Key Practice Point
#1
Recommendation
Limited research suggests that consuming plant-based and Mediterranean dietary patterns may reduce the risk or severity of COVID-19 infection. No evidence was identified examining the effects of these dietary patterns on symptoms related to long COVID.
A low histamine diet is not recommended for managing the symptoms of long COVID due to a lack of evidence and the challenges of eliminating dietary histamine.
Nutritional considerations in individuals with post-COVID-19 syndrome are based on nutritional deficiencies to support recovery. Little clinical research has been conducted on individuals with long COVID and it is derived from indirect evidence in other populations:
- Oral nutritional supplements can support improved energy and nutrient intake in individuals with malnutrition and early satiety.
- Higher protein (15-30 g/meal) may improve sarcopenia.
- Adequate hydration (2.5-3 L/day) is recommended to prevent dehydration.
- Individuals living with obesity may be at greater risk for worse outcomes after acute infections. Weight loss may be beneficial; however, the effects of interventions to modify body weight on symptoms of COVID-19 have not been studied.
Evidence Summary
A 2023 systematic review and meta-analysis identified that "high quality" dietary patterns (including plant-based and Mediterranean diet patterns) were associated with a reduced risk of COVID-19 infection (RR 0.72) and decreased hospitalization (RR 0.38). Subgroup analysis suggested plant-based diets reduced the risk of infection by 50% and Mediterranean diet patterns reduced the risk of infection by 22%. The results are limited by high heterogeneity among studies and that infection rates were assessed during the first wave of the pandemic only.
Grade of Evidence C
A 2022 narrative review examining the role of nutrients on features of long COVID identified that:
- Adequate energy and protein intake was needed to treat sarcopenia; however, individuals living with obesity (not defined) may be at a risk of worse outcomes after acute infection.
Grade of Evidence C - No studies were identified that examined the effects of interventions to modify body weight on symptoms of long COVID.
Grade of Evidence D - Adequate hydration (2.5-3 L/day) was recommended to prevent dehydration.
Grade of Evidence C. - A Mediterranean diet pattern may be beneficial as it contains bioactive compounds with anti-inflammatory and antioxidant effects. The recommendations in the review are limited as they were largely obtained from studies treating diseases with similar outcomes, but not post-COVID-19 syndrome.
No clinical research has examined the effects of dietary patterns on the symptoms related to long COVID.
Grade of Evidence DNo published studies were identified that examined the effects of a low histamine diet on the risk of COVID-19 infection or the symptoms of long COVID.
Grade of Evidence D
Remarks
Post-COVID-19 condition can affect anyone exposed to SARS-CoV-2. It is defined as continuing or the development of symptoms three months after the initial infection that lasts for at least two months. Over 200 different symptoms have been reported; common symptoms include: fatigue, shortness of breath and cognitive dysfunction.
It has been suggested that the increased inflammatory responses observed with long COVID may be due to histamine release by dysfunctional immune cells. In contrast, plant-based and Mediterranean dietary patterns are examples of anti-inflammatory diets that have been associated with reduced inflammatory markers.
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Current Contributors
Dawna Royall - Author
Elaine Anderson - Reviewer
Shée Lillejord - Reviewer, Topic Advisor