patients may be adapted for those with long COVID. This includes:

• ensuring patients are consuming a well-balanced diet, with regular sources of starchy carbohydrate, protein and a variety of fruits and vegetables;⁴
• providing softer foods and utilising ready meals.⁵

POST-COVID RECOVERY

There is currently little research specifically on diet and long COVID, however the NHS recommends the following for post-COVID recovery:⁵

• Consume a well-balanced diet.
• Take nourishing meals, snacks and drinks (and nutritional supplements if these have been prescribed by a doctor/dietitian) if you have lost weight or muscle mass.
• Consume regular sources of protein to prevent muscle wastage.
• Consider a multivitamin if dietary intake is limited.
• Consider a 10mcg daily vitamin D supplement if you are over 65, not spending much time outside or have a darker skin tone.
• Eat little and often and take drinks in between meals, particularly if you are feeling short of breath.

The NHS also have a volunteer responder number, which offers support to patients with their food shopping: 0808 196 3646.⁶

With the above in mind, it would be appropriate to advise that those suffering with long COVID have support to maximise their nutrition and recovery, and MDT working should consider the care of a dietitian if this is indicated.

Rebecca Gasche, RD

Clinical Lead Dietitian, Countess of Chester Hospital NHS Trust

Rebecca has a keen interest and specialises in gastroenterology dietetics
within the NHS, and is the dietetic lead for the
gastroenterology service within West Cheshire.

References

1 Gov.UK (2021). Retrieved from https://coronavirus.data.gov.uk/details/cases

2 National Health Service England. Post-covid syndrome (Long COVID). Retrieved from https://www.england.nhs.uk/coronavirus/post-covid-syndrome-long-covid/

3 National Institute for Health and Care Excellence (NICE 2020). COVID-19 rapid guideline: managing the long-term effects of COVID-19. Retrieved from https://www.nice.org.uk/guidance/ng188/chapter/1-Identifying-people-with-ongoing-symptomatic-COVID-19-or-post-COVID-19-syndrome

4 British Dietetic Association. Chronic Fatigue Syndrome and Diet. Retrieved from https://www.bda.uk.com/resource/chronic-fatigue-syndrome-diet.html

5 National Health Service (2020). Your COVID Recovery – Eating Well. Retrieved from  https://www.yourcovidrecovery.nhs.uk/your-wellbeing/eating-well/

6 https://nhsvolunteerresponders.org.uk/print-guide---faqs-for-people-self-isolating-and-members-of-the-public---21