Dietary Recommendations for Post-COVID-19 Syndrome, 2022, Barrea et al.

[Mij]

Abstract

At the beginning of the coronavirus disease (COVID-19) pandemic, global efforts focused on containing the spread of the virus and avoiding contagion. Currently, it is evident that health professionals should deal with the overall health status of COVID-19 survivors. Indeed, novel findings have identified post-COVID-19 syndrome, which is characterized by malnutrition, loss of fat-free mass, and low-grade inflammation.
In addition, the recovery might be complicated by persistent functional impairment (i.e., fatigue and muscle weakness, dysphagia, appetite loss, and taste/smell alterations) as well as psychological distress. Therefore, the appropriate evaluation of nutritional status (assessment of dietary intake, anthropometrics, and body composition) is one of the pillars in the management of these patients.
On the other hand, personalized dietary recommendations represent the best strategy to ensure recovery. Therefore, this review aimed to collect available evidence on the role of nutrients and their supplementation in post-COVID-19 syndrome to provide a practical guideline to nutritionists to tailor dietary interventions for patients recovering from COVID-19 infections.

Post-Covid Fatigue Syndrome:

Recent studies showed that a significant proportion of COVID-19 patients suffer from prolonged post-COVID-19 fatigue syndrome, with symptoms resembling chronic fatigue syndrome (CFS). The pathophysiology is complex and involves autonomic dysfunction, endocrine disturbances, and reactive mood disorders (i.e., depression or anxiety), combined with genetic, environmental, and socio-economic predispositions. At present, there is insufficient high-level evidence to directly support the use of nutritional supplements and modified diets to relieve symptoms in patients with post-COVID fatigue syndrome.
However, there is evidence to support that the deficiency of some nutrients (i.e., vitamin C, vitamin B group, sodium, magnesium, zinc, folic acid, l-carnitine, l-tryptophan, essential fatty acids, and coenzyme Q10) seems to be important in the severity and progression of CFS symptoms by increasing oxidative stress.

Recently, several trials focusing on CFS patients have reported the benefit of antioxidants and lipids to reduce CFS symptoms. Indeed, the supplementation of glycophospholipid–antioxidant–vitamin demonstrated an improvement in the overall fatigue scores of moderate subjects measured using the Piper Fatigue Scale (PFS).
Therefore, adequate nutritional supplements including essential fatty acids and antioxidants, or the same given in the form of a balanced healthy diet, could help in the control/alleviation of post-COVID-19 fatigue syndrome.


https://www.mdpi.com/2072-6643/14/6/1305/htm

 

[Midnattsol]

Just skimmed this, and it feels very much like claiming territory. Basic stuff and some claims thrown in.

That said, nutrient deficiencies when admitted to hospital is common in some (sub)populations, and unfortunately common in hospital settings as well. People at home with chronic health conditions can also be at increased risk of malnutrition. Assessment by a dietitian can be beneficial in these instances, although it might not do anything for the underlying issue, it can just help the body cope or at least prevent the added stress of being nutrient deficient.

 

[Peter T]

Though not mentioned in this abstract, are we seeing with Long Covid the development of higher rates of various food intolerances than in the well population or is it too soon for people to recognise any food intolerances in the course of their Long Covid?

It took me several years to recognise my gluten intolerance, as symptoms are delayed by 24 hours following ingestion and only once gluten was largely eliminated from my diet was it possible to see the pattern of symptoms resulting from when I did eat food containing gluten and to distinguish this from ME in general as there is a large symptom overlap. Also for me other intolerances such as caffeine only seemed to emerge as my ME worsened over a number of years.

It is frustrating that there is so little reliable evidence or good research in this field.

 

[Hutan]

I lost count of the claims made in that abstract that have no solid basis. The misinformation that swirls around CFS has been applied to Long Covid. Of course eat a good balanced diet. I very much doubt that more can be said at this point.

It could be worth checking out the references provided to back up the claims.

 

[Midnattsol]

Though not mentioned in this abstract, are we seeing with Long Covid the development of higher rates of various food intolerances than in the well population or is it too soon for people to recognise any food intolerances in the course of their Long Covid?

I think this will be difficult, for the reasons you state. Also food intolerances can require other factors, like exercise, to manifest. Like people with wheat dependent exercise induced anaphylaxis (allergy, not intolerance but still).

I lost count of the claims made in that abstract that have no solid basis. The misinformation that swirls around CFS has been applied to Long Covid. Of course eat a good balanced diet. I very much doubt that more can be said at this point.

It could be worth checking out the references provided to back up the claims.

If psychologists can, so can dietitians!

The titles of some of the references I looked at yesterday didn't fill me with confidence at their relevancy, and the reference for nutritionalist being of outstanding importance in the multidisciplinary care team doesn't contain any reference to patient's nutrition status. There are guidelines for nutritionalist treating covid-19 patients, but it's mostly (exclusively? I haven't studied it intensively) drawing on guidelines for other things, such as needs of patients on a respirator, bedbound patients, critically ill patients, and due to weight and diabetes are associated with increased risk of adverse events also to remember these factors. Which you should do anyway.

 

[Hutan]

Yes, they talk about "post-Covid-19 syndrome" as though it is one thing

Indeed, novel findings have identified post-COVID-19 syndrome, which is characterized by malnutrition, loss of fat-free mass, and low-grade inflammation.

and are defining it as

Currently, this condition is known as post-COVID-19 syndrome and is generally defined as “the persistence of signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis.”

And yet they talk about it in this way, mixing up all sorts of post-Covid health issues together.

Nevertheless, it has been reported that post-COVID-19 syndrome is more frequent in hospitalized patients (85%) but also in individuals managed in the outpatient clinic or at home (10–35%)

(By the way, I think the reference quoted for that hospitalised patients percentage actually said 80%, not 85%, although I need to double check).

This nutrition paper quotes reference 12 when referring to an eclectic range of symptoms of post-COVID-19 syndrome that includes chronic kidney disease.

In more detail, post-COVID-19 syndrome is characterized by a combination of symptoms, mainly fatigue and sleep disturbances [12]. Other common features are dyspnea, joint pains, anxiety, low mood, cognitive dysfunction, chest pain, thromboembolism, hair loss, and chronic kidney disease [12].

Here's the reference 12 that is cited:
(12]Iqbal, F.M.; Lam, K.; Sounderajah, V.; Clarke, J.M.; Ashrafian, H.; Darzi, A. Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and meta-analysis. EClinicalMedicine 2021, 36, 100899.
It makes no mention of chronic kidney disease as a symptom!

And that reference 12 actually concluded about prevalence rates and symptoms:

The available evidence is generally of poor quality, with considerable risk of bias, and are of observational design.

In conclusion, this review highlights that flaws in data capture and interpretation, noted in the uncertainty within our meta-analysis, affect the applicability of current knowledge.

This nutritionstudy seems oblivious to the uncertainty, saying

Over organ-specific effects, COVID-19 infection is known to cause severe catabolic muscle wasting [14]. Indeed, the significant systemic inflammation has negative effects on muscle protein synthesis, and there is increased nutritional demand, which is difficult to meet due to the loss of appetite, taste, and smell caused by the COVID-19 infection [15]. Therefore, skeletal muscle mass and function loss (sarcopenia), combined with poor intake due to frailty, low mood, and changes in the gut microbiome, have led to a high prevalence of malnutrition [15]. Malnutrition per se affects the recovery of all the other systems impacted by post-COVID-19 syndrome, so it is a key component that needs to be addressed. Consequently, nutritionists can play a crucial role both in the early onset of post-COVID-19 syndrome as well as in the follow-up of patients to improve the outcomes.

and this!!!

Current scientific evidence provides extensive information about the physiopathological mechanisms behind post-COVID-19 syndrome, thus contributing to the identification of potential targets for nutritional interventions

That's just from a skim of the first few paragraphs, before getting into the evidence for vitamin C helping chronic fatigue syndrome and so on.

It's a really shoddy paper. It deserves to be meticulously shredded. But, who's going to do that? It will just add to the morass of misinformation.

 

[Mij]

I ate very healthy before and during PVFS for 5-6 years. I never lost my appetite and was so positive that everyone in my family and friends didn't believe I was even ill. I also gained 7lbs which was a lot for me. My test results (antioxidants, proteins, fats et) were well below normal and that of malnourished person.

I replenished all my deficiencies and still have M.E.

 

[rvallee]

Disappointing that they completely missed the most important: foods to avoid. By now I have read thousands of comments from long haulers. The only way I see food discussed, and it happens often, is in the context of some foods triggering symptoms and avoiding them. (Other than lack of appetite and anosmia leading to food not tasting anything)

It's not fully consistent between people so there's a lot of trial and error but there do seem to be certain types of food that commonly cause significant digestion problems or increase symptoms. And holy crap the only reference to one of the two main ones is advice to drink more coffee (to increase fluid intake). Major facepalm. The other is alcohol, of course.

Avoiding certain foods, and even more importantly identifying which cause problems is basically the only way this topic is discussed as being relevant and significant by pwLC. It's usually discussed as histamine-rich or "inflammatory" foods, which is probably incorrect but the general idea obviously is and would benefit from expert input.

But experts don't listen to patients and this study falls for the usual trap of being about what interests the researchers and the questions they think of, not what's happening to the patients. Once more, the experts are mostly shambling around in circles ignoring what the patient community has known for well over a year by now. This is not how expertise works, this is bordering on anti-expertise, where prior knowledge is actually an obstacle to learning from experience because it boxes in all thinking.

I'm really beginning to see a major problem with the usual top-down "here's a bunch of books, memorize all of it" method of teaching medicine and how it's the complete opposite mode of thinking that makes some people able to learn from experience much quicker than others. If the only way most physicians learn is through a class model with a teacher, a textbook and an answer key where answering wrong is clear and unambiguous, no wonder medical research is struggling so hard, this is the opposite of how learning from experience works, where everything is fuzzy and you have to listen to what patients are saying because they are literally the whole point of it all.