Helping patients to manage symptoms, particularly those affecting eating and nutrition, can be difficult. Here is some information on managing symptoms which you can use to help your patients during their recovery.
Clinical recommendations
Considering the intermittent nature of COVID-19 symptoms, any association with nutrition may be challenging to identify. Symptom severity will also determine the impact COVID-19 has on nutrition and diet, whilst one mild symptom may be tolerable, several mild symptoms together can be very debilitating (Malnutrition Pathway, 2020 [PDF]).
Symptoms such as anosmia, dysgeusia (loss/alteration of taste) or diarrhoea, or a combination of these, increase risk of disease-related malnutrition (Ballesteros Pomar and Bretón Lesmes, 2020). There is a fundamental difference between symptoms related to post-viral chronic fatigue from those to traumatic stress disorder and those due to post-critical illness.
Some authors (Sudre et al., 2020) characterised two patterns for Long Covid: people with fatigue, headache and upper respiratory complaints (shortness of breath, sore throat, persistent cough and loss of smell) and/or people with additional multi-system complaints, including ongoing fever and gastroenterological symptoms. Other studies suggest that in some cases, symptoms relate to a pre-existing health condition or disability (NIHR, 2021).
Issues that affect dietary intake
- Respiratory: coughing and breathlessness, gas trapping and early satiety, caused by gulping air whilst eating, dry mouth due to breathing through the mouth, use of inhalers and oxygen therapy
- Changes to taste and smell impact appetite and desire to eat – for more information please see our underlying mechanisms for COVID-19 symptoms page
- Temperature, infection and inflammation: inflammatory response can suppress appetite and alter metabolism, increasing the need for specific nutrients and fluid when intake may be poor – for more information please see our underlying mechanisms for COVID-19 symptoms page
- Fatigue and weakness impact a patient’s ability to undertake normal activities of daily living, such as shopping and cooking
- Isolation impacts nutritional intake e.g. poor food availability and accessibility for those who struggle to go to the shops. Lack of visits from family or friends to provide food, company and feeding assistance. Cancellation of social lunch clubs
Useful resources
The BDA Critical Care Specialist Group provides eating recommendations after critical illness that can be offered to patients: Nutrition at Home after Critical Illness [PDF].
The Action for ME charity provides detailed guidance to support making an informed decision about various pacing approaches worth trying to address fatigue, weakness and other related symptoms: Pacing for people with M.E. [PDF]
There are various documents in the NHS archive that point to the use of aromatherapy to address sleep and anxiety issues:
- Effects of aromatherapy on sleep quality: A systematic review and meta-analysis
- The effect of lemon inhalation aromatherapy on blood pressure, electrocardiogram changes, and anxiety in acute myocardial infarction patients: a clinical, multi-centered, assessor-blinded trial design
- Essentials of essential oils
Symptom toolkit
The information below lists groups of symptoms that may influence nutritional status or be influenced by diet and/or nutrition, as identified from various documents (Gem COVID, 2020; NHS, 2020; NICE, 2020; Davis et al., 2021; NIHR, 2021; Wise, 2021).
Watch nutrition scientist, Dr Sarah Berry, discussing how to manage post-COVID syndrome related symptoms from a nutritional perspective – Diet and COVID-19 here.
Currently there is a new Long Covid symptom burden questionnaire, which is undergoing further development. See here for more info:
Several sections in this Hub contain valuable information relating to each group of symptoms and useful links have been added to support navigation to other resources. View more information about the mechanism of COVID-19 symptoms.
Resources to support food and symptom tracking
- Is there a link between food and my symptoms? by Hannah Hunter, Allergy Dietitian
- Download a food diary [Word.doc]
- Pacing for people with ME [PDF] Some lessons can be learned from the guidance to pace activities and physical activity on chronic fatigue patients. They suggest keeping a diary too
Additional references
B Balbi et al. (2020) ‘Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors (version April 3, 2020).’ doi: https://ers.app.box.com/s/npzkvigtl4w3pb0vbsth4y0fxe7ae9z9 [PDF] [accessed 25.05. 20].
Khoramipour, K. et al. (2021) ‘Physical activity and nutrition guidelines to help with the fight against COVID-19’, Journal of Sports Sciences, 39(1), pp. 101–107. doi:10.1080/02640414.2020.1807089.
Killerby, M.E. et al. (2020) ‘Characteristics Associated with Hospitalization Among Patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020’, Morbidity and Mortality Weekly Report, 69(25), pp. 790–794. doi:10.15585/mmwr.mm6925e1.
Lockyer, S. (2020) ‘Effects of diets, foods and nutrients on immunity: Implications for COVID-19?’, Nutrition Bulletin, 45(4), pp. 456–473. doi:10.1111/nbu.12470.
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.
NICE (2020) ‘COVID-19 rapid guideline: managing the long-term effects of COVID-19’, p. 35.
NIHR, E. (2021) Living with Covid19 - webinars - Informative and accessible health and- care research. Available at: https://evidence.nihr.ac.uk/themedreview/living-with-covid19-webinars/?source=chainmail (Accessed: 26 April 2021).
Polamarasetti, P. and Martirosyan, D. (2020) ‘Dietary Deficiencies Exacerbate Disparity in COVID-19 and Nutrition Recommendations for Vulnerable Populations’, Bioactive Compounds in Health and Disease, 3(11), pp. 204–213. doi:10.31989/bchd.v3i11.759.
Risso, D., Drayna, D. and Morini, G. (2020) ‘Alteration, Reduction and Taste Loss: Main Causes and Potential Implications on Dietary Habits’, Nutrients, 12(11), p. 3284. doi:10.3390/nu12113284.
SCCM (no date) SCCM | Long Term Neurological Complications of COVID-19, Society of Critical Care Medicine (SCCM). Available at: https://ics.ac.uk/resource/neurology-for-covid-19-patients-in-icu-and-beyond.html (Accessed: 16 March 2022).