Priya Chaudhari provides guidance about how to manage your nutritional needs if you have had the COVID-19 infection.Nutrition management is very important to enhance immune response especially in a person who has a viral infection. Therefore, verification of the nutritional status of people diagnosed with COVID-19 before, during and after the administration of general treatment and providing appropriate nutrition is important.Normal diet is recommended for any nutritional management in people with COVID-19. Enteral (feeding through tube) and Parenteral (administering nutrients through vein) is recommended based on the condition of the individual and nutrition based requirements. The recommended nutrition management below is based on symptoms that come with COVID-19.The symptoms of COVID-19 range from mild to severe symptoms that need specialized management. The stages of symptoms are:.Mild symptoms/uncomplicated illness like runny nose, fever, cough, headache, sore throatMild pneumonia – breathing difficulty, inflammation in the lungsSevere pneumonia and acute respiratory distress syndromeRecovery and rehabilitation.Mild symptoms/uncomplicated illnessConsult a clinical dietician to ensure that you are eating the correct quantity of foods based on your individualised health parameter and requirements. If you are unable to visit a dietician, register for an online consultation so that you may receive the necessary diet-related advice..Recommendations – if you or someone with COVID-19 is at home and experience runny nose, fever, cough, headache, sore throat:.Ensure that while recovering from COVID-19 you eat well.Increase frequency of meals to compensate for the increased caloric and protein requirement of fever.Hydration plays an important role in the body's response to recovery from the infection – Ensure intake of adequate fluids; at least two-three liters of water per day or more if there is fever. Liquids such as buttermilk, lime water, unsweetened fruit juices, moong dal water can be included to increase fluid intake.Diet should include a variety of foods like energy-rich foods, meat, milk, legumes and pulses, dry fruits, nuts, fruits and vegetables. Cough and sore throat can be relieved by taking hot tea, honey, ginger, turmeric, homemade soups, gargling and eucalyptus steam inhalation.Encourage use of culinary herbs like oregano, sage, cinnamon, cloves, neem, tulsi, as well as increase consumption of fruits and vegetables to improve antioxidant levels in the body.Consider supplementation with zinc, vitamins A, B, C, D, E, iron, folate and fibre if not getting enough of these from the diet.Proactively assess for vitamin D status and take measures to correct a deficiency, if observed.Limit intake of refined carbohydrates such as sugar, sweets, cake, soft drinks and sugar sweetened beverages.Eat adequate proteins from good sources like eggs, dairy, legumes, dal, ghee, pulses and lean meat in every meal to sustain energy released and to avoid a decrease in muscle mass.Fats are an important source of calories and the quantities can be increased by keeping in mind if any cardiovascular or high cholesterol are present. Medium-chain triglycerides (MCT) oils like coconut or can be used.Groundnut, soya, sesame, rice bran cooking oils can be primarily used.Sources of Omega-3 fats like flaxseeds, walnuts, and fatty fish must be included to boost immunity and decrease inflammation.Limit intake of foods containing trans fats and saturated fats e.g. fat and skin from meat, butter, cream, high fat dairy products, fried foods, cookies, and pastries.Ensure enough sleep, reduce stress, exercise, avoid intake of alcohol and tobacco products.It is crucial to take utmost care of the elderly and those with co-morbidities. Regular blood pressure and blood sugar control and monitoring needs to be initiated..Mild pneumoniaRecommendations – when you experience breathing difficulty or there is inflammation in the lungs:.Continue working with the guidelines for mild symptoms as mentioned above.Ensure the person with COVID-19 is eating adequately to meet the calories and protein requirement as well as micronutrients.If the disease progresses in severity, intestinal dysfunction can be expected. Pro and prebiotic food such as buttermilk, fermented foods, garlic can be eaten. Also onions, fruits, vegetables, legumes and if required, supplements can be taken.Consider nutritional calorie-high protein supplements (advised by your clinical nutritionist/treating physician) to meet the nutritional requirements if the person is not consuming adequateOther co-morbidities – A clinical nutritionist will consider presence of other disease such as heart or kidney disease, cancer or Diabetes and their specific nutrient requirement during nutritional management..Severe pneumonia and acute respiratory syndromeUsually, oral feeding can be continued if the person is comfortable to eat – with the support of oral nutritional supplement. If oral feeding is not possible, person receives nutrition through a feeding tube which has to be put through the nose or mouth into the stomach or nutrition can be received through the vein considering all the current medical conditions and nutritional requirements.Recovery and rehabilitationDuring or after recovery you may feel weak or tired and notice weight loss. This is completely normal. You need to prevent further weight loss to rebuild your strength, grow your muscles and get back to your usual daily activities..A healthy, balanced diet that includes high calorie, high protein diet is important to maintain good health and immunity. Whenever you feel fit to do exercise, this diet along with regular exercise would help to regain muscle mass..ProteinsProtein is very important to provide defence against infection. Include adequate good quality protein like –Vegetarian options – dals, pulses, dairy products (milk, curd, paneer), nuts, soybean and tofuNon-vegetarian options – fish, chicken and eggs.CarbohydratesIt is recommended to include healthy carbohydrates in each meal such as whole cereals, whole wheat flour, brown rice, jowar, bajra, ragi, starchy vegetables, fresh fruits and vegetables. Refined carbohydrates such as corn flour, maida, sugars and products prepared with the same, sweetened beverages, carbonated drinks, etc. should be avoided..Include good fatsHealthy fats sources such as nuts, oilseeds (flax, sesame and pumpkin seeds), fatty fish like salmon, tuna, sardines and mackerel should be included. Saturated fats such as high fat dairy products (cream, butter), organ meats should be included. Avoid trans fats from deep fried foods from eateries and restaurants, processed and packed foods, mayonnaise, bakery items, dalda, etc.Immunity boosting nutrientsDeficiency of single nutrients also results in altered immune responses.Vitamin AVitamin A is involved in the development of the immune system which can help the body fight COVID-19 infection.Good sources include – carrots, pumpkin, dark green leafy vegetables, chicken liver, eggs, mackerel fish and chicken. A combination of any three of these items would help achieve the daily requirement of this nutrient.Vitamin CVitamin C contributes to immune defence by supporting the immune system. Its deficiency results in higher susceptibility to infections like COVID-19.Good Sources include – fruits like oranges, guava, lime, amla, green leafy vegetables, broccoli and capsicum.Vitamin DVitamin D can affect the immune responses and its deficiency is associated with and increased susceptibility to infections. Vitamin D3 appears to be better than D2 at improving Vitamin D status..Good sources of vitamin D – Vitamin D3 (active form) – eggs, salmon, organ meats, ravas and oysters..Good sources of Vitamin D2 – mushrooms, soybean, and sesame seeds, ragi, walnuts, rajgeera, corn and pulses.Vitamin EVitamin E is a potent antioxidant and has the ability to boost the body's immune function especially in the elderly population who are more susceptible to COVID-19.Good sources include – pistachios, haleev (garden cress seeds), almonds, zucchini, spinach, flaxseeds and sunflower seeds..ZincZinc is crucial for normal development and function of immune cells.Good sources include – pulses, soya, sesame seeds, haleev (garden cress seeds), almonds, walnuts and poultry.MagnesiumMagnesium acts as a cofactor for the synthesis of immune cells of the body..Good sources include – pulses, jowar, green leafy vegetables, almonds, cashew nuts, sesame seeds, pumpkin seeds and sunflower seeds.Herbs and spicesCertain phytonutrients present in foods can help boost the immune function to fight infections at our DNA and RNA level. It would be advisable to use these herbs and spices in higher frequency in daily cooking in marinades or tempering as a tea or concoction to help boost immunity overtime.Include herbs and spices like – ginger, garlic, turmeric (fresh/dry), tulsi leaves, neem and lemon grass.What should you do if you have –Poor appetite, fatigue or feeling full quickly.Try to have small and frequent meals, eat 5-6 meals per day.Include nutritious, high calorie-high protein meals such as milkshakes, cream soups, kheer, dry fruit laddoos, Greek yoghurt with fruits, moong dal khichdi/ daliya with ghee, add cheese to the recipes, prepare recipes in homemade cow's ghee, add dry fruit powder to the recipes.Drink protein milkshakes by adding fruits and whole milk or meal replacements in between meals.If you are not able to eat enough, consider including multivitamin supplements..Loss of tasteConsume easy to digest and non-spicy meals.To enhance the flavour of the food, add lemon, salt, sugar, mint, ginger, seasonings and herbs to the preparations.Brush your teeth regularly..Difficulty swallowingTry to change the food consistency to semi-solid or soft.Try to have calorie dense liquid meals in-between meals.Eat non-spicy meals..RememberIt is important to be active on daily basis to improve the immunity and digestion. It is important to sleep sufficiently and at the right time. Follow 'early to bed, early to rise' routine for quick healing. Improve your sleep and wake up on time. Keep in touch with friends and family members through video calls to alleviate feelings of loneliness. Consult a physiotherapist who can design an exercise program to make you stronger. Make sure you follow all COVID-19 guidelines.Note: Before starting or altering any nutritional plan, consult a clinical dietician to ensure that you are eating the correct quantity of foods based on your individualised health parameter and requirements. If you are unable to visit a dietician, register for an online consultation so that you may receive the diet-related advice you require..Priya Chaudhari is a Consultant Dietician.