COVID-19, like other severe respiratory infections, require supportive nutrition to speed up the recovery process and reduce the risk of complications. In hospitals, this nutrition support is overseen by a team of expert clinical dieticians. For those recovering from home (thankfully this is the majority of those who contract the virus), however, there is often less support and much confusion about how to eat while in recovery.
Luckily, our in-house dieticians with clinical experience have kindly shared some insight into what to eat while recovering at home from COVID-19. Note that those who are asymptomatic or have very mild symptoms can likely eat as normal, but for those struggling with symptoms such as shortness of breath, loss of appetite, fever etc. your nutrition should be a priority. What do you need to know?
1. Bump up your calories
Remember that this is not the time to go on a diet! Your body requires a lot of energy to fight the virus and keep you strong. While you may not be burning calories from exercise, it is estimated that your body requires an extra 400 - 500 calories per day during stress and infection. A 1ºC increase in temperature during a fever can increase energy needs by about 11%. Your muscles may also be working overtime to breathe and cough, again requiring more energy.
The American Society for Parenteral and Enteral Nutrition (ASPEN) suggests aiming for around 2000 - 2500 calories per day while recovering from COVID-19 at home, but this is sometimes easier said than done. Eating can be hard work when you are short of breath. You may also lose your appetite, feel nauseous, or find food unappealing if you’ve lost your sense of taste and smell. Here are some top tips to help you eat enough calories while ill:
Eat small, frequent meals
Aim to eat around 6 small meals per day. While you may not be hungry, it is vital that you eat every 2-3 hours and do not skip meals. It is much easier (and more realistic) to reach your calorie needs through several small meals than one large meal, especially if you are nauseous, short of breath, or have a poor appetite.
Add ‘easy calories’
You don’t need to eat daunting, large portions to get more calories. Calorie dense foods, particularly fat, provide a lot of energy in a small quantity. So, try to double or even triple the amount of fat you add to your food. Pile the spreads and avocado on your toast, add extra nut butter to your porridge, and swirl cream cheese (or cream) into your soup. Foods containing some sugar, such as biscuits and granola bars may also be more palatable and are high in energy.
Another simple way to up your calorie intake is to drink them. Sipping on options such as fruit juice, smoothies, milk and custard not only helps with hydration, but also provides much-needed calories. You can also purchase over the counter oral nutritional supplements from your local pharmacy because these are specifically formulated to support nutrition during illness.
Modify according to your symptoms
If you experience shortness of breath, keep meals small, take little bites at a time and try to breathe while you chew. You may find it easier to eat moistened food or drink most of your calories, so keep plenty of high energy, high protein liquids on hand. If you are struggling with nausea, again keep meals small, manageable and frequent. You might find plain foods such as toast, crackers, potatoes, or tinned fruit easier to eat. For low appetite or taste and smell changes, food may be boring or unappealing, so try to add extra flavour with herbs, spices, acid like lemon juice, and salt. You may need to set a reminder on your phone to eat every 2-3 hours as it is easy to forget to eat when food is less appealing.
2. Prioritise protein
Protein makes up the building blocks of almost every system in the body, including our immune system. During times of illness, our bodies need more protein, not only to support the immune system but also to repair damaged tissues and organs. If we do not eat enough protein, our body will make another plan to get protein, and it does this by breaking down muscle. Unfortunately, muscle loss during illness can increase the risk of complications while prolonging your recovery time - so we can’t emphasise the importance of protein enough.
ASPEN recommends 75-100 g of protein per day during recovery at home, which is about 3 palm-size portions of protein-rich foods per day. Apart from the usual meat/fish/poultry, great sources of protein also include peanut or nut butter, eggs, milk, yoghurt, and cheese. If you are struggling to get enough protein from food, you can also consider a protein shake or over the counter oral nutritional supplements. It is also important to remember that for protein to be prioritised for repair and immunity, our bodies also require sufficient calories and carbohydrates. So don’t forget to up the calories, and now is certainly not the time to cut carbs.
3. Hydrate, hydrate, hydrate
Depending on your symptoms, you may be losing fluid more rapidly than usual, increasing your risk of dehydration. You may lose extra fluid from sweating during a fever, and extreme fluid losses can be seen if you experience vomiting and/or diarrhoea. Constant coughing and rapid breathing can also result in more water vapour losses.
ASPEN recommends around 3L of fluid per day if you are recovering at home, but your needs may be higher if you are losing large amounts of fluid. To meet this, it is recommended to drink a few sips (at least ¼ - ½ a cup) every 15 minutes. Water is a great source of hydration, but so too are higher calorie options like milk, juice and sports drinks. If you are vomiting or have diarrhoea it is important to rehydrate with an electrolyte-containing oral rehydration solution. A good indicator of hydration is passing pale yellow urine every 3-4 hours. If you are not able to receive enough hydration to maintain this, or have any other signs of dehydration, it is important to contact your healthcare provider urgently.
4. Don’t forget the micronutrients
We’ve spoken about the amount of energy and protein needed to support your immune system, but your immune system needs support from vitamins and minerals (aka micronutrients) too! If you have COVID-19, your immune system is working overtime so it is important to eat a varied diet, and do not skimp on the fruit and vegetables. If you are struggling to meet your 5-a-day during this time, you may want to take an A-Z multivitamin supplement until your appetite improves. You should also continue to take vitamin D supplements between October and early March (at least 10mcg/day) or whenever you are too unwell to go outside (or self-isolating). Your pharmacist can help you choose a supplement that will be right for you.
Often neglected, nutrition and hydration are an essential part of COVID-19 recovery from home. Let go of notions such as ‘starving a fever’ or praising a poor appetite because ‘at least I’ll lose weight’. If you are recovering from the virus at home, you need to nourish and support your recovery with adequate calories, protein, hydration and micronutrients. If you need further support, you can ask your doctor to refer you to a community dietitian. You can also read more information about nutrition and the coronavirus on the BDA’s website or check out the NHS website.