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  8. Gut symptoms and digestion

Gut symptoms and digestion

Problems with digestion and gut symptoms can be caused by a COVID-19 infection.

They can include:

  • Change in taste and smell (anosmia)
  • Reduced or increased appetite (not feeling hungry or wanting to eat more food than usual)
  • Reduced food intake due to symptoms
  • Feeling full quickly after eating food
  • Not enjoying food and eating
  • Not wanting to drink fluid
  • Dry mouth
  • Swallowing problems (dysphagia) – particularly after intubation (breathing tube) in intensive care
  • Diarrhoea 
  • Gut or tummy pain
  • Indigestion 

How do these symptoms affect my diet and nutrition?

Symptoms affecting the gut or digestion can make it harder to eat well and have a healthy diet. You may not feel hungry or only be able to manage certain foods.

Pain, indigestion and changes in bowel habit (diarrhoea or constipation) can cause anxiety around eating. These symptoms can increase the risk of poor nutrition or undernutrition (malnutrition).

Understanding how COVID-19 may cause gut symptoms

When the COVID-19 virus enters your body, it uses a specific 'key' to 'unlock' your cells. The key that fits into the special locks is called angiotensin converting enzyme 2 receptors (ACE2).  These locks are all over your body, including your lungs, nose, mouth, and gut.

The wide range of places the virus can attach (using those ACE2 receptors) helps explain why people experience so many different symptoms, such as losing their sense of taste or smell, and having gut problems (Kai-Yue et al., 2023).

Here’s what happens in your digestive system:

  • Virus entry: When the virus gets into the cells lining your gut, it can cause problems.
  • Inflammation and damage: The virus can cause inflammation, damaging the protective lining of your intestines.
  • Microbe imbalance: It can also throw off the balance of the helpful bacteria (microbes) that live in your gut.
  • Long-term issues: The virus might make existing gut problems, like Irritable Bowel Syndrome (IBS), feel worse. In fact, most people who suffer from Long COVID have at least one long-lasting digestive symptom.
  • Other factors: Medication and stress related to having the illness can also cause long-term gut issues.

This is for informational purposes only. For medical advice or a diagnosis, consult a professional.

Resources

Managing gut symptoms

You naturally have acid in your stomach to help digest food. Sometimes this acid causes pain or discomfort in your stomach or a burning feeling in your chest (behind your breastbone). This is called indigestion or heartburn and can happen with COVID-19 infection.

The BDA Critical Care Specialist Group and ICU Steps offer advice on managing indigestion after critical illness, which can be used after critical illness and while recovering from COVID-19 infection.

Diarrhoea or an upset stomach may also occur as you recover. You can find information from the BDA Critical Care Specialist Group and ICU Steps on managing an upset stomach or bowel [PDF].

Your gut has a community of microbes (like bacteria) called a microbiome, which can get out of balance due to various reasons, including a COVID-19 infection. Many people are interested in finding ways to restore a healthy balance. Probiotics might help, but the research results are mixed. Have a look at the BDA fact sheet to find out more about probiotics.

Swallowing problems

Managing not feeling hungry or a small appetite

Eating well during COVID-19 recovery

The Swansea Bay University Health Board therapy information pack includes ideas on how to eat and drink well and increase interest in food after COVID-19 infection. Find out more here: Covid and Long Covid recovery – therapy information pack.

This information from the BDA Critical Care Specialist Group and ICU Steps is about eating after critical illness. Some symptoms are similar to those recovering from COVID-19 infection. There is advice on how to have a balanced diet and ways to improve the amount of protein you eat. Find out more here: Nutrition at Home after Critical Illness [PDF].

Mindful eating 

Being more aware of what we eat and when we eat can encourage more positive eating behaviours and healthy eating choices. It can help you choose foods that are satisfying as well as nourishing for your body. Find out more from the BDA advice on mindful eating.

Note: The information on mindful eating may not be suitable for those with an active eating disorder. 

For more information, please see our page on how COVID-19 can affect eating and nutrition, along with simple tips to help you manage these changes during recovery.

New evidence

COVID-19 infection may cause new gastrointestinal symptoms (Cooney et al., 2022)

This very small study looked at digestive symptoms in 122 adults after a COVID-19 infection.

Here are the key takeaways:

  • Who was studied? Most participants (97%) had severe COVID-19 and needed to be hospitalised. Before getting sick, most (83.3%) had no digestive (gut) problems.
  • What happened after COVID-19? Six months after their infection, 43.8% reported new digestive symptoms that they didn't have before they got sick with COVID-19 infection.
  • New common symptoms included: Abdominal pain (29.2%), indigestion (29.2%), diarrhoea (18.8%), constipation (10.4%), nausea (10.4%)
  • Symptom frequency: Many people had these symptoms often with 39% experiencing them every day.

  • Limitations: Because the study size was very small, the results are limited, and more research is needed to confirm these findings.

What it means for you:

  • This study suggests that people who have more severe COVID-19 infection needing hospital care might develop new, long-lasting digestive problems. These problems could possibly be a new type of irritable bowel syndrome (IBS)

A new, experimental high-fibre supplement may reduce severe gut symptoms after COVID-19 infection (Wang et al., 2022).

This report is about a single patient who had severe gut problems after a COVID-19 infection. She was given a new high-fibre supplement for two months to see if it would help her symptoms by changing the bacteria in her gut (her gut microbiome).

Here are the key takeaways:

  • Results: After two months on the supplement, the patient's gut bacteria changed. She felt less nauseous, had a better appetite, and even her anxiety and heart palpitations improved.
  • Limitations: This was a study of just one person. A large study with many people is needed to confirm these results.

What it means for you:

  • Changing the fibre in your diet might help improve gut symptoms related to COVID-19 infection

A word of caution: If you decide to increase the fibre in your diet, do it slowly to avoid making your symptoms worse. It is best to get expert nutritional advice to find the right amount and type of fibre for your needs. Do not change your fibre intake if a doctor or dietitian has already recommended a special diet for you.

This is for informational purposes only. For medical advice or a diagnosis, consult a professional.