Long COVID : Anti-inflammatory Diet Guide

Long COVID : Anti-inflammatory Diet Guide

Nutrition and Long COVID

The quality of food is critical to your overall health. A healthy diet balances the good vs. bad bacteria in the gut helps reduce inflammation in the body and enhance immune system functioning.

Nutrition is one of the pillars in the approach to managing long COVID. The food you eat can help lessen symptoms, reduce complications, and improve recovery.

Intestinal Microbiota

Your diet affects the bacteria in your intestines, the intestinal microbiota, which in turn impacts your health. A key factor in the way the diet affects the gut microbiome, the overall environment of the gut, is the fiber - it nourishes and enhances the growth of anti-inflammatory bacteria in your gut.

Several studies suggest that COVID-19 may promote an imbalance of the microbiome. To counteract this effect, you can change your diet in such a way that it increases the “good” and decreases the “bad” bacteria. Within days your gut microbiota may be more balanced.

Based on the current evidence, there is no specific diet that prevents or cures COVID-19 infection or long COVID.  However, adopting a diet with the strongest anti-inflammatory effect is a logical approach. 

Such a diet consists of a variety of plant-based foods (this does not mean a vegetarian or vegan diet), and a healthy balance of fats and good quality protein. It provides a steady supply of long-lasting energy and reduces inflammation-promoting chemicals in your body. 

There aren’t specific recommendations for the use of supplements for long COVID, however there are vitamins and minerals from healthy food sources that help improve immune system function and the symptoms of long COVID. 

Anti-inflammatory Diet and Long COVID

The Mediterranean diet, which is a type of anti-inflammatory diet, is based on traditional eating patterns of countries surrounding the Mediterranean sea, like Greece, Spain, and Italy. The Mediterranean diet is believed to improve symptoms (e.g. fatigue) by decreasing inflammation, while balancing the gut microbiota.

The diet has a high proportion of fruits and vegetables (phytonutrients); a moderate amount of chicken, fish, eggs, and milk products; and minimal red meat and processed foods. It also includes healthy fats (e.g. omega-3 fatty acids), vitamins and minerals (micronutrients), and fiber. 

The Mediterranean diet has fewer pro-inflammatory foods and more anti-inflammatory ones. Unlike the pro-inflammatory diet, the anti-inflammatory diet is linked to a healthy weight and decreased risk of chronic conditions.

Anti-inflammatory And Pro-inflammatory Foods

What About Nightshade Vegetables And Inflammation?

Nightshade vegetables include tomatoes, eggplant, bell peppers, potatoes, and the spices, paprika, and cayenne pepper. 

Some people think nightshade vegetables trigger flare-ups of inflammatory conditions. The truth? There isn’t any evidence of a link between these foods and inflammation, however, some people may be sensitive to them.

If you think the nightshades worsen your symptoms, avoid them for two weeks, and see if your symptoms improve.

Do Low Histamine Diets Help With Recovery From Long COVID?

Histamine is a substance produced by cells as part of the immune system response to viruses, substances, etc. It increases inflammation thus it can cause or worsen symptoms. It has been suggested that this type of immune system response may play a role in long COVID. 

Histamine occurs naturally in food.  A low-histamine diet has been promoted to help reduce long COVID-related inflammation, as well as symptoms. 

For some people with actual food histamine intolerance, the diet may be recommended. However, there is little evidence to support its effectiveness in people with long COVID.

Problems With A Low-Histamine Diet

In addition to the lack of evidence to support the effectiveness of the low-histamine diet for long COVID, the following are also potential problems:

  • The diet is time-consuming and difficult to follow

  • There isn’t a test to diagnose food histamine intolerance

  • The process requires 2 to 4 weeks of eliminating, then gradually reintroducing foods to check for symptoms. It should be supervised by a dietitian or other healthcare provider

  • It limits many foods, many of which are healthy

  • Much of the available information about following the diet is conflicting

High-histamine Foods

Because the information about which foods are and are not high-histamine, the following are high-histamine foods:

  • Fruit: avocado, citrus fruits, strawberries, kiwifruit, papayas, pineapples, dried fruits

  • Vegetables: tomatoes, spinach, eggplant

  • Protein: fish (e.g. mackerel, tuna, sardines, anchovies, herring), eggs, aged beef, cured meats (e.g. salami, ham), meat or fish that is a leftover

  • Dairy: aged cheeses (cheddar, gouda, roquefort, parmesan), yogurt, kefir

  • Fermented foods: vinegar, sauerkraut, kimchi

  • Other: nuts, chocolate

  • All alcohol

Anti-inflammatory Meal Ideas

When you prepare your own meals, you can include anti-inflammatory foods and avoid pro-inflammatory ones. Here are some examples to get you started.

Breakfast

  • Eggs

    • 2 hard-boiled eggs with ½ avocado on 1 slice of whole-grain bread - rye, barley, or Ezekiel bread (sprouted grain bread)

    • 2 scrambled eggs with turmeric 

    • 2 poached eggs with smoked salmon and avocado

  • Oatmeal (rolled and steel-cut oats are higher in fiber than quick oats and less processed) with:

    • ½ cup (120 g) of berries and 2 tablespoons (20 g) of sunflower seeds

    • ½ cup (120 g) of unsweetened applesauce, 2 tablespoons (20 g) chopped almonds, and a dash of cinnamon, nutmeg, or pumpkin pie spice for extra flavor

    • ½ teaspoon (2.5 g) unsweetened cocoa powder and 1 teaspoon (5 g) of nut butter

  • Cocoa chia pudding (cocoa powder with chia seeds mixed together with any type of milk, and refrigerated overnight) with, 2 tablespoons (20 g) of chopped walnuts, ½ cup (120 g) of raspberries

  • Energizing protein smoothie with 1 tablespoon (15 g) unsweetened cocoa powder, ½ cup (120 mL) almond milk, 2 tablespoons (20 g) peanut butter or almond butter, ¼ cup (60 g) oats, 1 to 2 tablespoons (15-20 g) flaxseed,  and ½ to 1 (120-240 mL) cup water or almond milk to blend

Lunch or Dinner

You can prepare these meals or prep some of the ingredients ahead of time. You can store it for up to three days in the refrigerator or freeze it for later use.

  • Bean chili

  • Healthy soups

  • Mushroom and barley

  • Pumpkin

  • Lentil soup

  • Healthy protein, vegetable, and starch meal

    • Grilled or sauteed fish or chicken breast with roasted, grilled, sauteed, or stir-fried vegetables

    • Quinoa, sweet potato, or squash

  • Vegetable curry or stew with a side of quinoa

  • Vegetable ratatouille with a side of bulgur or barley

  • Build a salad

    • Start with a base: arugula, spinach, and/or kale

    • Pick a protein: tuna, hard-boiled eggs, chickpeas, black beans, edamame, cottage cheese, and/or grated cheese

    • Add some color: sweet potatoes, mixed bell peppers, mushrooms, beets, and/or celery

    • Add some crunch: chopped walnuts, sliced almonds, and/or roasted chickpeas 

    • Top with a dressing or healthy fat: avocado, olives, flaxseed, hemp seed, olive oil with dried herbs, and/or pesto 

Snacks

  • 1 serving Greek yogurt

  • 1 serving of fruit

  • ¼ cup (60 g) of raw unsalted nuts

  • Carrots with 2 tablespoons (20 g) hummus or guacamole

  • ½ ounce (14 g) dark chocolate

  • 1 cup (240 g) cooked edamame 

  • ½ cup (120 g) cottage cheese with 1 serving of fruit

  • 1 cup (240 g) goat milk yogurt with live cultures and 7 almonds

  • 1 baked pear or apple with cinnamon, nutmeg, and walnuts

  • 2 dates with a ¼ cup (60 g) of raw unsalted nuts

Eating Out

Even though restaurant food  may be challenging, you can still maintain your anti-inflammatory diet. It is easier when you plan ahead. You can call the restaurant to ask questions or review their menu online. 

Here are some ideas to consider, depending on the type of cuisine.

Italian

  • Cioppino - a fish or mixed seafood stew combined with fresh tomatoes in a wine sauce. Ask if the base contains heavy cream, if so they can make it without the high-fat dairy product

  • Baked or grilled chicken or fish with a side of vegetables. Request that they eliminate butter and cream

  • Whole wheat pasta dish. Ask for olive oil or vegetable (marinara) sauce.  You can request that they add vegetables to the dish

Asian

  • Order sushi with vegetables and salmon or tuna

  • Request brown, instead of white rice

  • Try miso soup or seaweed salad

  • Ask for low-salt soy sauce

  • Avoid  tempura and sweet and mayonnaise-based sauces

Indian

  • Many spices used in Indian cooking are anti-inflammatory (e.g. clove, cinnamon, ginger,  turmeric)

  • Try curry or dal (lentil- or garbanzo-based dish)

  • Avoid dishes with added cream

  • Order chicken or fish tandoori - tandoori is an Indian cooking method using a traditional clay oven

  • A great side dish is palak paneer (Indian cottage cheese cooked with spinach and spices)

Fast Food And Quick-Service

  • Burgers, chicken, and sides

  • Choose grilled instead of fried chicken

  • Skip the cheese, sauce, and bacon

  • Instead of French fries, choose a side salad with low-fat dressing

  • Have the burger without a bun

  • Avoid soda and milkshakes

  • A taco salad with leafy greens, beans, guacamole, salsa, and a lean protein is a good option

  • Chicken or seafood fajitas are a healthy choice since they have grilled, lean protein and a variety of vegetables

Take-along Snacks

When you’re away from home, take an anti-inflammatory snack with you. Make sure you check the portion size and ingredient list. Some excellent choices are:

  • Dark chocolate bars (2-3 squares of dark chocolate) *More cacao is better - aim for 70%

  • Protein, energy bars (Choose those with only a few ingredients)

  • Snack-size nut butters

  • Snack-size nuts or trail mix 

  • Seeds

  • Popcorn

Think about how you can make your own mixes. You can create combinations of dark chocolate pieces, almonds, sunflower seeds, popcorn, cashews, walnuts, pumpkin seeds, and so on.

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