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Healthy eating during the Covid-19 pandemic

19 Sep 2021

By Dr. Charuni Kohombange In the battle with Covid-19, nutrition plays a key role, but unfortunately, this particular aspect is often overlooked in discussions regarding Covid-19 management. However, what we eat and drink can, in fact, affect our body’s ability to prevent, fight, and recover from Covid-19. While no foods or dietary supplements can prevent or cure it entirely, healthy diets are important for supporting immune systems. Good nutrition can also reduce the likelihood of developing other health issues, including obesity, heart disease, diabetes, and some types of cancers. For babies, a healthy diet means exclusive breastfeeding in the first six months, and then the introduction of nutritious and safe foods to complement breast milk from six months to two years old. A healthy and balanced diet is of utmost importance for the growth and development of young children. For older people, nutrition is essential to ensure healthier and more active lives.  University of Colombo Faculty of Medicine Professor in Nutrition Prof. Ranil Jayawardena shared his expertise in this regard at a media conference recently held at the Health Promotion Bureau.  This article contains excerpts of his discussion. Never skip your meals and keep them in balance During the lockdown period, it’s common for many people to skip their breakfast and limit their food to only two main meals per day. According to Prof. Jayawardena, this is a wrong practice when concerning nutrition.  “It is essential to adhere to your routines, including waking up at your usual time and consuming all three main meals, as it is important to maintain the biological clock without any disruptions,” he said. He added that in addition to three main meals, you can have two snacks a day. For main meals, the main component should consist of starch i.e. carbohydrates, as it provides at least 60% of the energy we need for daily activities. Fortunately, in Sri Lanka, almost all households consume starch in adequate quantities as our staple food is rice. However, in almost as many instances, households do not include an adequate number of vegetables and fruits in their meals.  Prof. Jayawardena emphasised on the importance of consuming at least three vegetables and two fruits a day, saying: “Vegetables and fruits contain all the vitamins and minerals which are needed to maintain good immunity to fight infections, and it is not necessary to take vitamins as supplements if your meals contain adequate numbers of vegetables and fruits.”  During the lockdown, most people are getting used to unhealthy snacks such as biscuits, and eat just to while away their lockdown time in front of televisions. This habit should be stopped immediately in order to prevent obesity, which aggravates the “syndemic”; the synergistic pandemic of Covid-19 and non-communicable diseases.     Proteins are essential for immunity Some adults believe it is harmful to consume proteins while affected with an infectious disease. This is incorrect, and has been linked with mythical beliefs regarding viral infections. Protein is an essential component in developing immunity, and it is important to include a source of protein in all three main meals. In general, people consider food rich in protein such as meat, fish, eggs, etc. to be highly expensive and unaffordable. While that is a very reasonable concern when considering the prices of food items in the market, you can still consume proteins at a considerably low cost.  “When considering fish, the protein content of all fish types will be almost the same. For example, the consumption of 100 grams of highly expensive fish will add the same amount of proteins (about 25 grams of protein) to your meal as the same weight of less expensive fish,” explained Prof. Jayawardena. In addition to fish, meat, and dried fish, which are expensive, eggs are considered a rich protein source that can be consumed at a low cost. Including at least one egg in a main meal on a daily basis will provide a reasonable amount of protein.  Sri Lanka, being a Buddhist nation, has a considerable number of vegans. For them, it is highly important to include protein-rich pulses such as dhal, mung beans, chickpeas, and soya products in their meals on a daily basis.  Covid-19 and consumption of fat In relation to Covid-19 infection, fats or oils do not play a major role. However, high consumption of fats can aggravate pre existing non-communicable diseases. There are two categories of fats: saturated fats and unsaturated fats. In general, saturated fats are available in animal-derived oils such as butter, margarine, and pork etc. According to research, coconut oil and palm oil also contain saturated fats. Consumption of saturated fats can be detrimental for the development of immunity.  Unsaturated fats, on the other hand, are helpful for developing immunity. These fats are commonly found in non-animal derivatives such as sunflower oil, sesame oil, and soya bean oils. Among the unsaturated fats, the most useful type in regards to the development of immunity are the Omega-3 fats. These Omega-3 fats are commonly found in oily fish and also can be obtained as capsules.  Diet of diabetes patients during the Covid-19 infection According to the current data across the globe, patients with diabetes are more prone to develop severe diseases alongside Covid-19, and they have an increased risk of tenfold for being infected with Covid-19 compared to others, because of low immunity and changes in metabolism in patients with diabetes. Due to these, their ability to fight the infection is diminished. Hence, it is important to be more cautious about nutrition if the Covid-19 patient has pre-existing diabetes. Checking blood sugar levels regularly using a glucometer and keeping contact with the physician on the sugar control status is important to prevent its development into a more severe version of the disease.  When considering nutrition, carbohydrates play a major role in determining sugar levels in the blood. However, as mentioned earlier, it is essential to include carbohydrates in the diet as the main energy source. Hence, for patients with diabetes, it is important to take carbohydrates rich in fibres as they will control the absorption of carbohydrates, preventing sudden surges in blood sugar levels. Unpolished rice and atta flour are some examples for carbohydrates containing foods rich in fibre. In addition, consuming vegetables in all meals is especially important for patients with diabetes. In the diet of a diabetes patient, having a protein component in all three meals is of utmost importance because they are more prone to develop muscle wasting and weakness.  “Unlike in others, patients with diabetes can develop vitamin deficiencies. Hence, having Vitamin B, C, and D as supplements prescribed by a doctor would be useful,” said Prof. Jayawardena.  Low-sugar fruits and nuts can be recommended as healthy snack options for patients with diabetes. When choosing a fruit, you can determine the sugar content by its taste. In general, the fruits that taste sweeter (ex: bananas, grapes) contain more sugar than the fruits which do not taste as sweet (ex: guava, papaw). In addition, having two snacks with milk products, and consuming a low-fat diet is also important.  Most importantly, taking medicine for diabetes in the correct doses as prescribed is essential to control blood sugar levels.  More about vitamins Almost all vitamins except for vitamin D are obtained from a person’s diet and almost 90% of the vitamin D requirement is acquired from sunlight. Therefore, most of the Covid-19 patients, as well as the people confined to their homes during the lockdown period, may have vitamin D deficiencies.  “Taking vitamin D supplements for a short period is advisable to overcome vitamin D deficiency. When prescribing vitamin D, the ideal way is to prescribe the dosage after measuring the vitamin D levels in the blood. However, since it is not practical for such tests at the moment, obtaining vitamin D supplements with a dose range of 2000-5000 International Units will be adequate and safe to use during the pandemic,” said prof. Jayawardena.  Currently, we see a cocktail of vitamins being consumed by the public as they are freely available as over-the-counter medicines. In this regard, Prof. Jayawardena emphasised that it is rather risky to take vitamins unnecessarily. “Many patients, and the public in general, are consuming 500 mg vitamin C megadoses, which is not useful at all. The daily vitamin C requirement for an adult is only 90mg, which will be readily available from vegetables and fruits. Hence, it is not necessary to take vitamin C as supplements. Further, there is no scientific evidence to prove that vitamin C supports in boosting immunity,” he explained.    Preventing dehydration in Covid-19-infected patients Covid-19-infected patients are predisposed to get dehydrated as they may have symptoms like fever, diarrhea, and vomiting. A normal adult is required to consume at least two to three liters of water per day, and for Covid-19 patients, this requirement further increases. Hence, it is important to be vigilant on the volume of water that is consumed daily. “If you are dehydrated, you can detect it by simply looking at the colour of your urine. If the colour is dark and not the usual straw colour (pale yellow) you are not taking water in adequate amounts,” Prof. Jayawadena explained. “If you have noticed that you have not taken adequate fluids, first, consume at least a glass of water every half an hour. When the colour of urine becomes normal, having a glass of water every hour would be adequate.”  Sometimes patients dislike drinking water as their sensation of taste is altered due to the disease. In these instances, attention should be paid on fluid intake, and drinking tea, juices, and koththamalli etc. may be necessary to supplement it. However, drinks that contain caffeine, and soft drinks should not be consumed, as they may be detrimental for immunity.  Many patients with Covid-19 complain of a dryness in the throat. Taking sips of lukewarm water at frequent intervals will be helpful for these patients.  Nutrition of the elderly Since elders are the group of individuals at most risk to develop the more severe version of the disease, paying more attention to their nutrition is highly important. Due to reasons such as difficulties in chewing, they cannot consume many foods that others can. Therefore, it is important to prepare a palatable diet for them that includes all the necessary nutrients. In extended families, sometimes the nutrition of the elders may get neglected as more attention is  paid to the children. While paying attention to providing a balanced diet, it might be useful to provide them with food supplements as well. Since the elderly are inefficient in absorbing vitamins, vitamin B12 deficiency is more commonly seen among them. Hence, providing vitamin B and D supplements would be effective for elderly patients. With the changes to the sensation of taste, they might not take adequate amounts of water and get dehydrated very easily. Dehydration is more dangerous in the elderly as it critically affects many of their systems. Dehydrated elderly patients can develop confusion, which makes management much more difficult. Hence, close attention should be paid on the nutrition and hydration of the elderly, especially during home management.  Improving appetite  It is normal to lose your appetite when infected with Covid-19. In such instances, improving the taste of food by adding spices will make the food more palatable. For patients taking dietary supplements, including more dairy products and malted milk products will be useful to maintain immunity.   Adequate rest, hydration, and proper nutrition are the key elements to manage a Covid-19 patient. Thus, it is vital to improve nutrition by adopting healthy eating habits during the pandemic.        (The writer is a Medical Officer at the Directorate of Healthcare Quality and Safety, Ministry of Health)


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