I did not change my diet much to adjust for long COVID, but I did make a couple of tweaks.
My main long COVID symptom is fatigue. I do not have Mast Cell Activation Syndrome (MCAS) or any other gut complications.
Low Inflammation Diet
The long COVID clinic I went to suggested a low-inflammation diet. Suggestions from Johns Hopkins: Anti Inflammatory Diet.
When I read about this diet, it is very similar to what I was already eating. I did add some more fish to my diet and now completely avoid french fries and processed meats.
ME/CFS Recommendations
The U.S. ME/CFS Clinician Coalition in their treatment recommendations, page 8, under “Gastrointestinal Issues” suggest,
Healthy, varied diet low in processed food. Dietary changes and elimination of certain foods that provoke symptoms. Many patients do better avoiding foods such as caffeine, alcohol, spicy foods, aspartame, sugar, possibly dairy and gluten.
I already avoid caffeine, alcohol, dairy, and aspartame.
Based on these recommendations and others, I tried not eating sweets. I was eating a bowl of ice cream about twice a week. Most days I would also have a handful of bitter chocolate chips. I cut out both.
I think cutting sweets helped a little because the sugar boosts my energy, but then of course comes the sugar crash. By eating less refined sugar, my energy was stabilized.
After not eating desserts, if I have a treat now, it tastes insanely sweet.
To be clear, I did not restrict all carbohydrates, just dessert. I don’t think many of the foods I eat have “added sugar.”
I did not try cutting out gluten, although I avoid large pasta dishes and pancakes because generally they make me feel bad.
Animal Protein
My acupuncturist says that I need to “build my blood” because my pulse is “thin.” I can find no western medical measurement that correlates to this suggestion. However, she gave me a handout of foods to build my blood that included frequent, small portions of animal protein. At the same time my western doctor found my B12 was a little low.
Before long COVID I was not vegetarian, but I tried to eat mostly plants. If there was a vegetarian option, I would choose it. B12 in nature is only available from animal protein.
When I started adding in chicken, I noticed that it helped boost my energy some. Chicken (and turkey) contain tryptophan, which helps in the production of serotonin and long COVID patients were found to have low serotonin, so maybe there’s something to that? (reference)
I’m still experimenting with having more chicken.
Red Bell Pepper
I have discovered that sometimes if I eat a whole, raw bell pepper that I get an immediate burst of energy. I have asked around and the cause is not clear, but the same thing happens to my brother. Red seems to have this effect much more than other bell pepper colors.
If I eat a red bell pepper multiple times a week then the effect is diminished. Maybe red bell pepper supplies nutrients I need? I don’t care why; I’m eating more red bell peppers.
Hydration
During my two COVID infections and four COVID vaccines, I found that drinking more water helped me feel better. The same is true for long COVID.
The paper, Dietary Recommendations for Post-COVID-19 Syndrome, has the following hydration recommendation:
adequate hydration (30 mL/kg actual body weight) is important for the complete recovery of patients with post-COVID-19 syndrome [114]. Therefore, these patients should increase their daily fluid intake (2.5–3 L/day) by consuming water, milk, fruit juice, broth, sports drinks, coffee, and tea.
To help with the units conversion, if you take your body weight in pounds and divide by 75, then you get roughly the number of liters they recommend per day. I weigh 165 pounds, so 165 / 75 means they recommend 2.2 liters per day. (The actual divisor is 73.5, but 75 seems close enough.)
Most water bottles are in liters, but if you prefer the number in quarts (32 oz), then divide your body weight by 70. So in my case, 165 / 70 is 2.4 quarts per day.
Note that in hot weather when working outside I have to drink a lot more than these recommendations.
For 99% of my hydration I drink tap water. That’s been true for many years. Since long COVID, almost every day I add a packet of Trioral electrolytes to the first liter of the day.
Note that overhydration can also be dangerous, so drink enough water, but don’t go crazy.
Daily Calories
Managing the quantity of food I eat has been a challenge. My whole life I’ve had trouble knowing when I’m hungry. I’m getting a little better, but often I’ll say, “I feel bad” and my wife will say, “You’re just hungry.” I have to make sure I eat on a regular schedule.
At the beginning of long COVID, I was spending a lot of time in bed and gained a little bit of weight. I don’t care that much about my weight, but I cut back my portions a little and felt about the same, so that seemed like a good change.
In the middle of long COVID, I would have drops in energy that felt like my “hungry” feeling before long COVID. However, eating more would not restore my energy. This seems consistent with the idea that energy production in my body was broken, so more fuel didn’t help.
After my post-exertional malaise (PEM) stopped, I could do much more. Then when I had the low energy feeling, I thought my PEM was coming back. However, this time eating more restored my energy. I now have to eat much more to feel good, which makes sense because I’m burning a lot more fuel.
Pleasure
Food and drink are a great source of pleasure, which is one of the 4 Ps. Nourishing a sick body is important, but you can also drive yourself crazy trying to adhere to a particular diet. I eat and drink what I think is reasonable and also allows me to relax.