Long COVID: Mediterranean Diet Guide
Nutrition and Long COVID
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.
Your diet affects the bacteria in your intestines (the intestinal microbiota) which in turn impacts your health. A key factor in the way diet affects the gut microbiome (the overall environment of the gut) is the fiber in your diet. Fiber 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 to help increase the “good” and decrease the “bad” bacteria in your gut. 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 high-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.
Mediterranean Diet and Brain Health
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.
There seems to be a positive connection between the Mediterranean diet and better brain health. Research shows that the Mediterranean diet has a protective effect on the brain. It is associated with a decrease in cognitive decline and a lower risk of cognitive impairment.
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.
Foods To Include Vs. Foods To Limit
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 certain 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 and other 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.
Before Considering 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 considerations:
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 another healthcare provider.
It limits many healthy foods
Much of the available information about following the diet is conflicting
There is mixed information about what is considered a high-histamine food. The following are high-histamine foods:
Fruit: avocado, citrus fruits, strawberries, kiwifruit, papaya, pineapple, 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, miso (fermented soybeans)
Other: nuts, chocolate
Healthy Meal Ideas
When you prepare your own meals, you can include healthy foods and avoid unhealthy ones. Here are some examples to get you started.
2 hard-boiled eggs with ½ avocado on 1 slice of whole-grain bread - rye, barley, or sourdough 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 cup (120-240 mL) 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.
Mushroom and barley
Healthy protein, vegetable, and starch meal
Grilled or sautéed fish or chicken breast with roasted, grilled, sautéed, 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
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
Even though restaurant food may be challenging, you can still maintain a healthy 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.
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
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
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
When you’re away from home, take a healthy 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 at least 70%
Protein or energy bars (Choose those with only a few ingredients)
Snack-size nut butters
Snack-size nuts or trail mix
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.
Healthy Diet Shopping Suggestions
Use the following suggestions as you prepare your grocery shopping list.
Make sure you include a lot of vegetables
Some of the best vegetables are green and leafy. Iceberg or head lettuce is not a good choice. Choose arugula, collard, mustard, or turnip greens, leaf lettuce, kale, romaine lettuce, spinach, Swiss chard, or watercress
Other green vegetables include artichokes, broccoli, Brussels sprouts, cabbage, green beans, and peas
Orange vegetables like carrots, pumpkin, squash, sweet potatoes, and yams are excellent choices
Have a salad in mind when you select vegetables! There are endless combinations. A classic one includes leaf lettuce, tomato, carrots, celery, cucumber, peppers, mushrooms, onions, and olives
For a change, drink vegetable juice or use vegetable broth for sautéing
While still in the produce aisle, pick out some in-season fruit
Apples and pears in the fall
Cranberries and oranges in the winter
In the spring and summer, select berries, like blueberries, blackberries, strawberries, and raspberries
Try citrus fruits like oranges, or add lemon or lime slices to flavor your water
Be mindful of fruits high in sugar like apricots, bananas, cantaloupes, cherries, figs, grapefruit, grapes, mangos, nectarines, papaya, peaches, pineapple, plums, pomegranates, and watermelon. Enjoy them, but pay attention to portions.
When possible, opt for organic, grass-fed, hormone- and antibiotic-free meats
Try pasture-raised or free-range eggs
Make sure to include healthy, wild-caught seafood like cod, haddock, halibut, mahi-mahi, red snapper, salmon, sardines, sea bass, trout, and tuna
Choose canned fish in water that’s mercury-free
Below are good dairy/non-dairy choices
Unsweetened almond and coconut milk
Greek or goat’s milk yogurt with live and active cultures
Kefir, a fermented dairy product is high in healthy bacteria (probiotics)
Legumes provide healthy protein and other nutrients
Consider soup or chili with an assortment of black, kidney, and pinto beans
You can include chickpeas, lentils, or peas in a salad
Make or buy hummus as a dip for vegetables
For cooking and baking, focus on healthy oils like almond, avocado, olive, flaxseed, sesame, and walnut
Use ghee (a clarified butter) or butter in small amounts
Nuts and Seeds
Nuts and seeds make great snacks. Make sure you check the serving size
Choose raw, unsalted almonds, brazil nuts, cashews, hazelnuts, macadamia nuts, or pecans
Add seeds like chia, hemp, sesame, or sunflower to your dishes
As an alternative to unsweetened peanut butter, try almond, or walnut butter. You can also add nuts and seeds to almost any dish
Grains (in moderation)
Look for whole-grain - 100% whole grain is best
For breakfast, you can store a supply of unsweetened granola, muesli, or oats
Add a side dish of brown or wild rice, farro, or quinoa to your meal or mixed in your salad
Spices and Flavoring
Buy a few different herbs and spices that help decrease inflammation. Try a new one every few weeks. Have you tried cumin or turmeric? What about sage, rosemary, or thyme?
Think about growing some of your favorites right in your kitchen. Basil, dill, oregano, parsley, mint, or cilantro are good choices
Bake healthy versions of bars or cookies with cinnamon, clove, ginger, or nutmeg
Condiments, Dips, And Sauces
Stay away from high-fat, high-sugar condiments. Instead use mustard, olive- or avocado oil-based mayonnaise
Have guacamole or hummus dips
Use olive oil and vinegar (apple cider, balsamic, or red wine) on salads
Have something different like kimchi, fermented vegetables, or sauerkraut (fermented cabbage)
Try pesto or tomato sauce with your whole-grain pasta. Make a fresh salsa with tomato, onion, peaches or mango, and cilantro
Drink water! Pure, filtered water is best
Milk, like almond, coconut, and soy, are good choices. Watch for added sugars
Green or herbal teas can be hot or iced
Try something like kombucha, a fermented tea. (Read the ingredient list as some are very high in sugar)
To add sweetness use small amounts of dark chocolate, honey, maple syrup, or stevia.
For More Information
Centers for Disease Control and Prevention (2021). Healthy Eating Tips. Retrieved 1-21-2022 from https://www.cdc.gov/nccdphp/dnpao/features/healthy-eating-tips/index.html.
U.S. Department of Agriculture (2020). My Plate. Retrieved 1-21-2022 from https://www.myplate.gov/.