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  7. Is what I eat affecting my recovery from COVID-19?

Is what I eat affecting my recovery from COVID-19?

What you eat can play a big role in recovery from COVID-19. But it’s not always easy to know if you’re eating the right foods or getting the nutrition you need.

Below are six questions to help you understand more about your nutrition and eating.

Answering yes to a question might mean you need to make changes to your diet or seek advice from your healthcare professional or registered nutrition expert. Although this might be worrying, there are things you can do to improve your nutrition and eating.

1. Do you have ongoing symptoms after COVID-19 infection? 

Some people continue to have symptoms for many weeks after their COVID-19 infection. Long Covid is when symptoms last for more than 12 weeks. If you think you have this, it may be helpful to contact your GP surgery for advice.

Long Covid has some common symptoms listed below:

  • Loss of appetite (not feeling hungry)

  • Feeling tired all the time (fatigue)

  • Changes in taste or loss of smell

  • Coughing or breathing problems

  • Changes in your bowel movements (constipation, diarrhoea)

  • 'Brain fog' (trouble thinking clearly)

These symptoms can affect hunger, eating and food choice. If you don't feel hungry or regularly make unhealthy food choices, you could be at risk of poor nutrition. The end of this section suggests some next steps you might want to take.

What can I do to help myself?

  • Knowing how to manage symptoms can make it easier to eat well. This can help to improve your nutrition. Have a look at the symptom management section for some tips.
  • Keeping a diary of what you eat and any symptoms can help you and your healthcare professional better understand your symptoms and nutrition. Write down what you eat and any symptoms you have in the day on a piece of paper, computer or as a phone note. Making a note of when symptoms occur and how severe they are can also be useful. There are food and symptom diaries available on the internet, with some examples here: University Hospitals Plymouth, Cambridge University Hospitals, BUPA UK. The Patients Association also has more information on food and symptom diaries and how they can help.
  • Some symptoms may improve if you have a healthy, balanced diet. Are there changes you can make to improve your nutrition through what you eat? Why not begin by comparing your own diet with one of the Eatwell guides below? 
  • Talk to your healthcare professional about symptom management. They may be able to offer advice, treatment or signpost you to further support.

2. Has your eating or diet changed since having COVID-19?

Eating habits often change when you are unwell. Some people find they eat less healthy food, especially while recovering from illness. This may be due to changes in appetite, taste or feeling too unwell or tired to prepare a healthy meal or snack. If these unhealthy dietary choices continue or become usual eating habits, your nutrition will be poor. The end of this section suggests some next steps you might want to take.

What can I do to help myself?

  • Better symptom management will help improve your nutrition if ongoing symptoms are affecting your eating and food choices. Look at the managing symptoms section for tips.
  • Check to see if you are at risk of malnutrition (poor nutrition) by using the self-screening tools and checklist.
  • Talk to your healthcare professional if you need further advice or help with your diet and eating habits.
  • Make a note of what you are eating and any symptoms. This can be useful when talking to your healthcare professional about your diet. 
  • If you want to make positive changes to your diet have a look at the Eatwell guides for advice: Eatwell Guide, South Asian Eatwell Guide, African Caribbean Eatwell Guide or Plant-based Eatwell Guide. Are there any changes you feel able to make to improve your nutrition?

3. Do you have high blood pressure, diabetes or a high BMI (over 30kg/m2)?

Long-term conditions like high blood pressure (hypertension), diabetes, or a high body mass index (BMI) can put you at risk of a more severe COVID-19 infection. Managing your weight, blood pressure, and blood sugar level can help your recovery and general health. Speak to your healthcare professional if you would like to make changes to your diet and nutrition or contact your GP surgery for advice on where to go for help and support. The end of this section suggests some next steps you might want to take.

What can I do to help myself?

  • Changing your diet can help improve many long term conditions. Learn more about this by clicking on the relevant section below:
  • Making a note of what and when you eat and how hungry you are can help you to better understand your eating patterns. This can help you make positive changes to your eating. Be Body Positive has an example of how to record hunger levels. 
  • Talk to your healthcare professional or contact your GP surgery if you need more advice or support with your diet and lifestyle. Why not take along your food and hunger diary to help you talk about the challenges you are facing?

4. Were you hospitalised as a result of COVID-19?

If you were admitted to hospital it means you had a more severe COVID-19 infection. You might have struggled to eat properly during that time. You may still feel weak and tired, and this can affect your appetite and energy to shop for or prepare food. Your nutrition can be affected if this is an ongoing problem. The end of this section suggests some next steps you might want to take.

What can I do to help myself?

  • You should be offered a follow-up appointment one to two months after discharge from hospital. This is to review your recovery. It may be with your GP, a hospital consultant, at a COVID-19 clinic or an intensive care follow-up clinic. You may also see an allied healthcare professional such as a physiotherapist, occupational therapist or dietitian to talk about your recovery. 
  • Talk to your healthcare professional if you are struggling to eat well or worried about your nutrition after your hospital admission.
  • Keep a food diary noting everything you eat and drink. This can be helpful to use at appointments with healthcare professionals. Including any symptoms or hunger levels can also be helpful.
  • You may find information from the British Dietetic Association about managing symptoms after hospital admission helpful.
  • The Patients Association explains more about nutrition (malnutrition) and illness in their fact sheet and video.

5. Are you using an oral nutritional supplement? 

Your doctor or healthcare team might have given you oral nutritional supplements (ONS) to take between your meals. Your healthcare professional can advise on the best type of ONS for you, how many to take and how long to take them for.

These oral nutritional supplements give extra calories, protein and other nutrients. They are used when you can’t eat enough food because of illness or symptoms. Most people only need them in the short term (up to 12 weeks). ONS can also help improve your nutrition if you are at risk of malnutrition (undernutrition). 

Examples include Ensure Plus, Fortisip Compact, Fortisip Compact, Fresubin 2kcal, Resource Energy, Altraplen Compact and Aymes shake. You may also be buying ONS with common brands including Meritene Strength, Complan and Aymes Retail. 

The Patients Association has some tips about ONS, which may be helpful.

What can I do to help myself?

  • Check with your healthcare professional if you still need the oral nutritional supplements.You may not need them if you are now eating well, are not losing weight and are not underweight (BMI less than 18.5kg/m2).
  • Are the oral nutritional supplements improving your nutrition and helping you move closer to your nutritional goals? Talk to your healthcare professional about this. They should check that prescribed oral nutritional supplements are continuing to help you.
  • If you are unable to take oral nutritional supplements or manage the full prescription, please tell your healthcare professional. They can find different products or may advise on other treatments to support your nutrition.
  • Some people need expert advice from a dietitian. Your healthcare professional can refer you to an NHS dietitian for assessment and further advice if needed.
  • For further information on oral nutritional supplements, have a look at the factsheet on the Patients Association website. 

6. Have I got a vitamin or mineral deficiency?

If you think you’re missing important vitamins or minerals in your diet, contact your GP, healthcare professional, or a registered nutrition expert.  They can advise on assessments and guide you on what to do. You may be referred to a nutrition expert, such as a dietitian, for a more detailed assessment and advice. 

Always tell your healthcare professional is you are taking any supplements.

Vitamin D

About 1 in 6 adults in the UK has low vitamin D. The NHS recommends that everyone takes 10 micrograms (400 IU) of vitamin D each day between October and March. There’s no strong proof that vitamin D prevents COVID-19. If your vitamin D levels are low, taking a supplement could still help your recovery.

Next steps

If you answered 'yes' to any these questions you might want to:

Remember: Talk to your healthcare professional if you are concerned. They can help you get the right advice and support.

Your symptoms and dietary advice may change over time so come back to this section and re-check your risk of nutritional problems.

References

Bergan, Can vitamin D protect against COVID-19? BMJ 2022;378:o1822. doi: https://doi.org/10.1136/bmj.o1822 

Lin L, Smeeth L, Langan S, et al. Distribution of vitamin D status in the UK: a cross-sectional analysis of UK Biobank. BMJ Open 2021;11:e038503. doi: 10.1136/bmjopen-2020-038503.

Merino, J. et al. (2021) ‘Diet quality and risk and severity of COVID-19: a prospective cohort study’, Gut, 70(11), pp. 2096–2104. doi:10.1136/gutjnl-2021-325353.

National guidance for post-COVID syndrome assessment clinics (6 November 2020) [Internet]. Patient Safety Learning - the hub. [cited 2021 Jan 9]. Available from: https://www.pslhub.org/learn/coronavirus-covid19/guidance/national-guidance-for-post-covid-syndrome-assessment-clinics-6-november-2020-r3465/

Nguyen MH, et al. (2021) ‘Single and Combinative Impacts of Healthy Eating Behavior and Physical Activity on COVID-19-like Symptoms among Outpatients: A Multi-Hospital and Health Center Survey.’, Nutrients, 13(9). doi:10.3390/nu13093258.

Soltanieh S, Salavatizadeh M, Ghazanfari T, et al. Plant-based diet and COVID-19 severity: results from a cross-sectional study. BMJ Nutr Prev Health. 2023 Oct 4;6(2):182-187. doi: 10.1136/bmjnph-2023-000688. PMID: 38618542; PMCID: PMC11009546.

University of Leeds, Sivan M, Halpin S, University of Leeds, Gee J, Airedale NHS Foundation Trust. Assessing long-term rehabilitation needs in COVID-19 survivors using a telephone screening tool (C19-YRS tool). ACNR. 2020;19(4):14–7.