Eating Well to Regain Your Strength after COVID-19

Battling any kind of illness can sap your strength. If you or a loved one had COVID-19, you may not have been as active or eating as much as usual, which means your muscular strength may have declined. After you have fully recovered, it’s important to work to rebuild it.

Don’t be concerned if you’re not back to your old self overnight. Regaining any strength you may have lost takes time and effort. One simple but crucial way to start is by focusing on your diet.

A dish with salmon and vegetables.

Below is a summary of nutrition steps you can take to rebuild your strength and return to activities of daily living. For more detail, see the complete version of Your Guide to COVID-19 Nutritional Rehabilitation: Restore and Replenish from the rehabilitation experts at HSS.

  • Eat on schedule: Create an eating plan and make regular meals and snacks part of your routine. Eating regularly will help provide your body with the nutrients and calories you need to restore strength and immune function.
  • Protein: Eating enough protein (fish, poultry, other meat, dairy, beans) at every meal is essential to help stimulate muscle growth and prevent a continued breakdown of muscle. Coupled with physical training, eating protein will result in improved strength over time.
    • Eat 25 to 40 grams (3.5 to 6 oz) of protein at each meal and 10 to 20 grams (1.5 to 3 oz) at each snack. A 3 oz serving is the size of a deck of cards.
    • Use ready-to-drink protein shakes, homemade shakes, protein powders or bars to help you meet your protein needs if you find it difficult to do so by eating enough.
  • Calories: It is important that you eat enough calories in addition to well-balanced meals. This reduces stress on your body, allowing the food you eat to go toward rebuilding your strength. Round out your protein portions with vegetables, fruits, whole grains or other starches such as brown rice, potatoes, whole grain bread and beans, which have significant concentrations of both carbohydrates and proteins.
    • Monitor your weight. This is NOT the time to diet for weight loss! Once your weight has returned to your pre-illness weight, or a stable and reasonable weight if you were overweight, make sure to eat enough calories.
  • Vitamin C: Vitamin C helps keep your immune system healthy. It is found in many fruits and vegetables. Since vitamin C is water soluble (meaning it breaks down in water) and is used so often in your body, it is ideal to eat a food with vitamin C with each meal to ensure your body has the defense it needs. For example, eat an orange with breakfast, some sweet red pepper in a salad or on your sandwich at lunch, and some tomato sauce with dinner and/or mango for dessert.
  • Zinc: Zinc is another mineral essential for a healthy immune system. If you don’t get enough zinc, you are at a higher risk for infection. However, if you do get enough zinc, more is not better. Zinc is found mostly in seafood and meat and, to a lesser extent, in yogurt, nuts and beans. Learn more about zinc from the National Institutes of Health.
  • Vitamin D: Vitamin D has been found to be more than just a vitamin. It is actually a hormone in the body and is involved in many different systems, from bone health to muscle function and even immunity.
    • The vitamin D our bodies use can actually be made by our skin with the ultraviolet light from the sun. This is one reason why getting outside at least three times a week for 30 minutes (with exposure on your hands, arms, legs and face) is helpful and recommended. However, as we age, we may not convert the active form of vitamin D from the sun as well.
    • Vitamin D is also found in some foods (e.g., fatty fish such as salmon, fortified milk and eggs).
    • Since many people work indoors or live in parts of the country with limited sun, and getting enough vitamin D from food is not always realistic, taking a daily supplement is often necessary. Between 800 IU and 1,000 IU up to 2,000 IU a day is reasonable to start. Your doctor can determine the appropriate amount based on your blood levels when you have a follow-up visit.
    • It is probably best not to take more than 2,000 IU/day without being seen by a doctor, as too much vitamin D can lead to complications. Learn more about Vitamin D.
  • Gut health, probiotics and prebiotics: In addition to our skin, our gut is a first-line defense against infection. As we get older, our bodies become less able to maintain a healthy environment in our gut.
    • Probiotics are good strains of microorganisms/bacteria that can help us in a variety of ways.
    • Probiotics are found in fermented foods like yogurt (with active cultures, which even soy yogurt has), kefir, pickled vegetables, tempeh, kombucha tea, kimchi, miso and sauerkraut. Even eating one portion of yogurt a day with active cultures (it will say so on the label) or making a shake with kefir is very helpful.
    • Prebiotics are the food that probiotics live on. Prebiotics are found mostly in fruits, vegetables, beans and whole grains. Eating these foods helps to keep a healthy digestive tract as part of a healthy immune system.
  • Calcium: This is an important nutrient for bone health. As you lose muscle, you lose bone density. Calcium-rich foods are essential to help keep the bone mass you have.
    • Getting 1,000 to 1,200 mg of calcium each day is important for bone health. Your body can only absorb 500 mg of calcium at one time, so enjoy a calcium-rich food at different meals and snacks throughout the day.
    • Use a calcium calculator to figure how much you get daily from food or identify how you can increase that amount to meet your goal. What you do not consume in food, you should match in a supplement.
  • Omega-3 fatty acids: Commonly referred to as omega-3s, these may help with reducing excess inflammation. As you recover, your body may be experiencing a significant amount of inflammation as a result of fighting COVID-19 infection. Consuming food-based sources of omega-3s may be helpful.
    • Omega-3s are found mostly in fatty fish like salmon, tuna, sardines, herring, sea bass and mackerel. Chia seeds, ground flaxseeds and edamame provide a healthy type of omega-3s as well.
    • Aim to eat fatty fish two times a week to reach your goals, and/or consider supplementing.
    • Learn more about Omega-3s
  • Hydration: Staying well hydrated is always important, but especially so when you are sick. As we get older, our thirst sensation is not as acute, and we tend to drink less. So, like eating, it is a good idea to drink on somewhat of a schedule.
    • We actually absorb fluids better when we drink throughout the day rather than having a lot of fluid at once.
    • Good examples of fluids would be shakes, water, juice, milk or tea.
    • If you urinate every three to four hours and have a good amount of urine, you are probably doing a good job of staying hydrated.
  • Other health issues that may need further attention
    • Diabetes: It is essential that you meet with a doctor or diabetes nurse practitioner to help with your blood sugar control.
    • Heart disease, hypertension, pulmonary conditions and other health issues may also require individualized counseling. Ask your local hospital or doctor or find a registered dietitian in your area.
  • Other ways to support muscle building and recovery:
    • Exercise has the greatest effect on rebuilding endurance and strength and also helps build immune function. Nutritional supplements, especially for those 65 years and older, have slight or limited effect at best and can only support the effects of exercise – not replace exercise – as a way to improve function and ability to participate in activity of daily life..
    • Three supplements, in addition to the nutritional supplements outlined above, to consider include HMB, creatine and tart cherry juice. Ask your doctor if any of these are appropriate for you.
    • Taking a multivitamin/mineral will not help with muscle building but may help bridge the gap between what you are taking in and what you need.

For more in-depth information, read the the complete version of Your Guide to COVID-19 Nutritional Rehabilitation: Restore and Replenish.

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