16 Mar 2020

Last updated June 25 2020

Dietitians and the BDA have been asked many questions about nutrition and dietary issues related to the COVID-19 / Coronavirus pandemic.

We would always encourage members of the public to start by following the latest advice from governments, the NHS and public health authorities. It is important to note that social distancing guidance differs in England from advice in Scotland, Wales and Northern Ireland. You can find more information here;

In all cases, if you or someone you live with have COVID-19 symptoms, you should stay at home

If you are one of the estimated 1.5 million particularly vulnerable people identified as a result of an underlying health condition or specific treatments, the government has issued specific advice. They have also published a letter for patients explaining the next steps for those shielding.

If you have more specific concerns, please contact NHS 111 (or your GP in Scotland) or your local health services in a safe and appropriate manner online or by phone. If you have a serious health issue, it is important that you still seek medical help. If you have a medical emergency, dial 999. 

We have also created the following Frequently Asked Questions, which we will update and add to on a regular basis.

Supplements

Can I boost my immune system through my diet?

Simply put, you cannot “boost” your immune system through diet, and no specific food or supplement will prevent you catching COVID-19/Coronavirus. Good hygiene practice remains the best means of avoiding infection.

To date, the European Food Safety Authority have not authorised any claim for a food or food component in the UK to be labelled as protecting against infection. More info here.

There are many nutrients that are involved with the normal functioning of the immune system, so we would encourage maintaining a health balanced diet in order to support immune function (include copper, folate, iron, selenium, zinc and vitamins A, B6, B12, C and D). We don't recommend any one food over another, but instead encourage eating a variety of foods to maintain a health balanced diet. See our Healthy Eating Food Fact Sheet for more tips and guidance on how to do that.

Our Older People Specialist Group and the Rooted Project created an infographic you can share

Should I take a vitamin D supplement?

Vitamin D works with calcium and phosphorus for healthy bones, muscles and teeth. It is also important in protecting muscle strength and preventing rickets, osteomalacia and falls.

In normal circumstances, sunshine, not food, is where most of your vitamin D comes from. So even a healthy, well-balanced diet, that provides all the other vitamins and nutrients you need, is unlikely to provide enough vitamin D if you aren't able to get enough sun. During autumn and winter months when we spend more time indoors and the sun is weaker, adults and children over the age of one are advised to take a daily supplement containing 10 micrograms of Vitamin D.

Now we are in spring, if you can, you should seek to spend some time outdoors in the sunshine (e.g. your garden or balcony). However, if you are having to self isolate or if you are unable to go outside, you should consider taking a daily supplement containing 10 micrograms to ensure a healthy vitamin D status (for adults and children over the age of one).

All babies under one year should be given a daily supplement of 8.5-10 micrograms unless they have more than 500mls of fortified formula milk.

You can also eat plenty of vitamin D rich foods, including:

  • Oily fish such as salmon, sardines, pilchards, trout, herring, kippers and eel contain reasonable amounts of vitamin D.
  • Cod liver oil contains a lot of vitamin D, but don’t take this if you are pregnant.
  • Egg yolk, meat, offal and milk contain small amounts, but this varies during the seasons.
  • Margarine, some breakfast cereals, infant formula and some yoghurts have added vitamin D.

Find out more in our Vitamin D Food Fact Sheet.

General

What general nutrition advice would you give for an someone who may have contracted COVID-19 and is self-isolating as a result?

If you feel you cannot cope with your symptoms at home, your condition is worsening or you have had symptoms for more than seven days, visit NHS 111. Do not go to a GP, pharmacy or hospital unless told to do so.

If you are self-isolating and especially if you have symptoms, it is important to maintain good nutrition and hydration. Make sure you are eating and drinking regularly, even if you have low appetite.

If you are in an at risk group or you are concerned about someone who is, please read some of our more detailed questions below. 

If you have specific nutrition needs, it is important that you continue to follow the dietary recommendations made by your dietitian or other healthcare professional. This may involve asking friends or family members to get you specific foods so you can continue to follow an appropriate diet.

Contact your dietitian or other healthcare professional in a safe way if you have concerns.

How can I make best use of the food I buy?

We’ve also got some tips from our Food Services Specialist Group to help you plan your shop and how to make best use of the food that you buy:

  • Use up your fresh ingredients first. You don’t want any food to go to waste, so use up perishable ingredients before foods with a longer shelf life.
  • Know what keeps longest. Fresh foods with relatively long shelf life includes root vegetables such as potatoes, sweet potatoes, carrots, onions
  • Carefully wash, rinse and drain salad leaves and fresh herbs and spin dry in a salad spinner, place into a suitable plastic storage tray, cover and keep refrigerated. By following this procedure your salads and fresh herbs will last for several more days than if just stored in the fridge un-covered.
  • It might seem obvious but make sure you aren’t storing things in your fridge that don’t need to be in there. For example, fresh tomatoes, un-peeled onions, un-peeled jacket potatoes, whole butternut squashes don’t need to be stored refrigerated. Removing these items from your fridge and storing them in a cool dark place will free up fridge space for more perishable items.
  • If you are stuck at home, take the opportunity to tidy and declutter your kitchen cupboards to free up space for ambient food products.  This is a great opportunity to get rid of those unused & unwanted items that end up “living” in your valuable storage space. Remember to re-cycle as many of the items you are discarding as possible.
  • If you do get sick, it is worth having a few easy to cook and prepare foods in the house on standby. Canned soups, microwavable rice and frozen ready meals are easy options that you can keep in stock in reasonable quantities if you don’t have the energy to prepare more complex recipes.

If you’re looking for recipe ideas or more advice on cooking and food preparation, our Let’s Get Cooking programme have some great advice.

Our Eat Well, Spend Less fact sheet can help you eat well on a budget

Love Food Hate Waste have some fantastic advice on what you can do to minimise your waste.

Should I be concerned about food safety and COVID-19 transmission?

It is very unlikely that you can catch coronavirus from food. COVID-19 is a respiratory illness. It is not known to be transmitted by exposure to food or food packaging.

Please continue to follow general food safety advice; washing hands thoroughly, cleaning surfaces and separating raw meat/fish from other foods when preparing food. 

Public Health England have published guidance on COVID-19 for food businesses which should be followed to minimise the risk of infection from employees. 

The Food Standards Agency have also published advice if you are preparing or supplying food to food banks or vulnerable people

What should I do if I'm worried about COVID-19? What about my mental health?

It is understandable that many people will feel anxious or upset about the COVID-19 outbreak and the impact that it has on their lives. This is a stressful time even as lockdown is lifting and looking after your mental as well as your physical health is important.

Our colleagues at MIND have some great resources to help, including on planning for self isolation, looking after mental wellbeing and accessing further support. 

Public Health England have also published advice on mental health and wellbeing. Key tips include:

  • Keep connected
  • Support and help others
  • Look after your sleep
  • Manage difficult feelings and talk to others
  • Get the facts

You can also read our Food and Mood Fact Sheet to consider how your diet impacts your mental health. 

Is it bad to be snacking during the lockdown period?

During this prolonged period of "lockdown" where we spend more time at home, we might find ourselves eating and snacking more often. Snacking can be a good part of an balanced diet, but it can also lead to us consuming more energy, sugar, fat or salt than we need. Registered Dietitian and BDA Spokesperson Laura Tilt has put together few key tips for healthy adults to help you snack in a healthy way:

1. Ask yourself – Are You Hungry?

The challenges of working from home combined with anxieties and uncertainties about the future mean that we’re all potentially snacking more than normal. If instead you’re bored, lonely or stressed, Laura suggests building a toolkit of resources to support yourself instead of reaching for a snack. If you’re feeling a bit low – reach out to a friend, take some time out to enjoy a cup of tea by and likewise if you’re stressed with work, take a break.

2. Organise Your Environment

Research demonstrates that time and time again that we’ll opt to snack on the first thing we see. Laura suggests switching up your cupboards and fridge so that the healthiest choice also becomes the easiest. This can be as simple as moving healthy snacks such as nuts and seeds to the front and others to the back, either wrapped up or out of eye line.

3. Prep Ahead

If you wait until you’re hungry to eat, you’re likely to make less healthy choices. Laura advocates tweaking your new daily routine to take 5 minutes in the morning to prepare healthy snacks for the day ahead, for example chopping up vegi sticks or fruit slices.

4. Aim for Sources of Steady Energy

Laura advises making food choices that help keep energy and mood on a steady keel throughout the day. This means combining sources which are good source of both fibre and protein, for example wholemeal toast with a boiled egg or banana with peanut butter.

You can watch this video to hear more of Laura's tips and get her recipe for storecupboard hummus.

Read the BDA's Healthy Snacks Food Fact Sheet for more info

What other steps can I take to stay well when social distancing?

Professor Rachel Batterham from the RCP has developed a series of videos (featuring dietitian Dr Adrian Brown!) which show how people of different ages and abilities can stay fit and healthy even while staying at home. Take a look:

  1. Older adults, or people who are less active: https://youtu.be/8Frf1EjnZ_Y
  2. Active adults: https://youtu.be/S6dD0A7M8wY
  3. Children and young people: https://youtu.be/U9W9RJpQ7cY

Malnutrition

Why is malnutrition important to consider for COVID-19?

Many people who fall into the at-risk group and have been advised to follow stay at home, are also those considered to be at greater risk of malnutrition.

Malnutrition is a serious condition which can increase a person’s risk of infection as well as slowing down their recovery. Those with an infection are also at higher risk of developing malnutrition which slows their recovery.

Malnutrition is also more common for older people and those who are already socially isolated. Social distancing and social isolation could impact a person’s access to the wide variety of foods needed to keep healthy and may make them want to eat less.

Malnutrition can also increase the risk of frailty, which is also more common in older age. Frailty can lead to weaker muscles and make people more vulnerable to infections, falls and needing extra care. 

Unintentional weight loss due to disease or infection is not good, whatever someone’s original body weight was. Healthy eating in older age may look different to the general healthy eating guidelines. This is because older people are more at risk of malnutrition. Some older people may need reassuring that their diet should be different. 

Read our Malnutrition Food Fact Sheet for more info. 

How do I know if I or the person I care for is at risk of malnutrition?

Individuals (or their family member or friends) can self-identify whether they need nutritional help or extra nourishment here.

Health and Social care staff are recommended to screen at risk groups using the malnutrition universal screening tool (‘MUST’).

If you are unable to weigh someone due to self-isolation measures then the two part nutrition checklist can be used to guide and support action found at the bottom of this link.

Care Home staff are recommended to continue screening their residents for malnutrition using ‘MUST’.

What is the advice for someone at risk of malnutrition?

Our Malnutrition Food Fact Sheet has lots of information and advice on preventing and treating malnutrition, including a nutrient dense diet. 

It is important older people are still encouraged to keep active. Ideas for useful activity, including those that can be done at home, can be found here. Good nutrition, including eating enough protein, is essential to protect people’s muscles including respiratory muscles to help with breathing.  

Vitamin D can also help protect our muscles and taking a 10 microgram supplement each day (which can be purchased from any pharmacy or supermarket) is also advised for the winter months, people who are housebound and those not receiving much daylight. Find lots more tips and information in our Vitamin D Food Fact Sheet

Getting enough fluid is essential for good health, and you will need more fluid than usual is you have an infection. Adults are usually advised to have 6-8 mugs or large glasses a day, but this may need to be higher for someone with a high temperature. See our Fluid Food Fact Sheet for more information about how to get the fluid you need.

Our Older People Specialist Group and the Rooted Project have created an infographic with eight top tips on helping keep older people well that you can download here

For more information on practical tips for those at risk of malnutrition whilst self-isolating, please see this leaflet written by Bournemouth University (in collaboration with Wessex AHSN and the Malnutrition Task Force).

What support might someone at risk of malnutrition need?

If you are supporting or thinking about someone who is vulnerable to malnutrition, consider the following:

  • Can they access supermarkets and food outlets to purchase food and drink or have they been asked to remain at home?
  • Do they have enough food and drink in their house to meet their nutritional needs?
  • Do they have access to ingredients that they can use to increase the nutrient content of meals and fluid if they are at risk of malnutrition?
  • Do they have a store cupboard of non-perishable basic foods, pre-prepared and/or frozen meals? See our advice on essential store cupboard items
  • Can they be linked to local social prescribing teams or adult social care via their local council? 
  • Can they access meal home delivery services such as Wiltshire Farm Foods, Oakhouse Foods, Parsley Box or a local council meals on wheels service?
  • Can they maintain communication by telephone and technology to reduce social isolation?

Are you / a family member recovering from COVID-19 and worried about nutrition?

Dietitians can support you to recover and rehabilitate from COVID-19. If you have had COVID-19 and expecially if you have been in hospital, you may have lost weight, your appetite or have difficulties swallowing. Ensuring you are eating and drinking enough will be really important. Contact your GP or local dietetic team in a safe way if you think you might need support. 

The Malnutrition Pathway have created resources to help you find the right information on good nutrition during or after COVID-19 illness: https://www.malnutritionpathway.co.uk/covid19

Health Conditions

What should I do if I'm living with Diabetes?

Our colleagues at Diabetes UK have produced an excellent resource answering lots of questions for people living with both type 1 and type 2 diabetes which we would recommend you read. 

If you have serious concerns about your diabetes, please contact your GP, consultant or dietitian. Help is still available.

What should I do if I'm living with Coeliac Disease?

If you have Coeliac Disease, it is important that you continue to maintain a gluten free diet even during social distancing or if you have to isolate as a result of symptoms.

Our colleagues at Coeliac UK also have some further excellent advice which we would encourage you to read. 

What if I receive Home Enteral Nutrition?

The BDA's Parenteral and Enteral Nutrition Group have come together with the National Nutrition Nurses Group (NNNG) and PINNT, the support group for people receving artifical nutrition, to provide guidance to people receiving Home Enteral Nutrition (HEN).

Your hospital clinical teams, HEN providers and the national NHS bodies are working closely together to ensure your service continues with minimal disruption throughout this challenging period. This information has been prepared to reassure you and help you understand what measures have been, or are being, put in place by your hospital clinical teams and homecare providers to protect you and continue to provide a safe service. 

Read the latest information from our colleagues at BAPEN here

What if I have an existing respiratory disorder?

This leaflet produced by Royal Devon & Exeter NHS Foundation Trust is designed to support you to eat well and avoid unplanned weight loss. It includes information on meal planning, food fortification and has specific diet recommendation.

What should I do if I'm living with Crohn's Disease or Ulcerative Colitis?

If you have Crohn's or Colitis and are following a recommended diet, you should continue to do so. 

Our colleagues at Crohn's and Colitis UK have some excellent advice that we would recommend you read.

They recommend that you do not stop any treatment you are undergoing. If you are taking an immunosuppressive / immunomodulating medicine you would be categorised as "at high risk" and should take the recommended precautions as a result. 

What should I do if I or my child has food allergies?

We understand that some people are concerned that they can’t currently access specialist allergy products because of high demand in shops. Hopefully this will be resolved soon as supermarkets introduce more stringent measures to prevent panic buying.

It remains important that you maintain any diet recommended for you or your child by a dietitian or healthcare professional, and this may mean eating a more limited range of foods that usual for a short while. You or children won’t be harmed if this is in the short term, and if you are concerned about specific micronutrient deficiencies, you may wish to consider a vitamin and mineral supplement in the meantime, and these remain easy to access.

If you or your child has a serious allergic reaction, contact health services as you normally would - help is still available. 

For further information we have the following resources:

If your child uses specialist formulas, please see our FAQ below on this topic under “Pregnancy and Babies”

 

What should I do if I am living with IBS?

If you have IBS, you may be worried about the impact of COVID-19 and social isolation. Dietitians Kirsten Jackson has written a blog post for the BDA Freelance Dietitian website about IBS and coronoavirus which you can read here.

Kirsten has also developed a free webinar for those living with IBS, which considers anxiety, how to structure your day and dietary consideration. Access the webinar by clicking here

What appropriate alternatives are there for blended diets and food allergy if there are food shortages?

At this time we cannot recommend alternative products for those using blended diets and those with food allergies as there is limited knowledge on availability across the UK day to day. Please continue to check food labels for nutrition and allergen information when looking for alternatives, and where necessary, we advise age appropriate vitamin and mineral supplements daily.   

Read our Blended Diets policy statement for more information

Where can I access more expert advice on diet and health conditions?

The fantastic Patient Webinars series by Somerset NHS Dietitians are a series of free to access, patient-focused webinars on a range of topics. This means you can access advice without needing to see a dietitian face-to-face. 

Topics/conditions covered include:

  • Advice for Children
  • Coeliac Disease
  • Constipation
  • Diabetes
  • Adult Food Allergy
  • Inflammatory Bowel Disease
  • Irritable Bowel Syndrome
  • Kidney Health
  • Malnutrition

Pregnancy, babies and children

Should I continue to breastfeed my baby?

The Royal College of Paediatrics and Child Health and Royal College of Obstetricians and Gynaecologists have issued wide ranging advice relating to COVID-19 / Coronavirus and breastfeeding and pregnancy. They make the following recommendations:

"At the moment there is no evidence that the virus can be carried in breastmilk. The well-recognised benefits of breastfeeding are likely to outweigh any potential risks of transmission of coronavirus through breastmilk.

"If you have any concerns about how you feed your baby, you can discuss these with your maternity team.

"However, you feed your baby, the following precautions are recommended:

  • Wash your hands before touching your baby, breast pump or bottles
  • Try and avoid coughing or sneezing on your baby while feeding
  • Consider wearing a face mask while feeding, if available
  • Follow recommendations for pump cleaning after each use

"If you choose to feed your baby with formula or expressed milk, it is recommended that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used."

This guidance may change as knowledge evolves, so please refer to the RCOG or RCPCH website for up to date advice.

For advice on breastfeeding, you can contact the National Breastfeeding Helpline.You can also find and contact a lactation consultant for digital consultation via www.lcgb.org.

What if I'm pregnant?

If you have concerns about pregnancy and COVID-19 we would recommend you read guidance from the Royal College of Obstetricians and Gynaecologists. The TUC has also published a blog looking at the employment rights of pregnant women who many need to isolate themselves. 

If you are pregnant, you are more vulnerable to getting infections than a woman who is not pregnant. If you have an underlying condition, such as asthma or diabetes, you may be more unwell if you have coronavirus.

If you have any concerns about your pregnancy, contact your GP or consultant as usual. Help is still available.

I’m concerned about supplies of infant formula, free-from milks and other products, what should I do?

Images of empty shelves and stories of shoppers fighting for food provisions has triggered panic buying across supermarkets in the UK. The UK government has advised that people should plan ahead on what is needed for self-isolation in the specified time frame only. Do not be misinformed by articles suggesting stockpiling beyond government advice. Follow the advice of UK supermarkets to avoid risking food shortages to others.

The British Specialist Nutrition Association (BSNA), which represents manufacturers, have stated all infant formula companies are continually monitoring supply and demand in the UK. If you are concerned, or require specific information, all infant formula companies can be contacted via their careline services. In the extreme case of shortages, please look for guidance directly from the manufacturers on using appropriate alternatives.  

There have been claims that some infant formula companies are making free provisions to those unable to gain access to infant formula. This is not the approach of any infant formula company in the UK currently.

It is very important that you follow the manufacturers normal instructions on how to prepare your infant formula, unless otherwise advised by your healthcare professional. 'Watering down', manipulating or diluting the formula as a way to ‘ration’ your stock of powdered infant formula is not a good idea as the formula will no longer provide sufficient nutrition to your child.

For healthy infants over six months, cow’s milk (or alternatives where applicable) may be used in complementary foods, and as a main drink in those over one year. Offer other sources of calcium rich foods and continue to provide a varied diet, or where necessary, an age appropriate vitamin and mineral supplement daily.

If breastfeeding and using infant formula, consider replacing formula feeds with breastfeeds. If breastfeeding has been stopped, it is possible to re-start breastfeeding (contact the National Breastfeeding Helpline for assistance).

 

Should I be considering introducing complementary feeding / weaning early if there are infant formula shortages?

There have also been claims that parents of infants should consider early introduction of complementary foods in light of the COVID-19 outbreak and potential infant formula shortages. This is not official advice. 

Most infants should be offered complementary foods from around six months of age, only when they are developmentally ready. Some infants may begin complementary feeding after four months of age (but not before seventeen weeks). This should only start when developmental readiness has been achieved. Parents and caregivers should consult a healthcare professional when deciding to do this.

Our Complementary Feeding Food Fact Sheet has lots more information about how and when to start this with your child. 

My child usually gets free school meals, what can I do?

If you are looking for information on how to make use of vouchers or funding provided by your school. Dietitians and nutritionists at Tameside and Glossop Community Nutrition have produced specific advice, including advice on healthy recipe ideas. Read more here

Policies across the UK

Governments across the UK have announced support for families whose children were in receipt of free school meals. If you haven't been contacted or supplied by your school already, they should be providing support in some way. The process differs from country to country:

  • In England, the UK government have made it clear that they expect all schools to continue to provide support to FSM pupils if the school is only partly open or even closed. This may be by provision of a meal that can be picked up or delivered, or by the provision of a voucher/credit to families that can be spent in a supermarket. A national scheme using 'Edenred' online portal. Read the guidance here
  • In Scotland, the same expectation in in place and the Scottish government has created a specific fund set aside for local authorities to use. Read their policy here. 
  • In Northern Ireland, the government will pay families directly who were previously in receipt of free school meals, using the same method as payments made for uniforms. Read more here. 
  • In Wales, the government has followed a similar approach to England, but also suggested direct BACS payments can be made to families. Read the guidance here


BDA Advice in the media 

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