Written by Shwetha Bhatia
In my practice so far, I’ve managed cases from mild to severe across various age groups. As we fight the second wave, here are guidelines for those recovering from Covid 19 infection. A good diet promotes faster recovery. We now know that Covid is an inflammatory condition that can have lasting effects for up to six-eight months after discharge affecting different organs, especially the liver and lungs.
Aspects that need to be kept in mind:
*Managing other complications if any e.g.., hypertension, diabetes, kidney dysfunction, cardiac involvement.
*Digestive disturbances, loss of taste/smell.
*Difficulty in breathing
*Difficulty in swallowing, especially in those who may have been intubated during hospitalisation.
Adequate calories must be provided depending on the patient’s nutritional status. Malnutrition is not only having low body weight but also the inability to maintain healthy fat:muscle ratio.
Patients with obesity often have respiratory dysfunction, impaired immune function, increased inflammation and low lung volume and muscle strength. These individuals are more prone to pneumonia and cardiac stress. Obesity with diabetes is even more complicated. Caloric restriction is needed for ensuring healthy fat loss and lean mass maintenance in obese patients.
It is indicated as a top priority. It is recommended to be at 1.2-1.3 g/kg per day; increasing the supplementation of branched-chain amino acids (BCAA) to 50 per cent, to prevent muscle loss and enhance the strength of respiratory muscles. Whey protein is the ideal choice if budget permits, at least for the first two-three weeks. If not, fresh curd, paneer or thoroughly cooked eggs can be given depending upon meal preference and digestive function. Protein must be individually adjusted with regard to nutritional status, physical activity level and digestive tolerance.
The total must not exceed 100-150g per day. The usage of carbohydrates leads to the production of equal carbon dioxide (called respiratory quotient) which must be avoided to decrease respiratory distress. If the patient is diabetic, he/she has to be monitored closely for episodes of glucose highs and lows and the medication needs to be adjusted. Persistent high glucose is an effect of infection and can also delay recovery. Opt for pulses, dairy, and vegetables over grains. Avoid fruit juices.
To maintain calories, the proportion of fat can be increased. Give priority to the use of medium-chain fatty acids. Also, increase the proportion of omega-3 fatty acids. They play a major role in immune responses. They reduce inflammation. Coconut oil, butter, ghee, nuts, MCT oil can be used. Olive oil, rice bran oil, groundnut oil can also be used for cooking.
Routine supplements of multivitamins and minerals are needed with emphasis on adequate vitamin B/C/D, zinc, and selenium. Iron deficiency or anemia should be treated.
These are specific nutrients shown to have a considerable influence on immune function. There are several types of immunonutrients, such as arginine and glutamine which support both the immune and the digestive system. Curcumin (found in turmeric and as capsules) also aids recovery.
The alteration of healthy gut bacteria is due to the increase in gut permeability. This occurs as a result of infection as well as treatment with antibiotics. This drives the inflammation further. Probiotic supplements help to restore immunity. They need to be prescribed by a doctor in this case.
Fluids and salts
Even mild fever is associated with loss of fluids which can lead to dehydration. Thin buttermilk, soups, coconut water (unless there is a potassium restriction), salted lemon water and ORS can be used. For cardiac and kidney patients, the volume of fluid and sodium, along with other electrolytes may have to be restricted. Your physician will advise you on the total fluid intake for the day.
Meal frequency and consistency
If the patient’s dry cough and sore throat are severe, solid food intake may decrease. Therefore, warm, soft foods and supplements can be used. Small frequent feeds would be better if the appetite is less, timing of fluid consumption should be in between meals and not with the meal.
ICU patients can have swallowing issues called – prolonged post-extubation swallowing disorder – after discharge. This can last even up to four months after and must be managed with alternatives.
Prolonged homestay may lead to reduced regular physical activity and hence a drop in muscle mass. ICU patients suffer the most muscle loss. Once the patient is stable and the physician gives a clearance, exercise must be slowly encouraged as per tolerance.
Safe, simple, exercises may include, strengthening exercises, activities for balance and control, stretching, or a combination of these to maintain fitness, done preferably under guidance.
Finally, patients may need support with their mental health as well. Seek counselling from appropriately trained mental health professionals.
Even if you are vaccinated, here’s why you should still wear masks:
*No vaccine is 100 per cent effective.
*No vaccine is effective right away. It takes about two weeks for the immune system to make the antibodies that block viral infections, especially in the case where two doses are needed.
*In other words, a vaccinated person might still be able to spread the virus, even if they don’t feel sick.
*A vaccinated person might still be able to contract the infection with milder symptoms.
*Masks protect against any strain of the coronavirus, in spite of genetic mutations.
(The author is a nutritionist and dietician)