What’s the deal with post-COVID syndrome?

Over the last two years, nothing has ruled our lives and occupied our minds as much as the SARS-CoV2 pandemic. If we have not been personally affected yet, we all know someone who has. There is light at the end of the tunnel. One by one, countries are lifting their COVID restrictions to varying degrees and travel across borders is becoming easier. 

COVID-19 turned out to be a disease that comes in all shapes and sizes. Some people will have contracted SARS-CoV2 without even knowing as they do not develop symptoms. Most people affected experience mild to moderate symptoms, but about 20% get severely ill. Of those, 5% develop critical illness. According to the WHO, almost 6 million people have died to date in connection with this coronavirus, 

Typically, people infected with the virus develop symptoms within four to five days after exposure. If the disease is mild, they recover within seven to ten days. If they get severely or critically ill, it can take three to six weeks to recover. 

A minority requires hospitalisation, and the treatment can be long and traumatic. At first, it was thought that those who recovered from acute COVID-19 would simply get on with their lives once they regained their strength. Yet, as the pandemic progressed, it transpired that a significant percentage of people felt below par for weeks or even months after the initial infection. 

“Long COVID” or “post-COVID syndrome” is even more multi-faceted than the acute disease itself. For some people, it means that symptoms persist for much longer than usual. Others develop completely new symptoms, and even people whose initial infection went unnoticed can develop long-COVID. 

Most long COVID patients will test negative for SARS-CoV2. In other words, the virus has gone, but the patient remains ill. 

Long COVID symptoms

In acute COVID-19, people affected often experience flu-like symptoms – with or without fever - cough, sore throat, chest pain, shortness of breath, loss of smell, loss of appetite, headaches, diarrhoea and more. Those suffering from post-COVID syndrome experience such symptoms for much longer than usual, some continuously, some on and off. However, long COVID can also present with a completely new set and a broader range of symptoms, such as fatigue, poor quality of life, joint pain, muscle pain, skin rashes, palpitations, mental health problems, and more. 

Post-COVID syndrome can resemble other similarly puzzling diseases, such as postural orthostatic tachycardia syndrome (POTS) or myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). Indeed, more than 10% of patients who have had COVID-19 later receive a diagnosis of either POTS or ME/CFS.

Another condition long COVID is reminiscent of is mast cell activation syndrome (MCAS). The SARS-CoV2 virus has been found to trigger inflammatory immune cell responses, including that of mast cells. Patients suffering from MCAS experience frequent episodes of anaphylaxis, i.e., allergic symptoms such as hives, swelling, low blood pressure, difficulty breathing and severe diarrhoea. They also find that they are reacting to more and more things, including foods, over time. 

Diagnosis can be tricky

COVID-19 and long COVID are still new and poorly understood. Long COVID affects all ages, people with or without pre-existing conditions, those who had acute COVID and those who apparently didn’t. Risk factors for long COVID include being female, over 70 and having pre-existing conditions. However, it still occurs in younger, male, and previously healthy people, including children.

The wide array of symptoms – of which sufferers may have one, two or many – may also distract from the root cause of a patient’s discomfort. There are no definitive tests (yet). Post-COVID syndrome can manifest itself in conditions affecting the lungs or the heart, the nervous or the digestive system, sometimes even in one person.

Many people who contracted SARS-CoV2 remain asymptomatic and never know they had it. Just a couple of weeks after infection, tests come back negative. Not everyone makes antibodies either, and in those who do, their number goes down after recovery from the acute illness. By the time long COVID symptoms develop, antibodies may be completely undetectable. Such circumstances hamper the diagnosis of post-COVID syndrome. 

What treatment options are there?

Considering how new and varied the disease is, it is not surprising that for now, treatment options are few and far between. There is as yet no drug that would ease symptoms, let alone cure the illness. As long COVID symptoms resemble those of POTS and ME/CFS, repurposing medications developed to treat those conditions may be helpful in long COVID, too. More research is needed in that area. 

At the moment, the most promising treatment seems to be rehabilitation. Light exercise tailored to the patient’s capability, breathing exercises to strengthen the lungs and cognitive behavioural therapy (CBT) over four to six weeks have been shown to improve the condition. 

Does exercise help? 

Exercise is generally seen as one of the pillars of good health, and it does indeed improve or even prevent a plethora of health conditions. However, in long COVID, a survey found that 86% of participants relapsed following mental or physical activities. Even light exercise as used in rehabilitation may be too much for some sufferers of post-COVID syndrome. A high resting heart rate, high or low blood pressure or low blood oxygen saturation mean that exercise is counter-indicated. 

What about nutrition? 

For now, research into nutritional therapy for long COVID is scarce. However, just as scientists are hopeful about repurposing pharmaceutical treatments designed to treat POTS and ME/CFS, there is the option of doing the same with the non-pharmaceutical therapies that are used to manage these conditions. As POTS and ME/CFS have been around for longer, research is available about how optimum nutrition can help, and many nutrition professionals are experienced in working with POTS and ME/CFS patients. 

In the absence of research specific to post-COVID syndrome, the current advice is to follow a generally healthy diet that reduces inflammation, strengthens the intestinal microflora, and supports the immune system. This way of eating is considered to do no harm, and it may actually help.

As long COVID patients can sometimes show MCAS symptoms, it stands to reason that dietary approaches developed for MCAS – e. g. a low histamine diet - may be an option here. Again, there is no research yet to say whether this would work. A low histamine diet is challenging and can be quite restrictive. It should, in any case, only be attempted with the guidance of a nutrition professional. 

Watch this space

Both COVID-19 and post-COVID syndrome are still new, and a lot of research still needs to be done to understand those conditions fully. Post-COVID has many faces, and sometime soon, scientists will probably present a list of the different guises it comes in. Each one of them may require its own treatment. Given that millions of people worldwide have been affected, there is a substantial population of patients. This helps because the more people are likely to benefit from a solution, the more interest there is in funding and conducting studies. Also, there are more people available to potentially participate in such studies. 

So, for now, we can only make the most of the (sparse) current treatment options, such as rehabilitation. Eating junk foods and burning the candle at both ends are unlikely to improve long COVID, so a healthy diet, sleep, me-time, and relaxation seem like a good place to start. Typically, exercise is part of this list of healthy habits. For long COVID patients, however, it can be counterproductive. 

While recovery from post-COVID syndrome can be slow, patients are getting better, and the majority make a full recovery. If you are suffering with long COVID and would like to talk to me about improving your diet and lifestyle, feel free to book in a call here.

Further reading

https://covid19.who.int/

Raveendran AV, Jayadevan R, Sashidharan S (2021). Long COVID: An overview. Diabetes Metab Syndr. 2021 May-Jun;15(3):869-875. 

Yong SJ (2021: Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021 Oct;53(10):737-754. 

Plan for the life you want to create

How often have you started following a healthy eating plan only to be forced to make unhealthy choices because you didn’t have the right foods in the fridge, you didn’t have time to eat a ‘proper’ breakfast or make the lunch you wanted to take to work? I’m guessing quite a few because that’s just what happens when life gets in the way. 

You’ve probably heard the saying ‘failing to plan is planning to fail’. Or maybe ‘goals without a plan are just wishes’? They are things that we want but we have not yet committed to doing them… 

Without a weekly food plan, it will be pure luck if you end up with the right foods in the fridge or cupboards. And, without planning your time, you won’t always make the time to enjoy breakfast or make that lunch. 

Here’s the thing about planning: 

It’s easy to get derailed by events, situations, relationships, and tasks that insert themselves into our already-busy lives. So, if you’re committed to changing the way you eat, losing weight and, in fact, making any change in your life, this post is perfect for you. 

The very first thing you need to do is to find time to sit down and plan your meals. When can you do that? Get that in the diary now. 

If you’re one of those super-busy people who always finds themselves complaining that they don’t have time, I have an exercise for that, too. You see, ‘not having time’ is a story we tell ourselves or other people in order not to have to take responsibility for – or actually have to do – a particular thing. Sorry to be the one to break it to you, but you make time for what you prioritise in life. Anything else is just an excuse. 

If you’re reading this thinking, ‘yes but…’ let’s take a look at how you are spending your time. 

Ask yourself how you feel about how you are spending your time. Are you in control of your time? If you looked back over your life, would you be happy with the way you had spent your time? 

Every day over the next week use a daily planner to jot down everything you are doing in the time slots provided. This can help you discover the REAL reason behind what you say you want and what you actually do. It’s common, for example, to realise you are spending 15##plus## hours a week randomly online (on Facebook, following links or doing ‘research’). 

Where you are losing time or being inefficient with it? What is the cost to you of spending your time like this? 

Does it make it impossible to follow a healthy eating plan? Are the Starbucks breakfast bills piling up because you haven’t made time to get breakfast at home? How is this working for you? It’s often incredible how much time you gain so reorganise your life in a new way to fit in your new healthy habits. 

Organise your week

Once you at the set-aside time in your diary when you are going to plan your meals, work out when you are going to fit in the shopping. Can you allocate time to go to the supermarket? Or can you book in an online grocery delivery. Get that in the diary now too and book the slot.

Next, work out what’s happening over the course of the week. Are you going out to eat any days? Do your kids have after-school clubs or packed lunches that need making? Are you working late one evening, so might need a quick fix supper? With these in mind, mark in your journal which meals will fit with which occasion. 

Then check your cupboards and fridge for ingredients you may already have for these meals, so that you don’t double up. Write up a shopping list for the ingredients you need for you to take to the supermarket, or put these items into your online shopping basket.

Job done!

You now have a week’s worth of meals planned, ingredients organised, and shopping on its way. You can rest assured that you are eating well and won’t be tempted to order a takeaway as you don’t have the rights foods in! Plus, you know that there isn’t going to be a whole heap of food waste going on, so it’s better for the environment too. It’s a win-win!

And if you’d like some help coming up with a weekly menu, drop me a line! I’m here to help people plan what works for them and their families.

Here are my top five nutrition tips for helping to balance your hormones

1. Eat real food

If your hormones are out of whack or you struggle with anything to do with your mood, the very first thing to do is to take a good look at your diet and consider how much ‘real food’ you eat and how much of your diet is processed. If you switched to ONLY real food, making everything from scratch, you would see a big improvement in your health. Ready to do more?

2. Bring in more fruit and vegetables

Fruit and vegetables are packed full of nutrients compared to many other foods and are beneficial for all aspects of health. Focus on the low-sugar fruits (the ones that grow in this country ahead of tropical fruits like bananas, mango and pineapple). For veg, eat more of the stuff that grows above the ground as – as a general rule – it contains less starch and keeps blood sugar levels stable.

3. Eat protein regularly

Choose a good source of protein at every meal and snack. Protein is needed for growth and repair in the body. Good sources of protein include eggs, organic meat and poultry, oily fish like wild salmon, trout, etc. and Greek yoghurt, nuts and seeds.

4. Think carefully about starchy carbohydrates

Carbohydrates can be broken down into simple carbs and complex carbs. In simple carbs, the sugar molecules that occur either naturally or as a result of added sugar are quickly digested and absorbed into the bloodstream. Examples of simple carbs are cakes, cookies and pastries (in fact, anything with sugar), white bread, rice and pasta, and potato. The result is you get a short-term high but afterwards you feel more tired, fuzzy-headed and hungry. Complex carbs are made up of hundreds of sugar molecules, and these are absorbed much more slowly so they keep you feeling fuller and focussed for longer. Focus on bringing more of these into your diet ahead of simple carbs. They include brown rice, oats, beans, chickpeas and lentils, quinoa, sweet potato.

5. Do eat fat

Healthy fats are an essential part of a good diet and should not be seen as the enemy. Fats are also the building blocks of all hormones and keep cell membranes and nerve cells healthy. The best sources of fat are flaxseeds (also known as linseeds), avocado, olive oil, coconut oil, oily fish like wild salmon, nuts and seeds.

And don’t forget about sleep, movement, and stress relief when you’re looking at hormones! These are just as important as nutrition. If you’d like to know more, why not get in touch and see how I can help you.

TUNA AND SOYA BEAN SALAD

This is a quick and easy lunch recipe that is packed with nutrients to support hormone health. 

Soya or edamame beans are a fantastic source of phytoestrogens, which research shows may help symptoms when our oestrogen levels are bouncing up and down! 

Plus, this is an excellent blood sugar balancing meal that will keep you fuller for longer.

Serves 2

Ingredients:

200g frozen soya beans

2 spring onions, thinly sliced

1 can of tuna, drained

Handful of fresh coriander or flat leaf parsley, leaves roughly chopped

12 olives

10 cherry/ plum cherry tomatoes, sliced

2 tbsp apple cider vinegar

2 tbsp extra virgin olive oil

Sea salt & pepper

2 large handfuls of mixed leaves/ rocket

Method:

1. Cook the soya beans in some boiling water for 6-7 minutes before draining.

2. Place the spring onions, tuna, herbs, olives, tomatoes and soya beans into a large bowl and, using a fork, break the tuna into flakes.

3. Drizzle the vinegar and olive oil over the salad, seasoning with sea salt and black pepper. Toss well.

4. Fold in the leaves before serving.

5. Enjoy!

When you think about mental health, you’re probably thinking about your brain and how that works. The picture is often much more complex. Hormones play a big part because these chemical messengers are the background to everything that happens in your body. How you feel, therefore, is not just psychological, it’s biological.

Did you know, there are a huge number of symptoms that are common to both depression and hormonal imbalance? These include low energy, dizziness, low mood, apathy, anxiety, irritability, anger, lack of enthusiasm, despair, headaches, poor concentration, feelings of hopelessness, lack of confidence, low libido, fuzzy brain, memory loss, and insomnia (although there are others).

Rebalancing your hormones naturally is not something that happens overnight, but it can be greatly improved with the help of nutritional and lifestyle change. 

Mood and Cycle

Two of the main hormones that affect your feeling of mental wellbeing and clarity are oestrogen and progesterone, and these change throughout your menstrual cycle. It’s an over-simplification – but perhaps a helpful one – to think about oestrogen largely bringing positive effects to your mood and progesterone contributing more negative effects. With such a pronounced hormonal connection on mental health, it’s small wonder that women are twice as likely to suffer from depression than men.

According to the National Institute of Mental Health, 64% of women who suffer from depression say their symptoms get worse during the pre-menstrual period. Hormones are also likely to contribute to antenatal or postnatal depression, which affect around 10-15% of new mothers. And anxiety and depression are also starting to be recognised as symptoms of the perimenopause on top of hot flushes and night sweats.

How it works

At certain times in your cycle (in the run-up to ovulation), there will be lots of oestrogen in your system and women tend to feel brighter and better in their mood. You might even notice at this time you feel better at talking and articulating yourself. In the second half of your cycle, oestrogen dips, and progesterone comes into play. For some women, this can lead to lowered mood or depression.

You might already experience this as Pre-menstrual Syndrome (PMS), a very common condition linked to the changing levels of these hormones, that might include feelings of bloating, breast tenderness or headaches, or manageable emotional symptoms like irritability. For a small number of women (about 2-8%), the effect of these hormones on their mental wellbeing is pronounced. This is called Pre-menstrual Dysphoric Disorder (PMDD); an extreme form of PMS and one that, if you think might apply to you, you will want to ask your doctor about.

Why does this happen?

One of the first things to know is that the production of dopamine and serotonin (the two main brain chemicals associated with the development of depression and psychosis) is heavily linked to levels of oestrogen. 

Research seems to suggest that there isn’t a noticeable difference in levels of oestrogen between those who are affected by mental health symptoms around their period or during the menopause – it seems some women are just especially sensitive to hormonal change, or perhaps also that lifestyle problems like stress may also play a big part.

Impact of hormones on blood sugar levels

Declining oestrogen levels have a role to play in insulin sensitivity (that means how sensitive – or not – the cells in your body are to the fat storage hormone insulin). In fact, a lack of sensitivity to insulin (or even being resistant to the effects of insulin) is lurking behind many of the common menopause symptoms, like hot flushes, fatigue and weight gain as well as symptoms of low mood like brain fog, anxiety and depression.

Hormones and mental health is a complex picture in which your physiological health and mental wellbeing are inextricably intertwined. It might be best to work with a nutrition practitioner to unravel this for you. We might be able to piece together a hormone balancing food and lifestyle plan to suit your circumstances. Get in touch if you feel you'd like to discuss this further. 

How do you reward yourself? How do you comfort yourself when you are stressed? Think about that for a moment. 

Rewarding yourself for your successes, both large and small, is a key part of staying motivated. 

We are so time poor that rewarding ourselves with treat foods like cake and biscuits is the easiest way to show ourselves some self-love. And it’s the same for soothing ourselves if we’ve had a bad day. 

My experience of running a nutrition clinic is that so little of what or why people eat has to do with nourishing their body. The far greater part is to do with how you feel about yourself and about life in general. Eating half a packet of chocolate biscuits is much easier than figuring out – not to mention getting – what you really need, which might be a way to de-stress, feel loved, get attention, kick back your heels and even sleep. Many people are almost completely out of touch with their own bodies.

When I’m working with clients, one of the big things we are trying to achieve is to develop a different relationship with food and, also, a different relationship with rewards. 

Building in ways of making yourself feel good are essential for a number of reasons.  Perhaps the biggest among them is that you need to positively reinforce the fantastic healthy changes you are making to encourage you to maintain them long term. 

You need to build in more appropriate ways of making yourself feel better: far better to automatically choose to spend five minutes relaxing in the sunshine in the garden to recharge your batteries than to grab a handful of biscuits.  

Most of our rewards are habit. They are conditioning. Chances are, you have been conditioned to reward yourself with food, often from early childhood.

Normal ‘rewards’ are short lived and usually followed by recriminations. If you truly want lasting change, you need to find ways of regularly getting that feel-good feeling from other things. You’ll want to build in more appropriate ways of making yourself feel better and look forward to non-food related treats. 

I encourage my clients to build up a list of non-food treats to avoid any feelings of deprivation.  After a while, you will prefer these rewards and benefit from them far more than food treats that simply create other problems for you later. 

Regular ‘me time’ is important here as our lives are very busy and many of us have got into the habit of relying on food to give us a quick pleasure fix.  But, as we know, this ‘reward’ is short lived and usually followed by disappointment plus a large serving of guilt! If you truly want lasting change, you need to find ways of regularly getting that feel good feeling from other things.  We all deserve and need time to do positive things for ourselves - without feelings of guilt.  

Improving our relationship with food is all about changing behaviours.  We know that the carrot is more effective than the stick for long-term, self-motivated change.  So, as well as deciding on your big rewards for achieving long term goals, think of a few quick and easy things you can do at least 3 times every week.

So, as an example, you might be better to CHOOSE to spend 5 minutes relaxing in the sunshine in the garden to recharge your batteries than to grab a handful of biscuits.  

It can be a really empowering exercise to take a look at what you might normally do to reward yourself and think, are these appropriate now or do I need to replace them. 

Most of the time it’s a simple as putting in a new habit to replace the old one.  And, even better when the new habit is one that you really enjoy!  All this is good for your physical and mental health.  

Spend some time to identify some activities that you can build into your daily life that you enjoy and can use as your reward / de­stressor / way of taking a break / or just to have 5 minutes of indulgence or peace!

What would you like to spend more time doing?  What would make you feel good?

What would help you relax or de-stress?

A few examples:

• A soak in the bath
• Listening to calming music
• Yoga
• A gentle walk in peaceful surroundings
• Reading a favourite magazine
• Sitting quietly in the garden
• Phoning a good friend
• 10 minutes quiet relaxation

Add your own: think of at least 5 things that relax you...

Bored vs reward?

Most people can identify with eating when they were really bored. This often leads to mindless eating just to experience that sugar rush to give you a temporary high.  Or it may simply be that you need something to occupy your mind and hands as a distraction technique.  If you recognise yourself doing these things, then this is a great opportunity for you.  It actually means that you are looking for something fun / exciting / interesting to add into your life.  Use this as an opportunity to improve the quality of your life and build in new ways of enjoying yourself and enriching your experience of life.  

Simple steps to better rewards

1. Identify when you are using food as a reward or to make yourself feel better.
2. Choose a few alternative things you can do instead to make yourself feel good (that don’t involve food).
3. Test it: try out the new choices to start breaking the pattern - see what works well.
4. Change it: if something doesn’t work, change it or add to it until you find the right solution.
5. Practice!  Keep practising it until it becomes automatic: a new habit.

What are your personal interests?  What activities do you enjoy?

• Creative: eg. music, cooking, cinema, theatre, photography Physical: e.g. gardening, sport, dancing
• Social: eg. family, friends, games, volunteering
• Intellectual: eg. reading, learning a language, writing poetry / stories

What do you enjoy?  What would you like to try?  If you know this is something you want to improve on, it's worth spending a little time writing a list (in a notepad or on a phone rather than keeping it conceptually in your head). Choose one and have it as one of your goals for this week.

And if you’d like some help, why not book in a call with me here?